Medical-Surgical Nursing Exam 20

Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.

Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. When the nurse notes that the patient’s left great toe deviates laterally, she recognizes that the patient has a

1. hallux valgus.
   Hallux valgus is commonly referred to as a bunion.
2. hammertoe.
   Hammertoes are usually pulled upward.
3. pes cavus.
   Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot.
4. flatfoot.
   In flatfoot, the patient demonstrates a diminished longitudinal arch of the foot.

2. Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, characterizes which of the following bone disorders?

1. Osteitis deformans
   Osteitis deformans (Paget’s disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures.
2. Osteomalacia
   Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone.
3. Osteoporosis
   Osteoporosis is characterized by reduction of total bone mass and a change in bone structure which increases susceptibility to fracture.
4. Osteomyelitis
   Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread.

3. Most cases of osteomyelitis are caused by which of the following microorganisms?

1. Staphylococcus
   Staphylococcus aureus causes 70-80% of bone infections.
2. Proteus species
   While Proteus species are frequently found in osteomyelitis, they do not cause the majority of bone infections.
3. Pseudomonas species
   While Pseudomonas species are frequently found in osteomyelitis, they do not cause the majority of bone infections.
4. Escherichia coli
   While E. coli is frequently found in osteomyelitis, it does not cause the majority of bone infections

4. Which of the following statements reflects information to be included when teaching the patient about plantar fasciitis?

1. Management of plantar fasciitis includes stretching exercises.
   Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and the use of non-steroidal anti-inflammatory drugs (NSAIDs).
2. Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot that occurs when pressure is placed upon it and diminishes when pressure is released.
   Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon.
3. The pain of plantar fasciitis diminishes with warm water soaks.
   Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon.
4. Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.
   Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

5. Lifestyle risk factors for osteoporosis include

1. lack of exposure to sunshine.
   Lifestyle risk factors for osteoporosis include lack of exposure to sunshine, low calcium and vitamin D diet, cigarette smoking, use of alcohol and/or caffeine, and lack of weight-bearing exercise.
2. lack of aerobic exercise.
   Lack of weight-bearing exercise, not aerobic exercise, is a lifestyle risk factor for osteoporosis.
3. a low protein, high fat diet.
   A low calcium and vitamin D diet, not a low protein, high fat diet, is a lifestyle risk factor for osteoporosis.
4. an estrogen deficiency or menopause.
   An estrogen deficiency or menopause is an individual, not lifestyle risk factor for osteoporosis. Other individual risk factors include female gender, white non-Hispanic or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing co-existing medical conditions and medications.

6. The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following statements?

1. Walk or perform weight-bearing exercises out of doors.
   Risk-lowering strategies for osteoporosis include walking or exercising out of doors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.
2. Increase fiber in the diet.
   Risk-lowering strategies for osteoporosis include increasing dietary calcium and vitamin D intake,
   walking or exercising out of doors, smoking cessation, consuming alcohol and caffeine consumption in moderation, and performing a regular weight-bearing exercise regimen.
3. Reduce stress.
   Risk-lowering strategies for osteoporosis include walking or exercising out of doors, increasing dietary calcium and vitamin D intake, smoking cessation, consuming alcohol and caffeine consumption in moderation, and performing a regular weight-bearing exercise regimen.
4. Decrease the intake of vitamin A and D.
   Risk-lowering strategies for osteoporosis include increasing dietary calcium and vitamin D intake,
   walking or exercising out of doors, smoking cessation, consuming alcohol and caffeine consumption in moderation, and performing a regular weight-bearing exercise regimen.

7. Instructions for the patient with low back pain include which of the following?

1. When lifting, avoid overreaching.
   Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back.
2. When lifting, place the load away from the body.
   When lifting, the patient with low back pain should keep the load close to the body.
3. When lifting, use a narrow base of support.
   When lifting, the patient with low back pain should use a wide base of support.
4. When lifting, bend the knees and loosen the abdominal muscles.
   When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.

8. Dupuytren’s contracture causes flexion of the

1. fourth and fifth fingers.
   Dupuytren’s contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.
2. thumb.
   Dupuytren’s contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.
3. index and middle fingers.
   Dupuytren’s contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.
4. ring finger.
   Dupuytren’s contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

9. A metabolic bone disease characterized by inadequate mineralization of bone is

1. osteomalacia
   Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone.
2. osteoporosis
   Osteoporosis is characterized by reduction of total bone mass and a change in bone structure which increases susceptibility to fracture.
3. osteomyelitis
   Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread.
4. osteoarthritis
   Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

10. Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?

1. Sprain
   A sprain is caused by a wrenching or twisting motion.
2. Dislocation
   Dislocation refers to the separation of joint surfaces.
3. Subluxation
   Subluxation refers to partial separation or dislocation of joint surfaces.
4. Strain                                                                                                                                                          Strain refers to a muscle pull or tear.

11. Which of the following terms refers to failure of fragments of a fractured bone to heal together?

1. Nonunion
   When nonunion occurs, the patient complains of persistent discomfort and movement at the fracture site.
2. Dislocation
   Dislocation refers to the separation of joint surfaces.
3. Subluxation
   Subluxation refers to partial separation or dislocation of joint surfaces.
4. Malunion
   Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

12. The Emergency Department nurse teaches patients with sports injuries to remember the acronym RICE, which stands for which of the following combinations of treatment?

1. Rest, ice, compression, elevation
   RICE is used for the treatment of contusions, sprains, and strains.
2. Rest, ice, circulation, and examination
   While circulation problems must be examined, the RICE treatment does not refer to circulation and examination.
3. Rotation, immersion, compression and elevation
   Rotation of a joint is contraindicated when injury is suspected, and immersion of the area may be anatomically difficult.
4. Rotation, ice, compression, and examination
   Rotation of a joint is contraindicated when injury is suspected, and examination, while indicated, does not provide treatment.

13. The nurse anticipates that the physician will perform joint aspiration and wrapping with compression elastic dressing for which of the following musculoskeletal problems?

1. Joint effusion
   The described treatments are used with joint effusions and hemarthrosis.
2. Strain
   A strain is treated by RICE.
3. Sprain
   A sprain is treated by RICE.
4. Avascular necrosis
   Avascular necrosis describes death of tissue due to insufficient blood supply and may be associated with steroid use.

14. When x-ray demonstrates a fracture in which bone has splintered into several pieces, that fracture is described as

1. comminuted.
   A comminuted fracture may require open reduction and internal fixation.
2. compound.
   A compound fracture is one in which damage also involves the skin or mucous membranes.
3. depressed.
   A depressed fracture is one in which fragments are driven inward.
4. impacted.
   An impacted fracture is one in which a bone fragment is driven into another bone fragment.

15. When x-ray demonstrates a fracture in which the fragments of bone are driven inward, the fracture is described as

1. depressed.
   Depressed skull fractures occur as a result of blunt trauma.
2. compound.
   A compound fracture is one in which damage also involves the skin or mucous membranes.
3. comminuted.
   A comminuted fracture is one in which the bone has splintered into several pieces.
4. impacted.
   An impacted fracture is one in which a bone fragment is driven into another bone fragment.

16. A fracture is termed pathologic when the fracture

1. occurs through an area of diseased bone.
   Pathologic fractures can occur without the trauma of a fall.
2. results in a pulling away of a fragment of bone by a ligament or tendon and its attachment.
   An avulsion fracture results in a pulling away of a fragment of bone by a ligament or tendon and its attachment.
3. presents as one side of the bone being broken and the other side being bent.
   A greenstick fracture presents as one side of the bone being broken and the other side being bent.
4. involves damage to the skin or mucous membranes.
   A compound fracture involves damage to the skin or mucous membranes.

17. The most common complication after knee arthroscopy is

1. joint effusion.
   Joint effusion produces marked pain, and the physician may need to aspirate the joint to remove fluid and relieve the pressure.
2. infection.
   Infection is not a common complication of arthroscopy.
3. knee giving way.
   Complaints of the knee giving way are associated with functioning of the injured knee prior to arthroscopy.
4. knee locking.
   Complaints of the knee locking are associated with functioning of the injured knee prior to arthroscopy.

18. When the patient who has experienced trauma to an extremity complains of severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the patient is likely demonstrating signs of

1. reflex sympathetic dystrophy syndrome.
   RSD is frequently chronic and occurs most often in women.
2. avascular necrosis of bone.
   Avascular necrosis is manifested by pain and limited movement.
3. a reaction to an internal fixation device.
   Pain and decreased function are the prime indicators of reaction to an internal fixation device.
4. heterotrophic ossification.
   Heterotrophic ossification causes muscular pain and limited muscular contraction and movement.

19. Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent?

1. Greenstick
   A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent.
2. Spiral
   A spiral fracture is a fracture twisting around the shaft of the bone.
3. Avulsion
   An avulsion is the pulling away of a fragment of bone by a ligament or tendon and its attachment.
4. Oblique
   An oblique is a fracture occurring at an angle across the bone.

20. The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a patient who has sustained a fracture. The nurse suspects

1. fat embolism syndrome.
   Cerebral disturbances in the patient with fat embolism syndrome include subtle personality changes, restlessness, irritability, and confusion.
2. compartment syndrome.
   With compartment syndrome, the patient complains of deep, throbbing, unrelenting pain.
3. hypovolemic shock.
   With hypovolemic shock, the patient would have a decreased blood pressure and increased pulse rate.
4. reflex sympathetic dystrophy syndrome.                                                                                           Clinical manifestations of reflex sympathetic dystrophy syndrome include severe, burning pain, local edema, hyperesthesia, muscle spasms, and vasomotor skin changes.

21. A Colles’ fracture is a fracture of the

1. distal radius.
   A Colles’ fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.
2. elbow.
   A Colles’ fracture is a fracture of the distal radius.
3. humeral shaft.
   A Colles’ fracture is a fracture of the distal radius.
4. clavicle.
   A Colles’ fracture is a fracture of the distal radius.

22. With fractures of the femoral neck, the leg is

1. shortened, adducted, and externally rotated.
   With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.
2. shortened, abducted, and internally rotated.
   With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.
3. adducted and internally rotated.
   With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.
4. abducted and externally rotated.
   With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.

23. Which of the following terms most precisely refers to an infection acquired in the hospital that was not present or incubating at the time of hospital admission?

1. Nosocomial infection
   A 1970 CDC study found that about one-third of nosocomial infections could be prevented when effective infection control programs were in place.
2. Primary bloodstream infection
   A primary bloodstream infection is bacteremia or fungemia, which occurs without infection, identified at another anatomic site.
3. Secondary bloodstream infection
   A secondary bloodstream infection is bacteremia of fungemia of another anatomic site, which serves as a source for bloodstream contamination.
4. Emerging infectious diseases
   Emerging infectious diseases refer to diseases of infectious origin of which incidence in humans has increased within the past two decades or threaten to increase in the near future.

24. The usual incubation period (infection to first symptom) for AIDS is

1. 10 years.
   HIV is transmitted through sexual, percutaneous, or perinatal contact.
2. 3–6 months.
   The incubation period for HIV infection is greater than 3-6 months.
3. 1 year.
   The incubation period for HIV infection is greater than 1 year.
4. 5 years.
   The incubation period for HIV infection is greater than 5 years.

25. The usual incubation period (infection to first symptom) for hepatitis B is

1. 45-160 days.
   Hepatitis B is responsible for more than 200 deaths of healthcare workers annually.
2. 15-50 days.
   The incubation period for hepatitis B is 45-160 days.
3. 6-9 months.
   The incubation period for hepatitis B is shorter than 6-9 months.
4. unclear.
   The incubation periods for hepatitis D, E, and G are unclear.

26. Which of the following terms refers to a state of microorganisms being present within a host without causing host interference or interaction?

1. Colonization
   Understanding the principle of colonization facilitates interpretation of microbiologic reports.
2. Susceptible
   A susceptible host is a host who does not possess immunity to a particular pathogen.
3. Immune
   An immune host is a host who is not susceptible to a particular pathogen.
4. Infection
   Infection refers to host interaction with an organism.

27. The nurse teaches the parent of the child with chickenpox that the child is no longer contagious to others when

1. the vesicles and pustules have crusted.
   When the lesions have crusted, the patient is no longer contagious to others.
2. the first rash appears.
   The child remains contagious when the rash is present.
3. the fever disappears.
   The child remains contagious if the fever occurs as the rash is progressing.
4. the rash is changing into vesicles, and pustules appear.
   The child remains contagious when the rash is changing into vesicles and pustules.

28. Which of the following statements reflects the nursing management of the patient with West Nile Virus infection?

1. There is no treatment for West Nile Virus infection.
   Patients are supported by fluid replacement, airway management, and standard nursing care support during the time that the patient hasmeningitis symptoms.
2. The incubation period is three to five days.
   The incubation period (from mosquito bite until onset of symptoms) is between 5–15 days.
3. Patients with West Nile virus present with gastrointestinal complaints, such as nausea, vomiting, diarrhea, and abdominal pain.
   Most human infections are asymptomatic. When symptoms are present, headache and fever are most frequently reported. Less than one percent of those infected develop more severe illness, including meningitis.
4. Transmission of West Nile virus occurs from human-to-human.
   Birds are the natural reservoir for the virus. Mosquitoes become infected when feeding on birds and can transmit the virus to animals and humans. There is no human-to-human transmission of virus.

29. Prophylaxis antibiotic for anthrax is given to people with symptoms who have been in a defined “hot zone” for a period of

1. 60 days.
   Those with symptoms who have been in the hot zone should be given 60 days of prophylactic antibiotic. The aim of prophylaxis is to assure that if spores were inhaled, bacteria will be killed immediately upon release from spores. Those who have symptoms of fever, cough, headache, chills, and especially evidence of mediastinal lymph node involvement should be treated with intravenous antibiotics and respiratory support, if needed.
2. 30 days.
   Those with symptoms who have been in the hot zone should be given 60 days of prophylactic antibiotic
3. 14 days.
   Those with symptoms who have been in the hot zone should be given 60 days of prophylactic antibiotic
4. 10 days.
   Those with symptoms who have been in the hot zone should be given 60 days of prophylactic antibiotic

30. If a case of smallpox is suspected, the nurse should

1. call the CDC Emergency Preparedness Office.
   Anyone suspecting a case of smallpox should call the CDC Emergency Preparedness Office at 770-488-7100. The CDC will respond by immmediate provision of diagnostic support and eventual release of vaccine if a case is confirmed. Until instructed otherwise by the CDC, healthcare providers should carefully establish isolation with negative pressure, and maintain thorough lists of all those who have contact with the patient.
2. immediately vaccinate the patient and anyone in contact with the patient.
   The CDC will provide diagnostic support and will release the vaccine if the patient is confirmed to have smallpox.
3. establish isolation with positive pressure.
   Isolation with negative pressure should be established.
4. Assess the patient for signs of a rash similar to chickenpox in appearance and progression.  The lesions associated with smallpox may appear similar in appearance, but the progression is very different from that of chickenpox. Smallpox lesions will appear to be at the same stage of development as the rash progresses from macules to papules to pustules to scabs. This progression is very different from that of chickenpox. With chickenpox, lesions appear at different developmental stages.

31. The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a

1. mode of entry to host.
   The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a mode of entry to host.
2. mode of exit from the host.
   A mode of entry to the host, not a mode of exit from the host, is necessary for infection.
3. virulent host.
   The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a mode of entry to host.
4. latent time period.
   The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a mode of entry to host.

32. Which of the following statements reflect what is known about the Ebola and Marburg viruses?

1. The diagnosis should be considered in a patient who has a febrile, hemorrhagic illness after traveling to Asia or Africa.
   The diagnosis should be considered in a patient who has a febrile, hemorrhagic illness after traveling to Asia or Africa, or who has handled animals or animal carcasses from those parts of the world.
2. Treatment during the acute phase includes administration of acyclovir, and ventilator and dialysis support.
   No antivirals have been approved or show promise against the viruses. Treatment must be largely supportive maintenance of the circulatory system and respiratory systems. It is likely that the infected patient would need ventilator and dialysis support through the acute phases of illness.
3. The viruses can be spread only by airborne exposure.
   The viruses can be spread by exposure to blood or other body fluid, insect bite, and mucous membrane exposure.
4. Symptoms include severe lower abdominal pain, nausea, vomiting, and dehydration.
   Symptoms include fever, rash, and encephalitis which progress rapidly to profound hemorrhage, organ destruction, and shock.

33. Bubonic plague occurs

1. after the organism enters through the skin.
   Bubonic refers to enlarged lymph nodes that develop after the organism enters through the skin. Bubonic plague is the form seen most frequently, as the organism is transferred from rodents or other animals to humans by insect bite.
2. occurs after the organism is inhaled..
   Pneumonic plague occurs after the organism is inhaled. Only pneumonic plague can be contagious from person to person by an airborne route.
3. occurs when the organism causes a bloodstream infection.
   Septicemic plague occurs when the organism causes a bloodstream infection usually secondary to either pneumonic or bubonic, but sometimes without either entity.
4. after the organism is transferred by human to human contact.
   Bubonic plague is the form seen most frequently, as the organism is transferred from rodents or other animals to humans by insect bite.

34. The term given to the category of triage that refers to life-threatening or potentially life-threatening injury or illness requiring immediate treatment is

1. emergent.
   The patient triaged as emergent must be seen immediately.
2. urgent.
   The triage category of urgent refers to minor illness or injury needing first-aid-level treatment.
3. immediate.
   The triage category of immediate refers to non-acute, non-life-threatening injury or illness.
4. non-acute.
   The triage category of immediate refers to non-acute, non-life-threatening injury or illness.

35. When the patient has been field triaged and categorized as blue, the nurse recognizes that the patient requires

1. fast-track or psychological support.
   When a patient is categorized as blue, field triage has identified fast-track or psychological support needs.
2. emergent care.
   Field triaged patients who require emergent care will be categorized as red.
3. immediate care.
   Field triaged patients who require immediate care will be categorized as yellow.
4. urgent care.
   Field triaged patients who require urgent care will be categorized as green.

36. Which of the following guidelines is appropriate to helping family members cope with sudden death?

1. Show acceptance of the body by touching it, giving the family permission to touch.
   The nurse should encourage the family to view and touch the body if they wish, since this action helps the family to integrate the loss.
2. Inform the family that the patient has passed on.
   The nurse should avoid using euphemisms such as passed on.
3. Obtain orders for sedation for family members.
   The nurse should avoid giving sedation to family members, since this may mask or delay the grieving process.
4. Provide details of the factors attendant to the sudden death.
   The nurse should avoid volunteering unnecessary information (e.g., patient was drinking at the time of the accident).

37. Which of the following solutions should the nurse anticipate for fluid replacement in the male patient?

1. Lactated Ringer’s solution
   Replacement fluids may include isotonic electrolyte solutions and blood component therapy.
2. Type O negative blood
   O negative blood is prepared for emergency use in women of childbearing age.
3. Dextrose 5% in water
   Dextrose 5% in water should not be used to replace fluids in hypovolemic patients.
4. Hypertonic saline
   Hypertonic saline is used only to treat severe symptomatic hyponatremia and should be used only in intensive care units.

38. Induction of vomiting is indicated for the accidental poisoning patient who has ingested

1. aspirin.
   Overdose of aspirin should be treated with emesis or lavage, followed by ingestion of activated charcoal to absorb the aspirin.
2. rust remover.
   Rust remover is an alkaline product, which is corrosive, and induced vomiting is contraindicated.
3. gasoline.
   Gasoline is a petroleum distillate, and induced vomiting is contraindicated.
4. toilet bowl cleaner.
   Toilet bowl cleaners are corrosive, and induced vomiting is contraindicated.

39. Which of the following phases of psychological reaction to rape is characterized by fear and flashbacks?

1. Heightening anxiety phase
   During the heightened anxiety phase, the patient demonstrates anxiety, hyperalertness, and psychosomatic reactions, in addition to fear and flashbacks.
2. Acute disorganization phase
   The acute disorganization phase is characterized by shock, disbelief, guilt, humiliation, and anger.
3. Denial phase
   The denial phase is characterized by an unwillingness to talk.
4. Reorganization phase
   The reorganization phase occurs when the incident is put into perspective. Some patients never fully recover from rape trauma.

40. When preparing for an emergency bioterroism drill, the nurse instructs the drill volunteers that each biological agents requires specific patient management and medications to combat the virus, bacteria, or toxin. Which of the following statements reflect the patient management of variola virus (small pox)?

1. Small pox spreads rapidly and requires immediate isolation.
   Small pox is spread by droplet or direct contact. There are no antiviral agents effective against small pox, however vaccination within two to three days of exposure is protective.
2. Acyclovir is effective against smallpox.
   There are no antiviral agents effective against small pox; however, vaccination within two to three days of exposure is protective.
3. Small pox is spread by inhalation of spores.
   Small pox is spread by droplet or direct contact. It spreads rapidly and requires immediate isolation. Even in death, the disease can be transmitted.
4. Vaccination is effective only if administered within 12 to 24 hours of exposure.         Vaccination within two to three days of exposure of the small pox virus is protective. In four to five days, it may prevent death and should be administered with vaccinia immune globulin.

41. Which of the following statements reflect the nursing management of pulmonary anthrax (B. anthracis)?

1. Prophylaxis with fluoroquinone is suggested after exposure.
   Treatment is with ciprofloxacin or doxycycline.
2. Airborne person-to-person transmission occurs.
   Anthracis is a spore forming bacteria resulting in gastrointestinal, pulmonary, and skin symptoms. Symptoms are dependent upon contact, ingestion, or inhalation of the spores. Routine universal precautions are effective. Anthrax survives in the spore form for long periods making the body a potential source of infection for morticians.
3. Diagnosis is by pulmonary function testing and chest x-ray.
   Blood cultures are required to confirm the bacteria’s presence and diagnosis.
4. Pulmonary effects include respiratory failure, shock, and death within five to seven days after exposure.
   The pulmonary effects include respiratory failure, shock, and death within 24-36 hours after exposure.

42. Which of the following terms refers to injuries that occur when a person is caught between objects, run over by a moving vehicle, or compressed by machinery?

1. Crush injuries
   Crush injuries are those that occur when a person is caught between objects, run over by a moving vehicle, or compressed by machinery.
2. Blunt trauma
   Blunt trauma is commonly associated with extra-abdominal injuries to the chest, head, or extremities.
3. Penetrating abdominal injuries
   Penetrating abdominal injuries include those such as gunshot wounds and stab wounds.
4. Intra-abdominal injuries
   Intra-abdominal injuries are categorized as penetrating and blunt trauma.

43. A person suffering from carbon monoxide poisoning

1. appears intoxicated.
   A person suffering from carbon monoxide poisoning appears intoxicated (from cerebral hypoxia). Other signs and symptoms include headache, muscular weakness, palpitation, dizziness, and mental confusion.
2. presents with severe hypertension.
   A person suffering from carbon monoxide poisoning appears intoxicated (from cerebral hypoxia). Other signs and symptoms include headache, muscular weakness, palpitation, dizziness, and mental confusion.
3. appears hyperactive.
   A person suffering from carbon monoxide poisoning appears intoxicated (from cerebral hypoxia). Other signs and symptoms include headache, muscular weakness, palpitation, dizziness, and mental confusion.
4. will always present with a cherry red skin coloring.
   The skin coloring in the patient with carbon monoxide poisoning can range from pink to cherry red to cynanotic and pale and is not a reliable diagnostic sign.

44. Treatment of an acetaminophen overdose includes the administration of

1. N-acetylcysteine (Mucomyst).
   Treatment of acetaminophen overdose includes administration of N-acetylcysteine (Mucomyst).
2. flumazenil (Romazicon).
   Flumazenil is administered in the treatment of nonbarbituate sedative overdoses.
3. naloxone (Narcan).
   Naloxone (Narcan) is administered in the treatment of narcotic overdoses.
4. diazepam (Valium).
   Diazepam (Valium) may be administered to treat uncontrolled hyperactivity in the patient with a hallucinogen overdose.

45. Which of the following statements reflect the nursing management of the patient with a white phosphorus chemical burn?

1. Do not apply water to the burn.
   Water should not be applied to burns from lye or white phosphorus because of the potential for an explosion or deepening of the burn.
2. Immediately drench the skin with running water from a shower, hose or faucet.
   Water should not be applied to burns from lye or white phosphorus because of the potential for an explosion or deepening of the burn.
3. Alternate applications of water and ice to the burn.
   Water should not be applied to burns from lye or white phosphorus because of the potential for an explosion or deepening of the burn.
4. Wash off the chemical using warm water, then flush the skin with cool water.
   Water should not be applied to burns from lye or white phosphorus because of the potential for an explosion or deepening of the burn.

46. During a disaster, the nurse sees a victim with a green triage tag. The nurse knows that the person has

1. injuries that are minor and treatment can be delayed hours to days.
   A green triage tag (priority 3 or minimal) indicates injuries that are minor and treatment can be delayed hours to days.
2. injuries that are life-threatening but survivable with minimal intervention.
   A red triage tag (priority 1 or immediate) indicates injuries that are life-threatening but survivable with minimal intervention.
3. injuries that are significant and require medical care, but can wait hours without threat to life or limb.
   A yellow triage tag (priority 2 or delayed) indicates injuries that are significant and require medical care, but can wait hours without threat to life or limb.
4. indicates injuries that are extensive and chances of survival are unlikely even with definitive care.
   A black triage tag (priority 4 or expectant) indicates injuries that are extensive and chances of survival are unlikely even with definitive care.

47. If a person has been exposed to radiation, presenting symptoms, such as nausea, vomiting, loss of appetite, diarrhea, or fatigue can be expected to occur within _______ hours after exposure?

1. 48 to 72
   The prodromal phase (presenting symptoms) of radiation exposure occurs within 48 to 72 hours after exposure. Signs and symptoms include nausea, vomiting, loss of appetite, diarrhea, and fatigue. With high-dose radiation exposure, the signs and symptoms may include fever, respiratory distress, and increased excitability.
2. 6 to 12
   The prodromal phase (presenting symptoms) of radiation exposure occurs within 48 to 72 hours after exposure.
3. 12 to 24
   The prodromal phase (presenting symptoms) of radiation exposure occurs within 48 to 72 hours after exposure.
4. 24 to 48
   The prodromal phase (presenting symptoms) of radiation exposure occurs within 48 to 72 hours after exposure.

48. Which of the following refers to a management tool for organizing personnel, facilities, equipment, and communication for any emergency situation?

1. The Incident Command System
   The Incident Command System (ICS) is a management tool for organizing personnel, facilities, equipment and communication for any emergency situation. The federal government mandates that the ICS be used during emergencies. Under this structure, one person is designated as incident commander. This person must be continuously informed of all activities and informed about any deviation from the established plan. While the ICS is primarily a field structure and process, aspects of it are used at the level of an individual hospital’s emergency response plan as well.
2. Office of Emergency Management
   Office of Emergency Management (OEM) coordinates the disaster relief efforts at the state and local levels. The OEM is responsible for providing interagency coordination during an emergency. It maintains a corps of emergency management personnel, including responders, planners, and administrative and support staff.
3. National Disaster Medical System
   National Disaster Medical System (NDMS). The NDMS has many medical support teams such as Disaster Medical Assistance Teams (DMATs) that provide medical personnel to set up and staff a field hospital.
4. The Hospital Emergency Preparedness Plan
   The Hospital Emergency Preparedness Plan is a facility-specific plan for emergency preparedness required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

49. Which of the following terms refers to a process by which an individual receives education about recognition of stress reactions and management strategies for handling stress?

1. Defusing
   Defusing is a process by which the individual receives education about recognition of stress reactions and management strategies for handling stress. It is a component of critical incident stress management (CISM).
2. Debriefing
   Debriefing is a more complicated intervention of critical incident stress management (CISM); it involves 2- to 3- hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (e.g., flashbacks, difficulty sleeping, intrusive thoughts) and other psychological ramifications.
3. Follow-up
   In follow-up, members of the critical incident stress management (CISM) team contact the participants of a debriefing and schedule a follow-up meeting if necessary. People with ongoing stress reactions are referred to mental health specialists.
4. Critical incident stress management
   Critical incident stress management (CISM) is an approach to preventing and treating the emotional trauma that can affect emergency responders as a consequence of their jobs but that can also occur to anyone involved in a disaster or mass casualty incident.

50. The first step in decontamination is

1. removal of the patient’s clothing and jewelry and then rinsing the patient with water.
   To be effective, decontamination must include a minimum of two steps. The first step is removal of the patient’s clothing and jewelry and then rinsing the patient with water. The second step consists of a thorough soap and water wash and rinse.
2. a thorough soap and water wash and rinse of the patient.
   A thorough soap and water wash and rinse of the patient is the second step in the decontamination process. The first is to remove the patient’s clothing and jewelry and then rinsing the patient with water.
3. to immediately apply personal protective equipment.
   To be effective, decontamination must include a minimum of two steps. The first step is removal of the patient’s clothing and jewelry and then rinsing the patient with water. The second step consists of a thorough soap and water wash and rinse.
4. to immediately apply a chemical decontamination foam to the area of contamination.        To be effective, decontamination must include a minimum of two steps. The first step is removal of the patient’s clothing and jewelry and then rinsing the patient with water. The second step consists of a thorough soap and water wash and rinse.