ATI LPN
Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Chapter 72 : Emergency Nursing Questions
Question 1 of 5
A patient is being treated for bites that she suffered during an assault. After the bites have been examined and documented by a forensic examiner, the nurse should perform what action?
Correct Answer: B
Rationale: Washing bites with soap and water after forensic documentation prevents infection. Chlorhexidine dressings, hepatitis B vaccination, or immunization history are not immediate priorities.
Question 2 of 5
A nurse is caring for a patient who has been the victim of sexual assault. The nurse documents that the patient appears to be in a state of shock, verbalizing fear, guilt, and humiliation. What phase of rape trauma syndrome is this patient most likely experiencing?
Correct Answer: D
Rationale: The acute disorganization phase of rape trauma syndrome involves shock, fear, guilt, and humiliation. Denial, heightened anxiety, and reorganization occur in different stages.
Question 3 of 5
The ED nurse is planning the care of a patient who has been admitted following a sexual assault. The nurse knows that all of the nursing interventions are aimed at what goal?
Correct Answer: A
Rationale: Nursing interventions post-sexual assault focus on empowering the patient to regain control, prioritizing emotional recovery over legal outcomes, future safety guarantees, or forced verbalization.
Question 4 of 5
The ED nurse admitting a patient with a history of depression is screening the patient for suicide risk. What assessment question should the nurse ask when screening the patient?
Correct Answer: B
Rationale: Directly asking about suicidal thoughts is essential for risk assessment in depression. Mood, life expectancy, or severity ratings are less specific for suicide screening.
Question 5 of 5
A patient is brought to the ED by two police officers. The patient was found unconscious on the sidewalk, with his face and hands covered in blood. At present, the patient is verbally abusive and is fighting the staff in the ED, but appears medically stable. The decision is made to place the patient in restraints. What action should the nurse perform when the patient is restrained?
Correct Answer: A
Rationale: Frequent skin integrity checks prevent injury from restraints. Legal charges are not the nurse's role, interaction should continue, and a full assessment may be unsafe while combative.