Which of the following infection control measures is indicated in the patient with an active methicillin resistant staphylococcus aureus wound infection? A. Droplet precautions B. Contact preacutions C. Protective isolation D. Airborne precautions - CORRECT ANSWER B. Contact precautions Rationale: CDC recommends contact precautions for patients with active MRSA infection. A patient with a hand wound caused by a high-pressure paint gun is awaiting surgical wound exploration. Preoperatively, the emergency nurse will monitor the patient for the development of A. Lactic acidosis B. Compartment syndrome C. Tetanus infection D. Muscle contracture - CORRECT ANSWER B. Compartment syndrome Rationale: High-pressure injection injuries occur when a device (e.g., a paint or grease gun) injects the foreign substance into a body. This injury most commonly occurs to the dominant hand or index finger of the injection gun operator. Emergency care includes splinting the injury, obtaining radiographs, administering parenteral analgesics and broad-spectrum ABX, ensuring appropriate tetanus prophylaxis, and elevating the injury. High-pressure injection injuries are a surgical emergency requiring thorough cleansing and immediate decompression to prevent compartment syndrome and tissue necrosis. Hydrocarbon-based substances (e.g., fuel, paint thinners, organic solvents) cause the most severe inflammatory response and are associated with the highest incidence of subsequence amputations. Which of the following findings in a 20-yr-old burn patient indicates the need for burn center referral? A. 8% partial thickness burns to the anterior chest B. Partial thickness burns on the anterior right thigh C. 2% Full-thickness burns in the left knee area D. Superficial circumferential burns of the forearms - CORRECT ANSWER C. 2% Full thickness burns in the left knee area Rationale: According to the American Burn Association, patients with burns that overlay major joints should be referred to a burn center. A 5-year-old presents with dilated pupils, tachycardia, hot flushed skin, agitation, diminished bowel sounds, urinary retention, and hallucinations after ingesting several tiotropium (Spiriva) inhalation powder capsules. These findings suggest A. Neurogenic shock B. Diabetic ketoacidosis C. Anticholinergic crisis D. Beta-blocker overdose - CORRECT ANSWER C. Anticholinergic crisis Rationale: Symptoms of anticholinergic exposure can be recalled using the mnemonic "red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hotter than Hades." Treatment is largely symptomatic and supportive. After spraying pesticides all day, a farmhand walks into the ED complaining of diaphoresis, productive cough, nausea, vomiting, and diarrhea. The priority intervention is A. Intravenous cannulation B. O2 Supplementation C. Antidote administration D. Skin decontamination - CORRECT ANSWER D. Skin decontamination The patient's presentation and recent history suggest organophosphate or cabamate poisoning. These substances are found in industrial insecticides used on farms, as well as in home pesticides (bug spray). Toxicity causes a cholinergic crisis resulting in stimulation and hypersecretion of body fluids. Findings in the patient with a cholinergic toxicity are MUDDLE. Miosis (constriction of pupils), Urination (increase in urination), Diaphoresis, Defecation, Lacrimation, Excitement. As well as SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI upset, and Emesis. Death occurs related to respiratory occurs r/t respiratory failure caused by respiratory muscle paralysis nd increased secretions. In the walking and talking patient, the priority intervention is to decontaminate the patient to avoid crosscontamination of medical caregivers and equipment. Antidote administration-intravenous atropine and pralidoxime (2-PAM; Protopam)-will likely be required. A patient who grasped a live elctrical wire is admitted to the ED. The entire palmar surface of both hands is charred and dry. Anticipating fluid needs for this patient, the nurse knows A. to apply the Parkland burn fluid calculation formula B. these palm burns represent 1% of body surface area (BSA) C. BSA calculations do not predict electrical burn fluid needs D. to use the Consensus burn fluid calculation formula - CORRECT ANSWER C. BSA calculations do not predict electrical burn fluid needs. Rationale: Most electrical burn damage is internal, rather than dermal, BSA-based fluid calculations do not predict fluid needs in the electrically-injury patient. In a patient with acute onset gastrointestinal complaints, which items in the patient's history would suggest the culprit is food poisoning rather than another etiology? The presence of diarrhea and A. intermittent vomiting B. dilated pupils C. right lower quadrant pain D. bloody stools - CORRECT ANSWER A. Intermittent vomiting Rationale: Diarrhea is a non-specific finding with hundreds of potential causes. Nevertheless, with a good patient hx, an emergency nurse can greatly narrow down the possibilities. Food poisoning occurs when foodborne bacteria or virus either directly irritate the gastrointestinal tract or produce irritating toxins. In most cases of food poisoning (gastroenteritis), the ENTIRE GI tract is involved. This means patients will experience BOTH vomiting and diarrhea. If a patient is ONLY vomiting or ONLY experiencing diarrhea, food poisoning is less likely. Diarrhea in the patient with dilated pupils occurs in opioid withdrawal. Diarrhea associated with periumbilical pain that migrates to the RLQ is classic for appendicitis. Bloody stools suggest more than the garden variety gastroenteritis; think C.difficile or amoebic infection. The earliest symptoms of radiation exposure include A. GI bleeding B. N/V C. tremors and muscle weakness D. tachycardia and HTN - CORRECT ANSWER B. N/V