Emergency Management-PNC IV

7) The nurse understands that some factors affect health care delivery by creating new opportunities for the healthcare sector. Which would affect healthcare delivery? A) Advances in technology requiring specialized personnel B) Healthcare literacy programs C) Changing demographics that increase the need for new jobs D) Managed care frameworks that coordinate clients and insurance plans

Answer: A Explanation: A) Constant change is the new norm in medicine. Scientific knowledge related to health care is rapidly increasing and leading to more sophisticated technology. Information management systems have been created and are continually being refined. Such systems support bedside charting, monitoring, laboratory testing, and use of online evidence-based guidelines to provide appropriate care. New discoveries often modify how and where care may be provided. Many advances in technology require specialized personnel, creating new opportunities for individuals seeking employment in the healthcare sector.

Several victims of a suspected biologic attack are brought into the emergency department. Which type of personal protective equipment should be provided to these victims? 1. mask 2. gown 3. gloves 4. goggles

Correct Answer: 1 Rationale 1: In the event of a biologic attack, victims should be isolated from others or have some device to cover the nose and mouth to prevent the transmission of the organism. The victims should be wearing a mask. Rationale 2: A gown would not be indicated at this time. Rationale 3: Gloves would not be indicated at this time. Rationale 4: Goggles would not be indicated at this time. Global Rationale: In the event of a biologic attack, victims should be isolated from others or have some device to cover the nose and mouth to prevent the transmission of the organism. The victims should be wearing a mask. A gown, gloves, and goggles would not be indicated at this time.

Correct Answer: 1 Rationale 1: Patients who are critically injured and require immediate intervention should be tagged red (immediate threat to life). These patients need the most support and emergency care. This would include patients with a respiratory rate above 30. Rationale 2: This patient has life-threatening injuries. Rationale 3: This patient is not ambulatory and has life-threatening injuries. Rationale 4: With the appropriate interventions, this patient can be expected to live. Global Rationale: Patients who are critically injured and require immediate intervention should be tagged red (immediate threat to life). These patients need the most support and emergency care. This would include patients with a respiratory rate above 30.

The triage nurse is tagging victims of a train derailment. One patient has a sucking chest wound, BP 90/50, respirations 32, and is alert and able to respond to questions. Utilizing the identified chart, which colored tag should the nurse assign to the patient? 1. red, immediate threat to life 2. yellow, requiring medical attention but no threat of loss of life 3. green, ambulatory with minor injuries 4. black, not expected to survive

Correct Answer: 3 Rationale 1: Conventional triage is limited to normal circumstances or when there are only a few victims. In conventional triage, patients requiring the most support are transported first. Rationale 2: This is a mass-casualty event. It is a disaster. Rationale 3: A mass-casualty event with more than 100 victims requires the institution of reverse triage. Reverse triage works on the principle of the greatest good for the greatest number Rationale 4: The least injured and most ambulatory patients should be transported first. Global Rationale: A mass-casualty event with more than 100 victims is a disaster requiring the institution of reverse triage. Reverse triage works on the principle of the greatest good for the greatest number. Conventional triage is limited to normal circumstances or when there are only a few victims. In conventional triage, patients requiring the most support are transported first.

A train made up of railroad cars filled with toxic chemicals and a full school bus with 90 children on board collide in a populated area. A huge explosion occurs and a fire develops in a nearby factory. Which approach to care should be used to care for these victims? 1. emergency; use conventional triage 2. emergency; evacuate all ambulatory patients first 3. disaster; employ reverse triage 4. disaster; evacuate critically injured patients first

1) The nurse is participating on a local council as an advisor regarding community needs during an emergency. Which recommendation regarding community needs during an emergency response does the nurse include when advising the council? A) A coordinated response to emergencies. B) A comprehensive disaster plan. C) Programs to restore the community. D) The identification of potential hazards to the community.

Answer: A Explanation: A) During the mitigation phase of the emergency response, the community identifies the potential hazards and takes measures to prevent or minimize the emergency. A comprehensive disaster plan is part of phase 1, the preparedness phase. A coordinated response to emergencies occurs during the third phase, emergency response. Programs to restore the community are part of the recovery phase.

8) The nurse manager is discussing the preparedness phase of a revised emergency management plan for the emergency department. Which resources will the nurse manager utilize to help nurses understand their roles and responsibilities during an emergency response? Select all that apply. A) The American Nurses Association (ANA) B) The Federal Emergency Management Agency (FEMA) C) The AMA D) The Red Cross

Answer: A Explanation: A) During the preparedness phase, individual nurses must gain an understanding of their expected roles in an emergency and prepare for them. Because nurses will be required to allocate scarce resources and supplies and make unbelievably difficult client care decisions, they must understand the ethics associated with such choices. The ANA is a good source of information to guide nurses' understanding of their roles and possible consequences. Nurses must be aware of their employer's response plans and have a sense of how their state and local community will operate during an emergency.

3) A nurse working on a medical-surgical unit has opted to return to school to earn a Bachelor of Science in Nursing (BSN) degree. After considering projected changes in health care and the population cared for in the community, the student might consider selecting which elective course? A) A course on medical Spanish B) A psychology course on young adults C) A personal finance class D) A class on the effect of illness on a young child

Answer: A Explanation: A) Minorities in the United States will likely be the majority by the year 2042. By becoming proficient at other languages, such as Spanish, the nurse will be better able to meet the needs of the clients who seek care within the community. The largest group of clients will be age 65 or older in the near future, so an extra class about an aging population would be more helpful than a class about children or young adults. The student might consider a class on the effects of finance and cost in the delivery of health care rather than personal finance.

8) The nurse is taking care of a client being discharged but will need home nursing care, physical therapy, and speech therapy. Which framework helps the client who has multiple care needs? A) Case management B) Client-focused care C) Managed care D) Multidisciplinary nursing teams

Answer: A Explanation: A) Multidisciplinary teams led by a case manager are at the heart of successful case management. Case management is essential when a client has multiple care needs and requires the services of multiple providers. The goal of case management is to reach and then maintain the individual's optimum level of health, quality of life, and activities of daily living by ensuring that the individual's healthcare needs are met. The case manager may be a nurse, a social worker, or another healthcare team member. Case management enables clients to experience continuity of care, regardless of the location at which the care is provided. This activity on behalf of a client may be limited to a hospitalization or may occur across settings for clients receiving care in the community and/or at home.

6) The nurse knows that communication among healthcare team members is essential during mass casualty events. Which is essential when communicating under these circumstances? A) Providing concise, accurate, and timely information B) Preparing for ethical challenges C) Documenting to prevent legal issues D) Coordinating care between management and clinicians

Answer: A Explanation: A) Nurses face ethical and legal issues associated with the provision of care in mass casualty events (MCE). They are also challenged as they decide what care to provide to the patients they are caring for during a disaster. Communication among the various emergency team members must be concise, accurate, and timely during an MCE. Nurses must use their knowledge to foster better communication.

9) During a mass casualty event, the demand for nursing skills increases and calls for which implementation? A) Reverse triage B) Assessment skills C) Collaboration with primary caregivers D) Triage skills

Answer: A Explanation: A) Nurses perform triage every day in emergency departments. During a mass casualty event (more than 100 victims), the demand on nurses' knowledge and skills will be even greater. Mass casualty events call for the implementation of reverse triage, in which the most severely injured or ill victims who require the greatest resources are treated last to allow the greatest number of victims to receive medical attention.

7) The nurse is working with an emergency response team following massive flooding caused by a hurricane. When working with the Clinical Outreach Communication Activity (COCA) team of the Centers for Disease Control and Prevention (CDC), the COCA is responsible for which action? A) Provide two-way communication between clinicians and the CDC. B) Provide communication between doctors in the field during a disaster and their healthcare team. C) Provide resources to the community during times of disaster. D) Provide expert advice to nurses during natural disasters.

Answer: A Explanation: A) The CDC manages the COCA to ensure that clinicians have up-to-date information. The COCA is designed to provide two-way communication between clinicians and the CDC about emerging health threats such as pandemics, natural disasters, and terrorism. The COCA keeps a list of emergency preparedness and training resources offered by federal agencies and COCA partners.

10) The nurse providing rapid triage and emergency treatment for clients in an effort to stabilize them knows that which is the primary purpose of the warm zone? A) Decontamination B) Rapid triage C) Reverse triage D) Emergency medical treatment

Answer: A Explanation: A) The warm zone (also referred to as the yellow, contamination, or contamination reduction zone) is located at least 300 feet from the outer edge of the hot zone. Although the primary purpose is decontamination, rapid triage and emergency treatment to stabilize victims may also take place in the warm zone. Individuals who have the highest levels of contamination are treated with the highest priority. PPE is required in this zone.

5) A nurse is planning a community health fair at a local community center. Which goals regarding health promotion does the nurse plan to highlight at the event? Select all that apply. A) The ability to change and modify goals as health needs change B) The ability for clients to be able to assess and evaluate their health needs C) The ability for the client to promote health in other individuals D) The ability to promote cost-saving techniques to healthcare providers E) The ability to prevent disease by imitating nursing techniques

Answer: A, B Explanation: A) The nurse has an integral role in health promotion. The nurse's aim should be to teach clients how to remain healthy, thus preserving wellness. The overarching goal is to ensure that clients understand the importance of setting health goals for themselves and their children, and that clients are able to assess, implement, evaluate and, as their health needs change, modify them. Some examples of how nurses participate in health promotion include providing health education at every opportunity, evaluating and screening clients to identify prevention opportunities such as immunizations, and promoting wellness in the community by organizing and participating in community events such as health fairs.

2) A hospital in the community has been notified of a multi-car crash on the interstate that will result in the transfer of many injured clients to the hospital. As part of the emergency response, the charge nurses in the emergency department (ED) and intensive care unit (ICU) are responsible for which tasks? Select all that apply. A) Assigning care for the clients as they are admitted to the unit B) Assuring that there are enough pain medications available C) Assessing the acuity of the current clients on the unit D) Delegating staff nurses to gather needed supplies for the arriving clients E) Notifying the operating room of the potential influx of clients needing surgery

Answer: A, C, D Explanation: A) The charge nurses in each unit are responsible for assessing the current clients and recommending to the physicians those clients who can be moved to make room for clients needing more immediate care. All departments should be involved in preparing for the emergency, not just the Emergency Department. The pharmacy assures that medications are available. The charge nurse would delegate the gathering of supplies to the staff nurses. The individual in charge of directing the emergency response for the hospital would notify the operating room of the potential for an influx of clients requiring surgery. The charge nurse would also assign care for the clients who are admitted to the unit.

5) A nurse recently attended a seminar that discussed the many threats to homeland security. The nurse is responsible for planning for emergencies from bioterrorism as nurse manager of the emergency department. Which agents does the nurse include when planning for bioterrorism? Select all that apply. A) Anthrax B) Tuberculosis C) Cancer D) Flu E) Smallpox

Answer: A, E Explanation: A) Smallpox, anthrax, botulism, plague, viral hemorrhagic fevers, and tularemia are the agents that are of highest concern in regard to bioterrorism. Cancer, flu, and tuberculosis have not been developed into biological threats and would not kill the number of people that smallpox would.

3) The charge nurse assesses clients during a mass casualty incident (MCI) and transfers some to other units and some are discharged to home. In planning for the admission of critically ill clients from the emergency department, which nurses will the charge nurse assign the new clients to when admitted to the unit? A) Risk-reduction knowledge B) Advanced assessment skills C) Impeccable ethics D) Exceptional self-care methods

Answer: B Explanation: A) During the admission of injured clients, the charge nurse would assign the new clients to those nurses with advanced assessment, technical, and communication skills. Nurses do need to have good ethics, sufficient risk-reduction knowledge, and appropriate self-care knowledge during emergency responses. However, during the admission of victims, the charge nurse would want the highly competent nurses caring for the new clients.

4) A group of nurses attend an in-service regarding emergency preparedness for the hospital. One of the nurses has three small children and lives in a two-story house in the suburbs. After the class, the nurse plans to initiate which action to enhance family safety? A) Installing deadbolt locks on the doors B) Obtaining a fire escape ladder for the second floor of the home C) Planning to purchase a generator for the house D) Buying a water purification system in the home

Answer: B Explanation: A) The priority action for protecting the nurse's family is obtaining a fire escape ladder for the second floor. Water purification may be important, depending on the quality of the water, but obtaining a fire escape ladder is the priority. Installing a generator may be useful in the case of a power outage, but obtaining a fire escape ladder is the priority. Deadbolt locks are good to keep intruders out, but protecting the family from entrapment by fire is the priority.

4) The manager of a small clinic has cross-trained the nurses to perform electrocardiogram (ECG) testing, phlebotomy, and some respiratory therapy interventions. This clinic is providing client-focused care. Which are the benefits of this delivery model? Select all that apply. A) Collaboration among many disciplines in providing client care B) Decreased steps to provide client care C) Decreased personnel required to provide client care D) Ease in tracking client progress E) Cost-effective care resulting in improved outcomes

Answer: B, C Explanation: A) Client-focused care is a delivery model that brings all services and care providers to the client. Activities provided by auxiliary personnel (physical therapy, respiratory therapy, ECG testing, and phlebotomy) are moved close to the client, thereby decreasing the number of personnel involved and the number of steps to get the work done. Managed care focuses on cost-effective, quality care, which results in decreased costs and improved outcomes. Case management is a way to integrate healthcare services for individuals or groups and involves multidisciplinary teams that assume collaborative responsibility for planning, assessing needs, and coordinating, implementing, and evaluating care. Critical pathways are used to track the client's progress in case management.

6) The nurse is planning care for a number of clients who have been victims of a hurricane. Which is the priority nursing diagnosis to include in the plan of care for the victims? A) Chronic Confusion B) Decreased Cardiac Output C) Risk for Post-Trauma Syndrome D) Fatigue

Answer: C Explanation: A) Almost all victims of trauma would be at risk for post-trauma syndrome. Some victims may experience decreased cardiac output, but not all. Clients will not experience chronic confusion from the trauma unless there is a disease process already present that causes confusion. Fatigue may or may not affect the victims.

2) A nurse educator is teaching a group of students about managed care. The educator knows that the students have understood the concept when they state that managed care has which emphasis? Select all that apply. A) Bringing services to the client B) Integration of health care services C) Cost-effective care D) Preventive services E) Health promotion

Answer: C, D, E Explanation: A) Managed care describes a healthcare system that emphasizes cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of client. Managed care clinics will emphasize cost-effective care by offering preventive services and health promotion activities. Case management describes a range of models for integrating healthcare services for individuals or groups. Client-focused care is a delivery model that brings all services and care providers to the client.

1) The nurse is caring for a client who sustained multiple injuries in an automobile accident. As a part of secondary prevention for this client, which does the nurse include in the plan of care? A) Promote wellness. B) Detect early disease. C) Restore the client to previous functioning. D) Prevent the progression of more symptoms.

Answer: D Explanation: A) Rehabilitation is tertiary prevention and is aimed at restoring the client to the previous level of functioning. Prevention of the progression of symptoms and early detection of disease are secondary preventions. Promoting wellness is considered primary prevention.

A small commuter plane lost an engine and crashed into a shopping mall. The estimated number of injured people from this accident is 500. Which classification of incident should the nurse use when determining the care needed for these victims? 1. mass-casualty incident 2. multiple-casualty incident 3. accidental natural disaster 4. intentional human-generated disaster

Correct Answer: 1 Rationale 1: A mass-casualty incident occurs quickly and suddenly and overwhelms local resources with many seriously ill or injured victims needing care. Rationale 2: A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. Rationale 3: Natural disasters are caused by acts of nature or emerging diseases. Rationale 4: An intentional human-generated disaster is done with specific intent. Global Rationale: A mass-casualty incident occurs quickly and suddenly and overwhelms local resources with many seriously ill or injured victims needing care. A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. Natural disasters are caused by acts of nature or emerging diseases. An intentional human-generated disaster is done with specific intent.

A school bus transporting a local university's basketball team has just crashed in the rain on the side of the road. The bus was transporting approximately 60 people. Which classification should the nurse use to describe the situation? 1. multiple-casualty incident 2. natural disaster 3. human-generated disaster 4. mass-casualty incident

Correct Answer: 1 Rationale 1: A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. Rationale 2: Natural disasters are caused by acts of nature or emerging diseases. Rationale 3: Human-generated disasters are either accidental or intentional. Rationale 4: A mass-casualty incident occurs quickly and suddenly and overwhelms local resources with many seriously ill or injured victims needing care. Global Rationale: A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. Natural disasters are caused by acts of nature or emerging diseases. Human-generated disasters are either accidental or intentional. A mass-casualty incident occurs quickly and suddenly and overwhelms local resources with many seriously ill or injured victims needing care.

An individual arrives at the emergency department with injuries sustained in a natural gas explosion. The patient is unable to respond to questions and keeps repeating "I can't hear." For what should the nurse assess this patient? 1. tympanic membrane rupture 2. air embolism 3. oxygen saturation level 4. confusion

Correct Answer: 1 Rationale 1: After a blast injury, damage to the ear can include tympanic membrane rupture or damage to the cochlea. As the patient is expressing difficulty hearing, the tympanic membrane should be assessed. Rationale 2: An air embolism would impact the patient's respiratory status. Rationale 3: There is no evidence to suggest the patient's oxygen saturation level is impaired. Rationale 4: There is no evidence of confusion. Global Rationale: After a blast injury, damage to the ear can include tympanic membrane rupture or damage to the cochlea. As the patient is expressing difficulty hearing, the tympanic membrane should be assessed. An air embolism would impact the patient's respiratory status. There is no evidence to suggest the patient's oxygen saturation level is impaired. There is no evidence of confusion.

A patient is brought into the emergency department with chemical burns. What should the nurse do to help this patient? 1. Check to see if all clothing has been removed and begin flushing the patient's skin with water. 2. Begin flushing the patient's clothes and skin with warm water. 3. Do not remove any jewelry. 4. Keep the patient's contact lenses in place and flush only with warm water.

Correct Answer: 1 Rationale 1: After the chemical exposure, the patient's clothing should be removed. Rationale 2: The chemical should be flushed from the skin with copious amounts of cool running water. Rationale 3: Jewelry should be removed. Rationale 4: Contact lenses should be removed. Global Rationale: After the chemical exposure, the patient's clothing, jewelry, and contact lenses should be removed. The chemical should then be flushed from the skin with copious amounts of cool running water.

The nurse is caring for a patient who was brought into the emergency department after an explosion at a nuclear power plant. The patient is confused and keeps repeating that his skin is "on fire." What does this information indicate to the nurse? 1. The patient may not recover. 2. The patient's clothing is burning his skin. 3. There is gastrointestinal system involvement and the patient will survive if he receives fluids. 4. There is bone marrow damage and the patient needs oxygen for the confusion.

Correct Answer: 1 Rationale 1: For victims of a nuclear detonation, comfort measures, such as psychologic support and empathy, are given. Rationale 2: The patient's clothing would be burning his skin if he had experienced a chemical injury. Rationale 3: Evidence of gastrointestinal system involvement would be nausea, loss of appetite, diarrhea, and malaise. Rationale 4: Evidence of bone marrow damage would be nausea, fatigue, malaise, clotting disorders, and hemorrhage. Global Rationale: For victims of a nuclear detonation, comfort measures, such as psychologic support and empathy, are given. The patient's clothing would be burning his skin if he had experienced a chemical injury. Evidence of gastrointestinal system involvement would be nausea, loss of appetite, diarrhea, and malaise. Evidence of bone marrow damage would be nausea, fatigue, malaise, clotting disorders, and hemorrhage.

A victim of a plane crash exits the plane and runs to an emergency provider to tell him that his mother is trapped inside and is unable to walk out on her own. What should the emergency provider do? 1. Assist with clearing all the victims who are ambulatory first, then locate the trapped victim. 2. Enter the plane to locate the trapped victim. 3. Tell the victim's son that his mother will be fine and will be removed from the plane as soon as possible. 4. Tell the victim to go back inside and try to get his mother on her feet.

Correct Answer: 1 Rationale 1: If following the principles of reverse triage, emergency personnel should assist with clearing all victims who are ambulatory first and then locate the trapped victim. Rationale 2: The emergency provider should not enter the plane to locate the trapped victim first. Rationale 3: The emergency provider should not tell the son that his mother will be fine because there is no way of knowing the extent of her injuries. Rationale 4: The emergency provider should not tell the son to go back inside the wreckage and get his mother on her feet. Global Rationale: If following the principles of reverse triage, emergency personnel should assist with clearing all victims who are ambulatory first and then locate the trapped victim. The emergency provider should not enter the plane to locate the trapped victim first. The emergency provider should not tell the son that his mother will be fine because there is no way of knowing the extent of her injuries. The emergency provider should not tell the son to go back inside the wreckage and get his mother on her feet.

Several patients are admitted after being exposed to a substance that was released in their manufacturing plant. The patients are demonstrating flu-like symptoms, unproductive cough, and fever. These patients should be assessed for which type of exposure? 1. anthrax 2. smallpox 3. dirty bomb 4. nuclear detonation

Correct Answer: 1 Rationale 1: Inhalation anthrax carries the highest mortality rate among biologic weapons. The patient initially exhibits influenza-like symptoms such as fever, nonproductive cough, headache, and malaise that advance to respiratory distress, mediastinal widening, and hemodynamic collapse in 3 to 5 days. Death may occur shortly thereafter. Untreated patients die in 2 to 3 days. Rationale 2: Smallpox spreads by direct contact or by inhalation of respiratory droplets. Symptoms include a high fever, headache, and malaise, followed by a vesicular/pustular rash appearing simultaneously on the face and extremities. Rationale 3: A dirty bomb causes radiation sickness. Rationale 4: Nuclear detonation causes thermal burns. Global Rationale: Inhalation anthrax carries the highest mortality rate among biologic weapons. The patient initially exhibits influenza-like symptoms such as fever, nonproductive cough, headache, and malaise that advance to respiratory distress, mediastinal widening, and hemodynamic collapse in 3 to 5 days. Death may occur shortly thereafter. Untreated patients die in 2 to 3 days. Smallpox spreads by direct contact or by inhalation of respiratory droplets. Symptoms include a high fever, headache, and malaise, followed by a vesicular/pustular rash appearing simultaneously on the face and extremities. A dirty bomb causes radiation sickness. Nuclear detonation causes thermal burns.

The nurse is caring for a patient with injuries received in an earthquake. Which type of incident should the nurse identify as causing this patient's injuries? 1. natural disaster 2. human-generated disaster 3. emergency 4. multiple-casualty incident

Correct Answer: 1 Rationale 1: Natural disasters are caused by acts of nature and may be predictable, through advanced meteorological technologies, or unexpected. An earthquake is an example of a natural disaster. Rationale 2: A human-generated disaster can be either accidental or intentional. An example of a human-generated disaster is war or biological warfare. Rationale 3: An emergency can generally be handled within the emergency management system. Rationale 4: A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. Global Rationale: Natural disasters are caused by acts of nature and may be predictable through advanced meteorological technologies or unexpected. An earthquake is an example of a natural disaster. A human-generated disaster can be either accidental or intention. An example of a human-generated disaster is war or biological warfare. An emergency can generally be handled within the emergency management system. A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care.

The care area has been alerted to a possible illness associated with the tainting of a popular over-the-counter pain reliever. The nurse realizes the tainting of this product is what kind of event? 1. a nonconventional terrorist attack 2. a conventional terrorist attack 3. an accidental disaster 4. a natural disaster

Correct Answer: 1 Rationale 1: Nonconventional terrorism uses chemical, biological, and nuclear means to release a toxin, contaminate a food source, or contaminate some other product. Rationale 2: This would not be classified as a conventional type of terrorist attack. Rationale 3: This would not be classified as an accidental disaster. Rationale 4: This would not be classified as a natural disaster. Global Rationale: Nonconventional terrorism uses chemical, biological, and nuclear means to release a toxin, contaminate a food source, or contaminate some other product. This would not be classified as a disaster or a conventional type of terrorist attack.

The nurse is planning a program to address disaster mitigation activities in the community. What should the nurse consult when preparing this program? 1. community disaster preparedness plan 2. hospital administrators 3. physicians with practices in the community 4. schools and day care centers

Correct Answer: 1 Rationale 1: One role of the nurse in disaster planning is to prepare self, families, friends, and communities for disasters in conjunction with the local disaster preparedness plan. Rationale 2: The nurse does not need to consult hospital administrators when planning this program. Rationale 3: The nurse does not need to consult physicians when planning this program. Rationale 4: The nurse does not need to consult schools and day care centers when planning this program. Global Rationale: One role of the nurse in disaster planning is to prepare self, families, friends, and communities for disasters in conjunction with the local disaster preparedness plan. The nurse does not need to consult hospital administrators, physicians, or schools and day care centers when planning this program.

A local hospital has coordinated with the county emergency management team to plan and conduct disaster drills on a monthly basis. In which phase of disaster management planning is this hospital functioning? 1. Preparedness 2. Mitigation 3. Response 4. Evaluation

Correct Answer: 1 Rationale 1: Preparedness refers to proactive planning and preparation while the threat of a disaster is still in the future. Efforts are aimed at developing a disaster response prior to occurrence. Rationale 2: The mitigation phase occurs when there is knowledge about an impending disaster that has not yet occurred and includes measures to reduce the harmful effects. Activities during this stage include warning, pre-impact mobilization, and evacuation if appropriate. Rationale 3: The response phase involves the immediate response to the effects of the disaster. Rationale 4: The final stage of recovery is the evaluation phase, which involves determining what worked and what did not work, and what anticipated and unanticipated issues and challenges emerged. Global Rationale: Preparedness refers to proactive planning and preparation while the threat of a disaster is still in the future. Efforts are aimed at developing a disaster response prior to occurrence. The mitigation phase occurs when there is knowledge about an impending disaster that has not yet occurred and includes measures to reduce the harmful effects. Activities during this stage include warning, pre-impact mobilization, and evacuation if appropriate. The response phase involves the immediate response to the effects of the disaster. The final stage of recovery is the evaluation phase, which involves determining what worked and what did not work, and what anticipated and unanticipated issues and challenges emerged.

The nurse is caring for patients when a dirty bomb detonates at a nearby shopping mall. Which types of injuries should the nurse expect to see in the victims? 1. radiation sickness 2. fractured limbs and spinal injury 3. thermal burns 4. overexertion and exhaustion

Correct Answer: 1 Rationale 1: Radiation sickness commonly occurs with a radiological dispersion bomb or dirty bomb blast. Rationale 2: Fractured limbs and spinal injury can occur with blunt trauma. Rationale 3: Thermal burns occur with nuclear detonation. Rationale 4: Overexertion and exhaustion occur in other types of injuries, such as snowstorm-related injuries. Global Rationale: Radiation sickness commonly occurs with a radiological dispersion bomb or dirty bomb blast. Fractured limbs and spinal injury can occur with blunt trauma. Thermal burns occur with nuclear detonation. Overexertion and exhaustion occur in other types of injuries, such as snowstorm-related injuries.

A serious highway accident on a foggy night involves 22 vehicles. Several of the victims are ambulatory. The emergency personnel determine that their injuries are minor and arrange for transportation home. Why are these victims triaged first? 1. To do the greatest good for the greatest number of people 2. To remove them so they do not see the critically injured victims 3. To secure the site in case the vehicles become overheated and ignite 4. To improve traffic conditions to clear the accident site quickly

Correct Answer: 1 Rationale 1: Reverse triage works on the principle of the greatest good for the greatest number of people. Rationale 2: Because these victims are ambulatory, with minor injuries, emergency personnel arrange for them to be transported home and away from the scene of the accident. The purpose of reverse triage is not to prevent them from seeing critically injured victims. Rationale 3: The purpose of reverse triage is not to secure the accident site. Rationale 4: The purpose of reverse triage is not to improve traffic conditions. Global Rationale: Reverse triage works on the principle of the greatest good for the greatest number of people. Because victims are ambulatory, with minor injuries, emergency personnel arrange for them to be transported home and away from the scene of the accident. The purpose of reverse triage is not to prevent them from seeing critically injured victims, to secure the accident site, or improve traffic conditions.

Emergency response personnel arrive at the site of a collapsed building. Some victims are walking away from the building, while others are lying on the ground around the perimeter. If implementing reverse triage, what should the emergency personnel do first? 1. Identify one safe location for all ambulatory victims to be assessed and observed. 2. Systematically assess each victim lying on the ground and assign a color. 3. Enter the building to locate other victims who might not have been able to leave before the collapse. 4. Transfer the victims on the ground to stretchers and send them to the local emergency department.

Correct Answer: 1 Rationale 1: Reverse triage works on the principle of the greatest good for the greatest number of people. The emergency personnel should first identify one safe location for all ambulatory victims to be assessed and observed. Rationale 2: Systematically assessing the victims on the ground and assigning colors is not following the principle of reverse triage. Rationale 3: Entering the building to locate other victims would be done after all victims who are ambulatory or on the ground are assessed and treated. Rationale 4: Transferring victims on the ground to stretchers and sending them to local emergency departments is done after systematic assessment. Global Rationale: Reverse triage works on the principle of the greatest good for the greatest number of people. The emergency personnel should first identify one safe location for all ambulatory victims to be assessed and observed. Systematically assessing the victims on the ground and assigning colors is not following the principle of reverse triage. Entering the building to locate other victims would be done after all victims who are ambulatory or on the ground are assessed and treated. Transferring victims on the ground to stretches and sending them to local emergency departments is done after systematic assessment.

A patient is brought into the emergency department complaining of blindness after an explosion at an atomic power plant. What should the nurse explain to this patient? 1. "The effects of the blast will disappear with time." 2. "I'm afraid the blast has caused permanent blindness." 3. "I will contact Social Services so that resources can be identified to help you with your disability." 4. "There is a variety of resources available for those who are unable to see."

Correct Answer: 1 Rationale 1: The bright flash of a nuclear detonation can cause temporary blindness, but vision returns in up to 30 minutes. The patient may need assistance until vision is restored. The nurse should explain that the effects of the blast will disappear with time. Rationale 2: The nurse should not say that the patient is permanently blind. Rationale 3: The nurse does not need to contact social services at this time for the patient's temporary blindness. Rationale 4: Suggesting resources for the vision-impaired is premature, as the blindness is temporary. Global Rationale: The bright flash of a nuclear detonation can cause temporary blindness, but vision returns in up to 30 minutes. The patient may need assistance until vision is restored. The nurse should explain that the effects of the blast will disappear with time. The nurse should not say that the patient is permanently blind. The nurse does not need to contact social services at this time for the patient's temporary blindness. Suggesting resources for the vision-impaired is premature, as the blindness is temporary.

The nurse is assessing victims of a building collapse. Ambulances are nearby and a shelter has been set up with carts, chairs, tables, and refreshments for the victims. The nurse is most likely working within which decontamination zone? 1. cold 2. warm 3. control 4. hot

Correct Answer: 1 Rationale 1: The cold zone is considered the safe zone. It is adjacent to the warm zone and is the area where a more in-depth triage of victims would occur. Survivors may find shelter in this area, and the command and control vehicles as well as emergency transport vehicles would be found here. Rationale 2: The warm zone is adjacent to the hot zone. This is where decontamination of victims or triage and emergency treatment take place. Rationale 3: Another name for the warm zone is the control zone. This is where decontamination of victims or triage and emergency treatment take place. Rationale 4: The site where a weapon was released or contamination occurred is called the hot zone. It is considered to be contaminated, and only those persons in the appropriate personal protective equipment may enter this zone. Global Rationale: The cold zone is considered the safe zone. It is adjacent to the warm zone and is the area where a more in-depth triage of victims would occur. Survivors may find shelter in this area, and the command and control vehicles as well as emergency transport vehicles would be found here. The warm zone is adjacent to the hot zone. This is where decontamination of victims or triage and emergency treatment take place. The site where a weapon was released or contamination occurred is called the hot zone. It is considered to be contaminated, and only those persons in the appropriate personal protective equipment may enter this zone.

A train derailed in a local community. The contents of the train caused a hazardous spill, and noxious gasses are being released into the environment. All local and surrounding fire control and Hazmat teams have been mobilized and the event is considered under control. Which type of situation should the nurse prepare for? 1. emergency 2. disaster 3. human-generated accidental disaster 4. intentional emergency

Correct Answer: 1 Rationale 1: The difference between an emergency and a disaster is that an emergency can be handled by the management systems in place. Because the fire and Hazmat teams handled the event, it is considered an emergency. Rationale 2: A disaster would overwhelm the management systems in place. Rationale 3: Because the management systems in place were able to handle the event, this is not a disaster. Rationale 4: Intentional emergency is not a classification used for these types of event. Global Rationale: The difference between an emergency and a disaster is that an emergency can be handled by the management systems in place. Because the fire and Hazmat teams handled the event, it is considered an emergency rather than a disaster. A disaster would overwhelm the management systems in place. Intentional emergency is not a classification used for these types of event.

A group of nurses are attending a meeting to discuss the outcome and results of care provided to victims of a recent building collapse. In which phase of the disaster planning process are the nurses participating? 1. evaluation 2. recovery 3. restoration 4. response

Correct Answer: 1 Rationale 1: The final stage of recovery is evaluation, which is also an activity in the preparation and planning aspects of the nondisaster stage. Future-oriented activities take place to prevent subsequent disasters or to minimize their effects. Nurses participate by discussing suggestions to improve the response time to victims or ways to improve treatment. Rationale 2: The recovery aspect of disaster response, also called reconstruction, involves rebuilding and returning to some semblance of normalcy. Rationale 3: Restoration includes rebuilding, replacing lost or damaged property, returning to school and work, and continuing life without those who were killed in the disaster. Rationale 4: The response phase involves the immediate response to the disaster. Global Rationale: The final stage of recovery is evaluation, which is also an activity in the preparation and planning aspects of the nondisaster stage. Future-oriented activities take place to prevent subsequent disasters or to minimize their effects. Nurses participate by discussing suggestions to improve the response time to victims or ways to improve treatment. The recovery aspect of disaster response is also called reconstruction. The response phase involves the immediate response to the disaster. The recovery and reconstruction phase involves rebuilding and returning to some semblance of normalcy.

The nurse is admitting the second patient in 2 days who is experiencing malaise, high fever, and headache. Both patients attended a local air show the previous weekend. What should the nurse do? 1. Discuss the need to contact public health authorities regarding the similarity of the cases. 2. Plan to place the patients in the same room. 3. Ask the patients for permission to talk with family members regarding other symptoms. 4. Assess the patients for what foods they ate while at the air show.

Correct Answer: 1 Rationale 1: The nurse should be alert to illness patterns that could indicate an unusual infectious disease outbreak. Indicators of a biologic agent release include an increased disease incidence among people who attended the same event. The presence of one or more indicators should be reported to public health authorities to determine the source of the infectious disease and prevent further exposure. Rationale 2: Placing the patients in the same room may or may not be appropriate. Rationale 3: The family members of the patients do not need to be assessed at this time. Rationale 4: The foods ingested during the air show may not provide enough information about the patients' exposure. Global Rationale: The nurse should be alert to illness patterns that could indicate an unusual infectious disease outbreak. Indicators of a biologic agent release include an increased disease incidence among people who attended the same event. The presence of one or more indicators should be reported to public health authorities to determine the source of the infectious disease and prevent further exposure. Placing the patients in the same room may or may not be appropriate. The family members of the patients do not need to be assessed at this time. The foods ingested during the air show may not provide enough information about the patients' exposure. The nurse should contact public health authorities.

The nurse is caring for a patient who experienced a blast injury to the eye. Which intervention would be appropriate? 1. Flush the eye with eyewash. 2. Encourage the patient to rub the eye to get out specks of dust. 3. Apply a warm compress to the eye. 4. Remove debris lodged in the eye.

Correct Answer: 1 Rationale 1: The nurse should flush the patient's eye with eyewash. Rationale 2: The patient should be cautioned not to rub the eye that has specks of dust or debris in it. Rationale 3: A cool compress and not a warm compress should be applied to the eye. Rationale 4: Debris lodged in the eye should be stabilized and not removed without medical attention. Global Rationale: The nurse should flush the patient's eye with eyewash. The patient should be cautioned not to rub the eye that has specks of dust or debris in it. A cool, not warm, compress should be applied to the eye. Debris lodged in the eye should be stabilized, not removed without medical attention.

The nurse is presenting a program to residents of a local senior citizen housing facility about preparations in the event of a disaster. What should the nurse instruct the participants to do regarding essential preparations? 1. Have a list of medications, emergency contact numbers, and necessary survival items readily available. 2. Turn off all electrical devices before leaving the premises. 3. Pack enough nonperishable food items to last for several days. 4. Bring recreational items such as puzzles and card games for entertainment.

Correct Answer: 1 Rationale 1: The nurse should instruct older adults to prepare a current list of medications, doses, and times of administration. The names and phone numbers of significant persons, relatives, those with power of attorney, healthcare providers, and any others to be notified in case of emergency should also be kept in an easily accessible place. Additionally, the following materials should be considered essential should evacuation to a shelter be necessary: eyeglasses and eyeglass prescriptions, style and serial numbers of medical devices such as pacemakers, healthcare policies and numbers, identification, list of allergies, blood type, checkbook, credit cards, insurance agent's name and number, driver's license, 72-hour supply of medications, dentures, list of special dietary needs, sturdy shoes, warm clothing, blankets, incontinence briefs, prostheses, hearing aids, hearing aid batteries, extra wheelchair batteries, oxygen, and other assistive devices. Rationale 2: The residents of a senior facility do not need to be concerned with turning off electrical devices. Rationale 3: The residents of a senior facility do not need to be concerned with packing food items. Rationale 4: Recreational items are not considered survival items. Global Rationale: The nurse should instruct older adults to prepare a current list of medications, doses, and times of administration. The names and phone numbers of significant persons, relatives, those with power of attorney, healthcare providers, and any others to be notified in case of emergency should also be kept in an easily accessible place. Additionally, the following materials should be considered essential should evacuation to a shelter be necessary: eyeglasses and eyeglass prescriptions, style and serial numbers of medical devices such as pacemakers, healthcare policies and numbers, identification, list of allergies, blood type, checkbook, credit cards, insurance agent's name and number, driver's license, 72-hour supply of medications, dentures, list of special dietary needs, sturdy shoes, warm clothing, blankets, incontinence briefs, prostheses, hearing aids, hearing aid batteries, extra wheelchair batteries, oxygen, and other assistive devices. The residents of a senior facility do not need to be concerned with turning off electrical devices or packing food items. Recreational items are not considered survival items.

A victim of a chemical plant explosion is unconscious and brought into the emergency department. For what should the nurse assess this patient? 1. central nervous system injury 2. respiratory system injury 3. pulmonary emboli 4. radiation sickness

Correct Answer: 1 Rationale 1: The patient who is unconscious after an explosion should be further assessed for concussion, closed and open brain injury, stroke, spinal cord injury, or air embolism-induced injury. Rationale 2: Respiratory system injuries would manifest as hemothorax, pneumothorax, or pulmonary contusion and hemorrhage. Rationale 3: Pulmonary emboli can occur with respiratory or cardiac system injuries. Rationale 4: Evidence of radiation sickness includes nausea, diarrhea, and malaise. Global Rationale: The patient who is unconscious after an explosion should be further assessed for a concussion, closed and open brain injury, stroke, spinal cord injury, or air embolism-induced injury. Respiratory system injuries would manifest as hemothorax, pneumothorax, or pulmonary contusion and hemorrhage. Pulmonary emboli can occur with respiratory or cardiac system injuries. Evidence of radiation sickness includes nausea, diarrhea, and malaise.

Emergency response personnel are wearing gowns, gloves, goggles, and masks. In which decontamination zone are these personnel most likely working? 1. hot 2. warm 3. cold 4. yellow

Correct Answer: 1 Rationale 1: The site of the disaster where a weapon was released or where contamination occurred is called the hot zone. It is considered contaminated, and only those persons in the appropriate personal protective equipment may enter this zone. This equipment includes gloves, masks, goggles, gowns, and biologic disposal bags. Rationale 2: The warm zone is adjacent to the hot zone. This area is where decontamination of victims or triage and emergency treatment take place. The level of personal protective equipment required is based on the dynamic risk assessment of the threat and the agent involved. Rationale 3: The cold zone is considered the safe zone. It is adjacent to the warm zone and is the area where a more in-depth triage of victims would occur. Personal protective equipment needs are minimal in this zone. Rationale 4: There is no yellow decontamination zone. Global Rationale: The site of the disaster where a weapon was released or where contamination occurred is called the hot zone. It is considered contaminated, and only those persons in the appropriate personal protective equipment may enter this zone. This equipment includes gloves, masks, goggles, gowns, and biologic disposal bags. The warm zone is adjacent to the hot zone. This area is where decontamination of victims or triage and emergency treatment take place. The level of personal protective equipment required is based on the dynamic risk assessment of the threat and the agent involved. The cold zone is considered the safe zone. It is adjacent to the warm zone and is the area where a more in-depth triage of victims would occur. Personal protective equipment needs are minimal in this zone. There is no yellow decontamination zone.

The nurse arrives at the site of a bombed building. When preparing to triage victims, in which zone should the nurse conduct decontamination? 1. warm 2. hot 3. cold 4. green

Correct Answer: 1 Rationale 1: The warm zone, or control zone, is adjacent to the hot zone. This is where the decontamination of victims or triage and emergency treatment takes place. Rationale 2: The site where a weapon was released or where contamination occurred is called the hot zone. It is considered to be contaminated, and only those persons in the appropriate personal protective equipment may enter this zone. Rationale 3: The cold zone is considered the safe zone. Rationale 4: There is no green zone when working with decontamination. Global Rationale: The warm zone, or control zone, is adjacent to the hot zone. This is where the decontamination of victims or triage and emergency treatment takes place. The site where a weapon was released or where contamination occurred is called the hot zone. It is considered to be contaminated, and only those persons in the appropriate personal protective equipment may enter this zone. The cold zone is considered the safe zone. There is no green zone when working with decontamination.

Emergency medical personnel are at the scene of a mass casualty incident. What information should personnel document about each victim? Standard Text: Select all that apply. 1. Name and injuries 2. Medication history 3. Interventions performed 4. Allergies 5. Name of next of kin

Correct Answer: 1, 2, 3, 4 Rationale 1: Emergency medical systems (EMS) use a common triage tag state- or region-wide. The triage tag includes a sequential number and barcoded stickers for assigned categories. The triage personnel should include whatever information is available, such as the patient's name and presenting injury or complaint. Rationale 2: Emergency medical systems (EMS) use a common triage tag state- or region-wide. The triage tag includes a sequential number and barcoded stickers for assigned categories. The triage personnel should include whatever information is available, such as medication history. Rationale 3: Emergency medical systems (EMS) use a common triage tag state- or region-wide. The triage tag includes a sequential number and barcoded stickers for assigned categories. The triage personnel should include whatever information is available, such as any interventions performed in the field. Rationale 4: Emergency medical systems (EMS) use a common triage tag state- or region-wide. The triage tag includes a sequential number and barcoded stickers for assigned categories. The triage personnel should include whatever information is available, such as allergies. Rationale 5: The next of kin is not identified or documented for each victim of a mass casualty incident. Global Rationale: Emergency medical systems (EMS) use a common triage tag state- or region-wide. The triage tag includes a sequential number and barcoded stickers for assigned categories. The triage personnel should include whatever information is available, such as the patient's name, presenting injury or complaint, any interventions performed in the field, and allergy and medication history if possible. The next of kin is not identified or documented for each victim of a mass casualty incident.

Two school buses carrying 75 children each collide en route to an out-of-state field trip. The emergency department nurse knows that reverse triage will need to be instituted. What principles should the nurse follow when implementing reverse triage? Standard Text: Select all that apply. 1. When there is a mass casualty event with more than 100 victims, reverse triage may be instituted. 2. Reverse triage works on the principle of the greatest good for the greatest number. 3. A very basic reverse triage system is to categorize or label victims needing the most support and emergency care as red, so they can be treated first. 4. Victims most likely to survive are color-coded black, and are treated first. 5. Reverse triage works on the principle of the greatest good for the most critically ill.

Correct Answer: 1,2 Rationale 1: This is a principle of reverse triage. Rationale 2: This is a principle of reverse triage. Rationale 3: This is a principle of basic triage. Rationale 4: Victims who are color-coded black are not likely to survive. Rationale 5: Basic triage works on the principle of the greatest good for the most critically ill. Global Rationale: When there is a mass casualty event with more than 100 patients, reverse triage may be instituted. Reverse triage works on the principle of the greatest good for the greatest number. Labeling victims needing the most support and emergency care as red so they can be treated first is a principle of basic triage. Victims who are color-coded black are not likely to survive. Basic triage works on the principle of the greatest good for the most critically ill.

1. Patients present with symptoms of a rare disease. 2. The disease pattern is inconsistent with the age of the patient. 3. Multiple patients are presenting with viral-like symptoms. 4. The patients are all coming from the same geographic area. 5. Patients are all over the age of 39, indicating a smallpox exposure.

Correct Answer: 1,2,4 Rationale 1: Indicators of a biological agent release include patients presenting with symptoms of a rare disease. Rationale 2: Indicators of a biological agent release include a disease pattern inconsistent with the patient's age, such as chickenpox among adults. Rationale 3: Multiple people presenting with viral-like symptoms may merely be associated with normal exposure to a highly contagious virus. Rationale 4: An indicator of a biological agent release is increased disease incidence among people in the same geographical area. Rationale 5: If all the patients are over 39 years old, this does not necessarily indicate exposure to smallpox. The patients should be assessed for the clinical manifestations associated with smallpox. Children and young adults are equally susceptible to smallpox. Global Rationale: Healthcare providers should be alert to illness patterns that could indicate an unusual infectious disease outbreak. Indicators of a biological agent release include increased disease incidence among people in the same geographical area (e.g., people who attended the same event); a disease pattern inconsistent with patients' age, such as chickenpox among adults; and patient presenting with symptoms of a rare disease. In these cases, the nurse should notify the chain of command including the infectious disease nurse. Multiple people presenting with viral-like symptoms may merely be associated with normal exposure to a highly contagious virus. If all the patients are over 39 years old, this does not necessarily indicate exposure to smallpox. The patients should be assessed for the clinical manifestations associated with smallpox. Children and young adults are equally susceptible to smallpox.

The nurse is planning to attend a program to learn how to respond to mass casualty incidents. Which core competencies should the nurse expect to learn during this program? Standard Text: Select all that apply. 1. risk reduction, disease prevention, and health promotion 2. nursing process 3. policy development and planning 4. community care 5. ethical and legal practice

Correct Answer: 1,3,4,5 Rationale 1: Disaster nursing competencies include risk reduction, disease prevention, and health promotion. Rationale 2: The nursing process is not considered a core competency for disaster nursing. Rationale 3: Disaster nursing competencies include policy development and planning. Rationale 4: Disaster nursing competencies include community care. Rationale 5: Disaster nursing competencies include ethical and legal practice. Global Rationale: Disaster nursing competencies include risk reduction, disease prevention, and health promotion; policy development and planning; community care; and ethical and legal practice. The nursing process is not considered a core competency for disaster nursing.

The emergency department nurses are noting an unusually high number of patients coming in with complaints of nausea, vomiting, and severe headache. What should be done with this information? 1. No further action is needed at this time. 2. Contact the Infection Control Department and Laboratory Medicine. 3. Close the emergency department. 4. Call for more staffing to handle all the patients.

Correct Answer: 2 Rationale 1: Many people must be alerted at this time. Rationale 2: Healthcare providers must be alert when there is a change in the trend of symptoms within patients. The infection control nurse should be contacted. Laboratory medicine will run tests on specimens that would otherwise be discarded. The public health department is also contacted with this information. Rationale 3: Closing the emergency department would not be necessary. Rationale 4: Staffing may need to be adjusted based on the number or acuity of patients, not just a trend in symptoms. Global Rationale: Healthcare providers must be alert when there is a change in the trend of symptoms within patients. The infection control nurse should be contacted. Laboratory medicine will run tests on specimens that would otherwise be discarded. The public health department is also contacted with this information. Closing the emergency department would not be necessary. Staffing may need to be adjusted based on the number or acuity of patients, not just a trend in symptoms.

The community is holding a memorial service to honor members whose lives were lost in a flood one year ago. In which stage of the disaster recovery process is this community? 1. restoration 2. reconstitution 3. mitigation 4. disaster reflection

Correct Answer: 2 Rationale 1: Restoration is a recovery stage in which rebuilding takes place. Rationale 2: Reconstitution occurs when the life of the community returns to a "new" normal. Rationale 3: Mitigation activities focus on the prevention or reduction of the harmful effects of a disaster. Rationale 4: Disaster reflection is a recall of the events that have taken place. Global Rationale: Reconstitution occurs when the life of the community returns to a "new" normal. Restoration is a recovery stage in which rebuilding takes place. Mitigation activities focus on the prevention or reduction of the harmful effects of a disaster. Disaster reflection is a recall of the events that have taken place.

A patient comes into the clinic with the onset of itching after opening a letter received about a week ago that contained "quite a bit of white powder." It is suspected that this patient has had an anthrax exposure. Which medication can the nurse anticipate will most likely be prescribed for this patient? 1. normal saline solution flush to the skin 2. ciprofloxacin (Cipro) 3. acetaminophen 4. Solu-Medrol

Correct Answer: 2 Rationale 1: The exposure has already taken place. There is no purpose in cleaning the skin with normal saline. Rationale 2: On confirmation of anthrax exposure, prophylaxis is initiated with oral ciprofloxacin (Cipro) or doxycycline (Doxycin) for 60 to100 days. Rationale 3: Acetaminophen is used as an antipyretic and analgesic. Rationale 4: Solu-Medrol is used to manage allergic reactions and respiratory conditions. Global Rationale: On confirmation of anthrax exposure, prophylaxis is initiated with oral ciprofloxacin (Cipro) or doxycycline (Doxycin) for 60 to100 days. The exposure has already taken place. There is no purpose in cleaning the skin with normal saline. Acetaminophen is used as an antipyretic and analgesic. Solu-Medrol is used to manage allergic reactions and respiratory conditions.

A community hospital has been notified of a plane crash that occurred during a local air show. Which information will the hospital leadership need to prepare for the crash victims? Standard Text: Select all that apply. 1. Number of families who live in the community 2. Number of available beds in the hospital 3. Telephone list of staff to be called in to work immediately 4. Amount of intravenous fluids and emergency medications 5. List of current patients who can be immediately discharged

Correct Answer: 2, 3, 4, 5 Rationale 1: Knowing the number of families who live in the community will not help with planning for the victims of this disaster. Rationale 2: Hospitals must be constantly aware of the number of beds available. Rationale 3: Hospitals must be constantly aware of staffing. Rationale 4: Hospitals must be constantly aware of equipment and medications on hand. Rationale 5: Hospitals must be constantly aware of which patients may be discharged. Global Rationale: Hospitals must be constantly aware of the number of beds available, which patients may be discharged, staffing, equipment, other resources, and their overall ability to manage casualties quickly. Knowing the number of families who live in the community will not help with planning for the victims of this disaster.

The nurse notes that a large number of community members with diabetes have experienced insufficient glucose control and cold symptoms since a tornado ripped through the area a few weeks ago. What should the nurse consider as the cause for these symptoms? Standard Text: Select all that apply. 1. Blood stasis in extremities 2. Hindered immune response 3. Change in basal metabolic rate 4. Paralysis of gastrointestinal tract 5. Alteration in nutrient metabolism

Correct Answer: 2, 3, 5 Rationale 1: Blood pooling in extremities leads to thrombus formation. Rationale 2: In response to stress, the immune response is suppressed, leading to the onset of infections. Rationale 3: In response to stress, the basal metabolic rate changes, which alters protein, carbohydrate, and lipid metabolism. Rationale 4: Paralysis of gastrointestinal tract function affects elimination. Rationale 5: In response to stress, the basal metabolic rate changes, altering protein, carbohydrate, and lipid metabolism. Global Rationale: In response to stress, the basal metabolic rate changes, altering protein, carbohydrate, and lipid metabolism. The immune response is suppressed, leading to the onset of infections. Blood pooling in extremities leads to thrombus formation. Paralysis of gastrointestinal tract function affects elimination.

The administrator of a multihospital healthcare system contacts the National Response Framework (NRF) for help with managing care for victims of a flood. What assistance should the administrator expect to receive from this organization? Standard Text: Select all that apply. 1. Standing orders used when caring for victims of a flood 2. Information about local relief agencies available to assist 3. Frequency in which the area has flooded over the last 10 years 4. Amount of time a flood victim can withstand submersion in cold water 5. Names of organizations within the private sector who can help the victims

Correct Answer: 2, 5 Rationale 1: The NRF does not supply specific information about caring for victims of emergencies or disasters. Rationale 2: The NRF is a national effort designed to integrate resources of the local, state, and federal governments and includes voluntary relief agencies, the private sector, and international resources if needed to provide assistance to communities following natural or human-generated disasters. Rationale 3: The NRF does not supply statistics about disasters. Rationale 4: The NRF does not supply specific information about caring for victims of emergencies or disasters. Rationale 5: The NRF a national effort designed to integrate resources of the local, state, and federal governments and includes voluntary relief agencies, the private sector, and international resources if needed to provide assistance to communities following natural or human-generated disasters. Global Rationale: The NRF is a national effort designed to integrate resources of the local, state, and federal governments and includes voluntary relief agencies, the private sector, and international resources if needed to provide assistance to communities following natural or human-generated disasters. The NRF does not supply statistics about disasters or specific information about caring for victims of emergencies or disasters.

A series of thunderstorms ripped through a small town, causing massive power outages. The community nurse is reviewing the list of community members who might be adversely affected by the loss of power. For which residents should the nurse provide immediate care and support? Standard Text: Select all that apply. 1. 16-year-old male with asthma 2. 75-year-old male with sleep apnea 3. 72-year-old male with a pacemaker 4. 45-year-old female with multiple sclerosis 5. 86-year-old female who requires continuous oxygen 2 liters nasal cannula

Correct Answer: 2, 5 Rationale 1: The child with asthma will most likely not need additional support at this time. Rationale 2: The patient with sleep apnea might not be able to use the equipment without electricity. The nurse should provide care and support to this patient. Rationale 3: The patient with a pacemaker most likely will not need emergency support at this time. Rationale 4: The patient with multiple sclerosis most likely will not need emergency support at this time. Rationale 5: The patient who requires continuous oxygen will need immediate support because the oxygen concentrator needs electricity to run. Global Rationale: One role of the nurse in a disaster is to provide emergency services with consideration of victims' abilities, deficits, culture, language, or special needs. The patient needing continuous oxygen and the patient with sleep apnea will need immediate care and support in a power outage. The other patients have no identified needs impacted by the loss of electricity.

Utilizing the simple triage and rapid transport (START) system, in what order should the nurse prioritize the following patients? Standard Text: Click and drag the options below to move them up or down. Choice 1. A 67-year-old male complaining of chest pain. His heart rate is 120 beats/minute, his blood pressure is 100/68 mmHg, and his respiratory rate is 20 breaths/min. Choice 2. A 27-year-old woman presenting with a respiratory rate of 36 breaths/min and capillary refill of 4 seconds. Choice 3. A 58-year-old woman who is able to walk on her own and states over and over, "I don't know what happened." Choice 4. A 30-year-old male with a collapsed airway and multiple chest trauma. He does not have a palpable carotid pulse and the nurse is unable to assess respiratory movement.

Correct Answer: 2,1,3,4 Rationale 1: Those patients who are in less critical condition but still need to be transported to emergency centers for care are classified as yellow. These patients will require some medical attention but will not die if care is delayed. Their respiratory status is stable and they can follow simple commands. Rationale 2: Patients whose respiratory rate is above 30 and capillary refill is greater than 2 seconds should be tagged red and have first priority of care. Rationale 3: Patients who have minor injuries and do not warrant transport to an emergency center are categorized as green. They can walk and take care of themselves. Rationale 4: Patients who are least likely to survive or are already deceased are color coded as black. This category would include patients who are not breathing and remain apneic even after the airway is manually opened. Global Rationale: Triage means sorting. A very basic triage system is to categorize or label patients requiring the most support and emergency care as red. Patients whose respiratory rate is above 30 and capillary refill is greater than 2 seconds should be tagged red and have first priority of care. Those patients who are in less critical condition but still need to be transported to emergency centers for care are classified as yellow. These patients will require some medical attention but will not die if care is delayed. Their respiratory status is stable and they can follow simple commands. Patients who have minor injuries and do not warrant transport to an emergency center are categorized as green. They can walk and take care of themselves. Patients who are least likely to survive or are already deceased are color coded as black. This category would include patients who are not breathing and remain apneic even after the airway is manually opened.

The nurse is planning the coding for a triage disaster plan. Which colors should the nurse use for this plan? Standard Text: Select all that apply. 1. white 2. red 3. yellow 4. black

Correct Answer: 2,3,4,5 Rationale 1: The color white is not used in triage systems. Rationale 2: Red is one of the four basic colors used in triage systems. Red is considered critical. Rationale 3: Yellow is one of the four basic colors used in triage systems. Yellow indicates a victim who is stable but still needs attention at a hospital. Rationale 4: Black is one of the four basic colors used in triage systems. It represents a victim who has died or is unlikely to survive. Rationale 5: Green is one of the four basic colors used in triage systems. It indicates minor injuries. Global Rationale: The four basic colors used in triage systems are red, yellow, green, and black. Red is considered critical, yellow is stable but still needs attention at a hospital, green indicates minor injuries, and black represents a victim who has died or is unlikely to survive. The color white is not used in triage systems.

A mass casualty accident has occurred. The nurse in the emergency department receives a patient who is coded red. What care should the nurse prepare to provide to this patient? 1. Send the patient home. 2. Evaluate the patient in the next few hours. 3. Immediately evaluate this patient. 4. Permit the family to be with the patient as death approaches.

Correct Answer: 3 Rationale 1: Green coding means home care would be sufficient. Rationale 2: Yellow means that the patient can be evaluated within a few hours. Rationale 3: Red means the patient needs life-saving intervention. Rationale 4: Black means the patient will most likely die from the injuries. Global Rationale: Green means home care would be sufficient. Yellow means that the patient can be evaluated within a few hours. Red means the patient needs life-saving intervention. Black means the patient will most likely die from the injuries.

A patient says to the nurse, "I'm scared about a terrorist attack because I live so close to the airport." What should the nurse respond to the patient? 1. "Have you thought about moving?" 2. "That's silly to be so worried." 3. "What do you have in your home to help you in the event of a terrorist attack?" 4. "I would be concerned, too."

Correct Answer: 3 Rationale 1: Moving because of this fear is not realistic, and the suggestion does little to assist the patient at this time. Rationale 2: The nurse should not discount the patient's fears. Rationale 3: The general public looks to nurses for information and trusts that what the nurse advises is true and accurate. The nurse should ask the patient what he or she has prepared in the home should there be a terrorist attack. Rationale 4: The nurse should not compound the patient's fears. Global Rationale: The general public looks to nurses for information and trusts that what the nurse advises is true and accurate. The nurse should ask the patient what he or she has prepared in the home should there be a terrorist attack. The nurse should not discount the patient's fears or compound those fears. Moving because of this fear is not realistic, and the suggestion does little to assist the patient at this time.

The hospital has been notified of a subway derailment involving approximately 250 passengers. Many of the passengers are reported to be injured. For which type of situation should the emergency department manager prepare? 1. a natural disaster 2. a multiple-casualty incident 3. a mass-casualty incident 4. an accidental disaster

Correct Answer: 3 Rationale 1: Natural disasters are caused by acts of nature or emerging diseases. Rationale 2: A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. Rationale 3: A mass-casualty incident occurs quickly and suddenly and overwhelms local resources with many seriously ill or injured victims needing care. Rationale 4: An accidental disaster is human-generated. Global Rationale: A mass-casualty incident occurs quickly and suddenly and overwhelms local resources with many seriously ill or injured victims needing care. Natural disasters are caused by acts of nature or emerging diseases. A multiple-casualty event does not exceed the capacity of local resources to provide needed medical care. An accidental disaster is human-generated.

An older patient asks the nurse, "What can we do to be prepared if there's a disaster in our community?" How should the nurse respond? 1. "There is not really much we can do to be prepared." 2. "Plan to evacuate your home at a moment's notice." 3. "Make sure all your important papers, health information, medication information, and next-of-kin information is in one place." 4. "Make sure you can call your family to come and pick you up if this happens."

Correct Answer: 3 Rationale 1: Planning can significantly reduce adverse outcomes in the event of a disaster. Rationale 2: Not all disasters require immediate evacuation from the home. Rationale 3: The nurse should suggest this patient be prepared. One step is to have a current list of medications, doses, and times of administration that should be kept in an easily accessible, secure place. The names and phone numbers of significant persons, relatives, those with power of attorney, healthcare providers, and any others to be notified in case of emergency should also be kept in an easily accessible place. Rationale 4: Phone communication may not be possible during the initial phases of a disaster. Global Rationale: The nurse should suggest this patient be prepared. One step is to have a current list of medications, doses, and times of administration that should be kept in an easily-accessible, secure place. The names and phone numbers of significant persons, relatives, those with power of attorney, healthcare providers, and any others to be notified in case of emergency should also be kept in an easily accessible place. Planning can significantly reduce adverse outcomes in the event of a disaster. Not all disasters require immediate evacuation from the home. Phone communication may not be possible during the initial phases of a disaster.

The National Weather Service has announced the likelihood of a large snow event in a major metropolitan area. For which type of health problem should the nurses in the emergency department prepare? 1. stress-related injuries 2. crushing injuries 3. myocardial infarctions 4. burns

Correct Answer: 3 Rationale 1: Stress-related injuries would result from a situation that promotes anxiety. A snow event would not fulfill that criterion. Rationale 2: Crushing injuries would result from something falling on individuals. Snow does not meet that criterion. Rationale 3: Overexertion and exhaustion are major problems during the snow shoveling following a major snowstorm. The exertion required to shovel heavy snow in the extreme cold can cause myocardial infarction. Rationale 4: Burn injuries do not typically accompany snowfall. Global Rationale: Overexertion and exhaustion are major problems during the snow shoveling following a major snowstorm. The exertion required to shovel heavy snow in the extreme cold can cause myocardial infarction. Stress-related injuries would result from a situation that promoted anxiety. Crushing injuries would result from something falling on individuals. Snow does not meet those criteria. Burn injuries will not accompany snowfall.

The emergency response team is setting up an area in which to triage victims of a building blast in a major metropolitan area. Which area should the nurse identify to set up this triage location? 1. hot zone 2. warm zone 3. cold zone 4. clean zone

Correct Answer: 3 Rationale 1: The hot zone is closest to the site of the disaster. Decontamination takes place in the hot zone. It would not provide the needed safety to perform in-depth triage activities. Rationale 2: The warm zone serves as a location for decontamination of victims. Personal protective equipment is needed. It is not a safe location for the in-depth triage. Rationale 3: The cold zone is considered the safe zone. It is the area in which a more in-depth triage of victims can be performed. Rationale 4: None of the zones is referred to as a clean zone. Global Rationale: The cold zone is considered the safe zone. It is the area in which a more in-depth triage of victims can be performed. The hot zone is closest to the site of the disaster. Decontamination takes place in the hot zone. It would not provide the needed safety to perform in-depth triage activities. The warm zone also serves as a location for decontamination of victims. Personal protective equipment is needed. It is not a safe location for the in-depth triage. None of the zones is referred to as a clean zone.

Survivors of a bioterrorist attack are receiving basic care and support in a local motel until further plans for placement can be made. Several of these victims have been receiving care for autoimmune disorders. What should the nurse consider when providing these victims with food over the next several hours? Standard Text: Select all that apply. 1. Offer fresh salads. 2. Ensure that fruit is fresh. 3. Provide bottled water. 4. Provide cooked or processed meals. 5. Fill pitchers with tap water.

Correct Answer: 3, 4 Rationale 1: Fresh foods should be avoided because of the risk of contamination and subsequent infection. Rationale 2: Fresh foods should be avoided because of the risk of contamination and subsequent infection. Rationale 3: Bottled water should be ready so the patient can avoid drinking water of questionable purity. Rationale 4: Processed or canned foods are safest for this population. Rationale 5: Bottled water should be provided so that water of questionable purity can be avoided. Global Rationale: Patients who are immunocompromised pose special problems for the healthcare community, especially if access to health care is unavailable due to a disaster situation. Bottled water should be ready so the patient can avoid drinking water of questionable purity. Bone marrow and stem cell transplant patients are instructed not to eat fresh fruits and vegetables due to the risk of contamination and subsequent infection. It is safest for this population of patients to consume processed or canned foods if they can be heated to the proper temperatures.

There is a radiologic dispersion bomb (dirty bomb) explosion in a subway station. In what order should the nurse deliver patient care at the scene of the explosion? Standard Text: Click and drag the options below to move them up or down. Choice 1. Begin direct patient care for complaints of fatigue and nausea. Choice 2. Decontaminate clothing of patients. Choice 3. Assess patients for burns and blunt trauma. Choice 4. Evacuate patients from the exposure area.

Correct Answer: 3, 4, 2, 1 Rationale 1: There may be some early complaints of radiation exposure such as nausea or fatigue. The manifestations of serious radiation exposure may not occur for several hours and do not suggest imminent death. Care should begin after the victims are been evacuated from the exposure area. Rationale 2: Decontamination should begin as soon as patients are evacuated from the exposure area. Rationale 3: The major activities performed for patients who have suffered a dirty bomb blast are triage, evacuation or sheltering, search and rescue, radioactive monitoring, decontamination, and direct patient care. The patient will be assessed for injuries such as burns or blunt trauma. Rationale 4: The second step is to evacuate the victims from the exposure area, along with the healthcare providers and first responders. Global Rationale: The major activities performed for patients who have suffered a nuclear casualty are triage, evacuation or sheltering, search and rescue, radioactive monitoring, decontamination, and direct patient care. The patient will be assessed for injuries such as burns or blunt trauma. The victim should be evacuated from the exposure area, along with the healthcare provider and first responders. Decontamination should begin as soon as patients are evacuated from the exposure area. This may include an initial onsite decontamination followed by a second decontamination procedure at the healthcare facility. There may be some early complaints of radiation exposure such as nausea or fatigue. The manifestations of serious radiation exposure may not occur for several hours and do not suggest imminent death.

A woman arrives at the site of a disaster, hysterically crying because she was in the building that collapsed just minutes earlier. What should the nurse do with this patient? 1. Advise her to go home and be with her family. 2. Triage the patient and transport her to the hospital. 3. Have a nurse talk with the patient. 4. Ask psychiatric service personnel to talk with this patient.

Correct Answer: 4 Rationale 1: The patient is very upset and should not be sent away without any intervention. Rationale 2: The patient escaped the building before it collapsed and experienced no injuries. Triage services need to be preserved for those who suffered injuries. Rationale 3: This patient requires the assistance of psychiatric personnel. Rationale 4: Social Services personnel or psychiatric service personnel should be available to assist the "worried well" in coping with the trauma they have just experienced, witnessed, or heard about through the media. Global Rationale: Social Services personnel or psychiatric service personnel should be available to assist the "worried well" in coping with the trauma they have just experienced, witnessed, or heard about through the media. The patient is very upset and should not be sent away without any intervention. The patient escaped the building before it collapsed and experienced no injuries. Triage services need to be preserved for those who suffered injuries.

The nursing staff is planning to attend a presentation on disaster prevention. What should the nurse expect the purpose of this education to be? 1. to learn the organization's disaster plan 2. to have the nurses participate in the plan for handling a disaster 3. to educate the nurses in how to recognize possible terrorists 4. to learn how the nurse will participate in mitigation

Correct Answer: 4 Rationale 1: The staff should already be familiar with the organization's disaster plan. Rationale 2: The focus of the program is prevention, not handling a disaster that has already taken place. Rationale 3: Recognition of terrorists is not the focus of the nursing team. Rationale 4: Mitigation is the action taken to prevent or reduce the harmful effects of a disaster on human health or property. A key nursing activity related to mitigation is the active participation in learning activities to be able to teach the general public. Global Rationale: Mitigation is the action taken to prevent or reduce the harmful effects of a disaster on human health or property. A key nursing activity related to mitigation is the active participation in learning activities to be able to teach the general public. The staff should already be familiar with the organization's disaster plan. The focus of the program is prevention, not handling a disaster that has already taken place. Recognition of terrorists is not the focus of the nursing team.

During a disaster preparedness presentation, the nurse learns about the harmful effects of a dirty bomb. Which treatment should the nurse realize will preserve life in the event of this disaster? 1. support for the patient who will develop radiation sickness 2. heart-lung transplant 3. liver transplant 4. bone marrow transplant

Correct Answer: 4 Rationale 1: While the provision of support is important for patients who have developed radiation sickness, it does not directly preserve life. Rationale 2: Transplantation of a heart or lung will not reduce the damage caused by the radiation exposure of a dirty bomb. Rationale 3: Transplantation of a liver will not reduce the damage caused by the radiation exposure of a dirty bomb. Rationale 4: Radiation sickness results from exposure to a dirty bomb. While this condition can be deadly, it is survivable with bone marrow transplantation. Global Rationale: Radiation sickness results from exposure to a dirty bomb. While this condition can be deadly, it is survivable with bone marrow transplantation. While the provision of support is important for patients who have developed radiation sickness, it does not directly preserve life. Transplantation of a heart, lung, or liver will not reduce the damage caused by the radiation exposure of a dirty bomb.