Mass casualty/disaster

The registered nurse is teaching a group of student nurses about preventing post-traumatic stress disorder (PTSD) during a mass casualty event. Which statement made by the student nurse indicates effective learning? 1 "I should take a break whenever needed." 2 "I should not work more than 18 hours per day." 3 "I should monitor my own stress level and performance." 4 "I should avoid talking about my feelings with managers or staff."

1 "I should take a break whenever needed." During a mass casualty event nurses in charge of clients may develop PTSD due to the emotional impact of the incident. Therefore, the nurse should take breaks whenever needed. The nurse should not work more than 12 hours per day. The nurses should monitor each other's stress levels and performance. The nurse should talk about feelings with managers and staff.

The nurse is assessing four clients who were injured in a mass casualty event. Which client does the nurse plan to treat first according to the disaster triage tag system? 1 Client belonging to class I 2 Client belonging to class II 3 Client belonging to class III 4 Client belonging to class IV

1 Client belonging to class I Class I clients are emergent clients who are marked with red tag. These clients have an immediate threat to life and need attention first. . Class II clients have major injuries and need treatment within 30 minutes to 2 hours. Class III clients have minor injuries and can be treated in a delayed manner. Class IV clients are those who are expected to die or are dead.

The nurse is caring for different clients in a mass casualty event. Which clients should be provided with immediate care based on priority? 1 Clients with a red tag 2 Clients with a black tag 3 Clients with a green tag 4 Clients with a yellow tag

1 Clients with a red tag Clients who have a red tag should be provided with immediate care because red tags are given to clients who are in life-threatening situations. A black tag is given to clients who are expected to die or are already dead. Green tags are given to clients who can wait a short time for care. A yellow tag is given to clients in nonurgent situations.

A green-tagged client arrives at the emergency department (ED) after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this client? 1 Implementing decontamination measures 2 Performing a head to toe physical examination 3 Placing a special bracelet with a disaster number 4 Taking a digital photo and placing it on the medical record

1 Implementing decontamination measures The priority nursing action for a green-tagged client who arrives at the ED after exposure to radiation is implementing decontamination measures. This measure is the priority because it is essential that members of the healthcare team, and clients, are not exposed to the radiation while providing care. While the other nursing actions (performing a head to toe physical examination, placing a special bracelet with a disaster number, and taking a digital photo and placing it on the medication record) should occur during the admission process to the ED, these are not the priority actions.

The nurse is conducting triage under mass casualty conditions. Which tag should the nurse use for a client who is experiencing hypovolemic shock due to a penetrating wound? 1 Red 2 Black 3 Green 4 Yellow

1 Red The nurse would use a red tag for a client who has injuries that are an immediate threat to life, such as hypovolemic shock, during mass casualty conditions. A black tag is used for a client who is expected and allowed to die. A green tag is used for a client with minor injuries that do not require immediate treatment. A yellow tag is used for a client who has major injuries requiring treatment.

Which situation does not cover nurses who respond to a mass casualty incident (MCI) for malpractice or negligent lawsuits under the Good Samaritan Act? 1 Terrorist act 2 Neighborhood fire 3 Roadside car accident 4 High school sporting event

1 Terrorist act When terrorist acts occur, nurses are often required to go to an assigned site to offer aid. When this occurs, the nurse is not covered from malpractice or negligent lawsuits. Nurses who respond to injuries that occur in a neighborhood fire, roadside car accident, or a high school sporting event are covered under the Good Samaritan Act.

The nurse is caring for victims of a biologic terrorism incident that has caused them to develop hemorrhagic fever. What does the nurse know about the treatment of this condition? 1 There is no established treatment for this condition. 2 Antibiotics can be an effective treatment for hemorrhagic fever. 3 Multiple doses of atropine (AtroPen) can be used to control hemorrhagic fever. 4 Vaccination, even after first exposure, reduces the incidence of hemorrhagic fever.

1 There is no established treatment for this condition. There is no established treatment for most viruses that cause hemorrhagic fever. Anthrax, plague, and tularemia are biologic agents of terrorism that can be treated effectively with antibiotics if sufficient supplies are available and the organisms are not resistant. Smallpox is a biologic agent of terrorism that can be prevented or the incidence reduced by vaccination, even when first given after exposure. Nerve agent poisoning is a chemical agent of terrorism; antidotes for nerve agent poisoning include atropine (AtroPen).

A client with bubonic plague has a body temperature of 103° F associated with chills, swollen glands, headache, and weakness. Which microorganism is most likely responsible for the client's condition? 1 Yersinia pestis 2 Bordetella pertusis 3 Mycobacterium tuberculosis 4 Corynebacterium diphtheria

1 Yersinia pestis Bubonic plague is a reemerging infection caused by Yersinia pestis, which is associated with elevated body temperature, chills, swollen glands, headache, and weakness. Bordetella pertusis causes pertussis, which is associated with acute, highly contagious respiratory disease characterized by loud whooping cough. Mycobacterium tuberculosis causes tuberculosis, which is transmitted by inhalation of infected droplets. Corynebacterium diphtheria causes a localized infection of mucous membranes or skin such as diphtheria.

The nurse is a member of the critical incident stress management unit that looks to meet the psychosocial needs of first responders after a mass casualty incident. Which action by the nurse is appropriate when conducting a session? 1 Arranging group discussion 2 Administering antianxiety medication 3 Scheduling individual therapy appointments 4 Documenting individual responses to the session

1 arranging group discussion Many hospitals and DMATs have a critical incident stress management unit, which arranges group discussions to allow participants to share and validate their feelings and emotions about the experience. This is important for emotional recovery. The nurse does not administer antianxiety medications to the participants, schedule individual therapy appointments, or document individual responses to the group session.

The nurse is caring for clients who have been admitted to the emergency department after a bomb blast. On observing one client's legs, the nurse gives the client a yellow tag. What is the likely condition of the client? 1 Compound fracture 2 Transverse fracture 3 Green stick fracture 4 Comminuted fracture

1 compound fracture A yellow tag would be issued for class II clients who may have major injuries such as open or compound fractures. In an open or compound fracture, the bone sticks through the skin. Clients with compound fractures need urgent treatment but can wait a short time for care. Green stick fractures, transverse fractures, and comminuted fractures are closed fractures and are considered as minor injuries. Clients with minor injuries are issued with green tags.

What steps would the nurse explain are to be followed for preventing post-traumatic stress disorder (PTSD) in hospital staff during a mass casualty event? Select all that apply. 1 Drinking plenty of water 2 Encouraging co-workers 3 Monitoring each other`s stress levels 4 Being quiet and isolated from others 5 Working for more than 12 hours each day

1,2,3 It is recommended to drink plenty of water and eat healthy snacks for energy to overcome PTSD. It is essential to encourage and support co-workers who are suffering from PTSD. It is suggested that co-workers monitor each other`s stress levels and performance during PTSD. It is advised to talk about feelings with staff and managers and be in touch with family, friends, and significant others, rather than isolating oneself. It is important not to work for more than 12 hours each day because it will increase stress and lead to PTSD.

What should the nurse educator emphasize when teaching about mass casualty incidents (MCIs)? Select all that apply. 1 Involves large numbers of victims 2 Can be from man-made or natural causes 3 Causes permanent changes in a community 4 Requires minimal assistance from outside resources 5 Overwhelms a community's ability to respond with resources

1,2,3,5 Mass casualty incidents (MCIs) involve large numbers of victims. An MCI is a man-made or natural event or disaster that causes permanent changes within a community. It overwhelms a community's ability to respond with existing resources. MCIs always require significant assistance from resources outside the affected community

What would help facilitate communication and coordination during a mass casualty event in a hospital using the hospital incident command system? Select all that apply. 1 Activate communication equipment 2 Establish a command center in a designated location 3 Provide key personnel with distinctive clothing identifying their role 4 Ensure key personnel are properly immunized and have a personal emergency plan 5 Distribute job action sheets identifying reporting relationships, tasks, and responsibilities

1,2,3,5 To facilitate communication and coordination during a mass casualty event in a hospital using the hospital incidence command system, communication equipment needs to be activated. In addition, a command center needs to be created in a designated location. Key personnel need to be easily identified, which can be done by providing distinctive clothing which identifies their role. Jobs action sheets that identify reporting relationships, tasks, and responsibilities will also help facilitate communication and coordination at this time. Key personnel do not need to be immunized or have a personal emergency plan when handling a disaster within an organization.

Which nursing actions during a mass casualty incident should be included in the triage portion of an organizational disaster plan? Select all that apply. 1 Treatment 2 Stabilization 3 Evaluation of interventions 4 Formulation of nursing diagnosis 5 Decontamination for suspected contamination

1,2,5 Victims need to be treated and stabilized and, if there is known or suspected contamination, decontaminated at the scene. Evaluation of interventions and formulation of nursing diagnoses is not implemented until the client is admitted to the hospital.

The emergency department nurse is assigned duty at a mass casualty situation. Which measures should the nurse take for personal preparedness? Select all that apply. 1 Carrying lip balm 2 Carrying sunglasses 3 Carrying ready to cook food 4 Carrying lists of credit card numbers 5 Carrying matchboxes in a plastic bag

1,24 A personal preparedness plan should be made by every nurse for disaster treatment. The nurse should carry toiletries such a lip balm as a personal preparedness measure for disaster treatment. The nurse should carry sunglasses as a protective measure for eyes. The nurse should carry lists of credit card numbers and back accounts while preparing for disaster treatment. The nurse should carry nonperishable items and food that does not require cooking. The nurse should carry matchboxes in a waterproof container instead of a plastic bag.

Which emergency medical system (EMS) first responders can perform triage during mass casualty incidents? Select all that apply. 1 Paramedics 2 Unlicensed assistive personnel 3 Nurses appointed to a field team 4 A physician who survives the incident 5 Community response team members

1,3 Paramedics and nurses appointed to a field team are the EMS first responders who can perform triage during a mass casualty incident. Unlicensed assistive personnel can assist with providing client care in a hospital setting under the direction of a licensed practitioner. A physician who survives the incident can assist with treatment; however, this individual is not necessarily trained for triage. Community response team members can assist first responders; however, these individuals are not trained for triage.

A local emergency department (ED) recently implemented an automated tracking system for triage during mass casualty incidents (MCIs). Which items can the nurse track using this system? Select all that apply. 1 Priority upon arrival 2 Clinical manifestations 3 Interaction with caregivers 4 Priority per process of care 5 Priority according to location

1,3,4,5 Automated tracking systems using infrared and radiofrequency technology (RFT) are available in some emergency departments to track a client's triage priority upon arrival, location, and process of care. The interactions the client has with caregivers can also be tracked; this is an important safety strategy if the client is later found to have contaminants or a disease that could pose a risk to staff members who had close contact and require decontamination or prophylaxis. Clinical manifestations cannot be tracked using this system.

Which factors affect the stress that first responders feel after a mass casualty incident (MCI)? Select all that apply. 1 Age 2 Gender 3 Nature of event 4 Coping mechanisms 5 Psychologic history

1,3,4,5 Stress that occurs for first responders after an MCI can persist for an extended period and is influenced, in part, by the nature of the event, the individual's age, preexisting coping mechanisms, role in the event, and medical and psychologic history. Gender does not influence the affect that stress has on the first responder after an MCI.

In a mass casualty event, the nurses from medical-surgical nursing units are asked, in collaboration with the healthcare provider, to recommend clients for discharge to free up inpatient beds for disaster victims. Which clients are most likely to be discharged early? Select all that apply. 1 A client who could be cared for in a rehabilitation center 2 A client who has been admitted for observation and is bedridden 3 A client who is having diagnostic evaluations and is not bedridden 4 A client who has had no critical change in condition for the past day 5 A client who could be could be cared for at home with support from home healthcare services

1,3,5 Clients who are likely to be discharged early to free up inpatient beds for disaster victims include those who could be cared for in a rehabilitation center, those who are having diagnostic evaluations and are not bedridden, and those who could be could be cared for at home with support from family members or home healthcare services. A client who has been admitted for observation would be discharged early if he or she is not bedridden. A client who has had no critical change in condition for the past three days is likely to be discharged early.

The registered nurse is training the emergency department caregivers about types of disasters. Which statements made by the nurse would describe a mass casualty event? Select all that apply. 1 "In an aircraft explosion, nearly 112 persons died." 2 "There was a fire in a healthcare facility in Canada." 3 "In 2001, there was a terrorist attack on the World Trade Center." 4 "Five years ago there was a small chemical explosion at a medical college." 5 "The employees at a nuclear plant were severely injured by a radiation leak."

1,3,5 Mass casualty events require the collaboration of multiple agencies and healthcare facilities to handle the crisis. An aircraft explosion, a terrorist attack, and a nuclear explosion are external disasters that will require the collaboration of multiple agencies. A fire in a healthcare facility and a small chemical explosion at a medical college are examples of multi-casualty events that can be managed using local resources

Which symptoms are common during the fulminant stage of inhalation of anthrax? Select all that apply. 1 Dyspnea 2 Dry cough 3 Diaphoresis 4 Mild chest pain 5 High temperature

1,3,5 The fulminant stage of inhalation of anthrax is manifested by dyspnea, diaphoresis, and a high body temperature. The prodromal stage of inhalation of anthrax is manifested by a dry cough and mild chest pain.

The healthcare team is caring for clients in a mass casualty event. Which clients should be given the least priority of care? 1 Client reporting leg sprain 2 Client reporting hip fracture 3 Client reporting renal colic pain 4 Client reporting substernal chest pain

1. Client reporting leg sprain The three-tiered triage system in the emergency department includes emergent, urgent, and nonurgent levels in which the clients should be cared for accordingly. A client reporting a leg sprain indicates a nonurgent situation in which care for the client can be delayed. A hip fracture with renal colic pain may not be a life-threatening situation and care for the client can be delayed for a few minutes. A client reporting substernal chest pain is a life-threatening complication and, therefore, the client should be provided with immediate care.

What is the function of the hospital incident commander in a mass casualty event? 1 Assuming leadership for implementing the emergency plan 2 Deciding the number, acuity, and resource needs of clients 3 Evaluating each client to determine priorities for treatment 4 Serving as a liaison between the healthcare facility and the media

1. assuming leadership for implementing the emergency plan Assuming leadership for implementing the emergency plan is the function of the hospital incident commander in a mass casualty event. A medical command physician decides the number, acuity, and resource needs of clients. Evaluating each client to determine priorities for treatment is the role of the triage officer. The public information officer serves as a liaison between the healthcare facility and the media.

The victims of a mass casualty are brought to the emergency department. One of the healthcare team members re-evaluates some of the clients and realizes the need for immediate transfer to the orthopedic care unit. Who would take up the responsibility of re-evaluation of the client's acuity? 1 Triage officer 2 Public information officer 3 Medical command physician 4 Hospital incident commander

1. triage officer The triage officer is responsible for evaluation of each person who is brought to the hospital with triage tags, and re-evaluation of client acuity for assignment of the client to the appropriate area within the emergency department. The public information officer acts as a liaison between the healthcare facility and the media. The medical command physician focuses on determining the acuity and medical resource needs of victims arriving from the incident scene. Identifying the need for and calling in a specialist such as an orthopedic surgeon would be the responsibility of the medical command physician. The hospital incident commander is responsible for the overall leadership of implementing the emergency plan.

The nurse manager explains to staff nurses of a disaster management team the psychosocial response of clients when assessing survivors of a mass casualty event. Which statement made by the nurse executive indicates the need for further explanation? 1 "I should establish a rapport through honest communication." 2 "I should use the Impact of Event Scale-Revised in clients with short term memory loss." 3 "I should determine the client's reading level before giving the Impact of Event Scale-Revised tool." 4 "I should refer the clients with a high score on the Impact on the Event Scale-Revised to a psychiatrist."

2 "I should use the impact of event scale-revised in clients with short term memory loss." The use of the Impact of Event Scale-Revised (IES-R) scale should be avoided in clients with short-term memory loss. The nurse should establish a rapport through honest communication to help the survivors of a mass casualty event. Determining the client's reading level is important before giving IES-R tool because it is written at the tenth grade reading level. The clients with high score on the IES-R are to be referred to a psychiatrist.

When writing a disaster plan for implementation during a mass casualty incident (MCI), which percentage of victims often require admission to the hospital for further treatment? 1 25% 2 30% 3 35% 4 40%

2 30% The disaster plan should include provisions for approximately 30% of the victims of an MCI requiring hospital admission. The other percentages, 25, 35, and 40 are not accurate numbers to include in the disaster plan.

A nurse manager is informed that a community disaster drill will take place. The disaster scenario will include a bombing in a shopping mall with hundreds of casualties. What location should the nurse consider for triage of casualties when planning for this exercise? 1 In the hospital parking lot 2 At the scene of the disaster 3 In the emergency department 4 At the closest school gymnasium

2 At the scene of the disaster Triage is initiated at the scene. After the scene is determined to be safe for the healthcare team to approach, providers at a mass casualty incident (MCI) must analyze the number and severity of clients. Regardless of the systemused, the primary goal is to quickly sort the clients into transport categories and identify each of them with triage tags, colored tape or other means of priority. Mass casualty events have triage at the scene to prevent overwhelming the hospital with casualties, while at the same time preventing the hospital from becoming a secondary target of additional attacks. The hospital parking lot is too close to the hospital to provide safety from additional attacks. Performing triage in the emergency department will quickly overwhelm the department and will interfere with provision of care to clients who will benefit from interventions. The closest school gymnasium may be too far from the scene of the disaster and may become a target of secondary attack.

Which color tag will be given by the triage nurse to a client assigned to class IV, during a mass casualty situation? 1 Red 2 Black 3 Green 4 Yellow

2 Black A client considered class IV during triage in a mass casualty situation will be given a black tag. The red tag is associated with class I, green tag with class III, and yellow tag with class II.

which triage classification of client requires an urgent nursing priority in cause of a mass casualty? 1 class I 2 Class II 3 Class III 4 Class IV

2 Class II Class II clients have urgent nursing priority as required by major injuries. Class I clients are emergent clients who have an immediate threat to life. Class III clients are nonurgent clients who do not require immediate treatment. Class IV clients are clients who are dead or who are expected to die.

The nurse is caring for different clients in a mass casualty event. Which client is assigned the lowest priority for care? 1 Client with red tag 2 Client with black tag 3 Client with green tag 4 Client with yellow tag

2 Client with black tag Clients with black tags are expected to die or are already dead; therefore these clients are the lowest priority. The first priority should be given for clients with a red tag because the client's life may be saved with immediate treatment. A client with a yellow tag should be given second priority because he or she can wait for the treatment for some time. A client with a green tag can be given care after some time as his or her condition would be stable.

The nurse on a community terrorism response team is reviewing triage protocols. In contrast to triage policies used during local emergency situations occurring in the hospital, triage practices during mass casualty events do not prescribe treatment for clients who have which type of injury? 1 Multiple fractures 2 Closed head injuries 3 Internal abdominal trauma 4 Radiation/chemical exposures

2 Closed head injuries Individuals with serious head injuries are not treated immediately during mass casualty events because the need in those situations is to treat the largest number of people who have the least severe injuries and make the best use of limited resources. People with fractures or survivable radiation or chemical exposures, or those requiring uncomplicated abdominal surgeries are treated during mass casualty events.

Which healthcare professional serves as the liaison between hospital administration and the media to release only appropriate and accurate information in the event of a mass casualty event or disaster? 1 Triage officer 2 Community relations officer 3 Medical command physician 4 Hospital incident commander

2 Community relations officer Mass casualty incidents tend to attract a large amount of media attention. The community relations or public information officer can serve as the liaison between hospital administration and the media to release only appropriate and accurate information. The triage officer is a physician or nurse who rapidly evaluates each client to determine priorities for treatment. The medical command physician decides the number, acuity, and resource needs of clients arriving from the incident scene to the hospital and organizing the emergency healthcare team response to the injured or ill clients. The hospital incident commander is a physician or administrator who assumes overall leadership for implementing the emergency plan.

What would the nurse say is the difference between triage under usual conditions and triage under mass casualty conditions? 1 Urgent care 2 Expectant care 3 Emergent care 4 Nonurgent care

2 Expectant care Expectant care includes critical care to the clients who are expected to die or are dead. This condition is not included in the triage under usual conditions. Urgent care includes care to clients with major injuries that require immediate treatment. This condition is included in triage under usual and mass casualty conditions. Emergent care is provided when there is immediate threat to life. This condition is included in triage under usual and mass casualty conditions. Nonurgent care is when there are minor injuries that do not require immediate treatment. This is included in triage under usual and mass casualty.

In a mass casualty situation, which is the facility-level organizational model for disaster management used by the hospital or long-term care facility? 1 Emergency operations center (EOC) 2 Hospital Incident Command System (HICS) 3 National Incident Management System (NIMS) 4 Federal Emergency Management Agency (FEMA)

2 Hospital incident command system (HICS) The facility-level organizational model for disaster management is the Hospital Incident Command System (HICS). It attempts to standardize disaster operations by formally structuring roles under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources. The EOC, NIMS, and FEMA are not facility-level organizational models for disaster management. The EOC is established by the HICS personnel in a designated location with accessible communication technology to manage the overall incident. The NIMS is the overall system for incident management of which the HICS is a part; it is implemented by the Department of Homeland Security and FEMA. The FEMA provides numerous online resources so that people are better prepared for disasters and are able to respond more self-sufficiently to incidents and hazard situations in their own communities.

What would be the priority to maintain the hospital environment when a large number of clients walk into the emergency room asking to be treated for minor injuries sustained from the detonation of a car bomb? 1 Triage the injuries 2 Initiate a decontamination process 3 Document each name and address 4 Direct to have a seat in the waiting area

2 Initiate a decontamination process Green-tagged clients or the walking wounded who self-transport to a healthcare facility may unknowingly carry contaminants from a nuclear, biologic, or chemical incident into the hospital environment. These issues must be anticipated, and appropriate decontamination measures implemented. Triaging the injuries would not be needed since the clients walked into the emergency department. Documenting each name and address is essential however this is not the priority. Directing clients to sit in the waiting area encourages potential contamination of the hospital environment.

Which amount of time is appropriate for a nurse to spend triaging each client during a mass casualty incident? 1 Less than 10 seconds 2 Less than 15 seconds 3 Less than 30 seconds 4 Less than 60 seconds

2 Less than 15 seconds Triage of victims of an emergency or an MCI must be conducted in less than 15 seconds. The other time frames, 10 seconds, 30 seconds, and 60 seconds, are not accurate.

After a mass casualty incident related to an accidental fire in a residential area, the medical care team is assessing clients who were affected by this disaster. The nurse notices that many of the clients are incoherent and have panic attacks and exaggerated startle responses. What condition are the clients experiencing? 1 Ineffective coping 2 Post-trauma syndrome 3 Compromised resilience 4 Disturbed personal identity

2 Post-trauma syndrome Incoherence, panic attacks, and exaggerated startle responses are symptoms of post-trauma syndrome. Ineffective coping and compromised resilience is characterized by an inability to meet basic needs, inadequate problem solving, inability to attend to information, and isolation. Disturbed personal identity is manifested as self-hatred, feelings of being ineffectual, and perceived lack of control.

During resuscitation of a critically injured client in a bomb blast, the nurse finds the client is breathing spontaneously. Which nursing intervention would the nurse perform in this situation? 1 Inserting an endotracheal tube 2 Providing non-rebreather mask 3 Providing mechanical ventilation 4 Providing bag-valve-mask (BVM) ventilation

2 Providing non-rebreather mask A non-rebreather mask is used in spontaneously breathing clients. Providing an endotracheal tube and mechanical ventilation is beneficial in clients with significantly impaired consciousness. A client who needs ventilatory assistance during resuscitation requires a BVM ventilation with an appropriate airway adjunct and a 100 percent oxygen source.

What is a high priority assignment in an emergency department when a nurse is providing care for clients during a mass casualty? 1 Resolving stock availability problems 2 Taking inventory and restocking supplies 3 Debriefing to promote effective coping strategies 4 Outlining emergency expectations and arrangements

2 Taking inventory and restocking supplies A high priority assignment in an emergency department during a mass casualty is taking inventory and restocking supplies. Collaboration between the emergency department and the central supply department is essential for resolving stock availability problems. Debriefing teams provide sessions for small groups of staff to promote effective coping strategies. Outlining emergency expectations and arrangements should be part of the hospital's overall emergency preparedness plan.

The victims of a large scale disaster are brought to the hospital for treatment. The nurse notices that the mass casualty response team field has tagged a client with a green tag. How much time does the nurse have before it becomes imperative to begin the client's treatment? 1 The client will not be treated at all. 2 The client can be treated after three hours. 3 The client has to be treated immediately. 4 The client needs to be treated within 30 minutes to two hours

2 The client can be treated after 3 hours According to the disaster triage tag system, green-tagged clients have minor injuries that can be managed in a delayed fashion, generally more than two hours. So, the nurse could start the treatment for the green-tagged client after three hours. A black-tagged client is critically ill and injured and is expected and allowed to die. A red-tagged client has an immediate threat to life and will be treated immediately. A yellow-tagged client will have major injuries and should be treated within 30 minutes to two hours.

After a bomb blast in a city, why would the federal government send the Medical Reserve Corps (MRC) to the site? 1 To provide advanced Disaster Life Support training 2 To establish first aid stations or special-needs shelters 3 To establish fully functional field surgical facilities to victims 4 To provide medical equipment sufficient for 72 hours to victims

2 To establish first aid stations or special-needs shelters The Medical Reserve Corps (MRC) helps establish first aid stations or special-needs shelters to victims of a disaster. The National Disaster Life Support Foundation renders core, basic, and advanced disaster life support training courses. International Medical Surgical Response Teams (IMSuRTs) establish fully functional field surgical facilities. A Disaster Medical Assistance Team (DMAT) is a medical relief team that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours.

The registered nurse is teaching a student nurse about handling mass casualty disaster situations in the field. Which statements made by the student nurse shows the need for further teaching? Select all that apply. 1 "I will work with a goal of doing the greatest good for the greatest number of people." 2 "I will try to provide maximum care and save the clients tagged expectant or critically ill." 3 "I will provide green-tagged clients the least priority of care compared to other categories." 4 "I will manage the walking wounded clients with fractures and abrasions in a delayed fashion." 5 "I will categorize clients according to the disaster triage tag system based on the severity of injuries."

2,3 The least priority while providing care should be given to critically ill clients who are black-tagged or triaged as expectant. The triage system is implemented with the desired outcome of doing the greatest good for the greatest number of people. The walking wounded or green-tagged clients do not have immediate life threatening injuries. Most mass casualty response systems use a disaster triage tag system that categorizes triage priority by color and number based on the severity of injuries.

The head nurse of the emergency department (ED) is assigning duties to volunteer nurses to care for a group of clients injured in a mass casualty situation. Which assignments are appropriate in this situation? Select all that apply. 1 The general staff nurse should organize nursing services. 2 The trauma nurse manager should organize ancillary services. 3 The medical-surgical nurse should recommend clients for discharge. 4 The ED nurse leader should direct the ancillary departments to deliver supplies. 5 The hospital nurse leader should identify clients who can be transferred out of the unit.

2,3,4 While caring for clients after a disaster, the trauma nurse manager should help in organizing ancillary services to meet client needs. The medical-surgical nurse should collaborate with the primary healthcare provider in recommending clients for discharge to free inpatient beds. The ED nurse leader should direct the ancillary departments to deliver supplies to meet service needs. The general staff nurse should organize nursing services to provide care for stable emergency department clients. The hospital nurse leader should direct the ancillary departments to deliver supplies, medications, food, instrument trays, and personnel to meet service needs.

The primary healthcare provider prescribed selective serotonin reuptake inhibitor therapy for a client who survived a bomb blast. During a follow-up visit, the nurse finds that the symptoms did not subside. Which other medications would be beneficial for the client? Select all that apply. 1 Buspirone 2 Phenelzine 3 Trazodone 4 Mirtazapine 5 Imipramine

2,4,5 A client who survived a bomb blast would have posttraumatic stress disorder (PTSD). Selective serotonin reuptake inhibitors (SSRIs) are first-line agents used to treat PTSD. If SSRIs are not effective, then monoamine oxidase inhibitors (such as phenelzine or mirtazapine) or a tricyclic antidepressant (such as imipramine) may be effective in treating PTSD. Buspirone and trazodone are not used to treat PTSD.

People who are involved in a bioterrorism attack exhibit immediate reactions to the traumatic event. Which responses can a nurse expect in survivors during the period immediately following a traumatic event? Select all that apply. 1 Guilt 2 Denial 3 Altruism 4 Confusion 5 Helplessness

2,4,5 Shock and disbelief are the initial responses to a traumatic experience; a situational crisis usually is unexpected, and its impact causes disequilibrium. Disequilibrium results in confusion, disorganization, and difficulty making decisions. When a person is unable to cope, helplessness and regression often emerge; a crisis occurs when there is a painful, frightening event that is so overwhelming an individual's usual coping mechanisms are inadequate. Feelings of guilt may emerge later when the individual moves from focusing on the self to increased interaction with others. Concern for others emerges later, after the individual is able to set aside or resolve his or her own needs.

Which manifestations indicate the prodromal stage in a client with inhalation anthrax? Select all that apply. 1 Rhinitis 2 Fatigue 3 Sore throat 4 Mild chest pain 5 Dry harsh cough

2,4,5 The manifestations include low-grade fever; fatigue; mild chest pain; and a dry, harsh cough. Inhalation anthrax is a two-stage illness, prodromal and fulminant. The prodromal stage is the early stage and is difficult to distinguish from influenza or pneumonia. A special feature of inhalation anthrax is that it is not accompanied by upper respiratory manifestations of sore throat or rhinitis.

A registered nurse is teaching a group of student nurses about concepts of triage in a mass casualty incident. Which statement of the student nurse indicates effective learning? 1 "I will issue a black tag to class II, urgent clients." 2 "I will issue a yellow tag to class I, emergent clients." 3 "I will issue a green tag to class III, nonurgent clients." 4 "I will issue a red tag to class IV, expected-to-die clients."

3 "I will issue a green tag to class III, nonurgent clients." The disaster triage tag system classifies the triage priority by color and number. The green tag is for class III clients who are nonurgent or walking wounded. A black tag is issued to class IV clients who are expected to die. A yellow tag is issued to clients who do not require urgent treatment and the treatment can be delayed for some time. A red tag is used for clients who require emergent treatment.

Which statement by the nurse is true regarding mass casualty events related to disasters? 1 "They can be managed by a hospital using local resources." 2 "They are incidents inside a healthcare facility that could endanger the safety of clients." 3 "They may require the association of multiple agencies and healthcare facilities to handle the crisis." 4 "They are events outside the healthcare facility requiring the activation of the facility's emergency management plan."

3 "They may require the association of multiple agencies and healthcare facilities to handle the crisis." A mass casualty event overwhelms local medical capabilities and may require the collaboration of multiple agencies and healthcare facilities to handle the disaster. Multi-casualty events can be managed by the hospital using local resources. An internal disaster is an event that occurs inside a healthcare facility or campus that could endanger the safety of clients or staff. An external disaster is an event outside the healthcare facility or campus, somewhere in the community, that may require the activation of the facility's emergency management plan.

which client requires nonurgent treatment after a mass casualty incident? 1 A neonate with body temperature of 103° F 2 An elderly person with a rapidly falling pulse 3A middle-aged man with skin rash from shaving 4A pregnant woman with blood pressure of 140/90 mm Hg

3 A middle-aged man with skin rash from shaving A middle-aged man with a skin rash requires nonurgent treatment. A neonate with a body temperature of 103° F needs urgent treatment. .An elderly person with a rapidly falling pulse requires emergent treatment. High blood pressure in a pregnant woman of 140/90 mm Hg could lead to complications; therefore, the client should be given emergent treatment.

Which treatment for anthrax should be included in the biologic agent portion of a disaster plan for terrorist attacks? 1 Antivirals 2 Antitoxins 3 Antibiotics 4 Vaccinations

3 Antibiotics Anthrax is treated effectively with antibiotics if sufficient supplies are available and the organisms are not resistant. Antivirals would not be effective against anthrax, and there is no established treatment for most viruses that cause hemorrhagic fever. Botulism is treated with antitoxin, though several vaccines are being studied. Smallpox can be prevented or the incidence reduced by vaccination, even when first given after exposure.

Which class of clients during a mass casualty situation would the nurse refer to as the "walking wounded"? 1 Class I 2 Class II 3 Class III 4 Class IV

3 Class III Class III clients are considered "walking wounded" and are classified under the nonurgent category. Class I or emergent clients are identified with a red tag. Class II clients can wait a short time for care but have serious injuries that require near-term treatment. Class IV clients are expected to die or are dead and are issued a black tag

Which health care team member is a first responder when an emergency or mass casualty incident (MCI) occurs? 1 Medical unit nurse 2 Police officer 3 Critical care nurse 4 Unlicensed assistive personnel

3 Critical care nurse Critical care nurses are often considered emergency medical personnel that respond to emergency or MCIs. Firemen and police officers are first responders but are not members of the health care team. Unlicensed assistive personnel are not first responders.

The ER nurse expects death in a client critically injured in a bomb blast . What is the appropriate triage categorization for the client? 1 Urgent 2 Emergent 3 Expectant 4 Nonurgent

3 Expectant Clients who are expected to die or are dead are categorized under class IV triage level or as expectant. Urgent or class II clients are those who require immediate treatment, but can wait for a short period. Emergent or class I clients are those who have an immediate threat to life and require immediate treatment. Nonurgent or class III clients are those who have minor injuries and do not require immediate treatment.

Which type of clients are often referred to as the "walking wounded" in a mass casualty scene? 1 Red tagged clients 2 Black tagged clients 3 Green tagged clients 4 Yellow tagged clients

3 Green tagged clients Green tagged clients have minor injuries that can be managed in a delayed fashion, and they can evacuate themselves from the mass casualty scene and go by private vehicle. Therefore they are termed the "walking wounded" clients. Red tagged clients need immediate intervention because they have an immediate threat to life. Black tagged clients are those who are considered as dead or about to die. Yellow tagged clients also have major injuries that need treatment within 30 minutes to 2 hours and are not considered "walking wounded" clients.

The nurse suspects that a client with inhalation anthrax is in the prodromal stage of disease. Which symptoms support the nurse's conclusion? Select all that apply. 1 Hypoxia 2 Cyanosis 3 Dry cough 4 Hypotension 5 Mild chest pain

3, 5 Inhalation anthrax is a bacterial infection caused by the gram-positive organism Bacillus anthracis. It has two stages of illness, prodromal stage and fulminant stage. The prodromal stage is the early stage of disease, in which the symptoms are dry cough and mild chest pain. Cyanosis, hypoxia, and hypotension are symptoms that appear at sudden onset of illness in the fulminant stage.

After a mass casualty event, the incident commander considers "standing down" or deactivating the emergency response plan. What considerations would the nurse expect to be taken into account by the incident commander before making this decision? 1 Increased arrival of black-tagged clients to the emergency department of the facility. 2 No more expected "worried-well" clients to arrive at the emergency department of the facility. 3 New clients are not expected to arrive at a pace that could overwhelm the emergency department. 4 Decreased number of walking wounded personnel arriving at the emergency department of the facility.

3 New clients are not expected to arrive at a pace that could overwhelm the ED When clients are no longer expected to arrive at a pace that could overwhelm the facility, the incident commander considers "standing down" or deactivating the emergency response plan. Black-tagged clients who are dead are generally managed by the disaster mortuary operational response teams (DMORTs) and those clients who are expected to die are marked as expectant and are treated last. The "worried well" want evaluation, preventive treatment, or reassurance from a healthcare provider. A decreased number of walking wounded clients arriving to the ED of the facility shows proper provisions are made to handle them as part of the disaster plan.

The nurse is a first responder for a healthcare organization for a mass casualty incident. Which injury would the nurse tag as yellow during the triage process? 1 Ankle sprain 2 Hypovolemic shock 3 Open femur fracture 4 Massive head trauma

3 Open femur fracture When using a triage tag system, an open femur fracture is an urgent but not life-threatening injury that would be tagged as yellow. An ankle sprain is a minor injury that would be tagged as green. Hypovolemic shock is a life-threatening injury that requires immediate intervention and would be tagged as red. A massive head injury is tagged black as the client is expected to die.

A group of bomb blast victims needs to be transported to the hospital immediately. Which staff members of an emergency unit are most appropriate to handle this situation? 1 Triage officer 2 Medical command physician 3 Prehospital care providers 4 Emergency medicine physician

3 Prehospital care providers Prehospital care providers are the first caregivers who provide transport to the emergency department by ambulance or helicopter for clients in an emergency situation. Triage officers are responsible for evaluating each client to determine priorities for treatment. The medical command physician decides the number, acuity, and resource needs of clients. Emergency medicine physicians have specialized education and training in emergency client management.

During a critical incident stress debriefing (CISD) session conducted by the nurse for clients affected by a natural disaster, a client says, "The worst thing that happened on that day was that my child was severely injured and I was not in a position to help. I would like to forget that day as soon as possible. It was the most painful experience of my life." Which phase of CISD does this indicate? 1 Reentry phase 2 Thought phase 3Reaction phase 4 symptom phase

3 Reaction phase In the reaction phase, CISD participants talk about the worst thing of the incident - what they would like to forget and what was most painful. In the reentry phase, participants review materials discussed, ask questions, and discuss how they would like to bring closure to the debriefing. In the thought phase, participants discuss their first thoughts of the incident. In the symptom phase, participants describe their physical, cognitive, emotional, or behavioral experiences that happened at the incidence scene.

The charge nurse is preparing for the arrival of clients to the emergency department (ED) after a mass casualty incident (MCI). The hospital has an automatic tracking system that is implemented during MCIs. Which decision should the nurse use the system for during this MCI? 1 To determine the number of on-call staff needed 2 To determine the specific plan to be implemented 3 To determine how many casualties of each acuity level can be safety accepted 4 To determine how many clients can be safety discharged to allow for new admissions

3 To determine how many casualties of each acuity level can be safety accepted Automated tracking systems are a valuable component of the hospital's emergency preparedness infrastructure because they enable ED leaders to determine how many casualties of a particular acuity level a hospital can safely accept from the incident scene. The system is not used to determine the number of on-call staff that are needed, to determine the specific plan to be implemented, or to determine the number of clients who can be safely discharged to allow for new admissions.

Which action would the nurse think should be excluded to prevent staff from having posttraumatic stress disorder (PTSD) during a mass casualty assessment? 1 To work less than 12 hours 2 Encourage and motivate team members 3 To work continuously without any breaks 4 To discuss feelings with the team members

3 To work continuously without any breaks Working continuously without any breaks will result in increased stress. Working less than 12 hours may reduce stress. By motivating team members, posttraumatic stress disorder can be prevented. By discussing feelings with team members or nurse managers, stress can be reduced.

The nurse suspects that a client with inhalation anthrax is in the fulminant stage of the disease. Which symptom supports the nurse's conclusion? 1 Fever 2 Dry cough 3 Hematemesis 4 Mild chest pain

3 hematemesis Inhalation anthrax is a bacterial infection caused by Bacillus anthracis. This disease has two stages of illness, the prodromal stage and the fulminant stage. The symptom of the fulminant stage is hematemesis. The symptoms of the prodromal stage are fever, dry cough, and mild chest pain.

Which colored tag has the nurse correctly identified while classifying triage care in mass casualty conditions? 1 Urgent-red tag 2 Expectant-white tag 3 Nonurgent-green tag 4 Emergent-yellow tag

3 nonurgent-green tag When any triage is required in mass casualty conditions, the healthcare team would classify the clients according to the situation. Nonurgent clients are class III who have minor injuries that do not require immediate treatment and are tagged with a green color. Urgent or class II clients are those who have major injuries that require treatment and are tagged with a yellow color. Expectant or class IV are tagged with a black color. These clients will not receive immediate attention as they are either dead or are expected to die. Emergent or class I clients are those who will receive immediate care due to their life threatening condition and are tagged with a red color.

A client is admitted with dysphasia, dry mouth, drooping eyelids, blurred vision, vomiting, and diarrhea, and within 24 hours develops bilateral cranial nerve impairment and descending weakness. Which bioterrorism agent results in these clinical manifestations? 1 Plague 2 Anthrax 3 Botulism 4 Smallpox

3. Botulism These symptoms are found with botulism. With anthrax and smallpox, a rash will be noted. Symptoms of lymphatic plague include fever and chills, painful lymphadenopathy, gastrointestinal symptoms, and progressive weakness

The healthcare team member working at an emergency operation center (EOC) during a mass casualty swine flu outbreak has identified the need to call the infectious disease physician. Which healthcare personnel is responsible for calling the infectious disease physician? 1 Triage officer 2 Public information officer 3 Medical command physician 4 Hospital incident commander

3. medical command physician Medical command physician in the EOC is responsible for identifying the need for and calling in specialty providers such as an infectious disease physician. The public information officer serves as a liaison between the healthcare facility and the media. The triage officer evaluates each client to determine priorities for treatment. The hospital incident commander assumes leadership for implementing the institutional plan.

The nursing student is learning about triage during mass casualty incidents (MCIs). Which statement made by the nursing student indicates effective knowledge regarding MCIs? 1 "Two-thirds of victims are generally tagged red or black." 2 "The triage of victims of an MCI must be conducted in one minute." 3 "Victims who arrive at the hospital on their own are not considered during triage." 4 "The total number of victims can be estimated by doubling the number of victims who arrive in the first hour."

4 "The total number of victims can be estimated by doubling the number of victims who arrive in the first hour." The total number of victims a hospital can expect is estimated by doubling the number of victims who arrive in the first hour. In general, two thirds of victims are tagged green or yellow, and the rest of them are tagged red or black. Triage of victims of an MCI must be conducted in less than 15 seconds. Victims who arrive at the hospital on their own are known as walking wounded and are considered during triage.

What should the administrator of a community hospital do during a mass casualty event? 1 Call all staff to come into work 2 Ask local agencies for staffing assistance 3 Close the emergency department to admissions 4 Contact the county health department for assistance

4 Contact the county health department for assistance A mass casualty event overwhelms local medical capabilities and may require the collaboration of multiple agencies and healthcare facilities to handle the crisis. This coordination could occur through the county health department. A multi-casualty event can be managed by a hospital using local resources. This would include calling all staff to come into work and asking local agencies for staffing assistance. Closing the emergency department to admissions may or may not be a strategy to handle mass casualties or multi-casualty events.

A debriefing team is providing a session for healthcare professionals who are experiencing insomnia after working in a mass casualty incident. One of the healthcare professionals wants to leave the session. Which team member is responsible for intervening in this situation? 1 Police 2 Paramedic 3 Fire fighter 4 Doorkeeper

4 Doorkeeper The "doorkeeper" is responsible for keeping inappropriate people out of the session and talking with healthcare professionals who are leaving the session early in an effort to have him or her return. Police and paramedics are the debriefing team members who are used based on the needs of the group. Firefighters are first responders who rescue people from danger after a disaster event.

In a mass casualty situation, which healthcare professional can direct departments such as physical therapy or a surgical clinic to cancel their usual operations to convert the space into a minor treatment area? 1 Triage officer 2 Community relations officer 3 Medical command physician 4 Hospital incident commander

4 Hospital incident commander The hospital incident commander's role is to take a global view of the entire situation and facilitate client movement through the system in a mass casualty situation. He or she could direct departments such as physical therapy or a surgical clinic to cancel their usual operations to convert the space into a minor treatment area. The triage officer is a physician or nurse who rapidly evaluates each client to determine priorities for treatment. The community relations or public information officer can serve as the liaison between hospital administration and the media to release only appropriate and accurate information. The medical command physician decides the number, acuity, and resource needs of clients arriving from the incident scene to the hospital and organizing the emergency healthcare team response to the injured or ill clients.

Which entity is responsible for activating the disaster plan during a mass casualty incident (MCI)? 1 Local emergency management system 2 State emergency management system 3 Federal emergency management agency 4 Hospital-level emergency management system

4 Hospital-level emergency management system

The nurse manager is designated as a unit Chief during the formulation of a Hospital Incident Command System (HICS) for disaster preparedness. Which responsibility does the nurse manager assume in this role? 1 Public information 2 Medical command 3 Safety and security 4 Logistics and operation

4 Logistics and operation The facility-level organizational model for disaster management is the Hospital Incident Command System (HICS), which is a part of the National Incident Management System (NIMS) implemented by the Department of Homeland Security and FEMA to standardize disaster operations. In this system, roles are formally structured under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources. Chiefs are appointed to manage logistics, planning, finance, and operations as appropriate to the type and scale of the event. Officers, not chiefs, are named to oversee essential emergency preparedness functions such as public information, safety and security, and medical command.

The nurse is preparing a care plan for maintaining safety in clients who are injured in a bomb blast. Which intervention should the nurse include in the care plan to minimize the risk for error and adverse events? 1 Keeping rails up on stretcher 2 Using standard precautions at all times 3 Using two unique identifiers for the client 4 Obtaining a thorough client and family history

4 Obtaining a thorough client and family history Client and staff safety are major concerns in the emergency department (ED). Obtaining a thorough and accurate medical history of the client and family will help to minimize risk for error and adverse events. Keeping rails up on the stretcher will help to prevent injury to the client. Using standard precautions at all times prevents staff injury. Using two unique identifiers for the client will ensure identification of the client.

While assessing the airway patency of a client after a bomb blast, the nurse suspects severe brain injury and gives a score of 7 using the Glasgow Coma Scale (GCS). Which intervention is most appropriate for the client? 1 Performing the jaw-thrust maneuver 2 Maintaining vascular access using a large-bore catheter 3 Observing for chest wall trauma or other physical abnormalities 4 Preparing for endotracheal intubation and mechanical ventilation

4 Preparing for endotracheal intubation and mechanical ventilation The most appropriate intervention for a client with a GCS score of 7 is preparing for endotracheal intubation and mechanical ventilation. The jaw-thrust maneuver is performed in a client if there is any risk of spinal injury. The use of large-bore catheters to maintain vascular access is done to perform resuscitation in traumatic conditions. Observing for chest wall trauma or other physical abnormalities may not be the appropriate intervention for a client with brain injury.

A client with the diagnosis of inhalation anthrax is admitted to the intensive care unit. It is most important for the nurse to make a focused assessment of which body system? 1 Mental 2 Hydration 3 Neurologic 4 Respiratory

4 Respiratory Because respiratory collapse is an early sign of inhalation anthrax, a client's respiratory status requires immediate assessment and continued monitoring. Development of a central nervous system problem, such as anthrax-related meningitis, is a late sign of inhalation anthrax. Although assessing hydration status is important for any client who is acutely ill, it is not a nursing assessment that is specific to anthrax. Neurologic adaptations are late signs of inhalation anthrax.

A triage nurse assigns a green tag to a client during triage after a mass casualty event. Which statement is true about the client's injuries? 1 The client is expected and allowed to die. 2 The client has an immediate threat to life. 3 The client has major injuries that require treatment. 4 The client has minor injuries that do not require immediate treatment.

4 The client has minor injuries that do not require immediate treatment. The green tag is assigned to the client who has minor injuries that do not require immediate treatment. The client who is expected and allowed to die will be given a black tag. The client who has an immediate threat to life will be given a red tag. The client who has major injuries that require treatment is given a yellow tag.

Which client injury would receive a black tag by the triage nurse during a mass casualty incident? 1 Concussion 2 Ankle sprain 3 Open femur fracture 4 Full-thickness body burns 80% total body surface area (TBSA)

4 full thickness body burns 80% total body surface area A black tag indicates the client has suffered an extensive injury and is expected, or allowed, to die. Typical examples of black-tagged clients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation. Full-thickness body burns 80% TBSA would qualify as an extensive full-thickness body burn. Clients with a concussion, ankle sprain, and open femur fracture would receive yellow and green tags.

Which personnel of the institutional emergency response plan serves as a liaison between hospital administration and the media during a mass casualty incident such as an earthquake or a terrorist attack? 1 Triage officer 2 Medical command physician 3 Hospital incident commander 4 Community relations information officer

4. Community relations information officer The community public information officer is a person who serves as a liaison between the healthcare facility and the media releasing only appropriate or accurate information about the incident. A triage officer is a physician or nurse who rapidly evaluates each client to determine priorities for treatment. A medical command physician is the personnel who decides the number, acuity, and resource needs of the clients. A hospital incident commander is a physician or administrator who assumes overall leadership for implementing the emergency plan.

The nursing instructor is teaching a group of nursing students and describes a situation where the victims of a mass casualty event who have been exposed to radiologic dispersal devices (RDDs) are brought to the emergency department. Which statement about RDD made by a nursing student indicates effective learning? 1 RDD does not involve explosives. 2 RDD exposure generally causes acute radiation syndrome (ARS). 3 Iodine-131 used in an RDD affects people in a wide surrounding radius. 4 Ionizing radiation released by an RDD does not cause immediate serious illness to people nearby.

4. Ionizing radiation released by RDD does not cause immediate serious illness to people nearby The radioactive materials used in an RRD do not release enough ionizing radiation to cause immediate serious illness, except to those victims who are in close proximity to the explosion. RDD consists of a mix of explosives and radioactive material; the main danger from an RRD results from the explosion. ARS develops after a substantial exposure to ionizing radiation, such as that from a nuclear bomb or damage to a nuclear reactor. Uranium and iodine-131, generally used in an RDD, do not release enough ionizing radiation to cause serious harm to people who are not in close proximity to the explosion.

After assessing a victim of a bomb blast that has caused mass casualties, the emergency department nurse applies a black band to the hand. What is the rationale behind this nursing action? A The victim's blood pressure is 110/80 mmHg. B The victim has severe head injury and requires artificial ventilation. C The victim is able to walk for some distance without assistance. D The victim has the large wounds and requires treatment within 2 hours.

B The victim has severe head injury and requires artificial ventilation. A black tag should be given to victims of a disaster who are expected to die. A severe head injury and need for artificial ventilation indicates a low chance of survival. Blood pressure of 110/80 mm Hg is a normal finding. Clients who can ambulate without assistance would be given a green tag. A yellow band is applied to the victims with large wounds who require treatment within 2 hours.

A group of 100 bomb blast victims were admitted to the hospital within an hour of the event. How should the hospital management use this information? A Arrange surgery facilities for 50 victims. B Arrange beds for at least 20 more victims. C Prepare staff to treat 100 more clients. D Shift the 100 existing clients to other hospitals.

C Prepare staff to treat 100 more clients. Hospital management can anticipate the total number of victims of a disaster by doubling the number of victims who arrive in the first hour. Therefore they should prepare staff to treat 100 additional clients. Generally half of the victims require surgery within 8 hours; therefore the hospital management should arrange surgery facilities for at least 100 victims. Generally, 30% of total victims require admission to the hospital; therefore the hospital staff should arrange extra beds for 60 victims(30/200 × 100= 60). Shifting the 100 existing clients is not appropriate, as other hospitals may also be taking in of victims.

Which medical relief team would the nurse expect to help healthcare facilities that face personnel shortages during a mass casualty event? 1 Medical Reserve Corps (MRC) 2 Disaster Medical Assistance Team (DMAT) 3 Hospital Incident Command System (HICS) 4 International Medical Surgical Response Teams (IMSuRTs)

Medical Reserve Corps (MRC) MRC is a group of volunteer medical and public healthcare professionals. MRC helps healthcare settings that face personnel shortages in a mass casualty event. DMAT is a team of civilian medical, paraprofessional, and support personnel that supplies medical equipment to sustain operations for 72 hours. HICS is a facility-level organizational model to standardize disaster operations. IMSuRTs provide fully functional field surgical facilities in a mass casualty event whenever needed.

The nurse is caring for victims of a bomb blast in the emergency department who are receiving different pain medications. Which client must be placed on electrocardiogram equipment?

Naproxen Nonsteroidal antiinflammatory medications such as naproxen may result in cardiovascular events such as myocardial infarction, stroke, and heart failure, so the client who is on naproxen requires continuous assessment of the cardiovascular system. Therefore the nurse places client D on the electrocardiogram equipment. Aspirin does not result in myocardial infarction, stroke, or heart failure, so client A does not need to be on the electrocardiogram equipment. Methadone and butorphanol do not cause cardiovascular risks. Therefore clients B and C do not need to be on electrocardiogram equipment.

Which agents of bioterrorism can be treated effectively with antibiotics? Select all that apply. A Plague B Anthrax C Botulism D Tularemia E Hemorrhagic fever

a,b,d Bioterrorism agents such as plague, anthrax, and tularemia are caused by bacterial species and are treated effectively by antibiotics. Botulism is treated with antitoxin though several vaccines are being studied. There are no established antiviral medications for most viruses causing hemorrhagic fever.

The registered nurse is caring for clients in a mass casualty event. In what order should the nurse care for clients according to priority of care? 1.Clients with black tag 2.Clients with red tag 3.Clients with yellow tag 4. Clients with green tag

red, yellow, green, then black Red-tagged clients have immediate injuries that are life-threatening and require immediate attention. Therefore these clients should be given first priority of treatment. A yellow tag is mainly given to clients who have major injuries such as open fractures; these clients should be treated within 30 minutes to 2 hours. Green tags are given to clients with minor injuries and they can be managed in delayed fashion, generally more than 2 hours. Black tag is given to the clients who are expected to die or who are already dead. Therefore these clients are given least priority because there is no chance of survival.