Chapter 56: PrepU - Nursing Management: Emergencies and Disasters

A client has a gaping wound on his forearm that is bleeding profusely. Applying pressure to which pressure point would be most helpful? Brachial Femoral Radial Subclavian

1

A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority? Monitor vital signs and oxygen saturation every 15 to 30 minutes. Suction the client as needed to obtain a sputum specimen for culture and sensitivity. Assess intake and output and maintain adequate hydration. Reassure the client that intubation and mechanical ventilation will be temporary.

1

A nuclear accident (intentional or unintentional) can cause significant harm to those living nearby or at a distance. Harmful levels of invisible gamma radiation penetrate the body, not only causing devastating injuries but possibly contaminating others. What type of transmission precaution prevents such person-to-person contamination? contact airborne droplet standard

1

A nurse is preparing an in-service education program to a group of nurses who are members of a disaster response team specializing in biologic weapons. Which of the following would the nurse include as the agent of choice when dealing with a mass casualty incident involving anthrax? 1- Ciprofloxacin 2- Penicillin 3- Erythromycin 4- Gentamicin

1

A nurse is providing discharge instruction to a victim who has been exposed to anthrax but does not have any symptoms. The nurse's teaching includes that prophylactic antibiotics must be taken for: 1- 60 days. 2- 30 days. 3- 14 days. 4- 10 days.

1

A nursing instructor is describing the role of a nurse during a disaster. Which of the following would best reflect the nurse's role? Variable depending on the needs of the situation Client care within the area of expertise Provision of comprehensive client-specific care Directly specified by the physician in charge

1

All people who have household or face-to-face contact with the client diagnosed with smallpox after the fever begins should be vaccinated within what time frame to prevent infection and death? 1- 4 days 2- 1 week 3- 10 days 4- 2 weeks

1

During a facility disaster drill, an "injured client" presents to the emergency department with complaints of dry mouth, inability to focus his vision, and double vision. A nurse notes that the client has an unsteady gait and appears to be very weak. The client states, "My arms and legs feel like they just can't move." A nurse suspects the client may be a victim of bioterrorism with: 1- botulism. 2- anthrax. 3- herpes. 4- Ebola.

1

During a mass casualty incident (hurricane), a triage nurse participated in separating patients according to the severity of their injuries. She tagged a patient with a sucking chest wound with the color: 1- red 2- yellow 3- green 4- black

1

Following a motor vehicle collision, a client is brought to the ED for evaluation and treatment. The client is being assessed for intra-abdominal injuries. The client reports severe left shoulder pain (pain score of 10 on a 1 to 10 scale). The nurse suspects injury to the 1- spleen. 2- liver. 3- gallbladder. 4- large intestine.

1

Homeland Security has alerted the disaster response teams in your region of a potential terrorist attack in the form of a nuclear blast. You are a part of the disaster response system and you know that with a nuclear blast you would need to be prepared for what classification of disaster? Radiologic Chemical Biologic Manmade

1

In a mass casualty event a client has been field triaged and categorized as green. The nurse recognizes that interventons for this client require which of the following priorities? 1- Minimal 2- Delayed 3- Immediate 4- Expectant

1

The ED staff work collaboratively and follow the ABCDE method to establish and treat health priorities effectively in a client experiencing a trauma. Which action is completed by the nurse when implementing the "D" element of this method? 1- Assessing the client's Glasgow Coma Scale score 2- Managing hypothermia 3- Providing cervical spine protection 4- Undressing the client quickly

1

The nurse is caring for three clients who have been diagnosed with anthrax. They were exposed after boarding a flight where a white powdery substance was found in one of the restrooms. The nurse knows that these clients would be classed as being victims of which of the following? A biologic disaster A natural disaster A radiologic disaster A chemical disaster

1

The nurse is conducting a secondary survey on a client in the ED. Which action is completed during the secondary survey? Diagnostic and laboratory testing Assessment of peripheral pulses Establishing a patent airway Undressing the client

1

The nurse is working with a victim suffering from blast lung and resultant air emboli. The nurse should immediately place the victim in which position? 1- Prone left lateral 2- Supine right lateral 3- High Fowler 4- Semi-Fowler

1

When assessing a client with suspected carbon monoxide poisoning, which finding would be least reliable? 1- Cherry red skin color 2- Headache 3- Confusion 4- Palpitations

1

When assessing a client with suspected carbon monoxide poisoning, which finding would be least reliable? Cherry red skin color Headache Confusion Palpitations

1

Which of the following federal disaster resources provides scene control and collection of forensic evidence? 1- Federal Bureau of Investigation (FBI) 2- Federal Emergency Management Agency (FEMA) 3- Centers for Disease Control and Prevention (CDC) 4- National Disaster Medical System (NDMS)

1

You are caring for radiation victims. What is the most important factor that you should consider to assess a client's chance of survival in acute radiation syndrome (ARS)? 1- Dosage of gamma radiation 2- Concentration of nerve gas 3- Mode of infection 4- Direct physical contact

1

Nursing students are reviewing information about anaphylactic reactions and their possible causes. The students demonstrate understanding of this information when they identify which of the following as a common cause? Select all that apply. Insect stings Medications Latex Eggs Shellfish Green vegetables

1,2,3,4,5

A patient is brought to the ED by a friend, who states that a tree fell on the patient's leg and crushed it while they were cutting firewood. What priority actions should the nurse perform? (Select all that apply.) 1- Applying a clean dressing to protect the wound 2- Elevating the site to limit the accumulation of fluid in the interstitial spaces 3- Inserting an indwelling catheter 4- Splinting the wound in a position of rest to prevent motion 5- Performing a fasciotomy

1,2,4

A nurse who is a member of an emergency response team anticipates that several patients with airway obstruction may need a cricothyroidotomy. For which of the following patients would this procedure be appropriate? Select all that apply. 1- Patient with extensive facial trauma 2- Patient with a lumbar spine injury 3- Patient with laryngeal edema secondary to anaphylaxis 4- Patient who is bleeding from the chest 5- Patient with an obstructed larynx

1,3,5

The nurse is taking a class on chemical disasters with the local emergency response team. What toxins would the nurse be learning about? Select all that apply. 1- Blistering agents 2- Psychologic agents 3- Contact emulsifiers 4- Nerve agents 5- Cyanide

1,4,5

A client has been exposed to a vesicant and is undergoing decontamination. Which of the following most likely would be used? Sodium hypochlorite Soap and water Alcohol Chlorhexidine

2

A client with severe shortness of breath comes to the emergency department. He tells the emergency department staff that he recently traveled to China for business. Based on his travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute? 1- Droplet precautions 2- Airborne and contact precautions 3- Contact and droplet precautions 4- Contact precautions

2

A finger sweep is only to be used in which client population? 1- Conscious adult 2- Unconscious adult 3- Child 4- Adolescent

2

A nurse is completing her annual cardiopulmonary resuscitation training. The class instructor tells her that a client has fallen off a ladder and is lying on his back; he is unconscious and isn't breathing. What maneuver should the nurse use to open his airway? Head tilt-chin lift Jaw-thrust Abdominal thrust Seldinger

2

A nurse is working with a group of disaster victims to reduce the psychological effects of the trauma. Which of the following would be least helpful? Actively listening to the victims' concerns. Encouraging the victims to watch television replays of the event. Referring victims to appropriate social service agencies. Encouraging victims to return to normal activities as they feel ready.

2

A nurse working in an emergency department notes that several clients who have arrived at the emergency department within the past day are experiencing the same unusual signs and symptoms. All the clients have attended the same sporting event. Which of the following should the nurse do next? Report the findings to the Centers for Disease Control and Prevention (CDC). Obtain an extensive history from each of the clients. Notify the person in charge of the Emergency Operations Plan. Put on personal protective equipment.

2

After inserting an oropharyngeal airway, the nurse determines that it is in the proper position when the flange is located at which position? 1- Just below the tip of the patient's nose 2- Approximately at the patient's lips 3- Directly in front of the patient's teeth 4- At the level of the patient's epiglottis

2

During a disaster, the nurse triages a victim with a fractured wrist. Which color triage tag should the nurse apply? Red Green Black Yellow

2

Four clients injured in an automobile accident enter the emergency department at the same time. The triage nurse evaluates them immediately. The nurse should assign the highest priority to the client with the: 1- lumbar spinal cord injury and lower extremity paralysis. 2- maxillofacial injury and gurgling respirations. 3- severe head injury and no blood pressure. 4- second-trimester pregnancy in premature labor.

2

Inhalation of anthrax mimics which disease process? 1- Bronchospasm 2- Flu 3- Respiratory distress 4- Burns

2

Permanent brain injury or death will occur within which time frame secondary to hypoxia? 1 to 2 minutes 3 to 5 minutes 6 to 8 minutes 9 to 10 minutes

2

Several families arrive at the scene of a disaster and are asking for information about their family members. Which person would be most appropriate to provide them with any information? 1- Security personnel 2- Public Information Officer 3- Incident Commander 4- Hospital Safety Officer

2

The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates? Elevated risk of attack Severe, credible impending threat, usually with a site specified Risk of attack, without a site specified Risk of attack, without timing specified

2

The emergency department nurse is caring for clients involved in a chlorine exposure accident at a local chemical plant. The nurse is aware that permanent damage can occur to which body systems? 1- Cardiac 2- Respiratory 3- Renal 4- Hepatic

2

The emergency department nurse is caring for clients involved in a chlorine exposure accident at a local chemical plant. The nurse is aware that permanent damage can occur to which body systems? Cardiac Respiratory Renal Hepatic

2

Three victims of radiation exposure are brought into the Emergency Department. As the nurse caring for these clients, you would expect what substance to be ordered to reduce radiologic organ damage? 1- Cyan red 2- Potassium iodide 3- Russian blue 4- Medical iodine

2

When describing the Emergency Operations Plan (EOP) to a group of nurses working as part of a disaster response team, which of the following would be identified as its primary goal? 1- Coordinated response 2- Protection of the community 3- Threat level reduction 4- Communication

2

Which category of triage encompasses clients with serious health problems that are not immediately life threatening? Emergent Urgent Nonurgent Psychological support

2

A female patient was sexually assaulted when leaving work. When assisting with the physical examination, what nursing interventions should be provided? (Select all that apply.) Have the patient shower or wash the perineal area before the examination. Assess and document any bruises and lacerations. Record a history of the event, using the patient's own words. Label all torn or bloody clothes and place each item in a separate brown bag so that any evidence can be given to the police. Ensure that the police are present when the examination is performed.

2,3,4

The nurse is admitting a client who has been exposed to the botulinum toxin during a terrorist attack. What should the nurse include in the client's immediate interdisciplinary care? Select all that apply. Administration of immunoglobulins Administration of antitoxin Positive pressure isolation Respiratory support Negative pressure isolation

2,4

Smallpox is considered a biological agent of warfare. Which of the following are correct statements about the virus that will direct responses? Select all that apply. It has an incubation period of 72 hours It is extremely contagious after appearance of a rash The rash appears one week after exposure A large amount of the virus is present in the saliva and pustules One form, variola major, has a 30% mortality rate

2,4,5

A client comes to the emergency department after experiencing a wound. Inspection reveals an opening in the skin with distinct edges and whose depth is greater than the length of the wound. The nurse documents this as which type of wound? Laceration Avulsion Stab Patterned

3

A client comes to the emergency department with a suspected airway obstruction. The emergency department team prepares to manage the client as if he has a complete airway obstruction based on which of the following? Forceful coughing Wheezing between coughs High-pitched noise on inhalation Refusal to lie flat

3

A client is brought to the emergency department after being involved in a motor vehicle collision. Which of the following would lead the nurse to suspect internal bleeding? 1- Bradycardia 2- Rising blood pressure 3- Delayed capillary refill 4- Pale pink dry skin

3

A nursing instructor is reviewing the various security threat levels associated with the Department of Homeland Security. When describing the orange level, which of the following would the nurse include? 1- A specific site has been identified. 2- Lockdown occurs for security. 3- Security and screenings are increased. 4- Monitoring activities are increased.

3

A patient was suspected of being in direct contact with anthrax but is exhibiting no signs or symptoms. What type of prophylaxis does the nurse know this patient will have to take? Penicillin G IM for 1 dose Rocephin (Ceftriaxone) IV for 7 days Ciprofloxacin (Cipro) for 60 days Erythromycin for 2 weeks

3

Exposure to gamma radiation can be decreased by completing which action? Wearing thick clothes Lengthening the duration of exposure Providing distance from radiation source Providing plastic shielding

3

The clinic nurse is triaging a client who had visited a smallpox affected community 14 days ago. The client has developed a fever but no rash. Should the nurse consider the client at risk for smallpox? No, smallpox rash develops within 7 days. No, in smallpox a rash develops before fever. Yes, fever and rash may follow 14 asymptomatic days. No, fever and rash develop immediately on exposure.

3

The nurse is caring for a victim of a chemical disaster. Medications given in the treatment of this client include amyl nitrate, sodium nitrate, and sodium thiosulfate. What chemical agent does the nurse know this client has been exposed to? 1- Sarin 2- Mustard gas 3- Cyanide 4- Anthrax

3

The nurse is instructing on bioterrorism agents. Which of the following does the nurse emphasize as an agent which is transmitted from person to person? Anthrax Botulism Smallpox Varicella

3

The nurse is orienting to the emergency department and finds cases of potassium iodine tablets located in the supply closet. The nurse asked the nurse manager why this is stored in the closet. The nurse manager's best response is: "Potassium iodine is given to individuals who come to the emergency department dehydrated to replenish their potassium level." "Potassium iodine is given to individuals diagnosed with hypothyroidism in the emergency department." "Potassium iodine is given to individuals as a prophylaxis for protecting the thyroid gland from absorption of radiation in case of an accident at the local nuclear plant." "Potassium iodine is given to individuals who are given furosemide intravenously in the emergency department to replenish their potassium level."

3

The student nurse is completing a simulation where a client is the victim of nerve gas. The instructions are for the student to set up the room and have all needed supplies available. Which medication does the student nurse ensure is in the medication administration system to control seizures? 1- Phenobarbital intramuscular 2- Neurontin tablets 3- Valium intravenous injection 4- Dilantin tablets

3

When describing the use of smallpox as a biologic agent, which of the following would the nurse include as the primary means of infection? 1- Inhalation 2- Ingestion 3- Direct contact 4- Percutaneous absorption

3

When preparing to perform abdominal thrusts on a client with an airway obstruction, which of the following would be most appropriate? Having the conscious client lie down Placing the thumb side of one hand at the xiphoid process Positioning the hands in the midline slightly above the umbilicus Using a sequence of four thrusts, each progressing in intensity

3

Which statement reflects the nursing management of pulmonary anthrax (Bacillus anthracis)? 1- Airborne person-to-person transmission occurs with anthrax. 2- Diagnosis is done by pulmonary function testing and chest x-ray. 3- Treatment with ciprofloxacin or doxycycline is suggested after exposure. 4- Pulmonary effects include respiratory failure, shock, and death within 5 to 7 days after exposure.

3

While watching a television newscast, a nurse hears that the Department of Homeland Security has identified the security threat level as yellow. The nurse interprets to mean which of the following? 1- The risk of a credible attack is extremely high. 2- The condition is guarded with a generalized risk. 3- There is an elevated risk but no defined site. 4- The risk is low with little information known.

3

A nuclear reactor overheated, releasing radiation throughout the plant. A worker close to reactor received at least 800 rads and has had an onset of vomiting, bloody diarrhea, and, when brought to the hospital, was in shock. What is this patient's predicted survival? Possible Probable Likely Improbable

4

A patient has undergone a diagnostic peritoneal lavage. The nurse interprets which result as indicating a positive test? 1- Red blood cell count of 50,000/mm3 2- White blood cell count of 300/mm3 3- Absence of bile 4- Evidence of feces

4

A patient who has accidentally ingested toilet bowel cleaner is brought to the emergency department. Which action would NOT be appropriate for the nurse to implement? Dilution with water or milk Gastric lavage Administration of activated charcoal Induced vomiting

4

As part of an emergency department team, an emergency nurse is conducting a secondary survey on a client. Which of the following would the nurse include? 1- Establishing a patent airway 2- Providing adequate ventilation 3- Assessing neurologic function 4- Applying electrocardiogram electrodes

4

During a mass disaster, the nurse is caring for a victim whose status has been categorized as yellow during triage. How should the nurse best allocate time and resources to this client's care? Forego immediate care because the client is unlikely to survive Place a low priority on the client's care because the client will likely recover independently Provide high-priority, immediate care to save the client's life Delay the client's treatment for a few hours if other clients need immediate care

4

One of the nuclear power plants experiences a crack in the protection of the core when the cooling system malfunctions. The thought is that the cooling system was tampered with. Healthcare facilities in the area are inundated with victims residing in the area around the power plant. What category of disaster would this be? A biologic disaster A chemical disaster A nuclear blast A radiologic disaster

4

Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage? Priority 1 Priority 2 Priority 3 Priority 4

4

The nurse is administering 100% oxygen to a patient with carbon monoxide poisoning and obtains a carboxyhemoglobin level. Which level would the nurse interpret as indicating that oxygen therapy can be discontinued? 1- 9% 2- 7% 3- 6% 4- 4%

4

The nurse is assessing a victim who is reported to have been exposed to sulfur mustard. The nurse's assessment should include evaluation for 1- pulmonary edema. 2- diarrhea. 3- cardiac arrest and death. 4- partial-thickness burns.

4

The nurse is caring for a client diagnosed with botulism. Which medication classification does the nurse anticipate? An antibiotic An anti-inflammatory Antipyretics Antitoxins

4

The nurse is instructing volunteers at an emergency bioterrorism drill about the management and medications required to combat various viruses, bacteria, and toxins. The nurse knows that the volunteers understand the instruction when they state that managing clients who exhibit symptoms of the variola virus (smallpox) includes acyclovir. decontamination. radiation. isolation.

4

When preparing for an emergency bioterrorism drill, the nurse instructs the drill volunteers that each biological agent requires specific client management and medications to combat the virus, bacteria, or toxin. Which statement reflects the client management of variola virus (smallpox)? Acyclovir is effective against smallpox. Smallpox is spread by inhalation of spores. A vaccination is effective only if administered within 12 to 24 hours of exposure. Smallpox spreads rapidly and requires immediate isolation.

4

Which is defined as the potential of an agent to cause injury to the body? Volatility Latency Persistence Toxicity

4