Disaster

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Communication and Documentation 22. A hospital has "stood down" from a mass casualty disaster. The staff have rested and eaten. Which action by the nursing supervisor takes priority? a. Restocking the emergency department (ED) b. Making rounds on each unit to check staffing c. Determining which staff can go home d. Planning a critical incident stress debriefing

A Inventorying and stocking the ED are high-priority actions because the usual flow of emergency clients may not be lessened in the wake of a disaster. Supplies may be low or exhausted, and it would be vital to resupply the area. Rounding on inpatient units, determining the staff who can be relieved, and planning a debriefing are certainly important items, but they do not take priority over getting the ED ready for more clients. DIF: Cognitive Level: Knowledge/Remembering

1003 OBJ: 2 (clinical) TOP: Preparing Safe Drinking Water: Techniques KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. The nurse is aware that organisms that may be released in a bioterrorism attack because of their high lethality include: (Select all that apply.) a. Ebola. b. avian flu. c. botulism. d. smallpox. e. tularemia.

A, C, D, E Avian flu (bird flu) is not on the category A list. DIF: Cognitive Level: Comprehension

997 OBJ: 2 (theory) TOP: Disaster Preparation: Courses KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. The nurse demonstrates how water can be rendered safe for drinking in the event of a disruption of service by: (Select all that apply.) a. letting the water sit for 24 hours and dipping from the top. b. boiling the water for 3 to 5 minutes. c. adding 1 mL (16 drops) of household bleach to a gallon of water and letting it stand for 30 minutes. d. draining water from hot water heater and using without treatment. e. pouring water through several layers of cotton towels.

B, C, D Water can be rendered safe for drinking by boiling or treating with household bleach or using water in hot water heater or commode tank. DIF: Cognitive Level: Analysis

142 KEY: Emergency nursing MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 10. After a hospitals emergency department (ED) has efficiently triaged, treated, and transferred clients from a community disaster to appropriate units, the hospital incident command officer wants to stand down from the emergency plan. Which question should the nursing supervisor ask at this time? a. Are you sure no more victims are coming into the ED? b. Do all areas of the hospital have the supplies and personnel they need? c. Have all ED staff had the chance to eat and rest recently? d. Does the Chief Medical Officer agree this disaster is under control?

B Before standing down, the incident command officer ensures that the needs of the other hospital departments have been taken care of because they may still be stressed and may need continued support to keep functioning. Many more walking wounded victims may present to the ED; that number may not be predictable. Giving staff the chance to eat and rest is important, but all areas of the facility need that too. Although the Chief Medical Officer (CMO) may be involved in the incident, the CMO does not determine when the hospital can stand down. DIF: Applying/Application

1000 OBJ: 2 (theory) TOP: Institutional Disaster Plans KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 3. The nurse assures a patient that accredited health care facilities test their emergency plan with a drill at least _____ time(s) each year. a. 4 b. 3 c. 2 d. 1

C Disaster drills should be conducted 2 times a year. DIF: Cognitive Level: Comprehension

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Assessment) 9. A nurse is working at the scene of a catastrophic natural event. Which person does the nurse attend to first? a. Distraught mother looking for her children b. Person walking about with a bleeding head wound c. Supine person with pale, cool, clammy skin d. Child with a deformed lower leg crying in pain

C The person with pale, cool, clammy skin is in shock and needs immediate medical attention. The mother does not have injuries and so would be the lowest priority. The other two people need medical attention soon, but not at the expense of a person in shock. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss) MSC: Integrated Process: Caring 24. An emergency department (ED) supervisor has noted an increase in sick calls and bickering among the ED staff after a week with multiple trauma incidents. What action by the supervisor is most helpful? a. Organize a pizza party for each shift. b. Remind staff of facility sick-leave policy. c. Arrange critical incident stress debriefing. d. Talk individually with staff members.

C The staff may be suffering from critical incident stress and needs to have a debriefing by the critical incident stress management team to prevent the consequences of long-term, unabated stress. The other interventions may be helpful as well but are not as important as a debriefing. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Implementation) 4. A hospital is receiving large numbers of casualties from a disaster. Which clients does the supervisor identify as appropriate for discharge or transfer to another facility? (Select all that apply.) a. Client who had open reduction and internal fixation of a femur fracture 3 days ago b. Client who had a colostomy 4 days ago and whose daughter is a registered nurse c. Client admitted last night with community-acquired pneumonia d. Infant admitted 2 days ago for fever of unknown origin e. Client in the medical decision unit for evaluation of chest pain

A, B The client with the femur fracture could be transferred to a rehabilitation facility and the RN could provide care and teaching to her father. The newly admitted client with pneumonia would not be a good choice because culture results are not yet available and antibiotics have not been administered long enough. Also, the infant has not been in the hospital long enough for cultures to return for a definitive diagnosis. The client in the medical decision unit should be identified for dismissal if diagnostic testing reveals a noncardiac source of chest pain. DIF: Cognitive Level: Application/Applying or higher

1012 OBJ: 8 (theory) TOP: Plague: Fragility of Organism KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 17. Following a terrorist attack using smallpox virus, the nurse assesses a newly admitted patient with large vesicles all over her body that could be either smallpox or chickenpox. The nurse feels confident that the lesions are those of smallpox because of the lesions assessed on the: a. face. b. mucous membranes. c. soles of the feet. d. axilla.

C The lesions of smallpox can be found on the palms of the hands and soles of the feet. The lesions of chickenpox do not appear there. DIF: Cognitive Level: Comprehension

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Implementation) 2. A client who is hospitalized with burns after losing the family home in a fire becomes angry and screams at the nurse when dinner is served late. What is the nurse's best response? a. "Do you need something for pain right now?" b. "Please stop yelling. I brought dinner as soon as I could." c. "I suggest that you get control of yourself." d. "You seem upset. I have time to talk if you like."

D Clients should be allowed to ventilate their feelings of anger and despair after a catastrophic event. The nurse establishes rapport through active listening and honest communication and by recognizing cues that the client wishes to talk. Asking whether the client is in pain as the first response closes the door to open communication and limits the client's options. Simply telling the client to gain control does nothing to promote therapeutic communication. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms) MSC: Integrated Process: Nursing Process (Assessment) 4. An industrial accident has occurred near the hospital, and many victims are brought to the emergency department (ED) for treatment of their injuries. The nurse triages the victim with which injury with a red tag? a. Dislocated right hip and an open fracture of the right lower leg b. Large contusion to the forehead and a bloody nose c. Closed fracture of the right clavicle and arm numbness d. Multiple fractured ribs and shortness of breath

D Clients who have an immediate threat to life are given the highest priority, are placed in the emergent or class I category, and are given a red triage tag. The client with multiple rib fractures and shortness of breath most likely has developed a pneumothorax, which may be fatal if not treated immediately. The client with the hip and leg problem and the client with the clavicle fracture would be classified as class II; these major but stable injuries can wait 30 minutes to 2 hours for definitive care. The client with facial wounds would be considered the "walking wounded" and classified as nonurgent. DIF: Cognitive Level: Application/Applying or higher

141 KEY: Triage| emergency nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. An emergency department (ED) charge nurse prepares to receive clients from a mass casualty within the community. What is the role of this nurse during the event? a. Ask ED staff to discharge clients from the medical-surgical units in order to make room for critically injured victims. b. Call additional medical-surgical and critical care nursing staff to come to the hospital to assist when victims are brought in. c. Inform the incident commander at the mass casualty scene about how many victims may be handled by the ED. d. Direct medical-surgical and critical care nurses to assist with clients currently in the ED while emergency staff prepare to receive the mass casualty victims.

D The ED charge nurse should direct additional nursing staff to help care for current ED clients while the ED staff prepares to receive mass casualty victims; however, they should not be assigned to the most critically ill or injured clients. The house supervisor and unit directors would collaborate to discharge stable clients. The hospital incident commander is responsible for mobilizing resources and would have the responsibility for calling in staff. The medical command physician would be the person best able to communicate with on-scene personnel regarding the ability to take more clients. DIF: Applying/Application

1011 OBJ: 8 (theory) TOP: Category B Agents: Delivery Mode KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 13. The nurse clarifies that when a person has been exposed to particulate radioactive material, a chelating agent such as calcium edentate (EDTA) is given to: a. bind with radioactive material and allow it to be excreted. b. reduce radioactivity to nonharmful levels. c. form a protective coat in the gastrointestinal system. d. dissolve particulate material.

A Chelating agents bind with radioactive material, allowing it to be excreted without absorption. DIF: Cognitive Level: Comprehension

1006 OBJ: 6 (theory) TOP: Chlorine Gas: Assessing Threat KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 10. A tornado has touched down 1 mile from the hospital and a tornado warning has been issued with sirens. The nursing staff caring for the 36 patients on the second floor medical-surgical unit should move the patients to: a. the evacuation center across the street. b. the hall, closing room doors and windows. c. their rooms, padding the windows with bed linens. d. the basement in wheelchairs using the elevators.

B Movement to the hall is the safest and fastest and does not expose the patients to being out of doors, in elevators, or near exterior windows. DIF: Cognitive Level: Application

143 KEY: Emergency nursing| interdisciplinary team MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 1. The nurse informs a high school class that one of the differences between an emergency situation and a disaster is that, in an emergency situation: a. fewer than 50 people require emergent treatment. b. the community emergency rooms can meet the need. c. there is no need for a prearranged management plan. d. the community population is not affected by the event.

B An emergency situation, such as a plane crash at a local airport, can be handled by community emergency departments. Each community has in place an emergency plan as to dispersal of people needing to be treated, law enforcement participation, and transportation. Communities are always affected when a large scale emergency situation occurs. DIF: Cognitive Level: Comprehension

997 OBJ: 2 (theory) TOP: Disaster Plan: Essentials KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 22. The nurse is preparing a list of items that are needed in a disaster kit. The list will correctly include which items? (Select all that apply.) a. Water for 12 days b. Nonperishable food items c. Prescription medication d. Portable radio e. Bedding f. First aid kit

B, C, D, E, F It is suggested that water for 3 days be included in a disaster kit. All other options should be included in a disaster kit. DIF: Cognitive Level: Comprehension

143 KEY: Triage| emergency nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. A hospital prepares for a mass casualty event. Which functions are correctly paired with the personnel role? (Select all that apply.) a. Paramedic Decides the number, acuity, and resource needs of clients b. Hospital incident commander Assumes overall leadership for implementing the emergency plan c. Public information officer Provides advanced life support during transportation to the hospital d. Triage officer Rapidly evaluates each client to determine priorities for treatment e. Medical command physician Serves as a liaison between the health care facility and the media

B, D The hospital incident commander assumes overall leadership for implementing the emergency plan. The triage officer rapidly evaluates each client to determine priorities for treatment. The paramedic provides advanced life support during transportation to the hospital. The public information officer serves as a liaison between the health care facility and the media. The medical command physician decides the number, acuity, and resource needs of clients. DIF: Remembering/Knowledge

141 KEY: Triage| emergency nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. A hospital prepares to receive large numbers of casualties from a community disaster. Which clients should the nurse identify as appropriate for discharge or transfer to another facility? (Select all that apply.) a. Older adult in the medical decision unit for evaluation of chest pain b. Client who had open reduction and internal fixation of a femur fracture 3 days ago c. Client admitted last night with community-acquired pneumonia d. Infant who has a fever of unknown origin e. Client on the medical unit for wound care

B, E The client with the femur fracture could be transferred to a rehabilitation facility, and the client on the medical unit for wound care should be transferred home with home health or to a long-term care facility for ongoing wound care. The client in the medical decision unit should be identified for dismissal if diagnostic testing reveals a noncardiac source of chest pain. The newly admitted client with pneumonia would not be a good choice because culture results are not yet available and antibiotics have not been administered long enough. The infant does not have a definitive diagnosis. DIF: Applying/Application

146 KEY: Psychosocial response| crisis intervention MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity 12. An emergency department charge nurse notes an increase in sick calls and bickering among the staff after a week with multiple trauma incidents. Which action should the nurse take? a. Organize a pizza party for each shift. b. Remind the staff of the facilitys sick-leave policy. c. Arrange for critical incident stress debriefing. d. Talk individually with staff members.

C The staff may be suffering from critical incident stress and needs to have a debriefing by the critical incident stress management team to prevent the consequences of long-term, unabated stress. Speaking with staff members individually does not provide the same level of support as a group debriefing. Organizing a party and revisiting the sick-leave policy may be helpful, but are not as important and beneficial as a debriefing. DIF: Applying/Application

1006 OBJ: 8 (theory) TOP: Bioterrorism: Organisms with High Lethality KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 26. The nurse is participating in an educational program concerning nuclear disasters. The nurse correctly recognizes that the level of exposure will be determined by which factors? (Select all that apply.) a. Age of the victim b. Body surface area of the victim c. Length of exposure d. Distance of the victim from the nuclear source e. Shielding of the victim from the nuclear source

C, D, E The amount of damage to each person depends on the type of radiation, the dose received, the length of time of exposure, and the route of the exposure. Time, distance, and shielding are key to the quantity of radiation an individual will receive. The shorter the time of exposure, the farther away from the radiation source, and whether or not the person was shielded by materials that are impermeable to radiation are details pertinent to radiation risk. DIF: Cognitive Level: Comprehension

1012 OBJ: 8 (theory) TOP: Smallpox vs. Chickenpox KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 18. The nurse is aware that the purpose of debriefing as outlined in the disaster plan for the health professionals who were involved in caring for the victims of a disaster a month ago is to: a. analyze the effectiveness of the disaster plan. b. assess the efficiency of the service provided by various agencies. c. modify the disaster plan. d. help allay post-traumatic stress disorders.

D The debriefing is for the purpose of allowing the health professionals to ventilate about their experiences in an effort to allay long-term psychological problems. DIF: Cognitive Level: Comprehension

144 KEY: Emergency nursing MSC: Integrated Process: Nursing Process: Planning NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 5. The hospital administration arranges for critical incident stress debriefing for the staff after a mass casualty incident. Which statement by the debriefing team leader is most appropriate for this situation? a. You are free to express your feelings; whatever is said here stays here. b. Lets evaluate what went wrong and develop policies for future incidents. c. This session is only for nursing and medical staff, not for ancillary personnel. d. Lets pass around the written policy compliance form for everyone.

A Strict confidentiality during stress debriefing is essential so that staff members can feel comfortable sharing their feelings, which should be accepted unconditionally. Brainstorming improvements and discussing policies would occur during an administrative review. Any employee present during a mass casualty situation is eligible for critical incident stress management services. DIF: Applying/Application

145 KEY: Psychosocial response| crisis intervention MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Psychosocial Integrity 6. A nurse is caring for a client whose wife died in a recent mass casualty accident. The client says, I cant believe that my wife is gone and I am left to raise my children all by myself. How should the nurse respond? a. Please accept my sympathies for your loss. b. I can call the hospital chaplain if you wish. c. You sound anxious about being a single parent. d. At least your children still have you in their lives.

C Therapeutic communication includes active listening and honesty. This statement demonstrates that the nurse recognizes the clients distress and has provided an opening for discussion. Extending sympathy and offering to call the chaplain do not give the client the opportunity to discuss feelings. Stating that the children still have one parent discounts the clients feelings and situation. DIF: Applying/Application

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Concepts of Management) MSC: Integrated Process: Nursing Process (Implementation) 11. The nurse is teaching nursing students about personal emergency preparedness. Which statement by a student indicates that further teaching is indicated? a. "I will get a prescription for antibiotics just in case I have to work in an area that has been infected with anthrax." b. "I should keep an extra uniform in my locker in case I get stuck at work." c. "I may be torn between caring for my young daughter and caring for victims at work." d. "I should make plans for my family to evacuate our house in case of tornado or earthquake."

A The student would have no reason to obtain a prescription for anthrax unless he or she demonstrates clinical evidence of anthrax infection or has been exposed to a substance that tests positive for anthrax. Statements about planning to keep an extra uniform at work, recognizing the moral dilemmas he or she might encounter when working in a disaster situation, and understanding personal preparation for disasters all indicate that the student comprehends information about disaster planning and emergency preparedness. DIF: Cognitive Level: Application/Applying or higher

1002 OBJ: 5 (theory) TOP: Flood: Water Provision and Protection KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 6. The nurse is aware that during a power failure, perishable food should be kept at _____ F to prevent possibility of food poisoning. a. 40 b. 45 c. 50 d. 55

A To prevent spoilage, perishable foods should be kept at 40 F. DIF: Cognitive Level: Comprehension

p. 159 TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Implementation) 20. A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but is concerned about maintaining licensure in several different states. What statement by the nursing supervisor best addresses these concerns? a. "Deployed DMAT providers are federal employees, so their licenses are good in all 50 states." b. "The government has a program for quick licensure activation wherever you are deployed." c. "During a time of crisis, licensure issues would not be the government's priority concern." d. "If you are deployed, you will be issued a temporary license in the state in which you are working."

A When deployed, DMAT health care providers are acting as agents of the government, and so are considered federal employees. Thus their licenses are valid in all 50 states. Licensure is an issue that the government would be concerned with, but no programs for temporary licensure or rapid activation are available. DIF: Cognitive Level: Knowledge/Remembering

141 KEY: Triage| emergency nursing MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 8. A nurse wants to become involved in community disaster preparedness and is interested in helping set up and staff first aid stations or community acute care centers in the event of a disaster. Which organization is the best fit for this nurses interests? a. The Medical Reserve Corps b. The National Guard c. The health department d. A Disaster Medical Assistance Team

A The Medical Reserve Corps (MRC) consists of volunteer medical and public health care professionals who support the community during times of need. They may help staff hospitals, establish first aid stations or special needs shelters, or set up acute care centers in the community. The National Guard often performs search and rescue operations and law enforcement. The health department focuses on communicable disease tracking, treatment, and prevention. A Disaster Medical Assistance Team is deployed to a disaster area for up to 72 hours, providing many types of relief services. DIF: Remembering/Knowledge

142 KEY: Emergency nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 9. A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but is concerned about maintaining licensure in several different states. Which statement best addresses these concerns? a. Deployed DMAT providers are federal employees, so their licenses are good in all 50 states. b. The government has a program for quick licensure activation wherever you are deployed. c. During a time of crisis, licensure issues would not be the governments priority concern. d. If you are deployed, you will be issued a temporary license in the state in which you are working.

A When deployed, DMAT health care providers are acting as agents of the federal government, and so are considered federal employees. Thus their licenses are valid in all 50 states. Licensure is an issue that the government would be concerned with, but no programs for temporary licensure or rapid activation are available. DIF: Understanding/Comprehension

1015 OBJ: 3 (clinical) TOP: Pandemic Infections KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 21. The nurse explains that the essential elements in a disaster plan are the preparation and organization to provide: (Select all that apply.) a. shelter for victims. b. transportation. c. communication. d. welfare of victims. e. food.

A, B, C, D, E All options are essential elements in a disaster plan. DIF: Cognitive Level: Comprehension

998 OBJ: 3 (clinical) TOP: Disaster Kits: Minimal Provisions KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 23. The nurse encourages civic-minded people to enroll in local civil defense courses on disaster preparedness to better understand the role of the: (Select all that apply.) a. state government. b. federal government. c. law enforcement. d. individual service agencies. e. nurse as a volunteer.

A, B, C, D, E All options are part of the course presentation. DIF: Cognitive Level: Comprehension

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Implementation) 2. The triage nurse is assessing a client who has been brought to the emergency department (ED) by emergency medical services (EMS) following a mass casualty incident. Which assessment questions are used to determine the appropriate triage category for the client? (Select all that apply.) a. "Can you wiggle your toes?" b. "Are you having any difficulty breathing?" c. "Are you allergic to any medications?" d. "Does your family know that you are here?" e. "Can you tell me what day it is?" f. "Do you have any abdominal or back pain?"

A, B, E, F The triage nurse should assess for possible spinal cord injury, shortness of breath, abdominal or back pain, and disorientation when the client is brought to the ED. Determining allergies, although important, does not assist in categorizing clients, nor does inquiring about the client's family. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Implementation) 3. Emergency medical services (EMS) brings a large number of clients to the emergency department following a mass casualty incident. The nurse identifies clients with which injuries with yellow tags? (Select all that apply.) a. Partial-thickness burns covering both legs b. Open fractures of both legs with absent pedal pulses c. Neck injury and numbness of both legs d. Small pieces of shrapnel embedded in both eyes e. Head injury and difficult to arouse f. Bruising and pain in the right lower abdomen

A, C, D, F Clients with burns, spine injuries, eye injuries, and stable abdominal injuries should be treated within 30 minutes to 2 hours, and therefore should be identified with yellow tags. The client with the open fracture and the client with the head injury would be classified as urgent with red tags. DIF: Cognitive Level: Application/Applying or higher

145 KEY: Psychosocial response| crisis intervention MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity MULTIPLE RESPONSE 1. Emergency medical services (EMS) brings a large number of clients to the emergency department following a mass casualty incident. The nurse identifies the clients with which injuries with yellow tags? (Select all that apply.) a. Partial-thickness burns covering both legs b. Open fractures of both legs with absent pedal pulses c. Neck injury and numbness of both legs d. Small pieces of shrapnel embedded in both eyes e. Head injury and difficult to arouse f. Bruising and pain in the right lower abdomen

A, C, D, F Clients with burns, spine injuries, eye injuries, and stable abdominal injuries should be treated within 30 minutes to 2 hours, and therefore should be identified with yellow tags. The client with the open fractures and the client with the head injury would be classified as urgent with red tags. DIF: Analyzing/Analysis

141 KEY: Triage| emergency nursing MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 2. A nurse triages clients arriving at the hospital after a mass casualty. Which clients are correctly classified? (Select all that apply.) a. A 35-year-old female with severe chest pain: red tag b. A 42-year-old male with full-thickness body burns: green tag c. A 55-year-old female with a scalp laceration: black tag d. A 60-year-old male with an open fracture with distal pulses: yellow tag e. An 88-year-old male with shortness of breath and chest bruises: green tag

A, D Red-tagged clients need immediate care due to life-threatening injuries. A client with severe chest pain would receive a red tag. Yellow-tagged clients have major injuries that should be treated within 30 minutes to 2 hours. A client with an open fracture with distal pulses would receive a yellow tag. The client with full-thickness body burns would receive a black tag. The client with a scalp laceration would receive a green tag, and the client with shortness of breath would receive a red tag. DIF: Analyzing/Analysis

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Assessment) 5. The nurse working with survivors of a disaster wants to assess them for post-traumatic stress disorder. For which clients does the nurse perform further assessment before administering the Impact of Event Scale-Revised?(Select all that apply.) a. Older adult survivor with minor injuries b. Woman who lost both her children c. Middle-aged victim with multiple medical problems d. Young adult who had serious orthopedic injuries e. Older adolescent who had a traumatic brain injury

A, E The Impact of Event Scale-Revised tool should not be used with people who have short-term memory loss, so the nurse should assess the older adult survivor and the client with the brain injury for this problem before administering the tool. The other clients do not have medical issues that would preclude use of this tool. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Evaluation) 17. A nursing administrator is reviewing a hospital's disaster planning. The administrator evaluates the plan that addresses which component as being the best? a. Internal disasters such as fires or power outages b. All possible catastrophes in the community c. The Joint Commission's assessment of possible disasters d. Responses to all types of weather-related emergencies

B When The Joint Commission-accredited health care facilities are planning disaster preparedness programs, they need to take an "all-hazards approach" (versus planning by strict guidelines) and to plan for all credible threats to the community that could result in a disaster. This means planning for all events that could conceivably happen in that geographic area, including possible weather events. Planning only for internal disasters is too limited and does not account for weather- or terrorist-related threats. The Joint Commission does not assess what disasters are possible in the areas that accredited hospitals serve. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Stress Management) MSC: Integrated Process: Caring MULTIPLE RESPONSE 1. A large number of victims arrive at the emergency department after a bus is hit by a train. Which interventions are performed immediately for red-tagged victims? (Select all that apply.) a. Splinting a closed tibial fracture b. Intubating a cyanotic client in respiratory distress c. Initiating IV fluids for a client with a blood pressure of 96/60 mm Hg and a pulse of 144 beats/min d. Attaching an external pacemaker for a client with a heart rate of 44 beats/min e. Performing postmortem care for a client who has just died f. Removing glass that is embedded in a client's arm

B, C, D Priority interventions are those that must be performed to save the client's life, including intubation, IV fluid replacement for shock, and pacemaker placement. Splinting a fracture and removing glass from a client's arm can wait until after life-threatening injuries are cared for. Postmortem care would wait until after all clients have been cared for. DIF: Cognitive Level: Application/Applying or higher

1016 OBJ: 10 (theory) TOP: Debriefing: Purpose KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity 19. A patient comes to the emergency department with reports of exposure to a toxic chemical spill. The assessment reveals that the patient has inhaled the chemical and had the chemical on his clothing. What actions by the nurse are appropriate? a. The nurse advises the patient to leave in contact lenses to continue to provide protection to the eyes. b. The nurse will proceed to irrigate the patients eyes for 5 to 7 minutes with water. c. The nurse will use tongs to handle items taken off by the patient. d. The nurse will place the clothing in a metal receptacle for disposal.

C The clothing and contact lenses will be considered contaminated. They will need to be removed. Tongs will be included in the types of protective equipment needed to manage the patient. Eye irrigation will need to be performed for a period of 10 to 15 minutes. The clothing will need to be placed in a plastic bag for disposal. DIF: Cognitive Level: Analysis

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Assessment) 5. The nurse is working with a paramedic who just finished assisting at the scene of a school shooting where several students were killed. Which statement by the nurse is most therapeutic? a. "Would you like to talk about what happened?" b. "Surely the department will give you the day off tomorrow." c. "At least the gunman was taken into custody." d. "Let's just sit here for a while quietly."

A Allowing staff members to ventilate their feelings about the incident can facilitate recovery and effective coping afterward. The other choices do not facilitate open communication because the nurse is not providing the opportunity for the paramedic to talk. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication) MSC: Integrated Process: Communication and Documentation 14. The emergency department nurse manager is explaining concepts of emergency and disaster preparedness to a group of students. Which statement by the nurse manager is most accurate? a. "An internal disaster is something that occurs inside the health care facility." b. "An external disaster occurs when someone not employed here disrupts our operations." c. "A multi-casualty event involves disasters at several different locations." d. "The Joint Commission requires that we participate in a disaster drill once a year."

A An internal disaster is something that occurs within the health care facility, such as a fire. External disasters, such as a tornado or a hurricane, occur outside the health care facility. A multi-casualty event can be managed with hospital resources. The Joint Commission requires hospitals to participate in two disaster drills a year. DIF: Cognitive Level: Knowledge/Remembering

1001 OBJ: 3 (clinical) TOP: Disaster: Establishing Order KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity 9. The news reported that a train derailment 5 miles away from the clinic spilled a large amount of liquid chlorine that has been vaporized by the atmosphere. An indication that the chlorine gas is an imminent threat to the clinic would be: a. sighting of a low-lying green cloud. b. smelling almonds or burning feathers. c. sudden nausea. d. skin blistering.

A Chlorine gas can be seen as a low-lying green cloud. The smell of almonds is associated with cyanide. Skin blistering is the result of contact with liquid chlorine. DIF: Cognitive Level: Application

1006 OBJ: 3 (clinical) TOP: Food Supply: Preservation KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 8. To help restore order in a group of 18 people who are trapped in a third-floor office building by rising flood water, the nurse should: a. give everyone a specific duty, for example, arranging furniture for sleeping. b. let the people direct themselves to helpful tasks. c. make a list of essential jobs and ask the others to volunteer. d. put all the food in a central place and direct people to take what they need.

A During the impact stage, firm direction is needed, and executing essential helpful jobs will help restore order. Asking for volunteers when there is a loss of order and control would be counterproductive and would lack the direction needed by those affected. Food will need to be rationed in the event there is no rescue for an extended period of time. The rationing should be performed with direction and not allow the people to take whatever they wish. DIF: Cognitive Level: Analysis

1000 OBJ: 2 (theory) TOP: Disaster Drills: Frequency KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 4. A truck has just smashed into the dayroom of a long-term health care facility with enormous damage and injuring many of the residents. The noninjured residents are stunned and frightened and totally disorganized. Recognizing that everyone is in the impact stage, the nurse should: a. firmly instruct two CNAs to start wheeling residents to the dining room in their wheelchairs. b. begin wheeling residents back to their rooms herself. c. shout for everyone to hurry to the dining room. d. start treating the injured in the dayroom.

A In the impact stage, firm direction is needed to get people to a central place for safety and information. DIF: Cognitive Level: Analysis

p. 162 TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Planning) 23. A family in the emergency department is overwhelmed at the loss of several family members due to a shooting incident in the community. Which intervention by the nurse is most beneficial? a. Offer the family choices as appropriate and possible. b. Call the hospital chaplain to stay with the family. c. Do not allow visiting of the victims until the bodies are prepared. d. Provide privacy for law enforcement to interview the family.

A Offering choices when appropriate and when possible gives some personal control back to individuals. The family may or may not want the assistance of religious personnel; the nurse should assess for this before calling anyone. Visiting procedures should take into account the needs of the family. The family may appreciate privacy, but this is not as helpful as allowing choices when the family is able to make them. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Emergency Response Plan) MSC: Integrated Process: Teaching/Learning 12. The hospital administration has arranged for critical incident stress debriefing for the staff after a mass casualty incident. Which statement by the debriefing team leader is most appropriate for this situation? a. "You are free to express your feelings; whatever is said here stays here." b. "Let's determine what we can do better the next time we have this situation." c. "This session is only for nursing and medical staff, not for ancillary personnel." d. "Let's pass around the written policy compliance form for everyone."

A Strict confidentiality during stress debriefing is essential so that staff members can feel comfortable sharing their feelings, which should be accepted unconditionally. Brainstorming improvements and discussing policies would occur during an administrative review. Any employee present during a mass casualty situation is eligible for critical incident stress management services. DIF: Cognitive Level: Comprehension/Understanding

p. 157 TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Teaching/Learning 19. A nurse wants to become involved in community disaster preparedness and is interested in helping set up and staff first aid stations or community acute care centers in the event of a disaster. Which organization is the best fit for this nurse's interests? a. The Medical Reserve Corps b. The National Guard c. The Health Department d. A Disaster Medical Assistance Team

A The Medical Reserve Corps (MRC) consists of volunteer medical and public health care professionals who support the community during times of need. They may help staff hospitals, establish first aid stations or special needs shelters, or set up acute care centers in the community. The National Guard often performs search and rescue operations and law enforcement. The Health Department focuses on communicable disease tracking, treatment, and prevention. A Disaster Medical Assistance Team is deployed to a disaster area for up to 72 hours, providing many types of relief services. DIF: Cognitive Level: Knowledge/Remembering

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Concepts of Management) MSC: Integrated Process: Nursing Process (Planning) 8. An accident has occurred near the hospital, and a victim is brought to the emergency department with severe chest pain, a pulse of 120 beats/min, blood pressure of 100/60 mm Hg, and a respiratory rate of 28 breaths/min. The nurse assesses shortness of breath and diaphoresis. Which color tag does the nurse use when triaging this client? a. Red b. Yellow c. Green d. Black

A The client in the emergent triage category has a condition that may post an immediate threat to life or limb and is given the highest priority. Clients who should be treated emergently receive a red tag. Yellow tags signify major but stable injuries that can wait 30 minutes to 2 hours for definitive care. Green tags designate "walking wounded" who can wait longer than 2 hours to receive care. Black tags are used to designate those who are dead or who are expected to die. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Planning) 16. A nursing administrator is evaluating the hospital's response to a recent internal disaster. The administrator assesses that goals for disaster planning have been met when which outcome is assessed? a. The hospital was able to maintain client, staff, and visitor safety during the disaster. b. Supplies were readily available and were transported rapidly where needed. c. The hospital incident command officer successfully utilized ancillary areas for client care. d. All employees followed the chain of command and established policies and procedures.

A The most important outcome of any internal disaster is maintenance of safety for the hospital's clients, staff, and visitors. Other outcomes listed would be part of a successful disaster response, but are all too narrow to meet this objective. DIF: Cognitive Level: Application/Applying or higher

145 KEY: Psychosocial response| crisis intervention MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 11. A family in the emergency department is overwhelmed at the loss of several family members due to a shooting incident in the community. Which intervention should the nurse complete first? a. Provide a calm location for the family to cope and discuss needs. b. Call the hospital chaplain to stay with the family and pray for the deceased. c. Do not allow visiting of the victims until the bodies are prepared. d. Provide privacy for law enforcement to interview the family.

A The nurse should first provide emotional support by encouraging relaxation, listening to the familys needs, and offering choices when appropriate and possible to give some personal control back to individuals. The family may or may not want the assistance of religious personnel; the nurse should assess for this before calling anyone. Visiting procedures should take into account the needs of the family. The family may want to see the victim immediately and do not want to wait until the body can be prepared. The nurse should assess the familys needs before assuming the body needs to be prepared first. The family may appreciate privacy, but this is not as important as assessing the familys needs. DIF: Applying/Application

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Implementation) 1. A hospital responds to a local mass casualty event. Which action should the nurse supervisor take to prevent staff post-traumatic stress disorder during a mass casualty event? a. Provide water and healthy snacks for energy throughout the event. b. Schedule 16-hour shifts to allow for greater rest between shifts. c. Encourage counseling upon deactivation of the emergency response plan. d. Assign staff to different roles and units within the medical facility.

A To prevent staff post-traumatic stress disorder during a mass casualty event, the nurses should use available counseling, encourage and support co-workers, monitor each others stress level and performance, take breaks when needed, talk about feelings with staff and managers, and drink plenty of water and eat healthy snacks for energy. Nurses should also keep in touch with family, friends, and significant others, and not work for more than 12 hours per day. Encouraging counseling upon deactivation of the plan, or after the emergency response is over, does not prevent stress during the casualty event. Assigning staff to unfamiliar roles or units may increase situational stress and is not an approach to prevent post-traumatic stress disorder. DIF: Remembering/Knowledge

N/A TOP: Client Needs Category: Psychosocial Integrity (Stress Management) MSC: Integrated Process: Nursing Process (Assessment) 6. A wing of a hospital is on fire. Which actions by the nurse promote safe evacuation of clients? (Select all that apply.) a. Direct ambulatory clients on where to go to be safe. b. Use ambulatory clients to help push clients in wheelchairs. c. Use oxygen tanks for all clients who are on oxygen. d. Manually ventilate clients who are on ventilators. e. Move bedridden clients in their beds if possible.

A, B, D, E Ambulatory clients can evacuate themselves with direction or could be used to help push wheelchair-bound clients. Clients on ventilators need to be removed from the ventilator and "bagged" until evacuated, then they can be put back on the ventilator if one is available. Bedridden clients should be moved in their beds or on stretchers, or carried if needed. Any client who can breathe without oxygen should have it removed for the evacuation because oxygen is an accelerant. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication) MSC: Integrated Process: Communication and Documentation 3. A client is receiving follow-up care after surviving a tornado. The client reports insomnia and the nurse notes that the client jumped as the nurse entered the room. Which action by the nurse is most appropriate? a. Document findings on the client's chart and inform the physician. b. Perform additional assessments for post-traumatic stress disorder. c. Educate the client on nonpharmaceutical methods to promote sleep. d. Plan to initiate a referral to a psychologist experienced in survivor issues.

B An individual may experience physical symptoms as a normal response to profound grief or loss, particularly after a traumatic incident. Manifestations such as insomnia, being startled easily, having flashbacks, or feelings of numbness may indicate post-traumatic stress disorder, and the nurse should first assess for this problem. The nurse should document assessment findings, but only after performing a more thorough assessment. A referral may be necessary, but the nurse does not have enough information yet to initiate it. If assessment reveals that methods to assist with sleep would be helpful, the nurse could provide that education. DIF: Cognitive Level: Application/Applying or higher

1010 OBJ: 7 (theory) TOP: Radiation Exposure: Chelating Agents KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 14. The nurse takes into consideration that the period of time during which there is the greatest chance that aerosolized anthrax could be inhaled after a terrorist attack would be _____ the attack. a. the day of b. the day after c. 2 days after d. 7 days after

B Anthrax in an aerosolized form is most potent 1 day after the explosion as the organism dies very quickly and anthrax is not communicable from person to person. DIF: Cognitive Level: Comprehension

p. 159 TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Teaching/Learning 21. A community disaster has occurred and the hospital's emergency department (ED) has efficiently triaged, treated, and transferred most clients to appropriate units. The hospital incident command officer wants to "stand down" from the emergency plan. Which question by the nursing supervisor is most beneficial at this time? a. "Are you sure no more victims are coming into the ED?" b. "Do all other areas of the hospital have the supplies and personnel they need now?" c. "Have all ED staff had the chance to eat and rest recently?" d. "Are all other incident command officers and house supervisors in agreement with you?"

B Before "standing down," the incident command officer ensures that the needs of the other hospital departments have been taken care of because they may still be stressed and may need continued support to keep functioning. Many more "walking wounded" victims may present to the ED; that number may not be predictable. Giving staff the chance to eat and rest is important, but all areas of the facility need that too. Although agreement among incident officers is important, it is not the priority concern before standing down. DIF: Cognitive Level: Application/Applying or higher

1009 OBJ: 7 (theory) TOP: Monitoring for Radiation Exposure: Badges KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 12. The nurse takes into consideration that if terrorists were to use category B agents that produce low death rates and moderate illness, the organisms would most probably be delivered by which route? a. Vaporization b. Through water sources c. By an explosion d. From person-to-person contact

B Category B agents are usually delivered via a water source. DIF: Cognitive Level: Comprehension

1012 OBJ: 8 (theory) TOP: Plague: Respiratory Precautions KEY: Nursing Process Step: NA MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 16. The nurse is aware that the plague, caused by Yersinia pestis, will most probably be introduced as an aerosolized weapon in a terrorist attack. Although exposed individuals can die in 24 hours, the organism is very vulnerable and can be destroyed by: a. cold temperatures of 40 F. b. exposure to sunlight. c. strong chlorine solution. d. dry environment.

B Plague organisms can be destroyed by exposure to sunlight. DIF: Cognitive Level: Comprehension

1009 OBJ: 5 (theory) TOP: Chemical Disaster: KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. The nurse is teaching a course in the community concerning the actions that need to be taken in the event a pandemic occurs. A participant questions the nurse about how long she should be prepared to stay at home. What response by the nurse is most correct? a. The greatest danger during the pandemic will be in the first 48 to 72 hours. b. You should be prepared to remain at home for about 2 weeks. c. Residents should be prepared to stay home for 4 to 6 days. d. Staying home for a full 10 days will be needed.

B Preparations for pandemics include teaching people to be prepared to stay at home for at least 2 weeks. DIF: Cognitive Level: Comprehension

999-1000 OBJ: 6 (theory) TOP: Tornado: Patient Evacuation KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 11. The nurse explains that health workers who are caring for people exposed to radiation after the explosion of a nuclear bomb are monitored daily for exposure by way of: a. urinalysis. b. radiation badges. c. Geiger counters. d. sputum analysis.

B Radiation detection badges are worn under protective clothing and are analyzed for number of rads absorbed. DIF: Cognitive Level: Comprehension

997 OBJ: 1 (theory) TOP: Disaster vs. Emergency Situation KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 2. The nurse stresses that emergency preparedness plans are required for accredited hospitals by the: a. American Red Cross (ARC). b. Joint Commission (JC). c. Federal Emergency Management Agency (FEMA). d. Office of Civil Defense (OCD).

B The Joint Commission requires that all accredited facilities have a written emergency preparedness plan with designated roles and responsibilities. The American Red Cross is a voluntary organization that traditionally provides the basic essentials of shelter, food, and first aid during a natural disaster. Federal Emergency Management Agency (FEMA) is an organization under the federal government. It is activated by the Department of Homeland Security. It acts when states require assistance in times of disaster. The Office of Civil Defense (OCD) is no longer in existence. It was a federal agency that acted in cases of large scale disasters. It was replaced by FEMA. DIF: Cognitive Level: Comprehension

1001 OBJ: 3 (theory) TOP: Psychological Response: Stage I KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 5. The nursing staff of a medical clinic and 15 of their patients have moved to the third floor of an office building to escape flood waters. Public water supply has been contaminated. This floor has eight commode stalls in two different bathrooms. To provide drinking water, the nurse should: a. designate which commodes can be used for body waste. b. protect water in commode tanks to use for drinking. c. run cold water in sinks to have reservoirs of water. d. assign people to use specific bathrooms.

B The water in the tanks of the commodes has not been contaminated and the water in the hot water tanks has not been contaminated. Using any of the water for waste disposal is inappropriate. Using cold water pulls from the contaminated water supply. DIF: Cognitive Level: Analysis

1. The nurse has been assigned the role of triage nurse after a weather-related disaster. What is the priority action of the nurse? a. Call in additional staff to assist with care of the victims. b. Splint fractures and clean and dress lacerations. c. Perform a rapid assessment of clients to determine priority of care. d. Provide psychological support to staff and family members.

C The triage nurse classifies victims of the explosion into priority of care based on illness or injury severity. Calling in additional staff more likely would be done by the hospital incident commander or designee. Physical care is provided to victims after triage occurs. Psychological support should be an ongoing part of the disaster plan but is not included in triage responsibilities; this ensures that the greatest good is provided to the greatest number of people. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Nursing Process (Planning) 18. A nursing instructor is debriefing students who participated in a community-wide disaster drill. Several students are upset with the black-tagged triage category. Which statement by the nursing instructor is best? a. "To do the greatest good for the greatest number of people, it is necessary to sacrifice some." b. "Not everyone will survive a disaster, so it is best to identify those people early and move on." c. "In a disaster, extensive resources are not used for one person at the expense of many others." d. "With black tags, volunteers can identify those who are dying and can give them comfort care."

C In a disaster, military style triage is used; this approach identifies the dead or expectant dead with black tags. This practice helps to maintain the goal of triage, which is doing the most good for the most people. Precious resources are not used for those with overwhelming critical injury or illness, so that they can be allocated to others who have a reasonable expectation of survival. Clients are not "sacrificed." Telling students to move on after identifying the expectant dead belittles their feelings and does not provide an adequate explanation. Clients are not black-tagged to allow volunteers to give comfort care. DIF: Cognitive Level: Comprehension/Understanding

N/A TOP: Client Needs Category: Psychosocial Integrity (Stress Management) MSC: Integrated Process: Caring 25. A client has been treated in the emergency department after a tornado and is awaiting discharge instructions. This client is close to losing control, although other family members are attempting to calm him down. Which response by the nurse is most helpful? a. Call security and have them standing by in case they are needed. b. Instruct the person to leave the area until he can calm down. c. Offer the client the choice of waiting in the treatment room or the waiting room. d. Ask the family to help move the client out of the treatment area.

C Offering people choices often is a good way to get them to focus on something other than their distress. Calling security and telling the person to leave might escalate the situation, although if all other methods fail, the safety of staff, clients, and other visitors takes priority. Asking the family to help move the client puts him in a difficult position and may end up causing them injury. DIF: Cognitive Level: Application/Applying or higher

p. 155 TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Emergency Response Plan) MSC: Integrated Process: Teaching/Learning 15. The emergency department (ED) is expecting a large number of casualties after a bridge collapse. Which is a priority consideration for the ED leadership when activating the disaster plan? a. Responding paramedics and rescue personnel will notify the ED about exactly how many victims to expect. b. Responding paramedics and rescue personnel will triage all victims at the bridge collapse site before bringing them to the ED. c. The ED may receive many unexpected victims with minor injuries from the bridge collapse. d. Victims who have been contaminated with gasoline will be decontaminated by rescue personnel before arriving at the ED.

C Paramedics may not note all the "walking wounded" to give the ED an accurate count of victims to expect because these people might evacuate themselves from the accident scene without being seen by paramedics or rescue personnel. They may then secure their own transportation to the hospital and could overwhelm an ED that is already handling many severely injured victims who have been brought in by emergency medical services (EMS). DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication) MSC: Integrated Process: Caring 6. A young man comes into the foyer of the hospital and says that he has a container of anthrax, which he opens and pours on the floor. Which is the priority action for the nurse who first comes upon the scene? a. Don a protective gown, mask, and goggles. b. Escort the man to the decontamination room. c. Begin to evacuate the immediate area. d. Notify the local health department of a biohazard situation.

C The highest priority is to remove people from immediate danger, so the nurse should evacuate the immediate area and prevent injury to those near the spill. Donning personal protective equipment would probably take the nurse away from the scene to obtain the equipment and would not help protect those in immediate danger. The man may need to be escorted to a decontamination area after people are removed from the scene. Reporting the incident to the health department should be done after the scene is secured and could be delegated to someone else. DIF: Cognitive Level: Application/Applying or higher

p. 162 TOP: Client Needs Category: Psychosocial Integrity (Stress Management) MSC: Integrated Process: Communication and Documentation 13. The nurse is caring for a client whose wife just died in an accident. The client says to the nurse, "I can't believe that my wife is gone and I am left to raise my children all by myself." Which response by the nurse is most appropriate? a. "Please accept my sympathy for your loss." b. "I can call the hospital chaplain if you wish." c. "You sound anxious about being a single parent." d. "At least your children still have you in their lives."

C Therapeutic communication includes active listening and honesty. This statement demonstrates that the nurse recognizes the client's distress and has provided an opening for discussion. Extending sympathy and offering to call the chaplain do not give the client the opportunity to discuss feelings. Stating that the children still have one parent discounts the client's feelings and situation. DIF: Cognitive Level: Application/Applying or higher

146 KEY: Psychosocial response| crisis intervention MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Psychosocial Integrity 7. A nurse cares for clients during a community-wide disaster drill. Once of the clients asks, Why are the individuals with black tags not receiving any care? How should the nurse respond? a. To do the greatest good for the greatest number of people, it is necessary to sacrifice some. b. Not everyone will survive a disaster, so it is best to identify those people early and move on. c. In a disaster, extensive resources are not used for one person at the expense of many others. d. With black tags, volunteers can identify those who are dying and can give them comfort care.

C In a disaster, military-style triage is used; this approach identifies the dead or expectant dead with black tags. This practice helps to maintain the goal of triage, which is doing the most good for the most people. Precious resources are not used for those with overwhelming critical injury or illness, so that they can be allocated to others who have a reasonable expectation of survival. Clients are not sacrificed. Telling students to move on after identifying the expectant dead belittles their feelings and does not provide an adequate explanation. Clients are not black-tagged to allow volunteers to give comfort care. DIF: Understanding/Comprehension

1006 OBJ: 3 (clinical) TOP: Food Supply: Temperature KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 7. The nurse takes into consideration that a freezer that was full at the time of the power failure will keep food safe to eat for approximately _____ hours. a. 8 b. 12 c. 24 d. 48

D Food frozen in a full freezer will keep the food safe for 48 hours. A partially filled freezer will keep food safe for 24 hours. DIF: Cognitive Level: Application

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control—Handling Hazardous and Infectious Materials) MSC: Integrated Process: Nursing Process (Implementation) 7. Which is the priority action for the emergency department charge nurse in the event of a mass casualty situation? a. Directing medical-surgical and case management nurses to assist emergency department (ED) staff with critically injured victims b. Calling additional medical-surgical and critical care nursing staff to come to the hospital to assist when victims are brought in c. Informing the incident commander at the mass casualty scene about how many victims may be handled by the ED d. Directing medical-surgical and critical care nurses to assist with clients who are already in the ED while the ED staff prepares to receive the mass casualty victims

D The ED charge nurse should direct additional nursing staff to help care for current ED clients while the ED staff prepares to receive the mass casualty victims; however, they should not be assigned to the most critically ill or injured clients. The hospital incident commander is responsible for mobilizing resources and would have the responsibility for calling in staff. The medical command physician would be the person best able to communicate with on-scene personnel regarding the ability to take more clients. DIF: Cognitive Level: Application/Applying or higher

N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Implementation) 10. The hospital is overwhelmed when caring for victims after an earthquake that occurred 48 hours ago. Which responsibility of the nursing supervisor is most important at this time? a. Assuming leadership for implementation of the hospital emergency plan b. Releasing updates of client conditions to the media c. Converting the physical therapy clinic into a treatment area for the injured d. Arranging relief and coordinating breaks so nursing staff can rest and eat

D The nursing supervisor should ensure that the staff is not becoming dangerously overtired by working long shifts without food or rest. Overall leadership for implementing the emergency plan and re-designating areas for client care would fall under the job of hospital incident commander. The community relations/public information officer would work with the media. DIF: Cognitive Level: Application/Applying or higher

1011 OBJ: 8 (theory) TOP: Aerosolized Anthrax: Life Span of Organism KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 15. People who have plague and have been treated with appropriate antibiotics can be released from respiratory droplet precautions after: a. all symptoms are gone. b. there is no longer any blood in the sputum. c. the lesions are dried. d. 48 hours of antibiotic treatment.

D The patient with plague can be released from respiratory precautions 48 hours after initiation of antibiotic therapy. DIF: Cognitive Level: Comprehension

145 KEY: Post-traumatic stress disorder MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 2. A client who is hospitalized with burns after losing the family home in a fire becomes angry and screams at a nurse when dinner is served late. How should the nurse respond? a. Do you need something for pain right now? b. Please stop yelling. I brought dinner as soon as I could. c. I suggest that you get control of yourself. d. You seem upset. I have time to talk if youd like.

D Clients should be allowed to ventilate their feelings of anger and despair after a catastrophic event. The nurse establishes rapport through active listening and honest communication and by recognizing cues that the client wishes to talk. Asking whether the client is in pain as the first response closes the door to open communication and limits the clients options. Simply telling the client to stop yelling and to gain control does nothing to promote therapeutic communication. DIF: Applying/Application

146 KEY: Psychosocial response| crisis intervention MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Psychosocial Integrity 3. A nurse is field-triaging clients after an industrial accident. Which client condition should the nurse triage with a red tag? a. Dislocated right hip and an open fracture of the right lower leg b. Large contusion to the forehead and a bloody nose c. Closed fracture of the right clavicle and arm numbness d. Multiple fractured ribs and shortness of breath

D Clients who have an immediate threat to life are given the highest priority, are placed in the emergent or class I category, and are given a red triage tag. The client with multiple rib fractures and shortness of breath most likely has developed a pneumothorax, which may be fatal if not treated immediately. The client with the hip and leg problem and the client with the clavicle fracture would be classified as class II; these major but stable injuries can wait 30 minutes to 2 hours for definitive care. The client with facial wounds would be considered the walking wounded and classified as nonurgent. DIF: Analyzing/Analysis