Chapter 14 community nursing: disaster management

7. A nurse is working with a community during the preparedness stage of disaster management. Which of the following events would the nurse anticipate occurring? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

ANS: A Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. The other answers are false or describe the other stages.

2. Which of the following best describes countries that bear the greatest burden of disasters? a. Arid regions that are prone to drought b. Developing countries with limited resources c. Industrialized countries with much to lose d. Water-boundary regions that are prone to floods and hurricanes

ANS: B Disasters create the most devastation in developing countries, where the death rate is up to 12 times higher than in developed countries. The people of low socioeconomic status suffer the most because their houses are less sturdy and they have fewer resources and less means of social security.

13. A community is experiencing the Honeymoon phase following a disaster. Which of the following is most likely to occur in the community? a. First responders work tirelessly to save others b. Survivors share their stories c. Medical personnel experience exhaustion d. Community organizations rebuild the community

ANS: B During the Honeymoon phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the Heroic Phase. Medical personnel experience exhaustion during the Disillusionment Phase. The community begins to rebuild during the Reconstruction Phase.

9. The local hospital, health department, and university together planned and implemented a mock casualty drill, with the university's theater and nursing students playing the injured victims. After the drill, which of the following would the nursing students most likely complete? a. Volunteer as leaders in the next casualty drill b. Evaluate the drill and offer recommendations for more effectiveness in the future c. Recognize how to respond to a real disaster in the future d. Write a report on their actions and how they felt during the drill

ANS: B The nursing students should be prepared to offer a critique of the drill performance and suggest improvements for the next drill—or for an actual disaster.

1. Which of the following disasters would implementation of disaster medical assistance teams (DMATs)? (Select all that apply.) a. Disaster that covers a broad geographical area b. Disaster that is beyond the coping capabilities of the affected state c. Disaster that may result in substantial health and medical problems d. Disaster that may cause a large number of deaths and/or injuries

ANS: B, C, D A Presidentially Declared Disaster is one that requires implementation of disaster medical assistance teams (DMATs) because the disaster exceeds the capabilities of the involved state(s) to provide a timely and effective response. Such a disaster has the potential to cause a substantial number of deaths or injuries; substantial health and medical problems; or significant damage to the economic and physical infrastructure.

15. A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse should take? a. Limit the amount of equipment and medications brought into the shelter. b. Determine if the person has a psychological condition requiring special attention. c. Assess if this type of facility is appropriate for the person. d. Provide medical care for persons as if they were in a hospital.

ANS: C Any person who comes to a special needs shelter must be assessed by a nurse to determine whether this type of facility is appropriate.

11. A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the most crucial aspect for the nurse to consider? a. Detecting an increase in people with similar signs and symptoms b. Identifying typical chemical or biological agents c. Identifying factors that put people at risk d. Recognizing areas of vulnerability within an area

ANS: A An unannounced dissemination of a biological agent may easily go unnoticed, and the victims may have left the area of exposure long before the act of terrorism is recognized. Therefore, the first and most important aspect is recognizing that an outbreak has occurred by noting the increase in people presenting with similar signs and symptoms. The next step is striving to identify the biological or chemical agent.

18. A nurse, after working two weeks at the site of the largest natural disaster to hit the United States, returns home. Which of the following behaviors would suggest the nurse needs professional assistance? a. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there. b. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured. c. The nurse is moody and feels family demands are not really as important as the other members of her family think they are. d. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities.

ANS: A It is understandable that the nurse would return exhausted and moody. Indeed, concerns of major importance to family members may seem trivial when compared with problems the disaster victims were confronting. However, the fact that the nurse needs to continue to ventilate about the disaster, even after the family has quit listening, would suggest a delayed stress reaction that is not resolving and therefore warrants professional intervention.

5. A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most likely complete? a. Provide community educational programs and training on how to prepare for disasters. b. Request donations be sent to the affected area. c. Develop a notification procedure to be used by the international disaster relief office. d. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area.

ANS: A Mitigation refers to actions to prevent specific disasters from occurring or to reduce the severity of a disaster's effects if it cannot be avoided. Providing community educational programs on disaster preparedness is the only intervention that addresses mitigation.

20. Which of the following levels of prevention is being used by a nurse who is helping to develop a community-wide disaster management plan? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. All prevention levels

ANS: A Primary prevention takes place before a condition occurs. Primary prevention occurs when one participates in developing a disaster management plan for the community.

4. When does disaster management begin? a. Before the disaster occurs b. During the disaster c. Immediately following the disaster d. During the recovery period

ANS: A Disaster management includes the four stages of a disaster: prevention, preparedness, response, and recovery. The first stage of prevention (or mitigation) occurs before the disaster occurs.

1. Which of the following best defines a disaster? a. Any event that results in multiple deaths b. Devastation that cannot be relieved without assistance c. Devastation that covers a broad geographical area d. When the event results in multiple injuries and deaths as well as property damage

ANS: B A disaster is any human-made or natural event that causes destruction and devastation that cannot be relieved without assistance.

17. On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is feeling irritable and having difficulty focusing. Which of the following actions should the nurse take in response to the complaint of headache? a. Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later. b. Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break. c. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time. d. Suspect dehydration and encourage the worker to drink more fluids.

ANS: B Symptoms of early stress and burnout include minor tremors, nausea, inability to concentrate, difficulty thinking, and problems with memory. Suppressing feelings of guilt, powerlessness, anger, and other signs of stress eventually will lead to symptoms such as irritability, fatigue, headaches, and distortions of bodily functions. It is normal to experience stress, but it must be addressed. The worst thing anyone can do is to deny that it exists. The American Red Cross recommends that the worker get enough sleep and take time away from the disaster (i.e., take breaks).

19. After a house fire, a 4-year-old child begins sucking his thumb and wetting his bed. Which of the following would be the most appropriate action for the nurse to take? a. Explain to the child that it is important to be strong and not act like a baby. b. Explain to the family that this behavior is a normal reaction to disaster. c. Recommend admission for inpatient psychological counseling. d. Recommend behavior therapy as a means to overcome regression.

ANS: B The effects on young children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumbs, wetting their beds, crying, and clinging to parents. This regression is normal in response to the event.

14. A nurse was the first on the scene of a disaster and saw people with injuries ranging from minor to serious. Some of those with minor injuries were helping others. Which of the following injured persons would the nurse assist first? a. Those with life-threatening head and chest injuries b. Those who have life-threatening abdominal injuries c. Those who have serious injuries of limbs d. Those who are hurt but still mobile and functioning

ANS: B Triage is the process of separating casualties and allocating treatment on the basis of the victims' potentials for survival. The nurse will determine how seriously hurt individuals are and who should get care first, with the first priority being those who have life-threatening injuries but will probably survive if treated quickly. Although the textbook does not address the issue, because of the limited resources in a disaster situation and the fact that only the nurse is currently available to give care, seriously hurt individuals with head or chest injuries that have only a small chance of surviving are not treated.

12. Which of the following older adults is most in need of psychological support? a. The older adult who keeps asking if loans will be available for him to rebuild b. The older adult who keeps asking if he can go back home yet c. The older adult who keeps lamenting the loss of his family photos d. The older adult who keeps talking about how expensive his home theater was and how he will never be able to afford to replace it

ANS: C Older adults react deeply to the loss of personal possessions because of the high sentimental value attached to the items. Homes and electronic equipment can be replaced, but family photos, and therefore family history, are not replaceable but lost forever. Such a loss warrants psychological support.

3. What is the purpose of the National Response Framework? a. Create a new branch of government that deals with bioterrorism b. Establish a way for the Red Cross to carry out its mission c. Develop a nationwide all-hazards approach to domestic incident management d. Extend presidential power to act quickly upon weapons of mass destruction

ANS: C The National Response Framework is a unified, all-discipline, all-hazards approach to domestic incident management. It is built upon scalable, flexible, and adaptable coordinating structures to align key roles and responsibilities linking all levels of government and organizations.

8. A community health nurse has invited several agencies in the community to a meeting to discuss the disaster plan for the community. Which of the following best describes the purpose of this meeting? a. To increase stability in the community b. To improve overall community functioning c. To manage response to disasters in the community d. To enhance communication among agencies in the community

ANS: C The level of community preparedness for a disaster is only as good as the people and organizations in the community make it. Although natural disasters cannot be prevented, much can be done to minimize further increases in accidents, death, and destruction after impact. A concise, realistic, and well-rehearsed disaster plan is essential for managing the response to disaster.

10. Which of the following organizations would direct nurses' response to a county-wide disaster? a. American Red Cross b. Centers for Disease Control and Prevention c. Emergency Management Agency d. The local public health department

ANS: C The first level of disaster response occurs at the local level with the mobilization of responders such as the fire department, law enforcement, public health, and emergency services. If the disaster stretches local resources, the county or city emergency management agency (EMA) will coordinate activities through an emergency operations center (EOC). Generally, local responders within a county sign a regional or state-wide mutual aid agreement to allow the sharing of needed personnel, equipment, services, and supplies.

16. A nurse learns about a huge disaster a few states away. Which of the following actions by the nurse would be most helpful in this situation? a. Contributing funds to any charity that is assisting the victims b. Driving over to the area and volunteering to assist c. Sending clothes and food to the area for distribution d. Training to become a Red Cross disaster volunteer

ANS: D Lack of information or inaccurate information regarding the scope of the disaster and its initial effects can contribute to the misuse of resources. Often too many volunteers who lack official sponsorship convene at the site of disaster and are disappointed when their help cannot be used. Similarly, well-meaning people may send clothes and food to disaster sites. The unneeded contributions of food and clothing add to the stress of coping with the disaster, particularly if refrigeration and storage are not available. Although contributing to an organization like the American Red Cross is to be encouraged and commended, many fraudulent scam charities may pop up claiming to collect funds for the victims.

6. A nurse is employed by the American Red Cross and is frequently assigned to fly to a disaster zone. Which of the following should the nurse's family members have readily available? a. Gloves, mask, and other personal protective equipment b. A copy of the nurse's professional license c. A 5-day supply of water d. A disaster/emergency plan

ANS: D The nurse and the nurse's family are best protected by having the skills and knowledge to cope with a disaster, including details such as where families will reunite in the event of an emergency. The nurse should have his/her own copy of the professional license. It is recommended that a 3-day supply of water (1 gallon per person per day) be part of an emergency planning kit. Gloves, mask, and other personal protective equipment are recommended for the professional nurse to have available as an emergency supply.