Unit 1 - Disaster Planning

What are the effects of long-term exposure to mustard gas? Select all that apply.

Skin burns Skin blisters Irritation of eyes

After assessing a victim of a bomb blast that has caused mass casualties, the emergency department nurse applies a black band to the hand. What is the rationale behind this nursing action?

The victim has severe head injury and requires artificial ventilation

The survivors of an explosion develop heat stroke. Which intervention should be performed by the nurse on the disaster management team?

Apply ice packs on the client's scalp

While performing a secondary emergency assessment survey, the nurse uses the mnemonic AMPLE to determine the client's condition after a natural disaster. Which type of assessment is performed in this scenario?

History and head-to-toe assessment Allergies Medication history Past health history Last meal Events/environment preceding illness or injury

A nurse, while assessing different survivors of a tornado, assigns a red tag to a client. What could be the casualty condition of the client?

Requires emergent treatment, threat to life

After a large fire, many people were admitted to the emergency department. The nurse noticed many clients with moist blebs and blistered skin with a cherry red color that are hypersensitive to touch or air. What types of injuries are identified in these clients?

Second-degree burns

Which factors affect the stress that first responders feel after a mass casualty incident (MCI)? Select all that apply.

Age Nature of event Coping mechanisms Psychologic history

For which threats would a healthcare organization routinely plan hazardous materials training? Select all that apply.

Anthrax exposure Pesticide plant leak Nuclear reaction explosion

After a bomb blast, the victims were brought to the emergency department and the nurses initiated triage for the clients. Which client is classified as class IV?

Client D

Which internal disaster may create a need for evacuation or relocation of clients?

Gas explosion

After a fire in the hospital, a client is found to have dyspnea and gasping breathing. The client also has neck trauma and is unable to speak. Which nursing interventions are most appropriate? Select all that apply.

Performing jaw-thrust maneuver Prepare assist in performing endotracheal intubation

Which biologic agents of terrorism can be treated effectively with antibiotics? Select all that apply.

Plague Anthrax Tularemia

The nurse is performing peritoneal lavage on a client who is hypothermic, as a surface rewarming measure. What is the highest temperature up to which the fluid can be heated?

113° F (45°C)

At which body temperature does the blood pressure of a victim of hypothermia become obtainable only by Doppler?

91.4° F (33°C)

The nurse is implementing measures to reorient a confused client post earthquake and suggests that a family member accompany the client. Which safety consideration is the nurse demonstrating?

Injury prevention for the client

A nurse manager is informed that a community disaster drill will take place. The disaster scenario will include a bombing in a shopping mall with hundreds of casualties. What location should the nurse consider for triage of casualties when planning for this exercise?

At the scene of the disaster

Which is the priority nursing action to include in a disaster plan for the radioactive dust and smoke that can cause illness from a radiologic dispersal device (RDD)?

Covering the nose

Which action, if performed by the nurse, is inappropriate while caring for different clients after a disaster?

Evacuating injured and uninjured people from a danger area

The nurse manager is designated as a unit Chief during the formulation of a Hospital Incident Command System (HICS) for disaster preparedness. Which responsibility does the nurse manager assume in this role?

Logistics and operation

A nurse manager is evaluating the effectiveness of a disaster drill during which nurses were sent from their usual assignments to the emergency department. Which criterion should be used for the nurse manager to evaluate care during the disaster drill?

Nurse-to-client ratio on units

Which are the most common types of injuries that should be identified along with treatment options in an organizational disaster plan for the use of explosive devices as agents of terrorism? Select all that apply.

Blast Crush Penetration

Which statement effectively describes the steps to be taken by healthcare personnel when responding to healthcare facility fires?

The respiratory status of clients on life support should be maintained manually

The hospital management wants to prevent post-traumatic stress in the nursing staff. Which implemented strategies will be ineffective in pursuing this goal?

Encouraging the staff to work for more than 12 hours per day

Which aspect of client tracking using radiofrequency technology (RFT) does the nurse recognize as a major safety strategy of the emergency department (ED) to prevent potentially disastrous consequences in the hospital?

Interactions between client and caregiver

While caring for different clients who were injured in a hurricane, the nurse finds that a client is confused. What are the most appropriate nursing interventions to prevent injury in the client? Select all that apply.

Keeping the side rails up on the stretcher Maintaining adequate lightening in the room Asking a family member to remain with the client Reminding the client to use the call light for assistance

A group of clients who sustained severe injuries in an earthquake received a full continuum of trauma services. Which level of trauma center provided these services to the clients?

Level I

A registered nurse (RN) is chosen to be a member of the disaster medical assistance team (DMAT). Which specialized support skills will the RN learn during the training process for DMAT? Select all that apply.

Logistics Security Communications

Which phase in the disaster management continuum does the nurse understand as including the attempt to limit a disaster's impact on human health and community function?

Mitigation

Which nursing actions contribute to a healthcare facility's emergency preparedness and response prior to a natural disaster? Select all that apply.

Participating in drills Evaluating outcomes

The terrorist attack event on the World Trade Center on September 11, 2001, resulted in mass casualties that led to changes in hospital and community disaster planning efforts. What would the nurse say was the impact of this technological external disaster on the emergency medical services (EMS) for improving the safety of the public? Select all that apply.

Providing routine training to facility staff about hazardous materials Upgrading decontamination facilities and equipment to protect staff Developing approaches for preparedness to nuclear, biologic, chemical (NBC) threats

The nurse is conducting triage under mass casualty conditions. Which tag should the nurse use for a client who is experiencing hypovolemic shock due to a penetrating wound?

Red

Four clients who sustained different levels of injury during an earthquake are assigned different tags as listed below: In which order should care for these clients be prioritized?

Red, yellow, green, black

A client is admitted to an emergency unit after a factory explosion. The nurse is obtaining the client's family history and checking for a medical alert bracelet. Which safety consideration is the nurse following?

Risk for errors and adverse events

A group of clients who were in a bus accident is admitted to the emergency department with injuries. Which group is considered urgent according to the three-tier triage system?

Severe abdominal pain

The nurse is administering vaccines following an episode of pandemic influenza. Which entity should the nurse consult as being ultimately responsible for the implementation of the plan?

State officials

The triage nurse assigns a red tag to a client who has been brought in following a massive earthquake in the region. Which statement best describes the client's condition?

The client has an immediate threat to life

The nursing student is learning about triage during mass casualty incidents (MCIs). Which statement made by the nursing student indicates effective knowledge regarding MCIs?

The total number of victims can be estimated by doubling the number of victims who arrive in the first hour."

The charge nurse is preparing for the arrival of clients to the emergency department (ED) after a mass casualty incident (MCI). The hospital has an automatic tracking system that is implemented during MCIs. Which decision should the nurse use the system for during this MCI?

To determine how many casualties of each acuity level can be safety accepted

The nurse is planning a protocol for providing care to earthquake victims found with severe injuries. Which order of care should the nurse include in the protocol?

To maintain the cervical spine alignment To assess the breath sounds To stop bleeding by applying external pressure To infuse intravenous fluids

The nurse is caring for the victims of a natural disaster who are suffering from hypothermia. Which is most likely to be the core body temperature of the client with moderate hypothermia?

89.6° F (32°C)

While responding to a fire in a healthcare facility, which intervention made by the facility personnel would the nurse feel is inappropriate?

Exposing themselves to risk of injury by attempting to extinguish the fire

What is the function of the medical command physician with respect to the emergency preparedness and response plan for clients after a natural disaster? Select all that apply.

Anticipates the number of clients Checks the resource needs for clients

The nurse is caring for the victims of a terrorist attack involving explosive devices. Which type of damage is most likely caused by a crush injury?

Blunt trauma to the head

The registered nurse asks the student nurse, "Which action should be provided in a client who survived an earthquake and presents with abdominal trauma to the emergency department?" Which response by the student nurse requires further teaching?

"I should remove an impaled object immediately."

The registered nurse is teaching a group of student nurses about preventing post-traumatic stress disorder (PTSD) during a mass casualty event. Which statement made by the student nurse indicates effective learning?

"I should take a break whenever needed."

A registered nurse is teaching a student nurse about the role of nurses in case of a fire in the hospital. Which statement made by the student nurse indicates ineffective learning?

"I will continue oxygen for all clients, even those who can breathe without it."

The registered nurse is teaching a student nurse about preparedness when responding to a fire in the healthcare facility. Which statements made by the student nurse indicates the need for further teaching? Select all that apply.

"I will endanger myself while moving and protecting the clients from the fire." "I will continue to provide oxygen to the clients that can breathe on their own."

When writing a disaster plan for implementation during a mass casualty incident (MCI), which percentage of victims often require admission to the hospital for further treatment?

30%

The victims of a natural disaster are brought to the emergency department and found to be suffering from hypothermia. What is most likely to be the core body temperature of the hypothermic victim in whom shivering is diminished or absent?

82.4° F (28°C)

In a mass casualty event, the nurses from medical-surgical nursing units are asked, in collaboration with the healthcare provider, to recommend clients for discharge to free up inpatient beds for disaster victims. Which clients are most likely to be discharged early? Select all that apply.

A client who could be cared for in a rehabilitation center A client who is having diagnostic evaluations and is not bedridden A client who could be could be cared for at home with support from home healthcare services

The nurse is caring for the victims of a snowstorm who have been exposed to cold temperatures. Which clients are at a high risk of sustaining cold injuries? Select all that apply.

A client who is hypoglycemic A client who is on opioid medication A client who has been a heavy smoker for years

Which type of event can often be handled by an individual hospital disaster plan without collaboration with other systems?

A motor vehicle accident involving 5 cars

The registered nurse is appointed as a triage officer of the disaster management team. What would be the responsibility of the nurse as a triage officer?

To determine the priority of treatment for clients

What would help facilitate communication and coordination during a mass casualty event in a hospital using the hospital incident command system? Select all that apply.

Activate communication equipment Establish a command center in a designated location Provide key personnel with distinctive clothing identifying their role Distribute job action sheets identifying reporting relationships, tasks, and responsibilities

While triaging clients after an earthquake that has caused mass casualties, the nurse notes that a client with a massive head injury does not respond to stimulation and cannot breathe independently. Which color tag would be given to the client?

Black tag

A disaster management team is planning measures to prevent the spread of pandemic influenza. Which interventions would the nurse consider to be most appropriate to be included in the plan?

Distribute antiviral agents to clients

A hospital in an urban setting is located on two rivers which are spanned by several bridges. Resources arrive to this community via commercial trains or airplanes. Which credible threats should this hospital prepare for when constructing the emergency preparedness plan? Select all that apply.

Floods Bridge collapses Boating accidents Train derailments

In a mass casualty situation, which healthcare professional can direct departments such as physical therapy or a surgical clinic to cancel their usual operations to convert the space into a minor treatment area?

Hospital incident commander

The nurse is categorizing victims of hypothermia as having mild, moderate, and severe hypothermia. Which assessment findings will help the nurse identify the clients with moderate hypothermia? Select all that apply.

Hypovolemia Respiratory acidosis

What does the registered nurse consider to be the roles and functions of a medical command physician during implementation of an emergency preparedness and response plan? Select all that apply.

Identifying the need for and calling in specialty trained providers Determining the clients who require a higher level of care and relocating them

The nurse is caring for clients with sleep disturbances after surviving a large-scale disaster. Which client is most likely contraindicated for further evaluation using the Impact of Event Scale—Revised (IES-R)?

Alzheimer's disease

The registered nurse is teaching a student nurse about the disaster triage tag system. Which statement made by the student nurse indicates ineffective learning?

"I will use a yellow tag for clients with shock."

In a health care system, the nurse is planning management of a disaster that involves second order change. Which type of change would characterize this disaster? Select all that apply.

Revolutionary and episodic change Change requiring radical adjustments in a person or in the structure of the system

After a mass casualty event, the incident commander considers "standing down" or deactivating the emergency response plan. What considerations would the nurse expect to be taken into account by the incident commander before making this decision?

New clients are not expected to arrive at a pace that could overwhelm the emergency department

An administrator for a community hospital notes that actions to help with emergency room visits caused by adverse weather events have not been successful over the last few months. What should the administrator consider implementing to address ongoing issues?

Permanent quality improvement (QI) team

The first responders rescue and bring submersion victims of a natural disaster to the emergency department. Which is an appropriate intervention for treating clients with submersion injuries?

Stabilize or immobilize cervical spine in all near-drowning victims

The nurse is triaging a group of clients injured in a tornado using the three-tier system. Which conditions are triaged as life-threatening conditions? Select all that apply.

Stroke Active hemorrhage Respiratory distress Chest pain with diaphoresis

What are the functions of the Hospital Incident Command System (HICS) in disaster management? Select all that apply.

To standardize disaster operations To establish an emergency operations center (EOC)

What would the nurse describe as the uses of automated tracking systems with infrared and radiofrequency technology (RFT) in emergency departments? Select all that apply.

To track client's triage priority upon arrival To track interaction of clients with caregivers To portray the overall census and acuity of clients

The victims of a mass casualty are brought to the emergency department. One of the healthcare team members re-evaluates some of the clients and realizes the need for immediate transfer to the orthopedic care unit. Who would take up the responsibility of re-evaluation of the client's acuity?

Triage officer

Which individuals will the emergency department (ED) charge nurse collaborate with during an actual disaster to organize nursing and ancillary services to meet client needs? Select all that apply.

Triage officer Trauma program manager Medical command physician

A nurse who is a member of a disaster medical assistance team (DMAT) has been asked to travel to a community that recently experienced devastating tornadoes. What should the nurse communicate to the nurse manager about the work schedule before leaving on this trip?

Will not be able to work for 2 weeks

A group of clients injured in a bus accident are admitted into an emergency unit. Which personnel should the nurse refer to for implementing the emergency plan?

Hospital incident commander

An emergency management team is removing foreign bodies and performing cricothyroidotomy on a client post burn injury. Which emergency assessment has been performed on this client?

Airway with simultaneous cervical spine stabilization

The nursing student is comparing the causative agents of hyperthermia and hypothermia. Which causative agent is common to both conditions?

Alcohol

The nurse is teaching a client about the post-surgical care that needs to be taken following eye surgery. Which statement given by the client indicates the need for further teaching?

"I will wait for more obvious signs of infection before reporting to my primary physician."

The registered nurse is teaching a nursing student who underwent training for disaster management on how to cope effectively after a disaster event. Which statements by the nursing student indicate a need for further teaching? Select all that apply.

"I will work for 15 hours per day." "I will talk about my feelings with my family."

The nurse is caring for a client with injuries from a bomb blast. Which emergency assessments are performed by the nurse in a primary survey? Select all that apply.

Airway Breathing Circulation Identify deformities

The nurse administrator for a long-term care facility is implementing a disaster response plan for staff and residents. Which staff member statements indicate correct understanding of the plan? Select all that apply.

"We have to implement annual drills." "The plan must include an evacuation plan."

The nurse is caring for different clients who are affected in a disaster. What is the order of priority in which the nurse would provide care to the clients?

1. 40-year-old client with hemorrhagic shock 2. 50-year-old client with open fractures and large wounds 3. 70-year-old client with closed fractures 4. 35-year-old client with sprains and abrasions

What is the correct order of phases in a disaster management plan? What is the correct order of phases in a disaster management plan?

1. Preparedness 2. Mitigation 3. Response 4. Recovery 5. Evaluation

A diabetic client survives a fire. The client has a head injury, tachycardia, and pale and ashen-colored skin. Which primary interventions should the nurse perform? Select all that apply.

Administering cool intravenous fluids Placing the client in a cool environment Managing and maintaining airway, breathing, and circulation

The state department of health recommends administering tetanus vaccine to pregnant women who have not received it previously. What is the correct action of the nurse in this situation?

Administering the vaccine to pregnant women at any gestational age

A hospital located near a major earthquake fault line has set an organizational goal to participate in emergency management of disasters. What do the employees of this hospital need to do before being recognized by the National Incident Management System (NIMS)?

Attend training on the incident command system

Which system would the nurse expect to determine the number of casualties of a particular acuity level a hospital can safely accept from the incident scene in a disaster situation?

Automated tracking system

Why would the nurse claim class III clients are of major concern in the hospital environment after a nuclear accident?

Because they often come to the hospital on their own

While caring for clients with injuries after a terrorist attack, the nurse observed ear bleeding, conjuctival hemorrhage, and severe lacerations in a client and provided mechanical ventilation. Which tag would be appropriate for this client according to the disaster triage tag system?

Black tag

The emergency department nurse is assigned duty at a mass casualty situation. Which measures should the nurse take for personal preparedness? Select all that apply.

Carrying lip balm Carrying sunglasses Carrying lists of credit card numbers

A team is sent to care for earthquake victims. Which basic professional certification is most desirable in the nurse to become the member of this team?

Certification in Emergency Care

The nurse is caring for clients who have been admitted to the emergency department after a bomb blast. On observing one client's legs, the nurse gives the client a yellow tag. What is the likely condition of the client?

Compound fracture

While managing the aftermath of a massive fire in a rural area, a physician is quickly examining clients and shifting them to urban health centers if required. What are the other duties of the physician in this role? Select all that apply.

Determining the resource needs of the clients Deciding the number and acuity of the clients

One component of a hospital disaster plan would include a workplace violence protection plan. Which unit in the hospital would be the priority for implementation and evaluation of this plan?

Emergency department

A client is admitted to the emergency department after a train derailment. The primary health care provider orders staff members to monitor vital signs, perform basic wound care, and ensure spinal immobilization. Which emergency staff member should provide this care for the client's condition?

Emergency medical technician

The ER nurse expects death in a client critically injured in a bomb blast . What is the appropriate triage categorization for the client?

Expectant

What would the nurse say is the difference between triage under usual conditions and triage under mass casualty conditions?

Expectant care

The disaster management team is working to manage the aftermath of an accidental explosion in a fertilizer plant and has started evacuating the injured and uninjured victims from danger as first line of action. Which team member most likely engages in this action?

Firefighter

Which client injury would receive a black tag by the triage nurse during a mass casualty incident?

Full-thickness body burns 80% total body surface area (TBSA)

An avalanche caused mass casualties. When taken to the nearby hospital, the health care provider provides basic trauma client stabilization and advanced life support before referring them to other trauma centers. Which level trauma center were the victims initially taken into?

Level IV

While the nurse was caring for a client with chemical burns after a factory explosion, there was increased edema in the surrounding tissues. What might have led to increased edema?

Lowering burned limbs below the heart

The nurse is caring for a client who survived an earthquake. Which nursing intervention indicates a need for correction?

Making prejudicial remarks

Following a massive explosion, victims are brought to a nearby hospital where a physician assesses the number of clients admitted and determines the resources needed to provide effective treatment. What is the role of this physician?

Medical command physician

While caring for victims of a hurricane, a nurse is teaching hygiene practices and symptoms of various infections. Which phase of disaster management is the nurse executing?

Mitigation

The fire alarm is sounding in a skilled nursing facility and smoke is pouring from the kitchen. What should the nurse do to ensure the safety of the clients, staff, and family members? Select all that apply.

Move bedridden clients via stretcher Turn off all sources of supplemental oxygen Provide manual respiratory support to critically ill clients Close all windows and doors and use an ABC fire extinguisher

Which agency's operations would the registered nurse consider to be most in need of incident command system (ICS) training?

NIMS (National Incident Management System)

Which groups may be activated by state and federal government authorities to assist during a flooding situation that results from a hurricane? Select all that apply.

National Guard American Red Cross Medical Reserve Corps Public health departments

What criteria should a nurse manager use to determine the feasibility of altering an emergency department triage process? Select all that apply.

Need for resources Readiness of others Evaluation of risk factors

Which colored tag has the nurse correctly identified while classifying triage care in mass casualty conditions?

Nonurgent-green tag

Which effect is seen in clients exposed to sarin?

Paralysis of respiratory muscles

A client has an eye injury from exposure to a chemical blast. Which immediate nursing intervention is most appropriate for the client?

Performing ocular irrigation

While caring for an 8-year-old victim of an earthquake, the nurse finds that the child has trouble sleeping, startles easily, and experiences "flashbacks" of the disaster. What is the appropriate nursing intervention in this situation?

Referring the child to a clinical psychologist

Which would the registered nurse say is the priority action of first responders after a community disaster?

Removing the victims from danger

What are the potential life-threatening conditions that should be considered during the primary survey for a client admitted after a fire accident? Select all that apply.

Shock Inhalation injury Direct cardiac injury

The nurse is triaging clients who have arrived at the hospital after an explosion in a fertilizer plant. Which client conditions are categorized under class III according to the disaster triage tag system? Select all that apply.

Sprained hand Contusions on legs

Community members have received mailed notices asking them to come to different healthcare agencies within the community at the same time on the upcoming Saturday afternoon. What is the purpose of asking community members to perform this task?

Test the emergency preparedness plan

A client who is admitted to the emergency department could not get treatment on time due to an internal disaster. What might be the possible reason for this situation?

The specialist arrived late due to lack of communication because of a damaged telephone system in hospital

The nurse is caring for the victims of a natural disaster who are all hypothermic. Which interventions does the nurse employ when using spontaneous rewarming? Select all that apply.

Using radiant lights Moving the client to a warm and dry place