Emergencies/Disaster

3 (Carbon monoxide poisoning develops when carbon monoxide combines with hgb. Carbon monoxide binds quicker than O2 does, tissue anoxia results. The nurse should admin 100% O2 by mask to reduce the half life of carboxyhemoglobin. WRONG: #1 gastric lavage is for ingested poisons #2 metabolism with anoxia is reduced, which lowers the temp, so warming would be required. #4 WHAT? maybe if they did it on purpose but this ? does not say that and it would not be first)

1 A client is admitted to the ED with a headache, weakness, and slight confusion. The HCP diagnoses carbon monoxide poisoning. What should the nurse do first? 1. Initiate gastric lavage 2. Maintain body temp 3. Admin 100% O2 by mask 4. Obtain a psychiatric referral

1

34 The nurse is assessing the client (smallpox photo) who has recently returned from a 2 month mission in Africa. What type of respiratory protection is appropriate for the staff? 1. N95 particulate respirator 2. double layered surgical mask 3. surgical mask with eye shield 4. no respiratory protection needed

1 3 2 4 (1. Adult with severe bleeding should be seen first LEVEL 1 3 Adult with asthma and rapid bleeding is emergent 2 Child with lacerations, less urgent 4 Adult with VS wnl and non urgent)

25 Four people have been injured in a car accident are admitted to the ED Using emergency severity index (ESI) in which order should the victims be seen by the HCP? 1. an adult with severe bleeding from a laceration to the leg 2. a child with lacerations on the arms and legs 3. an adult with history of asthma and RR of 30/min 4. an older adult with normal VS, but is confused

2,4 (UAP can cover body and transport to morgue. Deaths by gunshot will need medical examiner, keep all lines and tubes in body. The nurse notifies chaplain, the HCP notifies family)

35 A client who was a victim of a gunshot wound was treated in the ED and died. What should the nurse direct the UAP to do during postmortem care? SATA 1. Removed all the tubes and IV lines 2. Cover the body with a sheet 3 Notify the family 4. Transport the body to the morgue 5. Notify the chaplain

1

36 The nurse in the ED is administering a prescription for 20 mg IV furosemide, which is to be given immediately. The nurse scans the clients ID band and the medication barcode. The medication administration system does not verify that furosemide is prescribed for this client; however, the furosemide is prepared with the accurate unit dose for IV infusion. What should the nurse do next? 1. Contact the pharmacist immediately to check the prescription and the barcode label for accuracy 2. Administer the medication now, knowing the medication is labeled and the client identified 3. Report the problem to the information technology team to have the barcode system recalibrated 4. Ask another nurse to verify the medication and the client so the medication can be given now

1,2 (When reporting: type of incident persons involved/description vehicles involved/description date and time incident occurred weapons involved current location of parties involved All reports of threats, actual episodes of violence or suspicious individuals of activities must be investigated)

37 The nurse notices a pair of nervous acting individuals entering the ED. When reporting the suspicious activity, the nurse should include which information in the report? SATA 1. vehicle(s) description 2. current location of the parties involved 3. names and phone numbers of parties involved 4. relationship to the hospitalized client 5. tone of voice of each party involved

2 (Infection prevention!! Although rest and diet rich in fiber to prevent straining is important, these are lower priority than infection control to get to surgery)

5. The nurse is discharging a client who had a fish hook embedded in the eye. The fish hook was removed surgically in the ED. but the surgeon has informed the client that a corneal transplant may restore some vision but the surgery cannot be performed for 6-8 weeks and only if no infection occurs. A priority in the teaching includes: 1. resting to reduce strain to the eye and promote healing after surgery 2. washing hands carefully to keep the area clean and decrease risk of infection 3. verbalize feelings regarding vision loss 4 eating a healthy diet to promote healing and prevent constipation

2 (Standing up will avoid heavy exposure because the chemical will sink toward the floor or ground. )

A chemical exposure has just occurred at an airport. An off duty nurse, knowledgeable about biochemical agents, is giving directions to the travelers. Which direction should the nurse provide to the travelers? 1. Hold their breath as much as possible 2. Stand up to avoid heavy exposure 3. Lie down to stay under the exposure 4. Attempt to breath through their clothing

4 (This is called the IMMEDIATE category. Individuals in this group can progress rapidly to EXPECTANT if treatment is delayed. WRONG: #1 describes Black or priority 4 aka Expectant #2 This is Green or priority 3 aka Minimal #3 This is Yellow or priorty 2 aka Delayed)

According to the NATO triage system, which situation is considered a level red (Priority 1)? 1. Injuries are extensive and chances of survival are unlikely 2. Injuries are minor and treatment can be delayed hours to days 3. Injuries are significant but can wait hours without threat to life and limb 4. Injuries are life threatening but survivable with minimal interventions

2 (Emergency operations plans will have a designated disaster plan coordinator All public information should be routed thru this person)

During a disaster a local news reporter comes to the ED requesting information about the victims. Which action is most appropriate for the nurse to implement? 1. Have the security escort the reporter off the premises 2. Direct the reporter to the disaster command post 3. Tell the reporter this is a violation of HIPPA 4. Request the reporter to stay out of the way

1 (Cremation is recommended because the virus can stay alive in the scabs of the body for 13 years. Burying the body quickly is the 2nd best option, but it still risks people getting contaminated/sick.. the hospital not the family notifies the public health dept)

The client has expired secondary to smallpox. Which information about funeral arrangements is most important for the nurse to provide to the clients family? 1. The client should be cremated 2. Suggest an open casket funeral 3. Bury the client within 24 hrs 4. Notify the public health dept

2 (Clients with botulism are at risk for respiratory paralysis, and this is the priority problem.)

The client presents to the ED with acute V after eating at a fast food restaurant. There has not been any diarrhea. The nurse suspects botulism poisoning. Which nursing problem is the highest priority? 1 Fluid volume loss 2. Risk for respiratory paralysis 3. Abd pain 4. Anxiety

3 (This is the first step. Depending on the type of exposure, this step alone can remove a large portion of exposure. WRONG: #1 In most situations this is the first step, but with potential chemical or biological exposure, the first step must be the safety of the hospital, therefore, the client must be decontaminated. #2 This is the 2nd step in decontamination, #4 This assumption could cost many people in the hospital, as well as clients their lives)

The triage nurse in a large trauma center has been notified of an explosion in a major chemical manufacturing plant. Which action should the nurse implement first when the clients arrive at the ED? 1 Triage the clients and send them to the appropriate areas 2. Thoroughly wash the clients with soap and water then rinse 3. Remove the clients clothing and have them shower 4. Assume the clients have been decontaminated at the plant

2

The triage nurse is working in the ED. Which client should be assessed first? 1. The 10 year old whose dad thinks his leg is broken 2. The 45 year old who is diaphoretic clutching his chest 3. The 58 year old complaining of headache and seeing spots 4. The 25 year old who cut his hand with a hunting knife

1,2,3,4 (CULTURAL ISSUES: #5 does not address cultural although its part of organization and may need to be done)

Which cultural issues should the nurse consider when caring for clients during a bioterrorism attack? SATA 1. LAnguage difficulties 2. Religious practices 3. PRayer times for the people 4. Rituals for handling the dead 5. Keeping the family in the designated area

4 (defib=v-fib)

14 Automated external defibrillators (AEDS) are used in cardiac arrest situations for: 1 early defibrillation in cases of atrial fibrillation 2. cardioversion in cases of atrial fibrillation 3. pacemaker placement 4. early defibrillation in cases of ventricular fibrillation

2 1 4 3 (2 AIRWAY check for anaphylaxis by checking airway, breathing and VS with attention to signs of increasing edema and respiratory distress. 1. Other indications : urticaria, feelings of impending doom, fright, weakness, sweating (from systemic vasodilation) which causes decreased perfusion, decreased venous return, and decreased cardiac output. 4. Rapid Response team 3 Notify HCP)

12 A client is experiencing an allergic response. The nurse should perform the actions in which order from first to last? 1. assess for urticaria 2. assess the airway, and breathing pattern 3. Notify the HCP 4. Activate the rapid response team

4 (Broken ribs can lead to pneumothorax and other internal injuries Other injuries are not usually associated with improper hand placement)

13 Proper placement for chest compressions during CPR is essential to reduce the risk for which complication? 1. GI bleeding 2. MI 3. emesis 4. rib fracture

1 (VS consistent with FVD likely from bleeding or hypovolemic shock. The other prescriptions can be done after the NS)

10 A client is brought to the ED with abdominal trauma following an automobile accident. The VS are as follows; HR 132, RR 28, BP 84/58, T 97 and O2 sat 89% on room air. Which prescription should the nurse implement first? 1. Admin 1 L NS IV 2 Draw a CBC with H&H 3. Obtain an abdominal x-ray 4 Insert an indwelling urinary cath

1 (Calling the clients name and gently shaking the vicitm is used to establish unresponsiveness. #2 the head tilt chin lift is to open airway #3 feeling for air movement indicates breathing #4 the rescuer can watch to see if breathing)

11 A middle aged man collapses in the ED waiting room. The triage nurse should first: 1 Ask the client to state his name 2. Perform the head tilt/chin lift to open the victims airway 3. Feel for any air movement from the victims nose or mouth 4. Watch the clients chest for respirations

2,3,4,5,6 (Food poisoning is a sudden illness that occurs after ingestion of contaminated foods. You dont discard the food, because you want to know the source and type)

16 An adult has been admitted in the ED dx with food poisoning following an outdoor picnic. What should the nurse do? SATA 1 tell the family to discard the contaminated food 2. collect specimens for lab examination 3. assess VS 4. initiate support for respiratory system 5. monitor F&E status 6. provide antiemetics as prescribed

4 (self explanatory really)

17 A client is admitted to the ED after being found in daze walking away from her burning car after an accident. She was not injured in the accident, but the other driver died. She states " I cannot handle it anymore There is no point to it all" The crisis nurse recommends hospital admission based on the identification of which concern? 1. The client was walking around in a daze 2. The client has lack of knowledge of what to do next 3. The client is having delusions and is not in touch with reality 4. The client is expressing helplessness and hopelessness and is a risk for suicide

1 (following seizure postictal stage, the client will most likely be tired and want to sleep Maintaining the airway is the priority. drawing phenytoin and assessing VS are important, but safety is first priority . CT scan not indicated at this time)

18 A client is brought to the ED via ambulance accompanied by her sister. The sister states "She was playing cards with use and had a seizure. Then she had another seizure just as the first one was stopping, so I called the ambulance." The client is currently not demonstrating any seizure activity, her eyes are closed, and she does not respond to any commands. Which intervention should the nurse implement first? 1. Make sure suction equipment is setup bedside 2. draw blood for phenytoin level 3. assess the clients VS 4. Prepare the client for CT

1,2,3,4 (Upon a HCP written prescription requesting HIV test for a client consent must be obtained. Consent exceptions include: prescribed by HCP under emergency conditions, and the testing is medically necessary to dx or treat the clients condition. testing is prescribed by a court, testing is done on blood collected or tested anonymously as part of epidemiologic survey, or an emergency medical provider has been exposed to clients blood or bodily fluids)

19 The nurse in the ED reports there is possibility of having direct contact with blood of a client who is suspected of having HIV/AIDS. The nurse requests that the client have a blood test. Consent for HIV testing can only be completed when which circumstances are present? SATA 1. An emergency medical provider has been exposed to the clients blood or bodily fluids 2. Testing is prescribed by a HCP under emergency circumstances 3. Testing is prescribed by a court, based on evidence that the client poses a threat to others 4. TEsting is done on blood collected anonymously in an epidemiologic survey 5. A HCP who is taking care of a client suspected of having HIV/AIDS requests blood testing

4

30 A severe acute respiratory syndrome (SARS) epidemic is suspected in a community of 10,000 people. As clients with SARS are admitted to the hospital, what type of precautions should the nurse institute? 1. enteric precautions 2. handwashing precautions 3. reverse isolation precautions 4. airborne precautions

1

39 Which client admitted to the ED should be seen first? 1. experiencing a ripping sensation in the chest 2. with a BP 170/95 3. with urine output 240 mL/12 hours 4. taking anticoagulants with bloody stool

3 4 1 2 (RACE: remove, activate alarm, contain/confine, extinguish)

8 The nurse notices a fire in a wastebasket in a clients room. in which order of priority from first to last should the nurse perform the actions? 1. confine the fire by closing the door to the clients room 2. extinguish the fire 3. remove the client from the room 4. pull the fire alarm at the alarm pull station

1

The father of a child brought to the ED is yelling at the staff and obviously intoxicated. Which approach should the nurse take with the father? 1. Talk to the father in a low calm voice 2. Tell the father to wait in the waiting room 3. Notify the childs mother to come to the ED 4. Call the police dept to come arrest him

1 (Level A protection is worn when the highest level of respiratory, skin, eye, and mucous membrane protection is required. In this situation of possible inhalation of anthrax such protection is required. WRONG: 2: Level B is similar to Level A, but is used when lesser level required. 3: Level C protection requires an air purified respirator, which uses filters or absorbent materials to remove harmful substances. 4: Level D is basically the work uniform)

The health care facility has been notified an alleged inhalation anthrax exposure has occurred at the local post office. Which category of PPE should the response team wear? 1. Level A 2. Level B 3. Level C 4. Level D

b (Rationale: Clients who are infected with smallpox can spread the infection to others by droplets. The nurse would place this client in droplet isolation to prevent the spread of the organism. Vital signs and ordered medications are a standard for all clients and are not an individualized intervention for the client with smallpox. This client would not likely be transported to x-ray because of the risk of spreading the organism. If the client needs an x-ray, a portable x-ray would be ordered. )

The nurse initiates which individualized intervention for a client who has been exposed to smallpox? a Prepare the client for transport to x-ray. b Place the client in droplet isolation. c Obtain routine vital signs. d Administer ordered medications.

3,4,5 (Clients who experience a-fib for more than 48 hrs are at an increased risk of developing blood clots due to stasis of blood in the atria. Initially it will be important to maintain a ventricular HR <100 bpm and prevent complications related to clot formation including an embolic stroke. Decreasing HR will help to increase exercise intolerance. A fib causes a decrease in cardiac output, and a goal of therapy would be to increase cardiac output. It is imperative to determine the time client has been in a-fib prior to performing a cardioversion. If a client has a-fib longer than 48 hrs and a cardioversion is performed a clot may be dislodged and find its way to brain, lungs or coronary arteries)

4 A client is admitted to the ED with atrial fibrillation and does not recall how long the rapid pulse and irreg heart rate has been occurring The nurse should include which goals of care at this time? SATA 1.. Convert the HR to sinus rhythm 2. Decrease cardiac output and workload 3. Increase exercise tolerance 4. Maintain a ventricular response below 100 bpm 5.. Prevent an embolic stroke

2 (Circ can be impaired by circumferential burns and edema, causing compartment syndrome. Early recognition and Tx of impaired blood supply is key. The HCP should be informed since escharotomy (incision through full thickness eschar) is freq performed to restore circulation. Pain management is important for burn clients, but restoration of circulation is the priority. Assessment should be performed every 15 mins while there is absence of the radial pulse. Excercise will not help restore circ)

9 A client is admitted to the ED with a full thickness burn to the R arm. Upon assessment the arm is edematous, fingers are mottled and radial pulse is now absent. The client states that the pain is 8 on a scale of 1-10. The nurse should: 1 administer morphine sulfate IV push for severe pain 2. call the HCP to report the loss of the radial pulse 3 continue to assess the arm every hour for any additional changes 4. instruct the client to exercise the fingers and wrist

c (Rationale: The nurse is helping this family recover from the emergency so that their life can return to normal. Mitigation refers to identifying the threats to a community. Response is the plan that the community will use when an emergency occurs. Preparedness refers to a community having a comprehensive plan for dealing with emergencies. )

The nurse helping a family find a new home after heavy rain flooded their home. The nurse is participating in: a The response phase of emergency response b The preparedness phase of emergency response c The recovery phase of emergency response d The mitigation phase of emergency response

2 (This client has a very poor prognosis, and even with treatment survival is unlikely. WRONG: #1 This is PRiority 1, Red. If not treated stat, a tension pneumothorax will occur #3 This is PRiority 2, Yellow, this comes after Red #4 This is Priority 3, Green, this client can wait days for Tx)

The nurse in a disaster is triaging the following clients. Which client should be triaged as an Expectant Category, Priority 4, Black? 1. The client with a sucking chest wound who is alert 2. The client with a head injury who is unresponsive 3. The client with an abdominal wound with stable VS 4. The client with a sprained ankle which may be fractured

3 (The HCP's are not guaranteed absolute protection, even with all the training and protective equipment. This is the most important info individuals wearing PPE should know because all other procedures should be followed at all times. #1 Masks are kept in designated areas, not at entry doors, #2 this is true, in an emergency situation the respondent should use the equipment even if not trained. #4 This is true but not most important)

The nurse is teaching a class on bioterrorism and is discussing PPE. Which statement is the most important fact for the nurse to share with the participants? 1. Health care facilities should keep masks at entry doors 2. The respondent should be trained in the proper use of PPE 3. No single combination of PPE protects against all hazards 4. The EPA has divided PPE into four levels of protection

3 (Federal resources include organizations such as DHHS and the Dept of Justice. Each of these federal depts oversees hundreds of agencies, including the American Red Cross, which respond to disasters. WRONG: #1 This organization mandates all health care facilities to HAVE an emergency operations plan, but it is a national agency, not federal agency #2 Most cities and states have an OEM, which coordinates disaster relief efforts at the state and local levels #4 MMRS teams are local teams in cities deemed possible terrorist targets)

Which federal agency is a resource for the nurse volunteering at the American Red Cross who is on a committee to prepare the community for any type of disaster? 1. The Joint Commission (JC) 2. Office of Emergency Management (OEM) 3. Dept of Health and Human Services (DHHS) 4. Metro Medical Response Systems (MMRS)

2 (Exposure to anthrax bacilli via the skin results in skin lesions, which cause edema with pruritus and the formation of macules or papules, which ulcerate, forming a 1-3 mm vesicle. Then a painless eschar develops, which falls off in 1-2 weeks. WRONG: Scabby clear fluid filled vesicle= Chickenpox #3 Irreg brownish-pink spots around hairline=Rubella #4 Tiny purple spots, flush with skin = Petechiae)

Which S/S should the nurse assess in the client who has been exposed to the anthrax bacillus via the skin? 1 A scabby clear fluid filled vesicle 2. Edema, pruritis, and a 2 mm ulcerated vesicle 3. Irregular brownish-pink spots around the hairline 4. Tiny purple spots flush with the surface of the skin

4 (The client with a sucking chest wound needs immediate attention and will likely survive. WRONG: #2 The 80 yo is classified as delayed, emergency personnel can stabilize the fracture, cover the wound #3 the 10 yo has minimal injury and can wait #1 The client with SCI is not likely to survive and should not be among the first transported)

20. Thirty people are injured in a train derailment. Which client should be transported to the hospital first? 1. a 20 yo who is unresponsive and has a high injury to the spinal cord 2 an 80 yo who has a compound fracture of the arm 3. a 10 yo with a laceration on his leg 4. a 25 yo with a sucking chest wound

1,2,3 (Tracking victims: tag securely attached, that indicates: triage priority available ID info Care if any performed/given Time/Date Record in disaster log and used to track victims and inform families. Not necessary to document the presence of jewelry and next of kin)

24 An airplane crash results in mass casualties The nurse is directing personnel to tag all victims. Which information should be placed on the tag? SATA 1. triage priority 2. identifying information when possible (such as name, age, address) 3 medications and treatments administered 4 presence of jewelry 5. next of kin

1,4 (Anthrax is Tx with antibiotics and client must continue them 60 days even without symptoms. The client may have lesions with macula or papule formation, the eschar will fall off in 1-2 weeks. Clients are NOT contagious, do not need isolation, and anthrax from skin exposure is not transmitted by resp contact and the client does not need to wear a mask)

29 A suspected outbreak of anthrax has been transmitted by skin exposure. A client is admitted to the ED with lesions on the hands. The HCP prescribes antibiotics and send the client home. What should the nurse instruct the client to do? SATA 1. take the prescribed antibiotics for 60 days 2. avoid contact with other members of the family during the treatment period 3. wear a mask for 60 days 4.. expect the skin lesions to clear up within 1-2 weeks 5 wash hands frequently

4

A gang war has resulted in 12 young males being brought to the ED. Which action by the nurse is priority when a gang member points a gun at a rival gang member in the trauma room? 1. Attempt to talk to the person who has the gun 2. Explain to the person the police are coming 3. Stand between the client and the man with the gun 4. Get out of the line of fire and protect self

d (Rationale: Radiation victims experience bone marrow depression, and the nurse would protect the client from exposure to infection. Removing clothes and jewelry is appropriate for those who have been burned. Keeping the ear canals clean is appropriate for those with ear injuries. Puncture wounds are more likely to occur during blasts or perhaps a tornado. )

A nurse is working in a trauma center in the town where a radiation accident has occurred. The nurse plans to assist these clients by: a Removing the clients' clothes and jewelry b Keeping the ear canals clean c Treating puncture wounds d Reducing the clients' exposure to infection

1

A vat of chemicals spills on a client Which action should the occupational health nurse implement first? 1. Have the client stand under a shower while removing all clothes 2. Check the MSDS sheets for the antidote 3. Admin O2 via NC 4. Collect a sample of the chemicals in the vat for analysis

a (Rationale: The nurse would understand that planning is a key to survival during a disaster. Clients are taught to have emergency supplies, a radio, and a safe place in the home for the family to meet. Calling the police during the event is not appropriate unless the family is in jeopardy. Depending on the type of event, it is probably not safe to try to evacuate until local authorities order an evacuation. If the home is intact, it is best to remain at home until authorities indicate that it is safe to venture out of the home. )

The nurse is planning to teach local high school students measures that families can take to improve their chances of surviving a community disaster. The nurse plans to include which personal preparation as a suggestion? a Stock a safe area in the home with water and blankets. b Call the local police during the event for safety tips. c Keep gas in the car for evacuation purposes during an event. d Seek public shelter instead of remaining in the home.

4 (The nurse should follow the hospital policy. many times the nurse will stay at home until decisions are made as to where the employees should report. )

The off duty nurse hears on the TV of a bioterrorism act in the community. Which action should the nurse take first? 1. Immediately report to the hospital ED 2. Call the American Red Cross to find out where to go 3. PAck a bag and prepare to stay at the hospital 4. Follow the nurses hospital policy for responding

3 (The tag should never be removed from the client until the disaster is over or the client is admitted and the tag becomes part of the clients record. The HCP needs to be informed immed of his action #2 The VS Should be documented on the tag!)

The triage nurse has placed a disaster tag on a client. Which action warrants immediate intervention by the nurse? 1. The nurse documents the tag number in the disaster log 2 The UAP documents VS on the tag 3 The HCP removes the tag to examine the limb 4. The LPN securely attaches the tag to the clients foot

1 (MSDS provides chemical info for chemicals found in hospital. #3 WRONG because any facility that administers antineoplastic agents must have specific spill kits avail)

Which information warrants the nurse obtaining information from the MSDS? 1. The custodian spilled a chemical solvent in the hallway 2. A visitor slipped and fell on the floor that had been mopped 3. A bottle of antineoplastic agent broke on the clients floor 4. The nurse was stuck with a contaminated needle in the clients room

1 (CISM is an approach to preventing and treating the emotional trauma affecting emergency responders as a consequence of their job. Performing CPR and treating a young child affects the emergency personnel psychologically, and the death increases the traumatic experience)

Which situation requires the emergency dept manager to schedule and conduct a Critical Incident Stress Management (CISM)? 1. Caring for a 2 year old child who died from severe physical abuse 2. Performing CPR on a middle aged male executive who died 3. Responding to a 22 year old victim bus accident with no apparent fatalities 4. Being required to work 16 hrs without taking a break

4 (New settings and atypical roles for nurses may be required during disasters, med-surg nurses can provide first aid and may be required to work unfamiliar settings.)

Which statement best describes the role of the medical surgical nurse during a disaster? 1. The nurse may be assigned to ride in the ambulance 2. The nurse may be assigned as a first assistant in the OR 3. The nurse may be assigned to crowd control 4. The nurse may be assigned to the ED

4 (Avoiding cross-contamination is a priority for personnel and equipment, the fewr the number of people exposed the safer the community and area. WRONG: #1: This is not a rationale, this is a statement, #2 This separates the clients until decontamination, but the question asks for scientific rationale. #3 This is a FALSE statement, the supplies should not be kept in the decontamination area)

The nurse teaching a class on bioterrorism, Which statement is the scientific rationale for designating a specific area for decontamination? 1. Showers and privacy can be provided to the client in this area 2. This area isolates the clients who have been exposed to the agent 3. It provides a centralized area for stocking the needed supplies 4. It prevents secondary contamination to the HCP's

4 (Because of the variety of agents, the means of transmission, and lethality of the agents, biological weapons including anthrax, smallpox, and plague are especially dangerous. Sources of biological agents include inhalation, insects, animals and people. The only known vaccine against a possible bioterrorism attack is the smallpox vaccine, which is not available in quantities sufficient to inoculate the public. Because of the vast range of agents, a biological weapon is more of a threat, a biological agent can be released in one city and affect people in other cities miles away)

The nurse is teaching a class on biological warfare. Which information should the nurse include in the presentation? 1. Contaminated water is the only source of transmission of biological agents 2 Vaccines are available and being prepared to counteract biological agents 3. Biological weapons are less of a threat than chemical agents 4. Biological weapons are easily obtained and result in significant mortality

d (Rationale: The best method of increasing core knowledge is to be fully aware of the agency disaster plan. All agencies have a disaster plan or manual, and new employees should be aware of the plan so that they can assume the role assigned during an emergency. Keeping up knowledge of new products would be part of technical skills, not core knowledge. Joining the ANA is recommended, but will not help the nurse function better during a disaster. A personal emergency plan is also recommended but will not enhance the nurse's ability to function during a disaster. )

The nurse recognizes that certain competencies are required for the nurse to perform effectively during a community emergency. The nurse increases core knowledge by: a Joining a chapter of the American Nurses Association (ANA) b Attending an inservice on new products c Forming a personal emergency plan d Reviewing the hospital disaster plan

2 (2: The nurse should take note of any unusual illness for the time of year or clusters of clients coming from single geographical location who all exhibit s/s of possible biological terrorism. )

The nurse in the ED has admitted 5 clients in the last 2 hours with complaints of fever and GI distress. Which question is most appropriate for the nurse to ask each client to determine if there is a bioterrorism threat? 1. Do you live near any large powerlines? 2. Where were you immediately before you got sick? 3. Can you write down everything you ate today? 4 What other health problems do you have?

3 (The prodromal phase (presenting symptoms) of radiation exposure occurs 48-72 hrs after exposure and are the s/s of N/V/D, anorexia, and fatigue. S/S of higher levels of exposure inclulde fever, respiratory distress, and excitability. WRONG: #4 these are signs of botulism inhalation #1 are signs in LATENT phase of radiation exposure which occur from 72 hrs to years after exposure. #3 Are signs of bubonic plague)

The nurse is caring for the client in the prodromal phase of radiation exposure. Which s/s should the nurse assess in the client? 1 Anemia, leukopenia, thrombocytopenia 2. sudden fever, chills, and enlarged lymph nodes 3. N/V/D 4. Flaccid paralysis, diplopia, dysphagia

3 (First admin O2 in atrial fibrillation, the workload of the heart is increased as is myocardial O2 demand. WRONG #1 Heparin may be prescribed, but not clear how long client is in a-fib, and critical to determine before tx initiated.#2 &#4 BB and cardioversion are not primary interventions and it is important to determine first if the client is hemodynamically stable and the length of time client has been in a-fib)

3 A client admitted to the ED with atrial fibrillation has a HR of 160. The nurse should implement which prescription first? 1. Admin a heparin bolus 2. Admin a beta blocker 3. Admin O2 via nc 4. Prepare the client for immediate cardioversion

2 ( Says 3 hours ago, open fracture, and degree of contamination via ditch the risk of infection is VERY high. The nurse should be aware of s/s of infection or early signs of infections such as debris in the wound site, temp abnormalities, results of lab studies, CBC and wound cultures, or heat or redness around the wound. WRONG: #1,#3,#4 : VS are WNL and cardiovascular status are stable. so hemorrhage is not the primary concern. The client is talking coherently which does not suggest shock. The nurse should continue to assess for s/s of hemorrhage and shock, but right now they are good. There will be surgery asap minimizing the risk of deformity)

2 Three hours ago a client was thrown from a car into a ditch and is now admitted to the ED in a stable condition with VS wnl, alert, oriented, with good coloring, and an open fracture of the R tibia. For which sign should the nurse be especially alert? 1. hemorrhage 2 infection 3 deformity 4. shock

1,2,4,5 (Victims with chemical burns, 2nd and 3rd degree burns over more than 20% of the BSA and those with inhalation injury should be transported to a burn center The victim with 1st degree burn of the hands can be treated on scene and referred to health care facility)

21 An explosion at a chemical plant produces flames and smoke. more than 20 people have burn injuries. Which victims, all adults, should be transported to a burn center? SATA 1. The victim with chemical spills on both arms 2. The victim with 3rd degree burns of both legs 3. The victim with 1st degree burns of both hands 4. The victim in respiratory distress 5. The victim who inhaled smoke

1 (The nurse should institute Tx for hemorrhagic fever viruses. including contact isolation with double gloving and shoe covers, strict hand hygiene, and protective eyewear. The nurse should start respiratory isolation with NEGATIVE pressure rooms. Enteric precautions are not needed because the virus is spread by droplet and contact. )

31 Several clients who work in the same building are brought to the ED. They all have fever, headache, a rash over the entire body, and abdominal pain with vomiting and diarrhea. Upon initial assessment, the nurse finds that each client has low BP, and has developed petechiae in the area where the BP cuff was inflated. Which isolation precautions should the nurse initiate? 1. contact isolation with double gloving and shoe covers 2. respiratory isolation with positive pressure rooms 3. enteric precautions 4. reverse isolation

c (rationale: Tularemia can be placed in our food or water supply to poison people. Anthrax is not transmitted from one person to another. The first symptoms of botulin poisoning are double or blurred vision and slurred speech. Smallpox is spread from person to person in droplets)

The nurse is teaching a class for high school students regarding bioterrorism as part of a community preparedness program. The nurse concludes that the students understood the teaching when they respond: a "I should not go home if I have been exposed to anthrax and risk exposing my family." b "I cannot contract smallpox from another person." c "Tularemia can be placed in our water or food supply." d "If I have been poisoned with botulism, the first sign is generalized itching."

2 (The middle aged female is likely in SHOCK. She is classified as a triage level I, requiring immediate care. WRONG: #1 The child with moderate trauma is classified as triage level III, urgent and can be treated within 30 mins. #3 The man with asthma and the man with severe headache are classified as level II and can be transported by ambulance and reach the hospital within 15 mins.)

7. There has been a car accident that involved four vehicles on a remote highway. The nearest emergency dept is 15 mins away. Which victim should be transported by helicopter rather than an ambulance to the nearest hospital? 1. A 10 year old with a simple fracture of the femur who is crying and cannot find his parents 2. a middle aged female with cold clammy skin, HR 120, and is unconscious 3. middle aged male with severe asthma, HR 120, and is having difficulty breathing 4. An older adult with severe headache, but conscious

4 (Safety of the staff and others is the first priority. Isolating reduces the chances of contaminating others. (secondary contamination). VS can be obtained when it is safe. AFter protecting staff, clients and visitors from secondary contamination. O2 is not indicated for the listed symptoms. REmoving clothing is important to prevent the client from further exposure but first protect the staff and others. The client can remove their own clothing and put in plastic bags. After this decontamination showers, if staff not trained 911 may be more appropriate response, finding out which chemicals involved is important but not priority over preventing secondary contamination)

32 Eight farm workers are admitted to the ED after they were splashed with "a couple of chemicals" at work 30 mins ago. The have watery, itchy eyes, slight cough, diaphoresis, and constricted pupils and are conscious and oriented. Their clothes are wet. What actions should the nurse do first? 1. Apply O2 at 3L nc 2 Remove their clothing 3. begin decontamination showering 4. isolate the clients

2 (RESPIRATORY DISTRESS: Should go first, probably inhalation injury. WRONG: #1 pregnant woman not in imminent danger, not at risk for fast birth #3 10 yo not at risk for infection and can be outpatient and #4 1st degree, not so urgent)

22 An apartment fire spreads to seven apartment units. Victims suffer burns, minor injuries, and broken bones from jumping from windows. Which client should be transported first? 1. a woman who is 5 months pregnant with no apparent injuries. 2 A middle aged man with no injuries who has rapid respirations and coughs 3. A 10 year old with simple fracture of the humerus who is in severe pain 4. a 20 year old with 1st degree burns on her hands and forearms

2,3 (preserve forensic evidence. Put each item of clothing in seperate paper bag and label. Wet clothing should be hung to dry. Nurses should not cut or otherwise handle clothing particularly clothing with evidence such as blood or bodily fluids. The nurse should carefully document the clients description of the incident and quote around the clients words when possible. The documentation will become part of the clients record and can be subpoeoned for investigation. The nurse should NOT handle bullets from the client)

23 There is a shooting in a shopping mall. Three victims with gunshot wounds are brought to the ED. What should the nurse do to preserve forensic evidence? SATA 1. Cut around the blood stains to remove clothing 2. Place each item of clothing in a separate paper bag 3. hang wet clothing to dry 4. refrain from documenting pt statements 5. Place bullets in a sterile container

1,2 (The victim with neck injury should be immobilized and moved as little as possible. It is also important to establish airway; can be done with jaw thrust which does not require tilting head. DO NOT ROLL to side lying or elevate feet. They could cause more SCI. Placing a collar causes movement and should not be done as a first aid measure)

26 A small airplane crashes in a neighborhood of 10 houses. One of the victims appears to have a cervical spine injury. What should first aid for this victim include? SATA 1. establish an airway with the jaw thrust maneuver 2. immobilize the spine 3. logroll the victim to a side-lying position 4. elevate the feet 6 inches 5. place a cervical collar around the neck

1 (disaster teams are available for crisis intervention for the families and children affected. )

27 Thirty-two children are brought to the ED after a school bus accident. Two children were killed along with the three people in the care that caused the crash. Before the victims arrive, in addition to ensuring that the hospital staff are prepared for the emergency, which step should the nurse anticipate carrying out? 1. calling the nearest crisis response team 2.. alerting the news media 3. notifying the hospital volunteer office 4. calling the school to inform the teachers of the accident

3 2 4 1 (3 14 yo with asthma needs immed lifesaving intervention 2 22 yo confused needs assess for head injury could be a blunt force injury with temple laceration 4. Preg needs assessment, but not urgent unless other s/s 1 75 year old is nonurgent and can wait several hours)

28 The nurse in the ED is triaging victims of an airplane crash. Prioritize the clients in the order in which they should be treated from first to last 1 a 75 yo with a 2-inch laceration to the LFA 2. A 22 yo with a 2 inch laceration to the L temple, slightly confused 3 A 14 yo with a 2 inch laceration to the chin, history of asthma, RR 26, audible wheezing 4. A 22 yo female 36 weeks pregnant with contractions every 10-15 mins

2,3 (Crushing chest pain and open fracture and client with displaced femur and missing pulses can be classified as immediate because they will have successful outcomes if measures initiated. WRONG: #1 and #4 Are classified as BLACK because of critical injuries and unavailability of advanced trauma care... not good expected outcome)

33 The nurse is triaging victims of an earthquake who were removed from a building following its collapse. Which victims should be classified as red? SATA 1. a 10 yo boy with a crushing chest wound, tachypnea, with labored breathing, unconscious, impaled object in the forehead 2. a 49 yo male with crushing chest pain radiating to the lower jaw, is diaphoretic, nauseated, and has an open fracture of the L wrist 3. A 75 yo F with obvious fracture of the femur, absent pedal pulses on the affected side, HR 110, RR 34, skin diaphoretic, awake/alert, states pain 10 on 1-10 scale 4 A 32 yo F who is unconscious, 3 inch laceration to forehead, ecchymosis behind the ears, RR 10, and shallow; radial pulse is weak, thready, rapid. no breath sounds on the right side

1,2

38 There has been an increase in medication errors and errors in prescribing laboratory studies in the ED. The nurse manager is conducting a staff education session on when to use "read-back" procedures. "Read-back" procedures should be performed in which situations? SATA 1. when medication prescription or critical laboratory result is received verbally or over the telephone 2. when any verbal or phone prescription is received 3. whenever a written prescription or printed critical value is received 4. when the unit secretary takes a phone prescription 5. when the agency uses computerized health care records

3 (Give them a mask and tissues. dispose of tissues correctly. Not appropriate to make others move away, but the nurse can ask the pt to stay 3 ft from others in waiting room if there is room )

6. A client is admitted to the ED with sneezing and coughing. The client is in the triage area waiting to be seen by the HCP. To prevent spreading the infection to others in the area and to the healthcare staff, the nurse should: 1. place the client in an isolation room 2. ask the others in the area to move away from the client 3. give the client a surgical mask to wear 4. ask the client to wash the hands before being examined

1,2,5 (Practice drills allow for troubleshooting any real life issues before incidents occur. A deactivation response is important so resources are not overused, and the facility can return to normal and routine care, A coordinated security plan involving facility and community agencies is the key to controlling otherwise chaotic situations. WRONG#3 Need communication with external resources too #4 a post-incident response is important to include a critique and debriefing. A pre-incident response is the plan itself.)

The nurse is teaching a class on disaster preparedness. Which are components of an emergency operations plan (EOP) SATA 1. A plan for practice drills 2. A deactivation response 3. A plan for internal communication only 4. A pre-incident response 5. A security plan