hof ch 71 - mass casualty and disaster preparedness

What is the highest level of personal protective equipment (PPE) for respiratory protection? 1. Level A 2. Level B 3. Level C 4. Level D

1 Level A is the highest level of respiratory, eye, mucous membrane, and skin protection. This level provides protection against gas, vapor, liquid, and oxygen-deficient atmospheres.

The nurse is conducting triage under mass casualty conditions. Which tag should the nurse use for a patient who is experiencing hypovolemic shock due to a penetrating wound? 1) Red 2) Black 3) Green 4) Yellow

1 The nurse would use a red tag for a patient who has injuries that are an immediate threat to life, such as hypovolemic shock, during mass casualty conditions.

What is the goal of triage? 1. Maximize number of survivors 2. Provide lifesaving measures 3. Determine level of care needed 4. Prioritize care needs of all victims

1 regardless of the system used, the primary goal of disaster triage is to maximize the number of survivors.

Which is the priority in the preparedness of health-care professionals in any type of disaster plan? 1) Identification of hazards 2) Cooperation with state authorities 3) Collaboration with local authorities 4) Implementation of federal mandates

1 Identification of hazards is the priority in the preparedness of health-care professionals in any type of disaster plan.

The nurse dons which level of personal protective equipment (PPE) when assigned to care for a patient when the type of airborne exposure is unknown? 1. Level A 2. Level B 3. Level C 4. Level D

1 Level A is the highest level of respiratory, eye, mucous membrane, and skin protection. This level provides protection against gas, vapor, liquid, and oxygen-deficient atmospheres. This level should be selected when the hazards are unknown or unquantifiable or when the greatest level of protection is required. It provides full protection against liquids and vapors.

A green-tagged patient arrives at the emergency department after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this patient? 1) Implementing decontamination measures 2) Performing a head-to-toe physical examination 3) Placing a special bracelet with a disaster number 4) Taking a digital photo and placing it on the medical record

1 The priority nursing action for a green-tagged patient who arrives at the ED after exposure to radiation is implementing decontamination measures. These measures are the priority because it is essential that members of the health-care team and patients are not exposed to the radiation while providing care.

The nurse is contributing to a disaster plan for a possible terrorist attack. Which biological agents should be included in the plan? Select all that apply. 1) Rubella 2) Anthrax 3) Measles 4) Botulism 5) Tularemia

2 4 5 Biological agents most commonly used in terrorist attacks include anthrax, smallpox, botulism, plague, tularemia, and hemorrhagic fever.

In a disaster, which hospital department is responsible for the secondary triage of patients? 1. Medical unit 2. Operating suite 3. Radiology department 4. Emergency department

4 At the hospital, secondary triage is typically performed by Emergency Department (ED) personnel, and then patients are assigned to a treatment area for care.

The nurse is a member of the critical incident stress management unit that looks to meet the psychosocial needs of first responders after a mass casualty incident. Which action by the nurse is appropriate when conducting a session? 1) Arranging group discussion 2) Administering anti-anxiety medication 3) Scheduling individual therapy appointments 4) Documenting individual responses to the session

1 Many hospitals and DMATs have a critical incident stress management unit, which arranges group discussions to allow participants to share and validate their feelings and emotions about the experience. This is important for emotional recovery.

Which emergency medical system (EMS) first responders can perform triage during mass casualty incidents? 1) Unlicensed assistive personnel 2) Nurses appointed to a field team 3) A physician who survives the incident 4) Community response team members

2 Paramedics and nurses appointed to a field team are the EMS first responders who can perform triage during a mass casualty incident.

Which organization requires hospitals to have disaster and evacuation plans in the event of an emergency? 1. American Hospital Association (AHA) 2. Hospital Regulatory Agency 3. Homeland Security 4. Federal Emergency Management Agency (FEMA)

2 The decision to evacuate a hospital should be based on the ability of the hospital to meet the medical needs of the patients. Hospitals should have in place plans for either a full or partial evacuation, and those plans should be consistent with regulatory requirements.

During the implementation of a disaster plan that involves exposure to toxic substances, who is responsible for decontamination? 1. Safety/security officer 2. Operations chief 3. Logistics section chief 4. Incident commander

2 The operations chief is responsible for all tactical operations, including decontamination, rescue/extrication, triage, treatment, transportation, communication, and medical control.

Which amount of time is appropriate for nurse to spend triaging each patient during a mass casualty incident? 1) Less than 10 seconds 2) Less than 15 seconds 3) Less than 30 seconds 4) Less than 60 seconds

2 Triage of victims of an emergency or an MCI must be conducted in less than 15 seconds. The other time frames, 10 seconds, 30 seconds, and 60 seconds, are not accurate.

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. 1) Burn 2) Blast 3) Crush 4) Penetration 5) Psychological

2 3 4 Blast, crush, and penetration injuries are most common when explosive devices are used as an agent of terrorism. These injuries should be identified in the organizational disaster plan along with appropriate treatment options for each

What are the key elements to ensure the safety of all personnel participating in an emergency hospital drill? Select all that apply. 1. Use real equipment. 2. All drill communications begin and end with "This is a drill." 3. Have strict start and stop times for the drill. 4. There must be a safety officer with the sole responsibility to monitor any unsafe situations. 5. Use strategies to make the situation realistic.

2 4 This is correct. The two key elements to ensure safety for all participants are that (1) all communications during the drill should start and end with "This is a drill"; and (2) a safety officer with the sole responsibility to monitor and respond to any unsafe situations should be identified.

The nurse is a first responder for a health-care organization for a mass casualty incident. Which injury would the nurse tag as yellow during the triage process? 1) Ankle sprain 2) Hypovolemic shock 3) Open femur fracture 4) Massive head trauma

3 When using a triage tag system, an open femur fracture is an urgent but not life- threatening injury that would be tagged as yellow.

Based upon Simple Triage and Rapid Treatment (START), the nurse tags the patient with which injury as yellow during the triage process? 1. Ankle sprain 2. Hypovolemic shock 3. Open femur fracture 4. Massive head trauma

3 When using a triage tag system, an open femur fracture is an urgent but not life-threatening injury that would be tagged as yellow.

Which psychosocial nursing actions are appropriate when providing patient care after a community disaster? Select all that apply. 1) Performing triage of injuries 2) Administering first aid to wounds 3) Offering choices whenever possible 4) Establishing rapport through active listening 5) Requesting assistance from crisis counselors

3 4 5 Psychosocial nursing actions appropriate when providing care after a community disaster include offering choices whenever possible, establishing rapport through active listening, and requesting assistance from crisis counselors.

Which patient injury would receive a black tag by the triage nurse during a mass casualty incident? 1. Concussion 2. Ankle sprain 3. Open femur fracture 4. Full-thickness body burns

4 A black tag indicates the patient has suffered an extensive injury and is expected, or allowed, to die. Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation.

Which is the critical factor among health-care professionals, state agencies, and federal agencies to determine when and how to evacuate safely during a natural disaster? 1) Cooperation 2) Classification 3) Collaboration 4) Communication

4 Communication is the critical factor among health-care professionals, state agencies, and federal agencies to determine when and how to evacuate safety during a natural disaster.

Which entity is responsible for activating the disaster plan during a mass casualty incident (MCI)? 1) Local emergency management system 2) State emergency management system 3) Federal emergency management agency 4) Hospital-level emergency management system

4 Each hospital has its own policy that specifies who has the authority to activate and how to activate the disaster or emergency preparedness plan.

What is the priority intervention when treating patients during a mass casualty event using Simple Triage and Rapid Treatment (START)? 1. Assessing for a pulse 2. Administering oxygen 3. Preparing for endotracheal tube intubation 4. Applying direct pressure to control bleeding

4 The START triage allows for only two interventions during the triage process: (1) direct pressure to control bleeding and (2) basic airway-opening maneuvers; therefore, this is the priority intervention for the nurse to implement.

Which public health risk became a major focus for hospitals after the September 11, 2001 terrorist attacks? 1) Anthrax exposure 2) Multi-casualty incidents 3) Mass casualty incidents (MCI) 4) Weapons of mass destruction (WMD)

4 Weapons of mass destruction (WMD) rapidly became a focus of public health risk after the terrorist attacks that occurred on September 11, 2001.

Which medication should be listed as the antidote to a nerve agent in the disaster plan for a terrorist attack? 1) Atropine 2) Dopamine 3) Epinephrine 4) Norepinephrine

1 Atropine should be listed as the antidote for nerve agent poisoning in the disaster plan for a terrorist attack.

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? 1) "We have to implement annual drills." 2) "Nursing homes are not required to have a plan." 3) "Our facility is held to the same standards as hospital facilities." 4) "This is an important component to receive insurance payments for care."

1 Hospitals are not the only health-care agencies that are required to practice disaster drills. Long-term care (LTC) facilities are also mandated to have annual drills to prepare for mass casualty events. Part of the response plan must include a method for evacuation of residents from the facility in a timely and safe manner.

Which organization in the United States mandates ongoing disaster preparedness for hospitals? 1) The Joint Commission (TJC) 2) The local government 3) The state government 4) The Occupational Safety and Health Administration (OSHA)

1 In the United States, The Joint Commission mandates that hospitals have an emergency preparedness plan that is tested through drills or actual participation in a real event at least twice yearly.

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)? 1) Covering the nose 2) Protecting the eyes 3) Decontaminating the skin 4) Administering prophylactic antibiotics

1 The priority nursing action to protect against the radioactive dust and smoke that can cause illness from an RDD is covering the nose and the mouth to decrease the risk for inhalation.

Which situation does not cover nurses who respond to a mass casualty incident (MCI) for malpractice or negligent lawsuits under the Good Samaritan Act? 1) Terrorist act 2) Neighborhood fire 3) Roadside car accident 4) High school sporting event

1 When terrorist acts occur, nurses are often required to go to an assigned site to offer aid. When this occurs, the nurse is not covered from malpractice or negligent lawsuits.

The nurse manager is reviewing the hospital disaster plan with other members of the committee. Which is the minimum number of disaster drills the committee must plan and implement each year? 1) Two 2) Three 3) Four 4) Five

1 While it is appropriate to have more than the minimum number of disaster drills each year, the minimum that must be implemented per The Joint Commission (TJC) requirements is twice per calendar year.

Which nursing actions are necessary when initiating care for patients who have been injured in a natural disaster? Select all that apply. 1) Taking risks 2) Using principles 3) Stepping into the unknown 4) Showing a commanding presence 5) Formulating individualized plans of care

1 2 3 4 Nursing actions that are required when initiating care for patients who have been injured in a natural disaster include taking risks, using principles, stepping into the unknown, and showing a commanding presence.

In preparing an educational presentation regarding potential injuries and medical issues during a blizzard, the nurse includes which injuries? Select all that apply. 1. Orthopedic issues 2. Acute myocardial infarction 3. Carbon monoxide poisoning 4. Animal attacks/bites 5. Abdominal trauma

1 2 3 5 Injuries associated with blizzards include orthopedic injuries; acute myocardial infarction; carbon monoxide poisoning; cold exposure; hypothermia; frostbite; frostnip; motor vehicle accidents; head, chest, and abdominal injuries from snowmobile accidents; and injuries from the use of power equipment for clearing debris, fallen trees, and snow.

Which threats, included in the term "NBC," lead to the implementation of improved emergency medical services (EMS) and hospital safety programs? Select all that apply. 1) Nuclear 2) Biological 3) Botulism 4) Chemical 5) Nipah virus

1 2 4 The term "NBC" was coined to describe nuclear, biological, and chemical threats. In response, emergency medical services (EMS) agencies and hospitals improved safety by upgrading their decontamination facilities, equipment, and all levels of personal protective equipment to better protect staff.

Which nursing actions during a mass casualty incident should be included in the triage portion of an organizational disaster plan? Select all that apply. 1) Treatment 2) Stabilization 3) Evaluation of interventions 4) Formulation of nursing diagnosis 5) Decontamination for suspected contamination

1 2 5 Victims need to be treated and stabilized and, if there is known or suspected contamination, decontaminated at the scene.

A nurse is working an evening shift when a fire breaks out at the hospital. Which actions by the nurse are appropriate? Select all that apply. 1) Removing patients from immediate danger 2) Discontinuing the use of oxygen for all patients 3) Using a wheelchair to move a bedridden patient 4) Directing ambulatory patients to walk to a safe location 5) Containing the fire immediately to avoid patient evacuation

1 3 4 According to the fire safety portion of the emergency response for internal disasters, the nurse should remove patients from immediate danger, use a wheelchair to move bedridden patients, and direct ambulatory patients to walk to a safe location.

Which events may require a hospital evacuation with no advanced warning? Select all that apply. 1. Explosions 2. Floods 3. Building Fires 4. Hurricanes 5. Tornadoes

1 3 5 No advanced warning events include earthquakes, building fires, tornadoes, and explosions. Decisions must often be made very quickly in the midst of the disaster or immediately afterward.

Which type of event can often be handled by an individual hospital disaster plan without collaboration with other systems? 1) A motor vehicle accident involving five cars 2) A tornado destroying 50 homes and businesses 3) An act of terrorism injuring and kills hundreds of people 4) A hurricane causing flooding, displacing thousands of people

1 A multi-casualty event, such as a motor vehicle accident involving five cars, is an event that can often be handled with the implementation of an individual hospital disaster plan without collaboration with other systems.

The nurse is helping devise a training plan to familiarize health-care providers with emergency response procedures. Which training measure is most effective to adequately prepare the trainees? 1) Drills 2) Tabletop exercises 3) Access to the policy 4) Computer simulations

1 Hospital disaster drills are priority training measures to familiarize health-care providers with emergency response procedure.

The nurse is conducting triage under mass casualty conditions and assigns which tag to the patient who is experiencing hypovolemic shock as a result of a penetrating wound? 1. Red 2. Black 3. Green 4. Yellow

1 The nurse uses a red tag for a patient who has injuries that are an immediate threat to life, such as hypovolemic shock, during mass casualty conditions.

The nurse dons which level of personal protective equipment (PPE) when assigned to care for a patient requiring the highest level of respiratory protection but less skin protection? 1. Level A 2. Level B 3. Level C 4. Level D

2 Level B provides the greatest level of respiratory protection but a lower level of skin protection than level A. It provides splash protection against liquids and should be selected when the highest level of respiratory protection is necessary but a lesser level of skin protection is needed.

What are the three main goals of decontamination? Select all that apply. 1. Enlist as many hospital personnel as possible. 2. Restrict contaminated patients from entering the hospital. 3. Decontaminate patients as quickly as possible. 4. Protect the decontamination team. 5. Treat all patients who are contaminated in the emergency department.

2 3 4 Hospitals must plan to protect the decontamination team from secondary exposure and injury. This includes having enough decontamination suits, respirators, boots, and gloves on hand to sustain the facility for at least 24 hours with a cadre of staff rotating through the process.

A nurse manager is a member of the emergency response planning team for a hospital located in the Rocky Mountains. Which type of natural disaster will the nurse manager recommend be included in their hospital disaster plan? 1) Tornado 2) Hurricane 3) Avalanche 4) Earthquake

3 Disaster drills are ideally planned based on a risk assessment or vulnerability analysis that identifies the events most likely to occur in a particular community. For a hospital in the Rocky Mountains, there is a significant risk for an avalanche. The nurse manager will, therefore, recommend that avalanche planning be included in the hospital disaster plan.

What is the most common example of an advanced warning event that might require a hospital evacuation? 1. Bomb threat 2. Earthquake 3. Hurricane 4. Tornado

3 Hurricanes are the most common example of an advanced warning event. With advanced warning events, the hospital incident commander has time before the event to make a decision but must remember there is a limited opportunity to evacuate.

A workplace violence prevention plan is often one component of a hospital disaster plan. Which unit assumes priority for implementation and evaluation of this component to the plan? 1) Medical unit 2) Surgical unit 3) Radiology department 4) Emergency department

4 The Emergency Nursing Association (ENA) supports comprehensive workplace violence prevention plans to be included as a component of the organizational disaster plan. The ENA recommends that the comprehensive workplace violence prevention plan be implemented and evaluated in every emergency department.

The nurse provides care to patients who have been exposed to radiation. Which actions does the nurse implement to minimize personal exposure? Select all that apply. 1. Use hand sanitizer after patient contact. 2. Ensure that all personal vaccinations are current. 3. Wear a radiation badge to monitor exposure time. 4. Provide distance from the source if on site of the accident. 5. Wear appropriate personal protective equipment when providing patient care.

4 5 This is correct. Providing distance from the radiation source at the site of the action is an action the nurse implements to decrease personal exposure to radiation. This is correct. The use of personal protective equipment is an action the nurse implements to decrease personal exposure when providing care to the patient who is exposed to radiation

The nurse dons which level of personal protective equipment (PPE) when needing only protection from nontoxic (nuisance) contamination? 1. Level A 2. Level B 3. Level C 4. Level D

4 Level D PPE consists of a surgical gown, mask, and gloves. It provides no additional protection for respiratory or splash hazards and only minimal protection for nuisance contamination.

Which treatment for anthrax should be included in the biological agent portion of a disaster plan for terrorist attacks? 1) Antivirals 2) Antitoxins 3) Antibiotics 4) Vaccinations

3 Anthrax is treated effectively with antibiotics if sufficient supplies are available and the organisms are not resistant.

When conducting triage assessments using Simple Triage and Rapid Treatment (START), how long does the nurse assess a patient before moving to the next one? 1. 15 seconds or less 2. 30 seconds or less 3. 45 seconds or less 4. 60 seconds or less

4 START uses physiological parameters and is designed to be completed in 60 seconds or less. It is based on three observations: (1) respirations, (2) perfusion (or pulse), and (3) mental status. The mnemonic RPM is used as a memory aid.

Which health-care team member is a first responder when an emergency or mass casualty incident (MCI) occurs? 1) Fireman 2) Police officer 3) Critical care nurse 4) Unlicensed assistive personnel

3 Critical care nurses are often considered emergency medical personnel that respond to emergency or MCIs.

The nurse works in an emergency department (ED) in a city that experiences an earthquake prepares to care for patients with which type of injury? 1. Drowning 2. Electrocution 3. Crush injuries 4. Carbon monoxide poisoning

3 Crush injuries are anticipated during and after an earthquake; therefore, the nurse should prepare to treat patients with this injury.

The nurse dons which level of personal protective equipment (PPE) when assigned to care for a patient when the type of airborne exposure is known? 1. Level A 2. Level B 3. Level C 4. Level D

3 Level C provides the same skin protection as level B but a lesser level of respiratory protection than levels A and B. Level C consists of a nonencapsulated chemical-resistant suit (splash protection), air-purifying respirator (APR), gloves, and boots. Level C is used when the type of airborne exposure is known to be guarded against adequately by an APR.

The nurse responds to a mass casualty event and implements Simple Triage and Rapid Treatment (START) to triage patients. Which patient does the nurse tag as green? 1. The patient who remains apneic after airway repositioning. 2. The patient who begins breathing after airway management is implemented. 3. The patient who is walking, has abrasions, and follows commands appropriately. 4. The breathing patient with a capillary refill of 3 seconds who cannot follow simple direction.

3 green = minor damage yellow = major red = immediate - (ex: hypovolemic shock) black = deceased This patient is capable of ambulating, understands directions, and has adequate perfusion to stay upright; therefore, this patient is tagged "green" or "minor."

Which patient injury would receive a black tag by the triage nurse during a mass casualty incident? 1) Concussion 2) Ankle sprain 3) Open femur fracture 4) Full-thickness body burns

4 A black tag indicates the patient has suffered an extensive injury and is expected, or allowed, to die. Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation.