Ch. 26 Zerwekh Emergency Preparedness
Which of the following represents a Level II disaster? a.A building collapse that fills the local emergency room with patients. b.A freeway accident that involves multiple vehicles. c.Flooding of a three-state area affecting food and water resources. d.Earthquake that destroys homes and transportation facilities.
ANS: A Level II disasters require the community health nurse to respond in a greater capacity using larger casualty practices in coordination with regional response agencies (such as state health and emergency management agencies). Level I disasters are small-scale, local disasters that do not require an outside agency response. Level III disasters consume local, state, and federal resources to the fullest extent and will require an extended response time by the community health nurse that can extend into weeks or months.
A nursing professor is educating students on nerve agents. The nursing professor judges teaching to be effective when one of students states: a."Sarin gas is a chemical agent that is classified as a nerve agent." b."Mustard gas is a chemical agent that is classified as a nerve agent." c."Ricin is a chemical agent that is classified as a nerve agent." d."Chlorine gas is a chemical agent that is classified as a nerve agent."
ANS: A Sarin gas is an organophosphate ester classified under nerve agents. The nerve agents inhibit the uptake of acetylcholine. Mustard gas is classified as a vesicating (skin) agent. Ricin is a biological agent. Chlorine gas is classified as a choking agent.
An emergency department nurse should suspect a possible bioterrorist agent if, during the Fourth of July weekend, the nurse notices which of the following? a.Three patients arrive complaining of abrupt onset of severe myalgia, fever, sore throat, and headache. b.Four patients, all from the same family picnic, arrive complaining of abdominal pain and nausea, vomiting, and diarrhea. c.Two patients arrive from the local lake complaining of tiredness, weakness, dizziness, muscle cramps, and headache. d.Two patients arrive from a local concert with superficial burns on the faces, necks, arms, and legs and complaining of pain in these areas. They are tachycardic and appear dehydrated.
ANS: A Symptoms of influenza in July are not a normal occurrence and should be investigated further. Bioterrorist agents are usually not endemic to an area (patients coming from the same location [e.g., local lake or local concert]). Having GI symptoms after a picnic more than likely is a foodborne pathogen.
A public health nurse is giving a presentation on the recovery stage of a disaster to a group of nursing managers. The teaching has been effective when one of the nurse managers states: a."The recovery stage deals with operations that occur after the disaster." b."The recovery stage deals with operations during a disaster." c."The recovery stage deals with operations before a disaster." d."The recovery stage involves the process of dealing with disasters."
ANS: A The recovery mode of a disaster deals with operations that occur after the disaster. During the recovery stage, the nurse may be confronted with unexpected or sudden loss of key personnel, patients, and the management of mental health issues related to the disaster. The preparedness mode of a disaster deals with operations done before a disaster. The response mode of a disaster deals with operations during a disaster.
Which federal program provides a "push-pack" that, when requested, can be transported within 12 hours to an affected community and consists of medical assets such as medications, medical equipment and supplies, and personal protective equipment? a.Strategic National Stockpile (SNS) b.CHEMPACK federal program designed to supplement the medical response. c.Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) d.National Incident Management System (NIMS)
ANS: A This federally funded program under the auspices of the Centers for Disease Control and Prevention can aid any stricken community within the United States or its territories within 12 hours by delivering critical medical assets to assist the emergency medical and public health response. The SNS is primarily stored for biological acts of terrorism or large-scale natural disasters. CHEMPACK is a similar program but is specifically targeted for chemical agents or chemical exposures on a large scale. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (e.g., retired, nonlicensed) during an emergency response. The National Incident Management System (NIMS) provides a consistent nationwide template to establish federal, state, tribal, and local governments and private sector and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism.
A nurse is one of the first responders on the scene of a disaster. What is initial priority? a.Triage the patients. b.Delegate care to additional personnel as they arrive. c.Task assignment. d.Prioritize care.
ANS: A Triage can be used by lightly trained emergency department (ED) personnel and is not to supersede or instruct medical techniques. A common triage system is known as START (Simple Triage and Rapid Treatment). Triage is used during natural disasters and mass casualty events. Delegation, assigning tasks, and prioritizing care are daily functions done by the nurse manager.
A patient is tagged as "Minor" during a mass casualty event. An example of a "Minor" triage is a patient with a. a strained right shoulder. b. a large laceration to the right leg. c. an obstructed airway. d. who is unconscious.
ANS: A Under the START triage system, those tagged "Minor" are injured persons who can be assisted after those who are tagged as "Immediate" and "Delayed" have been medically tended to. Persons tagged as "Minor" will not need medical care for at least several hours and can usually walk with assistance (usually consisting of bandages and acute first aid). A patient with a large laceration to the right leg would be classified under Delayed triage. Patients with obstructed airway or who are unconscious would be classified under Immediate triage.
A public health nurse is discussing disaster planning with family. What suggestions can be made to help them be prepared? (Select all that apply.) a.Discuss probable disasters in the area. b.Create a family disaster preparedness kit. c.Establish family emergency communication. d.Only prepare if there is a guarantee of a disaster in the area. e.Create an evacuation plan.
ANS: A, B, C, E The nurse can suggest that the family discuss probable disasters in the area, create a family disaster preparedness kit, establish family emergency communication, and create an evacuation plan. The family should not wait until there is a guarantee of disaster because the goal is to be prepared in advance.
A patient has been exposed to chlorine gas. What symptoms can the nurse expect the patient to have? (Select all that apply.) a.Nose and throat irritation b.Eye redness c.Ear pain d.Cough e. Suffocation
ANS: A, B, D, E The nurse should expect the patient to have the following symptoms: nose and throat irritation, eye redness, cough, and suffocation. Ear pain is not a symptom of exposure to chlorine gas.
A nurse manager is educating a staff nurse on the four top agents for potential bioterrorism. The nurse manager judges that the teaching has been effective when the staff nurse states that the top agents include (Select all that apply.) a. smallpox. b.anthrax. c.flu virus. d.botulism. e. plague.
ANS: A, B, D, E The teaching is effective when the staff nurse identifies the following as the top four agents for potential bioterrorism: Smallpox, anthrax, botulism, and the plague. The flu virus is not considered one of the four agents.
Which statement by the nurse indicates the most important goal in the management of a disaster such as one caused by a category 5 hurricane? a."Rescue the victims." b."Plan to prevent such disasters." c."Give immediate first aid and medical care to the victims." d."Evacuate the injured to medical facilities."
ANS: B Although all of the options are important, the most important aspect of any disaster management is to have a plan of prevention in place. Disaster prevention can eliminate or reduce tremendous pain, suffering, and loss of life that could occur if, for example, people were not evacuated from a coastal area before a hurricane. Having a plan in place sets the procedures for rescuing victims, evacuating facilities, and administering first aid and medical care. The National Incident Management System (NIMS) provides a consistent nationwide template to establish federal, state, tribal, and local governments and private sector and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. NIMS benefits include a unified approach to incident management; standard command and management structures; and emphasis on preparedness, mutual aid, and resource management.
The nurse has been studying endemic diseases and understands that they can occur in clusters of people from the same geographically distinct area. Which statement by the nurse indicates the understanding of the biological agents that can be disseminated by airborne release? a."Anthrax and plague can be disseminated 50% of the time." b."Botulism and anthrax can be disseminated." c."Plague and smallpox are airborne illnesses that can be disseminated." d."Botulism and smallpox can be disseminated 100% of the time."
ANS: B Both anthrax and botulism can be aerosolized and inhaled and disseminated by airborne release. Plague and smallpox are spread person to person.
An infection control nurse is educating a nurse about potential bioterrorism agents. The nurse knows the teaching has been effective when the nurse states: a."Smallpox has three routes of exposure to humans." b."Anthrax has three routes of exposure to humans." c."Botulism is caused by a bacterium found only in animals." d."Tularemia is transmitted via ingestion of toxin-contaminated food."
ANS: B Infection with Bacillus anthracis, the cause of anthrax, can occur via three routes of exposure: cutaneous, gastrointestinal, and inhalation. Botulism can be transmitted via ingestion of toxin- contaminated food. The toxin can be aerosolized and inhaled (artificial). Tularemia is not known to be spread from person to person and is caused by the bacterium Francisella tularensis, which is found in animals (especially rodents, rabbits, and hares).
The nurse has an adequate understanding of smallpox when the nurse states which of the following? a."Smallpox does not exist because of vaccines." b."Smallpox can easily be spread from person to person." c."Smallpox must be ingested for a person to become sick." d."Smallpox is resistant to vaccines."
ANS: B The nurse has an adequate understanding when the nurse states that smallpox an easily be spread from person to person. Smallpox does still exist, does not need to be ingested for a person to become sick, and is not resistant to vaccines.
The nurse has an adequate understanding of phosgene gas when stating which of the following? a."Phosgene gas smells like bleach." b."Phosgene gas smells like fresh cut grass." c."Phosgene gas smells like almonds." d."Phosgene gas smells like rotting fruit."
ANS: B The residue from the choking agent known as phosgene gas on the clothes or skin of an affected patient has the distinct odor of freshly cut grass. Chlorine gas has been described as smelling like bleach. Cyanide gas has been described as smelling like almonds. VX gas has been described as smelling like Vicks VapoRub or rotting fruit.
A nurse is caring for patients after a major disaster has occurred. What is the best action in caring for these patients? (Select all that apply.) a.Avoid discussing the disaster that has occurred. b.Encourage patients to talk about their experience. c.Empathize with patients and their emotions and experiences. d.Ask patients not to discuss the disaster until they are under the care of a psychologist. e.Reinforce their emotions and reactions as normal.
ANS: B, C, E The nurse should encourage patients to talk about their experience, empathize with patients about their emotions and experiences, and reinforce their emotions and reactions as normal.
A nurse is caring for a group of sick patients. Which patient would the nurse be less likely to use isolation precautions with? a.Tuberculosis (TB) b.Plague c.Botulism d.Smallpox
ANS: C Botulism is transmitted by ingestion of toxin-contaminated food. It can be aerosolized and inhaled. The patient needs supportive care only; no isolation precautions are necessary. Tuberculosis (TB), smallpox, and plague require droplet precautions.
Which unit's responsibilities include triage of victims at a disaster site, medical care at the site, and staging locations outside the disaster site for transportation of patients to alternative health care facilities? a.Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) b.Medical Reserve Corps (MRC) c.Disaster Medical Assistance Teams (DMAT) d.NIMS National Incident Management System (NIMS)
ANS: C DMAT units are composed of teams of various clinical health specialties that include, but may not be limited to, communications, logistics, maintenance, and security. These teams are locally based but can be deployed federally on request. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (e.g., retired, nonlicensed) during an emergency response. START is a form of triage care used during a mass casualty event. MRC is a registry of medical reserve corps persons who can be recruited for overall assistance with a health or hospital facility during an emergency response. NIMS is the national framework developed by the Department of Homeland Security and FEMA to standardize emergency response from a local through federal level.
The charge nurse is educating a nurse on the process of surveillance for the outbreak of disease in the hospital setting. The charge nurse judges the education to be effective when the nurse states: a."Surveillance is primarily the responsibility of the safety officer." b."Surveillance is primarily the responsibility of the risk manager." c."Safety is primarily the responsibility of the infection control nurse." d."Safety is primarily the responsibility of the hospital surveillance officer."
ANS: C In the hospital, the infection control nurse is responsible for both passive and active hospital surveillance monitoring.
A nurse manager is educating a new hire on which form of standardized structure is implemented in the hospital during an emergency response. The teaching has been effective when the new hire states: a."Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR- VHP) is implemented to coordinate and standardize command and operations." b."START system of triage is implemented to coordinate and standardize command and operations." c."Hospital Incident Command System (HICS) is implemented to coordinate and standardize command and operations." d."Initiation of the Medical Reserve Corps (MRC) is implemented to coordinate and standardize command and operations."
ANS: C The Hospital Incident Command System (HICS) is a standardized command structure that allows for coordination and collaboration across jurisdictions and professions within a hospital facility during an emergency response. ESAR-VHP is a registry of health professionals that can be accessed and executed to recruit medical and clinical professionals (e.g., retired, nonlicensed) during an emergency response. START is a form of triage care used during a mass casualty event. MRC is a registry of medical reserve corps persons who can be recruited for overall assistance with a health or hospital facility during an emergency response.
A nurse manager is educating a group of nurses on biological agents that do not have a chemoprophylaxis therapy and only allows for the nurse to provide supportive care. The manager judges the teaching to be effective when the nurses can state: a."Anthrax is one of these biological agents." b."The plague is one of these biological agents." c."Smallpox is one of these biological agents." d."Botulism is one of these biological agents."
ANS: D Botulism is the only CDC Level A biological agent that has no known therapy or treatment. Because of the toxin that is released from the bacterium, there is methodology known to minimize or reduce the activation and metabolism of the toxin that causes flaccid paralysis within the patient. Standard isolation precautions are used for anthrax. Plague can be treated with antibiotics and droplet isolation precautions. For smallpox, droplet precautions are recommended, especially if pocks develop outside the buccal cavity.
Second- or third-degree burns that cover more than 50% of the body would be classified under what stage of triage? a. Expectant b. Delayed c. Minor d. Immediate
ANS: D Patients classified as "Immediate" require advanced medical care within 1 hour of trauma, such as a patient who has burns. Expectant patients are those who are deceased or beyond the scope of medical care and services. Delayed patients are those who can be assisted after Immediate- tagged patients are cared for first. Minor-tagged patients are those who can be cared for last; these persons can usually wait several hours before medical care and can walk with little to no assistance with minor bandages and first aid.
After the September 11, 2001, attack on the United States, President George W. Bush created what agency in response to the terrorist attacks? a.The Incident Command System (ICS) b.The Office of Emergency Response (OER) c.The Federal Emergency Management Agency (FEMA) d.The Department of Homeland Security (DHS)
ANS: D President George W. Bush created the Department of Homeland Security (DHS) in 2001. FEMA was created in 1979 to coordinate federal disaster assistance. The ICS was adopted by FEMA to coordinate responses to a disaster. The OER was an office existing before 2001 that was moved to the DHS.