Community Chapter 22: Disaster Management: Caring for Communities in an Emergency

19. In a city where tornadoes have been known to strike, an emergency siren sounds, suggesting to its citizens that an emergency is imminent. What should a community/public health nurse do first? a. Call every family member and tell them to come home immediately. b. Call the local civil defense office for specific instructions for the nurse's agency. c. Follow the disaster plan of the local emergency management agency. d. Start driving to the hospital and prepare to care for the injured.

ANS: C On the basis of their employment position, nurses should know their role and specific responsibilities for disaster response. Therefore, the nurse should be prepared to follow the emergency preparedness plan. DIF: Cognitive Level: Analysis REF: p. 557

34. Which of the following actions should every nurse take to prepare for a possible local disaster? a. Completing an American Red Cross training program b. Having a personal preparedness kit stored in the home c. Providing volunteer assistance during a disaster in a neighboring community d. Educating the community about the recovery phases after a disaster

ANS: B Having personal supplies will allow the nurse to provide self-help, as well as aid others. The American Red Cross has many training programs, such as cardiopulmonary resuscitation (CPR). It is assumed that most nurses have completed programs such as CPR training before graduating from their nursing program. Community education is necessary for preparedness for a disaster; the priority would not be for education about the recovery phases. DIF: Cognitive Level: Application REF: pp. 563-564

9. The Mississippi River floods a small riverside town. A few citizens decide to stay even after the flood hits the town. Assuming flooding overwhelms city services, which of the following is the most dangerous problem? a. Inability to drink safe water from the flooded city water pipes b. Inability to eat because of food spoilage from lack of electrical service to refrigerators c. Inability to relax, which would result in anxiety and tension d. Inability to sleep because furniture will be wet

ANS: A Canned food would be edible. Although anxiety, tension, and sleeplessness may well occur, safe drinking water is the most important immediate physiologic need. Priority would have to be first to obtain safe drinking water for stranded people. DIF: Cognitive Level: Synthesis REF: p. 554

38. A registered nurse flown in to help with a disaster was feeling very tired, irritable, and anxious. In addition, the nurse seemed to be having difficulty concentrating and making decisions. Which of the following is the most likely cause of such feelings? a. The close involvement in the disaster, which has traumatized the nurse as well b. The knowledge that the nurse cannot meet all of the needs of the flood victims c. The realization that the nurse cannot undo the damage of the flood d. The recognition that the nurse is not adequately compensated for working this hard

ANS: A Disaster workers also experience distress and need debriefing and support. Many disaster workers report being overwhelmed by the devastation and extent of personal injuries. Some may feel unqualified to cope, particularly after working for 24 to 36 hours without adequate support staff. Care providers also need care and an opportunity to address their own stress issues. DIF: Cognitive Level: Application REF: p. 569

23. A woman was told that everyone would be getting low-interest loans to rebuild their houses and businesses, and several of her neighbors were starting to rebuild. No one from the government had even come to look at damage to her house yet, which caused her to feel angry and resentful. What is the most likely reason for these feelings? a. She is focusing on her own problems. b. She is grieving over loss of her own property. c. She is suffering from acute posttraumatic stress disorder. d. She does not care about anyone else's damage.

ANS: A In the disillusionment phase, there are negative feelings of disappointment because of delays or failures when promises of aid are not fulfilled. People seek help to solve their own personal problems rather than community problems. DIF: Cognitive Level: Application REF: p. 557

16. Which of the following is an appropriate definition of mitigation? a. The actions used to avoid or prevent disaster damage b. The cleaning-up process after a disaster c. The process used to react to a disaster in order to minimize the death rate d. The psychological intervention used to help people cope with a disaster

ANS: A Mitigation is a term used in disaster planning that describes actions or processes, or both, that can be used to prevent or reduce the damage caused by a specific disaster event. DIF: Cognitive Level: Knowledge REF: p. 555

35. What should all nurses know about their community? a. All the medical and social agency resources that may be available b. All of the nursing roles that may need to be fulfilled in a disaster c. The emergency personnel departments in the local area that may need to be recruited d. The nursing actions that may be performed during a disaster as defined by the state's nurse practice act

ANS: A Nurses should know in advance all community medical and social agency resources that will be available during a disaster, as well as where equipment and supplies have been stored and their own role and rendezvous site. As a volunteer during a disaster, the nurse in most situations is covered by the Good Samaritan Act of the state. DIF: Cognitive Level: Comprehension REF: pp. 567-568

30. During the aftermath of a disaster, the nurse is assigned to triage incoming injured people. A man shows all the symptoms of a myocardial infarction. What should the nurse do first? a. Give him a red tag so that he is the next person for the physician to treat. b. Give him a green tag because without a cardiac care unit, the man will not survive. c. Allow him to die with dignity by giving him a black tag. d. Provide care for the man until a physician becomes available.

ANS: A Red tags are used to identify the most urgent, first-priority injuries. Although his condition is life threatening, survival probability is high, so the man would be a first-priority client. Green tags are used to show third priority and black tags are used for persons who are dying or dead. DIF: Cognitive Level: Synthesis REF: p. 561

3. What group or organization defined the term disaster as "a threatening or occurring event," either natural or man-made, "that causes human suffering and creates human needs that victims cannot alleviate without assistance"? a. American Red Cross b. Department of Health and Human Services c. National Office of Disaster Control d. Department of Homeland Security

ANS: A The American Red Cross-the voluntary agency historically most involved in disaster relief-so defined the term in 1975. DIF: Cognitive Level: Knowledge REF: p. 553

31. Knowing that a disaster can occur at any time, staff at a community hospital create a disaster plan that is based on a risk assessment. Which of the following activities should be included in the plan? a. Scheduling periodic mock disasters to practice preparedness b. Developing an ongoing media campaign that stresses the excellence of the employer c. Reviewing all of the hospital policies for consistency and appropriateness d. Sharing stories of problems that have occurred when communities have not been prepared for a disaster

ANS: A The Joint Commission (TJC) requires all hospitals to have a disaster plan, hold disaster drills, and regularly evaluate those plans and activities to meet accreditation requirements. DIF: Cognitive Level: Application REF: p. 562

22. Everyone in the emergency shelter told their neighbors what they were doing and how they got away. Which of the following is the most likely reason why these people are sharing their escape stories? a. They are euphoric because they are safe in the shelter. b. They are in the "honeymoon phase," when everyone draws together. c. They are in the reconstruction phase, reviewing just how everything happened. d. They are totally unrealistic, as they clearly had no idea of the extent of the disaster.

ANS: B In the "honeymoon phase," there is a drawing together of people who simultaneously experienced the catastrophic event. DIF: Cognitive Level: Application REF: p. 557

5. Which of the following actions is the most important to perform first in caring for victims of a mass casualty incident? a. Call in all part-time and on-call staff to help care for newly admitted clients. b. Contact surrounding communities for assistance. c. Call the hospital supply store and order extra dressings, intravenous fluids, and other materials. d. Discharge as many hospital patients as possible to make room for disaster victim admissions.

ANS: B A mass casualty incident involves 100 or more people, which overwhelms a single institution, help must be summoned immediately, before the patients even arrive. DIF: Cognitive Level: Synthesis REF: pp. 553-544

6. A terrorist releases a poison gas in a crowded subway. This is an example of which of the following? a. Appropriate political action b. Man-made disaster c. Media event d. Natural disaster

ANS: B By definition, release of poison gas is a man-made disaster. Man-made disasters include war, chemical and biologic terrorism, transportation accidents, food or water contamination, and building collapse. DIF: Cognitive Level: Application REF: p. 554

8. Of the following disasters, which would probably cause the most suffering? a. A fire during finals' week in a private residential college b. A fire in an Alzheimer disease unit of an extended-care facility c. A fire in an outpatient dermatology clinic at a major urban hospital d. A thunderstorm that downs electrical lines to the local rural hospital

ANS: B Certain characteristics of humans influence the severity of the disaster's effect on individuals and communities. For example, the age of a person, preexisting health problems, degree of mobility, and emotional stability all play a part in how someone responds in a disaster situation. Because patients with Alzheimer disease are less cognitively capable and physically less fit, many of them would probably be unable to escape and therefore would be injured or killed. DIF: Cognitive Level: Synthesis REF: p. 554

25. Which of the following actions is considered most important by the Centers for Disease Control and Prevention? a. Assisting in recognizing and detaining known terrorists b. Educating health professionals to recognize and treat biochemical hazards c. Establishing and maintaining a database about known biochemical hazards d. Printing and distributing informational materials about known biohazards

ANS: B Educating health professionals to recognize and treat biochemical hazards is a priority because there is concern that biologic hazards can be used as terrorist weapons. DIF: Cognitive Level: Knowledge REF: p. 558

37. A nurse is assisting at a disaster shelter. Which of the following interventions would be most appropriate for the nurse to implement? a. Encouraging everyone in the shelter to guard their own things from possible theft b. Keeping healthy victims busy by assigning them specific duties to perform c. Putting hysterical or panic-stricken victims with adults who can listen to them d. Separating the children from the adults so that the adults can rest while the children play

ANS: B Families should be kept together. Panic-stricken or hysterical people should be isolated. Although watching one's things may seem important, stressing that need feeds fear and loss. Survivors may be given tasks to keep them busy and reduce trauma to their self-esteem. DIF: Cognitive Level: Application REF: p. 568

1. Which natural disaster is the most common worldwide? a. Earthquakes b. Floods c. Hurricane (water)/tornado (over land) d. Volcanic eruption

ANS: B Flooding is the most common natural disaster worldwide and also the third leading cause of weather-related deaths in the United States. DIF: Cognitive Level: Knowledge REF: p. 553

27. A local community has experienced a disaster. What should the community do first? a. Call the federal government for immediate funding assistance. b. Implement its emergency operations plan. c. Recruit volunteers who will see what needs to be done and start doing it. d. Try to escape the disaster area.

ANS: B Local communities are responsible for safety and welfare of their residents and are required to have an emergency operations plan. DIF: Cognitive Level: Application REF: p. 559

15. Which fact would suggest to a family that they may want to check building codes and availability of insurance and reconsider the location of their next home? a. The area where they are looking had a huge neighborhood fire after a lightning strike last year, and people are just starting to rebuild. b. The building lot is beautiful but in an area that has had forest fires and all the houses have burned three times in the past 20 years. c. The empty building lot was in a neighborhood of very nice homes, but the home that used to be there was burned when the smoker fell asleep in his bed. d. The home is very historic with features that cannot be replicated at any price today, but the damage from the fireplace fire is still very visible in the main living area.

ANS: B Most disasters are infrequent (such as being struck by lightning) and controllable (a person does not have to smoke, particularly in bed), but if such an event is predictable and frequent, action should be taken to avoid a disaster. In this case, it is probably foolish to build in an area where forest fires recur at frequent intervals. DIF: Cognitive Level: Synthesis REF: p. 555

11. Several people were involved in a local community shooting, and one victim died shortly thereafter. Which person will need the most help immediately after the shooting? a. The police officer who will have to notify the victim's family and follow up with the crime investigation b. The woman who has been living with victim and has never experienced death of a close friend or family member c. The woman who broke up with victim about a month ago and has not forgiven him for moving out of her apartment d. The victim's best friend, who is accustomed to gang shootings and random violence

ANS: B Personal variables influence an individual's reaction. Psychological proximity and previous experience influence response. Risk for developing severe consequences is greater if that person is emotionally close to the individual affected or has never before experienced a disaster. DIF: Cognitive Level: Synthesis REF: p. 555

28. The President of the United States has declared an area a major disaster area. Which of the following actions will be taken by the American Red Cross? a. Ensuring that privacy and confidentiality of affected families are maintained b. Engaging in mass care, including provision of food, shelter, supplies, health services, and family services c. Establishing a financing loan program for people to rebuild their homes and businesses d. Keeping details of the extent of the disaster confidential

ANS: B The American Red Cross was granted a charter in 1905 to act as the primary voluntary national disaster relief agency for the American people if a disaster has been declared by the President. Among the responsibilities of the American Red Cross are damage assessment; mass care, including provision of food, shelter, health, and family services; and maintaining inquiry/communication information. DIF: Cognitive Level: Application REF: p. 559

20. As the flood receded from the town, the Disaster Action Team (DAT) met for debriefing. Why is this debriefing important for the whole community, as well as for the disaster team members? a. The DAT is too tired to keep working and needs to sit and rest a while. b. The DAT has insights that can help modify disaster plans to be used in the future. c. The DAT has to give details of their names and addresses, so formal appreciation for their efforts can be sent. d. The DAT needs some time to just socialize.

ANS: B The experience of implementing the disaster plan is extremely useful in knowing which changes need to be made. DIF: Cognitive Level: Application REF: p. 557

13. Which of the following citizens trapped in a flood is in most need of supportive intervention by the nurse? a. A handyman who was planning to remodel soon anyway b. The man who had never been in a flood before and did not realize how much damage could be done c. The store owner whose storefront was under water yet again d. The woman whose house and small business were badly damaged but who had flood insurance

ANS: B The man who had no previous experience with a flood is psychologically unprepared for the disaster, whereas the other three citizens seem more prepared or do not seem to perceive the disaster as overwhelming. DIF: Cognitive Level: Application REF: p. 555

33. Five years after a major flood, a 52-year-old woman visits the family nurse practitioner (FNP) complaining primarily of inability to sleep but also of trouble concentrating on her job and household tasks and lack of interest in her former hobbies. Which of the following actions should the nurse take next? a. Ask whether she has any other menopausal symptoms such as hot flashes. b. Ask whether she has frequent nightmares or intrusive memories about the flood. c. Suggest ferrous sulfate for anemia, which may be the underlying cause of the symptoms. d. Suggest hot cocoa and relaxation exercises to help the woman sleep and regain her vigor.

ANS: B The woman's symptoms suggest posttraumatic stress disorder, but further assessment is needed to confirm the initial diagnosis. DIF: Cognitive Level: Application REF: p. 563

24. Which federal government entity is responsible for coordinating all federal disaster assistance? a. American Red Cross b. Department of Homeland Security c. Federal Emergency Management Agency (FEMA) d. National Disaster Risk Reduction and Management Council

ANS: C FEMA was established in 1979 as the coordinating agency for all available federal disaster assistance. The American Red Cross is a voluntary nongovernmental organization. The Department of Homeland Security is responsible for managing domestic incidents. The National Disaster Risk Reduction and Management Council is part of the Philippine government and is not a federal government agency in the United States. DIF: Cognitive Level: Knowledge REF: p. 557

21. After a disaster, one citizen was most impressed with how much his neighbors went out of their way to help rescue him and take him to the emergency shelter. What is the most likely reason why his neighbors helped him? a. They feared that he would sue them if they did not help him. b. They hoped that, because he was very wealthy, he might give a reward for their help. c. Such help is part of the pattern of behavior during the heroic phase of reaction to a disaster. d. Such behavior is what any American would expect of a neighbor today.

ANS: C Helping other people survive is often the first phase of a community's reaction to a disaster. DIF: Cognitive Level: Application REF: p. 557

4. When is the term mass casualty incident used in a disaster or crisis? a. Fewer than 100 victims, which strains resources b. Man-made disaster events c. More than 100 victims, which overwhelms resources d. Natural disaster events

ANS: C In a multiple casualty incident, 2 to 99 people are injured. In a mass casualty incident, a large number people, usually 100 or more, are injured, which significantly overwhelms available emergency medical services, facilities, and resources. DIF: Cognitive Level: Knowledge REF: pp. 553-554

12. A nurse, serving as a volunteer, was helping community residents who had been taken to an emergency shelter for food, clothes, and life necessities. Of the following families, which is in most need of receiving assistance from the nurse? a. A woman who is visiting her father and sees the flood as helpful to finally convince her father to move in with her and her husband b. The couple who believe the flood is God's will and are attempting to determine its meaning for their life c. The man who cannot believe that everything important to him is now lost d. The man who believes the flood is a test of his faith but knows he will be alright

ANS: C Professionally, the nurse should concentrate on the victim to whom the disaster is the most overwhelming psychologically. DIF: Cognitive Level: Application REF: p. 555

29. What is the first and most important aspect of managing disasters? a. Evacuating injured persons to medical facilities b. Giving immediate first aid and medical care to the victims c. Planning to prevent such disasters whenever possible d. Rescuing the victims

ANS: C The eight principles of disaster management, in order of priority, begin with prevention of the disaster whenever possible. DIF: Cognitive Level: Comprehension REF: p. 560

14. A family is supporting each other in the emergency shelter after a flood. The nurse overhears the conversation. Which family member most needs the other family members to listen and understand? a. An 11-year-old girl, who lost her teddy bear collection and is crying b. A 45-year-old adult, who keeps telling everyone that at least he still has his job and that they can cope with this c. A 43-year-old woman, who keeps saying, "Without our family pictures, we've lost our history" d. A 16-year-old boy, who has lost his favorite hunting rifle and seems angry

ANS: C The nurse should concentrate on the victim whose perception of the disaster is the most overwhelming. Losing one's personal history would be the most overwhelming loss both psychologically and objectively. DIF: Cognitive Level: Application REF: p. 555

10. Of the following families, which is most likely to need the most support to recover from the loss of electricity? a. The family who moved into their motor home with its generator b. The family who was away on vacation at the time c. The family who was without electricity for 2 weeks d. The family who was without electricity for 3 days

ANS: C The scope and severity of the disaster have a major effect on a person's ability to cope. In general, people without electricity for longer periods of time have a more difficult time. Consequently, 2 weeks is more difficult than a few days to be without a major utility. DIF: Cognitive Level: Application REF: p. 554

36. A disaster is occurring in a community. Which of the following actions should the nurse take first? a. Calling all members of the nurse's family together at their home b. Immediately driving to the hospital in preparation for giving care to victims c. Remaining in place until the situation has stabilized d. Contacting the emergency operations center to receive instructions

ANS: C While a disaster is occurring, professionals are usually advised to remain in place until the situation has stabilized before attempting to provide care. Phone lines may be nonoperable, and roads may not be open for traffic. The priority is to remain in place, and the next step will be to contact the emergency operations center if necessary. DIF: Cognitive Level: Application REF: p. 567

32. A man continued to state that the flood was not that bad, the town can rebuild, and no real damage was done. From his statements, what can be concluded? a. He has totally recovered and thinks everyone else has as well. b. He is having a strong emotional response but is overcompensating. c. He is psychotic and needs medication. d. He is still in denial, and the disaster has not really registered yet.

ANS: D Denial is the first stage of emotional response to a disaster. Victims will deny the magnitude of the problem or understand the problem but seem unaffected emotionally. DIF: Cognitive Level: Application REF: p. 563

17. Of the following communities, which had a poor reaction to a disaster? a. Chicago, which, after a large fire, now requires all buildings to be made of fireproof brick b. Hilo, Hawaii, which, after the downtown was again destroyed by a tsunami, created an oceanfront park and moved small businesses farther up the mountain c. Los Angeles, which is in the process of strengthening highway resistance to earthquake damage d. Settersville, which, after a tornado flattened downtown, decided to appeal for state funds to rebuild, and which, if no funds are forthcoming, will simply cease to exist as a town

ANS: D Healthy cities that are susceptible to particular disasters on a frequent basis try to establish prewarning, or control, measures that can reduce the impact of disasters. Thus, a healthy community is one that plans to minimize damage and strengthens structural resources. An unhealthy community might just give up. DIF: Cognitive Level: Comprehension REF: pp. 556-557

18. Floods have hit a small town on the Mississippi many times. The last time, a levee broke, and there was extensive property damage, as well as several deaths. What should be the first preparation that the nurse should make before another flood hits? a. Create child care centers. b. Establish morgue facilities. c. Plan for a parking area for rescue workers. d. Practice the nurse's personal family response plan.

ANS: D Nurses should establish their own family disaster response plans to protect their family and homes and still be able to respond to their community's need. DIF: Cognitive Level: Application REF: p. 557

26. In a state where a disaster occurred, which of the following actions should the governor take first? a. Touring the disaster area with the media b. Encouraging community members to volunteer c. Publicizing the disaster and asking the national government for funding d. Opening the state's Emergency Operations Center

ANS: D One state agency is usually designated as the emergency management agency for all state-coordinated efforts. The state governor will open the state's Emergency Operations Center to coordinate state agencies' disaster relief efforts. The Emergency Management Agency advises the governor when the state has exhausted its resources or if the disaster is such that the state does not have adequate resources to respond. DIF: Cognitive Level: Application REF: pp. 558-559

7. In an earthquake, the roads and underground pipes were all destroyed. Fires and explosions began to occur from the broken leaking gas lines. Which of the following would be used to describe the fire? a. A man-made disaster b. The cause of the earthquake c. The primary agent d. The secondary agent

ANS: D The earthquake was the primary agent that caused the damage; the fires were secondary agents that resulted from damage by the primary agent. In this incident, primary agents include falling buildings, heat, wind, rising water, chemical and biologic agents, and smoke; secondary agents include bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction. Primary and secondary agents vary according to the type of disaster. DIF: Cognitive Level: Application REF: p. 554

2. Why might citizens be concerned about disasters, especially terrorism, even before they occur? a. Charities will be trying to collect money for the victims by using personal stories. b. Financial costs of a disaster or terrorist attack increase citizens' taxes. c. Laws have been passed requiring preparation for disaster education for laypeople. d. There have been an increased number of terrorist activities throughout the world.

ANS: D Worldwide, there have been an increased number of terrorist activities that have been widely publicized using various forms of media. DIF: Cognitive Level: Comprehension REF: p. 553

1. After a severe tornado hit the center of town, the American Red Cross set up an emergency shelter. The Emergency Operations Center was established. What would a nurse member of the Disaster Action Team most likely be asked to do? (Select all that apply.) a. Debrief all the professionals assisting at the shelter. b. Establish a personal family disaster response plan. c. Appear on the local radio and TV stations to encourage citizens to stay calm. d. Ride in a helicopter and assess the amount of damage done to the community. e. Assign people who come to the shelter a space and give them emotional support. f. Triage injured people, set up morgue facilities, and help with immediate first aid.

ANS: E, F Nurses who are members of the disaster action team will be assigned a shelter and asked to assess needs and provide support. During the disaster, injured people are triaged, morgue facilities are established, and rescue activities are organized. Although a personal family disaster response plan is an excellent idea, the plan should be prepared before a disaster hits. Debriefing occurs during the recovery phase, not immediately after the disaster hits. DIF: Cognitive Level: Synthesis REF: pp. 570-571