Exam 4- Emergency Preparedness
Surge capacity
Community's ability to rapidly meet the increased demand for qualified personnel and resources—including healthcare resources—in the event of a disaster Community with trained individuals and resources to meet the needs of individuals in a disaster or an emergency
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: "If I have been poisoned with botulism, the first sign is generalized itching." "I should not go home if I have been exposed to anthrax and risk exposing my family." "Tularemia can be placed in our water or food supply." "I cannot contract smallpox from another person."
"Tularemia can be placed in our water or food supply." 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.
Emergency preparedness
Act of making plans to prevent, respond to, and recover from emergencies Food and water storage; generator availability
The nurse in the emergency department works closely with emergency medical services (EMS). Some EMS personnel have certifications in Advanced Life Support techniques. Which personnel can operate on that level? (Select all that apply.) Ultrasound technicians Emergency medical technicians Advanced emergency medical technicians Emergency medical responders Paramedics
Advanced emergency medical technicians Paramedics Advanced emergency medical technicians and paramedics have Advanced Life Support certification. Emergency medical responders and emergency medical technicians have Basic Life Support certification. Ultrasound technicians are not part of EMS staff.
A public health nurse reads updates from the Centers for Disease Control and Prevention (CDC). Which guidelines are used by the CDC to prioritize responses to biological agents? (Select all that apply.) Agents that cause mass exodus Agents that cause public panic Agents with a significant impact on public health Agents with a high suspicion index Agent easily transmitted from individual to individual
Agents that cause public panic Agents with a significant impact on public health Agent easily transmitted from individual to individual The CDC prioritizes their responses to biological agents that are easily transmitted from individual to individual, those with a significant impact on public health, and those that cause public panic. Their guidelines do not include agents with a high suspicion index or ones that cause mass exodus.
Which diseases have been identified as high risk for bioterrorism threats? (Select all that apply.) Anthrax Botox Staphylococcus Chicken pox Smallpox
Anthrax and smallpox have been identified as high risk for bioterrorism threats. Chicken pox and staphylococcus are not considered high-risk bioterrorism threats. Botox is a medication, not a disease.
A nurse is shadowing an emergency department nurse manager during the evening shift. They discussed the commonalities of prioritizing between triage and reverse triage. What are the bases for these commonalities? (Select all that apply.) Availability of supplies and resources Access to health insurance coverage Decisions based on severity of injury Estimated distance from home Decisions based on severity of illness
Availability of supplies and resources Decisions based on severity of injury Decisions based on severity of illness Both triage and reverse triage are based on severity of illness or injury. They also prioritize based on availability of supplies and resources. Triage and reverse triage are not based on access to health insurance coverage or estimated distance from home.
The CDC is most concerned about six biological pathogens that might be used in a bioterrorism attack. Which biological agent is the only one caused by a toxin? Bubonic plague Tularemia Botulism Smallpox
Botulism is caused by a toxin. Bubonic plague and tularemia are caused by bacteria. Smallpox is caused by a virus.
In a disaster drill, a nurse is selected by her peers to lead the practice response team. Their support was acknowledgment of the nurse's evident critical thinking skills. What kind of skills was the team looking for? (Select all that apply.) Enthusiasm Clinical judgment Decision making Poise Prioritizing
Clinical judgment Decision making Prioritizing Critical thinking skills include decision making, prioritizing, and clinical judgment. They do not include enthusiasm and poise.
In which disaster zone is personal protective equipment worn just in case conditions change? Hot Neutral Warm Cold
Cold Personal protective equipment (PPE) is worn in the cold zone just in case conditions change. PPE is required In the warm and hot zones regardless of conditions changing. There is no neutral disaster zone.
Anthrax Bacillus anthracis, a spore-forming bacterium Three types: Cutaneous Respiratory Gastrointestinal
Cutaneous: The first symptom is a small sore that becomes a blister then progresses to a skin ulcer with a black spot in the center. All lesions are painless. Transmission: direct skin contact with spores; often result from handling products, such as wool, from infected animals Respiratory: Initially: sore throat, mild fever and muscle aches. Later: respiratory symptoms, e.g., cough, chest discomfort, shortness of breath, tiredness and achy muscles. Transmission: inhalation of aerosolized spores (rare unless weaponized) Gastrointestinal: Nausea, loss of appetite, bloody diarrhea, and fever followed by bad stomach pain. Transmission: eating undercooked meat or dairy products from infected animals (rare)
Mass casualty event (MCE), AKA: mass casualty incident (MCI)
Disaster in which more than 100 lives are lost 9/11 event in New York City
Smallpox Variola virus
During the incubation period (from 7 to 17 days), an infected individual has no symptoms and is not contagious. Prodromal phase (2-4 days) symptoms include a fever of 101°-104°F, head and body aches, and possibly vomiting. This phase may be contagious. The early rash phase is the most contagious period. The rash first appears as spots on the tongue and in the mouth, which then progress into sores that break open allowing large amounts of the virus to spread into the mouth and throat. The disease is highly contagious during this phase. Within 24 hours the rash, which begins on the face, spreads down and across the entire body. By the third day of the rash, raised bumps develop. By the fourth day of the rash, the bumps fill with thick, opaque fluid and have a depression in the center that resembles a belly button—a distinguishing characteristic of smallpox. Fever increases again. Pustular rash (duration of 5 days): Pustular bumps develop (they feel like BBs under the skin), then form a crust and scab over. The scabs fall off, leaving pitted scars. The individual is contagious until all the scabs have fallen off. Direct and fairly long face-to-face exposure is usually necessary under normal circumstances; however, weaponized smallpox can be spread by aerosol. Direct contact with body fluids or contaminated items such as clothing or bed linen could spread the disease. Humans are the only natural host of variola.
Which agencies identify national threats and create emergency management plans at the national level? (Select all that apply.) National Institutes of Health Federal Emergency Management Agency The Joint Commission Centers for Disease Control and Prevention Department of Homeland Security
Federal Emergency Management Agency Centers for Disease Control and Prevention Department of Homeland Security The Federal Emergency Management Agency (FEMA), the Department of Homeland Security, and the Centers for Disease Control and Prevention (CDC) identify national threats and create emergency plans at the national level. The National Institutes of Health is a biomedical research center. The Joint Commission is an accreditation agency.
Plague Yersinia pestis, a bacterium Pneumonic plague develops within 1-6 days of exposure.
Fever, weakness, rapidly developing pneumonia with dyspnea, chest pain, cough, and sometimes bloody or watery sputum An old mnemonic is "The fleas and lice on rats and mice cause plague." Bubonic plague is transmitted via an infected flea bite or exposure of broken skin to infected material. Pneumonic plague is of particular interest as a biological weapon because it can be released via weaponized aerosol. It can also be transmitted from individual to individual.
Botulism Clostridium botulinum toxin Food-borne botulism
Food-borne botulism symptoms: Usually develop within 12-36 hours after exposure. May include visual effects, e.g., double vision; and neurological symptoms including slurred speech, dysphagia, and muscle weakness that begins in the shoulders and descends through the body to the calves; and paralysis of the breathing muscles, which if left untreated, may result in death. Food-borne: individual ingests preformed toxin. Infant: Occurs in small number of infants who harbor C. botulinum in their intestinal tract. Wound botulism: Occurs when existing wounds are infected with the toxins of C. botulinum.
Emergency management
Four phases of dealing with situations: Mitigation, preparedness, response, and recovery Identifying earthquake possibility on the San Andreas fault in California; being prepared; responding in October 2004; rebuilding collapsed freeway
In a disaster drill, a nurse is portraying a contaminated victim. In this portrayal, which color of disaster zone would the nurse be prohibited from entering? Green zone Red zone Yellow zone Blue zone
Green zone The green disaster zone is for decontaminated victims, so the nurse would not be allowed to enter it. Contaminated victims are treated in the red and yellow disaster zones. There is no blue disaster zone.
A novice nurse is questioning the clinical nurse specialist (CNS) about the rationale for reverse triage in a disaster. Which statement by the novice nurse shows an understanding of the CNS's explanation? "Emergency personnel use reverse triage on a daily basis." "In reverse triage, the most severely injured clients are treated last." "Reverse triage gives priority to the very young and very old." "Triage and reverse triage are interchangeable concepts."
In reverse triage, the most severely injured clients are treated last. Emergency personnel use triage, not reverse triage, on a daily basis. Reverse triage does not give priority based on age. Triage and reverse triage are not interchangeable concepts.
Pandemic
Infection that spreads rapidly around the world Hong Kong flu
A veteran nurse is showing the new graduate nurse how to practice lavage on a mannequin in the simulation lab. In which situation during a mass casualty incident could that technique be used? To treat wounds To treat dehydration To treat coma To treat fractures
Lavage technique could be used to treat wounds. Lavage technique would not be used for fractures, dehydration, or a coma.
An operating room nurse is participating in a training activity to help the local community get more surge capacity in case of emergency. How does the training activity accomplish this function? Opening off-site operating rooms for emergencies Satisfying need for current recovery operations Helping shelters house more evacuated individuals Meeting increased demand for qualified personnel
Meeting increased demand for qualified personnel The training activity accomplishes getting more surge capacity by meeting an increased demand for qualified personnel. The training is not about recovery operations, shelters, or off-site operating rooms.
What resources could an emergency plan name to address the immediate and long-term psychological impacts of a disaster? (Select all that apply.) Mental health nurse practitioners Acupuncturists Physical therapists Counselors Critical Incidents Stress Debriefing teams
Mental health nurse practitioners Counselors Critical Incidents Stress Debriefing teams Critical Incidents Stress Debriefing teams, counselors, and mental health nurse practitioners can adresss the immediate and long-term psychological impact of a disaster. Physical therapists and acupuncturists could help, but would not be named for that function.
A rehabilitation clinic nurse created an emergency plan for the nurse's immediate family. How does this personal plan best fit into the larger picture of the community's preparedness phase? Larger plans are based on consolidating personal plans. Nurses must limit facing issues of their own grief. Personal plans are only practice for the larger plans. Nurses need to know their families can survive emergencies.
Nurses need to know their families can survive emergencies. It is not a matter of their own grief process, practice for the larger plans, or piecing together parts to form a larger plan.
The nurse initiates which individualized intervention for a client who has been exposed to smallpox? Prepare the client for transport to x-ray. Place the client in droplet isolation. Administer ordered medications. Obtain routine vital signs.
Place the client in droplet isolation. 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.
Disaster
Public emergency requiring assistance from individuals outside the affected community Earthquake; tsunami
A nurse receives specialized training to better help the local community in a mass casualty incident. The training team used the acronym CBRNE to remind the audience about the different types of exposure to agents. Which agents did they include? (Select all that apply.) Radiological agents Nuclear agents Caustic agents Breaking agents Exodus agents
Radiological agents Nuclear agents Chemical, biological, radiological and nuclear defense (CBRN defense or CBRNE defense) is protective measures taken in situations in which chemical, biological, radiological or nuclear warfare (including terrorism) hazards may be present.
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: Keeping the ear canals clean Treating puncture wounds Removing the clients' clothes and jewelry Reducing the clients' exposure to infection
Reducing the clients' exposure to infection 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 moved with family members into an area of the county that has a "tornado alley." Shortly after the nurse's arrival, the town was hit by a tornado. Which activities constituted the community's emergency response phase? (Select all that apply.) Establishing emergency operations centers Repairing utilities Opening shelters Implementing warning systems Establishing critical care services
Repairing utilities Opening shelters Establishing critical care services Opening shelters, repairing utilities, and establishing critical care services are part of the community's emergency response phase. The mitigation phase, including implementing warning systems and establishing emergency operations centers, could happen before the emergency response phase or after the recovery phase.
The nurse recognizes that certain competencies are required for the nurse to perform effectively during a community emergency. The nurse increases core knowledge by: Attending an inservice on new products Joining a chapter of the American Nurses Association (ANA) Forming a personal emergency plan Reviewing the hospital disaster plan
Reviewing the hospital disaster plan 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.
Viral hemorrhagic fevers (VHF) Several distinct families of zoonotic viruses that reside in an animal reservoir host (e.g., rodent) or arthropod vector (e.g., ticks and mosquitos) Ebola
Signs and symptoms, which develop after a 5- to 10-day incubation period, vary by the type of VHF. Early signs and symptoms often include marked fever, fatigue, dizziness, myalgia, weakness, exhaustion, and a rash on the trunk. Severe cases may be accompanied by bleeding under the skin, in internal organs, or from body orifices like the mouth, eyes, or ears. Clients rarely die from this blood loss. Severe cases may cause shock, nervous system breakdowns, coma, delirium, and seizures. Renal failure may occur in some types of VHF. VHFs are most commonly spread by exposure to an animal reservoir host or arthropod vector. Humans are not natural reservoirs for VHFs; however, some VHFs can be transmitted from individual to individual after an initial human has been infected.
A postal worker seeks advice from a public health nurse after contact with a white powder leaking from an envelope. The public health nurse looks for signs of cutaneous anthrax. Which early symptom will the public health nurse assess for with this exposed client? Small sores that become blisters Sore throat, mild fever, and muscle aches Nausea and loss of appetite Bloody diarrhea and high fever
Small sores that become blisters The earliest symptoms of cutaneous anthrax are small sores that become blisters. Sore throat, mild fever, and muscle aches can be symptoms of respiratory anthrax. Gastrointestinal anthrax can have initial symptoms of nausea and loss of appetite; later, bloody diarrhea and a high fever can occur.
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? Stock a safe area in the home with water and blankets. Seek public shelter instead of remaining in the home. Keep gas in the car for evacuation purposes during an event. Call the local police during the event for safety tips.
Stock a safe area in the home with water and blankets. 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.
Tularemia Francisella tularensis
Sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, and progressive weakness If F. tularensis was used as a biological weapon and made airborne for exposure by inhalation, the infected people would experience severe respiratory illness, including life-threatening pneumonia and systemic infection. Spread by bacterium found in animals (especially rodents, rabbits, and hares.) Means of spread include: Being bitten by infected ticks, deerflies, other insects Handling infected animal carcasses and skins Eating or drinking contaminated food or water Inhaling F. tularensis.
Emergency
Sudden, often unforeseen event that threatens the health or safety of individuals Oil refinery fire; 20-car pile-up
What does the acronym PPE stand for? Personal protective equipment Preparedness phase event Pending practice experience Private pediatric expert
The acronym PPE stands for personal protective equipment.
COLD ZONE
The cold zone, also referred to as the green zone and support zone, is located outside of the warm zone and is the site where decontaminated victims are triaged and treated. It is considered to be comparatively safe although PPE is still required in case circum- stances change, for example, if wind direction shifts. The primary purpose of this zone is to provide medical services and to transport victims who require more than first aid to locations where they will be provided higher levels of service.
Which measure has the federal government taken to ensure availability of medical supplies in case of a disaster? Federal Disaster Relief Strategic National Stockpile Medical Supply Inventory Central Materials Storage
The federal government created the Strategic National Stockpile to ensure availability of medical supplies in case of a disaster.
HOT ZONE
The hot zone is the most dangerous zone, being the initial site of the incident. In the diagram, it is shown in red. All responders entering the hot zone must wear personal protective equipment (PPE). Within this location, only the most basic treatment is rendered, including: Locating victims Establishing airways Controlling hemorrhages Administering antidotes Identifying the dead and those who cannot be saved
One phase of emergency management is unique in that it takes place both before and after an emergency event. Which phase has that dual timing? Preparedness phase Mitigation phase Recovery phase Learning phase
The mitigation phase takes place both before and after an emergency event. Preparedness takes place before an emergency event. Recovery takes place after an emergency event. There is no phase of emergency management called the open double quote"learning phase.close double quote
The nurse helping a family find a new home after heavy rain flooded their home. The nurse is participating in: The recovery phase of emergency response The mitigation phase of emergency response The preparedness phase of emergency response The response phase of emergency response
The recovery phase of emergency response 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.
WARM ZONE
The warm zone (also referred to as the yellow, contamination, or contamination reduction zone) is located at least 300 feet from the outer edge of the hot zone. Although its primary purpose is decon- tamination, rapid triage and emergency treatment to stabilize vic- tims may take place in the warm zone. Individuals who have the highest levels of contamination are treated with the highest priority. PPE is required in this zone. After decontamination is completed, victims are moved to the cold zone.
Simple Triage and Rapid Treatment System (START)
This method uses the ability to: obey commands respiratory rate, radial pulse measurements, combined with additional factors to determine "survivability" over time. START is the most commonly used mass casualty triage algorithm in the United States today.
Why does a mass casualty response team implement reverse triage? To prevent complications of toxic infected wounds To allow greatest number of victims to get treated To make the assessment process efficiently move faster To best utilize emergency department personnel
To allow greatest number of victims to get treated The purpose of implementing reverse triage in a mass casualty response is to allow the greatest number of victims to get treated. The goal is not about infections, efficiency, or utilizing ED personnel.
Incident Command System (ICS)
a standardized, on-scene, all-hazards incident management approach. It allows for the integration of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure. ICS is used by all levels of government, nongovernmental organizations, and the private sector. ICS has six major functional areas: Command Operations Planning Logistics Finance/administration Intelligence/investigations
A nurse is receiving training during a hospital simulation experience on the deliberate release of biological agents. The nurse is given a scenario to provide care to a client who is exposed to inhaled anthrax. Which IV medication does the nurse anticipate the client will be prescribed by the healthcare provider? ampicillin 500 mg every 6 hours morphine 0.05-0.2 mg/kg/dose every 4 hours sulfamethoxazole 15-20 mg/kg/day ciprofloxacin 400 mg every 12 hours
ciprofloxacin 400 mg every 12 hours The nurse anticipates that the healthcare provider will prescribe IV ciprofloxacin 400 milligrams every 12 hours. No other antibiotic, such as ampicillin or sulfa drug, has been found effective against inhaled anthrax. IV morphine would not be indicated.
An elementary school nurse is participating in a quarterly fire drill for the school district. The nurse is aware of the responsibility of nurses during an emergency. What slogan captures this responsibility? "Fastest triage for physical injuries" "Most intense help for most severe injuries" "Scope of practice changes with circumstances" "Greatest good for the greatest number"
"Greatest good for the greatest number" The slogan that captures nursing responsibility during an emergency is "Greatest good for the greatest number." It is not a matter of responding to the severity of injuries or the speed of triage. Nurses' scope of practice does not change with circumstances.
A novice nurse is introduced to the features of an Incident Command System (ICS) during a full-day training session. After the completion of the session, what statement by the nurse would show the need for further education? "ICS relies on a standardized organizational structure." "ICS is used by the public sector, rather than the private sector." "ICS has teams dedicated to major functional areas." "ICS is an all-hazards incident management approach."
"ICS is used by the public sector, rather than the private sector." ICS is used by both the public and the private sector. ICS is an all-hazards incident management approach that relies on a standardized organizational structure. ICS has teams dedicated to major functional areas.
