Deck 7: Nursing Care of Patients Experiencing Disasters

Question 1

A serious highway accident on a foggy night involves 22 vehicles. Several of the victims are ambulatory. The emergency personnel determine that their injuries are minor and arrange for transportation home. Why are these victims triaged first?

A) To do the greatest good for the greatest number of people
B) To remove them so they do not see the critically injured victims
C) To secure the site in case the vehicles become overheated and ignite
D) To improve traffic conditions to clear the accident site quickly

Answer 1

To do the greatest good for the greatest number of people

Question 2

The nurse is assessing victims of a building collapse. Ambulances are nearby and a shelter has been set up with carts, chairs, tables, and refreshments for the victims. The nurse is most likely working within which decontamination zone?

A) cold
B) warm
C) control
D) hot

Answer 2

cold

Question 3

A patient is brought into the emergency department complaining of blindness after an explosion at an atomic power plant. What should the nurse explain to this patient?

A) "The effects of the blast will disappear with time."
B) "I'm afraid the blast has caused permanent blindness."
C) "I will contact Social Services so that resources can be identified to help you with your disability."
D) "There is a variety of resources available for those who are unable to see."

Answer 3

"The effects of the blast will disappear with time."

Question 4

Several victims of a suspected biologic attack are brought into the emergency department. Which type of personal protective equipment should be provided to these victims?

A) mask
B) gown
C) gloves
D) goggles

Question 5

The nurse arrives at the site of a bombed building. When preparing to triage victims, in which zone should the nurse conduct decontamination?

A) warm
B) hot
C) cold
D) green

Question 6

A school bus transporting a local university's basketball team has just crashed in the rain on the side of the road. The bus was transporting approximately 60 people. Which classification should the nurse use to describe the situation?

A) multiple-casualty incident
B) natural disaster
C) human-generated disaster
D) mass-casualty incident

Question 7

An individual arrives at the emergency department with injuries sustained in a natural gas explosion. The patient is unable to respond to questions and keeps repeating "I can't hear." For what should the nurse assess this patient?

A) tympanic membrane rupture
B) air embolism
C) oxygen saturation level
D) confusion

Question 8

Two school buses carrying 75 children each collide en route to an out-of-state field trip. The emergency department nurse knows that reverse triage will need to be instituted. What principles should the nurse follow when implementing reverse triage?

A) When there is a mass casualty event with more than 100 victims, reverse triage may be instituted.
B) Reverse triage works on the principle of the greatest good for the greatest number.
C) A very basic reverse triage system is to categorize or label victims needing the most support and emergency care as red, so they can be treated first.
D) Victims most likely to survive are color-coded black, and are treated first.
E) Reverse triage works on the principle of the greatest good for the most critically ill.

Question 9

A small commuter plane lost an engine and crashed into a shopping mall. The estimated number of injured people from this accident is 500. Which classification of incident should the nurse use when determining the care needed for these victims?

A) mass-casualty incident
B) multiple-casualty incident
C) accidental natural disaster
D) intentional human-generated disaster

Question 10

The nurse is caring for a patient who was brought into the emergency department after an explosion at a nuclear power plant. The patient is confused and keeps repeating that his skin is "on fire." What does this information indicate to the nurse?

A) The patient may not recover.
B) The patient's clothing is burning his skin.
C) There is gastrointestinal system involvement and the patient will survive if he receives fluids.
D) There is bone marrow damage and the patient needs oxygen for the confusion.

Question 11

A train derailed in a local community. The contents of the train caused a hazardous spill, and noxious gasses are being released into the environment. All local and surrounding fire control and Hazmat teams have been mobilized and the event is considered under control. Which type of situation should the nurse prepare for?

A) emergency
B) disaster
C) human-generated accidental disaster
D) intentional emergency

Question 12

The nurse is caring for a patient who experienced a blast injury to the eye. Which intervention would be appropriate?

A) Flush the eye with eyewash.
B) Encourage the patient to rub the eye to get out specks of dust.
C) Apply a warm compress to the eye.
D) Remove debris lodged in the eye.

Question 13

Emergency response personnel arrive at the site of a collapsed building. Some victims are walking away from the building, while others are lying on the ground around the perimeter. If implementing reverse triage, what should the emergency personnel do first?

A) Identify one safe location for all ambulatory victims to be assessed and observed.
B) Systematically assess each victim lying on the ground and assign a color.
C) Enter the building to locate other victims who might not have been able to leave before the collapse.
D) Transfer the victims on the ground to stretchers and send them to the local emergency department.

Question 14

A victim of a plane crash exits the plane and runs to an emergency provider to tell him that his mother is trapped inside and is unable to walk out on her own. What should the emergency provider do?

A) Assist with clearing all the victims who are ambulatory first, then locate the trapped victim.
B) Enter the plane to locate the trapped victim.
C) Tell the victim's son that his mother will be fine and will be removed from the plane as soon as possible.
D) Tell the victim to go back inside and try to get his mother on her feet.

Question 15

Emergency response personnel are wearing gowns, gloves, goggles, and masks. In which decontamination zone are these personnel most likely working?

A) hot
B) warm
C) cold
D) yellow

Question 16

The nurse is caring for a patient with injuries received in an earthquake. Which type of incident should the nurse identify as causing this patient's injuries?

A) natural disaster
B) human-generated disaster
C) emergency
D) multiple-casualty incident

Question 17

The nurse is caring for patients when a dirty bomb detonates at a nearby shopping mall. Which types of injuries should the nurse expect to see in the victims?

A) radiation sickness
B) fractured limbs and spinal injury
C) thermal burns
D) overexertion and exhaustion

Question 18

Several patients are admitted after being exposed to a substance that was released in their manufacturing plant. The patients are demonstrating flu-like symptoms, unproductive cough, and fever. These patients should be assessed for which type of exposure?

A) anthrax
B) smallpox
C) dirty bomb
D) nuclear detonation

Question 19

A victim of a chemical plant explosion is unconscious and brought into the emergency department. For what should the nurse assess this patient?

A) central nervous system injury
B) respiratory system injury
C) pulmonary emboli
D) radiation sickness

Question 20

The nurse is admitting the second patient in 2 days who is experiencing malaise, high fever, and headache. Both patients attended a local air show the previous weekend. What should the nurse do?

A) Discuss the need to contact public health authorities regarding the similarity of the cases.
B) Plan to place the patients in the same room.
C) Ask the patients for permission to talk with family members regarding other symptoms.
D) Assess the patients for what foods they ate while at the air show.

Question 21

The emergency department nurses are noting an unusually high number of patients coming in with complaints of nausea, vomiting, and severe headache. What should be done with this information?

A) No further action is needed at this time.
B) Contact the Infection Control Department and Laboratory Medicine.
C) Close the emergency department.
D) Call for more staffing to handle all the patients.

Question 22

The hospital has been notified of a subway derailment involving approximately 250 passengers. Many of the passengers are reported to be injured. For which type of situation should the emergency department manager prepare?

A) a natural disaster
B) a multiple-casualty incident
C) a mass-casualty incident
D) an accidental disaster

Question 23

An older patient asks the nurse, "What can we do to be prepared if there's a disaster in our community?" How should the nurse respond?

A) "There is not really much we can do to be prepared."
B) "Plan to evacuate your home at a moment's notice."
C) "Make sure all your important papers, health information, medication information, and next-of-kin information is in one place."
D) "Make sure you can call your family to come and pick you up if this happens."

Question 24

The nurse is planning the coding for a triage disaster plan. Which colors should the nurse use for this plan?

A) white
B) red
C) yellow
D) black
E) green

Question 25

The emergency response team is setting up an area in which to triage victims of a building blast in a major metropolitan area. Which area should the nurse identify to set up this triage location?

A) hot zone
B) warm zone
C) cold zone
D) clean zone

Question 26

During a disaster preparedness presentation, the nurse learns about the harmful effects of a dirty bomb. Which treatment should the nurse realize will preserve life in the event of this disaster?

A) support for the patient who will develop radiation sickness
B) heart-lung transplant
C) liver transplant
D) bone marrow transplant

Question 27

A patient comes into the clinic with the onset of itching after opening a letter received about a week ago that contained "quite a bit of white powder." It is suspected that this patient has had an anthrax exposure. Which medication can the nurse anticipate will most likely be prescribed for this patient?

A) normal saline solution flush to the skin
B) ciprofloxacin (Cipro)
C) acetaminophen
D) Solu-Medrol

Question 28

A patient says to the nurse, "I'm scared about a terrorist attack because I live so close to the airport." What should the nurse respond to the patient?

A) "Have you thought about moving?"
B) "That's silly to be so worried."
C) "What do you have in your home to help you in the event of a terrorist attack?"
D) "I would be concerned, too."

Question 29

The care area has been alerted to a possible illness associated with the tainting of a popular over-the-counter pain reliever. The nurse realizes the tainting of this product is what kind of event?

A) a nonconventional terrorist attack
B) a conventional terrorist attack
C) an accidental disaster
D) a natural disaster

Question 30

The nursing staff is planning to attend a presentation on disaster prevention. What should the nurse expect the purpose of this education to be?

A) to learn the organization's disaster plan
B) to have the nurses participate in the plan for handling a disaster
C) to educate the nurses in how to recognize possible terrorists
D) to learn how the nurse will participate in mitigation

Question 31

The National Weather Service has announced the likelihood of a large snow event in a major metropolitan area. For which type of health problem should the nurses in the emergency department prepare?

A) stress-related injuries
B) crushing injuries
C) myocardial infarctions
D) burns

Question 32

The nurse is planning a program to address disaster mitigation activities in the community. What should the nurse consult when preparing this program?

A) community disaster preparedness plan
B) hospital administrators
C) physicians with practices in the community
D) schools and day care centers

Question 33

The nurse is reviewing the stages and phases of a disaster as part of a continuing education program in the hospital. In which order should the nurse list the stages of disaster management?

A) Preparedness, mitigation, response, recovery, and evaluation
B) Mitigation, preparedness, response, recovery, and evaluation
C) Mitigation, response, recovery, preparedness, and evaluation
D) Response, mitigation, evaluation, recovery, preparedness

Question 34

A woman arrives at the site of a disaster, hysterically crying because she was in the building that collapsed just minutes earlier. What should the nurse do with this patient?

A) Advise her to go home and be with her family.
B) Triage the patient and transport her to the hospital.
C) Have a nurse talk with the patient.
D) Ask psychiatric service personnel to talk with this patient.

Question 35

The nurse is presenting a program to residents of a local senior citizen housing facility about preparations in the event of a disaster. What should the nurse instruct the participants to do regarding essential preparations?

A) Have a list of medications, emergency contact numbers, and necessary survival items readily available.
B) Turn off all electrical devices before leaving the premises.
C) Pack enough nonperishable food items to last for several days.
D) Bring recreational items such as puzzles and card games for entertainment.

Question 36

A mass casualty accident has occurred. The nurse in the emergency department receives a patient who is coded red. What care should the nurse prepare to provide to this patient?

A) Send the patient home.
B) Evaluate the patient in the next few hours.
C) Immediately evaluate this patient.
D) Permit the family to be with the patient as death approaches.

Question 37

The nurse is planning to attend a program to learn how to respond to mass casualty incidents. Which core competencies should the nurse expect to learn during this program?

A) risk reduction, disease prevention, and health promotion
B) nursing process
C) policy development and planning
D) community care
E) ethical and legal practice

Question 38

A patient is brought into the emergency department with chemical burns. What should the nurse do to help this patient?

A) Check to see if all clothing has been removed and begin flushing the patient's skin with water.
B) Begin flushing the patient's clothes and skin with warm water.
C) Do not remove any jewelry.
D) Keep the patient's contact lenses in place and flush only with warm water.

Question 39

A group of nurses are attending a meeting to discuss the outcome and results of care provided to victims of a recent building collapse. In which phase of the disaster planning process are the nurses participating?

A) evaluation
B) recovery
C) restoration
D) response

Question 40

The community is holding a memorial service to honor members whose lives were lost in a flood one year ago. In which stage of the disaster recovery process is this community?

A) restoration
B) reconstitution
C) mitigation
D) disaster reflection

Question 41

The triage nurse is tagging victims of a train derailment. One patient has a sucking chest wound, BP 90/50, respirations 32, and is alert and able to respond to $$\begin{array} { | l | l | l | } \hline \text { Red } & \text { Immediate } & \text { Immediate threat to life } \\\hline \text { Yellow } & \text { Delayed } & \text { Require medical attention but delay will not threaten loss of life } \\\hline \text { Green } & \text { Ambulation } & \text { Minor injuries, ambulatory } \\\hline \text { Black } & \text { Expectant } & \text { Deceased; not expected to survive } \\\hline\end{array}$$

A) red, immediate threat to life
B) yellow, requiring medical attention but no threat of loss of life
C) green, ambulatory with minor injuries
D) black, not expected to survive

Question 42

Utilizing the simple triage and rapid transport (START) system, in what order should the nurse prioritize the following patients?

A) A 67-year-old male complaining of chest pain. His heart rate is 120 beats/minute, his blood pressure is 100/68 mmHg, and his respiratory rate is 20 breaths/min. Choice
B) A 27-year-old woman presenting with a respiratory rate of 36 breaths/min and capillary refill of 4 seconds. Choice
C) A 58-year-old woman who is able to walk on her own and states over and over, "I don't know what happened." Choice
D) A 30-year-old male with a collapsed airway and multiple chest trauma. He does not have a palpable carotid pulse and the nurse is unable to assess respiratory movement.
E) non of the above.

Question 43

A train made up of railroad cars filled with toxic chemicals and a full school bus with 90 children on board collide in a populated area. A huge explosion occurs and a fire develops in a nearby factory. Which approach to care should be used to care for these victims?

A) emergency; use conventional triage
B) emergency; evacuate all ambulatory patients first
C) disaster; employ reverse triage
D) disaster; evacuate critically injured patients first

Question 44

A local hospital has coordinated with the county emergency management team to plan and conduct disaster drills on a monthly basis. In which phase of disaster management planning is this hospital functioning?

A) Preparedness
B) Mitigation
C) Response
D) Evaluation

Question 45

A community hospital has been notified of a plane crash that occurred during a local air show. Which information will the hospital leadership need to prepare for the crash victims?

A) Number of families who live in the community
B) Number of available beds in the hospital
C) Telephone list of staff to be called in to work immediately
D) Amount of intravenous fluids and emergency medications
E) List of current patients who can be immediately discharged

Question 46

The nurse notes that a large number of community members with diabetes have experienced insufficient glucose control and cold symptoms since a tornado ripped through the area a few weeks ago. What should the nurse consider as the cause for these symptoms?

A) Blood stasis in extremities
B) Hindered immune response
C) Change in basal metabolic rate
D) Paralysis of gastrointestinal tract
E) Alteration in nutrient metabolism

Question 47

There is a radiologic dispersion bomb (dirty bomb) explosion in a subway station. In what order should the nurse deliver patient care at the scene of the explosion?

A) Begin direct patient care for complaints of fatigue and nausea.
B) Decontaminate clothing of patients.
C) Assess patients for burns and blunt trauma.
D) Evacuate patients from the exposure area.
E) non of the above.

Question 48

The nurse in the emergency department notes that several patients are demonstrating illness patterns that could indicate an unusual infectious disease process. What did the nurse assess that indicates a possible biological infection in these patients?

A) Patients present with symptoms of a rare disease.
B) The disease pattern is inconsistent with the age of the patient.
C) Multiple patients are presenting with viral-like symptoms.
D) The patients are all coming from the same geographic area.
E) Patients are all over the age of 39, indicating a smallpox exposure.

Question 49

After an anthrax exposure, the healthcare provider orders doxycycline 100 mg po. The label on the bottle of doxycycline powder states it is to be reconstituted with sterile water to prepare a concentration or 0.025 g/5 mL. The nurse should prepare to administer ______ mL to the patient.

Question 50

The nurse is sent to the scene of a radioactive explosion and instructed to do in-depth triage of the patients. Place an "X" in the zone where the nurse should perform this task.

Question 51

The administrator of a multihospital healthcare system contacts the National Response Framework (NRF) for help with managing care for victims of a flood. What assistance should the administrator expect to receive from this organization?

A) Standing orders used when caring for victims of a flood
B) Information about local relief agencies available to assist
C) Frequency in which the area has flooded over the last 10 years
D) Amount of time a flood victim can withstand submersion in cold water
E) Names of organizations within the private sector who can help the victims

Question 52

A patient with a confirmed diagnosis of anthrax is prescribed ciprofloxacin 500 mg to be administered intravenously over 60 minutes. The pharmacy provides a 1-gram vial of Cipro to the nursing unit to be diluted with 10 mL of sodium chloride. How many mL of the medication should the nurse give to the patient?

Question 53

A patient exposed to smallpox would present with a vesicular/pustular rash over which areas of the body? Place an "X" over the areas where the rash would initially present.

Question 54

Survivors of a bioterrorist attack are receiving basic care and support in a local motel until further plans for placement can be made. Several of these victims have been receiving care for autoimmune disorders. What should the nurse consider when providing these victims with food over the next several hours?

A) Offer fresh salads.
B) Ensure that fruit is fresh.
C) Provide bottled water.
D) Provide cooked or processed meals.
E) Fill pitchers with tap water.

Question 55

A series of thunderstorms ripped through a small town, causing massive power outages. The community nurse is reviewing the list of community members who might be adversely affected by the loss of power. For which residents should the nurse provide immediate care and support?

A) 16-year-old male with asthma
B) 75-year-old male with sleep apnea
C) 72-year-old male with a pacemaker
D) 45-year-old female with multiple sclerosis
E) 86-year-old female who requires continuous oxygen 2 liters nasal cannula

Question 56

Emergency medical personnel are at the scene of a mass casualty incident. What information should personnel document about each victim?

A) Name and injuries
B) Medication history
C) Interventions performed
D) Allergies
E) Name of next of kin