Question 1

Which is the priority action for the emergency department charge nurse in the event of a mass casualty situation?

Accepted Answer

The ED charge nurse should direct additional nursing staff to help care for current ED clients while the ED staff prepares to receive the mass casualty victims; however,they should not be assigned to the most critically ill or injured clients.The hospital incident commander is responsible for mobilizing resources and would have the responsibility for calling in staff.The medical command physician would be the person best able to communicate with on-scene personnel regarding the ability to take more clients.

Question 2

The emergency department nurse manager is explaining concepts of emergency and disaster preparedness to a group of students.Which statement by the nurse manager is most accurate?

Accepted Answer

An internal disaster is something that occurs within the health care facility,such as a fire.External disasters,such as a tornado or a hurricane,occur outside the health care facility.A multi-casualty event can be managed with hospital resources.The Joint Commission requires hospitals to participate in two disaster drills a year.

Question 3

A nurse wants to become part of a Disaster Medical Assistance Team (DMAT)but is concerned about maintaining licensure in several different states.What statement by the nursing supervisor best addresses these concerns?

Accepted Answer

When deployed,DMAT health care providers are acting as agents of the government,and so are considered federal employees.Thus their licenses are valid in all 50 states.Licensure is an issue that the government would be concerned with,but no programs for temporary licensure or rapid activation are available.

Question 4

An accident has occurred near the hospital,and a victim is brought to the emergency department with severe chest pain,a pulse of 120 beats/min,blood pressure of 100/60 mm Hg,and a respiratory rate of 28 breaths/min.The nurse assesses shortness of breath and diaphoresis.Which color tag does the nurse use when triaging this client?

Accepted Answer

The client in the emergent triage category has a condition that may post an immediate threat to life or limb and is given the highest priority.Clients who should be treated emergently receive a red tag.Yellow tags signify major but stable injuries that can wait 30 minutes to 2 hours for definitive care.Green tags designate "walking wounded" who can wait longer than 2 hours to receive care.Black tags are used to designate those who are dead or who are expected to die.

Question 5

A nursing instructor is debriefing students who participated in a community-wide disaster drill.Several students are upset with the black-tagged triage category.Which statement by the nursing instructor is best?

Accepted Answer

In a disaster,military style triage is used; this approach identifies the dead or expectant dead with black tags.This practice helps to maintain the goal of triage,which is doing the most good for the most people.Precious resources are not used for those with overwhelming critical injury or illness,so that they can be allocated to others who have a reasonable expectation of survival.Clients are not "sacrificed." Telling students to move on after identifying the expectant dead belittles their feelings and does not provide an adequate explanation.Clients are not black-tagged to allow volunteers to give comfort care.

Question 6

The emergency department (ED)is expecting a large number of casualties after a bridge collapse.Which is a priority consideration for the ED leadership when activating the disaster plan?

Accepted Answer

Paramedics may not note all the "walking wounded" to give the ED an accurate count of victims to expect because these people might evacuate themselves from the accident scene without being seen by paramedics or rescue personnel.They may then secure their own transportation to the hospital and could overwhelm an ED that is already handling many severely injured victims who have been brought in by emergency medical services (EMS).

Question 7

A client who is hospitalized with burns after losing the family home in a fire becomes angry and screams at the nurse when dinner is served late.What is the nurse's best response?

Accepted Answer

Clients should be allowed to ventilate their feelings of anger and despair after a catastrophic event.The nurse establishes rapport through active listening and honest communication and by recognizing cues that the client wishes to talk.Asking whether the client is in pain as the first response closes the door to open communication and limits the client's options.Simply telling the client to gain control does nothing to promote therapeutic communication.

Question 8

An industrial accident has occurred near the hospital,and many victims are brought to the emergency department (ED)for treatment of their injuries.The nurse triages the victim with which injury with a red tag?

Accepted Answer

Clients who have an immediate threat to life are given the highest priority,are placed in the emergent or class I category,and are given a red triage tag.The client with multiple rib fractures and shortness of breath most likely has developed a pneumothorax,which may be fatal if not treated immediately.The client with the hip and leg problem and the client with the clavicle fracture would be classified as class II; these major but stable injuries can wait 30 minutes to 2 hours for definitive care.The client with facial wounds would be considered the "walking wounded" and classified as nonurgent.

Question 9

The nurse is working with a paramedic who just finished assisting at the scene of a school shooting where several students were killed.Which statement by the nurse is most therapeutic?

Accepted Answer

Allowing staff members to ventilate their feelings about the incident can facilitate recovery and effective coping afterward.The other choices do not facilitate open communication because the nurse is not providing the opportunity for the paramedic to talk.

Question 10

A nurse is working at the scene of a catastrophic natural event.Which person does the nurse attend to first?

Accepted Answer

The person with pale,cool,clammy skin is in shock and needs immediate medical attention.The mother does not have injuries and so would be the lowest priority.The other two people need medical attention soon,but not at the expense of a person in shock.

Question 11

A client is receiving follow-up care after surviving a tornado.The client reports insomnia and the nurse notes that the client jumped as the nurse entered the room.Which action by the nurse is most appropriate?

Accepted Answer

An individual may experience physical symptoms as a normal response to profound grief or loss,particularly after a traumatic incident.Manifestations such as insomnia,being startled easily,having flashbacks,or feelings of numbness may indicate post-traumatic stress disorder,and the nurse should first assess for this problem.The nurse should document assessment findings,but only after performing a more thorough assessment.A referral may be necessary,but the nurse does not have enough information yet to initiate it.If assessment reveals that methods to assist with sleep would be helpful,the nurse could provide that education.

Question 12

A nurse wants to become involved in community disaster preparedness and is interested in helping set up and staff first aid stations or community acute care centers in the event of a disaster.Which organization is the best fit for this nurse's interests?

Accepted Answer

The Medical Reserve Corps (MRC)consists of volunteer medical and public health care professionals who support the community during times of need.They may help staff hospitals,establish first aid stations or special needs shelters,or set up acute care centers in the community.The National Guard often performs search and rescue operations and law enforcement.The Health Department focuses on communicable disease tracking,treatment,and prevention.A Disaster Medical Assistance Team is deployed to a disaster area for up to 72 hours,providing many types of relief services.

Question 13

The nurse is caring for a client whose wife just died in an accident.The client says to the nurse,"I can't believe that my wife is gone and I am left to raise my children all by myself." Which response by the nurse is most appropriate?

Accepted Answer

Therapeutic communication includes active listening and honesty.This statement demonstrates that the nurse recognizes the client's distress and has provided an opening for discussion.Extending sympathy and offering to call the chaplain do not give the client the opportunity to discuss feelings.Stating that the children still have one parent discounts the client's feelings and situation.

Question 14

The hospital administration has arranged for critical incident stress debriefing for the staff after a mass casualty incident.Which statement by the debriefing team leader is most appropriate for this situation?

Accepted Answer

Strict confidentiality during stress debriefing is essential so that staff members can feel comfortable sharing their feelings,which should be accepted unconditionally.Brainstorming improvements and discussing policies would occur during an administrative review.Any employee present during a mass casualty situation is eligible for critical incident stress management services.

Question 15

A nursing administrator is evaluating the hospital's response to a recent internal disaster.The administrator assesses that goals for disaster planning have been met when which outcome is assessed?

Accepted Answer

The most important outcome of any internal disaster is maintenance of safety for the hospital's clients,staff,and visitors.Other outcomes listed would be part of a successful disaster response,but are all too narrow to meet this objective.

Question 16

A young man comes into the foyer of the hospital and says that he has a container of anthrax,which he opens and pours on the floor.Which is the priority action for the nurse who first comes upon the scene?

Accepted Answer

The highest priority is to remove people from immediate danger,so the nurse should evacuate the immediate area and prevent injury to those near the spill.Donning personal protective equipment would probably take the nurse away from the scene to obtain the equipment and would not help protect those in immediate danger.The man may need to be escorted to a decontamination area after people are removed from the scene.Reporting the incident to the health department should be done after the scene is secured and could be delegated to someone else.

Question 17

A nursing administrator is reviewing a hospital's disaster planning.The administrator evaluates the plan that addresses which component as being the best?

Accepted Answer

When The Joint Commission-accredited health care facilities are planning disaster preparedness programs,they need to take an "all-hazards approach" (versus planning by strict guidelines)and to plan for all credible threats to the community that could result in a disaster.This means planning for all events that could conceivably happen in that geographic area,including possible weather events.Planning only for internal disasters is too limited and does not account for weather- or terrorist-related threats.The Joint Commission does not assess what disasters are possible in the areas that accredited hospitals serve.

Question 18

The hospital is overwhelmed when caring for victims after an earthquake that occurred 48 hours ago.Which responsibility of the nursing supervisor is most important at this time?

Accepted Answer

The nursing supervisor should ensure that the staff is not becoming dangerously overtired by working long shifts without food or rest.Overall leadership for implementing the emergency plan and re-designating areas for client care would fall under the job of hospital incident commander.The community relations/public information officer would work with the media.

Question 19

The nurse is teaching nursing students about personal emergency preparedness.Which statement by a student indicates that further teaching is indicated?

Accepted Answer

The student would have no reason to obtain a prescription for anthrax unless he or she demonstrates clinical evidence of anthrax infection or has been exposed to a substance that tests positive for anthrax.Statements about planning to keep an extra uniform at work,recognizing the moral dilemmas he or she might encounter when working in a disaster situation,and understanding personal preparation for disasters all indicate that the student comprehends information about disaster planning and emergency preparedness.

Question 20

The nurse has been assigned the role of triage nurse after a weather-related disaster.What is the priority action of the nurse?

Accepted Answer

The triage nurse classifies victims of the explosion into priority of care based on illness or injury severity.Calling in additional staff more likely would be done by the hospital incident commander or designee.Physical care is provided to victims after triage occurs.Psychological support should be an ongoing part of the disaster plan but is not included in triage responsibilities; this ensures that the greatest good is provided to the greatest number of people.

Quiz 12: Concepts of Emergency and Disaster Preparedness