Disaster Nursing Review

This activity contains 10 questions.

A nursing student is studying about disasters and emergency preparedness. Which of the following statements by the nursing student depicts a correct understanding of the difference between a disaster and an emergency? “Disasters are man-made only.” “An emergency is an unforeseen combination of circumstances calling for immediate action for a range of victims.” “Man-made disasters are intentional only.” “Emergencies are caused by acts of nature or emerging diseases.”

An emergency room nurse is working when there is a bioterrorism attack in the city. Which of the following statements is a correct with regard to injuries or symptoms associated with a bioterrorism attack? The main purpose of biological weapon use is contained devastation. It is not uncommon for the results of a biological attack to be made known several hours or days after the attack. Biological attacks are usually known right away. Detection is easy as clients go to a number of different health care facilities.

The nurse is caring for a client with a blast injury. Which of the following nursing assessments would be most appropriate for this client? Assess for vasovagal hypotension Assess the client for confusion Assess for asphyxia Assess for hypervolemia

An emergency room nurse is working when an Amtrak train derails. The emergency room nurse knows that reverse triage may need to be instituted. What is the rationale for using reverse triage? Mass casualty is an event with greater than 20 victims. A very basic reverse triage system is to categorize or label victims needing the most support and emergency care as red. Victims most likely to survive are color coded as black.

Reverse triage works on the principle of the greatest good for the greatest number.

There has been a radioactive explosion nearby. The emergency room nurse must triage and manage the decontamination of the clients systematically. Which of the following clients would be decontaminated first? A client with severe injuries. A client with minor injuries. A client with the least injuries. A client with the most injuries.

A preceptor is teaching a graduate nurse the concepts of mitigation. Which of the following statements, if made by the graduate nurse, would indicate an understanding of this concept? “A key nursing activity related to mitigation is the active participation in learning about the major aspects of disasters.” “Response is having a comprehensive disaster plan in place that coordinates efforts.” “Mitigation is the health care system’s ability to rapidly expand beyond normal services to meet the increased demand for qualified personnel.” “The key to effective disaster management is predisaster planning and response.”

A military nurse is working in Iraq. Because of the potential threat of hazardous gas, which of the following should be worn when working in a dangerous war zone? Select all that apply. A gas mask A surgical mask Protective clothing A hood, helmet, or headgear Sunglasses

An emergency room nurse is at work when a major terrorist attack occurs. In addition to caring for injured clients, the nurse must control the crowd. Which of the following statements, if made by the nurse, demonstrates an understanding of the concept of crowd control?

“The job of crowd control is under the auspices of the nurses.” “Even if the crowd control is maintained, chaos ensues.” “The agency’s security personnel and/or the local police force must control these crowds.” “Nurses will need to enter areas that have not been secured yet in order to reach the clients.”

A newly graduated nurse is learning about the nurse’s role in disaster relief as part of an orientation to the hospital. Which of the following concepts is accurate? Learning about the prevention and mitigation of disasters is nice to know, but not essential. Nurses take a passive role in helping others to save lives and fulfill an important obligation. Applying advanced skills can be very helpful until help arrives. Nurses may have to assume expanded roles in making decisions for the most appropriate treatment of casualties.

A nursing student is learning about how to manage immunocompromised clients in a disaster situation. Which of the following statements made by the nursing student demonstrates an understanding of this concept? “The immunocompromised population is at lesser risk for complications and death than the general population should a bioterrorist attack occur.” “A compromised immune system may be due to treatments such as chemotherapy, those who have had organ or bone marrow transplants, or from an underlying disease such as HIV.” “In noncompromised persons, generalized vaccinia consists of vesicles or pustules appearing on normal skin near the vaccination site.” “Bone marrow transplant clients are instructed to eat fresh fruits and vegetables due to the risk of contamination of canned goods.”

A nursing student is studying about disasters and emergency preparedness. Which of the following statements by the nursing student depicts a correct understanding of the difference between a disaster and an emergency? Your Answer: “An emergency is an unforeseen combination of circumstances calling for immediate action for a range of victims.” Rationale: # 1 is incorrect because disasters may be natural or man-made. # 3 is incorrect because man-made disasters are either accidental or intentional. # 4 is incorrect because natural disasters, not emergencies, are caused by acts of nature or emerging diseases. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Application

Objective: Distinguish the difference between an emergency and a disaster. Strategy: Look at each statement to see if it clearly defines either a disaster or emergency. Then select the correct answer.

2. An emergency room nurse is working when there is a bioterrorism attack in the city. Which of the following statements is a correct with regard to injuries or symptoms associated with a bioterrorism attack? Your Answer: It is not uncommon for the results of a biological attack to be made known several hours or days after the attack. Rationale: Biological terrorism is the use of etiological agents (disease) to cause harm or kill a population, food, and/or livestock. # 1 is incorrect because the main purpose of biological weapon use is mass devastation. # 3 is incorrect because a biological attack may not be known for several hours or days after the attack. # 4 is incorrect because detection is difficult as clients go to a number of different health care facilities for treatment. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Objective: Describe the types of injuries or symptoms that are associated with biological, chemical, or radiological terrorism. Strategy: Examine each statement to look for a correct statement about bioterrorism.

3. The nurse is caring for a client with a blast injury. Which of the following nursing assessments would be most appropriate for this client? Your Answer: Assess the client for confusion Correct Answer: Assess for vasovagal hypotension Rationale: Blast injuries are the result of explosive munitions, often involving car or package bombs. Care for persons injured by blast injuries typically focuses on abdominal and lung injuries, penetrating wounds, traumatic amputations, and burns. # 2 is incorrect because a concussion, closed and open brain injury, stroke, spinal cord injury, and an air embolism-induced

injury could result from a blast injury. #3 is incorrect because asphyxia could result from a hurricane injury. # 4 is incorrect because the client would have hypovolemia as a result from a blast injury. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Objective: Evaluate nursing interventions related to the treatment of injuries related to biological, chemical, or radiological terrorism. Strategy: Differentiate between the different types of common injuries and the associated assessments necessary to care for the client.

4. An emergency room nurse is working when an Amtrak train derails. The emergency room nurse knows that reverse triage may need to be instituted. What is the rationale for using reverse triage? Your Answer: Victims most likely to survive are color coded as black. Correct Answer: Reverse triage works on the principle of the greatest good for the greatest number. Rationale: During a disaster, nurses may be expected to perform triage. Triage means sorting. # 1 is incorrect because a mass casualty is an event with more than 100 victims. # 2 is incorrect because it describes basic triage and not reverse triage. # 3 is incorrect because victims least likely to survive or are already dead are color-coded as black. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application Objective: Explain the rationale for reverse triage in disasters versus conventional triage in emergencies. Strategy: Read each answer choice to decide which statement correctly depicts the concepts of reverse and conventional triage.

5.

There has been a radioactive explosion nearby. The emergency room nurse must triage and manage the decontamination of the clients systematically. Which of the following clients would be decontaminated first? Your Answer: A client with minor injuries. Correct Answer: A client with the least injuries. Rationale: Reverse triage works on the principle of the greatest good for the greatest number. In this case, those persons who are the most ambulatory and least injured would be instructed to move quickly to the warm zone, away from the immediate accident site to get decontaminated and processed first. Those with minor injuries would be decontaminated next. Those with more severe to most severe injuries would be treated in that order. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Application Objective: Discuss situations requiring the need for client isolation or client decontamination. Strategy: Determine which client needs to be decontaminated first based on reverse triage principles.

6. A preceptor is teaching a graduate nurse the concepts of mitigation. Which of the following statements, if made by the graduate nurse, would indicate an understanding of this concept? Your Answer: “Mitigation is the health care system’s ability to rapidly expand beyond normal services to meet the increased demand for qualified personnel.” Correct Answer: “A key nursing activity related to mitigation is the active participation in learning about the major aspects of disasters.” Rationale: Health care professionals are among the essential Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application Objective: Discuss the role of the nurse in disaster planning, response, and mitigation.

Strategy: Understand and be able to define the concepts of disaster planning, response, and mitigation. Utilize these definitions in order to select the correct answer.

7. A military nurse is working in Iraq. Because of the potential threat of hazardous gas, which of the following should be worn when working in a dangerous war zone? Select all that apply. Your Answer: A surgical mask Protective clothing Sunglasses Correct Answers: A gas mask Protective clothing A hood, helmet, or headgear Rationale: Gas masks are used in a broad range of military, industrial, and emergency situations to protect the user from hazardous dust, gas, or other aerosols. Biological contaminants that are spread through aerosolized droplets create a threat to those not wearing personal protective equipment. A gas mask may be considered as a high-performance respirator, usually equipped with both eye protection and air supply protection or treatment. A hood, helmet, or headgear is generally worn to protect the skin, eyes, airways, and respiratory systems. Protective clothing is made to guard against mild irritants to serious lethal materials. Some protective suits are disposable, intended for one use only. Others are durable, multi-layered fabrics, are completely impermeable and are reusable. Sunglasses and a surgical mask will not provide enough protection in this instance. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application Objective: Discuss the role of the nurse in disaster planning, response, and mitigation. Strategy: Determine if each item would be indicated in this situation. Multiple answers are correct.

8.

An emergency room nurse is at work when a major terrorist attack occurs. In addition to caring for injured clients, the nurse must control the crowd. Which of the following statements, if made by the nurse, demonstrates an understanding of the concept of crowd control? Your Answer: “Nurses will need to enter areas that have not been secured yet in order to reach the clients.” Correct Answer: “The agency’s security personnel and/or the local police force must control these crowds.” Rationale: When a disaster occurs, many people converge on the site. Those who come are the curious and those who truly mean to assist in the rescue and recovery of victims. However, this crowd of people needs to be controlled by authorities in charge of the site and rescue and recovery. #1 is incorrect because the job of crowd control is not under the auspices of the nurse. # 2 is incorrect because chaos ensues when the crowd is not maintained. # 4 is incorrect because nurses should not enter an area that has not been secured. Nursing Process: Planning Client Need: Safe, Effective Care Environment Cognitive Level: Application Objective: Discuss the role of the nurse in disaster planning, response, and mitigation. Strategy: Determine if the principles of crowd control are demonstrated in each answer choice. Eliminate each answer choice that incorrectly describes crowd control.

9. A newly graduated nurse is learning about the nurse’s role in disaster relief as part of an orientation to the hospital. Which of the following concepts is accurate? Your Answer: Nurses take a passive role in helping others to save lives and fulfill an important obligation. Correct Answer: Nurses may have to assume expanded roles in making decisions for the most appropriate treatment of casualties. Rationale: Nurses must be aware of the roles nurses play in all aspects of disaster preparedness and response. #1 is incorrect because learning about disasters is essential. #2 is incorrect because the nurse’s role will be active, not passive. #3 is incorrect because basic skills should be applied. Nursing Process: Planning Client Need: Safe, Effective Care Environment

Cognitive Level: Analysis Objective: Discuss the role of the nurse in disaster planning, response, and mitigation. Strategy: Examine the role of the nurse in disaster planning.

10. A nursing student is learning about how to manage immunocompromised clients in a disaster situation. Which of the following statements made by the nursing student demonstrates an understanding of this concept? Your Answer: “In noncompromised persons, generalized vaccinia consists of vesicles or pustules appearing on normal skin near the vaccination site.” Correct Answer: “A compromised immune system may be due to treatments such as chemotherapy, those who have had organ or bone marrow transplants, or from an underlying disease such as HIV.” Rationale: Clients who are immunocompromised pose special problems to the health care community especially if these persons are unable to access health care quickly in a disaster situation. # 1 is incorrect because the risk is greater. # 3 is incorrect because the vesicles or pustules will be distant from the vaccination site. # 4 is incorrect because bone marrow transplant clients need to avoid fresh fruits and vegetables. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Analysis Objective: Identify ways that nurses are able to provide care to clients with special considerations. Strategy: Determine if each statement is correct with regard to caring for the immunocompromised client. ………………………………………………….. The nurse is triaging four clients injured in a train derailment. Which client should receive priority

treatment? A A 42. year-old with dyspnea and chest asymmetr y B A 17. year-old with a fractured arm C. A 4-yearold with facial laceration s D A 30. year-old with blunt abdomina l trauma

2.

Direct pressure to a deep laceration on the client’s lower leg has failed to stop the bleeding. The nurse’s next action should be to: A. Place a tourniquet proximal to the laceration. B. Elevate the leg above the level of the heart. C. Cover the laceration and apply an ice compress.

D. Apply pressure to the femoral artery.

3.

A pediatric client is admitted after ingesting a bottle of vitamins with iron. Emergency care would include treatment with: A. Acetylcysteine B. Deferoxamine C. Calcium disodium acetate D. British antilewisite

4.

The nurse is preparing to administer Ringer’s Lactate to a client with hypovolemic shock. Which intervention is important in helping to stabilize the client’s condition? A. Warming the intravenous fluids B. Determining whether the client can take oral fluids C. Checking for the strength of pedal pulses D. Obtaining the specific gravity of the urine

5.

The emergency room staff is practicing for its annual disaster drill. According to disaster triage, which of the following four clients would be cared for last? A. A client with a pneumothorax code red B. A client with 70% TBSA full thickness burns code black C. A client with fractures of the tibia and fibula code yellow D. A client with smoke inhalation injuries code red

6.

An unresponsive client is admitted to the emergency room with a history of diabetes mellitus. The client’s skin is cold and clammy, and the blood pressure reading is 82/56. The first step in emergency treatment of the client’s symptoms would be: A. Checking the client’s blood sugar B. Administering intravenous dextrose C. Intubation and ventilator support D. Administering regular insulin

7.

A client with a history of severe depression has been brought to the emergency room with an overdose of barbiturates. The nurse should pay careful attention to the client’s: A. Urinary output B. Respirations C. Temperature D. Verbal responsiveness

8.

A client is to receive antivenin following a snake bite. Before administering the antivenin, the nurse should give priority to: A. Administering a local anesthetic B. Checking for an allergic response C. Administering an anxiolytic D. Withholding fluids for 6–8 hours

9.

The nurse is caring for a client following a radiation accident. The client is

determined to have incorporation. The nurse knows that the client will: A. Not need any medical treatment for radiation exposure B. Have damage to the bones, kidneys, liver, and thyroid C. Experience only erythema and desquamation D. Not be radioactive because the radiation passes through the body

10.

The emergency staff has undergone intensive training in the care of clients with suspected anthrax. The staff understands that the suggested drug for treating anthrax is: A. Ancef (cefazolin sodium) B. Cipro (ciprofloxacin) C. Kantrex (kanamycin) D. Garamycin (gentamicin)

Answer Rationales 1.

Answer A is correct. Following the ABCDs of basic emergency care, the client with dyspnea and asymmetrical chest should be cared for first because these symptoms are associated with flail chest. Answer D is incorrect because he should be cared for second because of the likelihood of organ damage and bleeding. Answer B is incorrect because he should be cared for after the client with abdominal trauma. Answer C is incorrect because he should receive care last because his injuries are less severe.

2.

Answer B is correct. If bleeding does not subside with direct pressure, the nurse should elevate the extremity above the level of the heart. Answers A and D are done only if other measures are ineffective, so they are incorrect. Answer C would slow the bleeding but will not stop it, so it’s incorrect.

3.

Answer B is correct. Deferoxamine is the antidote for iron poisoning. Answer A is the antidote for acetaminophen overdose, making it wrong. Answers C and D are antidotes for lead

poisoning, so they are wrong. 4.

Answer A is correct. Warming the intravenous fluid helps to prevent further stress on the vascular system. Thirst is a sign of hypovolemia; however, oral fluids alone will not meet the fluid needs of the client in hypovolemic shock, so answer B is incorrect. Answers C and D are wrong because they can be used for baseline information but will not help stabilize the client.

5.

Answer B is correct. The client with 70% TBSA burns would be classified as an emergent client. In disaster triage, emergent clients, code black, are cared for last because they require the greatest expenditure of resources. Answers A and D are examples of immediate clients and are assigned as code red, so they are wrong. These clients are cared for first because they can survive with limited interventions. Answer C is wrong because it is an example of a delayed client, code yellow. These clients have significant injuries that require medical care.

6.

Answer A is correct. The client has symptoms of insulin shock and the first step is to check the client’s blood sugar. If indicated, the client should be treated with intravenous dextrose. Answer B is wrong because it is not the first step the nurse should take. Answer C is wrong because it does not apply to the client’s symptoms. Answer D is wrong because it would be used for diabetic ketoacidosis, not insulin shock.

7.

Answer B is correct. Barbiturate overdose results in central nervous system depression, which leads to respiratory failure. Answers A and C are important to the client’s overall condition but are not specific to the question, so they are incorrect. The use of barbiturates results in slow, slurred speech, so answer D is expected, and therefore incorrect.

8.

Answer B is correct. The nurse should perform the skin or eye test before administering antivenin. Answers A and D are unnecessary and therefore incorrect. Answer C would help calm the client but is not a priority before giving the antivenin, making it incorrect.

9.

Answer B is correct. The client with incorporation radiation injuries requires immediate medical treatment. Most of the damage occurs to the bones, kidneys, liver, and thyroid. Answers A, C, and D refer to external irradiation, so they are wrong.

10.

Answer B is correct. Cipro (ciprofloxacin) is the drug of choice for treating anthrax. Answers A, C, and D are not used to treat anthrax, so they are incorrect.

http://www.scribd.com/doc/23310179/COMPREHENSIVENURSING-REVIEW-MORE-QUESTIONS-600-PAGES Your most asked questions about NCLEX prep, Question 3 Beneficence: The ethical obligation to do good to and for one's client. (NCSBN's CE course: Ethics of Nursing Practice) This is the last in a three-part series about frequently asked student questions. Previously, I have written about therapeutic lab values and isolation protocol . Now, let’s turn our attention to an overview of triage in disaster situations, for instance a multiple vehicle or bus collision. Question Three: How are victims of a disaster triaged? A disaster is: "a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources." – World Health Organization Modern hospitals have always had some type of disaster plan. I can remember going through drills and mock disasters as a staff nurse. I was usually assigned to be a (not very convincing) victim. In recent years, the Department of Homeland Security has refined and standardized these drills, so as to better prepare hospitals for a multi-disciplinary health response to major events – both natural and man-made. A shift in thinking… Triage: from the French verb, meaning “to sort” In health care, triage is a screening process used to determine priority for treatment. Most of us understand that if there is a room full of people in a hospital emergency department, the most seriously ill or injured person is the one who is treated first. But in a disaster situation, there is a shift from doing what is best for the individual to doing the greatest good for the largest number of people. The key is to maximize patient survival with an efficient use of available resources. Who to help first To help determine how to “sort” victims, a widely accepted and systematic color-coding system has been developed:

    

WHITE = uninjured GREEN = “minimal” – the “walking wounded”, who will eventually require treatment. YELLOW = “delayed” – these people’s lives are not in immediate danger; they will require urgent, not immediate, medical care (usually the majority of victims). RED = “immediate” – people whose lives are in immediate danger and require immediate treatment. BLACK = “expectant” (or no priority) – people who are dead when initially assessed or those with such extensive injuries that they cannot be saved with the limited available resources.

When checking victims and determining which group they should be assigned to, the primary assessments to use can be remembered using the acronym: R-P-M   

R = respiration P = perfusion (check for radial pulses – not carotid) M = mental status

Applying this information For those of you who have taken our review course, you probably remember a question about a disaster situation at a day care center. Many students write to me and insist that something is wrong with this question. Although it may seem counterintuitive at first, or even in opposition to beneficence, (and so very sad, don’t you think?), the child with the most severe injuries is the one that is cared for last, since there is little chance of survival. In another question, there is a disaster at a factory and a UAP (unlicensed assistive personnel) is available to help the nurse. Many students want the UAP to check blood pressures, but this vital sign is not important initially. The correct answer is to check (radial) pulses, which is a skill that every UAP should know how to do. Now it’s your turn The World Medical Association says, “It is unethical for a physician to persist, at all costs, at maintaining the life of a patient beyond hope, thereby wasting to no avail scarce resources needed elsewhere.” How might this affect nurses working in triage? Why is this so difficult for all involved? Are there any other topics you would like me to discuss in an upcoming blog?