The nurse has been assigned the role of triage nurse after a weather-related disaster. What is the priority action of the nurse?
a.Call in additional staff to assist with care of the victims.
b.Splint fractures and clean and dress lacerations.
c.Perform a rapid assessment of clients to determine priority of
care.
d.Provide psychological support to staff and family members.
ANS: C
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.
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?
a.“Do you need something for pain right now?”
b.“Please stop yelling. I brought dinner as soon as I
could.”
c.“I suggest that you get control of yourself.”
d.“You seem upset. I have time to talk if you like.”
ANS: D
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.
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?
a.Document findings on the client’s
chart and inform the physician.
b.Perform additional assessments for post-traumatic stress disorder.
c.Educate the client on nonpharmaceutical methods to promote sleep.
d.Plan to initiate a referral to a psychologist experienced in survivor issues.
ANS: B
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.
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?
a.Dislocated right hip and an open fracture of the right lower leg
b.Large contusion to the forehead and a bloody nose
c.Closed fracture of the right clavicle and arm numbness
d.Multiple fractured
ribs and shortness of breath
ANS: D
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.
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?
a.“Would you like to talk about what happened?”
b.“Surely the department will give you the day off tomorrow.”
c.“At least the gunman was taken into custody.”
d.“Let’s just sit here for a while quietly.”
ANS: A
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.
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?
a.Don a protective gown, mask, and goggles.
b.Escort the man to the decontamination room.
c.Begin to evacuate the immediate
area.
d.Notify the local health department of a biohazard situation.
ANS: C
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.
Which is the priority action for the emergency department charge nurse in the event of a mass casualty situation?
a.Directing medical-surgical and case management nurses to assist emergency
department (ED) staff with critically injured victims
b.Calling additional medical-surgical and critical care nursing staff to come to the hospital to assist when victims are brought in
c.Informing the incident commander at the mass casualty scene about how many victims may be handled by the ED
d.Directing medical-surgical and critical care nurses to assist with clients who are already in the ED while the ED staff prepares to receive the mass casualty victims
ANS: D
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.
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?
a.Red
b.Yellow
c.Green
d.Black
ANS: A
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.
A nurse is working at the scene of a catastrophic natural event. Which person does the nurse attend to first?
a.Distraught mother looking for her children
b.Person walking about with a bleeding head wound
c.Supine person with pale, cool, clammy skin
d.Child with a deformed lower leg
crying in pain
ANS: C
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.
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?
a.Assuming leadership for implementation of the hospital emergency plan
b.Releasing updates of client conditions to the media
c.Converting the physical therapy clinic into a treatment area for the injured
d.Arranging relief and coordinating breaks so nursing staff can rest and eat
ANS: D
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.
The nurse is teaching nursing students about
personal emergency preparedness. Which statement by a student indicates that further teaching is indicated?
a.“I will get a prescription for antibiotics just in case I have to work in an area that has been infected with anthrax.”
b.“I should keep an extra uniform in my locker in case I get stuck at work.”
c.“I may be torn between caring for my young daughter and caring for victims at work.”
d.“I should make plans for my family to evacuate our house in case of tornado or earthquake.”
ANS: A
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.
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?
a.“You are free to express your feelings; whatever is said here stays here.”
b.“Let’s
determine what we can do better the next time we have this situation.”
c.“This session is only for nursing and medical staff, not for ancillary personnel.”
d.“Let’s pass around the written policy compliance form for everyone.”
ANS: A
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.
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?
a.“Please accept my sympathy for your loss.”
b.“I can call the hospital chaplain if you wish.”
c.“You sound anxious about being a single parent.”
d.“At least your children still have you in their lives.”
ANS: C
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.
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?
a.“An internal disaster is something that occurs inside the health care facility.”
b.“An external disaster occurs when someone not employed here disrupts our operations.”
c.“A multi-casualty event involves disasters at several different locations.”
d.“The Joint Commission requires that we participate in a disaster drill once a year.”
ANS: A
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.
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?
a.Responding paramedics and rescue personnel will notify the ED about exactly how many victims to expect.
b.Responding paramedics and rescue personnel will triage all victims at the bridge collapse site before bringing them to the ED.
c.The ED may receive many unexpected victims with minor injuries from the bridge collapse.
d.Victims who have been contaminated with gasoline will be decontaminated by rescue personnel before
arriving at the ED.
ANS: C
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).
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?
a.The hospital was able to maintain client, staff, and visitor safety during the disaster.
b.Supplies were readily available and were transported rapidly where
needed.
c.The hospital incident command officer successfully utilized ancillary areas for client care.
d.All employees followed the chain of command and established policies and procedures.
ANS: A
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.
A nursing administrator is reviewing a hospital’s disaster planning. The administrator evaluates the plan that addresses which component as being the best?
a.Internal disasters such as fires or power outages
b.All possible catastrophes in the community
c.The Joint Commission’s assessment of possible disasters
d.Responses to all types of weather-related emergencies
ANS: B
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.
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?
a.“To do the greatest good for the greatest number of people, it is necessary to sacrifice some.”
b.“Not everyone will survive a disaster, so it is best to identify those people early and move on.”
c.“In a disaster, extensive resources are not used for one person at the expense of many others.”
d.“With black tags, volunteers can identify those who are dying and can give them comfort care.”
ANS: C
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.
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?
a.The Medical
Reserve Corps
b.The National Guard
c.The Health Department
d.A Disaster Medical Assistance Team
ANS: A
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.
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?
a.“Deployed DMAT providers are federal employees, so their licenses are good in all 50 states.”
b.“The government has a program for quick licensure activation wherever you are deployed.
c.“During a time of crisis, licensure issues would not be the government’s priority concern.”
d.“If you are deployed, you will be issued a temporary license in the state in which you are working.”
ANS: A
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.
A community disaster has
occurred and the hospital’s emergency department (ED) has efficiently triaged, treated, and transferred most clients to appropriate units. The hospital incident command officer wants to “stand down” from the emergency plan. Which question by the nursing supervisor is most beneficial at this time?
a.“Are you sure no more victims are coming into the ED?”
b.“Do all other areas of the hospital have the supplies and personnel they need now?”
c.“Have all ED staff had the chance to eat and
rest recently?”
d.“Are all other incident command officers and house supervisors in agreement with you?”
ANS: B
Before “standing down,” the incident command officer ensures that the needs of the other hospital departments have been taken care of because they may still be stressed and may need continued support to keep functioning. Many more “walking wounded” victims may present to the ED; that number may not be
predictable. Giving staff the chance to eat and rest is important, but all areas of the facility need that too. Although agreement among incident officers is important, it is not the priority concern before standing down.
A hospital has “stood down” from a mass casualty disaster. The staff have rested and eaten. Which action by the nursing supervisor takes priority?
a.Restocking the emergency
department (ED)
b.Making rounds on each unit to check staffing
c.Determining which staff can go home
d.Planning a critical incident stress debriefing
ANS: A
Inventorying and stocking the ED are high-priority actions because the usual flow of emergency clients may not be lessened in the wake of a disaster. Supplies may be low or exhausted, and it would be vital to resupply the area. Rounding on inpatient units,
determining the staff who can be relieved, and planning a debriefing are certainly important items, but they do not take priority over getting the ED ready for more clients.
A family in the emergency department is overwhelmed at the loss of several family members due to a shooting incident in the community. Which intervention by the nurse is most beneficial?
a.Offer the family choices as appropriate
and possible.
b.Call the hospital chaplain to stay with the family.
c.Do not allow visiting of the victims until the bodies are prepared.
d.Provide privacy for law enforcement to interview the family
ANS: A
Offering choices when appropriate and when possible gives some personal control back to individuals. The family may or may not want the assistance of religious personnel; the nurse should assess for this before
calling anyone. Visiting procedures should take into account the needs of the family. The family may appreciate privacy, but this is not as helpful as allowing choices when the family is able to make them.
An emergency department (ED) supervisor has noted an increase in sick calls and bickering among the ED staff after a week with multiple trauma incidents. What action by the supervisor is most
helpful?
a.Organize a pizza party for each shift.
b.Remind staff of facility sick-leave policy.
c.Arrange critical incident stress debriefing.
d.Talk individually with staff members.
ANS: C
The staff may be suffering from critical incident stress and needs to have a debriefing by the critical incident stress management team to prevent the consequences of long-term, unabated stress. The other interventions may be
helpful as well but are not as important as a debriefing.
A client has been treated in the emergency department after a tornado and is awaiting discharge instructions. This client is close to losing control, although other family members are attempting to calm him down. Which response by the nurse is most helpful?
a.Call security and have them standing by in case they are needed.
b.Instruct the
person to leave the area until he can calm down.
c.Offer the client the choice of waiting in the treatment room or the waiting room.
d.Ask the family to help move the client out of the treatment area.
ANS: C
Offering people choices often is a good way to get them to focus on something other than their distress. Calling security and telling the person to leave might escalate the situation, although if all other methods
fail, the safety of staff, clients, and other visitors takes priority. Asking the family to help move the client puts him in a difficult position and may end up causing them injury.
A large number of victims arrive at the emergency department after a bus is hit by a train. Which interventions are performed immediately for red-tagged victims? (Select all that apply.)
a.Splinting a closed tibial
fracture
b.Intubating a cyanotic client in respiratory distress
c.Initiating IV fluids for a client with a blood pressure of 96/60 mm Hg and a pulse of 144 beats/min
d.Attaching an external pacemaker for a client with a heart rate of 44 beats/min
e.Performing postmortem care for a client who has just died
f.Removing glass that is embedded in a client’s arm
ANS: B, C, D
Priority interventions are those that must
be performed to save the client’s life, including intubation, IV fluid replacement for shock, and pacemaker placement. Splinting a fracture and removing glass from a client’s arm can wait until after life-threatening injuries are cared for. Postmortem care would wait until after all clients have been cared for.
The triage nurse is assessing a client who has been brought to the emergency department (ED)
by emergency medical services (EMS) following a mass casualty incident. Which assessment questions are used to determine the appropriate triage category for the client? (Select all that apply.)
a.“Can you wiggle your toes?”
b.“Are you having any difficulty breathing?”
c.“Are you allergic to any medications?”
d.“Does your family know that you are here?”
e.“Can you tell me what day it is?”
f.“Do you have any abdominal or back pain?”
ANS: A, B, E, F
The triage nurse should assess for possible spinal cord injury, shortness of breath, abdominal or back pain, and disorientation when the client is brought to the ED. Determining allergies, although important, does not assist in categorizing clients, nor does inquiring about the client’s family.
Emergency medical services (EMS) brings a large number of clients to
the emergency department following a mass casualty incident. The nurse identifies clients with which injuries with yellow tags? (Select all that apply.)
a.Partial-thickness burns covering both legs
b.Open fractures of both legs with absent pedal pulses
c.Neck injury and numbness of both legs
d.Small pieces of shrapnel embedded in both eyes
e.Head injury and difficult to arouse
f.Bruising and pain in the right lower abdomen
ANS: A, C, D, F
Clients with burns, spine injuries, eye injuries, and stable abdominal injuries should be treated within 30 minutes to 2 hours, and therefore should be identified with yellow tags. The client with the open fracture and the client with the head injury would be classified as urgent with red tags.
A hospital is receiving large numbers of casualties from a disaster.
Which clients does the supervisor identify as appropriate for discharge or transfer to another facility? (Select all that apply.)
a.Client who had open reduction and internal fixation of a femur fracture 3 days ago
b.Client who had a colostomy 4 days ago and whose daughter is a registered nurse
c.Client admitted last night with community-acquired pneumonia
d.Infant admitted 2 days ago for fever of unknown origin
e.Client in the medical decision unit for evaluation of chest pain
ANS: A, B
The client with the femur fracture could be transferred to a rehabilitation facility and the RN could provide care and teaching to her father. The newly admitted client with pneumonia would not be a good choice because culture results are not yet available and antibiotics have not been administered long enough. Also, the infant has not been in the hospital long enough for cultures to return for a definitive
diagnosis. The client in the medical decision unit should be identified for dismissal if diagnostic testing reveals a noncardiac source of chest pain.
The nurse working with survivors of a disaster wants to assess them for post-traumatic stress disorder. For which clients does the nurse perform further assessment before administering the Impact of Event Scale–Revised? (Select all that apply.)
a.Older
adult survivor with minor injuries
b.Woman who lost both her children
c.Middle-aged victim with multiple medical problems
d.Young adult who had serious orthopedic injuries
e.Older adolescent who had a traumatic brain injury
ANS: A, E
The Impact of Event Scale–Revised tool should not be used with people who have short-term memory loss, so the nurse should assess the older adult survivor and the client with the
brain injury for this problem before administering the tool. The other clients do not have medical issues that would preclude use of this tool.
A wing of a hospital is on fire. Which actions by the nurse promote safe evacuation of clients? (Select all that apply.)
a.Direct ambulatory clients on where to go to be safe.
b.Use ambulatory clients to help push clients in wheelchairs.
c.Use oxygen
tanks for all clients who are on oxygen.
d.Manually ventilate clients who are on ventilators.
e.Move bedridden clients in their beds if possible.
ANS: A, B, D, E
Ambulatory clients can evacuate themselves with direction or could be used to help push wheelchair-bound clients. Clients on ventilators need to be removed from the ventilator and “bagged” until evacuated, then they can be put back on the ventilator if one is
available. Bedridden clients should be moved in their beds or on stretchers, or carried if needed. Any client who can breathe without oxygen should have it removed for the evacuation because oxygen is an accelerant.