Chapter 06: Disaster Preparedness Perry et al.: Nursing Interventions & Clinical Skills, 7th Edition

Multiple Choice

1. During a disaster drill, a patient presents with an open left femur fracture, BP 134/78 mmHg, pulse 102 beats/minute, and pedal pulses 1+/4+ bilaterally. Into which category would the nurse triage this patient?

a. Expectant b. Delayed c. Immediate d. Minimal

ANS: B

A patient with an open fracture can be triaged into the delayed category when bleeding is controlled and pulses are strong. This patient’s pulses, although weak, are equal bilaterally, which indicates this is probably a normal finding in him or her. An expectant patient is one who is dead or expected to die. If this patient had uncontrollable bleeding, the nurse would triage him or her as immediate. The minimal category consists of individuals with minor or no visible injury.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. Prepare ongoing educational programming. b. Require nurses become certified in trauma care. c. Collaborate with a local nursing school on simulations. d. Involve the staff in disaster planning.

2. The trauma unit manager wishes to improve the unit’s nurses’ capabilities in mass casualty situations. What action by the manager would be best?

ANS: C

While all options would increase nurses’ knowledge, using simulations has been s hown to be effective in promoting competence in disaster nursing. Students have also been shown to lack knowledge in this area, so collaborating with a nursing school would lead to improvement in both populations plus sharing the costs would make simulation more feasible for both.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Planning a. Put on personal protective equipment. b. Assess the non-breathing patient first. c. Determine if the scene is safe to enter. d. Open the non-breathing patient’s airway.

3. A trauma nurse has responded to the scene of a mass casualty incident. The nurse sees several injured patients lying together in a heap. One of them does not appear to be breathing. What action by the nurse takes priority?

ANS: C

All options are appropriate, however; before entering any disaster scene, the nurse must first determine if it is safe to do so. Otherwise the nurse risks become another victim.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. Resting periodically and drinking water b. Ensuring the breathing apparatus remains intact c. Replacing gloves frequently on a schedule d. Keeping the hard hat securely in place

4. A nurse has responded to the scene of hurricane devastation and must wear Level C protection as there are potential biohazards present. What action by the nurse takes priority?

ANS: A

Levels A, B, and C protective garments are self-enclosed and put the wearer at risk of dehydration and hyperthermia. The nurse needs to rest periodically and drink water so this does not occur. The self-contained breathing apparatus and hard hat are part of Level A protection. Regular gloves are worn with Level D protection.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Planning a. Places the patient in strict isolation. b. Prepares to administer ciprofloxacin. c. Educates close contacts on vaccination. d. Assists in obtaining hemodynamic monitoring.

5. During a disaster drill, a patient presents with manifestations of inhalation anthrax exposure. What action by the nurse indicates a need for further education?

ANS: A

Inhalation anthrax cannot be contracted through person-to-person contact, so strict isolation is not necessary. Ciprofloxacin and doxycycline are the two drugs used to treat anthrax. Close contacts might benefit from the vaccine, however; it is in short supply. Hemodynamic failure is a grave concern with inhalation anthrax so the patient would need hemodynamic monitoring.

DIF: Cognitive Level: Evaluating OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Evaluation a. Prepares to administer doxycycline. b. Cares for the patient using CDC isolation guidelines. c. Assesses and treats the patient’s pain. d. Encourages proper nutrition.

6. A patient is admitted with suspected smallpox infection. What action by the nurse indicates further education is needed on this type of patient?

ANS: A

Smallpox is a virus, so antibiotics are not used unless secondary infections occur. Treatment is supportive in nature. The CDC has isolation guidelines for health care personnel to use when caring for such patients. Symptoms include headache, myalgias, and back pain and might require analgesics. Good nutrition is important for healing.

DIF: Cognitive Level: Evaluating OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Evaluation a. Alert the authorities b. Evacuate downhill c. Begin decontamination d. Don PPE

7. The nurse assisting at a disaster site smells what seems to be burned or bitter almonds. What action by the nurse takes priority?

ANS: B

The smell of bitter almonds is characteristic of cyanide. The nurse needs to evacuate the area downhill, because cyanide is lighter than air and rises. Alerting the authorities should occur quickly, but the priority is to prevent further injury by evacuating people in the area. Decontamination will begin when facilities are set up or when patients are transported. The nurse should already be wearing PPE, but if not, should start evacuation immediately then don PPE.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. Rinse the patient’s eyes with tap water for 15 minutes. b. Assess the patient’s airway, breathing, and circulation. c. Wash the patient’s face with soap and warm water. d. Remove the patient’s contact lenses before irrigating the eyes.

8. A patient presents to the emergency department after a chemical exposure and reports blurry vision and “my eyes burn”. What action by the nurse takes priority?

ANS: B

Circulation, breathing, and airway always come first, so the nurse assesses these areas as the priority. If the patient is stable, irrigation of the eyes with plain water for 10–15 minutes is the correct first treatment. The nurse would remove or have the patient remove the contact lenses prior to irrigation.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. Antitoxin b. Antidote c. Bronchodilator d. Antibiotic

9. An explosion has occurred at a factory that makes pool supplies and chemicals. One of the victims presents to the emergency department with obvious shortness of breath. What medication does the nurse prepare to administer?

ANS: C

Chlorine is the suspected chemical exposure as it is used in pool maintenance. Chlorine can disrupt pulmonary function, so bronchodilators are indicated in this patient with respiratory distress. There is no antitoxin or antidote for chlorine exposure and antibiotics are ineffective on chemicals.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. Remove all clothing as quickly as possible. b. Conduct a focused assessment. c. Have a radiation assessment performed. d. Place patient in a room with a lead shield.

10. After a radiation exposure, a patient was brought to the emergency department. What nursing action is appropriate?

ANS: C

Prior to assessing or caring for a patient exposed to radiation, a radiation technologist will perform a brief radiation assessment of the victim. If the assessment is positive, a more thorough assessment will be done. The patient does not need to be in a room with lead shielding.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. “We don’t know how this radiation will affect the patient.” b. “Other health problems may mean the patient is worse than we think.” c. “We need to ensure the patient does not develop delirium.” d. “Organs in older people are more sensitive to radiation than in kids.”

11. An older employee of a nuclear energy plant was exposed to radiation. On initial assessment, the patient appears stable. The nurse delegates frequent vital sign monitoring to the nursing assistive personnel. When questioned for the need to monitor the patient so often, what response by the nurse is best?

ANS: B

Older adults often have coexisting medical conditions. The effects of radiation exposure may be worse than initially determined during triage. The nurse should delegate frequent vital signs in order to quickly spot any deterioration. Radiation exposure’s course of illness is well-known. The patient may or may not develop delirium, but frequent vital signs would not indicate it occurred. Children’s organs are more sensitive to the effects of radiation.

DIF: Cognitive Level: Understanding OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation a. Remove patient’s clothing and throw away. b. Refrain from touching patient without PPE. c. Assess for ciprofloxacin allergy. d. Request 911 dispatch a dosimeter to the scene.

12. An individual eating at an outdoor café suddenly grabs the chest and begins drooling uncontrollably. A nurse at the scene assesses pinpoint pupils and muscle twitching. The patient states “I think someone tried to kill me.” After calling 911, what action by the nurse is best?

ANS: B

This patient has manifestations of “lethal” nerve gas agent exposure such as sarin or VX. Proper PPE is required to assess and treat the patient so the nurse does not also become a victim. Clothing will be disposed of in a biohazard bag according to CDC recommendations.

Ciprofloxacin is not used for nerve gas exposure. A dosimeter would be needed for a radiation exposure.

DIF: Cognitive Level: Applying OBJ: NCLEX: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

Multiple Response

1. A nursing student learns that which of the following are potential hazards at a disaster site? (Select all that apply.)

a. Downed powerlines b. Public alarm c. Toxic gases d. Secondary explosions e. Snipers f. Fire

ANS: A, C, D, E, F

Public alarm is expected at the scene of a disaster and can be very disruptive, but it is not a primary potential hazard for responders. All other options are potential hazards at a disaster scene. Other possible hazards include smoke/toxic gasses, debris that can cause injury, ruptured gas lines, structural collapse, inclement weather, exposure to blood and/or body fluids, exposure to many types of hazardous materials, darkness, infections, and projectiles. Any of these could render a first responder incapacitated.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Safe and Effective Care Environment

TOP: Integrated Process: Teaching-Learning a. Gallon of water per person b. Utility knife c. First aid kit d. Pet supplies e. Household cleaners f. Plastic sheeting

2. A nurse is conducting a community education event of disaster preparedness. What items does the nurse inform participants are needed in a basic disaster kit? (Select all that apply.)

ANS: A, B, C, D, E

Plastic sheeting precut to fit over shelter openings would be needed in case of a chemical or radiological event. The other items are all needed in a basic disaster kit.

DIF: Cognitive Level: Understanding OBJ: NCLEX: Safe and Effective Care Environment

TOP: Integrated Process: Teaching-Learning a. Less vulnerable to the effects of radiation. b. More likely to develop secondary infections. c. Hypothermia with contamination is more severe. d. Behavior changes are possible after traumas. e. PPE is more easily accepted as it is new and interesting.

3. What does the nurse learn about disaster preparedness as it relates to children as compared to adults? (Select all that apply.)

ANS: B, D

There are some important differences in children the nurse is aware of. Their bodies are more vulnerable to the effects of radiation and toxins, they have immature immune systems so they are also vulnerable to secondary communicable diseases that might appear after a disaster, they become hypothermic more easily than adults, behavior changes can occur after a traumatic ordeal, and PPE may frighten children.

DIF: Cognitive Level: Remembering OBJ: NCLEX: Safe and Effective Care Environment

TOP: Integrated Process: Teaching-Learning