Chapter 14: Disaster Preparedness Nursing School Test Banks

MULTIPLE CHOICE

1. In addition to the Department of Homeland Security, which of the following agencies has a mission to ensure that the nation is well prepared to respond to an act of terrorism?

a.

AMA

b.

Red Cross

c.

CDC

d.

Salvation Army

ANS: C

The Centers for Disease Control and Prevention (CDC) is recognized as the leading federal agency designed to protect the health and safety of people at home and abroad. The mission of the CDCs Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) is to protect the health and enhance the living of all people in terms of community preparedness and response. The CDCs mission is to ensure that the nation is well prepared to respond to an act of terrorism (CDC, 2003). The American Medical Association has developed a series of National Disaster Life Support courses designed to provide a uniform, coordinated approach to all-hazards disaster management, but these courses are not designed specifically to combat terrorism. The CDC works with the American Red Cross because both are advocates of preparedness and coordination of prompt, effective emergency efforts. This preparedness coordination goes far beyond these individual agencies and includes outreach to other agencies or groups through mutual aid agreements. However, the CDC is the preeminent agency in this field. Other agencies (e.g., department stores, the Salvation Army, Goodwill) provide clothing. Their efforts are not directed primarily toward terrorist activity.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 324

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Centers for Disease Control and Prevention (CDC)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. Personal protection equipment is categorized by the level of safety provided. Standard work uniforms or work clothes offer what level of protection?

a.

Level A

b.

Level B

c.

Level C

d.

Level D

ANS: D

Standard work uniforms or work clothes offer level D protection. There is no respiratory protection. Standard precautions are important to take when level D protection is used.

Level A protection provides maximum protection because it offers self-contained breathing apparatus, fully encloses the individual, and includes chemical-resistant boots and gloves. Level B protection provides respiratory protection but less skin protection. Used by trained responders, this PPE includes self-contained breathing apparatus, a hooded chemical-resistant suit, and face, boot, and glove protection. First responders (those emergency personnel first on the scene) and hospital personnel are trained and fitted to use level C protection. As with level A and B protection, level C protection presents danger to the user, primarily for dehydration and hyperthermia.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 327

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Levels of Safety KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

3. The most recently labeled level of protection is BioPPE. The use of BioPPE requires which of the following items?

a.

Self-contained breathing apparatus

b.

Respiratory protection but less skin protection

c.

Chemically resistant boots and gloves

d.

Standard work clothes, contact and respiratory protective devices

ANS: D

The most recently labeled level of protection is BioPPE. BioPPE requires the use of standard work clothes, along with contact and respiratory protection. Double gloving and an N95 mask or a better respirator is recommended. Level A protection provides maximum protection in that it offers a self-contained breathing apparatus, fully encapsulates the individual, and includes chemically resistant boots and gloves. BioPPE protection is not adequate when caring for patients exposed to toxic chemicals; however, it provides adequate protection against radiological and biological agents.

DIF: Cognitive Level: Application REF: Text reference: p. 327

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: BioPPE KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

4. Upon arriving at a mass causality scene, health care providers using the SALT approach will initiate triage by doing which of the following first?

a.

Assess

b.

Move

c.

Sort

d.

Send

ANS: C

In the SALT process, the first step is to sort the affected individuals in to groups so that they may be assessed individually. Category 1 includes those who are not moving and have life-threatening injuries. Category 2 includes those who are able to wave or have purposeful movement. Category 3 consists of those able to walk on their own.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 327

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Triage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5. Disaster nursing differs from general nursing because when caring for patients during a disaster:

a.

the focus is on caring for the sickest people first.

b.

using a color tag system reduces the amount of emotional stress on the nurse.

c.

the focus is no longer on airway, breathing, and circulation.

d.

the focus is on caring for those most likely to survive.

ANS: D

Disaster nursing differs from general nursing in that the focus shifts from caring for the sickest people first to saving the greatest number of lives. Triage sorts the victims in to groups with color coded tags which identify statusblack for the dead or mortally injured, red for those in need of immediate attention to survive, yellow for those seriously injured but more stable than individuals coded red, and green for those with minimal injuries, This allows the rescue teams to direct resources in a most effective manner to save the greatest number of lives.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 328

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Disaster Nursing KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. The nurse has arrived at the scene of a natural disaster and is assigned to care for four patients. To which patient should the nurse provide care first?

a.

Patient with a closed head injury with no changes in level of consciousness

b.

Patient with a 3-cm laceration to the forearm

c.

Patient who is breathing eight times per minute

d.

Patient with a displaced wrist fracture

ANS: C

Nursing care should be prioritized when multiple patients are cared for at once. ABCs (airway, breathing, and circulation) should always take precedence. The patient who is breathing only eight times per minute is in need of immediate nursing care. The goal of triage is to sort, assess, and perform lifesaving measures as quickly as possible for large numbers of victims.

DIF: Cognitive Level: Analysis REF: Text reference: p. 328

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Disaster Nursing KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

7. The patient is brought into the emergency department as part of an MCI. The patient has white powder on his clothes, and it is suspected that the patient has been exposed to anthrax. What should the nurse do first?

a.

Cut off the patients clothing and place it in a plastic bag.

b.

Have the patient remove his sweater by pulling it over his head.

c.

Avoid using oxygen that could decrease the patients oxygen drive.

d.

Provide the patient with appropriate antibiotics.

ANS: A

If you suspect anthrax, remove the patients clothing and place it in a labeled plastic biohazard bag. Do not have the patient pull clothing off over the head, but rather cut off clothing. Administer oxygen therapy. Various biological agents (e.g., pulmonary anthrax) commonly cause respiratory symptoms that will result in an altered gas exchange. Exposure to these agents is commonly treated with ciprofloxacin and/or doxycycline, and botulism requires supportive care and use of an antitoxin.

DIF: Cognitive Level: Application REF: Text reference: p. 334

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Anthrax KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8. Which of the following biological agent requires the use of an antitoxin if exposure occurs?

a.

Anthrax

b.

Plague

c.

Botulism

d.

Typhoid

ANS: C

Botulism requires supportive care and use of an antitoxin. Attack with various biological agents (e.g., anthrax, plague, typhoidal tularemia) is commonly treated with ciprofloxacin and/or doxycycline.

DIF: Cognitive Level: Application REF: Text reference: p. 331

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Botulism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. The patient is admitted to the emergency department with possible smallpox exposure. The patient has never had a smallpox immunization. The nurse prepares to administer a smallpox vaccination, realizing that vaccination:

a.

within 3 days of exposure will completely prevent the disease.

b.

is effective only if received before exposure.

c.

4 to 7 days after exposure will completely prevent the disease.

d.

within 3 days will offer only some protection from disease.

ANS: A

In the event that smallpox is the biological weapon, the best treatment is prevention by immunization with vaccinia vaccine before the onset of symptoms. Vaccination within 3 days of exposure will completely prevent the disease or will significantly reduce its effect.

Vaccination 4 to 7 days post exposure offers some protection from disease or will decrease the severity of disease.

DIF: Cognitive Level: Application REF: Text reference: p. 334

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Smallpox KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. If a patient is receiving radiation using gamma rays, the nurse would be watching for which of the following?

a.

Severe pain during administration

b.

Development of an allergy to shellfish

c.

Severe burns or internal injury

d.

Confusion and lethargy

ANS: C

Gamma rays pose the greatest health risk because the waves penetrate deeply, causing severe burns and internal injury. Radiation does not cause patients to develop an allergy to shellfish and is painless during administration. Confusion and lethargy are not known side effects of radiation.

DIF: Cognitive Level: Analysis REF: Text reference: p. 340

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Gamma Rays KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

11. After a suspected radiological exposure, the initial scan of the patients extremities is positive. What will be the next step in this patients care?

a.

Washing the skin with soap and water while taking care not to irritate or abrade the skin

b.

Removing clothing to eliminate 70% to 90% of the contamination

c.

Isolating and covering up any skin that is positive for radiation using a plastic wrap

d.

Conducting a thorough survey of the patients entire body with the radiation sensing equipment

ANS: D

If the initial assessment of the patients face, hands, and feet is positive for radiation exposure the specially trained technician will a more thorough assessment of the patients entire body. Determining the amount and level of radiation is important in determining the level of danger to the caretaker and the level of care required for the patient. This determination precedes any other care.

DIF: Cognitive Level: Application REF: Text reference: p. 341

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Assessment of Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. How is a disaster best defined?

a.

Any event or situation that results in multiple casualties and/or deaths

b.

A catastrophic and/or destructive event that disrupts normal functioning

c.

An industrial accident and unplanned release of nuclear waste

d.

An event that results in human casualties that overwhelm available health care resources

ANS: B

A disaster is defined as a catastrophic and/or destructive event that disrupts normal functioning; it may include any anticipated or unexpected event whose effects lead to significant destruction and/or adverse consequences. Any event or situation that results in multiple casualties and/or deaths is called a mass casualty incident (MCI). An industrial accident with unplanned release of nuclear waste is classified as a technological disaster. A medical disaster is a catastrophic event that results in human casualties that overwhelm available health care resources.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 323

OBJ: Discuss the characteristics of different types of disasters. TOP: Disasters

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. Dispersal of biological agents is a real and psychological terrorist threat. Which of the following organisms has the potential to cause the greatest harm?

a.

Anthrax

b.

Ricin

c.

Salmonella

d.

Hantavirus

ANS: A

Category A organisms are considered the greatest threat because they can be transmitted easily from person to person and can cause high mortality with a potential for major public health impact. Of the organisms listed here, only anthrax (Bacillus anthracis) is considered a Category A organism. Category B organisms are moderately easy to disseminate and cause moderate morbidity and low mortality. They are considered high-risk organisms. Ricin toxin and Salmonella are classified as Category B. Hantavirus is considered a Category C organism or a pathogen that could be engineered for mass dissemination.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 325

OBJ: Discuss the characteristics of different types of disasters.

TOP: Potential Organisms for Bioterrorism by CDC Category

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Which of the following are goals of the Department of Homeland Security (DHS)? (Select all that apply.)

a.

Prevention of terrorist attacks

b.

Response to disasters

c.

Recovery from disasters

d.

Coordination of efforts among agencies

ANS: A, D

The DHS focuses on efforts to prevent terrorist attacks and coordination of efforts of multiple agencies to maintain the safety of the United States.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 323

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Department of Homeland Security (DHS)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. Which of the following should make the nurse suspect a biological event? (Select all that apply.)

a.

Large numbers of ill persons with unexplained similar symptoms

b.

Unexplained deaths among young and healthy populations

c.

A patient population with symptoms suggestive of a common agent

d.

An unusual geographical pattern associated with the symptoms

ANS: A, B, D

You should suspect a biological event when large numbers of ill persons present who have unexplained yet similar symptoms; when unexplained deaths occur, particularly among young and healthy populations; when an unusual pattern (e.g., geographical, season, patient population) is associated with the symptoms; when the patient fails to respond to traditional therapy; and when a single patient presents with symptoms suggestive of an uncommon agent (e.g., anthrax, smallpox). Once you suspect a biological event, notify incident command immediately.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 333

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Bioterrorism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

3. Why are children particularly vulnerable to environmental toxins? (Select all that apply.)

a.

They have stronger immune systems.

b.

They take in proportionally larger doses of toxins from food, water, and the air.

c.

Their organ systems are less able to remove toxins than adult organs systems.

d.

They have a greater number of years of life expectancy.

ANS: B, C, D

Children are particularly vulnerable to environmental toxins because they take in larger doses, pound-for-pound, of toxins than adults, their organ systems are less able to remove the toxins than those of adults, and they have a greater number of years of life expectancy over which to develop complications from the toxic exposure.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 335

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Psychological Status KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

4. The patient is admitted with exposure to an unknown chemical. His clothing appears to be grossly contaminated. What should the nurse do? (Select all that apply.)

a.

Avoid touching contaminated parts of clothing.

b.

Pull the patients tee shirt off over his head.

c.

Cut the patients clothes off.

d.

Wash the patient with large amounts of soap and water.

ANS: A, C, D

Remove all of the patients clothing, but do not pull it over the patients head; instead, cut garments off. Act quickly, and avoid touching contaminated parts of clothing as much as possible. Decontaminate the patient using large amounts of soap and water to wash the patient thoroughly.

DIF: Cognitive Level: Application

REF: Text reference: p. 335 |Text reference: p. 338 |Text reference: p. 342

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Decontamination KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

COMPLETION

1. The government agency that coordinates the efforts of multiple organizations to secure and maintain the safety of our nation is the __________________.

ANS:

Department of Homeland Security (DHS)

The Department of Homeland Security (DHS) was established to provide a unifying core as the basis for efforts to prevent and discourage terrorist attacks. This governmental agency coordinates the efforts of multiple organizations to secure and maintain the safety of our nation.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 323

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Department of Homeland Security (DHS)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The strategic plan of the Centers for Disease Control and Prevention in the event of a disaster first focuses on __________________.

ANS:

preparedness

The CDCs strategic plan in the event of a disaster first focuses on preparedness, which is key to the impact that any disaster has on the individuals or communities involved. Preparedness requires that nurses have a basic understanding of the science of a disaster and an understanding of the key components of any plan to deal with an MCI.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 324

OBJ: Describe elements of the CDCs strategic plan for disasters.

TOP: The Centers for Disease Control and Prevention (CDC)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. In the event of a mass casualty incident, part of the CDCs disaster preparedness program involves backup plans for maintaining public and intraagency/interagency ____________.

ANS:

communication

Traditional modes of communication will likely be interrupted in the event of an MCI; therefore part of disaster preparedness involves backup plans for maintaining public and intraagency/interagency communication (e.g., use of two-way radios and satellite phones).

DIF: Cognitive Level: Comprehension REF: Text reference: p. 324

OBJ: Describe elements of the CDCs strategic plan for disasters.

TOP: The Centers for Disease Control and Prevention (CDC)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. An outbreak of influenza A in the same geographical location is known as an __________.

ANS:

epidemic

An epidemic is an infectious disease or condition that attacks many people at the same time in the same geographical area.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 323

OBJ: Discuss the characteristics of different types of disasters. TOP: Epidemic

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. An outbreak of an infectious disease such as SARS in many parts of the world is known as a ______________.

ANS:

pandemic

A pandemic is an epidemic that occurs in many parts of the world.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 323

OBJ: Discuss the characteristics of different types of disasters. TOP: Pandemic

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. It is recommended that every household prepare a ____________.

ANS:

disaster supply kit

Every household should prepare a disaster supply kit that includes basic items (water, can opener, utility knife, food, first-aid kit, identification, etc.) but items unique to members of the household, like hearing aid batteries or an extra pair of glasses.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 335-336

OBJ: Discuss the characteristics of different types of disasters. TOP: Disaster Supply Kit

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

7. An _________________ provides a standard approach to managing emergencies in which multiple agencies are involved.

ANS:

incident command system

An incident command system (ICS), also referred to as the incident management system (IMS), provides a standard approach to managing emergencies in which multiple agencies are involved.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 325

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Incident Command Systems KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

8. Hurricane Zee has caused severe flooding and loss of power throughout the state. The local community has a stockpile of supplies that will help it get through the next 72 hours. Beyond this, once local and federal authorities confirm the need, a push package of supplies will be issued within 12 hours of the confirmation. These supplies will come from the ____________.

ANS:

strategic national stockpile (SNS)

The CDC has developed a strategic national stockpile (SNS) that contains large quantities of medical equipment in the event of a disaster. Most local communities will be prepared to provide essential resources for up to 72 hours (via hospitals, pharmacies, etc.) to support local needs. Once local and federal authorities confirm the need for the SNS, and upon request of the affected states governors office, the 12-hour push package is flown or transported within 12 hours to any state in the United States. The 12-hour push package contains approximately 100 steel containers that hold pharmaceuticals (prepackaged 10-day supplies of antibiotics, antidotes, narcotics, epinephrine, albuterol, prednisone, etc.), IV fluids and IV supplies, ventilators, suction equipment, airway supplies, tablet counting machines, and other emergency provisions.

DIF: Cognitive Level: Application REF: Text reference: p. 327

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Strategic National Stockpile (SNS)

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. __________ is the sorting of individuals by the seriousness of their condition and the likelihood of their survival.

ANS:

Triage

Triage is the sorting of individuals by the seriousness of their condition and the likelihood of their survival.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 328

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Triage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. The terrorist act of releasing a biological agent into a specified environment is known as _____________________.

ANS:

bioterrorism

biological attack

Bioterrorism or a biological attack is the result of the release of a biological agent into a specified environment.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 330

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Bioterrorism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

11. The patient is being treated for biological agent exposure and is resting in the emergency department bay. It is important that the nurse evaluate changes in airway, breathing, and circulation, as well as ____________________.

ANS:

psychological status

Observe for improved airway maintenance, breathing, circulation, level of consciousness, and neurological functioning. Evaluate vital signs, the condition of the patients skin, and changes that suggest improvement or deterioration of psychological status. Ask the patient, How do you feel right now? Check level of orientation and ability to conduct conversation. This evaluates the patients response to emotional trauma.

DIF: Cognitive Level: Application REF: Text reference: p. 333

OBJ: Describe psychosocial effects of disasters on patients. TOP: Psychological Status

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. For safety reasons, rescue workers should be upwind and uphill from a toxic chemical disaster scene to avoid exposure. The exception is when ____________ has been released, because it is lighter than air.

ANS:

cyanide gas

For safety reasons, rescue workers should be upwind and uphill from a toxic chemical disaster scene to avoid exposure. The exception is when cyanide gas has been released. Cyanide is lighter than air and thus will travel uphill. It has the unique smell of bitter almonds.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 336

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Cyanide Gas KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

13. A patient has been exposed to a toxic chemical. The nurses first priority is _______________.

ANS:

decontamination

Suspect a toxic chemical event when large numbers of ill persons present who have unexplained yet similar symptoms. The primary objective for initial care is decontamination, the process used to remove harmful contaminants from the surface of the skin. You achieve this by removing clothing, scrubbing the skin, and performing hydrolysis, a process of chemical dilution in which large volumes of water are used.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 336

OBJ: Discuss guidelines for patient care in the event of mass casualty care.

TOP: Decontamination KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

14. The dispersal of radioactive material via a dirty bomb or by deliberate contamination of food supplies or water supplies is known as a _________________.

ANS:

radiological event

A radiological event is the dispersal of radioactive material via a dirty bomb or by deliberate contamination of food supplies or water supplies or over the terrain.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 340

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Radiological Event KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

15. Releasing nuclear energy in an explosive manner as the result of a nuclear chain reaction is known as a ________________.

ANS:

nuclear event

A nuclear event involves a device that releases nuclear energy in an explosive manner as the result of a nuclear chain reaction.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 340

OBJ: Identify actions to take in the event of biological, chemical, and radiation exposure.

TOP: Nuclear Event KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

Leave a Reply