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 systems 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 agencys 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 nurses 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 systems 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 agencys 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 nurses 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 nurses 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-year-
old with
facial
laceration
s
D
.
A 30-
year-old
with
blunt
abdomina
l trauma

2. Direct pressure to a deep laceration on the clients lower leg has failed to stop
the bleeding. The nurses 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 Ringers Lactate to a client with
hypovolemic shock. Which intervention is important in helping to stabilize the
clients 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 clients skin is cold and clammy, and the blood pressure
reading is 82/56. The first step in emergency treatment of the clients symptoms
would be:
A. Checking the clients 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 clients:
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 68 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 its 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 clients 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 clients 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 clients 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/COMPREHENSIVE-
NURSING-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, lets 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 peoples 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, dont 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 its 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?