EMERGENCY AND DISASTER NURSING
PRACTICE QUESTIONS:
1. Nurse Ejay is assigned to a telephone triage. A client called
who was stung by a honeybee and is asking for help. The
client reports of pain and localized swelling but has no
respiratory distress or other symptoms of anaphylactic shock.
What is the appropriate initial action that the nurse should
direct the client to perform?
A. Removing the stinger by scraping it.
B. Taking an oral antihistamine
C. Applying a cold compress
D. Calling the 911
Since the stinger will continue to release venom into the skin.
removing the stinger should be the first action that the nurse
should direct to the client. Options B and C: After removing
the stinger. Antihistamine and cold compress follow. Option
D: The caller should be further advised about symptoms that
require 911 assistance.
2. Nurse Anna is an experienced travel nurse who was recently
employed and is assigned in the emergency unit. In her first
week of the job. which of the following area is the most
appropriate assignment for her?
A. Triage
B. Trauma team
C. Ambulatory section
D. Psychiatric care
The ambulatory section deals with clients with relatively
stable conditions. Options A. C. and D: These areas should be
filled with nurses who are experienced with hospital routines
and policies and has the ability to locate equipment
immediately.
3. A client arrives at the emergency department who suffered
multiple injuries from a head-on car collision. Which of the
following assessment should take the highest priority to take?
A. Irregular pulse
B. A deviated trachea
C. Ecchymosis in the flank area
D. Unequal pupils
A deviated trachea is a symptom of tension pneumothorax.
which will result in respiratory distress if left untreated.
4. Nurse Kelly. a triage nurse encountered a client who
complaints of mid-sternal chest pain. dizziness. and
diaphoresis. Which of the following nursing action should take
priority?
A. Complete history taking
B. Notify the physician
C. Put the client on ECG monitoring
D. Administer oxygen therapy via nasal cannula
The priority goal is to increase myocardial oxygenation.
Options A. B. and C: These actions are also appropriate and
should be performed immediately.
5. A group of people arrived at the emergency unit by a private
car with complaints of periorbital swelling. cough. and
tightness in the throat. There is a strong odor emanating from
their clothes. They report exposure to a "gas bomb" that was
set off in the house. What is the priority action?
A. Direct the clients to the decontamination area.
B. Direct the clients to the cold or clean zone for immediate
treatment.
C. Measure vital signs and auscultate lung sounds.
D. Immediately remove other clients and visitors from the
area.
E. Instruct personnel to don personal protective equipment
Decontamination in a specified area is the priority. Option B:
The clients must undergo decontamination before entering
cold or clean areas. Options C and D: Performing assessments
and moving others delays contamination and does not protect
the total environment. Option E: Personnel should don
personal protective equipment before assisting with
decontamination or assessing the clients.
6. When an unexpected death occurs in the emergency
department. which task is the most appropriate to delegate to a
nursing assistant?
A. Help the family to collect belongings
B. Assisting with postmortem care
C. Facilitate meeting between the family and the organ donor
specialist
D. Escorting the family to a place of privacy
Postmortem care requires some turning. cleaning. lifting. and
so on. and the nursing assistant is able to assist with these
duties. Option A: In cases of questionable death. belongings
may be retained for evidence so the chain of custody would
have to be maintained. Options C and D: A licensed nurse
should take responsibility for the other tasks to help the family
begin the grieving process.
7. The physician has ordered cooling measures for a child with
a fever who is likely to be discharged when the temperature
comes down. Which task would be appropriate to delegate to a
nursing assistant?
A. Prepare and administer a tepid sponge bath.
B. Explain the need for giving cool fluids.
C. Assist the child in removing outer clothing.
D. Advise the parent to use acetaminophen (Tylenol) instead
of aspirin.
The nursing assistant can help with the removal of outer
clothing. which allows the heat to dissipate from the child’s
skin. Option A: Tepid baths are not usually given because of
the possibility of shivering and rebound. Options B and D:
Explaining and Advising are teaching functions that are a
responsibility of the registered nurse.
8. You are preparing a child for IV conscious sedation before
the repair of a facial laceration. What information should you
report immediately to the physician?
A. The parent wants information about the IV conscious
sedation.
B. The parent is not sure regarding the child’s tetanus
immunization status.
C. The child suddenly pulls out the IV.
D. The parent’s refusal of the administration of the IV
sedation.
The refusal of the parents is an absolute contraindication;
therefore, the physician must be notified. Options A and C:
The RN can reestablish the IV access and provide information
about conscious sedation. Option B: Tetanus status can be
addressed later.
9. The emergency medical service has transported a client with
severe chest pain. As the client is being transferred to the
emergency stretcher. you note unresponsiveness. cessation of
breathing. and unpalpable pulse. Which of the following task
is appropriate to delegate to the nursing assistant?
A. Initiating bag valve mask ventilation.
B. Placing the defibrillator pads.
C. Doing chest compressions.
D. Assisting with the intubation.
Performing chest compressions are within the training of a
nurse assistant. Option A: The use of the bag valve mask
requires practice. and usually, a respiratory therapist will
perform the function. Option B: The defibrillator pads are
clearly marked; however, placement should be done by the RN
or physician because of the potential for skin damage and
electrical arcing.
10. The nursing manager decides to form a committee to
address the issue of violence against ED personnel. Which
combination of employees would be best suited to fulfill this
assignment?
A. RNs. LPNs. and nursing assistants.
B. At least one representative from each group of ED
personnel.
C. Experienced RNs and experienced paramedics.
D. ED physicians and charge nurses.
At least one representative from each group of ED personnel
should be included because all employees are potential targets
for violence in the ED.
11. You’re working as a triage nurse during a disaster
situation. Based on the triage color code tags placed on each of
the wounded, which tag color represents the wounded who
have the highest priority of being treated first?
A. Green
B. Yellow
C. Red
D. Black
The answer is C: Red. The red tag indicates the patient must
be seen first because they have life-threatening injuries, but
could survive if treated quickly. The patient is still alive but
there is a severe alteration in their breathing, circulation, or
mental status that requires immediate medical attention.
12. A catastrophic disaster has occurred 5 miles from the
hospital you are working in. The hospital’s disaster plan is
activated and the wounded are brought to the hospital. You’re
helping triage the survivors. One of the wounded is able to
walk around and has minor lacerations on the arms, hands,
chest, and legs. You would place what color tag on this
survivor?
A. Red
B. Yellow
C. Green
D. Black
The answer is C: Green tags are for patients who have
MINOR injuries. If the patient can walk around, they are
tagged as green. Sometimes they are referred to as the
“walking wounded”.
13. Which statement below is INCORRECT about the yellow
triage tag color in regards to a disaster situation?
A. A survivor with this tag color is seen after patients with
green tag color.
B. A survivor with this tag color can have treatment delayed
for an hour or less.
C. A survivor with this tag color has serious injuries that could
eventually lead to the compromise of breathing, circulation, or
mental status, especially if treatment is delayed more than an
hour or so.
D. A survivor with this tag color has second priority for
treatment of injuries.
The answer is A. This statement is INCORRECT. It should
say: A survivor with this tag color is seen after patients with
the RED (not green) tag color.
14. For the next 7 questions, use the START method for adults
to help triage the wounded that have been involved in a
disaster situation. Each question will give you details on what
you have assessed and you will need to use those details to
help you assign a color tag to the individual: The wounded
victim is unable to walk, has respiratory rate of 40, capillary
refill is 6 seconds, and can’t follow simple commands. The
wounded victim is assigned what tag color?
A. Green
B. Red
C. Yellow
D. Black
15. While triaging the wounded from a disaster, you note that A. Cleansing the amputated digits and placing them directly
one of the wounded is not breathing, radial pulse is absent, into an ice slurry
capillary refill >2 seconds, and does not respond to your B. Wrapping the cleansed digits in saline-moistened gauze,
commands. What color tag is assigned? sealing in a plastic container, and placing it in icy water
A. Green C. Gently cleansing the amputated digits and the hand with
B. Red povidone-iodine
C. Yellow D. Cleansing the digits with sterile normal saline and placing
D. Black it in a sterile cup with sterile normal saline

The answer is D: Black. The black tag is placed on the Once a finger amputation has occurred, ischemic tolerance
wounded that are dying or have expired. The injuries are so times are 12 hours if warm and up to 24 hours if cold. For
severe that death is imminent. There is severe alteration or more proximal amputations, these times are halved. The
absence of breathing, circulation, and neuro status. amputated part should be covered in a normal saline-soaked
gauze, sealed in a plastic bag, and submerged in icy water with
16. The wounded victim is unable to walk, has respiratory rate no direct contact with ice. If there is direct contact with ice, it
of 12, capillary refill is 8 seconds, and is unresponsive. The could result in tissue damage and render the amputated part
wounded victim is assigned what tag color? non-viable.
A. Green
B. Red 22. A client arrives in the emergency unit and reports that a
C. Yellow concentrated household cleaner was splashed in both eyes.
D. Black Which of the following nursing actions is a priority?
A. Examine the client's visual acuity
17. The wounded victim is unable to walk, has respiratory rate B. Patch the eye
of 19, capillary refill of one second, and is able to obey your C. Use Restasis (Allergan) drops in the eye
commands. The wounded victim is assigned what tag color? D. Flush the eye repeatedly using sterile normal saline
A. Green
B. Red Initial emergency action during a chemical splash to the eye
C. Yellow includes immediate continuous irrigation of the affected eye
D. Black with normal saline. Immediate irrigation with copious amounts
of an isotonic solution as described previously is the mainstay
18. The wounded victim is unable to walk, respiratory rate is of treatment for chemical burns. Never use any substance to
absent but when airway is repositioned breathing is noted. The neutralize chemical exposure as the exothermic reaction can
wounded victim is assigned what tag color? lead to secondary thermal injuries. Option A: After irrigation,
A. Green visual acuity then is assessed. Irrigation should continue until
B. Red the pH of the eye is between 7.0 to 7.4 and remains within this
C. Yellow range for at least 30 minutes after the irrigation has been
D. Black discontinued. Option B: Patching the eye is not part of the
first-line treatment of a chemical splash. Irrigation should be
19. The wounded victim is unable to walk, respiratory rate is gentle, and care should be taken to avoid direct irrigation to
absent and when airway is repositioned breathing is still the cornea to prevent further injury. Use of a commercial
absent. The wounded victim is assigned what tag color? irrigation lens such as a Morgan lens may be helpful. Option
A. Green C: Restasis (Allergan) drops are used to treat dry eyes. A
B. Red topical anesthetic such as tetracaine can be applied directly to
C. Yellow the eye, or 10 mL of 1% lidocaine can be added to a liter of
D. Black irrigating fluid, taking care not to reach a toxic dose if copious
irrigation is required.
20. The wounded victim is able to walk and obey commands.
The wounded victim is assigned what tag color? 23. A client was brought to the emergency department after
A. Green suffering a closed head injury and lacerations around the face
B. Red due to a hit-run accident. The client is unconscious and has a
C. Yellow minimal response to noxious stimuli. Which of the following
D. Black assessment findings if observed after few hours, should be
reported to the physician immediately?
21. A client suffered an amputation of the first and second A. Drainage of a clear fluid from the client's nose
digits in a chainsaw accident. Which task should be delegated B. Withdrawal of the client in response to painful stimuli
to an LPN/LVN? C. Bruises and minimal edema of the eyelids
D. Bleeding around the lacerations

Option A: Clear drainage from the client’s nose indicates that
there is a leakage of CSF and should be reported to the
physician immediately.
24. A 5-year-old client was admitted to the emergency unit due
to the ingestion of an unknown amount of chewable vitamins
for children at an unknown time. Upon assessment, the child is
alert and with no symptoms. Which of the following
information should be reported to the physician immediately?
A. The child was nauseated and vomited once at home
B. The child has been treated several times for toxic substance
ingestion
C. The vitamin that was ingested contains iron
D. The child has been treated multiple times for injuries
caused by accidents
Iron is a toxic substance that can lead to massive hemorrhage,
shock, coma, and kidney failure. Iron poisoning is one of the
most common toxic ingestions and one of the deadliest among
children. Failure to diagnose and treat iron poisoning can have
serious consequences including multi-organ failure and death.
Option A: During the first stage (0.5 to 6 hours), the patient
mainly exhibits gastrointestinal (GI) symptoms including
abdominal pain, vomiting, diarrhea, hematemesis, and
hematochezia. The second stage (6 to 24 hours) represents an
apparent recovery phase, as the patient’s GI symptoms may
resolve despite toxic amounts of iron absorption. Option B:
Patients who have GI symptoms that resolve after a short
period of time and have normal vital signs require supportive
care and an observation period, as it may represent the second
stage of iron toxicity. Patients who remain asymptomatic 4 to
6 hours after ingestion or those who have not ingested a
potentially toxic amount do not require any treatment for iron
toxicity. Option D: This information needs further
investigation but will not change the immediate diagnostic
testing or treatment plan. Patients who have GI symptoms that
resolve after a short period of time and have normal vital signs
require supportive care and an observation period, as it may
represent the second stage of iron toxicity.
25. The following clients come to the emergency department
complaining of acute abdominal pain. Prioritize them for care
in order of the severity of the conditions.
A. A 43-year-old woman with moderate right upper quadrant
pain who has vomited small amounts of yellow bile and whose
symptoms have worsened over the week.
B. A 59-year-old man with a pulsating abdominal mass and
sudden onset of persistent abdominal or back pain, which can
be described as a tearing sensation within the past hour.
C. A 15-year-old boy with a low-grade fever, right lower
quadrant pain, vomiting, nausea, and loss of appetite for the
past few days.
D. A 57-year-old woman who complains of a sore throat and
gnawing midepigasttric pain that is worse between meals and
during the night.
E. A 27-year-old woman complaining of lightheadedness and
severe sharp left lower quadrant pain who reports she is
possibly pregnant.
B, E, C, A, D
1. The client with a pulsating mass has an abdominal
aneurysm that may rupture and he may decompensate easily.
An abdominal aortic aneurysm is a life-threatening condition
that requires monitoring or treatment depending upon the size
of the aneurysm and/or symptomatology.
2. The woman with lower left quadrant pain is at risk for a
life-threatening ectopic pregnancy. An ectopic pregnancy
occurs when fetal tissue implants outside of the uterus or
attaches to an abnormal or scarred portion of the uterus.
Ectopic pregnancies carry high rates of morbidity and
mortality if not recognized and treated promptly.
3. The 15-year-old boy needs evaluation to rule out
appendicitis. It should be considered in any patient with acute
abdominal pain without a prior appendectomy. The diagnosis
must be made as quickly as possible because with time, the
rate of rupture increases.
4. The woman with vomiting needs evaluation for gallbladder
problems, which appear to be worsening. Disruption of the
gallbladder’s normal physiology can result in a significant
medical burden. Over 20 million Americans suffer from
gallbladder disease and cholecystectomy is one of the most
common surgeries performed.
5. Lastly, the woman with mid-epigastric pain is suffering
from an ulcer, but follow-up diagnostic testing can be
scheduled with a primary care provider. It is important to
understand this disease process is both preventable and
treatable. Patients may be treated differently depending on the
etiology of their gastric ulcer.
26. The following clients are presented with signs and
symptoms of heat-related illness. Which of them needs to be
attended first?
A. A relatively healthy homemaker who reports that the air
conditioner has been broken for days and who manifest
fatigue, hypotension, tachypnea, and profuse sweating.
B. An elderly person who complains of dizziness and syncope
after standing in the sun for several hours to view a parade.
C. A homeless person who is a poor historian; has altered
mental status, poor muscle coordination, and hot, dry ashen
skin; and whose duration of heat exposure is unknown.
D. A marathon runner who complains of severe leg cramps
and nausea, and manifests weakness, pallor, diaphoresis, and
tachycardia.
The signs and symptoms manifested by the homeless person
indicate that a heat stroke is happening, a medical emergency,
which can lead to brain damage. Also, there must be clinical
signs of central nervous system dysfunction that may include
ataxia, delirium, or seizures, in the setting of exposure to hot
weather or strenuous physical exertion. Patients who present
with heat stroke typically have vital sign abnormalities to
include an elevated core body temperature, sinus tachycardia,
tachypnea, a widened pulse pressure, and a quarter of patients
will be hypotensive. Option A: The homemaker is
experiencing heat exhaustion, which can be managed by fluids
and cooling measures. It is important to differentiate where the
patient is on the heat illness continuum. The signs and
symptoms of heat exhaustion may present similarly include
cramping, fatigue, dizziness, nausea, vomiting, headache. If
progression to end-organ damage occurs it then becomes heat
injury. Option B: The elderly client is at risk for heat syncope
and should be advised to rest in a cool area and avoid similar
situations. Heat syncope is the temporary, self-limited
dizziness, weakness, or loss of consciousness during
prolonged standing or positional changes in a hot
environment, including physical activity. The thinking is that it
is due to a combination of dehydration, pooling of blood in the
venous system, decreased cardiac filling, and low blood
pressure, which leads to decreased cerebral blood flow. Option
D: The runner is experiencing heat cramps, which can be
managed with fluid and rest. Heat cramps: include involuntary
spasmodic contractions of large muscle groups as opposed to
an isolated muscle spasm/cramp that can also occur during or
after exertion. This condition is due to a relative deficiency of
sodium, potassium, chloride, or magnesium. Other symptoms
may include nausea, vomiting, fatigue, weakness, sweating,
and tachycardia.
27. An anxious female client complains of chest tightness,
tingling sensations, and palpitations. Deep, rapid breathing,
and carpal spasms are noted. Which of the following priority
action should the nurse do first?
A. Provide oxygen therapy
B. Notify the physician immediately
C. Administer anxiolytic medication as ordered
D. Have the client breathe into a brown paper bag
The client is suffering from hyperventilation secondary to
anxiety, the initial action is to let the client breathe in a paper
bag that will allow the rebreathing of carbon dioxide. The idea
behind breathing into a paper bag or mask is that rebreathing
exhaled air helps the body put CO2 back into the blood.
Option A: Acute anxiety may require treatment with a
benzodiazepine. Chronic anxiety treatment consists of
psychotherapy, pharmacotherapy, or a combination of both.
Anxiety disorders appear to be caused by an interaction of
biopsychosocial factors. Genetic vulnerability interacts with
situations that are stressful or traumatic to produce clinically
significant syndromes. Option B: Anxiety is one of the most
common psychiatric disorders but the true prevalence is not
known as many people do not seek help or clinicians fail to
make the diagnosis. Anxiety is one of the most common
psychiatric disorders in the general population. Specific
phobia is the most common with a 12-month prevalence rate
of 12.1%. Social anxiety disorder is the next most common,
with a 12-month prevalence rate of 7.4%. Option C: Selective
serotonin reuptake inhibitors (SSRIs), serotonin-
norepinephrine reuptake inhibitors (SNRIs), benzodiazepines,
tricyclic antidepressants, mild tranquilizers, and beta-blockers
treat anxiety disorders.
28. An intoxicated client comes into the emergency unit with
uncooperative behavior, mild confusion, and slurred speech.
The client is unable to provide a good history but he verbalizes
that he has been drinking a lot. Which of the following is a
priority action of the nurse?
A. Administer IV fluid incorporated with Vitamin B1 as
ordered
B. Administer Naloxone (Narcan) 4 mg as ordered
C. Contact the family to get information about the client
D. Obtain an order for the determination of blood alcohol level
The client has symptoms of alcohol abuse and there is a risk
for Wernicke syndrome, which is caused by a deficiency in
Vitamin B. Thiamine deficiency (vitamin B1) is common in
patients with alcohol dependence. Cognitive impairments may
be an early consequence of thiamine deficiency. Wernicke’s
encephalopathy is underdiagnosed and undertreated. Option B:
Multiple drug abuse is not uncommon; however, there is
currently nothing to suggest an opiate overdose that requires
the administration of naloxone. Naloxone is indicated for the
treatment of opioid toxicity, specifically to reverse respiratory
depression from opioid use. It is useful in accidental or
intentional overdose and acute or chronic toxicity. Option C:
Teens and young adults are at higher risk for binge drinking,
which can cause alcohol poisoning. Binge drinking is a pattern
of drinking that raises the blood alcohol level within a short
period of time. Though it varies from person to person, binge
drinking is usually defined as four drinks for women and five
drinks for men in a two-hour period. Option D: Additional
information or the results of the blood alcohol testing are part
of the management but should not delay the immediate
treatment. A blood alcohol test may be used to find out if the
patient has alcohol poisoning, a life-threatening condition that
happens when the blood alcohol level gets very high. Alcohol
poisoning can seriously affect basic body functions, including
breathing, heart rate, and temperature.
29. A nurse is providing discharge instructions to a woman
who has been treated for contusions and bruises due to
domestic violence. What is the priority intervention for this
client?
A. Arranging transportation to a safe house
B. Advising the client about contacting the police
C. Making an appointment to follow up on the injuries
D. Making a referral to a counselor
Safety is a priority for this client and she should not return to a
place where violence could recur. Make sure a safe
environment is provided. Offer shelter options, legal services,
counseling, and facilitate such referral. Option B: If the patient
does not want to go to a shelter, provide telephone numbers
for domestic violence or crisis hotlines and support services
for potential later use. Provide the patient with instructions but
be mindful that written materials may pose a danger once the
patient returns home. Option C: Without proper social service
and mental health intervention, all forms of abuse can be
recurrent and escalating problems, and the prognosis for
recovery is poor. Without treatment, domestic and family
violence usually recurs and escalates in both frequency and
severity. Option D: These are important for the long-term
management of this case. Health professionals provide an
opportunity for victims of domestic violence to obtain help. Of
those injured by domestic violence, over 75% continue to
experience abuse. Over half of battered women who attempt
suicide will try again; often they are successful with the
second attempt.

30. In the work setting, what is the primary responsibility of

the nurse in preparation for disaster management, that includes
natural disasters and bioterrorism incidents?
A. Being aware of the signs and symptoms of potential agents
of bioterrorism
B. Making ethical decisions regarding exposing self to
potentially lethal substances
C. Being aware of the agency's emergency response plan
D. Being aware of what and how to report to the Centers for
Disease Control and Prevention

In disaster preparedness, the nurse should know the emergency

response plan. This gives guidance that includes the roles of
the team members, responsibilities, and mechanisms of
reporting. Emergency preparedness encompasses diverse
fields within the hospital and regional settings. Planning
membership groups should address key aspects across these
fields including but not limited to: public safety, facilities,
logistics, pharmacy, transportation, clinical patient care, non-
clinical patient care, media/public relations, communications,
radiation, infection control, and administration. Option A:
Planning/Prevention focuses on providing protection from
disasters on both the domestic and international levels in an
attempt to limit the loss of life and reduce the financial impact
of disaster response. Planning includes care, evacuation, and
environmental planning and response standards. Option B:
Risk Assessment identifies high priority and vulnerability
areas and directs mitigation efforts. The goal of risk
assessment is the identification of the possible disasters that
challenge the area including both internal and external
disasters, collecting resource inventory, identifying a facility
or region’s vulnerabilities based on location and resources, and
generating a priorities list. Option D: The Centers for Disease
Control and Prevention (CDC) provides education and
information regarding specific disaster types, including
infectious diseases, chemical and radiation exposure, and
natural disaster or weather-related incidents.