Chapter 15- Disaster Management- Implications for the Critical Care Nurse My Nursing Test Banks

 

1.

A nurse from the ICU is participating in the hospitals disaster response preparedness team. One issue that proves difficult for the team to agree on is a statement regarding the standard of medical care observed during a disaster. Which of the following do you think the nurse should recommend to the team?

A)

The goal should be to provide the highest care possible, with limited resources and equipment.

B)

The lack of resources should not diminish the standard of care that the hospital provides.

C)

The medical staff should tend to the needs of the most critically ill first.

D)

If electrical power should be lost to the facility, patients on life support should be given lowest priority.

2.

A nurse learns that local law enforcement officials have informed the hospital that an imminent terrorist attack has been threatened in a building just down the street from the hospital. Which of the following are appropriate responses? Select all that apply.

A)

Explain to the patients in the ICU that a terrorist attack is expected and that their care may be interrupted.

B)

Begin making preparations to move all ICU patients to other hospital facilities in the area in the event of an attack.

C)

Review the hospitals disaster plan and make sure that it is distributed to the rest of the medical staff.

D)

Determine what her specific role in the disaster plan is.

E)

Not be concerned because federal deployable medical teams will likely be sent to the hospital in the event of an attack.

F)

Check the number of ventilators available in the ICU to determine whether more would be needed in the event of an attack.

3.

The nurse is at the bedside of her 90-year-old patient, Ruth, who is comatose and on life support in the ICU, when she begins to feel the room shaking violently. The power suddenly fails and emergency generators have not started yet. The nurse provides bag-mask resuscitation for Ruth while she waits for the power to be restored. Moments later, the ICU is inundated with patients injured by the collapse of a nearby apartment building as a result of the earthquake. The nurse is called to help. Kevin has been impaled by a metal rod through the chest, is in a state of shock, and will die without immediate intervention. Gwyneth has compound fractures of the femur and a dislocated shoulder, is in pain, but is responsive. Mason is unconscious and unresponsive. Based on the START triage categories, whom should the nurse assist first in this situation?

A)

Ruth

B)

Kevin

C)

Gwyneth

D)

Mason

4.

A patient arrives at the ICU after being injured by car bomb that exploded 20 feet away. The patient sustained only primary blast injuries. Which of the following are injuries he might have sustained? Select all that apply.

A)

Perforated eardrum caused by a sudden change in atmospheric pressure

B)

Laceration from a shard of glass that struck the patient

C)

Concussion as a result of his body being thrown against a brick wall

D)

Hemorrhagic contusion of the lungs

E)

Gastrointestinal hemorrhage

F)

Blunt force trauma from a piece of metal shrapnel that struck the patients head

5.

A group of patients, colleagues from the same office, arrive at the ICU with symptoms of nausea, vomiting, and diarrhea. It is determined that they are suffering from radiation exposure as a result of an inconspicuous device placed in the office that leaked radiation over a period of days. The nurse suspects that which of the following was used in this terrorist attack?

A)

Radiological dispersal device

B)

Improvised nuclear device

C)

Nuclear weapon

D)

Simple radiological device

6.

A patient arrives at the ICU with symptoms of radiation exposure. While in the ICU, he begins gasping for air and clutching his throat with his hand. What intervention should take priority at this point?

A)

Perform CPR on the patient to restore normal respiratory function.

B)

Evaluate the degree of radiation exposure in the patient using a Geiger counter.

C)

Undress the patient and have him shower and wash with soap to decontaminate himself.

D)

Administer potassium iodide.

7.

A woman arrives at the ICU after being the victim of a terrorist attack in a nearby shopping center involving a gas that spewed from a metal canister. The woman complains of a burning sensation in her eyes, mouth, and throat, and the nurse observes blistering on her face and arms. What chemical agent should the nurse suspect, and what intervention should she implement?

A)

Vesicant agent; apply lotion

B)

Nerve agent; administer benzodiazepine

C)

Vesicant agent; soap and water blot

D)

Nerve agent; provide ventilatory support

8.

A worker at a local chemical plant arrives at the ICU following an industrial accident involving a gas leak. The patient shows signs of pulmonary edema and bronchospasm. What chemical should the nurse suspect is involved, and what intervention would be most appropriate?

A)

Nitrogen mustard; soap and water blot

B)

Chlorine; airway management and ventilatory support

C)

Tear gas; irrigation of eyes with water

D)

Cyanide; sodium nitrate

9.

A man presents to the ICU with a severe case of H1N1 viral infection. What would be the most appropriate intervention for this patient?

A)

Administer an H1N1 vaccine.

B)

Administer an antibiotic.

C)

Administer an antiviral agent.

D)

Administer potassium iodide.

10.

A young man arrives at the ICU after being held hostage while a passenger on a commercial airplane. He sustained a bullet wound in his chest and has undergone surgery to repair his lung. He is now receiving an analgesic for his pain. The nurse observes that the patient frequently complains that he is sick to his stomach and has no appetite. His sleep is regularly interrupted by nightmares, and he is prone to outbursts of anger and grief. What is the most likely cause of these symptoms?

A)

Adverse reaction to pain medication

B)

Reaction to severe pain

C)

Post-traumatic stress disorder

D)

Delirium resulting from an infection

11.

The nurse is caring for a group of patients from the same workplace who have similar symptoms of cough, respiratory distress, and nausea and vomiting. What should the nurse suspect?

A)

Food poisoning at local restaurant

B)

Mass exposure to an inhaled agent

C)

Allergic response to a new cleaning agent

D)

Acute asthma exacerbation syndrome

12.

The nurse is part of a planning committee developing a disaster response plan for a hospital that serves as the major trauma center for the local area. The committee has identified that the most likely cause of a disaster in the community is a devastating tornado that significantly damages most major structures, including hospitals of all sizes, in the community. What component of the plan is least likely to be realistic?

A)

Transfer all noncritical patients to smaller hospitals in the community.

B)

Provide for secure storage of emergency supplies and equipment.

C)

Agree with other hospitals in town to share supplies and equipment.

D)

Interface with the city disaster management plan and command center.

13.

The nurse is preparing to assist with triage of victims from a large mass casualty incident. The patients are sorted into categories at the door of the facility. What category will receive care last?

A)

Minimal

B)

Delayed

C)

Immediate

D)

Expectant

14.

The nurse is assisting with triage in the emergency department. A large group of patients from a mass casualty incident arrive. These patients have been classified at the scene as minimal, delayed, immediate, and expectant. What is the best nursing approach?

A)

Use the classifications from the scene to determine the order of treatment.

B)

Reassess and reclassify patients quickly to determine the order of treatment.

C)

Treat the patients in the order they arrive at the emergency department.

D)

After the first 20 patients, refer all others to another emergency care facility.

15.

The nurse is caring for a patient who was exposed to a high dose of external radiation. What is the least likely nursing action?

A)

Assess for and facilitate treatment of life-threatening injuries.

B)

Assess radiological measurements with a Geiger counter.

C)

Remove clothing and shower patient as soon as possible.

D)

Assist in removing penetrating radioactive materials.

16.

The nurse is caring for a patient who has been exposed to radiation. The patient has been increasingly unstable, with decreasing lymphocytes, leukocytes, thrombocytes, and erythrocytes, along with shock, diarrhea, and altered level of consciousness for some weeks. Today, there is clear evidence of worsening shock, subnormal body temperature, and increased intracranial pressure. The family asks what the patients prognosis is. The best nursing response is based on what rationale?

A)

Increased intracranial pressure following other symptoms is a sign of impending death.

B)

The symptoms listed are typical of the latent phase of recovery, which lasts several weeks.

C)

Full recovery from radiation exposure can take many weeks to months.

D)

The absence of fever indicates the patient has entered the latent phase of recovery.

17.

The nurse is caring for a patient with a suspected cyanide exposure. The patient is anxious and hyperventilating. What is the nursing priority of care?

A)

Give antiseizure medications.

B)

Send toxicology screen.

C)

Give cyanide antidote.

D)

Obtain history of exposure.

18.

The nurse is assisting with the initial care and assessment of a group of patients with a massive topical toxic chemical exposure. What is the best way to decontaminate these patients?

A)

Use an antidote to the chemical of exposure.

B)

Use an alkaline substance for an acid contaminant.

C)

Soap-and-water shower first for most chemicals

D)

Administer 100% oxygen under positive pressure.

19.

A worker in a tanning factory comes to the emergency department with itchy, papular lesions on his hands and arms. Some of the lesions have black eschar in the center and some are vesicular. What biological exposure is most likely?

A)

Cutaneous anthrax

B)

Pulmonary anthrax

C)

Cutaneous smallpox

D)

Pneumonic plague

20.

A patient and his family have been exposed to probable anthrax spores through contaminated postal contents within the past 8 hours. Upon arrival at the emergency department, all members of the family are anxious and say they are afraid of dying. The best nursing response is based on what rationale?

A)

There is no treatment for anthrax exposure and their fears are realistic.

B)

A vaccine given in the first 3 days after exposure will stop the disease.

C)

Antibiotic therapy is very effective for cutaneous anthrax.

D)

A toxicology screen is necessary to determine whether there really was an exposure.

Answer Key

1.

A

2.

C, D, F

3.

B

4.

A, D, E

5.

D

6.

A

7.

C

8.

B

9.

C

10.

C

11.

B

12.

A

13.

D

14.

B

15.

D

16.

A

17.

C

18.

C

19.

A

20.

C

Page 1

Leave a Reply