Chapter 44: Care of Patients in Disasters or Bioterrorism Attack My Nursing Test Banks

Chapter 44: Care of Patients in Disasters or Bioterrorism Attack

MULTIPLE CHOICE

1. The nurse informs a high school class that one of the differences between an emergency situation and a disaster is that, in an emergency situation:

a.

fewer than 50 people require emergent treatment.

b.

the community emergency rooms can meet the need.

c.

there is no need for a prearranged management plan.

d.

the community population is not affected by the event.

ANS: B

An emergency situation, such as a plane crash at a local airport, can be handled by community emergency departments. Each community has in place an emergency plan as to dispersal of people needing to be treated, law enforcement participation, and transportation. Communities are always affected when a large scale emergency situation occurs.

DIF: Cognitive Level: Comprehension REF: 997 OBJ: 1 (theory)

TOP: Disaster vs. Emergency Situation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

2. The nurse stresses that emergency preparedness plans are required for accredited hospitals by the:

a.

American Red Cross (ARC).

b.

Joint Commission (JC).

c.

Federal Emergency Management Agency (FEMA).

d.

Office of Civil Defense (OCD).

ANS: B

The Joint Commission requires that all accredited facilities have a written emergency preparedness plan with designated roles and responsibilities. The American Red Cross is a voluntary organization that traditionally provides the basic essentials of shelter, food, and first aid during a natural disaster. Federal Emergency Management Agency (FEMA) is an organization under the federal government. It is activated by the Department of Homeland Security. It acts when states require assistance in times of disaster. The Office of Civil Defense (OCD) is no longer in existence. It was a federal agency that acted in cases of large scale disasters. It was replaced by FEMA.

DIF: Cognitive Level: Comprehension REF: 1000 OBJ: 2 (theory)

TOP: Institutional Disaster Plans KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

3. The nurse assures a patient that accredited health care facilities test their emergency plan with a drill at least _____ time(s) each year.

a.

4

b.

3

c.

2

d.

1

ANS: C

Disaster drills should be conducted 2 times a year.

DIF: Cognitive Level: Comprehension REF: 1000 OBJ: 2 (theory)

TOP: Disaster Drills: Frequency KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

4. A truck has just smashed into the dayroom of a long-term health care facility with enormous damage and injuring many of the residents. The noninjured residents are stunned and frightened and totally disorganized. Recognizing that everyone is in the impact stage, the nurse should:

a.

firmly instruct two CNAs to start wheeling residents to the dining room in their wheelchairs.

b.

begin wheeling residents back to their rooms herself.

c.

shout for everyone to hurry to the dining room.

d.

start treating the injured in the dayroom.

ANS: A

In the impact stage, firm direction is needed to get people to a central place for safety and information.

DIF: Cognitive Level: Analysis REF: 1001 OBJ: 3 (theory)

TOP: Psychological Response: Stage I KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

5. The nursing staff of a medical clinic and 15 of their patients have moved to the third floor of an office building to escape flood waters. Public water supply has been contaminated. This floor has eight commode stalls in two different bathrooms. To provide drinking water, the nurse should:

a.

designate which commodes can be used for body waste.

b.

protect water in commode tanks to use for drinking.

c.

run cold water in sinks to have reservoirs of water.

d.

assign people to use specific bathrooms.

ANS: B

The water in the tanks of the commodes has not been contaminated and the water in the hot water tanks has not been contaminated. Using any of the water for waste disposal is inappropriate. Using cold water pulls from the contaminated water supply.

DIF: Cognitive Level: Analysis REF: 1002 OBJ: 5 (theory)

TOP: Flood: Water Provision and Protection

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

6. The nurse is aware that during a power failure, perishable food should be kept at _____ F to prevent possibility of food poisoning.

a.

40

b.

45

c.

50

d.

55

ANS: A

To prevent spoilage, perishable foods should be kept at 40 F.

DIF: Cognitive Level: Comprehension REF: 1006 OBJ: 3 (clinical)

TOP: Food Supply: Temperature KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

7. The nurse takes into consideration that a freezer that was full at the time of the power failure will keep food safe to eat for approximately _____ hours.

a.

8

b.

12

c.

24

d.

48

ANS: D

Food frozen in a full freezer will keep the food safe for 48 hours. A partially filled freezer will keep food safe for 24 hours.

DIF: Cognitive Level: Application REF: 1006 OBJ: 3 (clinical)

TOP: Food Supply: Preservation KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

8. To help restore order in a group of 18 people who are trapped in a third-floor office building by rising flood water, the nurse should:

a.

give everyone a specific duty, for example, arranging furniture for sleeping.

b.

let the people direct themselves to helpful tasks.

c.

make a list of essential jobs and ask the others to volunteer.

d.

put all the food in a central place and direct people to take what they need.

ANS: A

During the impact stage, firm direction is needed, and executing essential helpful jobs will help restore order. Asking for volunteers when there is a loss of order and control would be counterproductive and would lack the direction needed by those affected. Food will need to be rationed in the event there is no rescue for an extended period of time. The rationing should be performed with direction and not allow the people to take whatever they wish.

DIF: Cognitive Level: Analysis REF: 1001 OBJ: 3 (clinical)

TOP: Disaster: Establishing Order KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

9. The news reported that a train derailment 5 miles away from the clinic spilled a large amount of liquid chlorine that has been vaporized by the atmosphere. An indication that the chlorine gas is an imminent threat to the clinic would be:

a.

sighting of a low-lying green cloud.

b.

smelling almonds or burning feathers.

c.

sudden nausea.

d.

skin blistering.

ANS: A

Chlorine gas can be seen as a low-lying green cloud. The smell of almonds is associated with cyanide. Skin blistering is the result of contact with liquid chlorine.

DIF: Cognitive Level: Application REF: 1006 OBJ: 6 (theory)

TOP: Chlorine Gas: Assessing Threat KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

10. A tornado has touched down 1 mile from the hospital and a tornado warning has been issued with sirens. The nursing staff caring for the 36 patients on the second floor medical-surgical unit should move the patients to:

a.

the evacuation center across the street.

b.

the hall, closing room doors and windows.

c.

their rooms, padding the windows with bed linens.

d.

the basement in wheelchairs using the elevators.

ANS: B

Movement to the hall is the safest and fastest and does not expose the patients to being out of doors, in elevators, or near exterior windows.

DIF: Cognitive Level: Application REF: 999-1000 OBJ: 6 (theory)

TOP: Tornado: Patient Evacuation KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

11. The nurse explains that health workers who are caring for people exposed to radiation after the explosion of a nuclear bomb are monitored daily for exposure by way of:

a.

urinalysis.

b.

radiation badges.

c.

Geiger counters.

d.

sputum analysis.

ANS: B

Radiation detection badges are worn under protective clothing and are analyzed for number of rads absorbed.

DIF: Cognitive Level: Comprehension REF: 1009 OBJ: 7 (theory)

TOP: Monitoring for Radiation Exposure: Badges

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse takes into consideration that if terrorists were to use category B agents that produce low death rates and moderate illness, the organisms would most probably be delivered by which route?

a.

Vaporization

b.

Through water sources

c.

By an explosion

d.

From person-to-person contact

ANS: B

Category B agents are usually delivered via a water source.

DIF: Cognitive Level: Comprehension REF: 1011 OBJ: 8 (theory)

TOP: Category B Agents: Delivery Mode

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

13. The nurse clarifies that when a person has been exposed to particulate radioactive material, a chelating agent such as calcium edentate (EDTA) is given to:

a.

bind with radioactive material and allow it to be excreted.

b.

reduce radioactivity to nonharmful levels.

c.

form a protective coat in the gastrointestinal system.

d.

dissolve particulate material.

ANS: A

Chelating agents bind with radioactive material, allowing it to be excreted without absorption.

DIF: Cognitive Level: Comprehension REF: 1010 OBJ: 7 (theory)

TOP: Radiation Exposure: Chelating Agents

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. The nurse takes into consideration that the period of time during which there is the greatest chance that aerosolized anthrax could be inhaled after a terrorist attack would be _____ the attack.

a.

the day of

b.

the day after

c.

2 days after

d.

7 days after

ANS: B

Anthrax in an aerosolized form is most potent 1 day after the explosion as the organism dies very quickly and anthrax is not communicable from person to person.

DIF: Cognitive Level: Comprehension REF: 1011 OBJ: 8 (theory)

TOP: Aerosolized Anthrax: Life Span of Organism

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

15. People who have plague and have been treated with appropriate antibiotics can be released from respiratory droplet precautions after:

a.

all symptoms are gone.

b.

there is no longer any blood in the sputum.

c.

the lesions are dried.

d.

48 hours of antibiotic treatment.

ANS: D

The patient with plague can be released from respiratory precautions 48 hours after initiation of antibiotic therapy.

DIF: Cognitive Level: Comprehension REF: 1012 OBJ: 8 (theory)

TOP: Plague: Respiratory Precautions KEY: Nursing Process Step: NA

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

16. The nurse is aware that the plague, caused by Yersinia pestis, will most probably be introduced as an aerosolized weapon in a terrorist attack. Although exposed individuals can die in 24 hours, the organism is very vulnerable and can be destroyed by:

a.

cold temperatures of 40 F.

b.

exposure to sunlight.

c.

strong chlorine solution.

d.

dry environment.

ANS: B

Plague organisms can be destroyed by exposure to sunlight.

DIF: Cognitive Level: Comprehension REF: 1012 OBJ: 8 (theory)

TOP: Plague: Fragility of Organism KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

17. Following a terrorist attack using smallpox virus, the nurse assesses a newly admitted patient with large vesicles all over her body that could be either smallpox or chickenpox. The nurse feels confident that the lesions are those of smallpox because of the lesions assessed on the:

a.

face.

b.

mucous membranes.

c.

soles of the feet.

d.

axilla.

ANS: C

The lesions of smallpox can be found on the palms of the hands and soles of the feet. The lesions of chickenpox do not appear there.

DIF: Cognitive Level: Comprehension REF: 1012 OBJ: 8 (theory)

TOP: Smallpox vs. Chickenpox KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

18. The nurse is aware that the purpose of debriefing as outlined in the disaster plan for the health professionals who were involved in caring for the victims of a disaster a month ago is to:

a.

analyze the effectiveness of the disaster plan.

b.

assess the efficiency of the service provided by various agencies.

c.

modify the disaster plan.

d.

help allay post-traumatic stress disorders.

ANS: D

The debriefing is for the purpose of allowing the health professionals to ventilate about their experiences in an effort to allay long-term psychological problems.

DIF: Cognitive Level: Comprehension REF: 1016 OBJ: 10 (theory)

TOP: Debriefing: Purpose KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

19. A patient comes to the emergency department with reports of exposure to a toxic chemical spill. The assessment reveals that the patient has inhaled the chemical and had the chemical on his clothing. What actions by the nurse are appropriate?

a.

The nurse advises the patient to leave in contact lenses to continue to provide protection to the eyes.

b.

The nurse will proceed to irrigate the patients eyes for 5 to 7 minutes with water.

c.

The nurse will use tongs to handle items taken off by the patient.

d.

The nurse will place the clothing in a metal receptacle for disposal.

ANS: C

The clothing and contact lenses will be considered contaminated. They will need to be removed. Tongs will be included in the types of protective equipment needed to manage the patient. Eye irrigation will need to be performed for a period of 10 to 15 minutes. The clothing will need to be placed in a plastic bag for disposal.

DIF: Cognitive Level: Analysis REF: 1009 OBJ: 5 (theory)

TOP: Chemical Disaster: KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

20. The nurse is teaching a course in the community concerning the actions that need to be taken in the event a pandemic occurs. A participant questions the nurse about how long she should be prepared to stay at home. What response by the nurse is most correct?

a.

The greatest danger during the pandemic will be in the first 48 to 72 hours.

b.

You should be prepared to remain at home for about 2 weeks.

c.

Residents should be prepared to stay home for 4 to 6 days.

d.

Staying home for a full 10 days will be needed.

ANS: B

Preparations for pandemics include teaching people to be prepared to stay at home for at least 2 weeks.

DIF: Cognitive Level: Comprehension REF: 1015 OBJ: 3 (clinical)

TOP: Pandemic Infections KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

21. The nurse explains that the essential elements in a disaster plan are the preparation and organization to provide: (Select all that apply.)

a.

shelter for victims.

b.

transportation.

c.

communication.

d.

welfare of victims.

e.

food.

ANS: A, B, C, D, E

All options are essential elements in a disaster plan.

DIF: Cognitive Level: Comprehension REF: 997 OBJ: 2 (theory)

TOP: Disaster Plan: Essentials KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

22. The nurse is preparing a list of items that are needed in a disaster kit. The list will correctly include which items? (Select all that apply.)

a.

Water for 12 days

b.

Nonperishable food items

c.

Prescription medication

d.

Portable radio

e.

Bedding

f.

First aid kit

ANS: B, C, D, E, F

It is suggested that water for 3 days be included in a disaster kit. All other options should be included in a disaster kit.

DIF: Cognitive Level: Comprehension REF: 998 OBJ: 3 (clinical)

TOP: Disaster Kits: Minimal Provisions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

23. The nurse encourages civic-minded people to enroll in local civil defense courses on disaster preparedness to better understand the role of the: (Select all that apply.)

a.

state government.

b.

federal government.

c.

law enforcement.

d.

individual service agencies.

e.

nurse as a volunteer.

ANS: A, B, C, D, E

All options are part of the course presentation.

DIF: Cognitive Level: Comprehension REF: 997 OBJ: 2 (theory)

TOP: Disaster Preparation: Courses KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

24. The nurse demonstrates how water can be rendered safe for drinking in the event of a disruption of service by: (Select all that apply.)

a.

letting the water sit for 24 hours and dipping from the top.

b.

boiling the water for 3 to 5 minutes.

c.

adding 1 mL (16 drops) of household bleach to a gallon of water and letting it stand for 30 minutes.

d.

draining water from hot water heater and using without treatment.

e.

pouring water through several layers of cotton towels.

ANS: B, C, D

Water can be rendered safe for drinking by boiling or treating with household bleach or using water in hot water heater or commode tank.

DIF: Cognitive Level: Analysis REF: 1003 OBJ: 2 (clinical)

TOP: Preparing Safe Drinking Water: Techniques

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

25. The nurse is aware that organisms that may be released in a bioterrorism attack because of their high lethality include: (Select all that apply.)

a.

Ebola.

b.

avian flu.

c.

botulism.

d.

smallpox.

e.

tularemia.

ANS: A, C, D, E

Avian flu (bird flu) is not on the category A list.

DIF: Cognitive Level: Comprehension REF: 1006 OBJ: 8 (theory)

TOP: Bioterrorism: Organisms with High Lethality

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

26. The nurse is participating in an educational program concerning nuclear disasters. The nurse correctly recognizes that the level of exposure will be determined by which factors? (Select all that apply.)

a.

Age of the victim

b.

Body surface area of the victim

c.

Length of exposure

d.

Distance of the victim from the nuclear source

e.

Shielding of the victim from the nuclear source

ANS: C, D, E

The amount of damage to each person depends on the type of radiation, the dose received, the length of time of exposure, and the route of the exposure. Time, distance, and shielding are key to the quantity of radiation an individual will receive. The shorter the time of exposure, the farther away from the radiation source, and whether or not the person was shielded by materials that are impermeable to radiation are details pertinent to radiation risk.

DIF: Cognitive Level: Comprehension REF: 1009 OBJ: 7 (theory)

TOP: Nuclear Disaster KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

MATCHING

Assign triage categories to the disaster victims that they best fit.

a.

Red tag: emergent

b.

Yellow tag: urgent

c.

Green tag: nonurgent

d.

Black tag: terminal

27. Compound fracture of both femurs, concussion

28. Crushed chest, paraplegia

29. Closed fracture of arm, head laceration

30. Toddler with partial-thickness burns on both legs

31. Woman in labor, pains 10 minutes apart

32. Sucking chest wound, fully conscious

33. Amputated arm, conscious, but in shock

27. ANS: A DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

28. ANS: D DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

29. ANS: C DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

30. ANS: B DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

31. ANS: C DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

32. ANS: B DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

33. ANS: A DIF: Cognitive Level: Assessment REF: 1001

OBJ: 3 (theory) TOP: Triage: Process

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

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