Chapter 10: Concepts of Emergency and Disaster Preparedness
MULTIPLE CHOICE
1. A hospital responds to a local mass casualty event. Which action should the nurse
supervisor take to prevent staff post-traumatic stress disorder during a mass
casualty event?
a. Provide water and healthy snacks for energy throughout the event.
b. Schedule 16-hour shifts to allow for greater rest between shifts.
c. Encourage counseling upon deactivation of the emergency response plan.
d. Assign staff to different roles and units within the medical facility.
ANS: A
To prevent staff post-traumatic stress disorder during a mass casualty event, the
nurses should use available counseling, encourage and support co-workers, monitor
each others stress level and performance, take breaks when needed, talk about
feelings with staff and managers, and drink plenty of water and eat healthy snacks
for energy. Nurses should also keep in touch with family, friends, and significant
others, and not work for more than 12 hours per day. Encouraging counseling upon
deactivation of the plan, or after the emergency response is over, does not prevent
stress during the casualty event. Assigning staff to unfamiliar roles or units may
increase situational stress and is not an approach to prevent post-traumatic stress
disorder.
2. A client who is hospitalized with burns after losing the family home in a fire
becomes angry and screams at a nurse when dinner is served late. How should the
nurse respond?
a. Do you need something for pain right now?
b. Please stop yelling. I brought dinner as soon as I could.
c. I suggest that you get control of yourself.
d. You seem upset. I have time to talk if youd like.
ANS: D
Clients should be allowed to ventilate their feelings of anger and despair after a
catastrophic event. The nurse establishes rapport through active listening and
honest communication and by recognizing cues that the client wishes to talk. Asking
whether the client is in pain as the first response closes the door to open
communication and limits the clients options. Simply telling the client to stop yelling
and to gain control does nothing to promote therapeutic communication.
,3. A nurse is field-triaging clients after an industrial accident. Which client condition
should the nurse triage with a red tag?
a. Dislocated right hip and an open fracture of the right lower leg
b. Large contusion to the forehead and a bloody nose
c. Closed fracture of the right clavicle and arm numbness
d. Multiple fractured ribs and shortness of breath
ANS: D
Clients who have an immediate threat to life are given the highest priority, are
placed in the emergent or class I category, and are given a red triage tag. The client
with multiple rib fractures and shortness of breath most likely has developed a
pneumothorax, which may be fatal if not treated immediately. The client with the
hip and leg problem and the client with the clavicle fracture would be classified as
class II; these major but stable injuries can wait 30 minutes to 2 hours for definitive
care. The client with facial wounds would be considered the walking wounded and
classified as nonurgent.
4. An emergency department (ED) charge nurse prepares to receive clients from a
mass casualty within the community. What is the role of this nurse during the event?
a. Ask ED staff to discharge clients from the medical-surgical units in order to make
room for critically injured victims.
b. Call additional medical-surgical and critical care nursing staff to come to the
hospital to assist when victims are brought in.
c. Inform the incident commander at the mass casualty scene about how many
victims may be handled by the ED.
d. Direct medical-surgical and critical care nurses to assist with clients currently in
the ED while emergency staff prepare to receive the mass casualty victims.
ANS: D
The ED charge nurse should direct additional nursing staff to help care for current
ED clients while the ED staff prepares to receive mass casualty victims; however,
they should not be assigned to the most critically ill or injured clients. The house
supervisor and unit directors would collaborate to discharge stable clients. The
hospital incident commander is responsible for mobilizing resources and would
have the responsibility for calling in staff. The medical command physician would be
the person best able to communicate with on-scene personnel regarding the ability
to take more clients.
5. The hospital administration arranges for critical incident stress debriefing for the
staff after a mass casualty incident. Which statement by the debriefing team leader
is most appropriate for this situation?
,a. You are free to express your feelings; whatever is said here stays here.
b. Lets evaluate what went wrong and develop policies for future incidents.
c. This session is only for nursing and medical staff, not for ancillary personnel.
d. Lets pass around the written policy compliance form for everyone.
ANS: A
Strict confidentiality during stress debriefing is essential so that staff members can
feel comfortable sharing their feelings, which should be accepted unconditionally.
Brainstorming improvements and discussing policies would occur during an
administrative review. Any employee present during a mass casualty situation is
eligible for critical incident stress management services.
6. A nurse is caring for a client whose wife died in a recent mass casualty accident.
The client says, I cant believe that my wife is gone and I am left to raise my children
all by myself. How should the nurse respond?
a. Please accept my sympathies for your loss.
b. I can call the hospital chaplain if you wish.
c. You sound anxious about being a single parent.
d. At least your children still have you in their lives.
ANS: C
Therapeutic communication includes active listening and honesty. This statement
demonstrates that the nurse recognizes the clients distress and has provided an
opening for discussion. Extending sympathy and offering to call the chaplain do not
give the client the opportunity to discuss feelings. Stating that the children still have
one parent discounts the clients feelings and situation.
7. A nurse cares for clients during a community-wide disaster drill. Once of the
clients asks, Why are the individuals with black tags not receiving any care? How
should the nurse respond?
a. To do the greatest good for the greatest number of people, it is necessary to
sacrifice some.
b. Not everyone will survive a disaster, so it is best to identify those people early and
move on.
c. In a disaster, extensive resources are not used for one person at the expense of
many others.
d. With black tags, volunteers can identify those who are dying and can give them
comfort care.
ANS: C
, In a disaster, military-style triage is used; this approach identifies the dead or
expectant dead with black tags. This practice helps to maintain the goal of triage,
which is doing the most good for the most people. Precious resources are not used
for those with overwhelming critical injury or illness, so that they can be allocated
to others who have a reasonable expectation of survival. Clients are not sacrificed.
Telling students to move on after identifying the expectant dead belittles their
feelings and does not provide an adequate explanation. Clients are not black-tagged
to allow volunteers to give comfort care.
8. A nurse wants to become involved in community disaster preparedness and is
interested in helping set up and staff first aid stations or community acute care
centers in the event of a disaster. Which organization is the best fit for this nurses
interests?
a. The Medical Reserve Corps
b. The National Guard
c. The health department
d. A Disaster Medical Assistance Team
ANS: A
The Medical Reserve Corps (MRC) consists of volunteer medical and public health
care professionals who support the community during times of need. They may help
staff hospitals, establish first aid stations or special needs shelters, or set up acute
care centers in the community. The National Guard often performs search and
rescue operations and law enforcement. The health department focuses on
communicable disease tracking, treatment, and prevention. A Disaster Medical
Assistance Team is deployed to a disaster area for up to 72 hours, providing many
types of relief services.
9. A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but
is concerned about maintaining licensure in several different states. Which
statement best addresses these concerns?
a. Deployed DMAT providers are federal employees, so their licenses are good in all
50 states.
b. The government has a program for quick licensure activation wherever you are
deployed.
c. During a time of crisis, licensure issues would not be the governments priority
concern.
d. If you are deployed, you will be issued a temporary license in the state in which
you are working.
ANS: A
MULTIPLE CHOICE
1. A hospital responds to a local mass casualty event. Which action should the nurse
supervisor take to prevent staff post-traumatic stress disorder during a mass
casualty event?
a. Provide water and healthy snacks for energy throughout the event.
b. Schedule 16-hour shifts to allow for greater rest between shifts.
c. Encourage counseling upon deactivation of the emergency response plan.
d. Assign staff to different roles and units within the medical facility.
ANS: A
To prevent staff post-traumatic stress disorder during a mass casualty event, the
nurses should use available counseling, encourage and support co-workers, monitor
each others stress level and performance, take breaks when needed, talk about
feelings with staff and managers, and drink plenty of water and eat healthy snacks
for energy. Nurses should also keep in touch with family, friends, and significant
others, and not work for more than 12 hours per day. Encouraging counseling upon
deactivation of the plan, or after the emergency response is over, does not prevent
stress during the casualty event. Assigning staff to unfamiliar roles or units may
increase situational stress and is not an approach to prevent post-traumatic stress
disorder.
2. A client who is hospitalized with burns after losing the family home in a fire
becomes angry and screams at a nurse when dinner is served late. How should the
nurse respond?
a. Do you need something for pain right now?
b. Please stop yelling. I brought dinner as soon as I could.
c. I suggest that you get control of yourself.
d. You seem upset. I have time to talk if youd like.
ANS: D
Clients should be allowed to ventilate their feelings of anger and despair after a
catastrophic event. The nurse establishes rapport through active listening and
honest communication and by recognizing cues that the client wishes to talk. Asking
whether the client is in pain as the first response closes the door to open
communication and limits the clients options. Simply telling the client to stop yelling
and to gain control does nothing to promote therapeutic communication.
,3. A nurse is field-triaging clients after an industrial accident. Which client condition
should the nurse triage with a red tag?
a. Dislocated right hip and an open fracture of the right lower leg
b. Large contusion to the forehead and a bloody nose
c. Closed fracture of the right clavicle and arm numbness
d. Multiple fractured ribs and shortness of breath
ANS: D
Clients who have an immediate threat to life are given the highest priority, are
placed in the emergent or class I category, and are given a red triage tag. The client
with multiple rib fractures and shortness of breath most likely has developed a
pneumothorax, which may be fatal if not treated immediately. The client with the
hip and leg problem and the client with the clavicle fracture would be classified as
class II; these major but stable injuries can wait 30 minutes to 2 hours for definitive
care. The client with facial wounds would be considered the walking wounded and
classified as nonurgent.
4. An emergency department (ED) charge nurse prepares to receive clients from a
mass casualty within the community. What is the role of this nurse during the event?
a. Ask ED staff to discharge clients from the medical-surgical units in order to make
room for critically injured victims.
b. Call additional medical-surgical and critical care nursing staff to come to the
hospital to assist when victims are brought in.
c. Inform the incident commander at the mass casualty scene about how many
victims may be handled by the ED.
d. Direct medical-surgical and critical care nurses to assist with clients currently in
the ED while emergency staff prepare to receive the mass casualty victims.
ANS: D
The ED charge nurse should direct additional nursing staff to help care for current
ED clients while the ED staff prepares to receive mass casualty victims; however,
they should not be assigned to the most critically ill or injured clients. The house
supervisor and unit directors would collaborate to discharge stable clients. The
hospital incident commander is responsible for mobilizing resources and would
have the responsibility for calling in staff. The medical command physician would be
the person best able to communicate with on-scene personnel regarding the ability
to take more clients.
5. The hospital administration arranges for critical incident stress debriefing for the
staff after a mass casualty incident. Which statement by the debriefing team leader
is most appropriate for this situation?
,a. You are free to express your feelings; whatever is said here stays here.
b. Lets evaluate what went wrong and develop policies for future incidents.
c. This session is only for nursing and medical staff, not for ancillary personnel.
d. Lets pass around the written policy compliance form for everyone.
ANS: A
Strict confidentiality during stress debriefing is essential so that staff members can
feel comfortable sharing their feelings, which should be accepted unconditionally.
Brainstorming improvements and discussing policies would occur during an
administrative review. Any employee present during a mass casualty situation is
eligible for critical incident stress management services.
6. A nurse is caring for a client whose wife died in a recent mass casualty accident.
The client says, I cant believe that my wife is gone and I am left to raise my children
all by myself. How should the nurse respond?
a. Please accept my sympathies for your loss.
b. I can call the hospital chaplain if you wish.
c. You sound anxious about being a single parent.
d. At least your children still have you in their lives.
ANS: C
Therapeutic communication includes active listening and honesty. This statement
demonstrates that the nurse recognizes the clients distress and has provided an
opening for discussion. Extending sympathy and offering to call the chaplain do not
give the client the opportunity to discuss feelings. Stating that the children still have
one parent discounts the clients feelings and situation.
7. A nurse cares for clients during a community-wide disaster drill. Once of the
clients asks, Why are the individuals with black tags not receiving any care? How
should the nurse respond?
a. To do the greatest good for the greatest number of people, it is necessary to
sacrifice some.
b. Not everyone will survive a disaster, so it is best to identify those people early and
move on.
c. In a disaster, extensive resources are not used for one person at the expense of
many others.
d. With black tags, volunteers can identify those who are dying and can give them
comfort care.
ANS: C
, In a disaster, military-style triage is used; this approach identifies the dead or
expectant dead with black tags. This practice helps to maintain the goal of triage,
which is doing the most good for the most people. Precious resources are not used
for those with overwhelming critical injury or illness, so that they can be allocated
to others who have a reasonable expectation of survival. Clients are not sacrificed.
Telling students to move on after identifying the expectant dead belittles their
feelings and does not provide an adequate explanation. Clients are not black-tagged
to allow volunteers to give comfort care.
8. A nurse wants to become involved in community disaster preparedness and is
interested in helping set up and staff first aid stations or community acute care
centers in the event of a disaster. Which organization is the best fit for this nurses
interests?
a. The Medical Reserve Corps
b. The National Guard
c. The health department
d. A Disaster Medical Assistance Team
ANS: A
The Medical Reserve Corps (MRC) consists of volunteer medical and public health
care professionals who support the community during times of need. They may help
staff hospitals, establish first aid stations or special needs shelters, or set up acute
care centers in the community. The National Guard often performs search and
rescue operations and law enforcement. The health department focuses on
communicable disease tracking, treatment, and prevention. A Disaster Medical
Assistance Team is deployed to a disaster area for up to 72 hours, providing many
types of relief services.
9. A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but
is concerned about maintaining licensure in several different states. Which
statement best addresses these concerns?
a. Deployed DMAT providers are federal employees, so their licenses are good in all
50 states.
b. The government has a program for quick licensure activation wherever you are
deployed.
c. During a time of crisis, licensure issues would not be the governments priority
concern.
d. If you are deployed, you will be issued a temporary license in the state in which
you are working.
ANS: A
