Emergency Disaster Preparedness NCLEX

Emergency & Disaster Preparedness NCLEX

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?

• Do you need something for pain right now?
• Please stop yelling. I brought dinner as soon as I could.
• I suggest that you get control of yourself.
• You seem upset. I have time to talk if you'd like. - 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.

A nurse is field-triaging clients after an industrial accident. Which client condition should the nurse triage with a red tag?

• Dislocated right hip and an open fracture of the right lower leg
• Large contusion to the forehead and a bloody nose
• Closed fracture of the right clavicle and arm numbness
• Multiple fractured ribs and shortness of breath - 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.

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?

• You are free to express your feelings; whatever is said here stays here.
• Lets evaluate what went wrong and develop policies for future incidents.
• This session is only for nursing and medical staff, not for ancillary personnel.
• Lets pass around the written policy compliance form for everyone. - 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.

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?

• Please accept my sympathies for your loss.
• I can call the hospital chaplain if you wish.
• You sound anxious about being a single parent.
• At least your children still have you in their lives. - 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.

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?

• To do the greatest good for the greatest number of people, it is necessary to sacrifice some.
• Not everyone will survive a disaster, so it is best to identify those people early and move on.
• In a disaster, extensive resources are not used for one person at the expense of many others.
• With black tags, volunteers can identify those who are dying and can give them comfort care. -

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.

Emergency medical services (EMS) brings a large number of clients to the emergency department following a mass casualty incident. The nurse identifies the clients with which injuries with yellow tags? (SATA)

• Partial-thickness burns covering both legs
• Open fractures of both legs with absent pedal pulses
• Neck injury and numbness of both legs
• Small pieces of shrapnel embedded in both eyes
• Head injury and difficult to arouse
• Bruising and pain in the right lower abdomen - A, C, D, F ~ Clients with burns, spine injuries,

eye injuries, and stable abdominal injuries should be treated within 30 minutes to 2 hours, and therefore should be identified with yellow tags. The client with the open fractures and the client with the head injury would be classified as urgent with red tags.

A nurse triages clients arriving at the hospital after a mass casualty. Which clients are correctly classified? (SATA)

a. A 35-year-old female with severe chest pain: red tag

b. A 42-year-old male with full-thickness body burns: green tag

c. A 55-year-old female with a scalp laceration: black tag

d. A 60-year-old male with an open fracture with distal pulses: yellow tag

• An 88-year-old male with shortness of breath and chest bruises: green tag - A, D ~ Red-tagged

clients need immediate care due to life-threatening injuries. A client with severe chest pain would receive a red tag. Yellow-tagged clients have major injuries that should be treated within 30 minutes to 2 hours. A client with an open fracture with distal pulses would receive a yellow tag. The client with full-thickness body burns would receive a black tag. The client with a scalp laceration would receive a green tag, and the client with shortness of breath would receive a red tag.

A hospital prepares to receive large numbers of casualties from a community disaster. Which clients should the nurse identify as appropriate for discharge or transfer to another facility?

(SATA)

• Older adult in the medical decision unit for evaluation of chest pain
• Client who had open reduction and internal fixation of a femur fracture 3 days ago
• Client admitted last night with community-acquired pneumonia
• Infant who has a fever of unknown origin
• Client on the medical unit for wound care - B, E ~ The client with the femur fracture could be

transferred to a rehabilitation facility, and the client on the medical unit for wound care should be transferred home with home health or to a long-term care facility for ongoing wound care. The client in the medical decision unit should be identified for dismissal if diagnostic testing reveals a noncardiac source of chest pain. The newly admitted client with pneumonia would not be a good choice because culture results are not yet available and antibiotics have not been administered long enough. The infant does not have a definitive diagnosis.

A hospital prepares for a mass casualty event. Which functions are correctly paired with the personnel role? (SATA)

• Paramedic Decides the number, acuity, and resource needs of clients
• Hospital incident commander Assumes overall leadership for implementing the emergency

plan

• Public information officer Provides advanced life support during transportation to the hospital
• Triage officer Rapidly evaluates each client to determine priorities for treatment
• Medical command physician Serves as a liaison between the health care facility and the media
• B, D ~ The hospital incident commander assumes overall leadership for implementing the

emergency plan. The triage officer rapidly evaluates each client to determine priorities for treatment. The paramedic provides advanced life support during transportation to the hospital.The public information officer serves as a liaison between the health care facility and the media.The medical command physician decides the number, acuity, and resource needs of clients.