12

Chapter 12: Concepts of Emergency and Disaster Preparedness
Test Bank
MULTIPLE CHOICE
1. The nurse has been assigned the role of triage nurse after a weather-related disaster. What is
the priority action of the nurse?

Call in additional staff to assist with care of the victims.
Splint fractures and clean and dress lacerations.
Perform a rapid assessment of clients to determine priority of care.
Provide psychological support to staff and family members.
a.
b.
c.
d.
ANS: C
The triage nurse classifies victims of the explosion into priority of care based on illness or
injury severity. Calling in additional staff more likely would be done by the hospital incident
commander or designee. Physical care is provided to victims after triage occurs. Psychological
support should be an ongoing part of the disaster plan but is not included in triage
responsibilities; this ensures that the greatest good is provided to the greatest number of
people.
DIF: Cognitive Level: Application/Applying or higher
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care
Establishing Priorities)
MSC: Integrated Process: Nursing Process (Implementation)
2. A client who is hospitalized with burns after losing the family home in a fire becomes angry
and screams at the nurse when dinner is served late. What is the nurses best response?
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 like.
a.
b.
c.
d.
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 gain control does nothing to promote therapeutic communication.
REF: N/A
TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)
MSC: Integrated Process: Communication and Documentation
3. A client is receiving follow-up care after surviving a tornado. The client reports insomnia and
the nurse notes that the client jumped as the nurse entered the room. Which action by the
nurse is most appropriate?
a. Document findings on the clients chart and inform the physician.
b. Perform additional assessments for post-traumatic stress disorder.
c. Educate the client on nonpharmaceutical methods to promote sleep.
d. Plan to initiate a referral to a psychologist experienced in survivor issues.
ANS: B
An individual may experience physical symptoms as a normal response to profound grief or

loss, particularly after a traumatic incident. Manifestations such as insomnia, being startled
easily, having flashbacks, or feelings of numbness may indicate post-traumatic stress disorder,
and the nurse should first assess for this problem. The nurse should document assessment
findings, but only after performing a more thorough assessment. A referral may be necessary,
but the nurse does not have enough information yet to initiate it. If assessment reveals that
methods to assist with sleep would be helpful, the nurse could provide that education.
REF: N/A
TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms)
MSC: Integrated Process: Nursing Process (Assessment)
4. An industrial accident has occurred near the hospital, and many victims are brought to the
emergency department (ED) for treatment of their injuries. The nurse triages the victim with
which injury 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.
REF: N/A
MSC:
Integrated Process: Nursing Process (Assessment)
5. The nurse is working with a paramedic who just finished assisting at the scene of a school
shooting where several students were killed. Which statement by the nurse is most
therapeutic?
a. Would you like to talk about what happened?
b. Surely the department will give you the day off tomorrow.
c. At least the gunman was taken into custody.
d. Lets just sit here for a while quietly.
ANS: A
Allowing staff members to ventilate their feelings about the incident can facilitate recovery
and effective coping afterward. The other choices do not facilitate open communication
because the nurse is not providing the opportunity for the paramedic to talk.
REF: N/A
MSC: Integrated Process: Caring
6. A young man comes into the foyer of the hospital and says that he has a container of anthrax,
which he opens and pours on the floor. Which is the priority action for the nurse who first
comes upon the scene?
a. Don a protective gown, mask, and goggles.
b. Escort the man to the decontamination room.
c. Begin to evacuate the immediate area.
d. Notify the local health department of a biohazard situation.
ANS: C
The highest priority is to remove people from immediate danger, so the nurse should evacuate
the immediate area and prevent injury to those near the spill. Donning personal protective
equipment would probably take the nurse away from the scene to obtain the equipment and
would not help protect those in immediate danger. The man may need to be escorted to a
decontamination area after people are removed from the scene. Reporting the incident to the
health department should be done after the scene is secured and could be delegated to
someone else.
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control
Handling Hazardous and Infectious Materials)
7. Which is the priority action for the emergency department charge nurse in the event of a mass
casualty situation?
a. Directing medical-surgical and case management nurses to assist emergency
department (ED) staff with critically injured victims

b. Calling additional medical-surgical and critical care nursing staff to come to the
hospital to assist when victims are brought in

c. Informing the incident commander at the mass casualty scene about how many
victims may be handled by the ED

d. Directing medical-surgical and critical care nurses to assist with clients who are
already in the ED while the ED staff prepares 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 the mass casualty victims; however, they should not be
assigned to the most critically ill or injured 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.
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareConcepts
of Management)
MSC: Integrated Process: Nursing Process (Planning)
8. An accident has occurred near the hospital, and a victim is brought to the emergency
department with severe chest pain, a pulse of 120 beats/min, blood pressure of 100/60 mm
Hg, and a respiratory rate of 28 breaths/min. The nurse assesses shortness of breath and
diaphoresis. Which color tag does the nurse use when triaging this client?
a. Red
b. Yellow
c. Green
d. Black
ANS: A
The client in the emergent triage category has a condition that may post an immediate threat to
life or limb and is given the highest priority. Clients who should be treated emergently receive
a red tag. Yellow tags signify major but stable injuries that can wait 30 minutes to 2 hours for
definitive care. Green tags designate walking wounded who can wait longer than 2 hours to
receive care. Black tags are used to designate those who are dead or who are expected to die.
REF: N/A
MSC:
9. A nurse is working at the scene of a catastrophic natural event. Which person does the nurse
attend to first?
Distraught mother looking for her children
Person walking about with a bleeding head wound
Supine person with pale, cool, clammy skin
Child with a deformed lower leg crying in pain
a.
b.
c.
d.
ANS: C
The person with pale, cool, clammy skin is in shock and needs immediate medical attention.
The mother does not have injuries and so would be the lowest priority. The other two people
need medical attention soon, but not at the expense of a person in shock.
REF: N/A
10. The hospital is overwhelmed when caring for victims after an earthquake that occurred 48
hours ago. Which responsibility of the nursing supervisor is most important at this time?
Assuming leadership for implementation of the hospital emergency plan
Releasing updates of client conditions to the media
Converting the physical therapy clinic into a treatment area for the injured
Arranging relief and coordinating breaks so nursing staff can rest and eat
a.
b.
c.
d.
ANS: D
The nursing supervisor should ensure that the staff is not becoming dangerously overtired by
working long shifts without food or rest. Overall leadership for implementing the emergency
plan and re-designating areas for client care would fall under the job of hospital incident
commander. The community relations/public information officer would work with the media.
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareConcepts
of Management)
11. The nurse is teaching nursing students about personal emergency preparedness. Which
statement by a student indicates that further teaching is indicated?

a. I will get a prescription for antibiotics just in case I have to work in an area that
has been infected with anthrax.

b. I should keep an extra uniform in my locker in case I get stuck at work.
c. I may be torn between caring for my young daughter and caring for victims at
work.
d. I should make plans for my family to evacuate our house in case of tornado or
earthquake.
ANS: A
The student would have no reason to obtain a prescription for anthrax unless he or she
demonstrates clinical evidence of anthrax infection or has been exposed to a substance that
tests positive for anthrax. Statements about planning to keep an extra uniform at work,
recognizing the moral dilemmas he or she might encounter when working in a disaster
situation, and understanding personal preparation for disasters all indicate that the student
comprehends information about disaster planning and emergency preparedness.
REF: N/A
Emergency Response Plan) MSC:
Integrated Process: Teaching/Learning
12. The hospital administration has arranged 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 determine what we can do better the next time we have this situation.
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.
DIF: Cognitive Level: Comprehension/Understanding
REF: p. 162
TOP: Client Needs Category: Psychosocial Integrity (Stress Management)
13. The nurse is caring for a client whose wife just died in an accident. The client says to the
nurse, I cant believe that my wife is gone and I am left to raise my children all by myself.
Which response by the nurse is most appropriate?
a. Please accept my sympathy 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.
REF: N/A
14. The emergency department nurse manager is explaining concepts of emergency and disaster
preparedness to a group of students. Which statement by the nurse manager is most accurate?
a. An internal disaster is something that occurs inside the health care facility.
b. An external disaster occurs when someone not employed here disrupts our
operations.
c. A multi-casualty event involves disasters at several different locations.
d. The Joint Commission requires that we participate in a disaster drill once a year.
ANS: A
An internal disaster is something that occurs within the health care facility, such as a fire.
External disasters, such as a tornado or a hurricane, occur outside the health care facility. A
multi-casualty event can be managed with hospital resources. The Joint Commission requires
hospitals to participate in two disaster drills a year.
DIF: Cognitive Level: Knowledge/Remembering
REF: p. 155
15. The emergency department (ED) is expecting a large number of casualties after a bridge
collapse. Which is a priority consideration for the ED leadership when activating the disaster
plan?
a. Responding paramedics and rescue personnel will notify the ED about exactly how
many victims to expect.
b. Responding paramedics and rescue personnel will triage all victims at the bridge
collapse site before bringing them to the ED.
c. The ED may receive many unexpected victims with minor injuries from the bridge
collapse.
d. Victims who have been contaminated with gasoline will be decontaminated by
rescue personnel before arriving at the ED.
ANS: C
Paramedics may not note all the walking wounded to give the ED an accurate count of
victims to expect because these people might evacuate themselves from the accident scene
without being seen by paramedics or rescue personnel. They may then secure their own
transportation to the hospital and could overwhelm an ED that is already handling many
severely injured victims who have been brought in by emergency medical services (EMS).
REF: N/A
Integrated Process: Nursing Process (Planning)
16. A nursing administrator is evaluating the hospitals response to a recent internal disaster. The
administrator assesses that goals for disaster planning have been met when which outcome is
assessed?
a. The hospital was able to maintain client, staff, and visitor safety during the disaster.
b. Supplies were readily available and were transported rapidly where needed.
c. The hospital incident command officer successfully utilized ancillary areas for
client care.
d. All employees followed the chain of command and established policies and
procedures.
ANS: A
The most important outcome of any internal disaster is maintenance of safety for the hospitals
clients, staff, and visitors. Other outcomes listed would be part of a successful disaster
response, but are all too narrow to meet this objective.
REF: N/A
Integrated Process: Nursing Process (Evaluation)
17. A nursing administrator is reviewing a hospitals disaster planning. The administrator
evaluates the plan that addresses which component as being the best?
Internal disasters such as fires or power outages
All possible catastrophes in the community
The Joint Commissions assessment of possible disasters
Responses to all types of weather-related emergencies
a.
b.
c.
d.
ANS: B
When The Joint Commissionaccredited health care facilities are planning disaster
preparedness programs, they need to take an all-hazards approach (versus planning by strict
guidelines) and to plan for all credible threats to the community that could result in a disaster.
This means planning for all events that could conceivably happen in that geographic area,
including possible weather events. Planning only for internal disasters is too limited and does
not account for weather- or terrorist-related threats. The Joint Commission does not assess
what disasters are possible in the areas that accredited hospitals serve.
REF: N/A
18. A nursing instructor is debriefing students who participated in a community-wide disaster
drill. Several students are upset with the black-tagged triage category. Which statement by the
nursing instructor is best?
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.
DIF: Cognitive Level: Comprehension/Understanding
REF: p. 157
19. 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.
REF: p. 159
Emergency Response Plan)
20. A nurse wants to become part of a Disaster Medical Assistance Team (DMAT) but is
concerned about maintaining licensure in several different states. What statement by the
nursing supervisor 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
When deployed, DMAT health care providers are acting as agents of the government, and so
are considered federal employees. Thus their licenses are valid in all 50 states. Licensure is an
issue that the government would be concerned with, but no programs for temporary licensure
or rapid activation are available.
REF: p. 159
21. A community disaster has occurred and the hospitals emergency department (ED) has
efficiently triaged, treated, and transferred most clients to appropriate units. The hospital
incident command officer wants to stand down from the emergency plan. Which question
by the nursing supervisor is most beneficial at this time?
a. Are you sure no more victims are coming into the ED?
b. Do all other areas of the hospital have the supplies and personnel they need now?
c. Have all ED staff had the chance to eat and rest recently?
d. Are all other incident command officers and house supervisors in agreement with
you?
ANS: B
Before standing down, the incident command officer ensures that the needs of the other
hospital departments have been taken care of because they may still be stressed and may need
continued support to keep functioning. Many more walking wounded victims may present
to the ED; that number may not be predictable. Giving staff the chance to eat and rest is
important, but all areas of the facility need that too. Although agreement among incident
officers is important, it is not the priority concern before standing down.
REF: N/A
22. A hospital has stood down from a mass casualty disaster. The staff have rested and eaten.
Which action by the nursing supervisor takes priority?

a. Restocking the emergency department (ED)
b. Making rounds on each unit to check staffing
c. Determining which staff can go home
d. Planning a critical incident stress debriefing
ANS: A
Inventorying and stocking the ED are high-priority actions because the usual flow of
emergency clients may not be lessened in the wake of a disaster. Supplies may be low or
exhausted, and it would be vital to resupply the area. Rounding on inpatient units, determining
the staff who can be relieved, and planning a debriefing are certainly important items, but they
do not take priority over getting the ED ready for more clients.
REF: p. 162
23. A family in the emergency department is overwhelmed at the loss of several family members
due to a shooting incident in the community. Which intervention by the nurse is most
beneficial?
a. Offer the family choices as appropriate and possible.
b. Call the hospital chaplain to stay with the family.
c. Do not allow visiting of the victims until the bodies are prepared.
d. Provide privacy for law enforcement to interview the family.
ANS: A
Offering choices when appropriate and when possible gives some personal control back to
individuals. The family may or may not want the assistance of religious personnel; the nurse
should assess for this before calling anyone. Visiting procedures should take into account the
needs of the family. The family may appreciate privacy, but this is not as helpful as allowing
choices when the family is able to make them.
REF: N/A
TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)
24. An emergency department (ED) supervisor has noted an increase in sick calls and bickering
among the ED staff after a week with multiple trauma incidents. What action by the
supervisor is most helpful?
a. Organize a pizza party for each shift.
b. Remind staff of facility sick-leave policy.
c. Arrange critical incident stress debriefing.
d. Talk individually with staff members.
ANS: C
The staff may be suffering from critical incident stress and needs to have a debriefing by the
critical incident stress management team to prevent the consequences of long-term, unabated
stress. The other interventions may be helpful as well but are not as important as a debriefing.
REF: N/A
25. A client has been treated in the emergency department after a tornado and is awaiting
discharge instructions. This client is close to losing control, although other family members
are attempting to calm him down. Which response by the nurse is most helpful?
a. Call security and have them standing by in case they are needed.
b. Instruct the person to leave the area until he can calm down.
c. Offer the client the choice of waiting in the treatment room or the waiting room.
d. Ask the family to help move the client out of the treatment area.
ANS: C
Offering people choices often is a good way to get them to focus on something other than
their distress. Calling security and telling the person to leave might escalate the situation,
although if all other methods fail, the safety of staff, clients, and other visitors takes priority.
Asking the family to help move the client puts him in a difficult position and may end up
causing them injury.
REF: N/A

MULTIPLE RESPONSE
1. A large number of victims arrive at the emergency department after a bus is hit by a train.
Which interventions are performed immediately for red-tagged victims? (Select all that
apply.)
a. Splinting a closed tibial fracture
b. Intubating a cyanotic client in respiratory distress
c. Initiating IV fluids for a client with a blood pressure of 96/60 mm Hg and a pulse
of 144 beats/min
d. Attaching an external pacemaker for a client with a heart rate of 44 beats/min
e. Performing postmortem care for a client who has just died
f. Removing glass that is embedded in a clients arm
ANS: B, C, D
Priority interventions are those that must be performed to save the clients life, including
intubation, IV fluid replacement for shock, and pacemaker placement. Splinting a fracture and
removing glass from a clients arm can wait until after life-threatening injuries are cared for.
Postmortem care would wait until after all clients have been cared for.
REF: N/A
2. The triage nurse is assessing a client who has been brought to the emergency department (ED)
by emergency medical services (EMS) following a mass casualty incident. Which assessment
questions are used to determine the appropriate triage category for the client? (Select all that
apply.)
a. Can you wiggle your toes?
b. Are you having any difficulty breathing?
c. Are you allergic to any medications?
d. Does your family know that you are here?
e. Can you tell me what day it is?
f. Do you have any abdominal or back pain?
ANS: A, B, E, F
The triage nurse should assess for possible spinal cord injury, shortness of breath, abdominal
or back pain, and disorientation when the client is brought to the ED. Determining allergies,
although important, does not assist in categorizing clients, nor does inquiring about the
clients family.
REF: N/A
3. Emergency medical services (EMS) brings a large number of clients to the emergency
department following a mass casualty incident. The nurse identifies clients with which injuries
with yellow tags? (Select all that apply.)
a. Partial-thickness burns covering both legs
b. Open fractures of both legs with absent pedal pulses
c. Neck injury and numbness of both legs
d. Small pieces of shrapnel embedded in both eyes
e. Head injury and difficult to arouse
f. Bruising and pain in the right lower abdomen
ANS: 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 fracture and the client with the head injury would be classified as urgent with
red tags.
REF: N/A
4. A hospital is receiving large numbers of casualties from a disaster. Which clients does the
supervisor identify as appropriate for discharge or transfer to another facility? (Select all that
apply.)
a. Client who had open reduction and internal fixation of a femur fracture 3 days ago
b. Client who had a colostomy 4 days ago and whose daughter is a registered nurse
c. Client admitted last night with community-acquired pneumonia
d. Infant admitted 2 days ago for fever of unknown origin
e. Client in the medical decision unit for evaluation of chest pain
ANS: A, B
The client with the femur fracture could be transferred to a rehabilitation facility and the RN
could provide care and teaching to her father. 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. Also, the infant has not been in the hospital long enough
for cultures to return for a definitive diagnosis. The client in the medical decision unit should
be identified for dismissal if diagnostic testing reveals a noncardiac source of chest pain.
REF: N/A
5. The nurse working with survivors of a disaster wants to assess them for post-traumatic stress
disorder. For which clients does the nurse perform further assessment before administering the
Impact of Event ScaleRevised? (Select all that apply.)
a. Older adult survivor with minor injuries
b. Woman who lost both her children
c. Middle-aged victim with multiple medical problems
d. Young adult who had serious orthopedic injuries
e. Older adolescent who had a traumatic brain injury
ANS: A, E
The Impact of Event ScaleRevised tool should not be used with people who have short-term
memory loss, so the nurse should assess the older adult survivor and the client with the brain
injury for this problem before administering the tool. The other clients do not have medical
issues that would preclude use of this tool.
REF: N/A
MSC: Integrated Process: Nursing Process (Assessment)
6. A wing of a hospital is on fire. Which actions by the nurse promote safe evacuation of clients?
(Select all that apply.)

Direct ambulatory clients on where to go to be safe.
Use ambulatory clients to help push clients in wheelchairs.
Use oxygen tanks for all clients who are on oxygen.
Manually ventilate clients who are on ventilators.
Move bedridden clients in their beds if possible.
a.
b.
c.
d.
e.
ANS: A, B, D, E
Ambulatory clients can evacuate themselves with direction or could be used to help push
wheelchair-bound clients. Clients on ventilators need to be removed from the ventilator and
bagged until evacuated, then they can be put back on the ventilator if one is available.
Bedridden clients should be moved in their beds or on stretchers, or carried if needed. Any
client who can breathe without oxygen should have it removed for the evacuation because
oxygen is an accelerant.
REF: N/A

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Chapter 12: Concepts of Emergency and Disaster Preparedness

the priority action of the nurse?

An individual may experience physical symptoms as a normal response to profound grief or

department (ED) staff with critically injured victims

hospital to assist when victims are brought in

victims may be handled by the ED

statement by a student indicates that further teaching is indicated?

has been infected with anthrax.

Therapeutic communication includes active listening and honesty. This statement

Which action by the nursing supervisor takes priority?

TOP: Client Needs Category: Psychosocial Integrity (Stress Management)

(Select all that apply.)

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