Chapter 10- Iggy Flashcards
- 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 other’s 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.
- 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 you’d 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 client’s 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?
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.
- 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.
- 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. “Let’s 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. “Let’s 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.
- A nurse is caring for a client whose wife died in a recent mass casualty accident. The client says, “I can’t 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 client’s 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 client’s 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?
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.
- 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 nurse’s 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.
- 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 government’s 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 federal 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.
- After a hospital’s emergency department (ED) has efficiently triaged, treated, and transferred clients from a community disaster to appropriate units, the hospital incident command officer wants to “stand down” from the emergency plan. Which question should the nursing supervisor ask at this time?
a. “Are you sure no more victims are coming into the ED?”
b. “Do all areas of the hospital have the supplies and personnel they need?”
c. “Have all ED staff had the chance to eat and rest recently?”
d. “Does the Chief Medical Officer agree this disaster is under control?”
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 the Chief Medical Officer (CMO) may be involved in the incident, the CMO does not determine when the hospital can “stand down.”
- 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 should the nurse complete first?
a. Provide a calm location for the family to cope and discuss needs.
b. Call the hospital chaplain to stay with the family and pray for the deceased.
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
The nurse should first provide emotional support by encouraging relaxation, listening to the family’s needs, and offering choices when appropriate and possible to give 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 want to see the victim immediately and do not want to wait until the body can be prepared. The nurse should assess the family’s needs before assuming the body needs to be prepared first. The family may appreciate privacy, but this is not as important as assessing the family’s needs.
- An emergency department charge nurse notes an increase in sick calls and bickering among the staff after a week with multiple trauma incidents. Which action should the nurse take?
a. Organize a pizza party for each shift.
b. Remind the staff of the facility’s sick-leave policy.
c. Arrange for 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. Speaking with staff members individually does not provide the same level of support as a group debriefing. Organizing a party and revisiting the sick-leave policy may be helpful, but are not as important and beneficial as a debriefing.
- 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? (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 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? (Select all that apply.)
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
e. An 88-year-old male with shortness of breath and chest bruises: green tag
ANS: 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? (Select all that apply.)
a. Older adult in the medical decision unit for evaluation of chest pain
b. Client who had open reduction and internal fixation of a femur fracture 3 days ago
c. Client admitted last night with community-acquired pneumonia
d. Infant who has a fever of unknown origin
e. Client on the medical unit for wound care
ANS: 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.
