JAMIATU MARAWI AL-ISLAMIA FOUNDATION

MONCADO KADINGILAN, MARAWI CITY

NCM 106 EMERGENCY AND DISASTER NURSING
SEMI-FINALS EXAMINATION
DATE: _________________
NAME: __________________________________

PERMIT NUMBER: ______________________

PART I IDENTIFICATION
1. TRAUMA - Intentional or unintentional wounds/injuries on the human body from
particular mechanical mechanism that exceeds the bodys ability to protect itself from
injury
2. EMERGENCY MANAGEMENT - traditionally refers to care given to patients with
urgent and critical needs.
3. TRIAGE - process of assessing patients to determine management priorities.
4. FIRST AID - an immediate or emergency treatment given to a person who has been
injured before complete medical and surgical treatment can be secured.
5. BASIC LIFE SUPPORT (BLS) - level of medical care which is used for patient with
illness or injury until full medical care can be given.
6. ADVANCE CARDIAC LIFE SUPPORT (ACLS) - Set of clinical interventions for the
urgent treatment of cardiac arrest and often life threatening medical emergencies as
well as the knowledge and skills to deploy those interventions.
7. DEFIBRILLATION - Restoration of normal rhythm to the heart in ventricular or atrial
fibrillation
8. DISASTER - Any catastrophic situation in which the normal patterns of life (or
ecosystems) have been disrupted and extraordinary, emergency interventions are
required to save and preserve human lives and/or the environment.
9. MASS CASUALTY INCIDENT - situation in which the number of casualties exceeds the
number of resources.
10.
POST TRAUMATIC STRESS SYNDROME - characteristic of symptoms after a
psychologically stressful event was out of range of a normal human experience.
11.
EMERGENCY IT IS WHATEVER THE PATIENT OR THE FAMILY CONSIDERS IT TO
BE.
12.
EMERGENCY NURSING - It is the nursing care given to patients with urgent and
critical needs
13.
EMERGENCY NURSE - has a specialized education, training, and experience to
gain expertise in assessing and identifying patients health care problems in crisis
situations
14.
DISASTER NURSING - a branch of emergency nursing, it refers to nursing care
given to patients who are victims of disasters, whether it is manmade or natural
phenomena.
15.
INCIDENT COMMAND SYSTEM - It is a management tool for organizing
personnel, facilities, equipment, and communication for any emergency situation.
16.
INCIDENT COMMANDER - The head of the incident command system. He must
be continuously informed of all the activities and informed about any deviation from
the established plan
PART II MULTIPLE CHOICE

17.
In conducting a primary survey on a trauma patient, which of the following is
considered one of the priority elements of the primary survey?
(A)Complete set of vital signs
(B)Palpation and auscultation of the abdomen
(C)
Brief neurologic assessment
(D)
Initiation of pulse oximetry
A brief neurologic assessment to determine level of consciousness and pupil reaction is part
of the primary survey. Vital signs, assessment of the abdomen, and initiation of pulse
oximetry are considered part of the secondary survey.
18.
A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis,
and dizziness. This patient should be prioritized into which category?
(A)High urgent
(B)Urgent
(C)Non-urgent
(D)
Emergent
Chest pain is considered an emergent priority, which is defined as potentially lifethreatening. Patients with urgent priority need treatment within 2 hours of triage (e.g. kidney
stones). Non-urgent conditions can wait for hours or even days. (High urgent is not
commonly used; however, in 5-tier triage systems, High urgent patients fall between
emergent and urgent in terms of the time lapsing prior to treatment).
19.
The physician has ordered cooling measures for a child with fever who is likely to
be discharged when the temperature comes down. Which of the following would be
appropriate to delegate to the nursing assistant?
(A)
Assist the child to remove outer clothing.
(B)Advise the parent to use acetaminophen instead of aspirin.
(C)Explain the need for cool fluids.
(D)
Prepare and administer a tepid bath.
The nursing assistant can assist with the removal of the outer clothing, which allows the heat
to dissipate from the childs skin. Advising and explaining are teaching functions that are the
responsibility of the RN. Tepid baths are not usually performed because of potential for
rebound and shivering.
20.
It is the summer season, and patients with signs and symptoms of heat-related
illness present in the ED. Which patient needs attention first?
(A)An elderly person complains of dizziness and syncope after standing in the sun
for several hours to view a parade
(B)A marathon runner complains of severe leg cramps and nausea. Tachycardia,
diaphoresis, pallor, and weakness are observed.
(C)A previously healthy homemaker reports broken air conditioner for days.
Tachypnea, hypotension, fatigue, and profuse diaphoresis are observed.
(D)
A homeless person, poor historian, presents with altered mental
status, poor muscle coordination, and hot, dry, ashen skin. Duration of
exposure is unknown.

The homeless person has symptoms of heat stroke, a medical emergency, which increases
risk for brain damage. Elderly patients are at risk for heat syncope and should be educated
to rest in cool area and avoid future similar situations. The runner is having heat cramps,
which can be managed with rest and fluids. The housewife is experiencing heat exhaustion,
and management includes fluids (IV or parenteral) and cooling measures. The prognosis for
recovery is good.
21.
An anxious 24-year-old college student complains of tingling sensations,
palpitations, and chest tightness. Deep, rapid breathing and carpal spasms are noted.
What priority nursing action should you take?
(A)Notify the physician immediately.
(B)Administer supplemental oxygen.
(C)
Have the student breathe into a paper bag.
(D)
Obtain an order for an anxiolytic medication.
The patient is hyperventilating secondary to anxiety, and breathing into a paper bag will
allow rebreathing of carbon dioxide. Also, encouraging slow breathing will help. Other
treatments such as oxygen and medication may be needed if other causes are identified.
22.
A tearful parent brings a child to the ED for taking an unknown amount of
childrens chewable vitamins at an unknown time. The child is currently alert and
asymptomatic. What information should be immediately reported to the physician?
(A)
The ingested childrens chewable vitamins contain iron.
(B)The child has been treated several times for ingestion of toxic substances.
(C)The child has been treated several times for accidental injuries.
(D)
The child was nauseated and vomited once at home.
Iron is a toxic substance that can lead to massive hemorrhage, coma, shock, and hepatic
failure. Deferoxame is an antidote that can be used for severe cases of iron poisoning. Other
information needs additional investigation, but will not change the immediate diagnostic
testing or treatment plan.
23.
An intoxicated patient presents with slurred speech, mild confusion, and
uncooperative behavior. The patient is a poor historian but admits to drinking a few
on the weekend. What is the priority nursing action for this patient?
(A)Obtain an order for a blood alcohol level.
(B)Contact the family to obtain additional history and baseline information.
(C)Administer naloxone (Narcan) 2 4 mg as ordered.
(D)
Administer IV fluid support with supplemental thiamine as
ordered.
The patient presents with symptoms of alcohol abuse and there is a risk for Wernickes
syndrome, which is caused by a thiamine deficiency. Multiples drug abuse is not uncommon;
however, there is nothing in the question that suggests an opiate overdose that requires
naloxone. Additional information or the results of the blood alcohol level are part of the total
treatment plan but should not delay the immediate treatment.
24.
A teenager arrives by private car. He is alert and ambulatory, but this shirt and
pants are covered with blood. He and his hysterical friends are yelling and trying to

explain that that they were goofing around and he got poked in the abdomen with a
stick. Which of the following comments should be given first consideration?
(A)There was a lot of blood and we used three bandages.
(B)
He pulled the stick out, just now, because it was hurting him.
(C)The stick was really dirty and covered with mud.
(D)
Hes a diabetic, so he needs attention right away.
An impaled object may be providing a tamponade effect, and removal can precipitate
sudden hemodynamic decompensation. Additional history including a more definitive
description of the blood loss, depth of penetration, and medical history should be obtained.
Other information, such as the dirt on the stick or history of diabetes, is important in the
overall treatment plan, but can be addressed later.
25.
A prisoner, with a known history of alcohol abuse, has been in police custody for
48 hours. Initially, anxiety, sweating, and tremors were noted. Now, disorientation,
hallucination, and hyper-reactivity are observed. The medical diagnosis is delirium
tremens. What is the priority nursing diagnosis?
(A)
Risk for Injury related to seizures
(B)Risk for Other-Directed Violence related to hallucinations
(C)Risk for Situational Low Self-esteem related to police custody
(D)
Risk for Nutritional Deficit related to chronic alcohol abuse
The patient demonstrates neurologic hyperactivity and is on the verge of a seizure. Patient
safety is the priority. The patient needs chlordiazepoxide (Librium) to decrease neurologic
irritability and phenytoin (Dilantin) for seizures. Thiamine and haloperidol (Haldol) will also
be ordered to address the other problems. The other diagnoses are pertinent but not as
immediate.
26.
You are assigned to telephone triage. A patient who was stung by a common
honey bee calls for advice, reports pain and localized swelling, but denies any
respiratory distress or other systemic signs of anaphylaxis. What is the action that you
should direct the caller to perform?
(A)Call 911.
(B)
Remove the stinger by scraping.
(C)Apply a cool compress.
(D)
Take an oral antihistamine.
The stinger will continue to release venom into the skin, so prompt removal of the stinger is
advised. Cool compresses and antihistamines can follow. The caller should be further
advised about symptoms that require 911 assistance.
27.
In a multiple-trauma victim, which assessment finding signals the most serious
and life-threatening condition?
(A)
A deviated trachea
(B)Gross deformity in a lower extremity
(C)Decreased bowel sounds
(D)
Hematuria
A deviated trachea is a symptoms of tension pneumothorax. All of the other symptoms need
to be addressed, but are of lesser priority.

28.
A patient in a one-car rollover presents with multiple injuries. Prioritize the
interventions that must be initiated for this patient.
a. Secure/start two large-bore IVs with normal saline
b. Use the chin lift or jaw thrust method to open the airway.
c. Assess for spontaneous respirations
d. Give supplemental oxygen per mask.
e. Obtain a full set of vital signs.
f. Remove patients clothing.
g. Insert a Foley catheter if not contraindicated.
(A)
(B)G, F,
(C)A, B,
(D)

C, B, D, A, E, F, G
E, D, C, B, A
C, D, E, F, G
C, A, D, B, E, F, G

For a multiple trauma victim, many interventions will occur simultaneously as team
members assist in the resuscitation. Methods to open the airway such as the chin lift or jaw
thrust can be used simultaneously while assessing for spontaneous respirations. However,
airway and oxygenation are priority. Starting IVs for fluid resuscitation is part of supporting
circulation. (EMS will usually establish at least one IV in the field.) Nursing assistants can be
directed to take vitals and remove clothing. Foley catheter is necessary to closely monitor
output.

PART III FILL IN THE BLANKS

Situation:
In July 1990 at 16:26 hrs. local time, a severe earthquake registering 7.7 on the Richter
scale struck the northern Philippines. The earthquake caused damage over a region of about
7700 square miles, extending northwest from Manila through the densely populated Central
Plains of Luzon and into the mountains of the Cordillera Central. Over 5,000 people were
affected, a number severely injured, reported missing or dead as buildings and houses
collapsed or got buried by landslides resulting from the quake.
As you arrive, you are told that there where about 30 people inside for a meeting when
it struck. You first (29) SURVEY THE SCENE. After doing so, you look into the Building and
ask all those who can walk to leave. About 10 people crawl out of the building some helping
others and move toward the empty ground and they are considered or categorized as (30)
NON-EMERGENT/MINOR INJURIES. About 20 people remain in the Building. As a disaster
nurse you are going to perform triaging to these remaining patients accordingly.
For each of the following Patient Profiles, determine the most appropriate triage
category (Immediate, Delayed and Expectant). You will be given 15 seconds per profile to
perform your rapid assessment.

31.
A 36 year old male with profuse bleeding from scalp wound is talking to you.
Respirations: 20/min and radial pulse is present. DELAYED
32.
A 33 year old female complaining of severe back and pelvic pain. Respirations
20/min and present radial pulse. DELAYED
33.
A 13 year old female is covered in debris and unconscious with RR of 8/min and
present radial pulse. IMMEDIATE
34.
25 year old male with left arm amputation is talking to you and attempts to stop
the bleeding, RR 25/min and with radial pulse present. DELAYED
35.
22 year old female with neck sharply angulated is unconscious. Her respirations
is absent as well as her radial pulse. DECEASED
PART IV - ENUMERATION
Environmental emergencies
36.
37.
38.
39.
40.
41.

HEAT STROKE
FROST BITE
HYPOTHERMIA
NEAR-DROWNING
DECOMPRESSION SICKNESS
ANAPHYLACTIC REACTION
45. 9 %

PART V IDENTIFY THE PERCENTAGE OF EACH AREA OF A BURN INJURY PATIENTS.

46. 18%

48.
9%

47. 18%

44. 1%

43. 18%

42. 18%

50.
9%