MSII Prep U Ch. 73- Terrorism, Mass Casualty, and Disaster Nursing

To prepare the community for the possible threat of anthrax, a nurse must teach that:

anthrax can infect the integumentary, GI, and respiratory systems. Anthrax can infect the integumentary, GI, and respiratory systems. Immunizations are appropriate only for those at risk of anthrax exposure. Isoniazid, rifampin, and pyrazinamide are used to treat tuberculosis, not anthrax. Penicillin is the most common drug used to treat anthrax.

When preparing for an emergency bioterrorism drill, the nurse instructs the drill volunteers that each biological agent requires specific patient management and medications to combat the virus, bacteria, or toxin. Which of the following statements reflect the patient management of variola virus (smallpox)?

Smallpox spreads rapidly and requires immediate isolation. Smallpox is spread by droplet or direct contact. No antiviral agents are effective against smallpox; however, vaccination within 2 to 3 days of exposure is protective. It spreads rapidly and requires immediate isolation. Even in death, the disease can be transmitted. In 4 to 5 days, vaccination may prevent death and should be administered with vaccinia immune globulin.

A nurse who is working as part of a disaster response team is performing triage at a mass casualty incident. One of the victims has a sucking chest wound. The nurse would triage this client using which color-coded tag?

Red A client with a sucking chest wound is triaged as needing immediate care and would be tagged red. Clients with injuries that are significant and require immediate care but can wait hours without threat to life or limb would be tagged yellow. Clients with minor injuries would be tagged green. Clients with injuries that are extensive and whose chances of survival are unlikely even with definitive care are tagged black.

Nursing students are reviewing the various weapons of mass destruction, specifically biologic agents. The students demonstrate understanding of the information when they identify which of the following as the most likely weaponized agent?

Anthrax Although tularemia, botulism, and plague are biologic agents that can be used as weapons of mass destruction, anthrax is recognized as the most likely weaponized biologic agent.

A nurse is working with a group of disaster victims to reduce the psychological effects of the trauma. Which of the following would be least helpful?

Encouraging the victims to watch television replays of the event. Nurses should discourage victims from subjecting themselves to repeated exposure to the event through media replays and news articles. Nurses can assist disaster victims through active listening and providing emotional support, giving information and referring them to therapists, social workers, or mental health services as necessary. In addition, nurses should encourage victims to return to normal activities and social roles when appropriate.

You are an Emergency Department nurse who has to care for three victims of anthrax. The first victim inhaled the toxin, the second victim ingested it, and the third victim suffered a skin infection. Which client should be cared for first?

The one who inhaled the toxin The nurse should first treat the client who is at greatest risk. The most serious form of anthrax develops upon inhalation. If diagnosed incorrectly and untreated, the infection progresses to severe respiratory distress, and in severe situations, death may also occur. Ingesting the bacteria is less lethal, with symptoms of nausea, vomiting, diarrhea, and abdominal pain. Skin infection is the least deadly form characterized by painless lesions usually on the head, hands, and arms. Therefore, the client who inhaled the toxin should always get first priority.

Three victims of radiation exposure are brought into the Emergency Department. As the nurse caring for these clients, you would expect what substance to be ordered to reduce radiologic organ damage?

Potassium iodide Taking substances called potassium iodide, Prussian blue, and diethylenetriamine pentaacetate can prevent or reduce radiologic organ damage. Option A, C and D are incorrect and used only as distractors.

A pipe bomb detonated on a city bus, causing numerous casualties. This would be an example of which type of disaster?

intentional human Intentional human disasters include bombings, biologic disasters, and chemical disasters. Natural disasters are caused by nature; examples include tornadoes and hurricanes. Unintentional disasters are accidents that may result in mass trauma and disruptions of services depending on their scale. A biologic disaster is one in which pathogens or their toxins cause harm to many humans and other living species.

The nurse is caring for victims after a mass casualty incident with high-dosage radiation exposure. The victims are experiencing fever, respiratory distress, and increased excitability. The nurse documents that the victims are in which phase of radiation exposure?

Prodromal The nurse documents that the victims are in the prodromal phase. In this phase, symptoms present 48 to 72 hours after exposure and include fever, respiratory distress, and increased excitability for victims exposed to high doses of radiation. During the latent phase, symptoms include decreasing numbers of lymphocytes, leukocytes, thrombocytes, and red blood cells.

The nurse is triaging patients from a 10-car pile-up on the interstate and assesses a patient with a sucking chest wound. What category should this patient be placed in?

Priority 1 Triage category "Immediate" is priority 1 (red) and includes injuries that are life threatening but survivable with minimal intervention, such as sucking chest wound, airway obstruction secondary to mechanical cause, and shock

A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority?

Monitor vital signs and oxygen saturation every 15 to 30 minutes. Monitoring vital signs and oxygen saturation every 15 to 30 minutes takes priority. Suctioning the client as needed to obtain a sputum specimen may be necessary, but assessing the client for changes in his respiratory status takes priority. Assessing intake and output and providing adequate hydration are important steps for liquefying secretions; however, they don't take priority. Reassuring the client that intubation and mechanical ventilation is temporary is inappropriate. The client may not require intubation and mechanical ventilation; however, if he does, the nurse can't predict the length of time it may be necessary.

Exposure to gamma radiation can be decreased by completing which of the following actions?

Providing distance from radiation source Gamma radiation can penetrate clothing and skin. Thick clothes do not have any kind of protection. Lead blocks radiation, but it is safest to limit exposure and to distance oneself from the source

Which of the following is the most likely weaponized biological agent available?

Anthrax Anthrax is recognized as the most likely weaponized biologic agent available. Anthrax is caused by replicating bacteria that release toxin, resulting in hemorrhage, edema, and necrosis. The plague, smallpox, and botulism are not the most likely weaponized biological agents available.

Which of the following is defined as the potential of an agent to cause injury to the body?

Toxicity Persistence means that the chemical is less likely to vaporize and disperse. Volatility is the tendency for a chemical to become a vapor. Toxicity is the potential of an agent to cause injury to the body. Latency is the time from absorption to the appearance of symptoms.

A nursing instructor is describing the role of a nurse during a disaster. Which of the following would best reflect the nurse's role?

Variable depending on the needs of the situation The role of the nurse during a disaster varies and depends on the needs or situation. Nurses may be asked to perform duties outside their areas of expertise and may take on responsibilities normally held by physicians or advanced practice nurses. During a disaster, nursing care focuses on essential care from a perspective of what is best for all clients.

A nurse is providing care to a client who has been exposed to phosgene vapor. Which nursing diagnosis would the nurse identify as the priority?

Impaired gas exchange related to destruction of the pulmonary membrane Phosgene vapor is a pulmonary agent that destroys the pulmonary membrane leading to pulmonary edema, with shortness of breath. Therefore, impaired gas exchange would be the priority. Impaired skin integrity would be appropriate for exposure to a vesicant. Disturbed sensory perception, visual would be appropriate for a client exposed to a nerve agent. Decreased cardiac output would be appropriate for a client exposed to a blood agent, such as cyanide, which inhibits aerobic metabolism.

You are caring for clients who have been exposed to a toxic nerve agent. You will need to use diazepam with these clients. Why is diazepam given when managing the effects of toxic nerve agent toxicity?

To control possible seizures Seizures are likely to occur only after exposure to a nerve agent. Diazepam controls seizures. Atropine sulfate counteracts excess acetylcholine at muscarinic sites. Pralidoxime chloride reactivates acetylcholinesterase. Atropine is typically administered to stop any kind of hypersecretion.

You are caring for radiation victims. What is the most important factor that you should consider to assess a client's chance of survival in acute radiation syndrome (ARS)?

Dosage of gamma radiation The chance of surviving ARS depends on the dosage of gamma radiation a person receives. ARS is not related to chemical (gas) or biologic (infection, contact) disasters.

The nurse is developing a plan of care for patients exposed to radiation during a mass casualty incident. The nurse assesses the onset of gastrointestinal symptoms such as nausea, vomiting, loss of appetite, diarrhea, and/or fatigue within how many hours after exposure?

48 to 72 The prodromal phase (presenting symptoms) of radiation exposure occurs within 48 to 72 hours after exposure. Signs and symptoms include nausea, vomiting, loss of appetite, diarrhea, and fatigue. With high-dose radiation exposure, the signs and symptoms may include fever, respiratory distress, and increased excitability.

Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage?

Priority 4 Triage category "Expectant" is priority 4 (black) and applies to patients with injuries that are extensive and whose chances of survival are unlikely even with definitive care, such as unresponsive patients with penetrating head wounds, high spinal cord injuries, and wounds involving multiple anatomic sites and organs.

During a disaster, the nurse sees a victim with a green triage tag. The nurse knows that the person has which type of injuries?

Minor and treatment can be delayed hours to days A green triage tag (priority 3 or minimal) indicates injuries that are minor and treatment can be delayed hours to days. A red triage tag (priority 1 or immediate) indicates injuries that are life threatening but survivable with minimal intervention. A yellow triage tag (priority 2 or delayed) indicates injuries that are significant and require medical care, but can wait hours without threat to life or limb. A black triage tag (priority 4 or expectant) indicates injuries that are extensive and chances of survival are unlikely even with definitive care.

A client has been exposed to a vesicant and is undergoing decontamination. Which of the following most likely would be used?

Soap and water A client who is exposed to a vesicant agent undergoes decontamination with soap and water. Scrubbing with sodium hypochlorite solutions is avoided because they increase penetration of the nerve agent. Alcohol and chlorhexidine are inappropriate choices for decontamination.

When describing the use of smallpox as a biologic agent, which of the following would the nurse include as the primary means of infection?

Direct contact Smallpox is extremely contagious and infection occurs by direct contact, contact with clothing or linens, or droplets from person to person only after the fever has decreased and the rash phase has begun. Anthrax occurs via inhalation, skin contact, or gastrointestinal ingestion. Nerve agents can be precutaneously absorbed.

Homeland Security has alerted the disaster response teams in your region of a potential terrorist attack in the form of a nuclear blast. You are a part of the disaster response system and you know that with a nuclear blast you would need to be prepared for what classification of disaster?

Radiologic Radiologic disasters can occur in the following ways: Explosion of a dirty bomb; Damage to or human error in a nuclear power plant facility; Nuclear blast.

A nurse is providing disaster care in an event that is known to involve gamma radiation. When admitting victims of the disaster, what should the nurse do to best reduce victims' risks of injury?

Remove victims' clothing and have them wash themselves thoroughly. The nurse should have victims shower and change clothes and irrigate or wash open wounds with soap and water. Cleansing the skin helps to reduce the transition from external to internal radiologic contamination. Infectious microorganisms are not involved, so chlorhexidine is of no particular benefit. Applying PPE over contaminated clothing could worsen the risk for injury. Adequate ventilation is important, but removal of contaminants is the priority because of the increased risk for injury.

The nurse is on a community awareness safety committee. When prioritizing biological agents according to potential morbidity and mortality, which cluster of biological agents hold the highest mortality?

Anthrax, smallpox The cluster of agents with the highest mortality includes anthrax and smallpox. The Hantavirus and tuberculosis agents are not presently used for bioterrorism. Botulism and Salmonella as well as Escherichia coli and Brucella species are of low mortality.

During a disaster, the nurse triages a victim with a fractured wrist. Which color triage tag should the nurse apply?

Green A green triage tag (priority 3 or minimal) indicates injuries that are minor and treatment can be delayed hours to days. A red triage tag (priority 1 or immediate) indicates injuries that are life threatening, but survivable with minimal intervention. A yellow triage tag (priority 2 or delayed) indicates injuries that are significant and require medical care, but can wait hours without threat to life or limb. A black triage tag (priority 4 or expectant) indicates injuries that are extensive and chances of survival are unlikely even with definitive care.

A nurse volunteers to help decontaminate a victim. Which of the following is the first action that the nurse should take?

Removing victim's clothing and jewelry To be effective, decontamination must include a minimum of two steps. The first step is removing the patient's clothing and jewelry and then rinsing the patient with water. The second step consists of a thorough soap and water wash and rinse.

The NATO triage system uses color-coded tagging to identify severity of injuries. A patient with survivable but life-threatening injuries (i.e., incomplete amputation) would be tagged with which color?

Red Triage category "Immediate" is coded red and includes injuries that are life threatening but survivable with minimal intervention, such as an incomplete amputation.

A soldier is preparing to enter an area in which there is a high risk for chemical exposure to a nerve agent. What should the soldier be given prior to entering this area?

Mark I automatic injectors that contain 2 mg atropine and 600 mg pralidoxime chloride Military personnel believed to be at risk for chemical attack are provided with Mark I automatic injectors, which contain 2 mg atropine and 600 mg pralidoxime chloride. Diazepam may be administered by a partner.

All people who have household or face-to-face contact with the patient diagnosed with smallpox after the fever begins should be vaccinated within what timeframe to prevent infection and death?

4 days All people who have household or face-to-face contact with the patient after the fever begins should be vaccinated within 4 days to prevent infection and death.

A nurse is preparing to provide care to clients who are victims of an earthquake. Which of the following would the nurse identify as a factor that would least likely affect the emergency response?

Loss of building structures In the event of a natural disaster, loss of communications, potable water, and electricity is usualy the greatest obstacle to a well-coordinated emergency response. Loss of building structures could increase the risk to emergency response personnel but they would have the least effects on the emergency response.

The nurse is caring for a victim of a chemical disaster. Medications given in the treatment of this client include amyl nitrate, sodium nitrate, and sodium thiosulfate. What chemical agent does the nurse know this client has been exposed to?

Cyanide They administer one or all of the following antidotes: amyl nitrate, sodium nitrate, and sodium thiosulfate. Amyl nitrate promotes the formation of methemoglobin, which combines with cyanide to form nontoxic cyanmethemoglobin. Therefore, options A, B, and D are incorrect.

You are the nurse caring for three clients who have been diagnosed with anthrax. They were exposed after boarding a flight where a white powdery substance was found in one of the restrooms. You know that these clients would be classed as being victims of which of the following?

A biologic disaster Anthrax is a biologic agent that could be the cause of a biologic disaster, one in which pathogens or their toxins cause harm to many humans and other living species. Anthrax is not a natural, radiologic, or chemical agent of disaster.

During a mass casualty event, a person whose injuries are extensive and whose chances of survival are unlikely even with definitive care would receive which color tag?

Black A black tag means expectant death, and that the injuries are extensive and chances of survival are unlikely even with definitive care. A green tag is used when injuries are minor and treatment can be delayed hours to days. A red tag means that the person's injuries are life-threatening but survivable with minimal intervention. A yellow tag indicates a person whose injuries are significant and require medical care, but can wait hours without threat to life or limb.

A nuclear accident (intentional or unintentional) can cause significant harm to those living nearby or at a distance. Harmful levels of invisible gamma radiation penetrate the body, not only causing devastating injuries but possibly contaminating others. What type of transmission precaution prevents such person-to-person contamination?

contact Invisible gamma radiation penetrates the body and can be eliminated in blood, sweat, urine, and feces. Consequently, a contaminated person can contaminate others through contact with body fluids or surfaces he or she touches. Airborne transmission requires the suspension and transport on air currents beyond 3 feet and is the way in which many pathogens or toxins are transmitted. Invisible gamma rays do not fall into this category, however. Gamma radiation does not travel in a liquid, or droplet, form. Standard precautions encompass more than person-to-person contamination.

The nurse is instructing on bioterrorism agents. Which of the following does the nurse emphasize as an agent which is transmitted from person to person?

Smallpox Smallpox is highly contagious and caused by a variola virus. Individuals infected with the botulinum toxin and anthrax are not at risk to others; there are no reports of person to person transmission. Varicella, commonly called the chickenpox, is contagious but not a bioterrorism agent.

During a terrorist attack, multiple victims were exposed to nitrogen mustard. While caring for one of the victims admitted to the hospital, the nurse notes large, serous fluid-filled, circumscribed areas resembling a dome over the victim's axillae and antecubital spaces. The nurse should document this find as being which of the following?

Bullae The nurse should document the large, serous fluid-filled, circumscribed areas as bullae. Papules are solid elevated superficial lesions. Macules are flat circumscribed areas less than 1 cm in diameter. An abscess is a nodule/tumor greater than 1 cm that contains pus

A patient was suspected of being in direct contact with anthrax but is exhibiting no signs or symptoms. What type of prophylaxis does the nurse know this patient will have to take?

Ciprofloxacin (Cipro) for 60 days At present, anthrax is penicillin sensitive; however, strains of penicillin-resistant anthrax are thought to exist. Recommended treatment includes penicillin ( Penicillin V), erythromycin (Erythrocin), gentamicin ( Garamycin), or doxycycline (Vibramycin). If antibiotic treatment begins within 24 hours after exposure, death can be prevented. In a mass casualty situation, treatment with ciprofloxacin (Cipro) or doxycycline is recommended, because these easily administered oral antibiotic agents are stockpiled and there should be sufficient dosages to fully treat many anthrax-exposed patients.

Which of the following terms refers to a process by which an individual receives education about recognition of stress reactions and management strategies?

Defusing Defusing is a process by which the individual receives education about recognition of stress reactions and management strategies for handling stress. It is a component of critical incident stress management (CISM). Debriefing is a more complicated intervention of critical incident stress management (CISM) and it involves a 2 to 3 hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (eg, flashbacks, difficulty sleeping, intrusive thoughts) and other psychological ramifications. In follow-up, members of the critical incident stress management (CISM) team contact the participants of a debriefing and schedule a follow-up meeting, if necessary. People with ongoing stress reactions are referred to mental health specialists. Critical incident stress management (CISM) is an approach to preventing and treating the emotional trauma that can affect emergency responders as a consequence of their jobs but that can also occur to anyone involved in a disaster or mass casualty incident.

Inhalation of anthrax mimics which disease process?

Flu Anthrax symptoms mimic those of the flu, and usually treatment is sought only when the second stage of severe respiratory distress occurs. Burns occur with sulfur mustard. Bronchospasm can occur with phosgene or chlorine. Respiratory distress may occur with cyanide.

A nurse is preparing an in-service education program to a group of nurses who are members of a disaster response team specializing in biologic weapons. Which of the following would the nurse include as the agent of choice when dealing with a mass casualty incident involving anthrax?

Ciprofloxacin In mass casualty incidents involving anthrax, treatment with ciprofloxacin or doxycycline is recommended. Overall recommended agents for treating anthrax include penicillin, erythromycin, gentamicin, and doxcycline.

A client, contaminated following exposure to radiation, is brought to the hospital for assessment. Which nursing action is essential?

Place the client in strict isolation. It is important for the nurse to realize that a contaminated person can contaminate others through contact with body fluids or surfaces which he or she touches. Upon arrival to the hospital, the client is placed in strict isolation to minimize the exposure of others. The client will then have vital signs and a complete assessment.

The nurse is caring for a client who is critically ill and has high radiation levels in the system. When discussing the needs of patient care and the need to protect nursing staff, which is discussed as the optimal barrier against gamma radiation?

Lead barriers and protective aprons The optimal barrier against gamma radiation is lead. All other options may also be incorporated in the plan of care.

The nurse is caring for a client diagnosed with botulism. Which medication classification does the nurse anticipate?

Antitoxins Botulism is a disease that develops from the neurotoxin produced by Clostridium botulinum. Botulinum antitoxin is the only treatment after exposure to lessen the severity of symptoms. Antibiotics are used for anthrax. Supportive treatments such as antipyretics are used for smallpox. Anti-inflammatory medications are not treatments for botulism.

The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates?

Severe, credible impending threat, usually with a site specified Imminent threat level indicates a severe, credible impending threat, usually with a site specified.

The victims of a tornado disaster have been triaged, and a number of victims have been placed in the expectant category based on their injuries. What nursing interventions should be used to care for these clients? Select all that apply

Provide comfort. Provide emotional support. Nurses should provide comfort and emotional support to victims in an expectant triage category, and reassess them again after managing those in the immediate triage category. Nurses should not totally abandon victims in the expectant category; they should transport them for treatment when resources become available. Victims who have injuries that are treatable are the priority for attention, but those who may soon die should not be neglected.

The nurse is caring for a client exposed to a blistering agent. While the nurse is quickly decontaminating the client by showering and bagging all client clothing, what is the nurse simultaneously assessing for?

Respiratory compromise A person exposed to a blistering agent or vesicant must be decontaminated immediately, with clothing removed and bagged. Irrigation of the victim's eyes and application of topical analgesia, antibiotics, and lubricants to the skin occur. Simultaneously, the nurse is assessing the respiratory system for airway obstruction because blisters from inhaled toxics can swell obstructing respiratory passages.

During a mass casualty incident (hurricane), a triage nurse participated in separating patients according to the severity of their injuries. She tagged a patient with a sucking chest wound with the color:

red Red refers to a life-threatening but survivable injury. Refer to Table 56-3 in the text for an explanation of the other colors.

Smallpox is considered a biological agent of warfare. Which of the following are correct statements about the virus that will direct responses? Select all that apply.

It is extremely contagious after appearance of a rash A large amount of the virus is present in the saliva and pustules One form, variola major, has a 30% mortality rate The incubation period for smallpox is 10 to 12 days. A flat, red-lesioned rash appears 2 to 3 days postexposure.

A client is being treated for cyanide exposure. The nurse would least likely expect which agent to be used as part of the client's treatment?

Atropine Cyanide exposure is treated with amyl nitrate, sodium nitrite, and sodium thiosulfate. Atropine is used for nerve agent exposure.

A patient has been field triaged and categorized as blue. The nurse recognizes that the patient requires which of the following type of treatment?

Fast-track or psychological support When a patient is categorized as blue, field triage has identified fast-track or psychological support needs. Field triaged patients who require emergent care will be categorized as red. Field triaged patients who require immediate care will be categorized as yellow. Field triaged patients who require urgent care will be categorized as green.

Which isolation category should the nurse use to guide care when caring for a client with anthrax

Standard precautions Standard precautions, measures for reducing the risk of transmitting pathogens, are sufficient for caring for clients infected with anthrax. These precautions are for all patients being cared for in the hospital. Droplet, airborne, and contact precautions initiate additional measures beyond those for standard precautions.

A nuclear reactor overheated, releasing radiation throughout the plant. A worker close to reactor received at least 800 rads and has had an onset of vomiting, bloody diarrhea, and, when brought to the hospital, was in shock. What is this patient's predicted survival?

Improbable Improbable survivors have received more than 800 rad of total-body penetrating irradiation. People in this group demonstrate an acute onset of vomiting, bloody diarrhea, and shock. Any neurologic symptoms suggest a lethal dose of radiation (CDC, 2006). Possible survivors present with nausea and vomiting that persist for 24 to 48 hours. Probable survivors have either no initial symptoms or only minimal symptoms (e.g., nausea and vomiting), or these symptoms resolve within a few hours. "Likely" is not a survival category.

A patient with a minor burn would be triaged as which of the following?

Minimal A minor burn would be triaged as minimal. Conditions related to the immediate category include a sucking chest wound and shock. Conditions related to the delayed category include sift tissue injuries and most eye and CNS injuries. Conditions related to the expectant category include unresponsive patients with penetrating head wounds.

Several families arrive at the scene of a disaster and are asking for information about their family members. Which person would be most appropriate to provide them with any information?

Public Information Officer When dealing with family members requesting information about loved ones, the Public Information Officer would be the person who provides this information. Security personnel would be used to maintain order and keep media and others away from client care areas. The Incident Commander would be the person in charge of the Incident Command System and is responsible for the entire operation at the scene. The Hospital Safety Officer is a member of the hospital Incident Command System who reports directly back to the Incident Commander.

A nurse is providing care to a client who was a victim of a blast injury that occurred in an enclosed building. The nurse assesses the client closely for which of the following as occurring most frequently?

Tympanic membrane rupture The tympanic membrane is the most frequent injury after subjection to a pressure wave because it is the body's most sensitive organ to pressure. Internal organ damage, head injuries, and bone fractures are less common. Head injuries are typically minor and bone fractures are more common in older adults due to their decreased bone density.

One of the nuclear power plants experiences a crack in the protection of the core when the cooling system malfunctions. The thought is that the cooling system was tampered with. Healthcare facilities in the area are inundated with victims residing in the area around the power plant. What category of disaster would this be?

A radiologic disaster The devices that initiate, control, and sustain the nuclear reactions as well as spent fuel are a potential concern for the escape of radiation. The scenario described does not indicate option A, B, or C; therefore, they are incorrect.

The nurse is evaluating a skin lesion on a client brought to the emergency department. The nurse notes characteristics of chickenpox but has the physician evaluate the lesion for which biologic disaster agent?

Smallpox Smallpox may be mistaken for chickenpox due to the characteristics of the lesions. Botulism is a neurological toxin. Rubella is a communicable disease. Anthrax is a spore-forming bacterium that is inhaled or injected.

Four clients injured in an automobile accident enter the emergency department at the same time. The triage nurse evaluates them immediately. The nurse should assign the highest priority to the client with the:

maxillofacial injury and gurgling respirations. Emergency department triage involves giving priority to clients at highest risk for loss of life, limb, or vision. Clients with poor prognoses are given a lesser priority. The client with the maxillofacial injury and gurgling respirations needs immediate attention because of an impaired airway. The spinal cord injury client doesn't exhibit immediate airway needs. The client with the severe head injury and no blood pressure has a grave prognosis. Although the client in early labor is an urgent priority, early labor doesn't surpass airway compromise in importance.

A nursing instructor is reviewing the various security threat levels associated with the Department of Homeland Security. When describing the orange level, which of the following would the nurse include?

Security and screenings are increased. The orange level as identified by the Department of Homeland Security indicates a high threat level risk of attack but the specific site may not yet be identified. There are increased security and screenings and activation of the Incident Command System. The identification of a specific site and lockdown occurs with the red level of security threat. Increased monitoring activities occur with the yellow level of security threat

Which of the following would the nurse expect to assess in a client who has inhaled Clostridium botulinum? Select all that apply.

Diplopia Dysphagia Fever Dry mouth Inhalation of C. botulinum manifests with fever, symmetric descending flaccid paralysis with multiple cranial nerve palsies, diplopia, dysphagia, dry mouth, and alert mental status.

A public health nurse is presenting an educational event to the local disaster response team on radiation injury. The nurse describes a client whose burns and trauma are evident. What type of radiation injury is this?

External External radiologic contamination occurs from exposure to fallout on the skin, hair, and clothing. Direct and indirect are distracors for this question. This does not describe a client with internal radiologic contamination.

The nurse is caring for a client affected by a nerve agent. The nurse quickly gives a tutorial on the neurotransmitters and nervous system affected. Which couplet is most correct?

Acetylcholine, parasympathetic nervous system Nerve agents cause fatal consequences by inhibiting acetyl cholinesterase. Acetyl cholinesterase is an enzyme that inactivates acetylcholine, a neurotransmitter of the parasympathetic nervous system. No other option is correct.

The nurse is triaging people that have been involved in a bus accident. A triaged patient with psychological disturbances would be tagged with which color?

Green Triage category "Minimal" is coded green and includes injuries that are minor and for which treatment can be delayed hours to days, such as psychological disturbances.

During a facility disaster drill, an "injured client" presents to the emergency department with complaints of dry mouth, inability to focus his vision, and double vision. A nurse notes that the client has an unsteady gait and appears to be very weak. The client states, "My arms and legs feel like they just can't move." A nurse suspects the client may be a victim of bioterrorism with:

botulism. A client with a mild to moderate case of botulism experiences dry mouth, double vision, unfocused vision, weakness, a sense of paralysis, and an unsteady gait. Anthrax symptoms include fever, flulike symptoms, cough, and a sore throat. Herpes isn't an agent of bioterrorism. Ebola symptoms include malaise, fatigue, headache, sore throat, and nausea.

Which of the following statements reflects the nursing management of pulmonary anthrax (B. anthracis)?

Treatment with ciprofloxacin or doxycycline is suggested after exposure. Treatment is with ciprofloxacin or doxycycline. Anthracis is a spore forming bacteria resulting in gastrointestinal, pulmonary, and skin symptoms. Symptoms are dependent upon contact, ingestion, or inhalation of the spores. Routine universal precautions are effective. Anthrax survives in the spore form for long periods making the body a potential source of infection for morticians. Blood cultures are required to confirm the bacteria's presence and diagnosis. The pulmonary effects include respiratory failure, shock, and death within 24 to 36 hours after exposure.

A radiation disaster has occurred in the local community and clients are being transported to the nearby hospital. As part of the response team, an emergency department nurse is working to prepare the facility for the clients. As the clients arrive, which of the following would be done first?

Client would be checked with a meter for external contamination Each client who arrives at the hospital after radiation exposure should be surveyed with a radiation survey meter for external contamination and then directed toward the decontamination area as needed. After showering, the client would be resurveyed with the meter to ensure that all radioactive contaminants have been removed. If not, continued washings occur until the client if free of contaminants. Samples of urine, feces, and vomitus are surveyed if internal contamination is suspected. When the client is free of contaminants, then he or she would be allowed to enter the facility.

Which of the following federal disaster resources provides scene control and collection of forensic evidence?

Federal Bureau of Investigation (FBI) The FBI provides scene control and collection of forensic evidence. FEMA can activate teams such as the Urban Search and Rescue Teams (USRTs). The CDC collaborate to create the expertise, information, and tools needed to protect the health of the nation and the world. The NDMS has many medical support teams, such as National Medical Response Teams for Weapons of Mass Destruction.

The student nurse is completing a simulation where a client is the victim of nerve gas. The instructions are for the student to set up the room and have all needed supplies available. Which medication does the student nurse ensure is in the medication administration system to control seizures?

Valium intravenous injection The students nurse is correct to have Valium intravenously on hand for seizure activity. When seizure activity occurs, the intravenous route is the best option to deliver the medication safely and rapidly into the system. It would be very difficult to administer medication both orally and intramuscularly.

A patient was brought into the ED after sustaining injuries due to an explosion while welding. The patient is breathing but has an oxygen saturation of 90%, a respiratory rate of 32, and is coughing. What is the priority action by the nurse?

Administer oxygen with a nonrebreather mask. Blast lung results from the blast wave as it passes through air-filled lungs. The result is hemorrhage and tearing of the lung, ventilation-perfusion mismatch, and possible air emboli. Typical signs and symptoms include dyspnea, hypoxia, tachypnea or apnea (depending on severity), cough, chest pain, and hemodynamic instability. Management involves providing respiratory support that includes administration of supplemental oxygen with a nonrebreathing mask but may also require endotracheal intubation and mechanical ventilation.

MSII Prep U Ch. 73- Terrorism, Mass Casualty, and Disaster Nursing - Subjecto.com

MSII Prep U Ch. 73- Terrorism, Mass Casualty, and Disaster Nursing

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To prepare the community for the possible threat of anthrax, a nurse must teach that:

anthrax can infect the integumentary, GI, and respiratory systems. Anthrax can infect the integumentary, GI, and respiratory systems. Immunizations are appropriate only for those at risk of anthrax exposure. Isoniazid, rifampin, and pyrazinamide are used to treat tuberculosis, not anthrax. Penicillin is the most common drug used to treat anthrax.

When preparing for an emergency bioterrorism drill, the nurse instructs the drill volunteers that each biological agent requires specific patient management and medications to combat the virus, bacteria, or toxin. Which of the following statements reflect the patient management of variola virus (smallpox)?

Smallpox spreads rapidly and requires immediate isolation. Smallpox is spread by droplet or direct contact. No antiviral agents are effective against smallpox; however, vaccination within 2 to 3 days of exposure is protective. It spreads rapidly and requires immediate isolation. Even in death, the disease can be transmitted. In 4 to 5 days, vaccination may prevent death and should be administered with vaccinia immune globulin.

A nurse who is working as part of a disaster response team is performing triage at a mass casualty incident. One of the victims has a sucking chest wound. The nurse would triage this client using which color-coded tag?

Red A client with a sucking chest wound is triaged as needing immediate care and would be tagged red. Clients with injuries that are significant and require immediate care but can wait hours without threat to life or limb would be tagged yellow. Clients with minor injuries would be tagged green. Clients with injuries that are extensive and whose chances of survival are unlikely even with definitive care are tagged black.

Nursing students are reviewing the various weapons of mass destruction, specifically biologic agents. The students demonstrate understanding of the information when they identify which of the following as the most likely weaponized agent?

Anthrax Although tularemia, botulism, and plague are biologic agents that can be used as weapons of mass destruction, anthrax is recognized as the most likely weaponized biologic agent.

A nurse is working with a group of disaster victims to reduce the psychological effects of the trauma. Which of the following would be least helpful?

Encouraging the victims to watch television replays of the event. Nurses should discourage victims from subjecting themselves to repeated exposure to the event through media replays and news articles. Nurses can assist disaster victims through active listening and providing emotional support, giving information and referring them to therapists, social workers, or mental health services as necessary. In addition, nurses should encourage victims to return to normal activities and social roles when appropriate.

You are an Emergency Department nurse who has to care for three victims of anthrax. The first victim inhaled the toxin, the second victim ingested it, and the third victim suffered a skin infection. Which client should be cared for first?

The one who inhaled the toxin The nurse should first treat the client who is at greatest risk. The most serious form of anthrax develops upon inhalation. If diagnosed incorrectly and untreated, the infection progresses to severe respiratory distress, and in severe situations, death may also occur. Ingesting the bacteria is less lethal, with symptoms of nausea, vomiting, diarrhea, and abdominal pain. Skin infection is the least deadly form characterized by painless lesions usually on the head, hands, and arms. Therefore, the client who inhaled the toxin should always get first priority.

Three victims of radiation exposure are brought into the Emergency Department. As the nurse caring for these clients, you would expect what substance to be ordered to reduce radiologic organ damage?

Potassium iodide Taking substances called potassium iodide, Prussian blue, and diethylenetriamine pentaacetate can prevent or reduce radiologic organ damage. Option A, C and D are incorrect and used only as distractors.

A pipe bomb detonated on a city bus, causing numerous casualties. This would be an example of which type of disaster?

intentional human Intentional human disasters include bombings, biologic disasters, and chemical disasters. Natural disasters are caused by nature; examples include tornadoes and hurricanes. Unintentional disasters are accidents that may result in mass trauma and disruptions of services depending on their scale. A biologic disaster is one in which pathogens or their toxins cause harm to many humans and other living species.

The nurse is caring for victims after a mass casualty incident with high-dosage radiation exposure. The victims are experiencing fever, respiratory distress, and increased excitability. The nurse documents that the victims are in which phase of radiation exposure?

Prodromal The nurse documents that the victims are in the prodromal phase. In this phase, symptoms present 48 to 72 hours after exposure and include fever, respiratory distress, and increased excitability for victims exposed to high doses of radiation. During the latent phase, symptoms include decreasing numbers of lymphocytes, leukocytes, thrombocytes, and red blood cells.

The nurse is triaging patients from a 10-car pile-up on the interstate and assesses a patient with a sucking chest wound. What category should this patient be placed in?

Priority 1 Triage category "Immediate" is priority 1 (red) and includes injuries that are life threatening but survivable with minimal intervention, such as sucking chest wound, airway obstruction secondary to mechanical cause, and shock

A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority?

Monitor vital signs and oxygen saturation every 15 to 30 minutes. Monitoring vital signs and oxygen saturation every 15 to 30 minutes takes priority. Suctioning the client as needed to obtain a sputum specimen may be necessary, but assessing the client for changes in his respiratory status takes priority. Assessing intake and output and providing adequate hydration are important steps for liquefying secretions; however, they don’t take priority. Reassuring the client that intubation and mechanical ventilation is temporary is inappropriate. The client may not require intubation and mechanical ventilation; however, if he does, the nurse can’t predict the length of time it may be necessary.

Exposure to gamma radiation can be decreased by completing which of the following actions?

Providing distance from radiation source Gamma radiation can penetrate clothing and skin. Thick clothes do not have any kind of protection. Lead blocks radiation, but it is safest to limit exposure and to distance oneself from the source

Which of the following is the most likely weaponized biological agent available?

Anthrax Anthrax is recognized as the most likely weaponized biologic agent available. Anthrax is caused by replicating bacteria that release toxin, resulting in hemorrhage, edema, and necrosis. The plague, smallpox, and botulism are not the most likely weaponized biological agents available.

Which of the following is defined as the potential of an agent to cause injury to the body?

Toxicity Persistence means that the chemical is less likely to vaporize and disperse. Volatility is the tendency for a chemical to become a vapor. Toxicity is the potential of an agent to cause injury to the body. Latency is the time from absorption to the appearance of symptoms.

A nursing instructor is describing the role of a nurse during a disaster. Which of the following would best reflect the nurse’s role?

Variable depending on the needs of the situation The role of the nurse during a disaster varies and depends on the needs or situation. Nurses may be asked to perform duties outside their areas of expertise and may take on responsibilities normally held by physicians or advanced practice nurses. During a disaster, nursing care focuses on essential care from a perspective of what is best for all clients.

A nurse is providing care to a client who has been exposed to phosgene vapor. Which nursing diagnosis would the nurse identify as the priority?

Impaired gas exchange related to destruction of the pulmonary membrane Phosgene vapor is a pulmonary agent that destroys the pulmonary membrane leading to pulmonary edema, with shortness of breath. Therefore, impaired gas exchange would be the priority. Impaired skin integrity would be appropriate for exposure to a vesicant. Disturbed sensory perception, visual would be appropriate for a client exposed to a nerve agent. Decreased cardiac output would be appropriate for a client exposed to a blood agent, such as cyanide, which inhibits aerobic metabolism.

You are caring for clients who have been exposed to a toxic nerve agent. You will need to use diazepam with these clients. Why is diazepam given when managing the effects of toxic nerve agent toxicity?

To control possible seizures Seizures are likely to occur only after exposure to a nerve agent. Diazepam controls seizures. Atropine sulfate counteracts excess acetylcholine at muscarinic sites. Pralidoxime chloride reactivates acetylcholinesterase. Atropine is typically administered to stop any kind of hypersecretion.

You are caring for radiation victims. What is the most important factor that you should consider to assess a client’s chance of survival in acute radiation syndrome (ARS)?

Dosage of gamma radiation The chance of surviving ARS depends on the dosage of gamma radiation a person receives. ARS is not related to chemical (gas) or biologic (infection, contact) disasters.

The nurse is developing a plan of care for patients exposed to radiation during a mass casualty incident. The nurse assesses the onset of gastrointestinal symptoms such as nausea, vomiting, loss of appetite, diarrhea, and/or fatigue within how many hours after exposure?

48 to 72 The prodromal phase (presenting symptoms) of radiation exposure occurs within 48 to 72 hours after exposure. Signs and symptoms include nausea, vomiting, loss of appetite, diarrhea, and fatigue. With high-dose radiation exposure, the signs and symptoms may include fever, respiratory distress, and increased excitability.

Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage?

Priority 4 Triage category "Expectant" is priority 4 (black) and applies to patients with injuries that are extensive and whose chances of survival are unlikely even with definitive care, such as unresponsive patients with penetrating head wounds, high spinal cord injuries, and wounds involving multiple anatomic sites and organs.

During a disaster, the nurse sees a victim with a green triage tag. The nurse knows that the person has which type of injuries?

Minor and treatment can be delayed hours to days A green triage tag (priority 3 or minimal) indicates injuries that are minor and treatment can be delayed hours to days. A red triage tag (priority 1 or immediate) indicates injuries that are life threatening but survivable with minimal intervention. A yellow triage tag (priority 2 or delayed) indicates injuries that are significant and require medical care, but can wait hours without threat to life or limb. A black triage tag (priority 4 or expectant) indicates injuries that are extensive and chances of survival are unlikely even with definitive care.

A client has been exposed to a vesicant and is undergoing decontamination. Which of the following most likely would be used?

Soap and water A client who is exposed to a vesicant agent undergoes decontamination with soap and water. Scrubbing with sodium hypochlorite solutions is avoided because they increase penetration of the nerve agent. Alcohol and chlorhexidine are inappropriate choices for decontamination.

When describing the use of smallpox as a biologic agent, which of the following would the nurse include as the primary means of infection?

Direct contact Smallpox is extremely contagious and infection occurs by direct contact, contact with clothing or linens, or droplets from person to person only after the fever has decreased and the rash phase has begun. Anthrax occurs via inhalation, skin contact, or gastrointestinal ingestion. Nerve agents can be precutaneously absorbed.

Homeland Security has alerted the disaster response teams in your region of a potential terrorist attack in the form of a nuclear blast. You are a part of the disaster response system and you know that with a nuclear blast you would need to be prepared for what classification of disaster?

Radiologic Radiologic disasters can occur in the following ways: Explosion of a dirty bomb; Damage to or human error in a nuclear power plant facility; Nuclear blast.

A nurse is providing disaster care in an event that is known to involve gamma radiation. When admitting victims of the disaster, what should the nurse do to best reduce victims’ risks of injury?

Remove victims’ clothing and have them wash themselves thoroughly. The nurse should have victims shower and change clothes and irrigate or wash open wounds with soap and water. Cleansing the skin helps to reduce the transition from external to internal radiologic contamination. Infectious microorganisms are not involved, so chlorhexidine is of no particular benefit. Applying PPE over contaminated clothing could worsen the risk for injury. Adequate ventilation is important, but removal of contaminants is the priority because of the increased risk for injury.

The nurse is on a community awareness safety committee. When prioritizing biological agents according to potential morbidity and mortality, which cluster of biological agents hold the highest mortality?

Anthrax, smallpox The cluster of agents with the highest mortality includes anthrax and smallpox. The Hantavirus and tuberculosis agents are not presently used for bioterrorism. Botulism and Salmonella as well as Escherichia coli and Brucella species are of low mortality.

During a disaster, the nurse triages a victim with a fractured wrist. Which color triage tag should the nurse apply?

Green A green triage tag (priority 3 or minimal) indicates injuries that are minor and treatment can be delayed hours to days. A red triage tag (priority 1 or immediate) indicates injuries that are life threatening, but survivable with minimal intervention. A yellow triage tag (priority 2 or delayed) indicates injuries that are significant and require medical care, but can wait hours without threat to life or limb. A black triage tag (priority 4 or expectant) indicates injuries that are extensive and chances of survival are unlikely even with definitive care.

A nurse volunteers to help decontaminate a victim. Which of the following is the first action that the nurse should take?

Removing victim’s clothing and jewelry To be effective, decontamination must include a minimum of two steps. The first step is removing the patient’s clothing and jewelry and then rinsing the patient with water. The second step consists of a thorough soap and water wash and rinse.

The NATO triage system uses color-coded tagging to identify severity of injuries. A patient with survivable but life-threatening injuries (i.e., incomplete amputation) would be tagged with which color?

Red Triage category "Immediate" is coded red and includes injuries that are life threatening but survivable with minimal intervention, such as an incomplete amputation.

A soldier is preparing to enter an area in which there is a high risk for chemical exposure to a nerve agent. What should the soldier be given prior to entering this area?

Mark I automatic injectors that contain 2 mg atropine and 600 mg pralidoxime chloride Military personnel believed to be at risk for chemical attack are provided with Mark I automatic injectors, which contain 2 mg atropine and 600 mg pralidoxime chloride. Diazepam may be administered by a partner.

All people who have household or face-to-face contact with the patient diagnosed with smallpox after the fever begins should be vaccinated within what timeframe to prevent infection and death?

4 days All people who have household or face-to-face contact with the patient after the fever begins should be vaccinated within 4 days to prevent infection and death.

A nurse is preparing to provide care to clients who are victims of an earthquake. Which of the following would the nurse identify as a factor that would least likely affect the emergency response?

Loss of building structures In the event of a natural disaster, loss of communications, potable water, and electricity is usualy the greatest obstacle to a well-coordinated emergency response. Loss of building structures could increase the risk to emergency response personnel but they would have the least effects on the emergency response.

The nurse is caring for a victim of a chemical disaster. Medications given in the treatment of this client include amyl nitrate, sodium nitrate, and sodium thiosulfate. What chemical agent does the nurse know this client has been exposed to?

Cyanide They administer one or all of the following antidotes: amyl nitrate, sodium nitrate, and sodium thiosulfate. Amyl nitrate promotes the formation of methemoglobin, which combines with cyanide to form nontoxic cyanmethemoglobin. Therefore, options A, B, and D are incorrect.

You are the nurse caring for three clients who have been diagnosed with anthrax. They were exposed after boarding a flight where a white powdery substance was found in one of the restrooms. You know that these clients would be classed as being victims of which of the following?

A biologic disaster Anthrax is a biologic agent that could be the cause of a biologic disaster, one in which pathogens or their toxins cause harm to many humans and other living species. Anthrax is not a natural, radiologic, or chemical agent of disaster.

During a mass casualty event, a person whose injuries are extensive and whose chances of survival are unlikely even with definitive care would receive which color tag?

Black A black tag means expectant death, and that the injuries are extensive and chances of survival are unlikely even with definitive care. A green tag is used when injuries are minor and treatment can be delayed hours to days. A red tag means that the person’s injuries are life-threatening but survivable with minimal intervention. A yellow tag indicates a person whose injuries are significant and require medical care, but can wait hours without threat to life or limb.

A nuclear accident (intentional or unintentional) can cause significant harm to those living nearby or at a distance. Harmful levels of invisible gamma radiation penetrate the body, not only causing devastating injuries but possibly contaminating others. What type of transmission precaution prevents such person-to-person contamination?

contact Invisible gamma radiation penetrates the body and can be eliminated in blood, sweat, urine, and feces. Consequently, a contaminated person can contaminate others through contact with body fluids or surfaces he or she touches. Airborne transmission requires the suspension and transport on air currents beyond 3 feet and is the way in which many pathogens or toxins are transmitted. Invisible gamma rays do not fall into this category, however. Gamma radiation does not travel in a liquid, or droplet, form. Standard precautions encompass more than person-to-person contamination.

The nurse is instructing on bioterrorism agents. Which of the following does the nurse emphasize as an agent which is transmitted from person to person?

Smallpox Smallpox is highly contagious and caused by a variola virus. Individuals infected with the botulinum toxin and anthrax are not at risk to others; there are no reports of person to person transmission. Varicella, commonly called the chickenpox, is contagious but not a bioterrorism agent.

During a terrorist attack, multiple victims were exposed to nitrogen mustard. While caring for one of the victims admitted to the hospital, the nurse notes large, serous fluid-filled, circumscribed areas resembling a dome over the victim’s axillae and antecubital spaces. The nurse should document this find as being which of the following?

Bullae The nurse should document the large, serous fluid-filled, circumscribed areas as bullae. Papules are solid elevated superficial lesions. Macules are flat circumscribed areas less than 1 cm in diameter. An abscess is a nodule/tumor greater than 1 cm that contains pus

A patient was suspected of being in direct contact with anthrax but is exhibiting no signs or symptoms. What type of prophylaxis does the nurse know this patient will have to take?

Ciprofloxacin (Cipro) for 60 days At present, anthrax is penicillin sensitive; however, strains of penicillin-resistant anthrax are thought to exist. Recommended treatment includes penicillin ( Penicillin V), erythromycin (Erythrocin), gentamicin ( Garamycin), or doxycycline (Vibramycin). If antibiotic treatment begins within 24 hours after exposure, death can be prevented. In a mass casualty situation, treatment with ciprofloxacin (Cipro) or doxycycline is recommended, because these easily administered oral antibiotic agents are stockpiled and there should be sufficient dosages to fully treat many anthrax-exposed patients.

Which of the following terms refers to a process by which an individual receives education about recognition of stress reactions and management strategies?

Defusing Defusing is a process by which the individual receives education about recognition of stress reactions and management strategies for handling stress. It is a component of critical incident stress management (CISM). Debriefing is a more complicated intervention of critical incident stress management (CISM) and it involves a 2 to 3 hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (eg, flashbacks, difficulty sleeping, intrusive thoughts) and other psychological ramifications. In follow-up, members of the critical incident stress management (CISM) team contact the participants of a debriefing and schedule a follow-up meeting, if necessary. People with ongoing stress reactions are referred to mental health specialists. Critical incident stress management (CISM) is an approach to preventing and treating the emotional trauma that can affect emergency responders as a consequence of their jobs but that can also occur to anyone involved in a disaster or mass casualty incident.

Inhalation of anthrax mimics which disease process?

Flu Anthrax symptoms mimic those of the flu, and usually treatment is sought only when the second stage of severe respiratory distress occurs. Burns occur with sulfur mustard. Bronchospasm can occur with phosgene or chlorine. Respiratory distress may occur with cyanide.

A nurse is preparing an in-service education program to a group of nurses who are members of a disaster response team specializing in biologic weapons. Which of the following would the nurse include as the agent of choice when dealing with a mass casualty incident involving anthrax?

Ciprofloxacin In mass casualty incidents involving anthrax, treatment with ciprofloxacin or doxycycline is recommended. Overall recommended agents for treating anthrax include penicillin, erythromycin, gentamicin, and doxcycline.

A client, contaminated following exposure to radiation, is brought to the hospital for assessment. Which nursing action is essential?

Place the client in strict isolation. It is important for the nurse to realize that a contaminated person can contaminate others through contact with body fluids or surfaces which he or she touches. Upon arrival to the hospital, the client is placed in strict isolation to minimize the exposure of others. The client will then have vital signs and a complete assessment.

The nurse is caring for a client who is critically ill and has high radiation levels in the system. When discussing the needs of patient care and the need to protect nursing staff, which is discussed as the optimal barrier against gamma radiation?

Lead barriers and protective aprons The optimal barrier against gamma radiation is lead. All other options may also be incorporated in the plan of care.

The nurse is caring for a client diagnosed with botulism. Which medication classification does the nurse anticipate?

Antitoxins Botulism is a disease that develops from the neurotoxin produced by Clostridium botulinum. Botulinum antitoxin is the only treatment after exposure to lessen the severity of symptoms. Antibiotics are used for anthrax. Supportive treatments such as antipyretics are used for smallpox. Anti-inflammatory medications are not treatments for botulism.

The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates?

Severe, credible impending threat, usually with a site specified Imminent threat level indicates a severe, credible impending threat, usually with a site specified.

The victims of a tornado disaster have been triaged, and a number of victims have been placed in the expectant category based on their injuries. What nursing interventions should be used to care for these clients? Select all that apply

Provide comfort. Provide emotional support. Nurses should provide comfort and emotional support to victims in an expectant triage category, and reassess them again after managing those in the immediate triage category. Nurses should not totally abandon victims in the expectant category; they should transport them for treatment when resources become available. Victims who have injuries that are treatable are the priority for attention, but those who may soon die should not be neglected.

The nurse is caring for a client exposed to a blistering agent. While the nurse is quickly decontaminating the client by showering and bagging all client clothing, what is the nurse simultaneously assessing for?

Respiratory compromise A person exposed to a blistering agent or vesicant must be decontaminated immediately, with clothing removed and bagged. Irrigation of the victim’s eyes and application of topical analgesia, antibiotics, and lubricants to the skin occur. Simultaneously, the nurse is assessing the respiratory system for airway obstruction because blisters from inhaled toxics can swell obstructing respiratory passages.

During a mass casualty incident (hurricane), a triage nurse participated in separating patients according to the severity of their injuries. She tagged a patient with a sucking chest wound with the color:

red Red refers to a life-threatening but survivable injury. Refer to Table 56-3 in the text for an explanation of the other colors.

Smallpox is considered a biological agent of warfare. Which of the following are correct statements about the virus that will direct responses? Select all that apply.

It is extremely contagious after appearance of a rash A large amount of the virus is present in the saliva and pustules One form, variola major, has a 30% mortality rate The incubation period for smallpox is 10 to 12 days. A flat, red-lesioned rash appears 2 to 3 days postexposure.

A client is being treated for cyanide exposure. The nurse would least likely expect which agent to be used as part of the client’s treatment?

Atropine Cyanide exposure is treated with amyl nitrate, sodium nitrite, and sodium thiosulfate. Atropine is used for nerve agent exposure.

A patient has been field triaged and categorized as blue. The nurse recognizes that the patient requires which of the following type of treatment?

Fast-track or psychological support When a patient is categorized as blue, field triage has identified fast-track or psychological support needs. Field triaged patients who require emergent care will be categorized as red. Field triaged patients who require immediate care will be categorized as yellow. Field triaged patients who require urgent care will be categorized as green.

Which isolation category should the nurse use to guide care when caring for a client with anthrax

Standard precautions Standard precautions, measures for reducing the risk of transmitting pathogens, are sufficient for caring for clients infected with anthrax. These precautions are for all patients being cared for in the hospital. Droplet, airborne, and contact precautions initiate additional measures beyond those for standard precautions.

A nuclear reactor overheated, releasing radiation throughout the plant. A worker close to reactor received at least 800 rads and has had an onset of vomiting, bloody diarrhea, and, when brought to the hospital, was in shock. What is this patient’s predicted survival?

Improbable Improbable survivors have received more than 800 rad of total-body penetrating irradiation. People in this group demonstrate an acute onset of vomiting, bloody diarrhea, and shock. Any neurologic symptoms suggest a lethal dose of radiation (CDC, 2006). Possible survivors present with nausea and vomiting that persist for 24 to 48 hours. Probable survivors have either no initial symptoms or only minimal symptoms (e.g., nausea and vomiting), or these symptoms resolve within a few hours. "Likely" is not a survival category.

A patient with a minor burn would be triaged as which of the following?

Minimal A minor burn would be triaged as minimal. Conditions related to the immediate category include a sucking chest wound and shock. Conditions related to the delayed category include sift tissue injuries and most eye and CNS injuries. Conditions related to the expectant category include unresponsive patients with penetrating head wounds.

Several families arrive at the scene of a disaster and are asking for information about their family members. Which person would be most appropriate to provide them with any information?

Public Information Officer When dealing with family members requesting information about loved ones, the Public Information Officer would be the person who provides this information. Security personnel would be used to maintain order and keep media and others away from client care areas. The Incident Commander would be the person in charge of the Incident Command System and is responsible for the entire operation at the scene. The Hospital Safety Officer is a member of the hospital Incident Command System who reports directly back to the Incident Commander.

A nurse is providing care to a client who was a victim of a blast injury that occurred in an enclosed building. The nurse assesses the client closely for which of the following as occurring most frequently?

Tympanic membrane rupture The tympanic membrane is the most frequent injury after subjection to a pressure wave because it is the body’s most sensitive organ to pressure. Internal organ damage, head injuries, and bone fractures are less common. Head injuries are typically minor and bone fractures are more common in older adults due to their decreased bone density.

One of the nuclear power plants experiences a crack in the protection of the core when the cooling system malfunctions. The thought is that the cooling system was tampered with. Healthcare facilities in the area are inundated with victims residing in the area around the power plant. What category of disaster would this be?

A radiologic disaster The devices that initiate, control, and sustain the nuclear reactions as well as spent fuel are a potential concern for the escape of radiation. The scenario described does not indicate option A, B, or C; therefore, they are incorrect.

The nurse is evaluating a skin lesion on a client brought to the emergency department. The nurse notes characteristics of chickenpox but has the physician evaluate the lesion for which biologic disaster agent?

Smallpox Smallpox may be mistaken for chickenpox due to the characteristics of the lesions. Botulism is a neurological toxin. Rubella is a communicable disease. Anthrax is a spore-forming bacterium that is inhaled or injected.

Four clients injured in an automobile accident enter the emergency department at the same time. The triage nurse evaluates them immediately. The nurse should assign the highest priority to the client with the:

maxillofacial injury and gurgling respirations. Emergency department triage involves giving priority to clients at highest risk for loss of life, limb, or vision. Clients with poor prognoses are given a lesser priority. The client with the maxillofacial injury and gurgling respirations needs immediate attention because of an impaired airway. The spinal cord injury client doesn’t exhibit immediate airway needs. The client with the severe head injury and no blood pressure has a grave prognosis. Although the client in early labor is an urgent priority, early labor doesn’t surpass airway compromise in importance.

A nursing instructor is reviewing the various security threat levels associated with the Department of Homeland Security. When describing the orange level, which of the following would the nurse include?

Security and screenings are increased. The orange level as identified by the Department of Homeland Security indicates a high threat level risk of attack but the specific site may not yet be identified. There are increased security and screenings and activation of the Incident Command System. The identification of a specific site and lockdown occurs with the red level of security threat. Increased monitoring activities occur with the yellow level of security threat

Which of the following would the nurse expect to assess in a client who has inhaled Clostridium botulinum? Select all that apply.

Diplopia Dysphagia Fever Dry mouth Inhalation of C. botulinum manifests with fever, symmetric descending flaccid paralysis with multiple cranial nerve palsies, diplopia, dysphagia, dry mouth, and alert mental status.

A public health nurse is presenting an educational event to the local disaster response team on radiation injury. The nurse describes a client whose burns and trauma are evident. What type of radiation injury is this?

External External radiologic contamination occurs from exposure to fallout on the skin, hair, and clothing. Direct and indirect are distracors for this question. This does not describe a client with internal radiologic contamination.

The nurse is caring for a client affected by a nerve agent. The nurse quickly gives a tutorial on the neurotransmitters and nervous system affected. Which couplet is most correct?

Acetylcholine, parasympathetic nervous system Nerve agents cause fatal consequences by inhibiting acetyl cholinesterase. Acetyl cholinesterase is an enzyme that inactivates acetylcholine, a neurotransmitter of the parasympathetic nervous system. No other option is correct.

The nurse is triaging people that have been involved in a bus accident. A triaged patient with psychological disturbances would be tagged with which color?

Green Triage category "Minimal" is coded green and includes injuries that are minor and for which treatment can be delayed hours to days, such as psychological disturbances.

During a facility disaster drill, an "injured client" presents to the emergency department with complaints of dry mouth, inability to focus his vision, and double vision. A nurse notes that the client has an unsteady gait and appears to be very weak. The client states, "My arms and legs feel like they just can’t move." A nurse suspects the client may be a victim of bioterrorism with:

botulism. A client with a mild to moderate case of botulism experiences dry mouth, double vision, unfocused vision, weakness, a sense of paralysis, and an unsteady gait. Anthrax symptoms include fever, flulike symptoms, cough, and a sore throat. Herpes isn’t an agent of bioterrorism. Ebola symptoms include malaise, fatigue, headache, sore throat, and nausea.

Which of the following statements reflects the nursing management of pulmonary anthrax (B. anthracis)?

Treatment with ciprofloxacin or doxycycline is suggested after exposure. Treatment is with ciprofloxacin or doxycycline. Anthracis is a spore forming bacteria resulting in gastrointestinal, pulmonary, and skin symptoms. Symptoms are dependent upon contact, ingestion, or inhalation of the spores. Routine universal precautions are effective. Anthrax survives in the spore form for long periods making the body a potential source of infection for morticians. Blood cultures are required to confirm the bacteria’s presence and diagnosis. The pulmonary effects include respiratory failure, shock, and death within 24 to 36 hours after exposure.

A radiation disaster has occurred in the local community and clients are being transported to the nearby hospital. As part of the response team, an emergency department nurse is working to prepare the facility for the clients. As the clients arrive, which of the following would be done first?

Client would be checked with a meter for external contamination Each client who arrives at the hospital after radiation exposure should be surveyed with a radiation survey meter for external contamination and then directed toward the decontamination area as needed. After showering, the client would be resurveyed with the meter to ensure that all radioactive contaminants have been removed. If not, continued washings occur until the client if free of contaminants. Samples of urine, feces, and vomitus are surveyed if internal contamination is suspected. When the client is free of contaminants, then he or she would be allowed to enter the facility.

Which of the following federal disaster resources provides scene control and collection of forensic evidence?

Federal Bureau of Investigation (FBI) The FBI provides scene control and collection of forensic evidence. FEMA can activate teams such as the Urban Search and Rescue Teams (USRTs). The CDC collaborate to create the expertise, information, and tools needed to protect the health of the nation and the world. The NDMS has many medical support teams, such as National Medical Response Teams for Weapons of Mass Destruction.

The student nurse is completing a simulation where a client is the victim of nerve gas. The instructions are for the student to set up the room and have all needed supplies available. Which medication does the student nurse ensure is in the medication administration system to control seizures?

Valium intravenous injection The students nurse is correct to have Valium intravenously on hand for seizure activity. When seizure activity occurs, the intravenous route is the best option to deliver the medication safely and rapidly into the system. It would be very difficult to administer medication both orally and intramuscularly.

A patient was brought into the ED after sustaining injuries due to an explosion while welding. The patient is breathing but has an oxygen saturation of 90%, a respiratory rate of 32, and is coughing. What is the priority action by the nurse?

Administer oxygen with a nonrebreather mask. Blast lung results from the blast wave as it passes through air-filled lungs. The result is hemorrhage and tearing of the lung, ventilation-perfusion mismatch, and possible air emboli. Typical signs and symptoms include dyspnea, hypoxia, tachypnea or apnea (depending on severity), cough, chest pain, and hemodynamic instability. Management involves providing respiratory support that includes administration of supplemental oxygen with a nonrebreathing mask but may also require endotracheal intubation and mechanical ventilation.

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NASM Flashcards

Which of the following is the process of getting oxygen from the environment to the tissues of the body? Diffusion ...

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