Chapter 73 Terrorism, Mass Casualty, and Disaster Nursing

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

Green

The nurse is triaging victims after an explosion at an oil refinery. One victim reports tinnitus, dizziness, and otorrhea. For what probable condition should the nurse prepare care?

Tympanic rupture

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

A nurse working in an emergency department notes that several clients who have arrived at the emergency department within the past day are experiencing the same unusual signs and symptoms. All the clients have attended the same sporting event. Which of the following should the nurse do next?

Obtain an extensive history from each of the clients.

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

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

Toxicity

A nurse working as part of a disaster response team is triaging clients. Which of the following clients would the nurse color code as green? Select all that apply.

- Client with a fractured arm - Client with a first-degree burn to the forearm

A nurse is providing care to clients who were involved in an explosion and have sustained secondary blast injuries. Which types of injuries would the nurse expect to find? Select all that apply.

- Pentetrating trauma - Traumatic amputations

According to the U.S. Department of Homeland Security, what are indications of bioterrorism? Select all that apply.

- clusters of sick people from a shared location - higher numbers of people seeking healthcare - atypical incidence of illness for the time of year

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

4 days

The nurse is 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. The nurse knows that these clients would be classed as being victims of which of the following?

A biologic disaster

Your hospital has had an influx of clients who are in respiratory distress and require ventilator assistance. What might this indicate?

A bioterrorism attack

The disaster team in your region is responding to a local chemical plant leak. They are required to wash exposed areas of the victim's skin with a solution containing bleach and then flushed with plain water. What have these victims been exposed to?

A nerve agent

Which is the most likely weaponized biological agent available?

Anthrax

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

Antitoxins

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

Wear protective clothes

Ciprofloxacin (Cipro) for 60 days

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

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

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.

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

Anthrax acquired by which method develops into the most severe?

Inhalation

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

Minor; treatment can be delayed hours to days

A nurse is providing care to a client who was exposed to a nerve agent. Which of the following would the nurse most likely assess?

Miosis

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.

A client comes to the emergency department complaining of vision changes, nausea, vomiting, diarrhea, and tightness in the chest. The client reports that he was out on his farm spraying some pesticides. Based on the client's information, the nurse would suspect exposure to which of the following?

Nerve agent

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

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

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

Priority 4

A patient is suspected to have an air embolus after being in close proximity to an explosion at a sports arena. What position should the nurse place the patient in to prevent migration of the embolus?

Prone left lateral position

Exposure to gamma radiation can be decreased by completing which action?

Providing distance from radiation source

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

The nurse is caring for clients in the emergency department who have been admitted from the area surrounding a nuclear power plant. There had been a small explosion at the plant and a small amount of radiation had escaped. The nurse knows that this is what type of a disaster?

Radiologic

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

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.

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

Removing the victim's clothing and jewelry

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

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

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

Smallpox spreads rapidly and requires immediate isolation.

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 nurse is preparing a presentation for a group of nurses involved in a disaster training program at their facility. The nurse is describing blast injuries. Which statement would be most appropriate to include in this presentation?

The most commonly used explosive device is a pipe bomb.

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

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 nurse is caring for a client who has large dome-shaped lesions filled with clear or yellow fluid. The nurse knows that the toxic agent most likely to be the cause is what?

Vesicant

Which term refers to the tendency for a chemical to become a vapor?

Volatility

You are part of a disaster response team. Your team has been activated, and you have just reported to your mobilization point. You are assigned to triage clients as they come in. What is the first act you should perform while assessing victims of a disaster?

Wear protective clothes

A client who has been triaged as delayed would receive which color tag?

Yellow

The clinic nurse is triaging a client who had visited a smallpox affected community 14 days ago. The client has developed a fever but no rash. Should the nurse consider the client at risk for smallpox?

Yes, fever and rash may follow 14 asymptomatic days.

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

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

intentional human

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