Terrorism, Mass casualty, Disaster: Complete
A nurse is providing discharge instruction to a victim who has been exposed to anthrax but does not have any symptoms. The nurse's teaching includes that prophylactic antibiotics must be taken for: 60 days. 30 days. 14 days. 10 days.
60 days. Explanation: Victims who have been exposed to anthrax but are not exhibiting symptoms should take the prescribed prophylactic antibiotic for 60 days. The aim of the prophylaxis is to ensure that if spores were inhaled, bacteria will be killed immediately upon release from spores. Those who have symptoms of fever, cough, headache, chills, and especially evidence of mediastinal lymph node involvement should be treated with IV antibiotics and respiratory support, if needed.
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 A natural disaster A radiologic disaster A chemical disaster
A biologic disaster Explanation: 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.
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 biologic disaster A chemical disaster A nuclear blast A radiologic disaster
A radiologic disaster Explanation: 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.
A client asks the nurse what is meant by an imminent alert about a security threat posted on television by the Department of Homeland Security. What is the best response by the nurse? A specific pending threat has been identified. A lockdown is placed into effect for security purposes. Security and screenings are increased. Monitoring activities are increased.
A specific pending threat has been identified. Explanation: The National Terrorism Advisory System uses alerts and bulletins. A National Terrorism Advisory System bulletin describes trends and developments in threats of terrorism, whereas an National Terrorism Advisory System alert more fully warns of a credible threat of terrorism to the United States. The alerts may be more specifically designated as an elevated alert, meaning that there is indeed a credible alert posted, or an imminent alert, meaning that there is a specific pending threat of terrorism to the United States. An imminent alert does not involve a lockdown or increased screenings and activities.
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 Serotonin, sympathetic nervous system Norepinephrine, sympathetic nervous system Dopamine, parasympathetic nervous system
Acetylcholine, parasympathetic nervous system Explanation: 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.
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 at 2 L/min via nasal cannula. Administer oxygen with a nonrebreather mask. Start an IV of normal saline solution at 125 mL/h. Obtain a chest x-ray.
Administer oxygen with a nonrebreather mask. Explanation: 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.
The nurse is caring for a client diagnosed with botulism. Which medication classification does the nurse anticipate? An antibiotic An anti-inflammatory Antipyretics Antitoxins
Antitoxins Explanation: 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.
A client is being treated for cyanide exposure. The nurse would expect which agent to be the least likely used as part of the client's treatment? Amyl nitrate Sodium nitrite Sodium thiosulfate Atropine
Atropine Explanation: Cyanide exposure is treated with amyl nitrate, sodium nitrite, and sodium thiosulfate. Atropine is used for nerve agent exposure.
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 Penicillin Erythromycin Gentamicin
Ciprofloxacin Explanation: In mass casualty incidents involving anthrax, treatment with ciprofloxacin or doxycycline is recommended. Overall recommended agents for treating anthrax include penicillin, erythromycin, gentamicin, and doxycycline.
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? Penicillin G IM for 1 dose Rocephin (Ceftriaxone) IV for 7 days Ciprofloxacin (Cipro) for 60 days Erythromycin for 2 weeks
Ciprofloxacin (Cipro) for 60 days Explanation: 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.
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? Penicillin G IM for 1 dose Rocephin (Ceftriaxone) IV for 7 days Ciprofloxacin (Cipro) for 60 days Erythromycin for 2 weeks
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.
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. Head injuries Crush injuries Penetrating trauma Traumatic amputations Exacerbation of pre-existing conditions
Correct response: Penetrating trauma Traumatic amputations Explanation: Secondary-phase blast injuries, which result from debris or shrapnel within the bomb or from the scene, include penetrating trunk, skin, and soft tissue injuries, fractures, and traumatic amputations. Head injuries are related to the primary phase of the blast injury. Crush injuries and exacerbations of pre-existing conditions are related to the quaternary phase of the blast inj
The nurse is assessing a client who sustained a blast injury. The client is exhibiting signs and symptoms of an air embolus. The nurse would place the client in which position? Prone left lateral High-Fowler's Right side-lying Left Sims'
Correct response: Prone left lateral Explanation: A client who develops an air embolism secondary to a blast injury should be positioned in the prone left lateral position to prevent the embolus from migrating. High-Fowler's, right side-lying, and left Sims' positions would be inappropriate.
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? Sarin Mustard gas Cyanide Anthrax
Cyanide Explanation: 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.
During a mass disaster, the nurse is caring for a victim whose status has been categorized as yellow during triage. How should the nurse best allocate time and resources to this client's care? Forego immediate care because the client is unlikely to survive Place a low priority on the client's care because the client will likely recover independently Provide high-priority, immediate care to save the client's life Delay the client's treatment for a few hours if other clients need immediate care
Delay the client's treatment for a few hours if other clients need immediate care Explanation: For a client categorized as yellow, care can be safely delayed for six to eight hours. Death is not imminent, but spontaneous recovery is unlikely.
The nursing instructor is teaching her class about disasters. Which type of radiologic disaster would the instructor tell her students is less likely to cause acute radiation syndrome (ARS)? Nuclear power plant accident Explosion of a dirty bomb Nuclear blast Sarin attack
Explosion of a dirty bomb Explanation: A dirty bomb is a conventional explosive device that spreads small amounts of radiation in the form of powder or pellets. The greater danger is from the explosion; the radiation dispersed is a secondary danger. It is less likely to cause ARS, while a nuclear blast or a nuclear power plant accident can expose large numbers of people to gamma radiation. Sarin attack also involves a nerve agent but is not a radiologic disaster.
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 Direct Internal Indirect
External Explanation: External radiologic contamination occurs from exposure to fallout on the skin, hair, and clothing. Radiologic contamination is not characterized as direct or indirect. This does not describe a client with internal radiologic contamination.
Inhalation of anthrax mimics which disease process? Bronchospasm Flu Respiratory distress Burns
Flu Explanation: 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.
The nurse educator is preparing a presentation about the indicators of chemical terrorism. The nurse educator would include which indicators in the presentation. Select all that apply. Fog-like or low-lying cloud in the atmosphere Numerous dead animals and birds Increase in temperature in area of the event Strong wind in area of the event Unexplained odor atypical for the location
Fog-like or low-lying cloud in the atmosphere Numerous dead animals and birds Unexplained odor atypical for the location Explanation: The indicators that the nurse educator would include in the presentation are fog-like or low-lying cloud in the atmosphere, numerous dead animals and birds, and unexplained odor atypical for the location. The temperature in the area would not increase after a chemical event. There would be no wind associated with a chemical event.
During a disaster, the nurse triages a victim with a fractured wrist. Which color triage tag should the nurse apply? Red Green Black Yellow
Green Explanation: 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 they can wait hours without threat to life or limb. A black triage tag (priority 4, or expectant) indicates injuries that are extensive; chances of survival are unlikely even with definitive care.
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? Black Green Red Yellow
Green Explanation: 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.
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? Possible Probable Likely Improbable
Improbable Explanation: 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 is being brought into the ED who is probably infected with anthrax. The nurse should ensure what level of personal protective equipment to wear for everyone who will come in contact with the patient? Level A Level B Level C Level D
Level D Standard precautions are the only ones indicated to protect the caregiver exposed to a patient infected with anthrax. The patient is not contagious, and the disease cannot spread from person to person. Thus, only level D protection, the typical work uniform, is required.
The nurse is assisting in a disaster caused by a massive tornado that has destroyed much of the community. This disaster will require statewide and federal assistance. What classification would the disaster be? Level I Level II Level III Level IV
Level III Explanation: Level III disasters are those in which local and regional assets are overwhelmed and thus statewide or federal assistance is required. Level I disasters are those in which local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath. Level II disasters are those in which regional efforts and aid from surrounding communities are sufficient to manage the effects of the disaster. There is no Level IV disaster.
he nurse is assisting in a disaster caused by a massive tornado that has destroyed much of the community. This disaster will require statewide and federal assistance. What classification would the disaster be? Level I Level II Level III Level IV
Level III Explanation: Level III disasters are those in which local and regional assets are overwhelmed and thus statewide or federal assistance is required. Level I disasters are those in which local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath. Level II disasters are those in which regional efforts and aid from surrounding communities are sufficient to manage the effects of the disaster. There is no Level IV disaster.
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 Mark I automatic injectors that contain an antiseizure medication such as carbamazepine Mark I automatic injector filled with morphine 10 mg Mark I automatic injector filled with cyanide
Mark I automatic injectors that contain 2 mg atropine and 600 mg pralidoxime chloride Explanation: 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.
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? Cyan red Potassium iodide Russian blue Medical iodine
Potassium iodide Explanation: 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.
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 Priority 2 Priority 3 Priority 4
Priority 1 Explanation: 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.
The nurse is reviewing information from a recent disaster management training session. The nurse knows that all of the following activities are part of the preparedness phase of disaster management except for: Developing early warning systems and evacuation routes Designating locations of shelters Providing emergency care Conducting training and mock disaster response drills
Providing emergency care Explanation: The preparedness phase of disaster management is the phase of planning for saving lives. Preparedness would include conducting training and mock disaster response drills, as well as designating location of shelters and developing early warning systems and evacuation routes. Providing emergency care is an aspect of the response phase. The purpose of the response phase is to limit injuries and deaths as well as reduce property damage.
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? Black Green Red Yellow
Red Explanation: Triage category "Immediate" is coded red and includes injuries that are life threatening but survivable with minimal intervention, such as an incomplete amputation.
The nurse receives a call from EMS personnel that they are bringing in eight patients who have been exposed to a chemical after a spill. The patients have been "washed off." After the initial assessment, what should be done? Remove clothing and jewelry and rinse the patients off with water. Have the patients wash with soap and water and then rinse. Treat the patients for any burned areas from the chemical since they have already been decontaminated. Start an IV with lactated Ringer's solution at 125 mL/h.
Remove clothing and jewelry and rinse the patients off with water. Explanation: Decontamination must include a minimum of two steps. The first step is removal of the patient's clothing and jewelry and then rinsing the patient with water. Depending on the type of exposure, this step alone can remove a large amount of the contamination and decrease secondary contamination. The second step consists of a thorough soap-and-water wash and rinse. When patients arrive at the facility after being assessed and treated by a prehospital provider, it should not be assumed that they have been thoroughly decontaminated.
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? Neurological compromise Respiratory compromise Cardiovascular compromise Sensory neglect
Respiratory compromise Explanation: 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.
The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates? Elevated risk of attack Severe, credible impending threat, usually with a site specified Risk of attack, without a site specified Risk of attack, without timing specified
Severe, credible impending threat, usually with a site specified Explanation: Imminent threat level indicates a severe, credible impending threat, usually with a site specified.
A client who has been exposed to radiation develops acute radiation syndrome. It has been about 2 weeks since he initially showed signs and symptoms and the client is undergoing laboratory testing. Which of the following would the nurse expect to find? Altered electrolyte levels Thrombocytopenia Elevated neutrophil count Erythrocytosis
Thrombocytopenia Explanation: In the weeks following radiation exposure, lymphocytes, leukocytes, thrombocytes, and red blood cells decrease. Thus, thrombocytopenia would be noted. Neutrophils decrease within 1 week and red blood cells decrease within 3 weeks. Electrolyte imbalances would occur later in the course of the illness.
Which is defined as the potential of an agent to cause injury to the body? Volatility Latency Persistence Toxicity
Toxicity Explanation: The median lethal dose (LD50) is the amount of the chemical that will cause death in 50% of those who are exposed. Persistence means that the chemical is less likely to vaporize and disperse. Volatility is the tendency for a chemical to become a vapor. Latency is the time from absorption to the appearance of symptoms.
Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage? Priority 1 Priority 2 Priority 3 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.
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 Client care within the area of expertise Provision of comprehensive client-specific care Directly specified by the physician in charge
Variable depending on the needs of the situation Explanation: 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.
Which term refers to the tendency for a chemical to become a vapor? Persistence Volatility Toxicity Latency
Volatility The most common volatile agents are phosgene and cyanide. Persistence means that the chemical is less likely to vaporize and disperse. Toxicity is the potential of an agent to cause injury to the body. Latency is the time from absorption to the appearance of symptoms.
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. anthrax. herpes. Ebola.
botulism. Explanation: 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.
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 dead or dying vegetation higher numbers of people seeking healthcare atypical incidence of illness for the time of year unexplained odor atypical for the location
clusters of sick people from a shared location higher numbers of people seeking healthcare atypical incidence of illness for the time of year Explanation: The U.S. government has identified several key indications of bioterrorism to assist in its identification. These include high outbreak of similar symptoms among previously healthy people, increased numbers of sick people seeking healthcare, atypical incidence of illness for the time of year and geographic location, clusters of sick people from a shared locale, unusual mortality rates among people following a brief illness, and unexplained deaths or illness among domestic and wild animals.
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 airborne droplet standard
contact Explanation: 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.
A pipe bomb detonated on a city bus, causing numerous casualties. This would be an example of which type of disaster? intentional human natural unintentional human biologic
intentional human Explanation: 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 assessing a victim who is reported to have been exposed to sulfur mustard. The nurse's assessment should include evaluation for pulmonary edema. diarrhea. cardiac arrest and death. partial-thickness burns.
partial-thickness burns. Explanation: Sulfur mustard causes superficial to partial-thickness burns with vesicles that coalesce. Phosgene causes pulmonary edema. Sarin causes increased gastrointestinal motility and diarrhea. Cyanide causes cardiac arrest and death.
The first step in decontamination includes thoroughly washing the client with soap and water and then rinsing. removing the client's clothing and jewelry and then rinsing the client with water. immediately applying personal protective equipment to the client. immediately applying chemical decontamination foam to the area of contamination.
removing the client's clothing and jewelry and then rinsing the client with water. To be effective, decontamination must include a minimum of two steps. The first step is removal of the client's clothing and jewelry and then rinsing the client with water. The second step consists of thoroughly washing with soap and water then rinsing. The health care provider should wear PPE as indicated by the Environmental Protection Agency's levels A -D.
