"Disaster" and 1 other
After a radiation exposure, a patient has been assessed and determined to be a possible survivor. Following the resolution of the patient's initial symptoms, the care team should anticipate what event
A latent phase
A workplace explosion has left a 40-year-old man burned over 65% of his body. His burns are second- and third-degree burns, but he is conscious. How would this person be triaged
Black The patient would be triaged as black due to the unlikelihood of survival.
A client is brought to the emergency department after being exposed to nitrogen mustard. Which symptoms is the nurse likely to assess?
Conjunctivitis is a symptom of nitrogen mustard exposure. Skin blisters are seen with nitrogen mustard exposure. Nasal irritation is a symptom of nitrogen mustard exposure. Rationale 4: Vomiting is not a symptom of nitrogen mustard exposure. Rationale 5: Excessive salivation is not a symptom of nitrogen mustard exposure.
The nurse is attending a course to prepare for mass casualty incidents (MCIs). What technical skills will the nurse have to demonstrate to be a member of the response team?
Core competencies identified under technical skills include demonstrating the safe administration of medications. Core competencies identified under technical skills include demonstrating the safe administration of immunizations. Core competencies identified under technical skills include having knowledge of nursing interventions for adverse medication events.
A 3-year-old child ingested approximately 20 tablets of iron that were prescribed to the child's mother. The medication that the nurse will prepare to reverse iron is:
Deferoxamine (Desferal) is the antidote for iron overdose.
The announcement is made that the facility may return to normal functioning after a local disaster. In the emergency operations plan, what is this referred to as
Demobilization response
A client is prescribed dimercaprol as treatment for acute poisoning. The nurse understands that this medication is used as an antidote for which agents? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Dimercaprol is a chelating agent that neutralizes the effects of various heavy metals such as arsenic. Dimercaprol is a chelating agent that neutralizes the effects of various heavy metals such as gold. Dimercaprol is a chelating agent that neutralizes the effects of various heavy metals such as mercury. Rationale 4: This medication is not used to remove lead. Rationale 5: This medication is not used to remove nickel.
A nurse is undergoing debriefing with the critical incident stress management (CISM) team after participating in the response to a disaster. During this process, the nurse will do which of the following
Discuss own emotional responses to the disaster.
A nurse is triaging patients after a chemical leak at a nearby fertilizer factory. The guiding principle of this activity is what
Doing the greatest good for the greatest number of people
At a local health fair, the community nurse is educating the public on poison-control strategies. Which strategy should the nurse emphasize as the most important to follow?
Educating the community about accidental poisoning is an important part of community health nursing. Prevention is the first line of defense against accidental poisoning.
The nurse is facilitating a program on poison control and tells the group that if a known poison has been ingested, the first measure that must be taken is:
Education about accidental poisoning is an important part of nursing. Clients should keep the number of the local poison center close to the phone or call 1-800-222-1222.
A patient has been witness to a disaster involving a large number of injuries. The patient appears upset, but states that he feels capable of dealing with his emotions. What is the nurse's most appropriate intervention
Encourage the patient to return to normal social roles when appropriate.
A patient has been exposed to a nerve agent in a biochemical terrorist attack. This type of agent bonds with acetylcholinesterase, so that acetylcholine is not inactivated. What is the pathologic effect of this type of agent
Hyperstimulation of the nerve endings
A client is found at home unconscious with an empty bottle of diltiazem (Cardizem) near the couch. The emergency response team prepares to administer which antidote?
IV calcium is the antidote for Cardizem, a calcium channel blocker.
The ED staff has been notified of the imminent arrival of a patient who has been exposed to chlorine. The nurse should anticipate the need to address what nursing diagnosis
Impaired gas exchange
There has been a radiation-based terrorist attack and a patient is experiencing vomiting, diarrhea, and shock after the attack. How will the patient's likelihood of survival be characterized
Improbable
A nurse is caring for patients exposed to a terrorist attack involving chemicals. The nurse has been advised that personal protective equipment must be worn in order to give the highest level of respiratory protection with a lesser level of skin and eye protection. What level protection is this considered
Level B
The nursing supervisor at the local hospital is advised that your hospital will be receiving multiple trauma victims from a blast that occurred at a local manufacturing plant. The paramedics call in a victim of the blast with injuries including a head injury and hemorrhage. What phase of blast injury should the nurse expect to treat in this patient
Primary phase
A group of disaster survivors is working with the critical incident stress management (CISM) team. Members of this team should be guided by what goal
Providing individuals with education about recognizing stress reactions
The nurse is contacting the Centers for Disease Control and Prevention for supplies to be sent from the Strategic National Stockpile (SNS) to the site of a massive train derailment and chemical spill. What will the SNS provide?
Push Packages are preassembled caches of drugs, antidotes, and medical supplies that broadly cover a nonspecific emergency for use in early hours. Vendor-managed inventory (VMI) packages contain additional supplies that can be more event specific and ship within 24 to 36 hours.
The nurse is helping stock Push Packages. The purpose of these packages is to:
Push Packages include preassembled caches of drugs, antidotes, and medical supplies that broadly cover a nonspecific emergency for use in early hours. Stored strategically, deployment can be accomplished within 12 hours.
A client who experienced whole-body radiation exposure 6 hours ago is brought to the emergency department with radiation sickness. On assessment, the nurse would expect the client to report:
Radiation sickness occurs after exposure to ionizing radiation and can last from hours to days. The initial symptoms include nausea and vomiting.
The nurse manager in the ED receives information that a local chemical plant has had a chemical leak. This disaster is assigned a status of level II. What does this classification indicate
Regional efforts and aid from surrounding communities can manage the situation. Local efforts are likely to be overwhelmed, while state and federal assistance are not likely necessary.
Emergency department (ED) staff members have been trained to follow steps that will decrease the risk of secondary exposure to a chemical. When conducting decontamination, staff members should remove the patient's clothing and then perform what action
Rinse the patient with water.
The nurse is coordinating the care of victims who arrive at the ED after a radiation leak at a nearby nuclear plant. What would be the first intervention initiated when victims arrive at the hospital
Survey the victims using a radiation survey meter.
The nurse needs to find out what antibiotics are being stored by the Strategic National Stockpile (SNS). What agency will the nurse contact for this information?
The Centers for Disease Control and Prevention manages the Strategic National Stockpile to ensure immediate availability and deployment of essentials to any state.
A group of concerned people ask the community nurse speaking at a local town hall meeting if there is a vaccine for anthrax and, if so, if they should get it. The nurse's best response would be:
The Centers for Disease Control and Prevention recommends vaccination only for select populations: laboratory personnel who work with anthrax, military personnel deployed to high-risk areas, and those who deal with animal products imported from areas with a high incidence of the disease.
The nurse contacts the pharmacy to have the antidote for nerve agent poisoning available when victims of a mass casualty event arrive in the emergency department. The agent that the nurse is requesting is:
The antidote for nerve gas is the anticholinergic drug atropine sulfate.
A client is receiving edetate calcium disodium (Calcium EDTA) for lead poisoning. Which intervention should be part of this client's care?
The client should eat foods rich in zinc, calcium, magnesium, iron, and calcium to prevent storage of lead in the body.
A client is being treated for acute ethanol overdose. What interventions will the nurse perform when caring for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
The client will need intravenous fluids. Dextrose 5% and water may be prescribed to treat hypoglycemia, which can occur as an effect of ethanol overdose. Electrolyte imbalances can occur because of acute ethanol overdose and should be reported to the health care provider to ensure appropriate treatment. Urine output should be monitored for all clients being treated for overdose.
The nurse instructs a group of adults with young families that the five general principles for the treatment of acute poisoning are:
The five general principles are topical decontamination, prevention of absorption, neutralization, increase in the rate of excretion, and antidotes and symptomatic therapy.
Clients arrive in the emergency department complaining of difficulty breathing and eye tearing after a bomb explosion in a nearby store. The priority intervention of the health care team initially should be to:
The health care team should initially flush the skin and eyes with copious amounts of water to flush the offending agent.
A man survived a workplace accident that claimed the lives of many of his colleagues several months ago. The man has recently sought care for the treatment of depression. How should the nurse best understand the man's current mental health problem
The man is experiencing a common response following a disaster.
The nurse is teaching a group of community members about common potentially toxic substances. Which vitamin or mineral supplement would be addressed in this instruction?
The most common dangerous substances can poison, such as medicines and iron pills.
A client was exposed to cyanogen chloride. What will the nurse do to help this client?
The nurse should remove all clothing contaminated with this chemical agent.
The nurse has been notified that the ED is expecting terrorist attack victims and that level D personal protective equipment is appropriate. What does level D PPE include
The nurse's typical work uniform
A client was exposed to iodine-131. Which medication would the nurse administer to counteract the effects of this exposure?
The only recognized treatment available to counter the thyroid uptake of radiation is ingestion of potassium iodine (KI) before or immediately after exposure.
A 44-year-old male patient has been exposed to severe amount of radiation after a leak in a reactor plant. When planning this patient's care, the nurse should implement what action
The patient should be carefully protected from infection.
A major earthquake has occurred within the vicinity of the local hospital. The nursing supervisor working the night shift at the hospital receives information that the hospital disaster plan will be activated.
The supervisor will need to work with what organization responsible for coordinating interagency relief assistance Office of Emergency Management coordinates the disaster relief efforts at state and local levels
After an explosion at a nearby restaurant, several individuals require treatment at the hospital. The clients arrive at the emergency department with complaints of visual disturbances, burning of the eyes and skin, and loss of hearing. The nurses prioritize care based on the nursing diagnosis of:
This diagnosis speaks directly to the assessment of the explosion incident, and care would be centered around the risk of poisoning.
An industrial site has experienced a radiation leak and workers who have been potentially affected are en route to the hospital.
To minimize the risks of contaminating the hospital, managers should perform what action Establish a triage outside the hospital.
A client is brought to the emergency department with acute poisoning from an unknown agent. Place in order the principles that will be followed to treat this client. Standard Text: Click and drag the options below to move them up or down.
Topical decontamination Prevention of absorption Neutralization Increase in the rate of excretion Antidotes and symptomatic therapy
Which of the five general principles for treating acute poisoning would the nurse use to treat a client who was exposed to an external chemical agent? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Topical decontamination includes the removal of contaminated clothing and flushing of the skin or eyes. This would be appropriate for exposure to an external chemical agent. Application of an agent to neutralize the poison would be appropriate for an exposure to an external chemical agent.
The nurse is preparing to admit patients who have been the victim of a blast injury. The nurse should expect to treat a large number of patients who have experienced what type of injury
Tympanic membrane rupture
A nurse has had contact with a patient who developed smallpox and became febrile after a terrorist attack. This nurse will require what treatment
Vaccination
When assessing patients who are victims of a chemical agent attack, the nurse is aware that assessment findings vary based on the type of chemical agent. The chemical sulfur mustard is an example of what type of chemical warfare agent
Vesicant
A group of students arrive at the emergency department with complaints of burning eyes, coughing, and skin burning with blisters. The nurse reviews these symptoms and suspects the students could have been exposed to:
Vesicants blister the skin, respiratory tract, or eyes on contact. An acid burns the eyes, skin, and lining of the respiratory tract on contact. Tear gas irritates the eyes and respiratory tract.
A nurse who is a member of the local disaster response team is learning about blast injuries. The nurse should plan for what event that occurs in the tertiary phase of the blast injury
Victims are thrown by the pressure wave.
A client was exposed to radiation from a nuclear reactor explosion a month ago. What care will the nurse most likely provide to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Weight loss and anorexia are long-term effects of radiation sickness. Fatigue is a long-term effect of radiation sickness. Radiation sickness causes suppression of the bone marrow, which increases the client's risk of developing or contracting infections.
Which health problem is a direct effect of exposure to ionizing radiation?
When exposed to large amounts of radiation, or to small amounts over many decades, people tend to develop certain malignancies such as leukemia or thyroid cancer.
The nurse is reviewing a list from the Centers for Disease Control and Prevention that identifies bioterrorism agents that can be spread by person-to-person contact. What agents would be on this list?
Within 1-6 days after exposure, a person with pneumonic plague would be infectious to everyone who has come in contact with the person during that time.
The danger from radiation exposure arises primarily from: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
1. The amount of exposure. 2. The long-lasting effects. 3. The amount of cellular death. 4. The distance from the initial incident.
The nurse is reviewing the components of the Strategic National Stockpile (SNS), which include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
1. Intravenous administration equipment. 2. Antibiotics. 3. Life-support medications. 4. Chemical antidotes.
A patient has been admitted to the medical unit with signs and symptoms that are suggestive of anthrax infection. The nurse should anticipate what intervention
Administration of penicillin
A group of medical nurses are being certified in their response to potential bioterrorism. The nurses learn that if a patient is exposed to the smallpox virus he or she becomes contagious at what time
After a rash appears
The emergency response team is dealing with a radiation leak at the hospital. What action should be performed to prevent the spread of the contaminants
Air ducts and vents should be sealed.
A patient is admitted to the ED who has been exposed to a nerve agent. The nurse should anticipate the STAT administration of what drug
Atropine
Level C personal protective equipment has been deemed necessary in the response to an unknown substance. The nurse is aware that the equipment will include what
An air-purified respirator
A cruise ship off the coast of Maryland has capsized, and the nurse is triaging victims who were submerged in cold water. Which supplies from the Push Packages would be of most use when caring for these victims? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Antibiotics would be used to help the victims of this emergency. Life support medications would be used to help the victims of this emergency. Intravenous administration equipment would be used to help the victims of this emergency. Airway maintenance supplies would be used to help the victims of this emergency.
A patient who has been exposed to anthrax is being treated in the local hospital. The nurse should prioritize what health assessments
Assessment of respiratory status
A client recovering from plutonium poisoning from a nuclear reactor explosion is receiving edetate calcium disodium (Calcium EDTA). What will the nurse do to support this client?
Calcium EDTA may produce renal damage such as proteinuria and microscopic hematuria. Treatment-induced nephrotoxicity is dose dependent and may be reduced by ensuring adequate diuresis before therapy begins. Clients should be monitored for cardiac rhythm irregularities and other electrocardiogram changes during IV therapy. This medication can cause hypotension.
While developing an emergency operations plan (EOP), the committee is discussing the components of the EOP. During the post-incident response of an emergency operations plan, what activity will take place
Conducting a critique and debriefing for all involved in the incident
Which agent would the nurse administer to prevent the absorption of a poison that the client ingested?
Charcoal is used to prevent absorption of the poison.
Which interventions will the nurse include when planning care to enhance the removal of poison from a client who has overdosed on drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
Charcoal works by binding with the poison agent. The client's urine output should be monitored, noting the characteristics of urine for early identification of rhabdomyolysis. The client might need dialysis for rapid removal of lethal toxins. A nasogastric tube might be needed for lavage of stomach contents.
Which medication will the nurse prepare to administer as the primary antibiotic of choice for the treatment of anthrax?
Ciprofloxacin (Cipro) is the primary antibiotic used to treat anthrax, with a prophylaxis oral dose of 500 mg every 12 hours for 60 days.
A client is suspected of exposure to Clostridium botulinum because of respiratory distress experienced after eating food from a street vendor during a carnival. What care should the nurse provide for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Clostridium botulinum paralyzes the muscles, and respiratory failure can occur. The nurse should prepare to assist with ventilatory support for this client. The antitoxin should be given as soon as possible and not delayed pending the microbiologic testing.
A client is diagnosed with acute poisoning of acetylsalicylic acid (aspirin). The nurse knows that ion trapping will be the therapy of choice for this medication and prepares to:
Forced alkaline diuresis may be used to increase the excretion of acidic drugs like salicylates. A diuretic such as furosemide along with IV sodium bicarbonate makes the urine more alkaline.
A nurse is participating in the planning of a hospital's emergency operations plan. The nurse is aware of the potential for ethical dilemmas during a disaster or other emergency. Ethical dilemmas in these contexts are best addressed by which of the following actions
Having an ethical framework in place prior to an emergency
A client has taken 24 acetaminophen (Tylenol) tablets at once in a suicide attempt. Which medication would most likely be administered to reverse the effects of Tylenol?
Mucomyst is the antidote for acetaminophen (Tylenol) overdose.
A client with spinal stenosis was found unconscious by family members. The client's opioid pain medication and tricyclic antidepressant medication containers were empty. What will the nurse prepare to administer to this client?
Naloxone (Narcan) is the antidote for opioid medication overdose. Sodium bicarbonate is the antidote for tricyclic antidepressant medication overdose.
A patient was exposed to a dose of more than 5,000 rads of radiation during a terrorist attack. The patient's skin will eventually show what manifestation
Necrosis
A patient is being treated in the ED following a terrorist attack. The patient is experiencing visual disturbances, nausea, vomiting, and behavioral changes. The nurse suspects this patient has been exposed to what chemical agent
Nerve agent
A group of military nurses are reviewing the care of victims of biochemical terrorist attacks. The nurses should identify what agents as having the shortest latency
Nerve agents
A nurse has been called for duty during a response to a natural disaster. In this context of care, the nurse should expect to do which of the following
Practice outside of her normal area of clinical expertise.
A hospital's emergency operations plan has been enacted following an industrial accident. While one nurse performs the initial triage, what should other emergency medical services personnel do
Perform life-saving measures.
The nurse explains to a group of concerned citizens that a biologic terrorism agent that is especially dangerous because of its high contagion and prolonged incubation period, which allow exposure to a large number of people during the early stages of the disease, is:
Personal contact is needed to spread smallpox, but only a few viral droplets spread through the air or on contaminated objects are needed to produce the disease. Humans are the only carriers.
A patient suffering from blast lung has been admitted to the hospital and is exhibiting signs and symptoms of an air embolus. What is the nurse's most appropriate action
Position the patient in the prone, left lateral position.
A client is believed to have been exposed to the variola virus while working in a laboratory. What should the nurse assess before administering the vaccination to this client?
Smallpox vaccinations are contraindicated for persons with an impaired immune system, which would be assessed by the client's current white blood cell count. Smallpox vaccinations are contraindicated for persons with impaired immune systems, such as those who are HIV positive. Smallpox vaccinations are contraindicated for persons with eczema.
A nurse is giving an educational class to members of the local disaster team. What should the nurse instruct members of the disaster team to do in a chemical bioterrorist attack
Stand up.
The difference between the standard emergency triage practice and the current emergency triage of mass casualties is that:
Standard emergency triage may be reversed, focusing on clients with the best chance to live.
A nurse takes a shift report and finds he is caring for a patient who has been exposed to anthrax by inhalation. What precautions does the nurse know must be put in place when providing care for this patient
Standard precautions The patient is not contagious, and anthrax cannot be spread from person to person, so standard precautions are initiated.
