Exam #4-Disaster Nursing

Transmission of Anthrax

through handling/eating contaminated animal products or direct contact with bacteria and spores -NOT spread person to person

S/S of contamination with blood agents

-flushing -increased RR; hypoxia -increased HR/dysrhythmias -syncope -nonspecific neuro symptoms -stupor -coma -seizure preceding resp arrest

Med/Nursing MGMT of anthrax

-inhalation frequently fatal -ATB therapy for 60 days -level D precautions

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) A biologic disaster b) A chemical disaster c) A nuclear blast d) A radiologic disaster

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.

external emergencies could be

-natural disasters -terrorism -pandemic flu -train derailment -biological or chemical warfare

Common types of chemical agents

-nerve -blood -vesicant -pulmonary

S/S of tularemia

-abrupt onset of fever, chills, headache, dry cough, sore throat w/o adenopathy, malaise -lower backache (joint or muscle aches) -possible N/V/D

S/S of GI botulism

-cramps -N/V/D

Critical Incident Stress MGMT (CISM) includes

-defusing -debriefing -demobilization -follow-up care

Disaster tags are used for:

-identification and triaging of patients -tracking, assigning beds, providing families w/ info

Characteristics of nerve agents

-most toxic -tasteless, colorless, odorless -inhaled or absorbed percutaneously or subQ -effects can begin b/t 30 min and 18 hrs

contraindications in treatment of botulism

-no aminoglycosides or clindamycin

complications of tularemia

-pneumonia -meningitis -pericarditis -osteomyelitis

tularemia results in mortality secondary to

-pneumonitis -hemoptysis -resp insufficiency -sepsis & shock

Examples of green tagged injuries

-upper extremity fractures -minor burns (small surface area, not facial) -lacerations with minimal bleeding -behavioral/psychosocial disorders -sprains

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 patients clothing and then perform what action? A. Rinse the patient with water. B. Wash the patient with a dilute bleach solution. C. Wash the patient chlorhexidine. D. Rinse the patient with hydrogen peroxide.

Ans: A Feedback: The first step in decontamination is removal of the patients clothing and jewelry and then rinsing the patient with water. This is usually followed by a wash with soap and water, not chlorhexidine, bleach, or hydrogen peroxide.

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? A. Evaluate the care that he or she provided during the disaster. B. Discuss own emotional responses to the disaster. C. Explore the ethics of the care provided during the disaster. D. Provide suggestions for improving the emergency operations plan.

Ans: B Feedback: In debriefing, participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (e.g., flashbacks, difficulty sleeping, intrusive thoughts), and other psychological ramifications. The EOP and the care the nurse provided are not evaluated.

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? A. Viral agents B. Nerve agents C. Pulmonary agents D. Blood agents

Ans: B Feedback: Latency is the time from absorption to the appearance of signs and symptoms. Sulfur mustards and pulmonary agents have the longest latency, whereas vesicants, nerve agents, and cyanide produce signs and symptoms within seconds.

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? A. Place all potential victims on reverse isolation. B. Establish a triage outside the hospital. C. Have hospital staff put on personal protective equipment. D. Place hospital staff on abbreviated shifts of no more than 4 hours.

Ans: B Feedback: Triage outside the hospital is the most effective means of preventing contamination of the facility itself. None of the other listed actions has the potential to prevent the contamination of the hospital itself.

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? A. Administration of acyclovir B. Hematopoietic stem cell transplantation (HSCT) C. Administration of penicillin D. Hemodialysis

Ans: C Feedback: Anthrax infection is treated with penicillin. Acyclovir is ineffective because anthrax is a bacterium. Dialysis and HSCT are not indicated.

A patient was exposed to a dose of more than 5,000 rads of radiation during a terrorist attack. The patients skin will eventually show what manifestation? A. Erythema B. Ecchymosis C. Desquamation D. Necrosis

Ans: D Feedback: Necrosis of the skin will become evident within a few days to months at doses of more than 5,000 rads. With 600 to 1,000 rads, erythema will occur; it can disappear within hours and then reappear. At greater than 1,000 rads, desquamation (radiation dermatitis) of the skin will occur. Ecchymosis does not occur.

What is external radiation?

all or part of the body is exposed to radiation, they are not radioactive, decontamination is not necessary; not an emergency

hemorrhagic smallpox

all s/s of smallpox plus dusky erythema and petechiae to frank hemorrhage of skin and mucous membranes- results in death by day 5/6

What drugs are contraindicated with botulinum?

aminoglycosides and clindamycin because they can exacerbate neuromuscular blockade

What supportive interventions are appropriate for the plague?

fever control, fluid/lyte balance, pain control, droplet precautions

What are the s/s of GI anthrax?

fever, N/V, abd. pain, bloody diarrhea, dec. intravascular volume leading to sepsis

Prophylaxis antibiotic for anthrax is given to people with symptoms who have been in a defined "hot zone" for which time frame?

60 days

What are the s/s of nerve agents?

"DUMBBELS" diarrhea, urination, miosis, bronchospasm, bradycardia, emesis, lacrimation, and salivation

Treatment of tularemia

- Streptomycin or gentamicin/aminoglycoside 10-14 days -must be treated w/in 48 hrs of onset

Decon of vesicant agents

-soap and water -blot dry

incubation period of viral hemorrhagic fever

2-21 days

plague incubation period

2-6 days

tularemia incubation period

3-5 days can range 1-21 days

What is the mortality rate of smallpox?

30% due to toxemia associated with immune complexes

The nurse is developing a plan of care for clients 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

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

A bioterrorism attack

Incident Command System (ICS)

A federally mandated local organization that coordinates personnel, facilities, equipment, and communication in an emergency situation

Bodies of those who had anthrax should be what?

Cremate because spores can survive for decades after death

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

Cyanide

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

Defusing

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

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.

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? a) Green b) Red c) Black d) Yellow

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.

What is #3 priority category during a MCI?

Minimal-Green: injuries are minor and treatment can be delayed by hours to days; should be moved away from main triage area

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

isolation precautions for viral hemorrhagic fever

STRICT ISOLATION

What do nerve agents do?

continuous stimulation of nerve endings > Ach is not inactivated > causing cholinergic crisis

How is the bubonic plague spread?

transmitted via flea bites and infected rats

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. 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.

Initiating hospital emergency preparedness plans

-disaster activation should clearly state how Emergency Operation Plan (EOP) is to be initiated -Field Incident Command will give appx number of pts arriving -number of self-referring pts will be unknown

If a bomb threat is made in person/verbally

-do not chase -make note of direction the person left

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? A. Practice outside of her normal area of clinical expertise. B. Perform interventions that are not based on assessment data. C. Prioritize psychosocial needs over physiologic needs. D. Prioritize the interests of older adults over younger patients.

Ans: A Feedback: During a disaster, 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.

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 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? a) Possible b) Probable c) Improbable d) Likely

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.

What is the tx for cutaneous anthrax?

PCN, e-mycin, gentamicin, doxycycline

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

Toxicity

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

What precautions are necessary with the plague?

full face respirator for staff, pt should wear a mask; routine precautions in case of death

What is the emergency operations plan (EOP)?

health care facilities are required by the JC to create a plan for emergency preparedness and to practice this plan twice a year

In non-disaster situations, how does triage prioritize?

healthcare workers assign highest priority and allocate most resources to the most critically ill.

Where are radiation victims triaged?

outside of hospital to contain radiation

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 mans current mental health problem? A. The man is experiencing a common response following a disaster. B. The man fails to appreciate the fact that he survived the disaster. C. The man most likely feels guilty about his actions during the disaster. D. The mans depression most likely predated the disaster.

Ans: A Feedback: Depression is a common response to disaster. It does not suggest that the patient feels guilty about his actions or that he does not appreciate the fact that he survived. It is possible, but less likely, that the patient was depressed prior to the disaster.

A hospitals 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? A. Perform life-saving measures. B. Classify patients according to acuity. C. Provide health promotion education. D. Modify the emergency operations plan.

Ans: A Feedback: In an emergency, patients are immediately tagged and transported or given life-saving interventions. One person performs the initial triage while other emergency medical services (EMS) personnel perform lifesaving measures and transport patients. Health promotion is not a priority during the acute stage of the crisis. Classifying patients is the task of the triage nurse. EMS personnel prioritize life-saving measures; they do not modify the operations plan.

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? A. Nerve agent B. Pulmonary agent C. Vesicant D. Blood agent

Ans: A Feedback: Nerve agent exposure results in visual disturbances, nausea and vomiting, forgetfulness, irritability, and impaired judgment. This presentation is not suggestive of vesicants, pulmonary agents, or blood agents.

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? A. Hyperstimulation of the nerve endings B. Temporary deactivation of the nerve endings C. Binding of the nerve endings D. Destruction of the nerve endings

Ans: A Feedback: Nerve agents can be inhaled or absorbed percutaneously or subcutaneously. These agents bond with acetylcholinesterase, so that acetylcholine is not inactivated; the adverse result is continuous stimulation (hyperstimulation) of the nerve endings. Nerve endings are not deactivated, bound, or destroyed.

A nurse is participating in the planning of a hospitals 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? A. Having an ethical framework in place prior to an emergency B. Allowing staff to provide care anonymously during an emergency C. Assuring staff that they are not legally accountable for care provided during an emergency D. Teaching staff that principles of ethics do not apply in an emergency situation

Ans: A Feedback: Nurses can plan for the ethical dilemmas they may face during disasters by establishing a framework for evaluating ethical questions before they arise and by identifying and exploring possible responses to difficult clinical situations. Ethical principles do not become wholly irrelevant in emergencies. Care cannot be given anonymously and accountability for practice always exists, even in an emergency.

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? A. Impaired gas exchange B. Decreased cardiac output C. Chronic pain D. Excess fluid volume

Ans: A Feedback: Pulmonary agents, such as phosgene and chlorine, destroy the pulmonary membrane that separates the alveolus from the capillary bed, disrupting alveolarcapillary oxygen transport mechanisms. Capillary leakage results in fluid-filled alveoli and gas exchange ceases to occur. Pain is likely, but is acute rather than chronic. Fluid volume excess is unlikely to be a priority diagnosis and cardiac output will be secondarily affected by the pulmonary effects.

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? A. Office of Emergency Management B. Incident Command System C. Centers for Disease Control and Prevention (CDC) D. American Red Cross

Ans: A Feedback: The Office of Emergency Management coordinates the disaster relief efforts at state and local levels. The Incident Command System is a management tool to organize personnel, facilities, equipment, and communication in an emergency situation. The CDC is the agency for disease prevention and control and it supports state and local health departments. The American Red Cross provides additional support.

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? A. Demobilization response B. Post-incident response C. Crisis diffusion D. Reversion

Ans: A Feedback: The demobilization response occurs when it is deemed that the facility may return to normal daily functioning. This is not known as the post-incident response, crisis diffusion or reversion.

A 44-year-old male patient has been exposed to severe amount of radiation after a leak in a reactor plant. When planning this patients care, the nurse should implement what action? A. The patient should be scrubbed with alcohol and iodine. B. The patient should be carefully protected from infection. C. The patients immunization status should be promptly assessed. D. The patients body hair should be removed to prevent secondary contamination.

Ans: B Feedback: Damage to the hematopoietic system following radiation exposure creates a serious risk for infection. There is no need to remove the patients hair and the patients immunization status is not significant. Alcohol and iodine are ineffective against radiation.

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? A. Administer prophylactic antibiotics. B. Survey the victims using a radiation survey meter. C. Irrigate victims open wounds. D. Perform soap and water decontamination.

Ans: B Feedback: Each patient arriving at the hospital should first be surveyed with the radiation survey meter for external contamination and then directed toward the decontamination area as needed. This survey should precede decontamination efforts or irrigation of wounds. Antibiotics are not indicated.

A nurse is triaging patients after a chemical leak at a nearby fertilizer factory. The guiding principle of this activity is what? A. Assigning a high priority to the most critical injuries B. Doing the greatest good for the greatest number of people C. Allocating resources to the youngest and most critical D. Allocating resources on a first come, first served basis

Ans: B Feedback: In nondisaster situations, health care workers assign a high priority and allocate the most resources to those who are the most critically ill. However, in a disaster, when health care providers are faced with a large number of casualties, the fundamental principle guiding resource allocation is to do the greatest good for the greatest number of people. A first come, first served approach is unethical.

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? A. Level A B. Level B C. Level C D. Level D

Ans: B Feedback: Level B personal protective equipment provides the highest level of respiratory protection, with a lesser level of skin and eye protection. Level A provides the highest level of respiratory, mucous membrane, skin, and eye protection. Level C incorporates the use of an air-purified respirator, a chemical resistant coverall with splash hood, chemical resistant gloves, and boots. Level D is the same as a work uniform.

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? A. Victims pre-existing medical conditions are exacerbated. B. Victims are thrown by the pressure wave. C. Victims experience burns from the blast. D. Victims suffer injuries caused by debris or shrapnel from the blast.

Ans: B Feedback: The tertiary phase of the blast injury results from the pressure wave that causes the victims to be thrown, resulting in traumatic injury. None of the other listed events occurs in this specific phase of a blast.

After a radiation exposure, a patient has been assessed and determined to be a possible survivor. Following the resolution of the patients initial symptoms, the care team should anticipate what event? A. A return to full health B. Internal bleeding C. A latent phase D. Massive tissue necrosis

Ans: C Feedback: A latent phase commonly follows the prodromal phase of radiation exposure. The patient is deemed a possible survivor, not a probable survivor, so an immediate return to health is unlikely. However, internal bleeding and massive tissue necrosis would not be expected in a patient categorized as a possible survivor.

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? A. 6 to 12 hours after exposure B. When pustules form C. After a rash appears D. When the patient becomes febrile

Ans: C Feedback: A patient is contagious after a rash develops, which initially develops on the face, mouth, pharynx, and forearms. The patient exposed to the smallpox virus is not contagious immediately after exposure; only when pustules form, or with a body temperature of 38C.

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? A. Deciding when the facility will go from disaster response to daily activities B. Conducting practice drills for the community and facility C. Conducting a critique and debriefing for all involved in the incident D. Replacing the resources in the facility

Ans: C Feedback: A post-incident response includes critiquing and debriefing all parties involved immediately and at later dates. It does not include the decision to go from disaster response to daily activities; it does not include practice drills; and it does not include replacement of resources in the facility.

A nurse has had contact with a patient who developed smallpox and became febrile after a terrorist attack. This nurse will require what treatment? A. Watchful waiting B. Treatment with colony-stimulating factors (CSFs) C. Vaccination D. Treatment with ceftriaxone

Ans: C Feedback: All people who have had household or face-to-face contact with a patient with small pox after the fever begins should be vaccinated within 4 days to prevent infection and death. Watchful waiting would be inappropriate and CSFs are not used for treatment. Vaccination, rather than antibiotics, is the treatment of choice.

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? A. Determining whether the incident was managed effectively B. Educating survivors on potential coping strategies for future disasters C. Providing individuals with education about recognizing stress reactions D. Determining if individuals responded appropriately during the incident

Ans: C Feedback: In defusing, patients are given information about recognizing stress reactions and how to deal with handling the stress they may experience. Debriefing involves asking patients about their current emotional coping and symptoms, following up, and identifying patients who require further assessment and assistance in dealing with the stress experienced. The CISM team does not focus primarily on the management of the incident or on providing skills for future incidents.

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 nurses most appropriate action? A. Place the patient in the Trendelenberg position. B. Assess the patients airway and begin chest compressions. C. Position the patient in the prone, left lateral position. D. Encourage the patient to perform deep breathing and coughing exercises.

Ans: C Feedback: In the event of an air embolus, the patient should be placed immediately in the prone left lateral position to prevent migration of the embolus and will require emergent treatment in a hyperbaric chamber. Chest compressions, deep breathing, and coughing would exacerbate the patients condition. Trendelenberg positioning is not recommended.

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? A. Cover their eyes. B. Put on a personal protective equipment mask. C. Stand up. D. Crawl to an exit.

Ans: C Feedback: Most chemicals are heavier than air, except for hydrogen cyanide. Therefore, in the presence of most chemicals, people should stand up to avoid heavy exposure because the chemical will sink toward the floor or ground. For this reason, covering their eyes, putting on a PPE mask, or crawling to an exit will not decrease exposure.

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? A. A self-contained breathing apparatus B. A vapor-tight, chemical-resistant suit C. A uniform only D. An air-purified respirator

Ans: D Feedback: Level C incorporates the use of an air-purified respirator, a chemical resistant coverall with splash hood, chemical-resistant gloves, and boots. Level A provides the highest level of respiratory, mucous membrane, skin, and eye protection, incorporating a vapor-tight, chemical-resistant suit and selfcontained breathing apparatus (SCBA). Level B personal protective equipment provides the highest level of respiratory protection, with a lesser level of skin and eye protection, incorporating a chemicalresistant suit and SCBA. Level D is the same as a work uniform.

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? A. Nerve agent B. Blood agent C. Pulmonary agent D. Vesicant

Ans: D Feedback: Sulfur mustard is a vesicant chemical that causes blistering and results in burning, conjunctivitis, bronchitis, pneumonia, hematopoietic suppression, and death. Nerve agents include sarin, soman, tabun, VX, and organophosphates (pesticides). Hydrogen cyanide is a blood agent that has a direct effect on cellular metabolism, resulting in asphyxiation through alterations in hemoglobin. Chlorine is a pulmonary agent, which destroys the pulmonary membrane that separates the alveolus from the capillary bed.

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 nurses most appropriate intervention? A. Educate the patient about the potential harm in denying his emotions. B. Refer the patient to social work or spiritual care. C. Encourage the patient to take a leave of absence from his job to facilitate emotional healing. D. Encourage the patient to return to normal social roles when appropriate.

Ans: D Feedback: The patient should be encouraged to return to normal social roles when appropriate if he is confident and genuine about his ability to cope. The nurse should use active listening to the patients concerns and emotions to enable the patient to process the situation. The patient is not necessarily being unrealistic or dishonest. As a result, social work or spiritual care may not be needed. Time away from work may not be required.

A patient who has been exposed to anthrax is being treated in the local hospital. The nurse should prioritize what health assessments? A. Integumentary assessment B. Assessment for signs of hemorrhage C. Neurologic assessment D. Assessment of respiratory status

Ans: D Feedback: The second stage of anthrax infection by inhalation includes severe respiratory distress, including stridor, cyanosis, hypoxia, diaphoresis, hypotension, and shock. The first stage includes flu-like symptoms. The second stage of infection by inhalation does not include headache, vomiting, or syncope.

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? A. A chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots B. A self-contained breathing apparatus (SCBA) and a fully encapsulating, vapor-tight, chemicalresistant suit with chemical-resistant gloves and boots. C. The SCBA and a chemical-resistant suit, but the suit is not vapor tight D. The nurses typical work uniform

Ans: D Feedback: The typical work uniform is appropriate for Level D protection

Which is the most likely weaponized biological agent available?

Anthrax

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? a) Macules b) Bullae c) Papules d) Abscesses

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.

During a disaster, the nurse sees a victim with a green triage tag. The nurse knows that the person has which type of injuries? a) Minor and treatment can be delayed hours to days b) Significant and require medical care, but can wait hours without threat to life or limb c) Life-threatening but survivable with minimal intervention d) Extensive and chances of survival are unlikely even with definitive care

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.

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.

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? a) Radiologic b) Manmade c) Chemical d) Biologic

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 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? a) Black b) Yellow c) Green d) Red

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.

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? a) Sensory neglect b) Respiratory compromise c) Cardiovascular compromise d) Neurological compromise

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.

The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates? a) Risk of attack, without a site specified b) Risk of attack, without timing specified c) Elevated risk of attack d) Severe, credible impending threat, usually with a site specified

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

The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates? a) Severe, credible impending threat, usually with a site specified b) Risk of attack, without timing specified c) Risk of attack, without a site specified d) Elevated risk of attack

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

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? a) To control possible seizures b) To counter excess acetylcholine c) To reactivate acetylcholinesterase d) To control hypersecretion

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.

A patient who has been triaged as delayed would receive which color tag? a) Red b) Green c) Yellow d) Black

Yellow A yellow triage tag indicates delayed triage category. A red triage tag indicates immediate injuries. A green triage tag indicates a minimal triage category. Black triage tags indicate expectant injuries that are extensive and chances of survival are unlikely even with definitive care.

The nurse is triaging victims during a mass casualty incident. The nurse uses which color tag for a victim whose care can be delayed? a) Red b) Black c) Yellow d) Green

Yellow A yellow triage tag indicates delayed triage category. A red triage tag indicates immediate injuries. A green triage tag indicates a minimal triage category. Black triage tags indicate expectant injuries that are extensive and chances of survival are unlikely even with definitive care.

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.

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? a) No, in smallpox a rash develops before fever. b) Yes, fever and rash may follow 14 asymptomatic days. c) No, fever and rash develop immediately on exposure. d) No, smallpox rash develops within 7 days.

Yes, fever and rash may follow 14 asymptomatic days. A client infected with smallpox may be asymptomatic for the first 7 to 14 days. A few days before the rash develops, the person becomes noticeably ill with high fever. In the case of the client, rash may follow the fever. If there is no rash for 7 days, smallpox infection is not ruled out. Usually, rash develops a few days after the fever. In many cases, there are no symptoms for at least 7 days after infection.

What s/s occur in the pre-eruption phase of smallpox?

high fever, malaise, backache, headache, chills, and vomiting

What is a level three disaster?

local and regional efforts are overwhelmed; statewide or federal assistance is required

What is a level one disaster?

local emergency response personnel manage disaster; they must be prepared to act in isolation and provide competent care up to 5 days before other resources become available

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.

What are examples of Yellow category injuries?

most eye and CNS injuries, vascular injuries with collateral circulation

What are the causes of blast injury?

pipe bombs, dirty bombs, and Molotov cocktails

What is the cause of mortality with Tularemia?

pneumonitis (if inhalation is source) w/ copious watery or purulent sputum, hemopysis, respiratory insufficiency, sepsis, and shock

Who are the possible survivors of ARS?

present with N/V that persists for 24-48hrs, leukopenia, thrombocytopenia, lymphocytopenia

Who are the improbable survivors of the acutely ill?

present with n/v, diarrhea, shock and neurologic symptoms suggest lethal dose; survival time is variable

How do you start triage?

send all who can walk to specific location away and separate all green victims; location should be uphill, upwind, and upstream

What are personal protective equipment (PPE)?

shields the health care provider from chemical, physical, biological, and radiological hazzards

How are vesicants decontaminated?

soap and water, do not scrub or use hypochlorite solutions; eye exposure requires copious irrigation because it can lead to corneal ulcer, edema, and conjunctivitis

What are examples a Red category injury?

sucking chest wound, open fracture of long bones, tension pneumothorax

What is Level D PPE?

typical work uniform

Following an explosion at a chemical plant, a nurse is triaging clients. One client has a penetrating abdominal wound from a piece of shrapnel. What color coordinate would the nurse assign to this client?

yellow Explanation: A yellow triage tag means the client is in serious condition yet stable enough to survive if treatment is delayed 6 to 8 hours. Red tags are assigned to life-threatening injuries that require immediate medical attention. Green tags indicate the client has minor injuries, such as minor lacerations or superficial burns. Black tags indicate the client is going to die soon and usually apply to serious head injuries or multisystem traumas.

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. a) The rash appears one week after exposure b) A large amount of the virus is present in the saliva and pustules c) One form, variola major, has a 30% mortality rate d) It has an incubation period of 72 hours e) It is extremely contagious after appearance of a rash

• A large amount of the virus is present in the saliva and pustules • It is extremely contagious after appearance of a rash • 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.

You are teaching a disaster preparedness workshop at the local community center. Which of the following points would specifically apply to a biologic, chemical, or radiologic disaster? Select all that apply. a) Keep a 7-day supply of medications on hand at all times. b) Avoid drinking water from the faucet. c) Do not consume fresh fruit or vegetables. d) Stock a supply of canned or dried packaged food.

• Avoid drinking water from the faucet. • Do not consume fresh fruit or vegetables. While keeping a supply of medications, dried food, and canned food would be preparation for all types of disasters, clients should be aware that consuming fresh food or drinking local water supplies may be hazardous during a biologic, chemical, or radiologic disaster because they might be contaminated with pathogens, chemicals, or fallout.

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. a) Client with multiple injuries in profound shock b) Client with a fractured arm c) Client with a sucking chest wound d) Client with a first-degree burn to the forearm e) Unresponsive client with a penetrating head wound

• Client with a first-degree burn to the forearm • Client with a fractured arm In triage, green indicates minor injuries for which treatment can be delayed hours to days. A client with a fractured arm or with a first-degree burn would be triaged green. A client with a sucking chest wound would require immediate care and be triaged red. An unresponsive client with a penetrating head wound or with multiple injuries and in profound shock would be triaged black because the injuries are extensive and chances of survival are unlikely, even with definitive care.

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. a) Unresponsive client with a penetrating head wound b) Client with a sucking chest wound c) Client with multiple injuries in profound shock d) Client with a first-degree burn to the forearm e) Client with a fractured arm

• Client with a first-degree burn to the forearm • Client with a fractured arm In triage, green indicates minor injuries for which treatment can be delayed hours to days. A client with a fractured arm or with a first-degree burn would be triaged green. A client with a sucking chest wound would require immediate care and be triaged red. An unresponsive client with a penetrating head wound or with multiple injuries and in profound shock would be triaged black because the injuries are extensive and chances of survival are unlikely, even with definitive care.

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? a) Tularemia b) Plague c) Anthrax d) Botulism

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.

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

Antitoxins

The nurse is caring for victims who have inhaled anthrax. The nurses assesses for symptoms that mimic which of the following disease processes? a) Respiratory distress b) Burns c) Bronchospasm d) Flu

Flu When anthrax has been inhaled, symptoms mimic those of the flu. Treatment is usually 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.

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 nurse is instructing volunteers at an emergency bioterrorism drill about the management and medications required to combat various viruses, bacteria, and toxins. The nurse knows that the volunteers understand the instruction when they see that managing patients who exhibit symptoms of the variola virus (smallpox) includes which of the following? a) Isolation b) Radiation c) Decontamination d) Acyclovir

Isolation Smallpox is spread by droplet or direct contact and spreads rapidly. Patients exhibiting symptoms should be immediately placed in isolation.

Yellow tag injuries are...

LIFE-THREATENING, but survivable with intervention within an hour (hrs) -can progress rapidly to emergent or immediate

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.

Green triage tags are considered which level of urgency

Priority 3- Non-urgent or minimal

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

Priority 4

The nurse is triaging victims after an explosion at an oil refinery. One victim complains of tinnitus, dizziness, and otorrhea. For what probable condition should the nurse prepare care? a) Blast lung b) Tympanic rupture c) Head injury d) Abdominal injury

Tympanic rupture The nurse should prepare to care for a patient with probable tympanic rupture. Signs and symptoms of tympanic rupture include hearing loss, tinnitus, pain, dizziness, and otorrhea. Symptoms of blast lung include dyspnea, hypoxia, tachypnea or apnea, cough, chest pain, and hemodynamic instability. Symptoms of head injury include postconcussive syndrome. Symptoms of abdominal injury include pain, guarding, rebound tenderness, rectal bleeding, nausea, and vomiting.

A nurse is preparing a presentation to a local community group on disaster preparedness involving radiation exposure. Which of the following would the nurse least likely include when describing the factors that affect exposure?

Type of particle emitted

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? a) Neurontin tablets b) Valium intravenous injection c) Dilantin tablets d) Phenobarbital intramuscular

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 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

The nurse is triaging victims during a mass casualty incident. The nurse uses which color tag for a victim whose care can be delayed? a) Green b) Black c) Red d) Yellow

Yellow A yellow triage tag indicates delayed triage category. A red triage tag indicates immediate injuries. A green triage tag indicates a minimal triage category. Black triage tags indicate expectant injuries that are extensive and chances of survival are unlikely even with definitive care.

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? A. Primary phase B. Secondary phase C. Tertiary phase D. Quaternary phase

Ans: A Feedback: Pulmonary barotraumas, including pulmonary contusions; head injuries, including concussion, other severe brain injuries; tympanic membrane rupture, middle ear injury; abdominal hollow organ perforation; and hemorrhage are all injuries that can occur in the primary phase of a blast. These particular injuries are not characteristic of the subsequent phases.

Critical Incident Stress MGMT (CISM) definition

approach to preventing and treating emotional trauma that can affect emergency responders as a consequence of their job and that can happen to anyone in a disaster or MCI

Decontamination upon admission- **Reminder**

never assume pt has been decontaminated when arriving to the hospital after assessment from a prehospital provider

Those exposed to the plague should have what?

prophylaxis tx for 7 days with doxycycline

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

PPE for tularemia

standard precautions

What is the tx for plague?

streptomycin and gentamycin for 10-14 days; tetracycline and doxycycline are alternatives

What is the tx for Tularemia?

streptomycin or gentamicin for 10-14 days; if inhalation then it must be treated w/in 48 hrs; if a mass causality situation then use doxycycline and cipro

What are the s/s of bubonic plague?

sudden fever, chills, swollen and tender lymph nodes in groin/axilla/cervical, bacteremia progresses to septicemia, shock, and death

What is the second stage of s/s for inhalation anthrax?

sudden onset of high fever, stridor, dyspnea, pleural effusions, severe respiratory distress, meningitis (hemorrhagic CSF in 50%), septic shock

What is the tx for smallpox?

support with ATB for additional infections; prevent with vaccine; exposed unvaccinated people can get vaccine within 4 days of exposure to prevent or decrease severity

What is the tx for nerve agents?

supportive care, atropine, benzodiazepine, and pralidoxime (Protopam)

treatment of those exposed to tularemia

tetracycline or doxycycline for 14 days

Incident Command Systems are an integral part of

the National Incident Management System

What is inhalation anthrax similar to in appearance?

the flu

Initial review/response of a MCI occurs at which level then progresses to which levels?

the local level -state -federal

Where are radiation patients decontaminated?

they are showered outside of the ER; prevent run off

What affects radiation exposure?

time, distance, and shielding

What is a complications of the smallpox vaccine?

vaccinia necrosum that cause necrosis at injection site

What is the treatment of botulinum?

vent support, nutrition, fluids, equine antitoxin minimizes nerve damage

When is someone with smallpox contagioius?

very contagious but only after fever is gone and rash has begun but is no longer contagious once all the scabs are healed

What precautions should the staff take against radiation?

water resistant gowns, two pairs of gloves, caps, goggles, masks, and booties and dosimetry devices

Commonly seen after floods or water disasters

waterborne transmission of agents such as E. coli, salmonella shigella, typhoid, leptospirosis, malaria, and tularemia -widespread disease

How is botulinum spread?

direct contact; not contagious through human-to-human contact

Who are exceptions to triage system?

children, pregnant females, and fellow rescuers

What is the tx for vesicants?

requires ventilator for respiratory effects, dimercaprol IV or topical

What is the mortality of botulinum?

60% without rapid tx or ventilatory support

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? A. Green B. Yellow C. Red D. Black

Ans: D Feedback: The purpose of triaging in a disaster is to do the greatest good for the greatest number of people. The patient would be triaged as black due to the unlikelihood of survival. Persons triaged as green, yellow, or red have a higher chance of recovery.

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? a) Erythromycin for 2 weeks b) Rocephin (Ceftriaxone) IV for 7 days c) Penicillin G IM for 1 dose d) Ciprofloxacin (Cipro) for 60 days

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 patient was involved in an avalanche that killed many people on a ski trip, including the patient's brother. The nurse is educating the patient about recognition of stress reactions and ways to manage stress. What type of process is the nurse introducing to the patient?

Defusing Explanation: Components of a management plan include education (preparedness) before an incident occurs about critical incident stress and coping strategies; field support (ensuring that staff get adequate rest, food, and fluids, and rotating workloads) during an incident; and defusings, debriefings, demobilization, supportive services to the family, and follow-up care after the incident (Veenema, 2013). Defusing is a process by which the person receives education about recognition of stress reactions and management strategies for handling stress. Debriefing is a more complicated intervention; 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 (e.g., flashbacks, difficulty sleeping, intrusive thoughts), and other psychological ramifications.

When describing the use of smallpox as a biologic agent, which of the following would the nurse include as the primary means of infection? a) Percutaneous absorption b) Inhalation c) Ingestion d) Direct contact

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.

What are patients identified by during a disaster

Disaster tags

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.

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? a) Yellow b) Red c) Black d) Green

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 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 nurse is assessing a victim who is reported to have been exposed to sulfur mustard. The nurse's assessment should include evaluation for

partial-thickness burns.

What are examples of Black category injuries?

penetrating head wounds, high SCI, 2nd and 3rd degree burns, profound shock, agonal respirations, pupils fixed dilated

what must happen in order for the federal government to assist with a disaster

president must declare a disaster "presidential disaster declaration"

What is CISM?

program that include education, field support, defusing, debriefing, demobilization, follow-up

treatment of plague contact exposure

prophylaxis w/ doxy for 7 days

What are some ways to manage psychologic effects after a disaster?

provide information as needed, listen and provide emotional support, refer to therapist, discourage exposure to media, refer to critical incident stress management (CISM), people with ongoing problems should see mental specialist

What are chemical weapons and their types?

quickly cause injury and or death and panic; nerve agents, blood agents, vesicants, and pulmonary agents

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: a) red b) yellow c) black d) green

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.

NATO tinge tag system consists of

red, yellow, green, and black tags

What is a level two disaster?

regional efforts and aid from surrounding communities

What are the steps of decontamination?

remove all of patient's clothing and jewelry and rinse with water; thorough soap and water wash and rinse

Federal resources for an MCI are initiated when?

request is made when local resources have become or are expected to become depleted

How is the plague decontaminated?

rooms are terminally cleaned, clothing and linens should be cleaned with usual disinfectant

What is triage?

sorting patients to determine priority health care needs and the proper site of treatment

What precautions are used with anthrax?

standard precautions because it isn't contagious

How long can inhalation anthrax incubate?

up to 60 days

What are examples of Green category injuries?

upper extremity fracture, behavioral disorders

What is incorporation radiation?

uptake or the radioactive material into the body; usually kidney, bones, liver, or thyroid

Take what samples for radiation?

urine, vomitus, and stool to assess for internal contamination; decontaminate with catharsis, gastric lavage, and chelating agents

Bioterrorism/Chemical Exposure

use of biological agent as a weapon of mass destruction, delivered in either a liquid or dry state

All people who've had contact with smallpox pt after fever developed should be...

vaccinated within 4 days

What are the classic s/s of inhalation anthrax?

widened mediastinum, hemorrhagic mediastinitis (hallmark sign)

As a member of a disaster response team that is responding to a large industrial fire that may involve chemical exposure, a nurse is gathering information from several bystanders. Which statement would lead the nurse to suspect that cyanide is involved?

"The air had a strange smell of bitter almonds."

Common biological agents

-Anthrax -Small pox -Severe Acute Respiratory Syndrome -Tularemia (bacteria) -Botulism -Plague

Adverse effects of pralidoxime

-HTN -increased HR -weakness -dizziness -blurred vision; diplopia

Pharm treatment of sarin gas

-atropine IV (antidote) -pralidoxime -diazepam

Detection of bioterrorism/chemical exposure

-awareness of unusual increase in number of people seeking care for fever, resp, or GI symptoms -cluster of pts presenting with same unusual illness from single location -large number of rapidly fatal cases, especially when death occurs w/in 72 hrs of admission -increase in disease incidence in normally healthy population (i.e. young people)

Patho of the plague

-bacterial -causes destruction and necrosis of lymph nodes

Viral Hemorrhagic Fever contagion

-bacterial (ABT) or viral (support therapy)

Patho of botulism

-bacterial infection -blocks acetylcholine vesicles from fusing with terminal membranes

Examples of agents used for bioterrorism/chemical exposure

-bacterial/viral infections -nerve agents -vesicating agents

Lyme disease can lead to

-bells palsy -meningitis -nerve pain -problems w/ short term memory

Treatment of botulism

-induce vomiting -penicillin -equine antitoxin -supportive vent therapy if resp infection occurs

Nursing roles during disaster

-may be asked to perform duties out of expertise -should be clear who is in charge of designated areas & what RNs can/can't do -plan for ethical dilemmas they may experience

Clinical manifestations of Inhaled anthrax

-may resemble common cold, sore throat, cough, fever -progresses to dyspnea, respiratory failure, septicemia, shock

Examples of patients that would be red tagged

-mechanical airway obstruction/asphyxia -pneumothorax/hemothorax -open long bone fracture -partial amputations -chest wounds (sucking and unstable) -abdominal wounds -burns 15-40% of body/facial burns -shock

Caring for family & friends during a casualty

-must be cared for by facility -not allowed in treatment or triage areas -designated area with available social working, counselors, therapists, and or clergy -active listening, emotional support, give info, referrals

Green tagged injuries are considered...and should be..

-non life-threatening, treatment can be delayed hours to days -moved away from triage area

characteristics of blood agents

-odor of bitter almonds -released during combustion of plastics, rugs, silk, furniture, other construction materials during house fires -significant correlation b/t blood cyanide and carbon monoxide levels in those involved in house fires

Facility responsibility during disaster

-orient/educate on plan -crisis support -2 emergency preparedness plans per year -one community-wide practice drill per year

consider SARS w/

-outbreak of atypical pneumonia w/ travel to an area w/ a known SARS outbreak -healthcare worker w/ direct pt contact -lab tech in lab w/ live SARS-COV

plague PPE

-pt wears mask -isolation barrier w/ full face respirators

Pharm intervention for cyanide

-rapid admin of amyl nitrate, sodium nitrite, and sodium thiosulfate -alternative is hydroxocobalamin IV for those who have inhaled smoke

Communication with Media during a disaster

-should be a clearly defined process for managing media requests -designated spokesperson -a site for dissemination of info (away from pt care areas) -regular schedule for providing updates

Clinical manifestations of small pox

-similar to flu (high fever, malaise, headache, backache, & fatigue) -flat, red, lesions appearing after 2-3 days on face, mouth, pharynx, and forearms -lesions become filled with puss after several days & crust in 2 weeks -toxemia can develop

Decon & PPE for botulism

-skin exposure treated w/ soap and water or 0.1% hypochlorite -standard precautions

treatment of plague

-streptomycin or gentamicin for 10-14 days -tetracycline or doxycycline if aminoglycoside contraindicated

S/S of plague

-sudden fever/chills -H/A -weakness -dyspnea/cough -bloody sputum -pneumonia -chest pain -resp failure -shock

S/S of vesicant agents

-superficial to partial-thickness burn w/ vesicles that coalesce -hypotension -hypovolemic shock when blisters rupture

Medical & Nursing MGMT of smallpox

-supportive care with antibiotics for secondary infections -isolate & use transmission precautions

S/S as tularemia progresses

-sweating -fever -progressive weakness -anorexia/weight loss

S/S of inhalation botulism

-symmetric descending flaccid paralysis "botched face" -diplopia/blurred vision/enlarged sluggish pupils -dysphagia -dry mouth

Common admissions after natural disaster

-trauma related -electrocution -waterborne bacteria, parasites, etc..

3 forms of Anthrax

1. Inhalation 2. Cutaneous 3. GI

four phases of disaster management

1. mitigation/prevention 2. preparedness 3. response 4. recovery

Two steps of decontamination

1. removal of clothing & jewelry; rinsing pt with water 2. thorough soap & water wash rinse

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

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 providing discharge instruction to a victim who has been exposed to anthrax but who does not have any symptoms. The nurse's teaching includes that prophylactic antibiotics must be taken for how many days? a) 60 days b) 10 days c) 30 days d) 14 days

60 days Victims who have been exposed to anthrax but who 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.

goal of self-sufficiency in emergency preparedness plan

96 hours

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

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

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

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? a) Start an IV of normal saline solution at 125 mL/h. b) Obtain a chest x-ray. c) Administer oxygen at 2 L/min via nasal cannula. d) Administer oxygen with a nonrebreather mask.

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.

When working in an acute care facility as part of a disaster response team, a nurse is preparing to care for clients requiring level C protection. Which of the following would the nurse need to wear?

Air-purified respirator Explanation: Level C protection requires an air-purified respirator, a chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots. Level A protection requrie a self-contained breathing apparatus and a fully encapsulating, vapor-tight chemical-resistant suit with chemical-resistant gloves and boots. Level D protection requires the use of the typical work uniform.

What State and Local agencies are associated with emergency response?

American Red Cross, poison control centers, Office of Emergency Management (OEM) provides interagency coordination

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? A. Standard precautions B. Airborne precautions C. Droplet precautions D. Contact precautions

Ans: A Feedback: The patient is not contagious, and anthrax cannot be spread from person to person, so standard precautions are initiated. Airborne, contact, and droplet precautions are not necessary.

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? A. First responders can manage the situation. B. Regional efforts and aid from surrounding communities can manage the situation. C. Statewide or federal assistance is required. D. The area must be evacuated immediately.

Ans: B Feedback: Level II disasters indicate that regional efforts and aid from the surrounding communities will be able to manage the situation. Local efforts are likely to be overwhelmed, while state and federal assistance are not likely necessary. The disaster level does not indicate the necessity of evacuation.

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? A. Floors must be scrubbed with undiluted bleach. B. Waste must be promptly incinerated. C. The ventilation system should be deactivated. D. Air ducts and vents should be sealed.

Ans: D Feedback: All air ducts and vents must be sealed to prevent spread. Waste is controlled through double-bagging and the use of plastic-lined containers outside of the facility rather than incineration. Bleach would be ineffective against radiation and the ventilation system may or may not be deactivated.

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? A. Amyl nitrate B. Dimercaprol C. Erythromycin D. Atropine

Ans: D Feedback: Atropine is administered when a patient is exposed to a nerve agent. Exposure to blood agents, such as cyanide, requires treatment with amyl nitrate, sodium nitrite, and sodium thiosulfate. Dimercaprol is administered IV for systemic toxicity and topically for skin lesions when exposed to vesicants. Erythromycin is an antibiotic, which is ineffective against nerve agents.

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? A. Chemical burns B. Spinal cord injury C. Meningeal tears D. Tympanic membrane rupture

Ans: D Feedback: Tympanic membrane (TM) rupture is the most frequent injury after subjection to a pressure wave resulting from a blast injury because the TM is the bodys most sensitive organ to pressure. In most cases, other injuries such as meningeal tears, spinal cord injury, and chemical injuries are likely to be less common.

What is the fourth step of triage?

Assess mental status: if can't follow simple commands then triage as red, if they can follow commands then triage as yellow

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 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? a) Sodium nitrite b) Sodium thiosulfate c) Amyl nitrate d) Atropine

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

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? a) Black b) Red c) Green d) Yellow

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.

What physical injuries can occur after blast events?

Blast lung: contusion or barotrauma resulting in pneumo, hemothorax; tympanic membrane rupture-assess for CSF, bruising over mastoid and battle sign; Abdominal or Head injuries- TBI, rupture of the bowel

The nurse is taking a class on chemical disasters with the local emergency response team. What toxins would the nurse be learning about? Select all that apply.

Blistering agents Nerve agents Cyanide

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 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

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

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 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.

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.

If a bomb threat is is a handwritten note..

DON'T TOUCH (or handle as little as possible)- need fingerprints

A nurse who was working as part of an emergency response team for a mass casualty incident is engaging in a Critical Incident Stress Management program. The nurse has received information about how to recognize stress reactions and ways to manage them. The nurse is involved in which of the following?

Defusing

The nurse is working at a natural disaster scene. A client was found to have a compound fracture of the left lower leg. He was triaged accordingly. Which category would the client be assigned to?

Delayed

What is #2 priority category during a MCI?

Delayed-Yellow: significant injuries but can wait hours without threat to life or limb

What federal agencies are associated with emergency response?

Dept. of Health and Human Services, Dept. of Justice, and Dept of Homeland Security; FEMA, FBI, CDC, National Medical Response Teams for Weapons of Mass Destruction, Disaster Medical Assistance Teams

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

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)? a) Dosage of gamma radiation b) Direct physical contact c) Mode of infection d) Concentration of nerve gas

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.

Who determines the top ten critical medications used during normal operations?

EOP committee

What is #4 priority category during a MCI?

Expectant-Black: injuries are extensive and chances of survival are unlikely; comfort measures should be provided

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 Explanation: 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.

What are the clinical manifestations of GI Botulinum?

GI botulism cause cramps, N/V,and diarrhia

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

Green

How is inhalation anthrax treated?

If ATB begins with 24 hours of exposure then death can be prevented, use Cipro and doxycycline (vibramycin) for 60 days even if just exposed and not showing symptoms

What is #1 priority category during a mass causality incident (MCI)?

Immediate-Red: life threatening injuries but survivable with minimal intervention

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 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

Anthrax acquired by which method develops into the most severe?

Inhalation

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.

Which is a true statement regarding severe acute respiratory syndrome (SARS)?

It is most contagious during the second week of illness.

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

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? a) Mark I automatic injectors that contain 2 mg atropine and 600 mg pralidoxime chloride b) Mark I automatic injector filled with morphine 10 mg c) Mark I automatic injectors that contain an antiseizure medication such as carbamazepine d) Mark I automatic injector filled with cyanide

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.

A patient with a minor burn would be triaged as which of the following? a) Immediate b) Expectant c) Delayed d) Minimal

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.

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

Which chemical is a vesicant?

Nitrogen mustard

Which of the following is a vesicant? a) Nitrogen mustard b) Hydrogen cyanide c) Sarin d) Chlorine

Nitrogen mustard Examples of vesicants are phosgene, nitrogen mustard, and sulfur mustard. Sarin is a nerve agent. Hydrogen cyanide is a blood agent. Chlorine is a pulmonary agent.

The nursing instructor is talking with the students about botulism. The instructor tells the students that when caring for a client with botulism, what condition is most likely to cause death? a) Dysarthria b) Paralysis of respiratory muscles c) Dysphagia d) Diplopia

Paralysis of respiratory muscles In botulism, paralysis of respiratory muscles poses the greatest potential for lethality. Diplopia (double vision), dysarthria (difficulty in speaking), and dysphagia (difficulty in swallowing) are all early signs of botulism.

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

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? a) Priority 3 b) Priority 4 c) Priority 2 d) Priority 1

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.

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

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 emergency department nurse is caring for clients involved in a chlorine exposure accident at a local chemical plant. The nurse is aware that permanent damage can occur to which body systems?

Respiratory

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

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

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

Soap and water

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 client has been exposed to and inhaled botulism. When providing care to this client, which of the following would be necessary for the nurse to follow? a) Droplet precautions b) Standard precautions c) Contact precautions d) Airborne precautions

Standard precautions Standard precautions are used when providing care to clients with botulism because the agent is not contagious through human-to-human contact. Other precautions such as droplet, airborne, or contact precautions are not necessary.

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

While watching a television newscast, a nurse hears that the Department of Homeland Security has identified the security threat level as yellow. The nurse interprets to mean which of the following?

There is an elevated risk but no defined site.

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?

Thrombocytopenia

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 of the following is defined as the potential of an agent to cause injury to the body? a) Latency b) Toxicity c) Persistence d) Volatility

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.

Which statement reflects the nursing management of pulmonary anthrax (Bacillus anthracis)?

Treatment with ciprofloxacin or doxycycline is suggested after exposure.

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

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

Yellow

How is information during a disaster distributed from the hospital?

a designated spokesperson gives regular updates of information and does not allow media access to patient areas

What are internal disasters?

acts of war, terrorist attacks, and threats to national security such as WMD

What is ARS?

acute radiation syndrome: all body systems are affected

Goal for those utilizing agents for bioterrorism/chemical exposures

agents with long incubation periods to spread longer/contaminate larger numbers of people

What is Level C PPE?

air purified respirator, coverall with splash hood, chemical resistant gloves and hood

Level C PPE

air-purified respirator

What is the cause of mortality with Botulinum?

airway obstruction, inadequate tidal volume

What is the tx for cyanide poisoning?

amyl nitrate, sodium nitrate, sodium thiosulfate help to excrete cyanide; intubation, high dose of B12 IV

Although the thought of biologic disasters is alarming, treatment and transmission-based precautions can be relatively simple in some cases. Health care workers can protect themselves using standard precautions and treat clients using fluoroquinolone antibiotics for infections with which biologic agent?

anthrax Explanation: When anthrax is diagnosed by culturing blood, stool, and wound exudates, it is treated fairly successfully with antibiotic therapy. The preferred antibiotic is ciprofloxacin (Cipro) or levofloxacin (Levaquin), both of which are fluoroquinolones; the treatment lasts 4 weeks or longer for an inhalant infection. Botulinum antitoxin is the only immediate treatment after exposure to lessen the severity of botulism. No treatment currently exists for smallpox. Cyanide is a solid salt or volatile liquid chemical and not a biologic agent.

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

anthrax can infect the integumentary, GI, and respiratory systems.

Disaster is defined as

any man-made or natural event that overwhelms a community and it's resources

What is the third step triage?

assess perfusion: if cap refill is >2 sec then triage as red and continue to next pt, if <2 sec then continue assess pt

What is the second step of triage?

assess respirations: if greater then 30/min then triage as red and move to next patient, if less then 30/min continue assessing

In disaster situations, how does triage prioritize?

because of large number of causalities, decisions are based on the likelihood of survival and the consumption of resources

Action of vesicant agents

blistering

What do vesicants cause?

blistering, buring, respiratory effects are serious: purulent fibrinous pseudomembranous drainage leading to airway obstruction

What is cyanide?

blood agent

mechanism of nerve agents

bond w/ acetylcholinesterase so that acetylcholine is not inactivated = hyperstimulation of nerve endings = leads to cholinergic shock

What complication can occur with equine antitoxin?

chance of reaction so have benadryl and epinephrine at bedside

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

What support interventions should be initiated with Tularemia?

control fever, assess fluid and -lyte balance, control pain

Indication for diazepam (Valium) in treatment of sarin gas

control seizures -decrease fasciculations -alleviate apprehension/agitation

How are nerve agents decontaminated?

copious amounts of soap and water or saline for 8-20 minutes; blot do not wipe away; do not use plastic material because it can be absorbed into it

sarin gas decon

copious amounts of soap and water or saline solution for 8-20 min -WATER IS BLOTTED OFF -0.5% hypochlorite can be used

Anthrax (Bacillus Anthracis) can affect what body systems?

cutaneous, inhalation, and GI ingestion

How low does botulinum last for?

death within 3 days but can last for months with not fatal

How is smallpox (variola) spread?

direct contact with person, clothes/linens, or droplets

What does cyanide do?

direct effect on cellular metabolism causes asphyxiation

How is the waste of radiation victims contained?

double bagged and labeled

What s/s are associated with anthrax but not the flu?

dyspnea, chest discomfort, pleuritic pain

What are the s/s of cutaneous anthrax?

edema, pruritus, macule or papule formation leading to ulceration then to eschar

What is contamination radiation?

exposure to radioactive gases, liquids, or solids; requires immediate medical management to prevent incorporation

Black tagged injuries are considered

extensive and chances of survival are unlikely even with definitive care

What are the types of radiation?

external radiation, contamination, and incorporation

What are the s/s of Tularemia (Francisella Tularensis)?

fever, chills, malaise, cough, headache, sore throat w/o adenopathy as it progresses sweating, fatigue, anorexia, and weight loss occur

What are the initial s/s of inhalation anthrax?

fever, malaise, fatigue, chills, cough, chest and abdominal pain

What are the clinical manifestations of inhalation Botulinum?

fever, symmetric descending flaccid paralysis w/ multiple CN palsies leading to diplopia, dysphagia, dry mouth, ptosis, enlarged sluggish pupils, dysarthria, and dysphonia

What is Level B PPE?

high level of respiratory protection (SCBA) but lesser skin and eye protection; chemical resistant suit

Level B PPE

highest level of resp but lesser of skin/eye protection

Level A PPE

highest level of resp, skin, eye, and mucous membrane protection

Air ducts and vents are __ for radiation decontamination.

sealed

Mass Casualty Incident (MCI)

situation in which the number of casualties exceeds the number of resources

Neuro responses to sarin gas

-insomnia -forgetfulness -impaired judgment -depression -irritability

Types of disasters

-internal -external

Characteristics of Anthrax

-invisible & odorless -can travel great distance

progression of cyanide contamination

-lactic acidosis -resp arrest/failure -cardiac arrest -death

Sarin gas lethal dose responses

-loss of consciousness -seizures -copious secretions -fasciculations -flaccid muscles -apnea

An internal disaster may include

-loss of electricity -loss of water -damage R/T fire, weather, explosion -terrorist attack

Medical & Nursing Management for sarin gas

-maintain airway -frequent suctioning

Environmental Protection Agency Categories of PPE

-LEVELS A, B, C, D

What is associated with the flu and not anthrax?

nasal congestion and rhinorrhea

How long does Botulinum incubate for?

normally 1-5 days but if ingested can be within 24-36 hours; longer if inhaled

What to do in the midst of a bomb threat

-extend convo -listen to background noises -inquire about location -try to identify phone number -remain calm -have another staff contact police

Medical & nursing management of SARS

-droplet precautions, control of visits -supportive treatment

Clinical manifestations of SARS

-early: dry cough, SOB w/ or w/o other resp symptoms -xray confirmed pneumonia or acute RDS evident at 7-10 days along w/ fever and resp symptoms

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

Providing distance from radiation source

Common nerve agent

Sarin gas

What are the vesicants?

lewisite, sulfur mustard, nitrogen mustard, phosgene

How is the pneumonic plague spread?

transmitted via respiratory droplet

Patho of Small Pox

-DNA virus -extremely contagious -spread via direct contact or inhaled via droplets

Examples of vesicant agents

-Lewisite -sulfur mustard -nitrogen mustard -phosgene

Clinical manifestations of GI anthrax

-N/V/D -hematemesis -abd pain -ascites -sepsis -shock

viral hemorrhagic fever mode of transmission

-aerosol -person: person -possibly animals

botulism mortality secondary to:

-airway obstruction -inadequate TV

S/S of sarin gas

-bilateral miosis -salivation -urination -sweating -increased GI motility; NVD -fasciculations -bradycardia -HTN -bronchoconstriction; resp depression -death

Contagion of the plague

-bubonic: via flea bite w/ no person-person contact -pneumonic: resp droplet contact

Examples of black tagged injuries

-burns over 60% of BSA -wounds involving multiple organs/anatomical sites -high spinal cord injuries -penetrating head wounds & unresponsive -agonal respirations -pulseless, no BP -profound shock w/ multiple injuries -fixed and dilated pupils -seizures and vomiting within 24 hrs after radiation exposure

Antibiotic therapy for anthrax

-ciprofloxacin -PCN -doxycycline

Emergency Preparedness Plans should include

-communication -supplies/managing resources -safety and security -staff -utilities -clinical activity

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? a) 1 week b) 2 weeks c) 10 days d) 4 days

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.

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) A radiologic disaster b) A chemical disaster c) A natural disaster d) A biologic disaster

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.

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? a) Sarin b) Mustard gas c) Cyanide d) Anthrax

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.

Nursing students are reviewing information about weapons of terror. The students demonstrate understanding of the information when they identify which of the following as examples of chemical weapons? Select all that apply.

Cyanide Phosgene Sarin Explanation: Chemical weapons include cyanide (a blood agent), phosgene (a vesicant and pulmonary agent), and sarin (a nerve agent). Anthrax and tularemia are examples of biologic agents of terror.

A patient was involved in an avalanche that killed many people on a ski trip, including the patient's brother. The nurse is educating the patient about recognition of stress reactions and ways to manage stress. What type of process is the nurse introducing to the patient? a) Demobilization b) Preparedness c) Defusing d) Debriefing

Defusing Components of a management plan include education (preparedness) before an incident occurs about critical incident stress and coping strategies; field support (ensuring that staff get adequate rest, food, and fluids, and rotating workloads) during an incident; and defusings, debriefings, demobilization, supportive services to the family, and follow-up care after the incident (Veenema, 2013). Defusing is a process by which the person receives education about recognition of stress reactions and management strategies for handling stress. Debriefing is a more complicated intervention; 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 (e.g., flashbacks, difficulty sleeping, intrusive thoughts), and other psychological ramifications.

Federal agency that coordinates the activation and implementation of federal disaster management

FEMA

A patient has been field triaged and categorized as blue. The nurse recognizes that the patient requires which of the following type of treatment? a) Fast-track or psychological support b) Immediate care c) Urgent care d) Emergent care

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.

Inhalation of anthrax mimics which disease process?

Flu

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 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.

A pipe bomb detonated on a city bus, causing numerous casualties. This would be an example of which type of disaster? a) Unintentional human b) Intentional human c) Biologic d) Natural

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.

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 D Explanation: 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.

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 Explanation: 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.

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 Explanation: Exposure to a nerve agent manifests with signs and symptoms of cholinergic crisis including bilateral miosis, increased gastrointestinal motility, nausea, vomiting, diarrhea, substernal spasm, indigestion, bradycardia, bronchoconstriction, laryngeal spasm, weakness, fasciculations, and incontinence. Bullae are seen with vesicants.

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.

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 Explanation: In the event of an air embolus, the patient should be immediately placed in the prone left lateral position to prevent migration of the embolus and will require emergent treatment in a hyperbaric chamber (CDC, 2013).

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

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.

A client, contaminated following exposure to radiation, is brought to the hospital for assessment. Which nursing action is essential? a) Refer the client to the triage area. b) Place the client in strict isolation. c) Obtain vital signs and lab work. d) Assess the client for respiratory concerns.

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.

A patient comes to the ED after ingesting cyanide. The first thing the nurse should anticipate doing is which of the following? a) Administer sodium thiosulfate. b) Prepare the patient for intubation. c) Administer sodium nitrate. d) Prepare the patient for nasogastric insertion.

Prepare the patient for intubation. The nurse should prepare the patient for intubation. After the patient is placed on the ventilator, amyl nitrate pearls are crushed and placed in the ventilator reservoir. Then, the nurse should prepare to administer IV sodium nitrate and then sodium thiosulfate according to the physician's orders.

Red triage tags are which level of urgency

Priority 1- Emergent or Immediate -treat within 15 min

Yellow triage tags are considered which level of urgency

Priority 2- Urgent or delayed

Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage? a) Priority 3 b) Priority 4 c) Priority 1 d) Priority 2

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.

Black triage tags are considered which level urgency

Priority 4- expectant

When describing the Emergency Operations Plan (EOP) to a group of nurses working as part of a disaster response team, which of the following would be identified as its primary goal?

Protection of the community

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? a) Biologic b) Radiologic c) Manmade d) Chemical

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.

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

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

You are a nurse 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. You know that this is what type of a disaster? a) Explosive b) Natural c) Chemical d) Radiologic

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. The scenario does not describe a natural disaster or a chemical disaster. Option B is only a distractor.

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

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 volunteers to help decontaminate a victim. Which of the following is the first action that the nurse should take? a) Dressing victim in personal protective equipment b) Applying chemical decontamination foam to area c) Washing victim with soap and water and rinsing d) Removing victim's clothing and jewelry

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.

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.

viral hemorrhagic fever can lead to

hypovolemic shock

Level D PPE

typical work uniform; may include gloves, glasses, face shield

While watching a television newscast, a nurse hears that the Department of Homeland Security has identified the security threat level as yellow. The nurse interprets to mean which of the following? a) The risk is low with little information known. b) The risk of a credible attack is extremely high. c) There is an elevated risk but no defined site. d) The condition is guarded with a generalized risk.

There is an elevated risk but no defined site. A security threat level of yellow indicates an elevated threat with a possible risk but no defined identified site. A threat level of red indicates that the threat is severe wtih a high risk and specified site. A threat level of blue indicates that the situation is guarded, with a generalized risk without any specific risks identified. A threat level of green indicates low, little, or no risk as being perceived or known.

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.

Often, treatments used for exposure to biologic agents manage the symptoms; the disease process must run its course. Which biologic agent exposure requires the use of ventilation support of breathing, possibly for up to 2 to 3 months?

botulism Explanation: Generally, initial treatment of botulism follows a clinical rather than a laboratory diagnosis. Tests on serum, gastric, and fecal specimens tend to be too time consuming to justify a delay in treatment. Mechanical ventilation is required to support breathing for 2 to 3 months.

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.

How can Botulinum Toxin be spread?

in bioterrorism can be spread with aerosol and food supply sabotage

Man-made chemical disasters have been portrayed in movies and on television as nightmarish situations, at best. The most toxic chemical disasters are those caused by:

nerve agents. Explanation: Nerve agents, the most toxic of all chemical agents, are potent organophosphate compounds that cause fatal consequences by inhibiting acetyl cholinesterase, an enzyme that inactivates acetylcholine, a neurotransmitter of the parasympathetic (cholinergic) nervous system. Consequently, in cases of attacks with nerve agents, the functions of the parasympathetic nervous system will be active without any potential for disinhibition.

Who are the probable survivors of ARS?

those with no initial symptoms or only minimal symptoms

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

intentional human

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

Examples of yellow tagged injuries

-complex lower extremity fractures -vascular injuries without compromise (adequate circulation) -stable abdominal wounds (w/o hemorrhage) -CNS injuries -GU injuries -facial injuries w/o airway obstruction -children not accompanied by a parent -soft tissue -fxs requiring open reduction, debridement, & external fixation

Administering equine antitoxin

-diphenhydramine & epinephrine on hand

transmission & incubation of Botulism

-direct contact w/ improperly cooked/canned food / not person to person -12-36 hrs

Tularemia contagion

-direct contact w/ infected animal or aerosolized agent -ingestion of contaminated meat, soil, or water -insect bite -not contagious via human-human contact

Action of blood agents

-direct effect on cellular metabolism resulting in asphyxiation through alterations in hemoglobin -inhibition of aerobic metabolism

possible legal implications surrounding disaster

-failure to protect -failure to prepare -failure to train or educate staff -failure to provide safe and available operational resources -patient abandonment -failure to comply w/ legal duty

Medical/Nursing management for cyanide

1. intubated & placed on vent 2. amyl nitrate crushed & placed in vent 3. IV sodium nitrite 4. IV sodium thiosulfate

incubation period of small pox

10-12 days

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.

There has been a radiation-based terrorist attack and a patient is experiencing vomiting, diarrhea, and shock after the attack. How will the patients likelihood of survival be characterized? A. Probable B. Possible C. Improbable D. Extended

Ans: C Feedback: Patients who experience vomiting, diarrhea, and shock after radiation exposure are categorized as improbable survival, because they are demonstrating symptoms of exposure levels of more than 800 rads of total body-penetrating irradiation.

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.

Wear protective clothes

Ciprofloxacin (Cipro) for 60 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, creating not only devastating injuries but the radioactive contamination can also be spread to contaminate others. What type of transmission precaution prevents this person-to-person contamination? a) Airborne b) Droplet c) Contact d) Standard

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.

What are the s/s of primary septicemic plague?

DIC, necrosis of small vessels, and gangrene of digits and nose

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.

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.

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

Federal Bureau of Investigation (FBI)

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? a) Likely b) Possible c) Probable d) Improbable

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 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? a) Absence of potable water b) Loss of electricity c) Lack of communication systems d) Loss of building structures

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.

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.

During a disaster, the nurse sees a victim with a green triage tag. The nurse knows that the person has which type of injuries? a) Minor and treatment can be delayed hours to days b) Life-threatening but survivable with minimal intervention c) Extensive and chances of survival are unlikely even with definitive care d) Significant and require medical care, but can wait hours without threat to life or limb

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.

The nursing instructor is talking with their students about botulism. The instructor tells the students that when caring for a client with botulism what condition is most likely to cause death?

Paralysis of respiratory muscles

Which is a clinical manifestation of sulfur mustard?

Partial-thickness burns

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

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? a) Medical iodine b) Potassium iodide c) Cyan red d) Russian blue

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.

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 Explanation: 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.

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? a) Supine with head of the bed at 30 degrees b) Lithotomy c) High-Fowler's position d) Prone left lateral position

Prone left lateral position In the event of an air embolus, the patient should be immediately placed in the prone left lateral position to prevent migration of the embolus and will require emergent treatment in a hyperbaric chamber (CDC, 2013).

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 which of the following?

Provide 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.

Prevention is a tool we all can use to decrease our potential for gamma radiation contamination in the event of a nuclear accident or attack. Being aware of ways to limit external contamination empowers individuals to feel safer and to protect themselves and their loved ones. If caught outside during such an event, which of the following is the most effective way to decrease the potential for external gamma radiation contamination by an individual? a) Remove all garments and shoes before entering a house or public shelter. b) Cover the mouth and nose with a scarf or handkerchief. c) Turn on window fans or air conditioners to blow out contaminated air. d) Don't worry, gamma radiation is harmless.

Remove all garments and shoes before entering a house or public shelter. Removing all garments can eliminate 90% of external radioactive contamination. To limit external contamination, you should turn off window fans, air conditioners, and forced-air heating units. This is a way to limit internal, not external, contamination. Exposure to gamma radiation may cause acute radiation syndrome (ARS) and lead to death. Long-term effects experienced by those exposed to radiologic disasters include thyroid cancer, leukemia, and non-Hodgkin's lymphoma.

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. 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.

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? a) Security and screenings are increased. b) Monitoring activities are increased. c) Lockdown occurs for security. d) A specific site has been identified.

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.

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

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.

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? a) Rubella b) Smallpox c) Botulism d) Anthrax

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.

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? a) Chlorhexidine b) Alcohol c) Soap and water d) Sodium hypochlorite

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.

A client has been exposed to cyanide. Which of the following would the nurse expect to assist in administering? Select all that apply.

Sodium thiosulfate Sodium nitrite Amyl nitrate

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.

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

What is an Incident Command System (ICS)?

a local organization that coordinates personnel, facilities, equipment, and communication; it is federally mandated; it is the center of operations; one person is the incident commander

What does cyanide smell like?

bitter almonds

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

bullae. Explanation: 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.

commonly used blood agent

hydrogen "cyanide"

What are the primary clinical manifestations of variola major (smallpox) as opposed to chickenpox?

increased facial density, the lesions are at the same stage, and limited to thoracic distribution (chickenpox has more thoracic lesions), lesions on hands and feet persist the longest (chickenpox has no hand or feet lesions)

S/S of viral hemorrhagic fever

increased vascular permeability leading to: -thrombocytopenia -depletion of clotting factors -hemorrhage

Red tagged injuries are considered

life-threatening but survivable with immediate intervention -can progress rapidly to expectant

What is essential with chemical weapons?

limit exposure with evacuation and decontamination as soon as possible and as close as possible to the scene as possible

when is smallpox contagious

only after appearance of rash

What ethical conflicts does the nurse face during disaster response?

rationing care, futile therapy, consent, duty, confidentiality, resuscitation, assisted suicide

Clinical manifestations of cutaneous anthrax

resembles an insect bite, advances to depressed black ulcer, swollen lymph nodes, sepsis, and shock

What are the s/s of cyanide poisoning?

resp. muscle failure, resp. arrest, cardiac arrest, death; if inhaled causes flushing, tachypnea, stupor, coma, seizure, and resp. arrest

What are the nerve agents?

sarin, soman, organophosphates (pesticides)

What is Level A PPE?

self-containing breathing apparatus (SCBA), vapor tight chemical resistant suit, gloves, and boots

What are the s/s of pneumonic plague?

severe bronchospasm, CP, dyspnea, cough, hemoptysis; 100% mortality if not treated with 24 hours