Ch 73 Mass Casualty, disaster, terrorism

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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? 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.

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.

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.

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.

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.

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.

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.

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 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 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 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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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).

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 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.

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.

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 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.

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.

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.

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 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.

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.

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 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 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.