Chapter 73: Terrorism, Mass Casualty, and Disaster Nursing

Which is the most likely weaponized biological agent available?

Anthrax Explanation: Anthrax is recognized as the most likely weaponized biologic agent available. Anthrax is caused by replicating bacteria that release toxins, resulting in hemorrhage, edema, and necrosis. The plague, smallpox, and botulism are not the most likely weaponized biological agents available.

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 Explanation: In mass casualty incidents involving anthrax, treatment with ciprofloxacin or doxycycline is recommended. Overall recommended agents for treating anthrax include penicillin, erythromycin, gentamicin, and doxycycline.

A patient was suspected of being in direct contact with anthrax but is exhibiting no signs or symptoms. What type of prophylaxis does the nurse know this patient will have to take?

Ciprofloxacin (Cipro) for 60 days Explanation: At present, anthrax is penicillin sensitive; however, strains of penicillin-resistant anthrax are thought to exist. Recommended treatment includes penicillin ( Penicillin V), erythromycin (Erythrocin), gentamicin ( Garamycin), or doxycycline (Vibramycin). If antibiotic treatment begins within 24 hours after exposure, death can be prevented. In a mass casualty situation, treatment with ciprofloxacin (Cipro) or doxycycline is recommended, because these easily administered oral antibiotic agents are stockpiled and there should be sufficient dosages to fully treat many anthrax-exposed patients.

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 Explanation: 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 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. Radiologic contamination is not characterized as direct or indirect. This does not describe a client with internal radiologic contamination.

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

It is most contagious during the second week of illness. Explanation: Based on available information, SARS is most likely to be contagious only when symptoms are present, and clients are most contagious during the second week of illness. Diarrhea and hyperthermia may occur with SARS. Respiratory droplets spread the SARS virus when an infected person coughs or sneezes.

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 Explanation: Taking substances called potassium iodide, Prussian blue, and diethylenetriamine pentaacetate can prevent or reduce radiologic organ damage. Option A, C and D are incorrect and used only as distractors.

The nurse is triaging patients from a 10-car pile-up on the interstate and assesses a patient with a sucking chest wound. What category should this patient be placed in?

Priority 1 Explanation: Triage category "Immediate" is priority 1 (red) and includes injuries that are life threatening but survivable with minimal intervention, such as sucking chest wound, airway obstruction secondary to mechanical cause, and shock.

Clients involved in a mass casualty incident are triaged and assigned a color-coded tag. When prioritizing care, clients tagged with which color would be treated first?

Red Explanation: Clients who are tagged red require immediate care. These would be followed by clients who are tagged yellow and then green. Clients who are tagged black receive comfort measures.

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 Explanation: 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.

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 Explanation: 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.

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

Toxicity Explanation: The median lethal dose (LD50) is the amount of the chemical that will cause death in 50% of those who are exposed. Persistence means that the chemical is less likely to vaporize and disperse. Volatility is the tendency for a chemical to become a vapor. Latency is the time from absorption to the appearance of symptoms.

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 Explanation: All people who have household or face-to-face contact with the client 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 does not have any symptoms. The nurse's teaching includes that prophylactic antibiotics must be taken for:

60 days. Explanation: Victims who have been exposed to anthrax but are not exhibiting symptoms should take the prescribed prophylactic antibiotic for 60 days. The aim of the prophylaxis is to ensure that if spores were inhaled, bacteria will be killed immediately upon release from spores. Those who have symptoms of fever, cough, headache, chills, and especially evidence of mediastinal lymph node involvement should be treated with IV antibiotics and respiratory support, if needed.

The nurse is caring for three clients who have been diagnosed with anthrax. They were exposed after boarding a flight where a white powdery substance was found in one of the restrooms. The nurse knows that these clients would be classed as being victims of which of the following?

A biologic disaster Explanation: Anthrax is a biologic agent that could be the cause of a biologic disaster, one in which pathogens or their toxins cause harm to many humans and other living species. Anthrax is not a natural, radiologic, or chemical agent of disaster.

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.

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?

Anthrax Explanation: 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 Explanation: Botulism is a disease that develops from the neurotoxin produced by Clostridium botulinum. Botulinum antitoxin is the only treatment after exposure to lessen the severity of symptoms. Antibiotics are used for anthrax. Supportive treatments such as antipyretics are used for smallpox. Anti-inflammatory medications are not treatments for botulism.

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 Explanation: Triage category "Minimal" is coded green and includes injuries that are minor and for which treatment can be delayed hours to days, such as psychological disturbances.

Anthrax acquired by which method develops into the most severe?

Inhalation Explanation: The most severe form of anthrax develops through inhalation. At the onset, it may be mistaken for a cold or flu, but if it is diagnosed wrongly and untreated, the infections can lead into severe respiratory distress and almost certain death. Ingesting the bacteria is slightly less lethal, with symptoms of nausea, vomiting, diarrhea, and abdominal pain because they infect the gastrointestinal tract and circulatory and mesenteric lymph nodes. Skin infection is the least deadly form and the only one that may be transmitted by direct contact. One of the ways smallpox spreads is through contact with body fluids or contaminated objects that contain the live virus.

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 Explanation: They administer one or all of the following antidotes: amyl nitrate, sodium nitrate, and sodium thiosulfate. Amyl nitrate promotes the formation of methemoglobin, which combines with cyanide to form nontoxic cyanmethemoglobin. Therefore, options A, B, and D are incorrect

A client comes to the ED after attempting suicide with nerve gas. Which is an appropriate nursing intervention?

Frequent suctioning, as needed Explanation: Appropriate nursing interventions after exposure to nerve gas include frequent suctioning, as needed; decontaminating the skin by rinsing with saline or soap and water for 8 to 20 minutes; blotting versus wiping skin dry to prevent rubbing more of the agent into the skin; and administration of intravenous atropine or pralidoxime.

A cattle rancher with a new onset of fever, chills, and headache is suspected of being exposed to tularemia. Which medication will the nurse anticipate being prescribed for this client? Select all that apply.

Gentamicin Doxycycline Tetracycline Streptomycin Ciprofloxacin Explanation: Tularemia is a gram-negative coccobacillus that is contracted through direct contact with an infected animal. Treatment may include gentamicin, doxycycline, tetracycline, streptomycin, or ciprofloxacin for 10 to 14 days. Penicillin is not used to treat tularemia.

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 Explanation: 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.

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

anthrax can infect the integumentary, GI, and respiratory systems. Explanation: Anthrax can infect the integumentary, GI, and respiratory systems. Immunizations are appropriate only for those at risk of anthrax exposure. Isoniazid, rifampin, and pyrazinamide are used to treat tuberculosis, not anthrax. Penicillin is the most common drug used to threat anthrax.

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

Green Explanation: A green triage tag (priority 3, or minimal) indicates injuries that are minor, and treatment can be delayed hours to days. A red triage tag (priority 1, or immediate) indicates injuries that are life threatening but survivable with minimal intervention. A yellow triage tag (priority 2, or delayed) indicates injuries that are significant and require medical care, but they can wait hours without threat to life or limb. A black triage tag (priority 4, or expectant) indicates injuries that are extensive; chances of survival are unlikely even with definitive care.

The nurse assisting at the scene of a terrorist bombing is assessing bystanders for quinary effects from the blast. The nurse assesses for which signs and symptoms? Select all that apply.

Hyperpyrexia Diaphoresis Explanation: Quinary effects to bystanders ( near to the blast) include hyperpyrexia and diaphoresis. Fractures occur during the secondary and tertiary phases of blast injuries. Asthma exacerbation is seen during the quaternary phase.

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 Explanation: Phosgene vapor is a pulmonary agent that destroys the pulmonary membrane leading to pulmonary edema, with shortness of breath. Therefore, impaired gas exchange would be the priority. Impaired skin integrity would be appropriate for exposure to a vesicant. Disturbed sensory perception, visual would be appropriate for a client exposed to a nerve agent. Decreased cardiac output would be appropriate for a client exposed to a blood agent, such as cyanide, which inhibits aerobic metabolism.

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 Explanation: The client was working with pesticides, organophosphates, which are considered nerve agents. The client's signs and symptoms also reflect exposure to a nerve agent.

The school nurse is notified of an outbreak of varicella in school-age children in neighboring communities. Which information will the nurse include when informing the parents of the school students about the infection?

"The number of cases of varicella in school-age students exceeds what is considered a normal amount." Explanation: An outbreak is the occurrence of a disease within a population that exceeds normal expectations. The occurrence of varicella (chickenpox) in school-age students in neighboring communities would be appropriate to communicate to the parents. The occurrence of varicella in attendees at a county fair and widespread outbreak of the infection in all people who live in a community and surrounding area are characteristics of an epidemic. The statement that the infection has been found in several countries in the Northern Hemisphere describes a pandemic.

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 Explanation: The devices that initiate, control, and sustain the nuclear reactions as well as spent fuel are a potential concern for the escape of radiation. The scenario described does not indicate option A, B, or C; therefore, they are incorrect.ner

A client asks the nurse what is meant by an imminent alert about a security threat posted on television by the Department of Homeland Security. What is the best response by the nurse?

A specific pending threat has been identified. Explanation: The National Terrorism Advisory System uses alerts and bulletins. A National Terrorism Advisory System bulletin describes trends and developments in threats of terrorism, whereas an National Terrorism Advisory System alert more fully warns of a credible threat of terrorism to the United States. The alerts may be more specifically designated as an elevated alert, meaning that there is indeed a credible alert posted, or an imminent alert, meaning that there is a specific pending threat of terrorism to the United States. An imminent alert does not involve a lockdown or increased screenings and activities.

A client is being treated for cyanide exposure. The nurse would expect which agent to be the least likely used as part of the client's treatment?

Atropine Explanation: 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?

Black Explanation: 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.

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 arm contusions Client with a first-degree burn to the forearm Explanation: In triage, green indicates minor injuries for which treatment can be delayed hours to days. A client with contusions 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 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 defusing, 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.

During a mass disaster, the nurse is caring for a victim whose status has been categorized as yellow during triage. How should the nurse best allocate time and resources to this client's care?

Delay the client's treatment for a few hours if other clients need immediate care Explanation: For a client categorized as yellow, care can be safely delayed for six to eight hours. Death is not imminent, but spontaneous recovery is unlikely.

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 Explanation: 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 percutaneously absorbed.

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. Explanation: Nurses should discourage victims from subjecting themselves to repeated exposure to the event through media replays and news articles. Nurses can assist disaster victims through active listening and providing emotional support, giving information and referring them to therapists, social workers, or mental health services as necessary. In addition, nurses should encourage victims to return to normal activities and social roles when appropriate.

Inhalation of anthrax mimics which disease process?

Flu Explanation: Anthrax symptoms mimic those of the flu, and usually treatment is sought only when the second stage of severe respiratory distress occurs. Burns occur with sulfur mustard. Bronchospasm can occur with phosgene or chlorine. Respiratory distress may occur with cyanide.

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 Explanation: Improbable survivors have received more than 800 rad of total-body penetrating irradiation. People in this group demonstrate an acute onset of vomiting, bloody diarrhea, and shock. Any neurologic symptoms suggest a lethal dose of radiation (CDC, 2006). Possible survivors present with nausea and vomiting that persist for 24 to 48 hours. Probable survivors have either no initial symptoms or only minimal symptoms (e.g., nausea and vomiting), or these symptoms resolve within a few hours. "Likely" is not a survival category.

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 Explanation: The incubation period for smallpox is 10 to 12 days. A flat, red-lesioned rash appears 2 to 3 days postexposure.

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 Explanation: Military personnel believed to be at risk for chemical attack are provided with Mark I automatic injectors, which contain 2 mg atropine and 600 mg pralidoxime chloride. Diazepam may be administered by a partner.

In a mass casualty event a client has been field triaged and categorized as green. The nurse recognizes that interventions for this client require which of the following priorities?

Minimal Explanation: When a client is field triaged and categorized as green their treatment is considered minimal. Their injuries are minor and treatment can be delayed hours to days. When a client is categorized as yellow or delayed their injuries are significant and require care but can wait hours without threat to life or limb. When a client is categorized as red or immediate their injuries are life threatening but survivable with minimal intervention. When a client is categorized as black or expectant their injuries are extensive and chances for survival are unlikely even with definitive care.

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 Explanation: A green triage tag (priority 3, or minimal) indicates injuries that are minor; 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; chances of survival are unlikely even with definitive care.

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. Explanation: Monitoring vital signs and oxygen saturation every 15 to 30 minutes takes priority. Suctioning the client as needed to obtain a sputum specimen may be necessary, but assessing the client for changes in his respiratory status takes priority. Assessing intake and output and providing adequate hydration are important steps for liquefying secretions; however, they don't take priority. Reassuring the client that intubation and mechanical ventilation is temporary is inappropriate. The client may not require intubation and mechanical ventilation; however, if he does, the nurse can't predict the length of time it may be necessary.

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. Explanation: The nurse noticed specific trends about the clients. The next step is to obtain an extensive client history in an attempt to identify the possible agent involved. Once information is obtained, then suspicions or findings are reported to the appropriate resources in the facility and to proper authorities in the community. Putting on personal protective equipment would be appropriate if a hazard is identified.

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

Priority 4 Explanation: 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.

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

Providing distance from radiation source Explanation: Gamma radiation can penetrate clothing and skin. Thick clothes do not provide any kind of protection. Lead blocks radiation, but it is safest to limit exposure and to distance oneself from the source.

The nurse is reviewing information from a recent disaster management training session. The nurse knows that all of the following activities are part of the preparedness phase of disaster management except for:

Providing emergency care Explanation: The preparedness phase of disaster management is the phase of planning for saving lives. Preparedness would include conducting training and mock disaster response drills, as well as designating location of shelters and developing early warning systems and evacuation routes. Providing emergency care is an aspect of the response phase. The purpose of the response phase is to limit injuries and deaths as well as reduce property damage.

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 Explanation: 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 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 Explanation: 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. Explanation: The nurse should have victims shower and change clothes and irrigate or wash open wounds with soap and water. Cleansing the skin helps to reduce the transition from external to internal radiologic contamination. Infectious microorganisms are not involved, so chlorhexidine is of no particular benefit. Applying PPE over contaminated clothing could worsen the risk for injury. Adequate ventilation is important, but removal of contaminants is the priority because of the increased risk for injury.

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 Explanation: To be effective, decontamination must include a minimum of two steps. The first step is removing the client's clothing and jewelry and then rinsing the client 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 Explanation: The consequences of exposure to chlorine and other respiratory toxins are related to the amount, route, and length of chemical exposure. Death occurs as fluid infiltrates the pulmonary air spaces and terminal bronchioles interfering with gas exchange. Following recovery from an acute event, victims may develop chronic bronchitis and emphysema.

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 Explanation: A person exposed to a blistering agent or vesicant must be decontaminated immediately, with clothing removed and bagged. Irrigation of the victim's eyes and application of topical analgesia, antibiotics, and lubricants to the skin occur. Simultaneously, the nurse is assessing the respiratory system for airway obstruction because blisters from inhaled toxics can swell obstructing respiratory passages.

The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates?

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

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. Explanation: Smallpox is spread by droplet or direct contact. No antiviral agents are effective against smallpox; however, vaccination within 2 to 3 days of exposure is protective. In 4 to 5 days, vaccination may prevent death and should be administered with vaccinia immune globulin. Smallpox spreads rapidly and requires immediate isolation. Even in death, the disease can be transmitted.

A client is hospitalized for cutaneous exposure to anthrax. Which treatment option will the nurse anticipate for this client? Select all that apply.

Standard precautions Ciprofloxacin orally for 60 days Explanation: Anthrax is caused by replicating bacteria that release toxins, resulting in hemorrhage, edema, and necrosis. There are three main methods of infection: skin contact (cutaneous), gastrointestinal digestion, and inhalation. Standard precautions are needed when caring for a client infected with anthrax. The client is not contagious, and the disease cannot spread from person to person. Equipment should be cleaned using standard hospital disinfectant. If antibiotic treatment begins within 24 hours after exposure, death can be prevented. For clients who have been directly exposed to anthrax but have no signs and symptoms of disease, the antibiotics ciprofloxacin or doxycycline are used for prophylaxis for 60 days. The initiation of a sepsis protocol could be anticipated for a client who ingested anthrax but not for direct skin contact. High-dose corticosteroid therapy is not indicated. The client will not need intubation and mechanical ventilation for cutaneous exposure to anthrax.

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 Explanation: The nurse should prepare to care for a client 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 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 Explanation: The role of the nurse during a disaster varies and depends on the needs or situation. Nurses may be asked to perform duties outside their areas of expertise and may take on responsibilities normally held by physicians or advanced practice nurses. During a disaster, nursing care focuses on essential care from a perspective of what is best for all clients.

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 Explanation: Blisters that come together forming large, dome-shaped lesions filled with clear or yellow fluid suggest exposure to a vesicant. Anthrax typically causes black-centered blisters. A smallpox rash becomes fluid-filled raised papules, with a depressed central area. Chickenpox usually causes successive crops of small macules and papules.

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

Volatility Explanation: The most common volatile agents are phosgene and cyanide. Persistence means that the chemical is less likely to vaporize and disperse. Toxicity is the potential of an agent to cause injury to the body. Latency is the time from absorption to the appearance of symptoms.

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. Explanation: 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.

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.

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. Explanation: A client with a mild to moderate case of botulism experiences dry mouth, double vision, unfocused vision, weakness, a sense of paralysis, and an unsteady gait. Anthrax symptoms include fever, flulike symptoms, cough, and a sore throat. Herpes isn't an agent of bioterrorism. Ebola symptoms include malaise, fatigue, headache, sore throat, and nausea.

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 Explanation: Invisible gamma radiation penetrates the body and can be eliminated in blood, sweat, urine, and feces. Consequently, a contaminated person can contaminate others through contact with body fluids or surfaces he or she touches. Airborne transmission requires the suspension and transport on air currents beyond 3 feet and is the way in which many pathogens or toxins are transmitted. Invisible gamma rays do not fall into this category, however. Gamma radiation does not travel in a liquid, or droplet, form. Standard precautions encompass more than person-to-person contamination.

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 state that managing clients who exhibit symptoms of the variola virus (smallpox) includes

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

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. Explanation: Emergency department triage involves giving priority to clients at highest risk for loss of life, limb, or vision. Clients with poor prognoses are given a lesser priority. The client with the maxillofacial injury and gurgling respirations needs immediate attention because of an impaired airway. The spinal cord injury client doesn't exhibit immediate airway needs. The client with the severe head injury and no blood pressure has a grave prognosis. Although the client in early labor is an urgent priority, early labor doesn't surpass airway compromise in importance.

A client with a minor burn would be triaged as

minimal. Explanation: 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 soft-tissue injuries and most eye and central nervous system injuries. Conditions related to the expectant category include unresponsive clients with penetrating head wounds.

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. Explanation: Sulfur mustard causes superficial to partial-thickness burns with vesicles that coalesce. Phosgene causes pulmonary edema. Sarin causes increased gastrointestinal motility and diarrhea. Cyanide causes cardiac arrest and death.