Adult health Chapter 56: Nursing Management: Emergencies and Disasters

Permanent brain injury or death will occur within which time frame secondary to hypoxia?

3 to 5 minutes

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

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

Green

Which category of triage encompasses clients with serious health problems that are not immediately life threatening?

Urgent

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

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.

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

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

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

intentional human

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.

The first step in decontamination includes

removing the client's clothing and jewelry and then rinsing the client with water.

Following a motor vehicle collision, a client is brought to the ED for evaluation and treatment. The client is being assessed for intra-abdominal injuries. The client reports severe left shoulder pain (pain score of 10 on a 1 to 10 scale). The nurse suspects injury to the

spleen.

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.

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

A client comes to the emergency department with a suspected airway obstruction. The emergency department team prepares to manage the client as if he has a complete airway obstruction based on which of the following?

High-pitched noise on inhalation

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

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

A patient who has accidentally ingested toilet bowel cleaner is brought to the emergency department. Which action would NOT be appropriate for the nurse to implement?

Induced vomiting

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.

The nurse is administering 100% oxygen to a patient with carbon monoxide poisoning and obtains a carboxyhemoglobin level. Which level would the nurse interpret as indicating that oxygen therapy can be discontinued?

4%

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

A client with severe shortness of breath comes to the emergency department. He tells the emergency department staff that he recently traveled to China for business. Based on his travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute?

Airborne and contact precautions

Which is the most likely weaponized biological agent available?

Anthrax

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

Antitoxins

A female patient was sexually assaulted when leaving work. When assisting with the physical examination, what nursing interventions should be provided? (Select all that apply.)

Assess and document any bruises and lacerations. Record a history of the event, using the patient's own words. Label all torn or bloody clothes and place each item in a separate brown bag so that any evidence can be given to the police.

The ED staff work collaboratively and follow the ABCDE method to establish and treat health priorities effectively in a client experiencing a trauma. Which action is completed by the nurse when implementing the "D" element of this method?

Assessing the client's Glasgow Coma Scale score

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

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

Atropine Sodium nitrite Sodium thiosulfate

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 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 arm contusions Client with a first-degree burn to the forearm

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

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

A client is brought to the emergency department after being involved in a motor vehicle collision. Which of the following would lead the nurse to suspect internal bleeding?

Delayed capillary refill

The nurse is conducting a secondary survey on a client in the ED. Which action is completed during the secondary survey?

Diagnostic and laboratory testing

A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first?

Institute isolation precautions.

A nurse is completing her annual cardiopulmonary resuscitation training. The class instructor tells her that a client has fallen off a ladder and is lying on his back; he is unconscious and isn't breathing. What maneuver should the nurse use to open his airway?

Jaw-thrust

Which solid organ is most frequently injured in a penetrating trauma?

Liver

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

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.

Nursing students are reviewing information about common chemical agents that may be used in chemical warfare. The students demonstrate understanding of the information when they identify which of the following as a vesicant?

Phosgene

When preparing to perform abdominal thrusts on a client with an airway obstruction, which of the following would be most appropriate?

Positioning the hands in the midline slightly above the umbilicus

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

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 working with a victim suffering from blast lung and resultant air emboli. The nurse should immediately place the victim in which position? Prone left lateral

Prone left lateral

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 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

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

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 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

Removing the victim's clothing and jewelry

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

A nurse is providing an educational program for a group of occupational health nurses working in chemical facilities. Which of the following would the nurse include as the priority in the case of a chemical burn?

Rinsing the area with copious amounts of water

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

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

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.

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

To control possible seizures

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