disaster nursing

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

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%; Oxygen is administered until the carboxyhemoglobin level is less than 5%.

If a client has been exposed to radiation, the presenting symptoms, such as nausea, vomiting, loss of appetite, diarrhea, or fatigue, can be expected to occur within how many hours after exposure?

48 to 72

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

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; 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.

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

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; SARS, a highly contagious viral respiratory illness, is spread by close person-to-person contact. The client should be placed on airborne and contact precautions to prevent the spread of infection. Droplet precautions don't require a negative air pressure room and wouldn't protect the nurse who touches contaminated items in the client's room. Contact precautions alone don't provide adequate protection from airborne particles.

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

Amyl nitrate Sodium nitrite Sodium thiosulfate

The nurse is on a community awareness safety committee. When prioritizing biological agents according to potential morbidity and mortality, which cluster of biological agents hold the highest mortality?

Anthrax, smallpox

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

Antitoxins; 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.

A patient is brought to the ED by a friend, who states that a tree fell on the patient's leg and crushed it while they were cutting firewood. What priority actions should the nurse perform? (Select all that apply.)

Applying a clean dressing to protect the wound Elevating the site to limit the accumulation of fluid in the interstitial spaces Splinting the wound in a position of rest to prevent motion

As part of an emergency department team, an emergency nurse is conducting a secondary survey on a client. Which of the following would the nurse include?

Applying electrocardiogram electrodes; A secondary survey is completed after the primary survey priorities of airway, breathing, circulation, and disability have been addressed. Applying electrocardiogram electrodes would be a component of the secondary survey. Establishing a patent airway, providing adequate ventilation, and determining neurologic disability by assessing neurologic function are components of the primary survey.

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; The primary survey focuses on stabilizing life-threatening conditions. The ED staff work collaboratively and follow the ABCDE (airway, breathing, circulation, disability, exposure) method. While implementing the D element, the nurse determines neurologic disability by assessing neurologic function using the Glasgow Coma Scale and performing a motor and sensory evaluation of the spine. A quick neurologic assessment may be performed using the AVPU mnemonic: A, alert: is the client alert and responsive? V, verbal: does the client respond to verbal stimuli? P, pain: does the client respond only to painful stimuli? U, unresponsive: is the client unresponsive to all stimuli, including pain?

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

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

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

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

A patient working in a chemical facility sustains a chemical burn to his arms. The chemical involved was white phosphorus. Which of the following would be the priority nursing action?

Brushing off all traces of the chemical from the patient's skin

When assessing a client with suspected carbon monoxide poisoning, which finding would be least reliable?

Cherry red skin color; Skin color can range from pink or cherry-red to cyanotic and pale is not a reliable sign. In clients with carbon monoxide poisoning, central nervous system signs such as headache and confusion predominate. Palpitations also may occur.

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 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

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

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

Which statement reflects the nursing management of the client with a white phosphorus chemical burn?

Do not apply water to the burn; Water should not be applied to burns from lye or white phosphorus because of the potential for an explosion or deepening of the burn.

Inhalation of anthrax mimics which disease process?

Flu

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; 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. 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.

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

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

A patient is hemorrhaging from an open wound on his leg. The nurse implements care using the following steps. Place them in the order in which the nurse would perform them. Use all options.

Provide firm direct pressure Apply a pressure dressing Elevate the leg Immobilize the leg

Several families arrive at the scene of a disaster and are asking for information about their family members. Which person would be most appropriate to provide them with any information?

Public Information Officer; When dealing with family members requesting information about loved ones, the Public Information Officer would be the person who provides this information. Security personnel would be used to maintain order and keep media and others away from client care areas. The Incident Commander would be the person in charge of the Incident Command System and is responsible for the entire operation at the scene. The Hospital Safety Officer is a member of the hospital Incident Command System who reports directly back to the Incident Commander.

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 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 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

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; The location of pain can indicate certain types of intra-abdominal injuries. Pain in the left shoulder is common in a client with bleeding from a ruptured spleen, whereas pain in the right shoulder can result from laceration of the liver.

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

Treatment with ciprofloxacin or doxycycline is suggested after exposure.

A triage nurse determines that a client with non-life-threatening injuries requires imaging studies and moderate sedation. The triage nurse would document this client as which of the following?

Urgent; Clients who have non-life-threatening conditions but require two or more resouces to provide their care would be classified as urgent. In this situation, the client would be considered urgent becuase he requires imaging studies (one resource) and moderate sedation (a two-resource procedure). Clients in the resuscitation category need treatment immediately to prevent death. Clients in the emergent category may deteriorate rapidly and develop a major life-threatening situation or may require time-sensitive treatment. Clients in the nonurgent category have non-life-threatening conditions and likely need only one resource to provide for their needs.

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

Urgent; Urgent clients have serious health problems that not immediately life threatening. They must be seen within 1 hour. Emergent clients have the highest priority with life-threatening conditions and they must be seen immediately. Nonurgent clients have episodic illness that can be addressed within 24 hours without increased morbidity.

The student nurse is completing a simulation where a client is the victim of nerve gas. The instructions are for the student to set up the room and have all needed supplies available. Which medication does the student nurse ensure is in the medication administration system to control seizures?

Valium intravenous injection

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; 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 client with a minor burn would be triaged as

minimal

The first step in decontamination includes

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

A finger sweep is only to be used in which client population?

unconscious adult; A finger sweep should be used only in the unconscious adult client. This action draws the tongue away from the back of the throat and away from any foreign body that may be lodged there. A finger sweep should not be done on a conscious adult, child, or adolescent.