ch72.doc

[Osborn] chapter 72

Learning Outcomes[ Number and Title ]Learning Outcome 1 Define terrorism.Learning Outcome 2 Describe the historical use of various chemical and

biologic agents.Learning Outcome 3 Discuss various chemical agents, signs and symptoms, and

treatment.Learning Outcome 4 Compare and contrast biologic agents, signs and

symptoms, and treatment.Learning Outcome 5 Delineate the signs and symptoms of radiation illness.Learning Outcome 6 Apply the principles of an incident command system in

the hospital setting during a WMD event.Learning Outcome 7 Describe the role of DMAT, DMORT, and the Strategic

National Stockpile.Learning Outcome 8 Apply critical incident stress principles to WMD events.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice Copyright 2010 by Pearson Education, Inc.

1. A patient is brought into the emergency department with gunshot wounds inflicted by a former employee who returned to his place of employment and started shooting those in the office. The nurse realizes this patient experienced:

1. Domestic terrorism.2. International terrorism.3. Anger toward the federal government.4. Anger in order to intimidate a segment of the population to further a political

view.

Correct Answer: Domestic terrorism.

Rationale: Domestic terrorism describes a group or an individual operating out of the United States or Puerto Rico without foreign direction, and the activity is directed against the U.S. government or the U.S. population. Domestic terrorism can be caused by a group or by a lone individual. The patient was wounded by a lone individual without foreign direction. In international terrorism, violence is used by a person or group that is foreign based and has a connection to a foreign power. There is no evidence to support that the former employee is angry toward the federal government or that the former employee was demonstrating anger in order to further a political view.

Cognitive Level: AnalysisNursing Process: AssessmentClient Need: Safe, Effective Care EnvironmentLO: 1


2. A patient tells the nurse that while she was visiting the United Kingdom, the Dutch embassy was bombed. The nurse realizes this patient is describing a(n):

1. International terrorist attack.2. Domestic terrorist attack.3. Aggression toward the United Kingdom’s government in support of the Dutch

embassy.4. Dutch nationalists speaking against the treatment of the Dutch in the United

Kingdom.

Correct Answer: International terrorist attack.

Rationale: International terrorism is the use of force or violence committed by a group or individual that is foreign based and whose activities cross international boundaries. The Dutch embassy in the United Kingdom was bombed, which is an example of an international group whose activities cross international boundaries. A domestic terroristic attack is one in which groups or individuals operate out of their home country and conduct a terroristic activity against those within their own country. There is not enough information to know if the bombing represented aggression toward the United Kingdom or toward the Dutch people living in the United Kingdom.



3. A group of patients was brought into the emergency department after an attack occurred in an abortion clinic in the city. The newspapers and television had covered events of the attack. The nurse realizes the terrorist group who conducted the attack was most likely seeking:

1. Media attention to influence policy.2. Improved conditions for those seeking abortions.3. A way to call attention to the lack of abortion clinics in the city.4. A way to expose those who are employed in abortion clinics.

Correct Answer: Media attention to influence policy.

Rationale: The point of terrorist attacks is to attract media attention, increase support for the cause, influence policy, and create a sense of vulnerability. With the newspapers and television covering the terrorist event, those who staged the attack did receive media attention. There is not enough information to know if the terrorist group was trying to improve conditions in abortion clinics, calling attention to the lack of abortion clinics in the city, or trying to expose those who are employed in abortion clinics.



4. The panelists on a televised news broadcast are discussing how a bomb was found at the base of a large bridge in New York City. The bomb squad disabled the device and there were no casualties. The nurse realizes that the bomb is an example of a(n):

1. Explosive agent.2. Chemical agent.3. Radiologic agent.4. Biologic agent.

Correct Answer: Explosive agent.

Rationale: An explosive agent or device is one in which items are used that, when detonated, create an explosion; a bomb is an example of an explosive device. Chemical agents are chemicals that, when introduced into the body in unhealthy levels, will cause injury or death. Biologic agents are bacteria, viruses, and toxins that can lead to disease or death. Radiologic agents are those that lead to radiation exposure or death.



5. A patient tells the nurse that back in the mid-1980s while visiting Eastern Europe, she had to drink only bottled water because of the potential for radiation exposure. The nurse realizes the patient’s precaution is related to the:

1. Chernobyl Nuclear Reactor accident.2. Ongoing cold war with the former Soviet Union.3. Potential for contracting anthrax.4. Possibility of being infected with salmonella.

Correct Answer: Chernobyl Nuclear Reactor accident.

Rationale: The Chernobyl Nuclear Reactor accident occurred in 1986 and, even though there is no documentation to support what effects this accident had on the physical body, many avoided drinking the water because of the fear of radiation exposure. There is no evidence to support that the patient needed to drink bottled water because of the cold war with the former Soviet Union. Anthrax and salmonella are biological agents that have been associated with biological terrorism.



6. A patient who was in the Vietnam War tells the nurse about the wounds he received from being poked by the Vietcong in the bamboo cell where he was held captive. The scars are easily seen on his arms and legs. The nurse realizes the patient was most likely being terrorized by ___________ agents.

1. Biologic2. Chemical3. Radiologic4. Explosive

Correct Answer: Biologic

Rationale: During the Vietnam War, sticks were often infected with human waste and then used on prisoners to cause greatly infected sores. Chemical agents are chemicals that, when introduced into the body in unhealthy levels, will cause injury or death. Radiologic agents are those that lead to radiation exposure or death. An explosive agent or device is one in which items are used that, when detonated, create an explosion.

Cognitive Level: AnalysisNursing Process: AssessmentClient Needs: Safe, Effective Care EnvironmentLO: 2


7. A patient is brought into the emergency department after being exposed to a nerve gas. Which of the following will the nurse assess in this patient?

Select all that apply.

1. Miosis2. Rhinorrhea3. Shortness of breath4. Muscle pain5. Flaccid paralysis

Correct Answers:1. Miosis2. Rhinorrhea3. Shortness of breath

Rationale: Miosis. Miosis is defined as constricted pupils and is one of the most reliable signs of nerve poisoning. Rhinorrhea. Almost all people affected by a nerve agent will have rhinorrhea, or a runny nose. Shortness of breath. Almost all people affected by a nerve agent will have shortness of breath. Muscle pain. Muscle pain is not a symptom of nerve gas exposure. Flaccid paralysis. Flaccid paralysis is not a symptom of nerve gas exposure. Muscle fasciculations will be present.

Cognitive Level: ApplicationNursing Process: AssessmentClient Need: Physiological IntegrityLO: 3


8. A young male patient is admitted to the intensive care unit after being exposed to tear gas. The nurse realizes that which of the following most likely occurred in addition to the patient’s inhaling the gas?

1. The patient was participating in strenuous physical activity while being exposed to the gas.

2. The patient received severe skin burns from the gas.3. The patient returned home and showered.4. The patient received fresh air and breathed deeply.

Correct Answer: The patient was participating in strenuous activity while being exposed to the gas.

Rationale: Although normally the signs and symptoms of tear gas are of short duration and severity, young, healthy nonsmoking patients need intensive care treatment following exposure for hypoxia, hemoptysis, and pulmonary infiltrates when combined with strenuous activity. The most severe burns from tear gas are similar to second-degree burns that would not necessitate an intensive care admission. Showering helps alleviate the symptoms. Fresh air is the treatment of choice with tear gas exposure.

Cognitive Level: AnalysisNursing Process: AssessmentClient Need: Physiological IntegrityLO: 3


9. A patient is brought into the emergency department after an exposure that at first was believed to be to a nerve gas, but further assessment shows the symptoms are the opposite of those found with nerve gas exposure. The nurse now suspects the patient was most likely exposed to:

1. Incapacitating agents.2. Irritants.3. Blood agents.4. Asphyxiates.

Correct Answer: Incapacitating agents.

Rationale: Incapacitating agents cause symptoms that are the opposite of nerve agents, including stupor, confusion, and confabulation along with mydriasis, blurred vision, and a dry mouth. Irritants produce transient discomfort to the eyes, which leads to pain, burning, and lacrimation. Blood agents are gases that bind to the mitochondria in the cell, causing altered glucose metabolism and lactic acidosis. Asphyxiates are agents that cause lung damage, which leads to pulmonary edema and possible respiratory failure.



10. An organization has been notified of a possible Category A bacterial biologic exposure in a rural community. The nurse realizes that the community members might be exposed to which of the following agents?

Select all that apply.

1. Anthrax2. Plague3. Tularemia4. Viral hemorrhagic fever5. Botulism

Correct Answers:1. Anthrax2. Plague3. Tularemia

Rationale: Anthrax. A Category A pathogen is one in which there is a high mortality, is easily spread, and may cause public panic. Anthrax is caused by a bacterium within Category A. Plague. A Category A pathogen is one in which there is a high mortality, is easily spread, and may cause public panic. The plague is caused by a bacterium within Category A. Tularemia. A Category A pathogen is one in which there is a high mortality, is easily spread, and may cause public panic. Tularemia is caused by bacteria within Category A. Viral hemorrhagic fever. Category A biologic agents are either bacteria, viruses, or toxins. Viral hemorrhagic fever is caused by a Category A virus. Botulism. Category A biologic agents are either bacteria, viruses, or toxins. Botulism is caused by a Category A toxin.



11. A patient arrives at the emergency department after waking up in the morning with progressive weakness, blurred vision, photophobia, and a change in voice quality. The patient had attended a banquet the previous evening and was asymptomatic at that time. These symptoms most likely indicate which of the following biologic agent exposures?

1. Botulism2. Staphylococcal enterotoxin B3. Ricin4. Tricothecene mycotoxins

Correct Answer: Botulism

Rationale: Botulism is the most potent toxin known to mankind. Food-borne botulism is common in improperly prepared canned foods and presents 12 to 72 hours postexposure. Symptoms include symmetric and descending paralysis, blurred vision, photophobia, trouble talking, and an altered voice. Staphylococcal entertoxin B has an onset of symptoms generally within 3 to 4 hours and includes high fever, headache, myalgias, and a nonproductive cough. Ricin exposure causes nausea, vomiting, gastrointestinal necrosis, and renal, hepatic, and splenic failure. Ricin symptoms occur within 4 to 8 hours. Symptoms of tricothecene mycotoxins exposure include abdominal pain, nausea, vomiting, and diarrhea.



12. The nurse is caring for patient diagnosed with smallpox. Currently the lesions are scabbed throughout his body. The nurse realizes this patient would be considered:

1. Infectious.2. Clear of the infection.3. Incubating until the second crop of lesions appears.4. A carrier but unable to transmit the infection to others.

Correct Answer: Infectious.

Rationale: The smallpox virus can be recovered from scabs, so the patient should be isolated and considered infectious until all the scabs separate. Smallpox has a single crop of lesions.



13. A patient is brought into the emergency department after an acute exposure to radiation from the local atomic power plant. The patient has skin burns on his face, arms, and neck. The nurse realizes that which of the following should be done first for this patient?

1. Determine amount of radiologic exposure and treat the skin burns.2. Provide support for the onset of hypotension and diarrhea.3. Begin antibiotic therapy.4. Prepare to administer a blood transfusion.

Correct Answer: Determine amount of radiologic exposure and treat the skin burns.

Rationale: Most hospitals have Geiger counters to determine the presence or absence of radiation in the environment. The Geiger counter can be used to help assess the dose of radiation the patient received. However, people exposed to low-level external radiologic contamination may have skin burns that will heal. These people are not considered to be at higher risk for later cancer development. Those who have whole-body, or at least a significant part of the body, radiation exposure can develop acute radiation syndrome. In the prodromal phase of this syndrome, the patient will have a rapid onset of hypotension and diarrhea. In the illness phase of the syndrome, patients will need antibiotics and blood transfusions.

Cognitive Level: AnalysisNursing Process: PlanningClient Need: Physiological IntegrityLO: 5


14. A patient is brought into the emergency department after being exposed to over 1,000 rads of radiation. Which of the following should be done first to support this patient?

1. Administer sedatives and analgesics.2. Provide antiemetics.3. Prepare intravenous fluids and order a bland diet.4. Provide antibiotic therapy.

Correct Answer: Administer sedatives and analgesics.

Rationale: The patient exposed to over 1,000 rads of radiation will have central nervous system symptoms. Death will occur within hours to days. Care involves administering sedatives and analgesics to control seizures and anxiety. Antiemetics, intravenous fluids, and a bland diet would be indicated for the gastrointestinal symptoms of the illness phase of acute radiation syndrome. Antibiotic therapy is indicated for the hematopoietic symptoms of the illness phase of acute radiation syndrome.

Cognitive Level: ApplicationNursing Process: ImplementationClient Need: Physiological IntegrityLO: 5


15. A patient tells the nurse that he thought that he would feel better since it has been a few days after the radiation exposure, but he still feels weak and tired. Which of the following is the nurse’s best response to this patient?

1. “The weak and tired feelings will continue for a while longer.”2. “This means that your body is healing.”3. “After your strength returns, you might have diarrhea.”4. “Increasing your activity will help with the feelings of fatigue.”

Correct Answer: “The weak and tired feelings will continue for a while longer.”

Rationale: During the prodromal phase of acute radiation syndrome, the gastrointestinal symptoms of nausea, vomiting, and diarrhea usually resolve within 2 days, but the fatigue and malaise often continue. This does not mean that the patient’s body is healing. Diarrhea will precede the feelings of fatigue. Increasing activity will not help with the fatigue caused by this syndrome.



16. The organization has activated the hospital incident command system (HICS) and is currently triaging patients and determining the extent of injuries and casualties. The media is requesting information to share with the public. Which of the following hospital colleagues is responsible for providing this information?

1. The public information officer2. The incident commander3. The safety and security officer4. The liaison officer

Correct Answer: The public information officer

Rationale: There are four distinct roles within the HICS. The public information officer provides information to the media, releases other information as indicated, and assists with communication. The incident commander organizes and directs the emergency operations center and gives overall direction for the hospital operations. The safety and security officer monitors and has authority over the safety of rescue operations and hazardous conditions. The liaison officer is the contact person for representatives of other agencies, such as the fire department and police.

Cognitive Level: AnalysisNursing Process: ImplementationClient Need: Safe, Effective Care EnvironmentLO: 6


17. Victims of a multivehicular accident are arriving at the local emergency department. The hospital incident command system (HICS) has been activated. Nurses in the emergency room are determining which patients are able to ambulate and are moving them to one section of the department. Once in this designated section, these patients will be assigned to which of the following categories according to the START triage system?

1. Green2. Red3. Yellow4. Black

Correct Answer: Green

Rationale: The START triage system uses four categories: red means immediate care needed; yellow means delayed care is needed; green means minor care is needed; black means deceased or death is imminent. The first step of the triage process is to determine the “walking wounded” and directing these patients to move to one area or room.



18. The nurses in the emergency department and intensive care unit report that the pharmacy has run out of all normal saline intravenous solutions and the blood bank is down to 10 units of type O+ blood. The ________ department is responsible for procuring more needed supplies.

1. Logistics2. Planning3. Finance4. Operations

Correct Answer: Logistics

Rationale: Logistics provides the hospital with materials to meet all ongoing needs, such as food, medication, shelter, and other supplies. The planning section is responsible for providing a situation status report to hospital workers every 4 to 6 hours and interacts with operations to establish plans for medical staff rotation. Finance provides the funding for the operation and assists with recovery of costs. Operations covers the work of medical care.

Cognitive Level: ApplicationNursing Process: ImplementationClient Need: Safe, Effective Care EnvironmentLO: 6


19. A hurricane in Texas left thousands of people injured and homeless. The Strategic National Stockpile was deployed and supplies were used to treat these patients by nurses from local hospitals. The patients have now successfully been transported to hospitals or shelters, and the nurses are prepared to bring their support to a successful conclusion. The removal and retrieval of the remnants of the 12-hour push packs will be completed by:

1. The Technical Advisory Response Unit.2. The nurses who provided emergency care to the hurricane victims.3. The vendors.4. The Centers for Disease Control personnel.

Correct Answer: The Technical Advisory Response Unit.

Rationale: The Technical Advisory Response Unit is a team of advisors who assist in recovering the support equipment and cargo containers used to transport the 12-hour push packs. They also recover unused Strategic National Stockpile assets and materials. The nurses who provided the emergency care are not responsible for the removal or retrieval of the 12-hour push pack unused contents. The vendors are the organizations who provide the supplies within the 12-hour push packs and are not responsible for retrieving unused supplies. The Centers for Disease Control personnel are not responsible for retrieving unused supplies.



20. While reading and watching the reports of medical staff who participated in the care of victims from wildfires and flooding in California, the nurse is interested in learning how to participate as a disaster relief nurse. Which of the following should the nurse consider prior to pursuing this avenue of emergency nursing care?

1. Must provide and pay for own personal gear, including a sleeping bag2. Must be licensed to practice nursing in the state of the disaster3. Must be willing to be a volunteer since the positions are unpaid4. Must be willing to pay for own travel to the disaster region

Correct Answer: Must provide and pay for own personal gear, including a sleeping bag

Rationale: Members of the Disaster Medical Assistance Team, or DMAT, are volunteers; however, while deployed as members, they are considered federal employees and will be paid wages. Any license or certification the nurse holds will be automatically recognized in all 50 states. Travel to the disaster region is reimbursed. Each member is required to provide certain personal gear needed, such as eye and ear protection, leather work gloves, canteen, sleeping bag, camping knife, hand cleanser gel, and toilet paper.



21. The nurse, a member of a Disaster Medical Assistance Team, has the remains of several victims of a disaster to be identified and collected. The individuals responsible for this aspect of disaster care would be:

1. Disaster Mortuary Operations Response Teams.2. Office of Environmental Protection employees.3. Centers for Disease Control employees.4. Department of Health and Human Services employees.

Correct Answer: Disaster Mortuary Operations Response Teams.

Rationale: Disaster Mortuary Operations Response Teams are groups of volunteers who are responsible for morgue-related operations, remains identification, and family notification. The Office of Environmental Protection is the organization that oversees the Disaster Mortuary Operations Response Teams. The Centers for Disease Control and the Department of Health and Human Services are not participants in disaster relief activities.



22. The nurse, a member of a Disaster Medical Response Team, is attending a planning session to review the agenda for relief activities along with scheduling for breaks and ongoing information-sharing meetings. The nurse realizes this session is considered:

1. Preincident preparation.2. Demobilization.3. Critical incident defusing.4. Critical incident stress debriefing.

Correct Answer: Preincident preparation.

Rationale: In preincident preparation, knowledge is disseminated to those who will be providing care to victims of disasters. During these sessions, three avenues are planned and discussed that help to decrease the stress associated with a disaster. The first way to decrease the stress is through demobilization. These are group information briefings that occur during rest breaks, at the end of a shift, or in the middle of an event as the situation requires. Critical incident defusing consists of formal sessions that occur within 8 hours of the event. They typically last 20 to 45 minutes and are where the event, experiences, and reactions are reviewed. A critical incident stress debriefing is a formal session run by trained counselors that occurs within 72 hours of the event and lasts for 2 to 3 hours.

Cognitive Level: AnalysisNursing Process: PlanningClient Need: Psychosocial IntegrityLO: 8


23. The nurse, a member of the Disaster Medical Assistance Team, does not attend critical incident defusing sessions and plans to return home prior to the beginning of any critical incident stress debriefing meetings. The nurse realizes that she is increasing her risk of developing:

1. Post-traumatic stress disorder.2. Chronic fatigue syndrome.3. Fibromyalgia.4. Nutritional deficiency.

Correct Answer: Post-traumatic stress disorder.

Rationale: Critical incident stress management is a comprehensive approach to the management of stress and critical incidents. There are seven components to the approach, and the point of the interventions is to prevent the development of post-traumatic stress disorder, which has been identified in approximately 9% of those exposed to critical incidents in recent years. There is not enough information to know if the nurse will develop chronic fatigue syndrome, fibromyalgia, or a nutritional deficiency because of participating as a Disaster Medical Assistance Team member.

Cognitive Level: AnalysisNursing Process: ImplementationClient Need: Psychosocial IntegrityLO: 8


24. While attending a critical incident stress debriefing session, the facilitators are instructing the nurses on ways to cope with the stress that is created by providing disaster care to the victims. The nurses are participating in which phase of the debriefing session?

1. Teaching2. Reentry3. Fact4. Reaction

Correct Answer: Teaching

Rationale: During the teaching phase of the critical incident stress debriefing session, the facilitators of the session provide education regarding adaptive coping mechanisms. Reentry is where the session is summarized and questions are answered. The fact phase is where each participant describes the event from his or her own individual point of view. The reaction phase is when the participants identify their own emotional reactions to the most traumatic aspects of the event.

Cognitive Level: AnalysisNursing Process: ImplementationClient Need: Psychosocial IntegrityLO: 8


ch72.doc

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