Deck 72: Terrorism, Mass Casualty, and Disaster Nursing

Question 1

The nurse manager in the ED receives information that a local chemical plant has had a chemical leak. This disaster is assigned a status of level II. What does this classification indicate?

A) First responders can manage the situation.
B) Regional efforts and aid from surrounding communities can manage the situation.
C) Statewide or federal assistance is required.
D) The area must be evacuated immediately.

Answer 1

Regional efforts and aid from surrounding communities can manage the situation.

Question 2

A workplace explosion has left a 40 -year-old man burned over $65 \%$ of his body. His burns are secondand third-degree burns, but he is conscious. How would this person be triaged?

A) Green
B) Yellow
C) Red
D) Black

Answer 2

Black

Question 3

A patient has been witness to a disaster involving a large number of injuries. The patient appears upset, but states that he feels capable of dealing with his emotions. What is the nurses most appropriate intervention?

A) Educate the patient about the potential harm in denying his emotions.
B) Refer the patient to social work or spiritual care.
C) Encourage the patient to take a leave of absence from his job to facilitate emotional healing.
D) Encourage the patient to return to normal social roles when appropriate.

Answer 3

Encourage the patient to return to normal social roles when appropriate.

Question 4

A nurse is caring for patients exposed to a terrorist attack involving chemicals. The nurse has been advised that personal protective equipment must be worn in order to give the highest level of respiratory protection with a lesser level of skin and eye protection. What level protection is this considered?

A)Level A
B) Level B
C) Level C
D) Level D

Question 5

A patient who has been exposed to anthrax is being treated in the local hospital. The nurse should prioritize what health assessments?

A) Integumentary assessment
B) Assessment for signs of hemorrhage
C) Neurologic assessment
D) Assessment of respiratory status

Question 6

When assessing patients who are victims of a chemical agent attack, the nurse is aware that assessment findings vary based on the type of chemical agent. The chemical sulfur mustard is an example of what type of chemical warfare agent?

A) Nerve agent
B) Blood agent
C) Pulmonary agent
D) Vesicant

Question 7

A major earthquake has occurred within the vicinity of the local hospital. The nursing supervisor working the night shift at the hospital receives information that the hospital disaster plan will be activated. The supervisor will need to work with what organization responsible for coordinating interagency relief assistance?

A) Office of Emergency Management
B) Incident Command System
C) Centers for Disease Control and Prevention (CDC)
D) American Red Cross

Question 8

While developing an emergency operations plan (EOP), the committee is discussing the components of the EOP. During the post-incident response of an emergency operations plan, what activity will take place?

A) Deciding when the facility will go from disaster response to daily activities
B) Conducting practice drills for the community and facility
C) Conducting a critique and debriefing for all involved in the incident
D) Replacing the resources in the facility

Question 9

The announcement is made that the facility may return to normal functioning after a local disaster. In the emergency operations plan, what is this referred to as?

A) Demobilization response
B) Post-incident response
C) Crisis diffusion
D) Reversion

Question 10

A group of disaster survivors is working with the critical incident stress management (CISM) team. Members of this team should be guided by what goal?

A) Determining whether the incident was managed effectively
B) Educating survivors on potential coping strategies for future disasters
C) Providing individuals with education about recognizing stress reactions
D) Determining if individuals responded appropriately during the incident

Question 11

Level $\mathrm{C}$ personal protective equipment has been deemed necessary in the response to an unknown substance. The nurse is aware that the equipment will include what?

A) A self-contained breathing apparatus
B) A vapor-tight, chemical-resistant suit
C) A uniform only
D) An air-purified respirator

Question 12

Emergency department (ED) staff members have been trained to follow steps that will decrease the risk of secondary exposure to a chemical. When conducting decontamination, staff members should remove the patients clothing and then perform what action?

A) Rinse the patient with water.
B) Wash the patient with a dilute bleach solution.
C) Wash the patient chlorhexidine.
D) Rinse the patient with hydrogen peroxide.

Question 13

A nurse takes a shift report and finds he is caring for a patient who has been exposed to anthrax by inhalation. What precautions does the nurse know must be put in place when providing care for this patient?

A) Standard precautions
B) Airborne precautions
C) Droplet precautions
D) Contact precautions

Question 14

A group of medical nurses are being certified in their response to potential bioterrorism. The nurses learn that if a patient is exposed to the smallpox virus he or she becomes contagious at what time?

A) 6 to 12 hours after exposure
B) When pustules form
C) After a rash appears
D) When the patient becomes febrile

Question 15

A patient is being treated in the ED following a terrorist attack. The patient is experiencing visual disturbances, nausea, vomiting, and behavioral changes. The nurse suspects this patient has been exposed to what chemical agent?

A) Nerve agent
B) Pulmonary agent
C) Vesicant
D) Blood agent

Question 16

A patient is admitted to the ED who has been exposed to a nerve agent. The nurse should anticipate the STAT administration of what drug?

A) Amyl nitrate
B) Dimercaprol
C) Erythromycin
D) Atropine

Question 17

A patient was exposed to a dose of more than 5,000 rads of radiation during a terrorist attack. The patients skin will eventually show what manifestation?

A) Erythema
B) Ecchymosis
C) Desquamation
D) Necrosis

Question 18

There has been a radiation-based terrorist attack and a patient is experiencing vomiting, diarrhea, and shock after the attack. How will the patients likelihood of survival be characterized?

A) Probable
B) Possible
C) Improbable
D) Extended

Question 19

A 44-year-old male patient has been exposed to severe amount of radiation after a leak in a reactor plant. When planning this patients care, the nurse should implement what action?

A) The patient should be scrubbed with alcohol and iodine.
B) The patient should be carefully protected from infection.
C) The patients immunization status should be promptly assessed.
D) The patients body hair should be removed to prevent secondary contamination.

Question 20

The nurse is coordinating the care of victims who arrive at the ED after a radiation leak at a nearby nuclear plant. What would be the first intervention initiated when victims arrive at the hospital?

A) Administer prophylactic antibiotics.
B) Survey the victims using a radiation survey meter.
C) Irrigate victims open wounds.
D) Perform soap and water decontamination.

Question 21

An industrial site has experienced a radiation leak and workers who have been potentially affected are en route to the hospital. To minimize the risks of contaminating the hospital, managers should perform what action?

A) Place all potential victims on reverse isolation.
B) Establish a triage outside the hospital.
C) Have hospital staff put on personal protective equipment.
D) Place hospital staff on abbreviated shifts of no more than 4 hours.

Question 22

After a radiation exposure, a patient has been assessed and determined to be a possible survivor. Following the resolution of the patients initial symptoms, the care team should anticipate what event?

A) A return to full health
B) Internal bleeding
C) A latent phase
D) Massive tissue necrosis

Question 23

A hospitals emergency operations plan has been enacted following an industrial accident. While one nurse performs the initial triage, what should other emergency medical services personnel do?

A) Perform life-saving measures.
B) Classify patients according to acuity.
C) Provide health promotion education.
D) Modify the emergency operations plan.

Question 24

A nurse is triaging patients after a chemical leak at a nearby fertilizer factory. The guiding principle of this activity is what?

A) Assigning a high priority to the most critical injuries
B) Doing the greatest good for the greatest number of people
C) Allocating resources to the youngest and most critical
D) Allocating resources on a first come, first served basis

Question 25

A nurse has been called for duty during a response to a natural disaster. In this context of care, the nurse should expect to do which of the following?

A) Practice outside of her normal area of clinical expertise.
B) Perform interventions that are not based on assessment data.
C) Prioritize psychosocial needs over physiologic needs.
D) Prioritize the interests of older adults over younger patients.

Question 26

A nurse is participating in the planning of a hospitals emergency operations plan. The nurse is aware of the potential for ethical dilemmas during a disaster or other emergency. Ethical dilemmas in these contexts are best addressed by which of the following actions?

A) Having an ethical framework in place prior to an emergency
B) Allowing staff to provide care anonymously during an emergency
C) Assuring staff that they are not legally accountable for care provided during an emergency
D) Teaching staff that principles of ethics do not apply in an emergency situation

Question 27

A nurse is undergoing debriefing with the critical incident stress management (CISM) team after participating in the response to a disaster. During this process, the nurse will do which of the following?

A) Evaluate the care that he or she provided during the disaster.
B) Discuss own emotional responses to the disaster.
C) Explore the ethics of the care provided during the disaster.
D) Provide suggestions for improving the emergency operations plan.

Question 28

A man survived a workplace accident that claimed the lives of many of his colleagues several months ago. The man has recently sought care for the treatment of depression. How should the nurse best understand the mans current mental health problem?

A) The man is experiencing a common response following a disaster.
B) The man fails to appreciate the fact that he survived the disaster.
C) The man most likely feels guilty about his actions during the disaster.
D) The mans depression most likely predated the disaster.

Question 29

The nurse has been notified that the ED is expecting terrorist attack victims and that level $\mathrm{D}$ personal protective equipment is appropriate. What does level D PPE include?

A) A chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots
B) A self-contained breathing apparatus (SCBA) and a fully encapsulating, vapor-tight, chemicalresistant suit with chemical-resistant gloves and boots.
C) The SCBA and a chemical-resistant suit, but the suit is not vapor tight
D) The nurses typical work uniform

Question 30

The nurse is preparing to admit patients who have been the victim of a blast injury. The nurse should expect to treat a large number of patients who have experienced what type of injury?

A) Chemical burns
B) Spinal cord injury
C) Meningeal tears
D) Tympanic membrane rupture

Question 31

A nurse who is a member of the local disaster response team is learning about blast injuries. The nurse should plan for what event that occurs in the tertiary phase of the blast injury?

A) Victims pre-existing medical conditions are exacerbated.
B) Victims are thrown by the pressure wave.
C) Victims experience burns from the blast.
D) Victims suffer injuries caused by debris or shrapnel from the blast.

Question 32

A patient suffering from blast lung has been admitted to the hospital and is exhibiting signs and symptoms of an air embolus. What is the nurses most appropriate action?

A) Place the patient in the Trendelenberg position.
B) Assess the patients airway and begin chest compressions.
C) Position the patient in the prone, left lateral position.
D) Encourage the patient to perform deep breathing and coughing exercises.

Question 33

A patient has been admitted to the medical unit with signs and symptoms that are suggestive of anthrax infection. The nurse should anticipate what intervention?

A) Administration of acyclovir
B) Hematopoietic stem cell transplantation (HSCT)
C) Administration of penicillin
D) Hemodialysis

Question 34

The ED staff has been notified of the imminent arrival of a patient who has been exposed to chlorine. The nurse should anticipate the need to address what nursing diagnosis?

A) Impaired gas exchange
B) Decreased cardiac output
C) Chronic pain
D) Excess fluid volume

Question 35

The nursing supervisor at the local hospital is advised that your hospital will be receiving multiple trauma victims from a blast that occurred at a local manufacturing plant. The paramedics call in a victim
Of the blast with injuries including a head injury and hemorrhage. What phase of blast injury should the nurse expect to treat in this patient?

A) Primary phase
B) Secondary phase
C) Tertiary phase
D) Quaternary phase

Question 36

A nurse has had contact with a patient who developed smallpox and became febrile after a terrorist attack. This nurse will require what treatment?

A) Watchful waiting
B) Treatment with colony-stimulating factors (CSFs)
C) Vaccination
D) Treatment with ceftriaxone

Question 37

The emergency response team is dealing with a radiation leak at the hospital. What action should be performed to prevent the spread of the contaminants?

A) Floors must be scrubbed with undiluted bleach.
B) Waste must be promptly incinerated.
C) The ventilation system should be deactivated.
D) Air ducts and vents should be sealed.

Question 38

A patient has been exposed to a nerve agent in a biochemical terrorist attack. This type of agent bonds with acetylcholinesterase, so that acetylcholine is not inactivated. What is the pathologic effect of this type of agent?

A) Hyperstimulation of the nerve endings
B) Temporary deactivation of the nerve endings
C) Binding of the nerve endings
D) Destruction of the nerve endings

Question 39

A group of military nurses are reviewing the care of victims of biochemical terrorist attacks. The nurses should identify what agents as having the shortest latency?

A) Viral agents
B) Nerve agents
C) Pulmonary agents
D) Blood agents

Question 40

A nurse is giving an educational class to members of the local disaster team. What should the nurse instruct members of the disaster team to do in a chemical bioterrorist attack?

A) Cover their eyes.
B) Put on a personal protective equipment mask.
C) Stand up.
D) Crawl to an exit.