(Osborn) Chapter 72 Learning Outcomes (Number and Title)

[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.
2.
3.
4.
Domestic terrorism.
International terrorism.
Anger toward the federal government.
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: Analysis
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 1

Inc.
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 Kingdoms 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.
LO: 1

Inc.
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.
2.
3.
4.
Media attention to influence policy.

Improved conditions for those seeking abortions.
A way to call attention to the lack of abortion clinics in the city.
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.
LO: 1

Inc.
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.
2.
3.
4.
Explosive agent.
Chemical agent.
Radiologic agent.
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.
LO: 2

Inc.
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 patients precaution is related to the:
1.
2.
3.
4.
Chernobyl Nuclear Reactor accident.

Ongoing cold war with the former Soviet Union.
Potential for contracting anthrax.
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.
LO: 2

Inc.
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.
2.
3.
4.
Biologic
Chemical
Radiologic
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.
Client Needs: Safe, Effective Care Environment
LO: 2

Inc.
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.
2.
3.
4.
5.
Miosis
Rhinorrhea
Shortness of breath
Muscle pain
Flaccid paralysis
Correct Answers:
1. Miosis
2. Rhinorrhea
3. 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: Application
Client Need: Physiological Integrity
LO: 3

Inc.
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
patients 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.
LO: 3

Inc.
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.
2.
3.
4.
Incapacitating agents.
Irritants.
Blood agents.
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.
LO: 3

Inc.
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.
2.
3.
4.
5.
Anthrax
Plague
Tularemia
Viral hemorrhagic fever
Botulism
Correct Answers:
1. Anthrax
2. Plague
3. 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.
LO: 4

Inc.
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.
2.
3.
4.
Botulism
Staphylococcal enterotoxin B
Ricin
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.
LO: 4

Inc.
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.
2.
3.
4.
Infectious.
Clear of the infection.
Incubating until the second crop of lesions appears.
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.
LO: 4

Inc.
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.
2.
3.
4.
Determine amount of radiologic exposure and treat the skin burns.

Provide support for the onset of hypotension and diarrhea.
Begin antibiotic therapy.
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.
Nursing Process: Planning
LO: 5

Inc.
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.
2.
3.
4.
Administer sedatives and analgesics.

Provide antiemetics.
Prepare intravenous fluids and order a bland diet.
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.
Nursing Process: Implementation
LO: 5

Inc.
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 nurses best response to this patient?
1.
2.
3.
4.
The weak and tired feelings will continue for a while longer.
This means that your body is healing.
After your strength returns, you might have diarrhea.
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 patients body is healing.
Diarrhea will precede the feelings of fatigue. Increasing activity will not help with the
fatigue caused by this syndrome.
LO: 5

Inc.
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.
2.
3.
4.
The public information officer

The incident commander
The safety and security officer
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.
LO: 6

Inc.
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.
2.
3.
4.
Green
Red
Yellow
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.
LO: 6

Inc.
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.
2.
3.
4.
Logistics
Planning
Finance
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.
LO: 6

Inc.
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.
2.
3.
4.
The Technical Advisory Response Unit.

The nurses who provided emergency care to the hurricane victims.
The vendors.
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.
LO: 7

Inc.
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.
2.
3.
4.
Must provide and pay for own personal gear, including a sleeping bag
Must be licensed to practice nursing in the state of the disaster
Must be willing to be a volunteer since the positions are unpaid
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.
LO: 7

Inc.
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.
2.
3.
4.
Disaster Mortuary Operations Response Teams.

Office of Environmental Protection employees.
Centers for Disease Control employees.
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.
LO: 7

Inc.
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.
2.
3.
4.
Preincident preparation.
Demobilization.
Critical incident defusing.
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.
Nursing Process: Planning
Client Need: Psychosocial Integrity
LO: 8

Inc.
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.
2.
3.
4.
Post-traumatic stress disorder.

Chronic fatigue syndrome.
Fibromyalgia.
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.
LO: 8

Inc.
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.
2.
3.
4.
Teaching
Reentry
Fact
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.
LO: 8

Inc.

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[Osborn] chapter 72

Learning Outcomes[ Number and Title ]

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Domestic terrorism.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Media attention to influence policy.

Correct Answer: Media attention to influence policy.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Explosive agent.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Chernobyl Nuclear Reactor accident.

Correct Answer: Chernobyl Nuclear Reactor accident.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Biologic

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Incapacitating agents.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

10. An organization has been notified of a possible Category A bacterial biologic

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Botulism

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Infectious.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Determine amount of radiologic exposure and treat the skin burns.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Administer sedatives and analgesics.

Correct Answer: Administer sedatives and analgesics.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

The public information officer

Correct Answer: The public information officer

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Green

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Logistics

Osborn, et al., Test Item File for Medical-Surgical Nursing:

The Technical Advisory Response Unit.

Correct Answer: The Technical Advisory Response Unit.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Disaster Mortuary Operations Response Teams.

Correct Answer: Disaster Mortuary Operations Response Teams.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Preincident preparation.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Post-traumatic stress disorder.

Correct Answer: Post-traumatic stress disorder.

Osborn, et al., Test Item File for Medical-Surgical Nursing:

Correct Answer: Teaching

Osborn, et al., Test Item File for Medical-Surgical Nursing:

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