Question 1

A patient is admitted to the hospital with fever, cough, malaise, and weakness. Forty-eight hours later, the symptoms have become progressively worse, and they progress to severe respiratory distress, septicemia, and hemorrhagic meningitis. The nurse recognizes these signs and symptoms as:

A) tularemia.
B) smallpox.
C) inhalation anthrax.
D) pneumonic plague.

inhalation anthrax.

Accepted Answer

Inhalation anthrax is characterized by fever, cough, malaise, and weakness, which progress 2 to 3 days later to severe respiratory distress, septicemia, and hemorrhagic meningitis. Tularemia is characterized by fever, headache, chills, rigors, body aches, sneezing, and sore throat. Pneumonia and pleuritis may develop. Smallpox is manifested by a vesicular rash, which this patient does not have. Fever is a characteristic of both inhalational anthrax and smallpox. Pneumonic plague is manifested by high fever, cough, dyspnea, and hemoptysis, as well as gastrointestinal symptoms.

Question 2

A member of a community disaster response team received the smallpox vaccine 3 weeks ago and sees a nurse for a follow-up appointment. The nurse examines the area and should expect to see a:&#10;A) necrotic vesicle.&#10;B) small area of scarification.&#10;C) small, fluid-filled blister.&#10;D) red bump.

Accepted Answer

With smallpox vaccination, the scab falls off in the third week, leaving a small scar; the nurse should expect to see a scar. A necrotic vesicle would be a symptom of progressive vaccinia (vaccinia necrosum), which develops almost exclusively in those who are immunodeficient. There is progressive necrosis at the inoculation site. During the first week after inoculation, the bump becomes a blister, which begins to dry and develop a scab. Within 3 to 4 days of administration of the vaccine, a red, itchy bump appears.

Question 3

A group of people has been exposed to ricin by inhalation of ricin mist. When preparing to receive these victims in the emergency department, nurses will prepare to:&#10;A) administer antidotes.&#10;B) give chelating agents.&#10;C) provide respiratory support.&#10;D) start hemodialysis.

Accepted Answer

Within a few hours of inhaling ricin mist, victims experience coughing, tightness in the chest, difficulty breathing, nausea, and muscle aches. The airway may become severely inflamed and edematous and breathing can become extremely difficult. Management of poisoning with ricin is purely supportive. There is no antidote or chelating agent. Hemodialysis is not indicated.

Question 4

A nurse responds when a patient asks why the smallpox vaccine is no longer given. Which statement by the patient indicates a need for further teaching?&#10;A) &#34;The smallpox vaccine can cause serious side effects.&#34;&#10;B) &#34;The smallpox vaccine can confer protection when given after exposure.&#34;&#10;C) &#34;The smallpox vaccine is too expensive to give routinely.&#34;&#10;D) &#34;The smallpox vaccine may cause live virus to spread to others.&#34;

Accepted Answer

The smallpox vaccine can cause serious side effects and the live virus in the vaccine may be transmitted to others. Since it can confer protection even after exposure to the illness, it may be given when needed. It is not true that it is withheld because it is too expensive.

Question 5

A nurse is teaching a course in bioterrorism to a group of military nurses. Which statement by a military nurse indicates understanding of the teaching?&#10;A) &#34;Although smallpox has been eradicated, it remains a threat.&#34;&#10;B) &#34;Anthrax is spread rapidly from person to person.&#34;&#10;C) &#34;Pneumonic plague is not transmitted from person to person.&#34;&#10;D) &#34;Terrorists spreading tularemia would most likely put it in the water supply.&#34;

Accepted Answer

Smallpox has been eradicated as an endemic disease but it remains a threat because so many people are un-immunized. The virus is still available in laboratories throughout the world. Anthrax is not spread from person to person. Pneumonic plague is spread from person to person. Tularemia would be spread by terrorists as an aerosol.

Question 6

Terrorists have detonated a &#34;dirty bomb&#34; in a shopping center. Nurses are called to the site to assist with triage of victims. Besides treating injuries incurred from the blast itself, the priorities for treatment for most of the victims will include:&#10;A) administering potassium iodide as soon as possible.&#10;B) giving Prussian blue and monitoring electrolytes.&#10;C) monitoring urine and stool samples for radioactivity.&#10;D) removing clothing and bathing victims.

Accepted Answer

The primary danger from a dirty bomb is the blast itself, and not the radiation, since dispersal of the radiation is limited to a relatively small area. Persons exposed should remove clothing as soon as possible and then decontaminate the skin by showering or bathing. Since dirty bombs do not release iodine-131, taking potassium iodide is of no benefit. Prussian blue is used to hasten excretion of radioactive cesium and radioactive and non-radioactive thallium. Patients treated with Prussian blue should have close monitoring of stools and urine.

Question 7

A patient asks a nurse about who is eligible to receive anthrax vaccine (BioThrax). The nurse will respond by saying that which groups of people would be candidates for this vaccine? (Select all that apply.)

A) Hospital personnel
B) Laboratory workers
C) Military personnel
D) Nursing home residents
E) Veterinarians

Accepted Answer

Immunization for anthrax currently is limited to people considered at risk. BioThrax is approved for people at high risk of exposure to anthrax spores, such as veterinarians and laboratory workers. Also, military personnel are approved to receive this vaccine. Hospital personnel and nursing home residents are not groups at risk of contact with anthrax spores.

Question 8

A nurse is attending a conference about terrorism and emergency response. During a discussion of radiation emergencies, the use of potassium iodide is reviewed. When should potassium iodide be administered to be most effective after exposure to radiation?

A) Immediately after exposure
B) Within 48 hours after exposure
C) Within 72 hours after exposure
D) The time frame is not important

Accepted Answer

To be the most effective, potassium iodide must be taken immediately after exposure. If taken 48 hours after exposure, the drug is useless.

Question 9

A patient reported to have been exposed to mustard gas is brought to the emergency department. The patient's skin is red and swollen with small blisters, and the patient's eyes are red and tearing. The patient has a runny nose and a dry, barking cough. What should the nurse's initial action be?

A) Prepare for renal dialysis.
B) Provide oxygen and prepare for mechanical ventilation.
C) Remove the patient's clothing and clean the skin with soap and water.
D) Rush the patient to the intensive care unit for cardiorespiratory monitoring.

Accepted Answer

Patients exposed to sulfur mustard should undress immediately and wash three times with soap and water. Renal dialysis is not indicated. Oxygen may be useful but is not as important as decontamination. Rushing the patient to the ICU should not be the initial action.

Question 10

The nurse is providing smallpox vaccinations after determining that an individual who works for a local military laboratory was exposed. After administering the vaccine, how should the nurse instruct the individual to care for the site?

A) Cover the site with a bandage.
B) Leave the site open to the air.
C) Cover the site with a nonpermeable, occlusive dressing.
D) Cover the site with sterile gauze and tape the edges.

Accepted Answer

To prevent the spread of live viruses, which the vaccine contains, the site should be covered with a secure, sterile gauze or a semipermeable membrane. If a vaccination site is not securely covered, the vaccine, which contains live viruses, can be transferred to other areas of the body and to other people. A bandage is not a secure device. A semipermeable dressing, not a nonpermeable dressing, can be used to cover the inoculation site.

Deck 110: Potential Weapons of Biologic, Radiologic, and Chemical Terrorism