Nokea
The nurse is caring for a client affected by a nerve agent. The nurse quickly gives a tutorial on the neurotransmitters and nervous system affected. Which couplet is most correct?
- A. Acetylcholine, parasympathetic nervous system
- B. Serotonin, sympathetic nervous system
- C. Norepinephrine, sympathetic nervous system
- D. Dopamine, parasympathetic nervous system
Correct Answer: A
Rationale: Nerve agents cause fatal consequences by inhibiting acetyl cholinesterase. Acetyl cholinesterase is an enzyme that inactivates acetylcholine, a neurotransmitter of the parasympathetic nervous system. No other option is correct.
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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. A biologic disaster
- B. A natural disaster
- C. A radiologic disaster
- D. A chemical disaster
Correct Answer: A
Rationale: 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.
The emergency department nurse is caring for clients involved in a chlorine exposure accident at a local chemical plant. The nurse is aware that permanent damage can occur to which body systems?
- A. Cardiac
- B. Respiratory
- C. Renal
- D. Hepatic
Correct Answer: B
Rationale: The consequences of exposure to chlorine and other respiratory toxins are related to the amount, route, and length of chemical exposure. Death occurs as fluid infiltrates the pulmonary air spaces and terminal bronchioles interfering with gas exchange. Following recovery from an acute event, victims may develop chronic bronchitis and emphysema.
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?
- A. Neurological compromise
- B. Respiratory compromise
- C. Cardiovascular compromise
- D. Sensory neglect
Correct Answer: B
Rationale: 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.
Which isolation category should the nurse use to guide care when caring for a client with anthrax?
- A. Standard precautions
- B. Droplet precautions
- C. Airborne precautions
- D. Contact precautions
Correct Answer: A
Rationale: Standard precautions, measures for reducing the risk of transmitting pathogens, are sufficient for caring for clients infected with anthrax. These precautions are for all patients being cared for in the hospital. Droplet, airborne, and contact precautions initiate additional measures beyond those for standard precautions.
The nursing student is preparing a teaching presentation on disaster preparedness for a nursing class assignment. Which action(s) would the student include in the presentation? Select all that apply.
- A. Keep a supply of fresh foods on hand
- B. Keep a 24-hour supply of medications on hand at all times
- C. Affix a tag to a pet's collar with contact information
- D. Store a supply kit with extra batteries, flashlight, and radio
- E. Create a network of persons who can provide support during and after the disaster
Correct Answer: C,D,E
Rationale: The student should address that an individual should keep 7 days of medications on hand; 24 hours of medications is not enough of a supply for the individual to keep on hand. Individuals should keep canned or dried packaged food on hand as fresh foods will not remain safe if refrigeration is not available. Battery operated flashlights and radio, as well as extra batteries should be kept on hand. A network of persons who can provide support during and after the disaster is important to have on hand prior to an emergency.