Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 12Question 1Type: MCMA

The nurse is teaching the importance of drugs for emergency preparedness to local firemen. The nurse determines that learning has occurred when the firemen make which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "The vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours."

2. "Our local hospital is supposed to be stockpiling antibiotics."

3. "The push package can reach any community within 12 hours of an attack."

4. "The Strategic National Stockpile is located at the Centers for Disease Control and Prevention (CDC) in Atlanta."

5. "Our country's drug stockpile is managed by the Centers for Disease Control and Prevention (CDC)."

Correct Answer: 1,3,5

Rationale 1: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 2: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 3: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 4: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Rationale 5: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 12-3

Question 2Type: MCMA

The nurse works for the Centers for Disease Control and Prevention (CDC). In planning for a bioterrorist attack, what will the best plan of the nurse include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Learn the signs and symptoms of chemical and biological agents.

2. Obtain a listing of health and law enforcement contacts.

3. Assist in the stockpiling of medications.

4. Obtain current knowledge of emergency management.

5. Assist in triage at local hospitals.

Correct Answer: 1,2,4

Rationale 1: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 2: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 3: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 4: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Rationale 5: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-2

Question 3Type: MCSA

The patient comes to the emergency department with an anxiety attack. He tells the nurse he heard that there was another anthrax attack in the capitol and is concerned about running out of medications. What is the best response by the nurse?

1. "You don't need to worry about another attack at all; I think our government can take care of us."

2. "Your health is in danger due to the anxiety; we really need to focus on reducing your anxiety now."

3. "The Centers for Disease Control and Prevention (CDC) maintains a large stockpile of medications for us in case that occurs."

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. "I'm sure the Centers for Disease Control and Prevention (CDC) has contingency plans in the event of an anthrax attack."

Correct Answer: 3

Rationale 1: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient's concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Rationale 2: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient's concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Rationale 3: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient's concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Rationale 4: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient's concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-1

Question 4Type: MCSA

The nurse is teaching a class on anthrax to a group of emergency response workers. What is the best instruction to include?

1. Anthrax is a deadly bacterium; the most common and deadly form is gastrointestinal anthrax.

2. Cutaneous anthrax is the most common form, but inhaled anthrax is the most lethal form.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

3. Anthrax most commonly affects wild rodents such as mice, rats, squirrels, and chipmunks.

4. Cutaneous anthrax is serious because it quickly spreads by person-to-person contact.

Correct Answer: 2

Rationale 1: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Rationale 2: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Rationale 3: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Rationale 4: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-4

Question 5Type: MCSA

The patient has been exposed to anthrax. What treatment will the nurse plan to administer?

1. Penicillin (Bicillin LA) and vancomycin (Vancocin).

2. Tetracycline (Sumycin) and erythromycin (Erythrocin).

3. Ampicillin (Principen) and cefepime (Maxipime).

4. Ciprofloxacin (Cipro) and doxycycline (Vibramycin).

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Correct Answer: 4

Rationale 1: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 2: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 3: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 4: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-5

Question 6Type: MCSA

The patient was exposed to cutaneous anthrax 2 weeks ago. What will the nurse see when assessing the patient's skin?

1. Large pustules, and later, reddish scabs

2. Small, fluid-filled vesicles, and later, small skin erosions

3. Ulcerated areas, and later, keloids

4. Small skin lesions, and later, black scabsAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Correct Answer: 4

Rationale 1: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 2: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 3: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 4: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 12-5

Question 7Type: MCSA

The nursing instructor is teaching student nurses about the use of viruses in a bioterrorism attack. The nurse determines that learning has occurred when the students make which statement?

1. "The Centers for Disease Control and Prevention (CDC) has a plan to vaccinate Americans against most viruses."

2. "Actually, a bigger concern is a nuclear weapon exploding in a city."

3. "Most Americans have already been vaccinated against the lethal viruses."

4. "A bioterrorist attack with viruses is a real threat to Americans."

Correct Answer: 4

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 1: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 2: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 3: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 4: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 12-7

Question 8Type: MCSA

The patient tells the nurse that she is concerned about terrorist activity and questions if everyone should be immunized against smallpox. What is the best response by the nurse?

1. "The vaccine has side effects, which are serious and could kill many people."

2. "I really do not think our country has enough vaccine to do this."

3. "Don't be so concerned; if an attack comes, we will immunize people then."

4. "The vaccine has some serious side effects, but this is probably a good idea."

Correct Answer: 1Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 1: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Rationale 2: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Rationale 3: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Rationale 4: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-7

Question 9Type: MCSA

The nursing instructor is teaching student nurses about dangerous infectious diseases. The nurse determines that learning has occurred when the students make which statement?

1. "The influenza virus is the most dangerous virus today."

2. "The human immunodeficiency virus is the most deadly virus we have."

3. "The dengue fever virus will kill more people than any other virus."

4. "The Ebola virus has the potential to kill more people than any other virus."

Correct Answer: 1

Rationale 1: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 2: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Rationale 3: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Rationale 4: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 12-6

Question 10Type: MCSA

The patient has been exposed to a nerve agent. For which symptoms will the nurse most likely assess?

1. Salivation, involuntary urination, and convulsions

2. Dilated pupils and increased blood pressure and heart rate

3. Pinpoint pupils, decreased blood pressure, and increased heart rate

4. Rapid breathing and cold, clammy skin

Correct Answer: 1

Rationale 1: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Rationale 2: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 3: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Rationale 4: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 12-8

Question 11Type: MCSA

The patient has been exposed to a nerve agent. Which antidote will the nurse plan to administer?

1. Apomorphine

2. Atropine (AtroPen)

3. Acetate of ammonia

4. Hydroxyzine (Vistaril)

Correct Answer: 2

Rationale 1: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Rationale 2: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Rationale 3: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 4: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-8

Question 12Type: MCSA

A small nuclear weapon has been detonated in a nearby city. For which immediate symptoms of radiation sickness will the nurse assess in patients who have been exposed?

1. Dilated pupils and aggression

2. Nausea, vomiting, and diarrhea

3. Weight loss and fatigue

4. Anorexia and fatigue

Correct Answer: 2

Rationale 1: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Rationale 2: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Rationale 3: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Rationale 4: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

Global Rationale:

Cognitive Level: ApplyingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 12-9

Question 13Type: MCSA

The nurse administers potassium iodide (ThyroSafe) tablets to a patient who has been exposed to radiation from a nuclear weapon. What is the rationale for administering potassium iodide (ThyroSafe) to this patient?

1. It was administered to prevent thyroid cancer.

2. It was administered to prevent brain cancer.

3. It was administered to prevent liver cancer.

4. It was administered to prevent renal cancer.

Correct Answer: 1

Rationale 1: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Rationale 2: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Rationale 3: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Rationale 4: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 12-9

Question 14

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Type: MCSA

The nurse conducts a seminar in a local community center on how Americans can be affected by radiation from a nuclear attack. The nurse determines that the education is effective when the patients make which statement?

1. "I can protect myself from cancers by taking potassium iodide (ThyroSafe)."

2. "I need to stay inside my house for at least 2 days after the attack to be safe."

3. "I need to take at least four showers every day or I will develop skin ulcers."

4. "I am at risk to develop leukemia as a result of radiation exposure."

Correct Answer: 4

Rationale 1: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Rationale 2: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Rationale 3: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Rationale 4: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 12-9

Question 15Type: MCSA

The nurse is preparing an educational plan for parents about how to protect their children if a bioterrorist attack occurs. What is the best information to include?

1. “Don't worry, the Centers for Disease Control and Prevention (CDC) has everything under control.”

2. “Plan to call the Centers for Disease Control and Prevention (CDC) if an attack occurs.”

3. “Follow the Centers for Disease Control and Prevention (CDC) guidelines for immunizations.”

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. “Realistically, there is nothing that can be done.”

Correct Answer: 3

Rationale 1: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 2: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 3: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 4: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-3

Question 16Type: MCSA

Which of the following correctly and completely identifies the items found within the Strategic National Stockpile?

1. Bandages, airway devices, and IV supplies

2. Antibiotics and IV fluids

3. Emergency equipmentAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. Antibiotics, vaccines, and support supplies

Correct Answer: 4

Rationale 1: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Rationale 2: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Rationale 3: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Rationale 4: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

Global Rationale:

Cognitive Level: RememberingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-3

Question 17Type: MCMA

Anthrax is a potential agent of bioterrorism that

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. can be spread easily, causing panic and disruption.

2. can cause high morbidity, but low mortality.

3. is not spread easily, but can cause high mortality.

4. can be spread easily, causing moderate mortality.

Correct Answer: 1,4

Rationale 1: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Rationale 2: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Rationale 3: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption. Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 4: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption.

Global Rationale:

Cognitive Level: RememberingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 12-4

Question 18Type: MCSA

Following a bioterrorism attack, the nurse finds that the victims are suffering from small, black lesions on their forearms. The nurse identifies this as a symptom most likely caused by

1. cutaneous anthrax.

2. phosgene gas.

3. gastrointestinal anthrax.

4. hydrogen cyanide.

Correct Answer: 1

Rationale 1: Cutaneous anthrax produces small black lesions on the skin.

Rationale 2: Cutaneous anthrax produces small black lesions on the skin.

Rationale 3: Cutaneous anthrax produces small black lesions on the skin.

Rationale 4: Cutaneous anthrax produces small black lesions on the skin.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-2 and 12-5

Question 19Type: MCSA

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Which of the following is a key role for the nurse in the event of a bioterrorist attack?

1. Collecting evidence that might lead to the capture of the terrorists

2. Planning that includes developing a list of health and law enforcement contacts

3. Prescribing antibiotics

4. Prescribing vaccines

Correct Answer: 2

Rationale 1: The nurse's role includes being educated, knowing resources, diagnosing and treating, and planning.

Rationale 2: The nurse's role includes being educated, knowing resources, diagnosing and treating, and planning.

Rationale 3: The nurse's role includes being educated, knowing resources, diagnosing and treating, and planning.

Rationale 4: The nurse's role includes being educated, knowing resources, diagnosing and treating, and planning.

Global Rationale:

Cognitive Level: RememberingClient Need: Safe Effective Care EnvironmentClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-2

Question 20Type: MCSA

Which of the following would be most effective for the treatment of a person infected with anthrax?

1. Anthrax vaccination

2. Atropine

3. Ciprofloxacin

4. Antiviral agents

Correct Answer: 3

Rationale 1: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 2: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Rationale 3: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Rationale 4: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-5

Question 21Type: MCSA

Atropine would be most useful for a victim of bioterrorism who experienced exposure to

1. ionizing radiation.

2. nerve gas.

3. bacterial agents.

4. viral agents.

Correct Answer: 2

Rationale 1: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 2: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 3: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 4: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Global Rationale:

Cognitive Level: RememberingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-7

Question 22Type: MCSA

Victims of a bioterrorism attack experienced initial nausea and vomiting followed by weight loss and eventual thyroid cancer. Which of the following was the most likely causative agent?

1. Chemical agent

2. Viral agent

3. Bacterial agent

4. Ionizing radiation

Correct Answer: 4

Rationale 1: Exposure to radiation causes weight loss and eventual thyroid cancer.

Rationale 2: Exposure to radiation causes weight loss and eventual thyroid cancer.

Rationale 3: Exposure to radiation causes weight loss and eventual thyroid cancer.

Rationale 4: Exposure to radiation causes weight loss and eventual thyroid cancer.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-9

Question 23Type: MCSA

Which of the following would be the best choice for preventing thyroid cancer in persons exposed to ionizing radiation?

1. Potassium-iodine tablets

2. Calcium tablets

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

3. Antibiotics

4. Salt tablets

Correct Answer: 1

Rationale 1: Potassium—- tablets are the only recognized therapy for radiation exposure.

Rationale 2: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Rationale 3: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Rationale 4: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-9

Question 24Type: MCSA

Which of the following antidotes would be indicated for a patient who overdosed on a benzodiazepine?

1. Mucomyst

2. Digibind

3. Romazicon

4. Acetaminophen

Correct Answer: 3

Rationale 1: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 2: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 3: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 4: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Global Rationale:

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-1

Question 25Type: MCMA

As part of emergency nursing training, the nurse is reviewing the causes of disasters. Which agents can cause potential disasters?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Radiologic agents

2. Nuclear explosives

3. Biological agents

4. Chemical agents

5. Mechanical agents

Correct Answer: 1,2,3,4

Rationale 1: Potential disasters can result from radiologic agents.

Rationale 2: Potential disasters can result from nuclear explosives.

Rationale 3: Potential disasters can result from biologic agents.

Rationale 4: Potential disasters can result from chemical agents.

Rationale 5: Potential disasters cannot result from mechanical agents.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Safety and Infection ControlNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 12-1

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Question 26Type: MCMA

The nurse is reviewing the components of the Strategic National Stockpile (SNS), which include

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. intravenous administration equipment.

2. antibiotics.

3. life-support medications.

4. chemical antidotes.

5. hospital beds.

Correct Answer: 1,2,3,4

Rationale 1: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes intravenous (IV) administration equipment.

Rationale 2: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes antibiotics.

Rationale 3: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes life-support medications.

Rationale 4: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes chemical antidotes.

Rationale 5: The Strategic National Stockpile (SNS), a national repository of medical equipment, does not include hospital beds.

Global Rationale:

Cognitive Level: RememberingClient Need: Safe Effective Care EnvironmentClient Need Sub: Safety and Infection ControlNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 12-2

Question 27Type: MCMA

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

The danger from radiation exposure arises primarily from

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. the amount of exposure.

2. the long-lasting effects.

3. the amount of cellular death.

4. the distance from the initial incident.

5. the amount of potassium iodine ingested after exposure.

Correct Answer: 1,2,3,4

Rationale 1: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Some radioisotopes emit radiation for decades and even centuries.

Rationale 2: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer.

Rationale 3: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer.

Rationale 4: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site.

Rationale 5: The ingestion of potassium iodine does not contribute to the danger of radiation exposure.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Safety and Infection ControlNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-5

Question 28Type: MCMA

Which of the five general principles for treating acute poisoning would the nurse use to treat a patient who was exposed to an external chemical agent?

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Topical decontamination

2. Increase in the rate of excretion

3. Prevention of absorption

4. Neutralization

5. Antidotes and symptomatic therapy

Correct Answer: 1,4

Rationale 1: Topical decontamination includes the removal of contaminated clothing and flushing of the skin or eyes. This would be appropriate for exposure to an external chemical agent.

Rationale 2: This would be appropriate for treating an acute poisoning through ingestion.

Rationale 3: This would be appropriate for treating an acute poisoning through ingestion.

Rationale 4: Application of an agent to neutralize the poison would be appropriate for an exposure to an external chemical agent.

Rationale 5: Antidotes and symptomatic therapy would not be indicated for treating an external chemical agent.

Global Rationale:

Cognitive Level: ApplyingClient Need: Safe Effective Care EnvironmentClient Need Sub: Safety and Infection ControlNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 12-6

Question 29Type: MCMA

Which interventions will the nurse include when planning care to enhance the removal of poison from a patient who has overdosed on drugs?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

1. Administering activated charcoal

2. Monitoring urine output

3. Preparing the patient for dialysis

4. Inserting a nasogastric tube

5. Preparing corticosteroids for administration

Correct Answer: 1,2,3,4

Rationale 1: Charcoal works by binding with the poison agent.

Rationale 2: The patient's urine output should be monitored, noting the characteristics of urine for early identification of rhabdomyolysis.

Rationale 3: The patient might need dialysis for rapid removal of lethal toxins.

Rationale 4: A nasogastric tube might be needed for lavage of stomach contents.

Rationale 5: Corticosteroids are not used to enhance the removal of poison from the body.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Safe Effective Care EnvironmentClient Need Sub: Safety and Infection ControlNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 12-9

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.