Is it "possible"? Certainly. Is it likely? No.
The logistics of getting a nuke into the country to a good target area are pretty formidible...not impossible, but difficult. A nuke gives off ionizing radiation that is detectable by the Nuclear Emergency Search Team
www.fas.org/nuke/guide/usa/doctrine/doe/o5530_2.htm and those agencies working on concert with NEST to defeat those who would commit the ultimate act of terrorism.
That said...yes it could be done. That is why the Iranians and the North Koreans must be stopped. That is why we had to attack Saddam.
What would be the consequences? How many dead? How much property damage? That would be totally dependent upon the yield of the device, the location of the detonation, the time of day, weather conditions, etc.
The DoD and the Energy Dept. have conducted dozens of tests to ascertain the effects of various types and yields of bombs set off in the atmosphere at many different altitudes, on the surface of the land, sea and underground. Yield of the bomb has a great deal to do with overall effectiveness. For example, a nuclear device used as an airburst is designed to detonate at an optimal altitude, dependent upon the yeild of the weapon...and the target set for which it is intended. A relativey small device might have a much greater effect than a much larger one if the smaller one is set to detonate at its optimum altitude and the larger one is not. This is due to the phenomenon known as the "precursor" shock wave generated by the fireball detonation touching the surface of the earth then the reflected wave riding in phase with the sperical first wave. The effects are amazing.
Bottom line, even a small tactical nuke, say...maybe 10kts yield, would destroy much of a major metro area and kill many tens of thousands of persons.
The key then is to remove the threat before it comes here.
For a pretty accurate depiction of one such scenario, Iwould recommend Tom Clancy's "The Sum of All Fears".
Here's another NEST description:
www.janes.com/defence/news/jcbw/jcbw020827_1_n.shtml