A nurse is participating in a mass casualty triage following an explosion at a local chemical plant. For which of the following clients should the nurse assign an emergent triage tag? (Select all that apply.)

Rationale:

A. Obtain the client's serum ammonia level: Serum ammonia levels are typically monitored in clients with liver dysfunction or hepatic encephalopathy, not in early sepsis. Ammonia is not a primary marker of tissue hypoperfusion or sepsis-related metabolic changes.

B. Administer glucagon to the client: Glucagon is used primarily to treat hypoglycemia or beta-blocker overdose. It does not play a role in the management or diagnosis of sepsis and would not be indicated in this context.

C. Obtain the client's serum lactate level: Serum lactate is a key indicator in early sepsis, reflecting tissue hypoperfusion and anaerobic metabolism. Elevated lactate levels help identify severity and guide resuscitation efforts, making it an essential early diagnostic step.

D. Administer lactulose to the client: Lactulose is used to treat hepatic encephalopathy by reducing ammonia absorption in the gut. It is not relevant in the early identification or treatment of sepsis and would not address the pathophysiology of the condition.

Rationale:

A. Pays full costs for any health care service: Medicare does not cover 100% of all healthcare services. Beneficiaries are usually responsible for deductibles, copayments, and coinsurance. Some services may not be covered at all unless supplemental insurance or Medicare Advantage plans are used.

B. Receives funding through private insurance: Medicare is a federally funded health insurance program, not financed through private insurance. While some beneficiaries may choose Medicare Advantage through private insurers, traditional Medicare is publicly funded.

C. Covers nurse practitioner services: Medicare Part B covers services provided by nurse practitioners, including evaluation, diagnosis, and management of health conditions. These services are reimbursed similarly to those provided by physicians, as long as they meet established billing criteria.

D. Legally requires enrollment in supplemental insurance plan: Enrollment in a supplemental insurance plan, such as Medigap, is optional and not legally required. These plans can help cover out-of-pocket expenses, but beneficiaries are not mandated to purchase them.