The flight nurse arrived on scene of a bomb explosion and is assisting in the triage of clients. The client is found lying on the ground, confused but obeying commands. The client has a deformity to his lower leg with good peripheral pulses but is unable to ambulate. Using the START triage, what acuity level should be assigned to this client?

Yellow.

Black.

Red.

Green.

Answer and Explanation

The Correct Answer is A

Choice A reason: In the START triage system, the yellow category is designated for clients who are unable to walk, but their condition is stable and does not require immediate life-saving intervention. This client, though confused, is obeying commands, has a deformity to his lower leg with good peripheral pulses, and is unable to ambulate. These factors indicate that the client's injuries need attention but are not immediately life-threatening, making the yellow category appropriate.

Choice B reason: The black category is for clients who are deceased or have injuries so severe that they are not expected to survive even with immediate medical intervention. This client does not fall into this category as he is responsive and his condition is stable.

Choice C reason: The red category is assigned to clients who require immediate life-saving intervention. Although the client is unable to walk and has a deformity to his lower leg, he is stable, obeys commands, and has good peripheral pulses. Thus, he does not meet the criteria for the red category.

Choice D reason: The green category is used for clients who can walk and have minor injuries that do not require urgent medical attention. This client is unable to ambulate, indicating that his condition is more serious than those in the green category.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is ["A","B","C"]

Explanation

Choice A reason: This statement is incorrect because a mass casualty event refers to an incident that results in a large number of casualties, overwhelming the local healthcare system. A fight between visitors in the emergency department, although potentially serious, would not constitute a mass casualty event.

Choice B reason: This statement is incorrect because mass casualty events typically require a significant increase in the number of staff to manage the influx of patients and provide adequate care. Staffing levels are often augmented to ensure that the medical response can meet the demands of the situation.

Choice C reason: This statement is incorrect because mass casualty events are not limited to occurring within healthcare facilities. They can happen anywhere, such as at public events, natural disasters, or terrorist attacks, and involve a large number of casualties that overwhelm local medical resources.

Choice D reason: This statement is correct and does not indicate a need for further teaching. A mass casualty event is indeed characterized by overwhelming local medical capabilities, necessitating additional resources and support.

Choice E reason: This statement is correct and does not indicate a need for further teaching. Mass casualty events often require collaboration among multiple local agencies, such as emergency services, law enforcement, and healthcare providers, to effectively manage the situation.

A. Confirm the rehabilitation center has a room available at the time of transfer. B. Ensure the client has possession of his valuables. C. Complete a transfer form for the receiving facility. D. Assess how the client tolerates the transfer. E. Send a copy of the client's chart with diagnostic and laboratory results.

Correct Answer is ["A","B","C","E"]

Explanation

Choice A reason: Confirming that the rehabilitation center has a room available at the time of transfer is essential to ensure the client has a designated space upon arrival. This helps prevent any delays or complications during the transfer process.

Choice B reason: Ensuring the client has possession of his valuables is important for safeguarding the client's personal belongings during the transfer. This task helps prevent any loss or misplacement of valuable items.

Choice C reason: Completing a transfer form for the receiving facility is a critical task that involves documenting the client's medical information, treatment plan, and other relevant details. This form ensures that the receiving facility has all the necessary information to continue the client's care seamlessly.

Choice D reason: While assessing how the client tolerates the transfer is important, it is typically done after the transfer has occurred, rather than being a responsibility of the nurse at the sending facility. This task is more relevant to the receiving facility's staff.

Choice E reason: Sending a copy of the client's chart with diagnostic and laboratory results ensures that the receiving facility has access to the client's medical history, test results, and other pertinent information. This facilitates continuity of care and informed decision-making.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse educator is educating new staff nurses about mass casualty events. Which statements by the new nurse indicate a need for further teaching? (Select All That Apply)

Correct Answer is ["A","B","C"]

Explanation

A nurse is caring for a client with a stroke and is scheduled for transfer to a rehabilitation center. Which of the following tasks are the responsibility of the nurse from the sending facility? (Select All that Apply)

Correct Answer is ["A","B","C","E"]

Explanation

The nurse is working on the neurological unit. Which task would be most appropriate to delegate to the unlicensed assistive personnel assigned to the unit?

A school nurse is helping emergency medical services (EMS) triage students after a bus accident occurred in the school parking lot. A 10-year-old client is awake, alert, and ambulatory but reports a headache and neck pain. Using START triage, what acuity level would be assigned to this client?

A newly hired nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the nurse educator best provides information about this aspect of therapeutic communication?

The nurse is reviewing the laboratory results for a client who is scheduled for knee arthroplasty later in the day. Which laboratory value is most important to report to the health care provider before the surgery?

The newly hired nurse educator for the emergency department is reviewing the hospital disaster plan and policies and finds that it has not been reviewed with the staff for 3 years. Which finding would be most important for the nurse educator to address related to the disaster plan?

The nurse is caring for a group of clients. After making initial rounds, which client is the nurse's priority?

The nurse manager of the emergency department arranges for critical incident stress debriefing for the staff after a mass casualty incident. Which statement by the debriefing team leader is most appropriate for this situation?

The nurse is caring for a client on the medical unit when the waste basket catches fire. What is the priority action for the nurse?