The nurse is assisting in the care of clients during a mass casualty event.
For each client, click to specify if the client should be assigned a red, yellow, or black tag. A tag color may be assigned to more than one client.
Client 4
Client 2
Client 1
Client 3
The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"C"}}
Rationale
- Client 1: Red tag. This client has a significant loss of blood and a low heart rate, indicating they are in critical condition and need immediate intervention to survive.
- Client 2: Yellow tag. This client has second-degree burns and is in pain, but their condition is stable and not immediately life-threatening.
- Client 3: Black tag. This client is unresponsive with multiple severe burn injuries and Cheyne-Stokes respirations, indicating a very poor prognosis and unlikely survival.
- Client 4: Red tag. This client is experiencing severe chest pain and shortness of breath, which could indicate a life-threatening condition such as a heart attack and requires immediate attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
A. Ambulate with the client to bathroom. Safe sitters can assist with ambulation, ensuring the client’s safety while moving.
B. Document the client's vital signs. Safe sitters can document routine measurements like vital signs.
C. Assist the client with eating. Safe sitters can help clients with basic needs such as eating.
D. Administer PRN medication to the client. Administering medication requires clinical judgment and is within the scope of practice for licensed nurses, not safe sitters.
E. Notify the provider about the client's forearm. Communicating with providers about clinical concerns requires clinical judgment and is the responsibility of licensed nurses.
Correct Answer is C
Explanation
A. Delaying surgery in a life-threatening situation could endanger the client, so waiting for parental consent is not required under emergency circumstances.
B. The pediatrician does not have the authority to provide implied consent; this legal principle applies directly to the care team in emergency situations.
C. In emergency situations where a minor requires immediate, life-saving treatment and a parent or legal guardian is not available, implied consent allows the surgeon to proceed with necessary interventions to prevent harm.
D. An adult cousin does not have legal authority to provide consent for a minor’s treatment unless specifically designated as a legal guardian.
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