A nurse in the emergency department is assessing clients who have been triaged using the triage tag system following a hurricane disaster. Which of the following clients should the nurse assess first?
A client who has a red tag
A client who has a green tag
A client who has a yellow tag
A client who has a black tag
The Correct Answer is A
Choice A reason: A client who has a red tag is the first priority for the nurse, as it indicates that the client has life-threatening injuries that require immediate attention and treatment. The nurse should assess and stabilize the client as soon as possible.
Choice B reason: A client who has a green tag is the last priority for the nurse, as it indicates that the client has minor injuries that do not require urgent care. The nurse should assess and treat the client after all other clients have been attended to.
Choice C reason: A client who has a yellow tag is the second priority for the nurse, as it indicates that the client has serious injuries that require timely care but can wait for a short period of time. The nurse should assess and treat the client after the red-tagged clients have been stabilized.
Choice D reason: A client who has a black tag is not a priority for the nurse, as it indicates that the client is deceased or has fatal injuries that are beyond the scope of care. The nurse should not attempt to resuscitate or treat the client, but rather focus on the clients who have a chance of survival.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: The client's code status is not part of the background information, but rather the recommendation or request section of the SBAR Communication tool. The code status indicates the level of resuscitation the client wishes to receive in case of a cardiac or respiratory arrest.
Choice B reason: The client's vital signs are not part of the background information, but rather the assessment section of the SBAR Communication tool. The vital signs reflect the client's current condition and response to treatment.
Choice C reason: The client's name is part of the background information, along with the client's age, diagnosis, reason for admission, and relevant medical history. The background information provides a brief overview of the client's situation and helps to identify the client.
Choice D reason: A prescribed consultation is not part of the background information, but rather the recommendation or request section of the SBAR Communication tool. A consultation is a referral to another health care professional for further evaluation or management of the client's condition.
Correct Answer is A
Explanation
Choice A reason: This is the first action the nurse preceptor should take to demonstrate appropriate time management. By determining the client care goals, the nurse preceptor can prioritize the most important and urgent tasks for each client and delegate appropriately.
Choice B reason: This is not the first action the nurse preceptor should take to demonstrate appropriate time management. Reviewing the client's new laboratory values is an important task, but it should be done after determining the client care goals and before completing the required tasks.
Choice C reason: This is not the first action the nurse preceptor should take to demonstrate appropriate time management. Completing the required tasks is an essential part of nursing care, but it should be done after determining the client care goals and reviewing the client's new laboratory values.
Choice D reason: This is not the first action the nurse preceptor should take to demonstrate appropriate time management. Documenting the assessment data is a vital part of nursing care, but it should be done after completing the required tasks and before the end of the shift.
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