A nurse is assisting in performing triage on several clients following a mass casualty event. The nurse should assign a red tag to which of the following clients?

A client who has a sprained left ankle.

A client who has an open traumatic brain injury and agonal breaths.

A client who has sustained a partial amputation of the right leg.

A client who is deceased.

A client who has sustained a major burn to the upper torso and extremities.

Answer and Explanation

The Correct Answer is B

A.   A client who has a sprained left ankle is typically categorized as a lower priority in triage.
B.   A client who has an open traumatic brain injury and agonal breaths should be assigned a red tag and indicates immediate or emergent care; this client requires immediate attention.
C.   A client who has sustained a partial amputation of the right leg requires urgent care but may not be as immediately life-threatening as option B.
D.   A client who is deceased typically does not receive further medical intervention in a mass casualty situation.
E.   While serious, the severity may not necessitate immediate intervention compared to option B.
F.   This is typically categorized as a lower priority in triage.

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Correct Answer is A

Explanation

A. Influenza vaccines are typically produced using eggs, and individuals with egg allergies may react to the vaccine. However, there are egg-free alternatives available, and consultation with an allergist is recommended in such cases.
B. Polio vaccines do not contain egg proteins and are safe for individuals with egg allergies.=
C. Hib vaccines are not contraindicated for individuals with egg allergies.
D. Hepatitis B vaccines do not contain egg proteins and are generally safe for individuals with egg allergies.

A. Vomiting Hypoglycemia B. Hypertension C. Altered mental status D. Elevated WBC’s count

Correct Answer is C

Explanation

A. Vomiting is not a specific manifestation of sepsis.
B. Hypertension is not a typical finding in sepsis; hypotension is more common.
C. Altered mental status, such as confusion or lethargy, can be a sign of sepsis- induced organ dysfunction.
D. While an elevated white blood cell (WBC) count is often seen in infection, it alone does not indicate sepsis. The key in sepsis is the body's dysregulated response to infection leading to organ dysfunction.

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A nurse is assisting in performing triage on several clients following a mass casualty event. The nurse should assign a red tag to which of the following clients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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