A nurse is assisting with the care of a group of clients during a mass casualty event. Which of the following tasks should the nurse assign to an assistive personnel (AP)?
Respond to family members about a client's condition.
Determine which clients should be seen first.
Clean and dress client abdominal wounds.
Take vital signs on clients as they are admitted.
The Correct Answer is D
Choice A reason: Responding to family requires clinical judgment and communication skills beyond AP scope. Nurses handle this in mass casualty for accuracy.
Choice B reason: Triage prioritization needs nursing assessment skills, not AP training. Determining care order is a licensed responsibility in emergencies like this.
Choice C reason: Cleaning and dressing wounds involves sterile technique and assessment, outside AP scope. Nurses perform this in mass casualty settings.
Choice D reason: Taking vital signs is within AP scope, providing data for nurse triage. It’s a routine task, safely assigned in a mass casualty event.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Diminished pulses signal compromised circulation, a critical cast complication like compartment syndrome. This risks tissue necrosis or amputation if untreated, prioritizing it scientifically, as arterial flow disruption demands immediate intervention to preserve limb viability per vascular assessment standards.
Choice B reason: Ecchymosis suggests bruising, possibly from cast pressure, but isn’t immediately life-threatening like poor circulation. It’s a secondary concern, manageable later. Scientifically, it indicates trauma, not acute vascular emergency, ranking lower in urgency per cast complication protocols.
Choice C reason: Muscle spasms may indicate irritation or pressure, but they’re less urgent than absent pulses. Pain is common in casts, not always critical. Scientifically, this suggests nerve or muscle stress, not imminent tissue loss, making it a lower priority for immediate action.
Choice D reason: One fingerbreadth space is normal, preventing tightness, not a concern. It’s ideal fit, not a problem. Scientifically, this aligns with safe cast application, lacking urgency compared to circulatory threats, as it supports, rather than jeopardizes, limb health.
Correct Answer is D
Explanation
Choice A reason: Exchange transfusion treats severe conditions like hyperbilirubinemia, not HIV. It’s irrelevant for a 10-month-old’s ongoing viral management needs.
Choice B reason: Granulocyte colony-stimulating factor boosts neutrophils, not lymphocytes, in neutropenia. HIV targets CD4 cells, making this an ineffective intervention here.
Choice C reason: Droplet precautions suit respiratory infections, not HIV, which spreads via blood/body fluids. Standard precautions suffice, so this isn’t needed.
Choice D reason: Monitoring lymphocyte (CD4) count tracks HIV progression in infants. It guides antiretroviral therapy, a critical ongoing management step at 10 months.
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