A nurse is performing triage for a group of clients following a mass casualty incident (MCI). Which of the following clients should the nurse plan to care for first?
A client who has an open upper extremity fracture
A client experiencing a tension pneumothorax
A client who has full-thickness burns over 85% of their body
A client who has agonal respirations
The Correct Answer is B
A. A client who has an open upper extremity fracture: While this is a serious injury, it is less critical compared to a tension pneumothorax in a triage setting.
B. A client experiencing a tension pneumothorax: This is a life-threatening condition that requires immediate intervention to relieve pressure on the lungs and restore adequate breathing.
C. A client who has full-thickness burns over 85% of their body: This is a severe condition with a high mortality risk, but in a mass casualty situation, a tension pneumothorax is prioritized for immediate care.
D. A client who has agonal respirations: Agonal respirations indicate severe distress, but the immediate need for intervention is to address conditions that can rapidly compromise life, such as a tension pneumothorax.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Hormone therapy decreases the risk of cardiovascular events: This is incorrect. Hormone therapy can actually increase the risk of cardiovascular events, including heart disease and stroke.
B. Hormone therapy may prevent osteoporotic fractures: This is correct. Hormone therapy can help maintain bone density and reduce the risk of osteoporotic fractures in women undergoing menopause.
C. Hormone therapy should be taken in doses throughout the day: This is incorrect. Hormone therapy is usually taken in a single daily dose or as directed by a healthcare provider, not throughout the day.
D. If a dose is missed, then the next dose should be doubled: This is incorrect. Missing a dose of hormone therapy should be managed according to the provider's instructions, which typically do not involve doubling the next dose.
Correct Answer is B
Explanation
A. Prepare the client for transfer to a facility with a hyperbaric chamber: This may be required for severe cases of carbon monoxide poisoning, but immediate intervention with high-flow oxygen is essential first.
B. Apply oxygen via a nonrebreather mask at 15 liters: Carbon monoxide poisoning requires immediate high-flow oxygen to help displace carbon monoxide from hemoglobin. This is the first step in treatment to prevent further tissue hypoxia and complications.
C. Check the client's oxygenation level with a pulse oximeter: While important, it does not address the immediate need for high-flow oxygen to treat carbon monoxide poisoning.
D. Administer intravenous (IV) fluids: IV fluids may be necessary for supportive care but are not the priority for treating carbon monoxide poisoning. The immediate need is to provide high-flow oxygen.
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