A nurse is performing triage on the incident scene for 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 fractured fibula and tibia
A client who has sustained a major burn to their upper torso and extremities
A client who has a sprained ankle and laceration to the lower leg
A client who has an open traumatic brain injury and agonal breaths
The Correct Answer is D
A. A client who has a fractured fibula and tibia: This is incorrect. While serious, this injury does not require immediate life-saving intervention and is generally categorized as less urgent.
B. A client who has sustained a major burn to their upper torso and extremities: This is incorrect. Although severe, if the client is stable and responsive, they may be categorized as yellow (delayed) unless there are immediate life-threatening complications.
C. A client who has a sprained ankle and laceration to the lower leg: This is incorrect. These injuries are considered less severe and would typically be tagged as green (minor).
D. A client who has an open traumatic brain injury and agonal breaths: This is correct. Agonal breaths and severe head injury indicate a need for immediate life-saving intervention, so this client should receive a red tag for the highest priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Flu-like symptoms: This is correct. Inhalation anthrax initially presents with flu-like symptoms, including fever, cough, and malaise. This early presentation can progress to severe respiratory distress and systemic illness.
B. Vesicles on the skin: This is incorrect. Vesicular lesions are more characteristic of diseases such as smallpox or chickenpox, not anthrax.
C. Respiratory failure: While respiratory failure can occur with advanced inhalation anthrax, it is a later-stage complication rather than an initial finding.
D. Flaccid paralysis: This is incorrect. Flaccid paralysis is not a typical symptom of anthrax exposure but may be associated with diseases such as botulism.
Correct Answer is B
Explanation
A. History of sexually transmitted infection (STI): This is incorrect. A history of STI is not a contraindication for menopausal hormone therapy.
B. History of breast cancer: This is correct. Hormone therapy is not recommended for individuals with a history of breast cancer due to the potential risk of cancer recurrence or progression.
C. History of chronic obstructive pulmonary disease (COPD): This is incorrect. While HT might not be the primary treatment for COPD, it is not contraindicated solely due to COPD.
D. History of thyroiditis: This is incorrect. A history of thyroiditis does not contraindicate the use of hormone therapy for menopause.
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