BIO-TERRORISM & DISASTER

The nurse is a first responder for a health-care organization for a mass casualty incident. Which injury would the nurse tag as yellow during the triage process? 1) Ankle sprain 2) Hypovolemic shock 3) Open femur fracture 4) Massive head trauma

ANS: 3 When using a triage tag system, an open femur fracture is an urgent but not life-threatening injury that would be tagged as yellow.

In the work setting, what is your primary responsibility in preparing for disaster management that includes natural disasters or bioterrorism incidents? A. Knowledge of the agency's emergency response plan B. Awareness of the signs and symptoms for potential agents of bioterrorism C. Knowledge of how and what to report to the CDC D. Ethical decision-making about exposing self to potentially lethal substances

A In preparing for disasters, the RN should be aware of the emergency response plan. The plan gives guidance that includes roles of team members, responsibilities, and mechanisms of reporting. Signs and symptoms of many agents will mimic common complaints, such as flu-like symptoms. Discussions with colleagues and supervisors may help the individual nurse to sort through ethical dilemmas related to potential danger to self.

The emergency medical service (EMS) has transported a patient with severe chest pain. As the patient is being transferred to the emergency stretcher, you note unresponsiveness, cessation of breathing, and no palpable pulse. Which task is appropriate to delegate to the nursing assistant? A. Chest compressions B. Bag-valve mask ventilation C. Assisting with oral intubation D. Placing the defibrillator pads

A Nursing assistants are trained in basic cardiac life support and can perform chest compressions. The use of the bag-valve mask requires practice and usually a respiratory therapist will perform this function. The nurse or the respiratory therapist should provide PRN assistance during intubation. The defibrillator pads are clearly marked; however, placement should be done by the RN or physician because of the potential for skin damage and electrical arcing.

The physician has ordered cooling measures for a child with fever who is likely to be discharged when the temperature comes down. Which of the following would be appropriate to delegate to the nursing assistant? A. Assist the child to remove outer clothing. B. Advise the parent to use acetaminophen instead of aspirin. C. Explain the need for cool fluids. D. Prepare and administer a tepid bath

A The nursing assistant can assist with the removal of the outer clothing, which allows the heat to dissipate from the child's skin. Advising and explaining are teaching functions that are the responsibility of the RN. Tepid baths are not usually performed because of potential for rebound and shivering.

In the event of a mass casualty, prioritized medical care is provided based on the triage of victims using colored tags. Which patient receives immediate intervention? A patient with a red tag A patient with a blue tag A patient with a green tag A patient with a yellow tag

A patient with a red tag When a mass casualty incident occurs, the victims are triaged according to color-coded tags. These colored tags are used to designate both the seriousness of the injury and the likelihood of a patient's survival. Red indicates a life-threatening injury, such as shock that requires immediate intervention. Blue indicates those who are expected to die due to a massive head trauma. Green is for minor injuries like sprains, and yellow is for urgent, but not life-threatening injuries like open fractures. In general, two-thirds of patients are tagged green or yellow, and the remaining are tagged red, blue, or black.

Which medication should be listed as the antidote to a nerve agent in the disaster plan for a terrorist attack? 1) Atropine 2) Dopamine 3) Epinephrine 4) Norepinephrine

ANS: 1 Atropine should be listed as the antidote for nerve agent poisoning in the disaster plan for a terrorist attack.

The nurse is conducting triage under mass casualty conditions. Which tag should the nurse use for a patient who is experiencing hypovolemic shock due to a penetrating wound? 1) Red 2) Black 3) Green 4) Yellow

ANS: 1 The nurse would use a red tag for a patient who has injuries that are an immediate threat to life, such as hypovolemic shock, during mass casualty conditions.

A green-tagged patient arrives at the emergency department after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this patient? 1) Implementing decontamination measures 2) Performing a head-to-toe physical examination 3) Placing a special bracelet with a disaster number 4) Taking a digital photo and placing it on the medical record

ANS: 1 The priority nursing action for a green-tagged patient who arrives at the ED after exposure to radiation is implementing decontamination measures. These measures are the priority because it is essential that members of the health-care team and patients are not exposed to the radiation while providing care.

The client has expired secondary to smallpox. Which information about funeral arrangements is most important for the nurse to provide to the client's family? 1. The client should be cremated. 2. Suggest an open casket funeral. 3. Bury the client within 24 hours. 4. Notify the public health department.

ANS: 1. Cremation is recommended because the virus can stay alive in the scabs of the body for 13 years. 2. An open casket might allow for the spread of the virus to the general public; therefore, the nurse should not make this suggestion. The nurse should not tell the client's family how to make funeral arrangement for viewing. 3. Burying the body quickly is the second best option for safety of the funeral home personnel and anyone who could come in contact with the body. The quicker the burial, the safer the situation (if the family refuses cremation). 4. The hospital, not the client's family, must notify the public health department.

The health-care facility has been notified an alleged inhalation anthrax exposure has occurred at the local post office. Which category of personal protective equipment (PPE) should the response team wear? 1. Level A. 2. Level B. 3. Level C. 4. Level D.

ANS: 1. Level A protection is worn when the highest level of respiratory, skin, eye, and mucous membrane protection is required. In this situation of possible inhalation of anthrax, such protection is required. 2. Level B protection is similar to Level A protection, but it is used when a lesser level of skin and eye protection is needed. 3. Level C protection requires an air-purified respirator (APR), which uses filters or absorbent materials to remove harmful substances. 4. Level D is basically the work uniform.

Which signs/symptoms should the nurse assess in the client who has been exposed to the anthrax bacillus via the skin? 1. A scabby, clear fluid-filled vesicle. 2. Edema, pruritus, and a 2-mm ulcerated vesicle. 3. Irregular brownish-pink spots around the hairline. 4. Tiny purple spots flush with the surface of the skin.

ANS: 2. Exposure to anthrax bacilli via the skin results in skin lesions, which cause edema with pruritus and the formation of macules or papules which ulcerate, forming a one (1)- to (3)-mm vesicle. Then a painless eschar develops, which falls off in one (1) to two (2) weeks. 1. Scabby, clear fluid-filled vesicles are characteristic of chickenpox. 3. Irregular brownish-pink spots around the hairline are characteristic of rubella. 4. Tiny purple spots flush with the skin surface are petechiae.

Which treatment for anthrax should be included in the biological agent portion of a disaster plan for terrorist attacks? 1) Antivirals 2) Antitoxins 3) Antibiotics 4) Vaccinations

ANS: 3 Anthrax is treated effectively with antibiotics if sufficient supplies are available and the organisms are not resistant.

The triage nurse has placed a disaster tag on the client. Which action warrants immediate intervention by the nurse? 1. The nurse documents the tag number in the disaster log. 2. The unlicensed assistive personnel documents vital signs on the tag. 3. The health-care provider removes the tag to examine the limb. 4. The LPN securely attaches the tag to the client's foot.

ANS: 3. The tag should never be removed from the client until the disaster is over or the client is admitted and the tag becomes a part of the client's record. The HCP needs to be informed immediately of the action. 1. This is the correct procedure when tagging a client and does not warrant intervention. 2. Vital signs should be documented on the tag. The tag takes the place of the client's chart, so this does not warrant intervention. 4. The tag can be attached to any part of the client's body.

The triage nurse in a large trauma center has been notified of an explosion in a major chemical manufacturing plant. Which action should the nurse implement first when the clients arrive at the emergency department? 1. Triage the clients and send them to the appropriate areas. 2. Thoroughly wash the clients with soap and water and then rinse. 3. Remove the clients' clothing and have them shower. 4. Assume the clients have been decontaminated at the plant.

ANS: 3. This is the first step. Depending on the type of exposure, this step alone can remove a large portion of exposure. 1. In most situations this is the first step, but with a potential chemical or biological exposure, the first step must be the safety of the hospital; therefore, the client must be decontaminated. 2. This is the second step in the decontamination process. 4. This assumption could cost many people in the hospital staff, as well as clients, their lives.

The nurse is teaching a class on bioterrorism. Which statement is the scientific rationale for designating a specific area for decontamination? 1. Showers and privacy can be provided to the client in this area. 2. This area isolates the clients who have been exposed to the agent. 3. It provides a centralized area for stocking the needed supplies. 4. It prevents secondary contamination to the health-care providers.

ANS: 4. Avoiding cross-contamination is a priority for personnel and equipment— the fewer the number of people exposed, the safer the community and area. 1. This is not a rationale; this is a statement of what is done at the area. 2. This separates the clients until decontamination occurs, but the question is asking for the scientific rationale. 3. This is false statement—the supplies should not be kept in the decontamination area.

The nurse has been assigned the role of triage nurse after a weather-related disaster. What is the priority action of the nurse? a. Call in additional staff to assist with care of the victims. b. Splint fractures and clean and dress lacerations. c. Perform a rapid assessment of clients to determine priority of care. d. Provide psychological support to staff and family members.

ANS: C The triage nurse classifies victims of the explosion into priority of care based on illness or injury severity. Calling in additional staff more likely would be done by the hospital incident commander or designee. Physical care is provided to victims after triage occurs. Psychological support should be an ongoing part of the disaster plan but is not included in triage responsibilities; this ensures that the greatest good is provided to the greatest number of people.

A patient has been transported to an emergency room from the scene of a terrorist chemical attack. The emergency room staff members have been trained to follow steps that decrease the risk of secondary exposure to a chemical used in a terrorist attack. Which of the following initial steps must be implemented? A) Decontamination B) Universal precautions C) Defusing

Ans: A Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-3 Feedback: Decontamination must be implemented to remove the accumulated contaminants and decrease the risk of secondary exposure and contamination.

Which of the following precautions must be put in place for a patient who has been exposed to anthrax by inhalation? A) Standard B) Airborne C) Droplet D) Contact

Ans: A Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: A-2 Feedback: The patient is not contagious. Since anthrax cannot be spread from person to person, standard precautions are initiated.

A patient who is a victim of a terrorist attack involving a chemical agent presents to the emergency department with visual disturbances, nausea, vomiting, forgetfulness, and irritability. The nurse suspects this patient has been exposed to which of the following chemical agents? A) Nerve B) Pulmonary C) Vesicants D) Blood

Ans: A Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Patient Needs: D-4 Feedback: Nerve agent exposure results in visual disturbances, nausea, vomiting, forgetfulness, irritability, and impaired judgment.

A hospitals emergency operations plan has been enacted following an industrial accident. While one nurse performs the initial triage, what should other emergency medical services personnel do? A. Perform life-saving measures. B. Classify patients according to acuity. C. Provide health promotion education. D. Modify the emergency operations plan

Ans: A Feedback: In an emergency, patients are immediately tagged and transported or given life-saving interventions. One person performs the initial triage while other emergency medical services (EMS) personnel perform lifesaving measures and transport patients. Health promotion is not a priority during the acute stage of the crisis. Classifying patients is the task of the triage nurse. EMS personnel prioritize life-saving measures; they do not not modify the operations plan.

A patient has been exposed to a nerve agent in a biochemical terrorist attack. This type of agent bonds with acetylcholinesterase, so that acetylcholine is not inactivated. What is the pathologic effect of this type of agent? A. Hyperstimulation of the nerve endings B. Temporary deactivation of the nerve endings C. Binding of the nerve endings D. Destruction of the nerve endings

Ans: A Feedback: Nerve agents can be inhaled or absorbed percutaneously or subcutaneously. These agents bond with acetylcholinesterase, so that acetylcholine is not inactivated; the adverse result is continuous stimulation (hyperstimulation) of the nerve endings. Nerve endings are not deactivated, bound, or destroye

Emergency department (ED) staff members have been trained to follow steps that will decrease the risk of secondary exposure to a chemical. When conducting decontamination, staff members should remove the patients clothing and then perform what action? A. Rinse the patient with water. B. Wash the patient with a dilute bleach solution. C. Wash the patient chlorhexidine. D. Rinse the patient with hydrogen peroxide.

Ans: A Feedback: The first step in decontamination is removal of the patients clothing and jewelry and then rinsing the patient with water. This is usually followed by a wash with soap and water, not chlorhexidine, bleach, or hydrogen peroxide.

A nurse caring for patients exposed to a terrorist attack involving chemicals has been advised that personal protective equipment must be worn to give the highest level of respiratory protection with a lesser level of skin and eye protection. This is considered: A) Level A B) Level B C) Level C D) Level D

Ans: B Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-3 Feedback: Level B personal protective equipment provides the highest level of respiratory protection, with a lesser level of skin and eye protection. Level A provides the highest level of respiratory, mucous membrane, skin, and eye protection. Level C incorporates the use of an air-purified respirator, a chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots. Level D is the same as a work uniform.

The nurse is aware that the patient suspected of being exposed to the smallpox virus is contagious: A) Immediately after exposure B) Only when pustules form C) After a rash appears D) With a body temperature of 38° C

Ans: C Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 5 Patient Needs: A-2 Feedback: A patient is contagious after a rash that develops on the face, mouth, pharynx, and forearms initially.

A group of medical nurses are being certified in their response to potential bioterrorism. The nurses learn that if a patient is exposed to the smallpox virus he or she becomes contagious at what time? A. 6 to 12 hours after exposure B. When pustules form C. After a rash appears D. When the patient becomes febrile

Ans: C Feedback: A patient is contagious after a rash develops, which initially develops on the face, mouth, pharynx, and forearms. The patient exposed to the smallpox virus is not contagious immediately after exposure; only when pustules form, or with a body temperature of 38C.

A nurse has had contact with a patient who developed smallpox and became febrile after a terrorist attack. This nurse will require what treatment? A. Watchful waiting B. Treatment with colony-stimulating factors (CSFs) C. Vaccination D. Treatment with ceftriaxone

Ans: C Feedback: All people who have had household or face-to-face contact with a patient with small pox after the fever begins should be vaccinated within 4 days to prevent infection and death. Watchful waiting would be inappropriate and CSFs are not used for treatment. Vaccination, rather than antibiotics, is the treatment of choice.

A patient who has been exposed to anthrax is being treated in the local hospital. The nurse should prioritize what health assessments? A. Integumentary assessment B. Assessment for signs of hemorrhage C. Neurologic assessment D. Assessment of respiratory status

Ans: D Feedback: The second stage of anthrax infection by inhalation includes severe respiratory distress, including stridor, cyanosis, hypoxia, diaphoresis, hypotension, and shock. The first stage includes flu-like symptoms. The second stage of infection by inhalation does not include headache, vomiting, or syncope.

After assessing and treating a patient affected by a chemical spill, while completing documentation, what is the nurse's priority action? Continue to monitor the patient for changes. Ask another nurse to relieve him or her for a break. Clean up the area, and prepare for another patient. Ask the patient if he or she would like to watch television.

Continue to monitor the patient for changes. Because the patient remains in his or her care, it is important that the nurse continue to monitor the patient for any changes or adverse effects of therapy. It is not appropriate to take a break unless absolutely necessary. Cleaning the area should not be done at the expense of monitoring the patient. Offering television to the patient is not a priority.

A triage nurse in a busy emergency department assesses a patient who complains of 6/10 abdominal pain and states, "I had a temperature of 104.6º F (40.3º C) at home." The nurse's first action should be to a. tell the patient that it may be several hours before being seen by the doctor. b. assess the patient's current vital signs. c. obtain a clean-catch urine for urinalysis. d. ask the health care provider to order a nonopioid analgesic medication for the patient.

Correct Answer: B Rationale: The patient's pain and statement about an elevated temperature indicate that the nurse should obtain vital signs before deciding how rapidly the patient should be seen by the health care provider. A urinalysis may be needed, but vital signs will provide the nurse with more useful data for triage. The health care provider will not order a medication before assessing the patient.

During the primary assessment of a trauma victim, the nurse determines that the patient has a patent airway. The next assessment by the nurse should be to a. check the patient's level of consciousness. b. examine the patient for any external bleeding. c. observe the patient's respiratory effort. d. palpate for the presence of peripheral pulses.

Correct Answer: C Rationale: Even with a patent airway, patients can have other problems that compromise ventilation, so the next action is to assess the patient's breathing. The other actions are also part of the initial survey but are not accomplished as rapidly as the assessment of breathing.

Four victims of an automobile crash are brought by ambulance to the emergency department. The triage nurse determines that the victim who has the highest priority for treatment is the one with a. severe bleeding of facial and head lacerations. b. an open femur fracture with profuse bleeding. c. a sucking chest wound. d. absence of peripheral pulses.

Correct Answer: C Rationale: Most immediate deaths from trauma occur because of problems with ventilation, so the patient with a sucking chest wound should be treated first. Face and head fractures can obstruct the airway, but the patient with facial injuries has lacerations only. The other two patients also need rapid intervention but do not have airway or breathing problems.

The nurse should plan to assess soldiers who might have been exposed to nerve gas agents for which symptoms? A. Malaise and hemorrhaging B. Memory loss and fatigue C. Fever and headaches D. Convulsions and loss of consciousness

D Rationale: Overstimulation of the neurotransmitter acetylcholine causes convulsions and loss of consciousness within seconds.

A soldier in the military is exposed to a nerve agent. The nurse takes what immediate action? A. Prepare to inject atropine B. Flush eyes with water C. Apply a steroid to the skin D. Induce vomiting

A. Prepare to inject atropine Rationale: Atropine is given to block the attachment of acetylcholine to receptor sites, preventing overstimulation and death.

Which nursing actions during a mass casualty incident should be included in the triage portion of an organizational disaster plan? Select all that apply. 1) Treatment 2) Stabilization 3) Evaluation of interventions 4) Formulation of nursing diagnosis 5) Decontamination for suspected contaminat

ANS: 1, 2, 5 This is correct. Victims need to be treated and stabilized and, if there is known or suspected contamination, decontaminated at the scene. ong with ap

Which amount of time is appropriate for nurse to spend triaging each patient during a mass casualty incident? 1) Less than 10 seconds 2) Less than 15 seconds 3) Less than 30 seconds 4) Less than 60 seconds

ANS: 2 Triage of victims of an emergency or an MCI must be conducted in less than 15 seconds. The other time frames, 10 seconds, 30 seconds, and 60 seconds, are not accurate.

Which patient injury would receive a black tag by the triage nurse during a mass casualty incident? 1) Concussion 2) Ankle sprain 3) Open femur fracture 4) Full-thickness body burns

ANS: 4 A black tag indicates the patient has suffered an extensive injury and is expected, or allowed, to die. Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation.

A patient has been admitted to the medical unit with signs and symptoms that are suggestive of anthrax infection. The nurse should anticipate what intervention? A. Administration of acyclovir B. Hematopoietic stem cell transplantation (HSCT) C. Administration of penicillin D. Hemodialysis

Ans: C Feedback: Anthrax infection is treated with penicillin. Acyclovir is ineffective because anthrax is a bacterium. Dialysis and HSCT are not indicated.

A 40-year-old male patient who was at the site of a workplace explosion that is considered a disaster area has suffered second- and third-degree burns to 65% of his body, but he is conscious. This person would be triaged as: A) Green B) Yellow C) Red D) Black

Ans: D

A Level C personal protective equipment requirement is needed when caring for a patient. The nurse is aware that the equipment will include a(n): A) Self-contained breathing apparatus B) Vapor-tight, chemical resistant suit C) Uniform only D) Air-purified respirator

Ans: D Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-3 Feedback: Level C incorporates the use of an air-purified respirator, a chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots. Level A provides the highest level of respiratory, mucous membrane, skin, and eye protection, incorporating a vapor-tight chemical-resistant suit and self-contained breathing apparatus (SCBA). Level B personal protective equipment provides the highest level of respiratory protection, with a lesser level of skin and eye protection, incorporating a chemical-resistant suit and SCBA. Level D is the same as a work uniform.

The nurse expects the patient who has been admitted after exposure to a nerve agent to be treated with which of the following? A) Nitrate B) Dimercaprol C) Erythromycin D) Atropine

Ans: D Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 6 Patient Needs: D-2 Feedback: Atropine is administered when a patient is exposed to a nerve agent. Exposure to blood agents, such as cyanide, require treatment with amyl nitrate, sodium nitrite, and sodium thiosulfate. Dimercaprol is administered intravenously for systemic toxicity and topically for skin lesions when exposed to vesicants.

A patient is admitted to the ED who has been exposed to a nerve agent. The nurse should anticipate the STAT administration of what drug? A. Amyl nitrate B. Dimercaprol C. Erythromycin D. Atropine

Ans: D Feedback: Atropine is administered when a patient is exposed to a nerve agent. Exposure to blood agents, such as cyanide, requires treatment with amyl nitrate, sodium nitrite, and sodium thiosulfate. Dimercaprol is administered IV for systemic toxicity and topically for skin lesions when exposed to vesicants. Erythromycin is an antibiotic, which is ineffective against nerve agents.

The nurse works in an emergency department (ED) in a city that experiences an earthquake. Which patient injury does the nurse prepare to treat based on this information? A. Drowning B. Electrocution C. Crush injuries D. Open brain injuries

Answer: C Reasoning: A. Drowning is an injury that is anticipated for a tsunami, not an earthquake. B. Electrocution is an injury that is anticipated from a cyclone, hurricane, or typhoon, not an earthquake. C. Crush injuries are anticipated during and after an earthquake; therefore, the nurse should prepare to treat patients with this injury. D. Open brain injuries are anticipated for a tornado, not an earthquake.

A client is suspected of exposure to inhaled anthrax. The nurse assesses for which initial symptoms? A. Headache, blurred vision, and generalized aches B. Difficulty swallowing, cramping, and diarrhea C. Fever, persistent cough, and dyspnea D. Skin lesions that develop into black scabs

C Rationale: Fever, persistent cough, and dyspnea all are initial symptoms of inhaled anthrax.

An occupational health professional is conducting a class on risks of occupational exposure to inhalation of anthrax. Should an exposure occur, the employees are told they should receive which medication? A. Penicillin and vancomycin B. Erythromycin and vancomycin C. Ciprofloxacin and doxycycline D. Tetracycline and ampicillin

C Rationale: The FDA-approved combination therapy for inhalation of anthrax is ciprofloxacin and doxycycline.

In the triage area, a patient complains of pain in the right foot. The nurse assesses an injury sustained during a natural disaster. What should the nurse do while the patient waits for a full assessment? Elevate the right leg and place ice on the injury. Tell the patient the doctor has been busy all day. Give the patient a popsicle in the flavor of choice. Have the family take the patient to the waiting room

Elevate the right leg and place ice on the injury. Pain management strategies should start with nonpharmacologic methods such as splinting, elevation, ice, and distraction. Pain relief measures should be instituted before the patient and family are moved to the waiting room. The patient should not consume anything until the doctor has evaluated the patient. It is not appropriate to tell the patient the doctor has been busy all day, as this may cause more distress for the patient and does not address the patient's problems.

Chemical agents were used to cause harm to a group of patients. What parts of the body are most affected by chemical agents? Lungs and skin Adrenal glands Heart and lungs Bladder and rectum

Lungs and skin Chemical agents used in terrorism affect lungs by inhalation and the skin by contact. The heart, adrenal glands, bladder, and rectum are not as commonly directly affected by contact or inhalation of chemical agents.

A 65-year-old patient arrived at the triage area with complaints of diaphoresis, dizziness, and left-sided chest pain. This patient should be prioritized into which category? a-Non-urgent. b-Urgent. c-Emergent. d-High urgent.

c-emergent Chest pain is considered an emergent priority, which is defined as potentially life-threatening. Option B: Clients with urgent priority need treatment within 2 hours of triage (e.g. kidney stones). Option A: Non-urgent conditions can wait for hours or even days. Option D: High urgent is not commonly used; however, in 5-tier triage systems, High urgent patients fall between emergent and urgent in terms of the time elapsing prior to treatment.

A 15-year-old male client was sent to the emergency unit following a small laceration on the forehead. The client says that he can't move his legs. Upon assessment, respiratory rate of 20, strong pulses, and capillary refill time of less than 2 seconds. Which triage category would this client be assigned to? a-Black. b-Green. c-Red. d-Yellow.

d- Yellow The client is possibly suffering from a spinal injury but otherwise, has a stable status and can communicate so the appropriate tag is YELLOW.