Trauma & Disaster: Questions

Disaster The wounded victim is able to walk and obey commands. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black

A

Disaster Which statement below is INCORRECT about the yellow triage tag color in regards to a disaster situation? A. A survivor with this tag color is seen after patients with the green tag color. B. A survivor with this tag color can have treatment delayed for an hour or less. C. A survivor with this tag color has serious injuries that could eventually lead to the compromise of breathing, circulation, or mental status, especially if treatment is delayed more than an hour or so. D. A survivor with this tag color has second priority for treatment of injuries.

A RAT: This statement is INCORRECT. It should say: A survivor with this tag color is seen after patients with the RED (not green) tag color.

Disaster The wounded victim is unable to walk, has respiratory rate of 12, capillary refill is 8 seconds, and is unresponsive. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black

B

Disaster The wounded victim is unable to walk, has respiratory rate of 40, capillary refill is 6 seconds, and can't follow simple commands. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black

B

Disaster The wounded victim is unable to walk, respiratory rate is absent but when airway is repositioned breathing is noted. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black

B

Disaster The nurse is triaging clients arriving at the hospital after a large scale disaster. Which of these clients is incorrectly classified? A. Young adult with closed fractures of her right leg and arm: Yellow tag​ B. Older adult with severe abdominal pain who is dazed and confused: Black tag ​ C. Middle-aged adult with third-degree burns over 90% of his body: Red tag ​ D. Young adult with bruises and superficial lacerations: Green tag​​

B RAT: Black tags are used for those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation. (Think those who are dead or expected to die. Think no RR)

Disaster The wounded victim is unable to walk, has respiratory rate of 19, capillary refill of one second, and is able to obey your commands. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black

C

Disaster The weather center issued a tornado warning. As the charge nurse in the ED, what type of disaster do you anticipate will be activated? ​ ​ A. Pandemic​ B. Internal disaster ​ C. External disaster​ D. Mass casualty event​

C RAT: An internal disaster is any event inside a health care facility or campus such as a fire, explosion, or violence that could endanger patients or staff. An external disaster is any event outside the health care facility or campus, somewhere in the community, which requires the activation of a facility's emergency management plan. External disasters can be either natural, such as a tornado or hurricane, or technological, such as a biological terror attack. Multi-casualty and mass casualty (disaster) events are based on the scope and scale of the incident, considering the number and severity of victims or casualties involved.​

Disaster A catastrophic disaster has occurred 5 miles from the hospital you are working in. The hospital's disaster plan is activated and the wounded are brought to the hospital. You're helping triage the survivors. One of the wounded is able to walk around and has minor lacerations on the arms, hands, chest, and legs. You would place what color tag on this survivor? A. Red B. Yellow C. Green D. Black

C RAT: Green tags are for patients who have MINOR injuries. If the patient can walk around they are tagged as green. Sometimes they are referred to as the "walking wounded".

Disaster You're working as a triage nurse during a disaster situation. Based on the triage color code tags placed on each of the wounded, which tag color represents the wounded who have the highest priority of being treated first? A. Green B. Yellow C. Red D. Black

C RAT: The red tag indicates the patient must be seen first because they have life-threatening injuries, but could survive if treated quickly. The patient is still alive but there is a severe alteration in their breathing, circulation, or mental status that requires immediate medical attention.

Disaster The wounded victim is unable to walk, respiratory rate is absent and when airway is repositioned breathing is still absent. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black

D

Disaster While triaging the wounded from a disaster, you note that one of the wounded is not breathing, radial pulse is absent, capillary refill >2 seconds, and does not respond to your commands. What color tag is assigned? A. Green B. Red C. Yellow D. Black

D

Disaster After the crash of a 747 airplane at the local airport, the nurse is performing disaster triage. Which patient would be given a black tag?​ ​ A. 38-year-old male, left hand injury, moaning​ B. 26-year-old male with an open femur fracture ​ C. 52-year-old female, crying, with facial lacerations​ D. 42-year-old male, screaming, full-thickness burns to torso, upper and lower extremities​

D RAT: Rationale: Emergent (class I) patients are identified with a red tag; patients who can wait a short time for care (class II) are marked with a yellow tag; nonurgent or "walking wounded" (class III) patients are given a green tag; and patients who are expected to die or are dead are issued a black tag (class IV). 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. The rationale for this seemingly heartless decision is that limited resources must be dedicated to saving the most lives rather than expending valuable resources to save one life at the possible expense of many others.​

Four Phases of Emergency Management Which phase: * Focuses on preventing future emergencies or minimizing their effects * Includes any activities that prevent an emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies. * Examples: Buying flood and fire insurance for your home * These activities take place before and after emergencies.

Mitigation

Four Phases of Emergency Management include:

Mitigation- Preventing future emergencies or minimizing their effects Preparedness- Preparing to handle an emergency Response- Responding safely to an emergency Recovery- Recovering from an emergency

Four Phases of Emergency Management Which phase: * Includes plans or preparations made to save lives and to help response and rescue operations. * Examples: Evacuation plans and stocking food and water * These activities take place before an emergency occurs.

Preparedness

Four Phases of Emergency Management Which phase: * Includes actions taken to return to a normal or an even safer situation following an emergency. * Examples: getting financial assistance to help pay for the repairs. * These activities take place after an emergency.

Recovery

Four Phases of Emergency Management Which phase: * Includes actions taken to save lives and prevent further property damage in an emergency situation. * Puts your preparedness plans into action. * Examples: Seeking shelter from a tornado or turning off gas valves in an earthquake * These activities take place during an emergency.

Response

Trauma An air medical helicopter arrives on the scene of a high-speed motorcycle collision with a train. The client was not wearing a helmet and is very confused, with a Glasgow Coma Scale score of 13. There is an apparent partial amputation of both hands. Vital signs are stable and the airway is secure. Which level of trauma center would be the most appropriate destination for this client? a. Level I b. Level II c. Level III d. Level IV

a RAT: A Level I Trauma Center would be most appropriate to handle the complex level of care required by this client with a potential traumatic brain injury and apparent partial amputation of both hands. A Level I Trauma Center is a regional resource facility that provides leadership and collaborative care for every type of injury. Since the airway is secure and the vital signs are stable, there is no need to stop at a Level II, II or IV Trauma Center for stabilization. This client would require initial transfer to a Level I facility for likely surgery and rehabilitation in this situation.

Trauma A client with a gunshot wound is admitted to the emergency department (ED). Which minimum Standard Precaution activity does the nurse require for staff safety? a. Blood and body fluid precautions b. Metal detector screening of the client c. Placement of a security guard d. Use of a positive air-purifying respirator (PAPR)

a RAT: The ED nurse uses Standard Precautions at all times when there is the potential for contamination by blood or other body fluids. Screening of the client with a metal detector, appointing a security guard, and use of a PAPR, although beneficial are not minimum Standard Precautions issues.

Trauma A client comes into the emergency department (ED) clutching the chest. Which core competency for ED nurses is the first one used in this situation? a. Assessment b. Communication c. Priority setting d. Technical and procedural skills

a RAT: The first core competency that is essential in this situation is assessment and is the foundation of the ED nurse's skill base to determine normal from abnormal client findings. Communication, priority setting, and technical and procedural skills are not the first competencies to be used in this situation. Until the client has been accurately assessed, care can begin.

Trauma A client is admitted to the emergency department after reporting being raped. Who is the best team member for the admitting nurse to locate to provide care for this client? a. Forensic nurse examiner b. Physician or health care provider c. Psychiatric crisis nurse d. Police officer

a RAT: The forensic nurse examiner is the best and most appropriate team member able to recognize evidence of abuse and to intervene on the client's behalf. Although the forensic nurse examiner is the best team member to provide care for this client, physicians or other health care providers or a psychiatric crisis nurse may also play a role in the client's care. Law enforcement may or may not be involved dependent on local laws.

Disaster The triage nurse has a suggestion for improving response in the next mass casualty event. Which option does the nurse use to introduce this idea? a. Administrative review b. Hospital suggestion box c. Medical Reserve Corp d. Supervisor

a RAT: The triage nurse uses the Administrative review committee to present suggestions to improve responses in the next mass casualty event. The goal of the administrative review is to discern what went right and what went wrong during activation and implementation of the emergency preparedness plan. In this way, changes can be made. The hospital suggestion box and the supervisor are not the most effective ways to implement change in this situation. The purpose of the Medical Reserve Corp is to help with staffing and providing care, not revising policy or protocol.

Disaster The experienced nurse is teaching a new nurse about hospital emergency plans and personal emergency preparedness. Which specific arrangements should the experienced nurse discuss? Select all that apply a. Assembly of a "go bag" b. Plans for child and/or elder care c. Neighbor who is willing to care for dog d. Who will be called when the plan is activated e. How long an emergency is expected to last f. Where a nurse is expected to report if the emergency plan is activated g. Names, addresses, and telephone numbers to be used if a crisis occurs

a, b, c, d, f, g RAT: The experienced nurse should teach the new nurse how to assemble a "go bag"; to make plans for child, elder, and pet care; to understand who will be called when a hospital emergency plan is activated; to know where to report; and to have a list of names, addresses, and phone numbers to be used if a crisis occurs. The length of an emergency cannot be anticipated.

Disaster A number of nurses are floated to the ED to care for clients affected by an earthquake. Which appropriate float nurse assignments will the ED charge nurse make? Select all that apply a. GI laboratory nurse assigned to clients undergoing sedation b. Orthopedic nurse assigned to accompany clients to radiology c. Nursing administrator assigned to monitor loved ones in the waiting room d. Community health nurse assigned to care for clients with fractures e. Medical surgical nurse assigned to healthcare worker who is feeling overwhelmed

a, c RAT: The GI nurse, who often works with sedated clients, can safely care for clients affected by a mass casualty who will need sedation. The nursing administrator, who may have been away from the bedside for a period of time, can safely monitor loved ones in the waiting room. The orthopedic nurse should care for those with fractures, as other individuals can be assigned to accompany clients to radiology. The community health nurse may be more appropriate to accompany clients to radiology than to care for clients with fractures. The medical surgical nurse should be assigned to care for clients who have medical or surgical needs, as someone else can sit with the healthcare worker who is feeling overwhelmed.

Trauma The nurse is caring for a client who was attacked on a rooftop. The client was repeatedly kicked, and then shot in the leg which contributed to a fall from the 5-story building. Which mechanism of injury will the nurse document? Select all that apply a. Blunt b. Blast c. Penetration d. Acceleration-deceleration e. Laceration

a, c, d RAT: Blunt trauma has been sustained from being kicked. A gunshot is a penetrating injury. The fall from the rooftop reflects an acceleration-deceleration injury.

Disaster How does the high school nurse react directly after a random shooting at a high school after injuries are taken care of? a. Actively listens to students b. Assesses his or her own individual feelings c. Encourages students to vent feelings d. Facilitates community cohesion

b RAT: After injuries have been taken care after a random shooting at a high school, the high school nurse needs to first assess his/her own individual feelings. One cannot be an effective caregiver if one's own needs are not also met. Active listening, allowing students to express their feelings, and facilitating community cohesion are important, but are not what needs to be done first.

Trauma The provider is planning to discharge a client home. The nurse suspects domestic violence as the cause of injury, although the client denies this. What is the best course of action for the nurse to take? a. Call the police. b. Consult with Social Services. c. Discharge the client as instructed. d. Instruct the client to go to a safe place.

b RAT: Consulting with social workers or case managers is the best course of action to investigate resource needs for this client and to plan accordingly. Contacting law enforcement, discharging the client, or telling the client to go to a safe place as instructed may not be in this client's best interest.

Trauma As a direct result of overcrowding in emergency departments (ED), for whom must the emergency department nurse expect to provide care? a. A variety of age groups and cultures b. "Boarding" or holding inpatient clients c. Clients with a broad spectrum of issues, illnesses, and injuries d. Uninsured and underinsured clients

b RAT: ED overcrowding has led to frequent boarding or holding of admitted clients in the ED because of lack of beds in the hospital. The ED nurse must be adept at providing safe and competent care to clients who are awaiting bed placement. The focus becomes one of ongoing care instead of one-time orders. Although a variety of clients spanning all age ranges, cultures and illnesses may present to the ED for treatment, this is not a direct result of overcrowding. Overcrowding has nothing to do with clients who may be uninsured or underinsured.

Trauma A woman is admitted to the ED for complications from a reported fall in her kitchen. The nurse notices multiple bruises around the patient's face and upper arms. She appears upset and has been crying but does not offer details about what happened. Her husband repeatedly states that the patient fell in the kitchen. He agrees to leave the room for the nurse to examine the patient. What is the appropriate nursing intervention?​ ​ a. Complete the physical examination. ​ b. Ask the ED's forensic nurse examiner to see the patient. ​ c. State, "Is everything okay between you and your husband?"​ d. After the examination, make an anonymous call to social services to report suspected domestic violence. ​

b RAT: Many EDs have specialized teams that deal with high-risk populations of patients. Forensic nurse examiners (RN-FNEs) are educated to obtain patient histories, collect forensic evidence, and offer counseling and follow-up care for victims of rape, child abuse, and domestic violence, also known as intimate partner violence (IPV) (Desy, 2010). They are trained to recognize evidence of abuse and to intervene on the patient's behalf. Forensic nurses who specialize in helping victims of sexual assault are called sexual assault nurse examiners (SANEs) or sexual assault forensic nurses (SAFEs). Interventions performed by forensic nurses may include providing information about developing a safety plan or how to escape a violent relationship. Forensic nurse examiners document injuries and collect physical and photographic evidence. They may also provide testimony in court as to what was observed during the examination and information about the type of care provided.​

Trauma Emergency Medical Services arrives at the scene of an automobile crash. On primary assessment, the driver is found to be unresponsive, not breathing, and has a grossly deformed left leg with no pulse. What is the first resuscitation intervention to be performed? a. Carry out artificial respirations. b. Clear the airway. c. Place a cervical collar. d. Realign the leg and check for pulse.

b RAT: The airway should first be cleared of any secretions or debris with a suction catheter or manually, if necessary. The primary survey for a trauma client is based on the mnemonic "ABCDE", with "A" being airway. A cervical collar will need to be applied and respiration will need to be assisted with a bag-valve-mask (BVM) connected to 100% oxygen source. Although the leg does not have a pulse, life threats must be addressed before limb threats.

Trauma A flight nurse is preparing to care for a client who has been involved in a serious motor vehicle crash. When the helicopter lands, what is the nurse's priority action? a. Apply oxygen. b. Assess airway and stabilize cervical spine. c. Start 2 large-bore IVs and infuse normal saline. d. Apply pressure to any small bleeding wounds.

b RAT: The highest priority action for a client who has sustained life-threatening injuries is to assess the airway and stabilize the cervical spine to decrease risk for further injury. All other actions can be implemented after the airway is secured, and the cervical spine is stabilized.

Trauma A client from a local care facility has sustained a cardiac arrest in the emergency department (ED), and resuscitation was unsuccessful. The client's family wishes to view the body. What steps should the ED nurse take? Select all that apply a. Remove all lines and indwelling tubes. b. Cover the client with a sheet, leaving the face exposed. c. Call a chaplain or social worker to accompany the family. d. Tell the family that the client "is in a better place now." e. Dim the lights in the client's room.

b, e RAT: Covering the client with a sheet, leaving the face exposed, and dimming the lights in the client's room are steps the ED nurse would take prior to the viewing. Sometimes by leaving the hands out from underneath the sheet it allows the family more "permission" to touch the client if they desire. The nurse's response needs to be one of empathy and dignity in all interactions. This death may be reportable as a medical examiner's case therefore, IV lines and tubes may need to be maintained. The nurse may ask the family if they want a chaplain or social worker. Statements to the effect that the client "is in a better place now" are inappropriate.

Trauma A trauma client has been brought to the emergency department after a motor vehicle crash. The client has severe injuries. What action does the nurse perform first?​ ​ a. Start 2 large-bore IVs and run normal saline.​ b. Apply oxygen and an oximeter probe to the client.​ c. Stabilize the cervical spine and assess the airway.​ d. Place pressure on a large bleeding wound to the forehead.​

c

Disaster A client comes to the emergency department covered with coagulated blood and a white powder. The client is hysterical and fears that it is anthrax. What does the nurse do first? a. Administers antibiotics b. Provides emotional support c. Takes the client to the decontamination room d. Triages the client

c RAT: Decontamination must precede triage. Only the most basic life-sustaining interventions would be performed before or during decontamination. The coagulated blood indicates that any major active bleeding has likely subsided. Taking antibiotics unnecessarily will promote the growth of resistant bacteria and may cause serious drug-related side effects. In addition, anthrax exposure has not yet been verified. Emotional support is important but is not the priority here. Although triage is important, SAFETY is a higher priority.

Disaster Which essential item is added to a personal-readiness supplies "go bag?" a. Fruits and vegetables b. Laptop computer c. Potable water d. Television

c RAT: The "go bag" would contain 1 gallon of potable water per person per day. Potable water is drinking water and is required to prevent dehydration. Any foods included in a "go bag" would be nonperishable. Fruits and vegetables are perishable. A television would not be practical. A radio (battery-powered or hand-crank generated) would be better. A laptop computer would also not be practical. A "go bag" is a disaster supply kit for the home and automobile with clothing and basic survival supplies. It allows for a rapid response for disaster staffing coverage (Table 10-3). "Go bags" are needed for all members of the family, including pets, in the event the disaster requires evacuation of the community or for people to take shelter in their own homes.

Disaster What is the main role of the incident commander in a disaster? a. Call in extra staff b. Contact other facilities to arrange transfers c. Oversee the movement of clients through the system d. Notify the media of hospital capacity

c RAT: The main role of the incident commander in a disaster is to oversee the movement of clients through the system and assist in the organization of hospital-wide services. This activity rapidly expands hospital capacity, recruits paid or volunteer staff, and ensures the availability of medical supplies. The role of calling in extra staff would be delegated as would contacting other facilities if transfers are needed. The public information officer would serve as media liaison.

Disaster After a mass casualty event, the nurse is triaging clients in the field. Which client is correctly classified? a. 38-year-old with an open femur fracture: Black tag b. 42-year-old with multiple abrasions and contusions: Yellow tag c. 54-year-old with third-degree burns over 90% of the body: Green tag d. 61-year-old who is having difficulty breathing and wheezing: Red tag

d RAT: A client with difficulty breathing and wheezing should be classified with a red tag, since this is an emergent situation. The client with the open fracture should have a yellow tag; the client with multiple abrasions and contusions should have a green tag; and the client with third-degree burns over 90% of the body should have a black tag.

Disaster During a mass casualty, which injury receives care first? a. Abdominal evisceration b. Open fracture of the left forearm c. Sprained ankle d. Sucking chest wound

d RAT: A sucking chest wound receives care first during a mass casualty. This type of injury is a red tag, or emergent, injury because it can be quickly resolved until further help can be given. Remember the A,B,Cs. Airway, breathing, and circulation always come first. The abdominal evisceration would be considered a black tag because of the amount of time it would require to provide adequate care. The open fracture of the left forearm would be yellow tagged. The injury requires care but can wait. The sprained ankle would be green tagged and considered "walking wounded."

Trauma A client is admitted to the emergency department after being in a motor vehicle crash. The client was wearing a seat belt and the airbag deployed. There are no apparent injuries besides an abrasion from the shoulder harness across the clavicle and anterior chest. First vital signs are BP 110/70, HR 98, R 18, SaO2 98% on room air. The client's Glasgow Coma Scale score is 15. What does the nurse do next? a. Allows the client to go home b. Checks blood alcohol levels c. Prepares the client for surgery d. Monitors the client

d RAT: Blunt force injuries are from acceleration/deceleration forces, and can cause trauma to bones, blood vessels, and soft tissue. An injury may not be evident right away. A seat belt abrasion across the chest would alert the nurse to monitor closely for signs of potential internal injuries. While the nurse is monitoring the client, routine labs, including blood alcohol levels, may be obtained as well as computerized tomography (CT) scans. Based on these results, a decision regarding disposition will be made. Allowing the client to go home or preparing for surgery are not appropriate actions in this situation.

Disaster The emergency department charge nurse is making client assignments and delegating care after a mass casualty event. Which of these clients could be delegated to an unlicensed assistive personnel (UAP)? a. Client who has multiple left rib fractures and reports dyspnea b. Client who reports severe left anterior chest pain c. Client who has a femoral fracture with palpable distal pulses d. Client who is unconscious with massive aortic bleeding from the chest

d RAT: The client who is unconscious and has massive aortic bleeding is unlikely to survive and would be "black-tagged" and assigned to a UAP for comfort. The client with rib fractures and dyspnea, the client with chest pain, and the client with a femoral fracture with palpable pulses are likely to survive and would not be delegated to licensed staff members.

Trauma There has been an explosion at a local refinery. Numerous injuries have occurred. The following clients arrive from the scene by private vehicle. Which client is considered a priority for treatment? a. Child with an open fracture of the arm b. Man with a contusion on the head c. Teenager with a closed fracture of the leg d. Woman bleeding heavily

d RAT: The critically injured woman with active hemorrhage is the emergent priority in this situation. This condition is potentially life threatening. The child with an open fracture of the arm, the man with a contusion of the head, and the teenager with a closed fracture of the leg are urgent and treatment can wait.

Disaster After successful treatment of clients involved in a mass casualty incident, the incident commander deactivates the emergency response plan. Which activity is most important for the emergency department (ED) charge nurse to initiate at this time? a. Analyze the ED response to the mass casualty incident. b. Follow up with survivors to determine the need for additional referrals. c. Initiate critical incident stress debriefing (CISD) for staff members. d. Take inventory and restock the ED with supplies and equipment.

d RAT: The most important priority for the ED charge nurse at this time is to take inventory and restock the ED to return to normal operation. Analysis of the ED response, CISD debriefing, and follow-up with survivors and referrals can occur after the ED is restored to operational status.

Disaster After losing her home to a hurricane several years ago, the client says, "I get very nervous during a thunderstorm and want to hide under the bed." What is the nurse's best response? a. "But it's just a thunderstorm. You would have warning if a hurricane was approaching." b. "I understand. That is normal and is nothing to worry about." c. "That is post-traumatic stress disorder (PTSD). You might want to see a counselor." d. "What do you do when you feel this way?"

d RAT: The nurse's best response to a client who says she is very nervous during a hurricane is to ask the client what do you do when you feel this way? This statement helps to acknowledge the client's statement and further evaluates whether the thought is causing maladaptive behavior to the situation. Weather-related concerns, particularly stemming from past experience, can be normal for one's life and are not necessarily an indication of maladaptive behavior. Minimizing the client's concerns is not therapeutic. Telling the client he/she has PTSD is not appropriate.

Trauma The emergency nurse is working in the triage area. Which of these four patients should the nurse evaluate first?​ ​ a. 72-year-old woman who has a productive cough and a temperature of 101.6 F. ​ b. 9-year-old boy who has a broken arm, with the bone protruding from the wrist.​ c. 22-year-old man who is bent over in pain and believes he has kidney stones. ​ d. 62-year-old woman who is reporting severe chest pain, nausea, dizziness, and profuse sweating. ​

d RAT: The patient experiencing crushing substernal chest pain, shortness of breath, and diaphoresis would be classified as emergent and triaged immediately to a treatment room within the ED. The emergent triage category implies that a condition exists that poses an immediate threat to life or limb. The urgent triage category indicates that the patient should be treated quickly but that an immediate threat to life does not exist at the moment. Examples of patients who typically fall into the urgent category are those with a new onset of pneumonia (as long as respiratory failure does not appear imminent), renal colic, complex lacerations not associated with major hemorrhage, displaced fractures or dislocations, and temperature greater than 101 F (38.3 C).​

Trauma A woman has just been admitted to the ED and reports feeling dizzy. As the nurse asks the patient her name, the patient suddenly falls unconscious. What is the priority nursing action?​ ​ a. Obtain vital signs.​ b. Ask the husband to leave the room. ​ c. Evaluate the patient's level of consciousness. ​ d. Establish a patent airway by positioning, suctioning, and administering oxygen, as needed.

d RAT: The primary survey organizes the approach to the patient so that immediate threats to life are rapidly identified and effectively managed. The primary survey is based on a standard "ABC" mnemonic with a "D" and "E" added for trauma patients: airway/cervical spine (A), breathing (B), circulation (C), disability (D), and exposure (E). The highest priority intervention is to establish a patent airway. ​

Trauma The ED nurse who is just beginning a shift is assigned to care for four clients. Which client does the nurse assess first? a. 19-year-old with a closed femur fracture who received pain medication 15 minutes earlier b. 24-year-old with nausea, vomiting, and diarrhea who has infusing IV fluids and is resting c. 33-year-old who cut her hand while working in a kitchen, and is awaiting suturing d. 41-year-old awaiting transport to the operating room for an emergency appendectomy

d RAT: This client should be seen first since (1) he or she has an emergent condition that could result in poor outcomes if not treated soon, and (2) on the way to the surgery. The other clients listed, although still being seen in the ED, do not have conditions that are as concerning, and all are stable at this time.

Disaster During a mass casualty, staff roles are defined. If the triage officer is incapacitated, who is the best choice for replacement? a. Communications officer b. Hospital incident commander c. Medical command physician d. Triage nurse

d RAT: When the triage officer is incapacitated, the triage nurse is the best choice for replacement. When physician resources are limited, an experienced nurse may assume this role. The communications officer serves as the liaison between the health care facility and the media. Typically, the hospital incident commander and the medical command physician are too busy to serve as triage officer as well.