Nclexrn Quiz: Disaster Triage And Mass Casualty Principles
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Disaster Triage And Mass Casualty PrinciplesQuestion 1 of 20

Following a bombing in a public area, the nurse is performing START triage at the scene. Using START triage, how should the nurse categorize this victim: a 45-year-old with respirations 36/min, weak radial pulse, and unable to follow simple commands after you tell him to squeeze your hand?

Green tag (minor)
Yellow tag (delayed)
Red tag (immediate)
Black tag (expectant/deceased)
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Nclexrn Quiz: Disaster Triage And Mass Casualty Principles

Practice Disaster Triage And Mass Casualty Principles in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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Question 1

Following a bombing in a public area, the nurse is performing START triage at the scene. Using START triage, how should the nurse categorize this victim: a 45-year-old with respirations 36/min, weak radial pulse, and unable to follow simple commands after you tell him to squeeze your hand?

  1. Green tag (minor)
  2. Yellow tag (delayed)
  3. Red tag (immediate) (correct answer)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer C reflects the most appropriate triage decision because the victim has a respiratory rate of 36/min (greater than 30), weak radial pulse indicating poor perfusion, and inability to follow commands, all criteria for immediate (red tag) categorization. The distractors are less appropriate: A (green) is for minor injuries with ability to walk and stable parameters; B (yellow) is for delayed care with stable vital signs but inability to walk; D (black) is for deceased or expectant victims with no respirations even after intervention. In triage prioritization, red-tag victims with threats to airway, breathing, or circulation are treated first to maximize survivability. Decision-making principles involve quick sequential assessments to categorize based on urgency in resource-limited settings. A transferable strategy for triage in mass casualty events is to use color-coded tags to organize transport and treatment priorities efficiently.

Question 2

After a bombing, the nurse is triaging multiple victims using START. Which victim should the nurse attend to FIRST? (1) 36-year-old with respirations 18/min, capillary refill 2 seconds, follows commands, severe arm pain with deformity; (2) 50-year-old with respirations 22/min, capillary refill 2 seconds, follows commands, soot around mouth and hoarse voice; (3) 29-year-old walking, respirations 20/min, alert, minor abrasions; (4) 61-year-old with respirations 24/min, capillary refill 2 seconds, alert, nausea and headache.

  1. 36-year-old with respirations 18/min, capillary refill 2 seconds, follows commands, severe arm pain with deformity
  2. 50-year-old with respirations 22/min, capillary refill 2 seconds, follows commands, soot around mouth and hoarse voice (correct answer)
  3. 29-year-old walking, respirations 20/min, alert, minor abrasions
  4. 61-year-old with respirations 24/min, capillary refill 2 seconds, alert, nausea and headache

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the 50-year-old has normal parameters but signs of inhalation injury (soot, hoarseness), indicating potential airway compromise and need for immediate (red tag) priority despite START criteria. The distractors are less appropriate: A is delayed (yellow) with deformity; C is minor (green); D is minor (green) with symptoms but stable. In triage prioritization, impending threats like airway burns are escalated even if current vitals normal. Decision-making principles incorporate clinical judgment beyond algorithm for deteriorating risks. A transferable strategy for triage in mass casualty events is to flag potential complications like inhalation for rapid evaluation.

Question 3

During hurricane aftermath response, the nurse is triaging at a community shelter using START. Which victim should the nurse attend to FIRST? (1) 63-year-old with history of diabetes, confused, respirations 20/min, capillary refill 2 seconds, blood glucose not available; (2) 37-year-old with respirations 34/min after near-drowning, coughing pink frothy sputum; (3) 12-year-old walking with minor abrasions, respirations 18/min, alert; (4) 46-year-old with rib pain, respirations 22/min, capillary refill 2 seconds, follows commands.

  1. 63-year-old with diabetes, confused, respirations 20/min, capillary refill 2 seconds
  2. 37-year-old with respirations 34/min after near-drowning, coughing pink frothy sputum (correct answer)
  3. 12-year-old walking with minor abrasions, respirations 18/min, alert
  4. 46-year-old with rib pain, respirations 22/min, capillary refill 2 seconds, follows commands

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the 37-year-old has a respiratory rate of 34/min (greater than 30) and pink frothy sputum suggesting pulmonary edema, classifying as immediate (red tag). The distractors are less appropriate: A is immediate (red) due to confusion but less acute than B's respiratory distress; C is minor (green); D is delayed (yellow) with pain but stable. In triage prioritization, respiratory rates over 30 indicate urgent breathing issues to address first. Decision-making principles weigh immediate threats like airway compromise over stable alterations. A transferable strategy for triage in mass casualty events is to prioritize based on ABCs while considering potential deterioration.

Question 4

During hospital emergency overflow after a city-wide disaster, the nurse is assigned to triage with START principles at the entrance. Using START triage, how should the nurse categorize this victim: a 58-year-old with respirations 8/min, cyanotic lips, strong radial pulse, and confusion after falling debris struck his head?

  1. Green tag (minor)
  2. Yellow tag (delayed)
  3. Red tag (immediate) (correct answer)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer C reflects the most appropriate triage decision because the victim has a low respiratory rate of 8/min, cyanosis, and confusion, meeting criteria for immediate (red tag) due to respiratory compromise and altered mental status. The distractors are less appropriate: A (green) for minor walking wounded; B (yellow) for stable non-walkers; D (black) for non-responsive to airway opening. In triage prioritization, abnormal breathing rates and mental changes are flagged for immediate intervention. Decision-making principles prioritize ABCs (airway, breathing, circulation) in rapid assessments. A transferable strategy for triage in mass casualty events is to integrate scene safety and personal protective equipment use.

Question 5

A bus accident has produced multiple casualties. Using START triage, how should the nurse categorize this victim: a 60-year-old who is not able to walk, respirations 20/min, capillary refill 2 seconds, follows commands, and reports severe abdominal pain with a rigid abdomen?

  1. Green tag (minor)
  2. Yellow tag (delayed) (correct answer)
  3. Red tag (immediate)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the victim cannot walk, has severe abdominal pain with rigidity suggesting internal injury, but normal vital signs and mental status, classifying as delayed (yellow tag). The distractors are less appropriate: A (green) for stable walkers; C (red) for abnormal parameters; D (black) for deceased. In triage prioritization, potential internal bleeding is monitored but deferred if stable. Decision-making principles use palpation for clues but rely on algorithm. A transferable strategy for triage in mass casualty events is to position yellow victims for comfort while awaiting care.

Question 6

A bus crash has produced multiple pediatric victims at a rural clinic, and the nurse is using JumpSTART triage for children. Using JumpSTART, how should the nurse categorize this victim: a 4-year-old who is not breathing, has a palpable pulse, and begins breathing after the airway is repositioned; respirations are now 18/min, capillary refill 2 seconds, withdraws from pain but does not follow commands?

  1. Green tag (minor)
  2. Yellow tag (delayed)
  3. Red tag (immediate) (correct answer)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles using the JumpSTART protocol for pediatric victims. JumpSTART is the pediatric adaptation of START triage, with special considerations for children's physiological differences. The correct answer is C (Red tag/immediate) because in JumpSTART, a child who was initially apneic but begins breathing after airway positioning, even with abnormal mental status (withdraws from pain only), receives RED tag priority. The child would not be GREEN (minor) due to altered mental status, not YELLOW (delayed) because of the initial apnea requiring intervention, and not BLACK (expectant) because breathing resumed with simple airway maneuver. In JumpSTART, children who respond to airway positioning or rescue breaths are given a chance at survival with immediate priority. The key strategy is remembering that JumpSTART includes rescue breaths for apneic children with a pulse, unlike adult START triage.

Question 7

Following a bombing, the nurse is caring for a RED-tagged victim in the immediate treatment area. Which intervention should the nurse implement IMMEDIATELY for a 36-year-old with a partial leg amputation and uncontrolled arterial bleeding, respirations 28/min, skin cool and pale, and weak carotid pulse?

  1. Apply a tourniquet proximal to the wound and tighten until bleeding stops (correct answer)
  2. Clean the wound with sterile saline and apply a dry sterile dressing
  3. Start an intravenous line and wait for a provider order to give fluids
  4. Reassess vital signs and document findings before intervening

Explanation: This question tests disaster triage and mass casualty principles, specifically immediate life-saving interventions for RED-tagged victims. In mass casualty events, simple interventions that can quickly save lives take priority. The correct answer is A because applying a tourniquet for uncontrolled arterial bleeding from a partial amputation is the most immediate life-saving intervention - this can be done quickly and prevents exsanguination. Choice B (wound cleaning) is not priority with active bleeding, Choice C (IV access) delays critical bleeding control, and Choice D (reassessment) wastes time when immediate action is needed. The principle is that in the immediate treatment area, interventions focus on the ABCs with emphasis on controlling life-threatening bleeding first. The transferable strategy is to perform the quickest intervention that addresses the most immediate threat to life - in this case, stopping arterial bleeding takes seconds with a tourniquet.

Question 8

During hospital emergency overflow after a city-wide disaster, the nurse is using START triage at the ambulance entrance. Using START triage, how should the nurse categorize this victim: a 47-year-old with crush injury to the pelvis, respirations 22/min, radial pulse present, but is confused and does not follow simple commands?

  1. Green tag (minor)
  2. Yellow tag (delayed)
  3. Red tag (immediate) (correct answer)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles using START triage mental status criteria. The START protocol uses ability to follow simple commands as the mental status assessment. The correct answer is C (Red tag/immediate) because the victim fails to follow simple commands despite having respirations within normal range (22/min) and present radial pulse - altered mental status alone qualifies for RED tag. The victim would not be GREEN (minor) due to significant injury and confusion, not YELLOW (delayed) because failure to follow commands indicates immediate need, and not BLACK (expectant) as they are breathing with adequate perfusion. In START triage, any one critical finding (respirations <10 or >30, absent radial pulse, or inability to follow commands) results in RED tag priority. The transferable strategy is to use simple commands like "squeeze my hand" or "open your eyes" as a rapid neurological assessment - failure indicates significant compromise requiring immediate care.

Question 9

At the scene of a hurricane aftermath, the nurse is using START triage with limited supplies. What is the nurse's PRIORITY action when a 2-year-old is carried in by a parent, is not breathing, has a palpable pulse, and there are multiple other victims awaiting triage?

  1. Initiate cardiopulmonary resuscitation for 2 minutes before making a triage decision
  2. Use JumpSTART steps: open the airway, and if still apneic with a pulse, give 5 rescue breaths and reassess breathing (correct answer)
  3. Tag the child as black/expectant immediately because the child is apneic
  4. Obtain a full set of vital signs and blood glucose before intervening

Explanation: This question tests disaster triage and mass casualty principles, specifically the application of pediatric triage protocols. While the question states the nurse is using START triage, pediatric victims require JumpSTART protocol modifications. The correct answer is B because JumpSTART protocol for an apneic child with a pulse includes opening the airway and, if still apneic, giving 5 rescue breaths before reassessing - this gives children a chance at survival that adults wouldn't receive in START. Choice A (CPR for 2 minutes) is too time-consuming during triage, Choice C (immediate black tag) is incorrect as JumpSTART includes rescue breaths for apneic children with pulses, and Choice D (obtaining full vitals) delays critical intervention. The principle is that children have different physiological reserves and may respond to brief respiratory support. The transferable strategy is to recognize when to switch from START to JumpSTART protocol - any victim appearing under 8 years old should receive pediatric triage considerations.

Question 10

During hospital emergency overflow, the nurse is applying START triage. Using START triage, how should the nurse categorize this victim: a 66-year-old who is not walking, respirations 14/min, capillary refill 2 seconds, follows commands, with a large facial laceration and controlled bleeding?

  1. Green tag (minor)
  2. Yellow tag (delayed) (correct answer)
  3. Red tag (immediate)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the non-walking victim has normal respiratory rate, perfusion, and mental status with controlled bleeding, classifying as delayed (yellow tag). The distractors are less appropriate: A (green) for walkers; C (red) for abnormals; D (black) for deceased. In triage prioritization, facial injuries are managed after life threats. Decision-making principles focus on function over appearance. A transferable strategy for triage in mass casualty events is to control bleeding with pressure in yellow victims.

Question 11

A bus accident has resulted in numerous injuries at a rural clinic, and the nurse is using START triage. Which victim should the nurse attend to FIRST? Victims include: (1) a 26-year-old ambulatory with a painful wrist deformity, respirations 18/min, radial pulse present; (2) a 40-year-old with respirations 10/min, shallow, responds to verbal stimuli, radial pulse weak; (3) a 58-year-old with a large scalp laceration, bleeding controlled, respirations 20/min, oriented; (4) a 33-year-old who is crying and hyperventilating at 30/min after minor abrasions, follows commands and has a strong radial pulse.

  1. The 26-year-old ambulatory with a painful wrist deformity and respirations 18/min
  2. The 40-year-old with respirations 10/min, shallow breathing, and a weak radial pulse (correct answer)
  3. The 58-year-old with a scalp laceration and controlled bleeding who is oriented
  4. The 33-year-old hyperventilating at 30/min with minor abrasions who follows commands

Explanation: This question tests disaster triage and mass casualty principles, specifically prioritization using START triage respiratory criteria. The START protocol identifies victims needing immediate intervention based on abnormal vital signs. The correct answer is B because the 40-year-old with respirations of 10/min (at the lower threshold) and weak radial pulse meets RED tag criteria for immediate care due to respiratory compromise. Choice A (ambulatory with wrist injury) would be GREEN tag, Choice C (controlled bleeding with normal vitals) would be YELLOW tag, and Choice D (hyperventilating but following commands with strong pulse) would be YELLOW tag as respirations alone over 30 with good perfusion and mentation may indicate anxiety. The principle is that respirations at or below 10/min indicate significant respiratory depression requiring immediate intervention. The transferable strategy is to recognize that shallow breathing at 10/min or less represents impending respiratory failure, warranting immediate priority.

Question 12

After a hurricane, the nurse is part of a response team triaging victims outside a shelter using START. Which victim should the nurse attend to FIRST? Victims include: (1) a 45-year-old with wheezing after smoke exposure, respirations 32/min, speaks in 1–2 word phrases; (2) a 52-year-old with a deep forearm laceration, bleeding controlled, respirations 18/min, radial pulse present, oriented; (3) a 30-year-old with a closed ankle injury, respirations 16/min, ambulatory; (4) a 63-year-old with mild confusion and thirst, respirations 20/min, radial pulse present, obeys commands.

  1. The 52-year-old with a deep forearm laceration and controlled bleeding
  2. The 45-year-old with wheezing and respirations 32/min who speaks in 1–2 word phrases (correct answer)
  3. The 30-year-old with a closed ankle injury who is ambulatory
  4. The 63-year-old with mild confusion, thirst, and a present radial pulse

Explanation: This question tests disaster triage and mass casualty principles, specifically prioritization using START triage criteria. The START protocol evaluates respirations, perfusion, and mental status to rapidly categorize victims. The correct answer is B because the 45-year-old with respirations of 32/min and speaking in 1-2 word phrases meets RED tag criteria - respirations over 30/min indicate immediate priority. Choice A (controlled bleeding with normal vitals) would be YELLOW tag, Choice C (ambulatory with ankle injury) would be GREEN tag, and Choice D (mild confusion but normal respirations) would be YELLOW tag. In START triage, respirations over 30/min automatically qualify for RED tag/immediate priority, as this indicates respiratory distress requiring urgent intervention. The key strategy is to assess respirations first - if over 30/min or under 10/min, the victim receives immediate priority regardless of other findings.

Question 13

After a hurricane, the nurse is performing START triage at a community shelter. Using START triage, how should the nurse categorize this victim: a 60-year-old with a history of chronic obstructive pulmonary disease who is sitting upright, respirations 24/min, radial pulse present, answers questions appropriately, and reports mild shortness of breath but can speak full sentences?

  1. Green tag (minor)
  2. Yellow tag (delayed) (correct answer)
  3. Red tag (immediate)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles using START triage criteria. The START protocol systematically evaluates respirations, perfusion, and mental status to categorize victims. The correct answer is B (Yellow tag/delayed) because the victim has respirations of 24/min (within 10-30 range), present radial pulse, appropriate mental status, and can speak in full sentences despite mild dyspnea - meeting criteria for delayed care. The victim would not be GREEN (minor) due to increased respiratory rate and dyspnea, not RED (immediate) because vital signs are stable and can speak full sentences, and not BLACK (expectant) as they are conscious and stable. In START triage, victims with abnormal findings that don't meet immediate criteria receive YELLOW tags for delayed treatment. The transferable strategy is to distinguish between compensated (YELLOW) and decompensated (RED) respiratory distress - ability to speak in full sentences indicates adequate air exchange.

Question 14

A bus rollover on an icy rural highway has sent multiple victims to a small clinic, and the nurse is using the START triage protocol at the ambulance bay. Which victim should the nurse attend to FIRST? Victims include: (1) a 34-year-old with an open tibia fracture, respirations 22/min, radial pulse present, follows commands; (2) a 70-year-old with chest pain and diaphoresis, respirations 20/min, radial pulse present, oriented; (3) a 19-year-old found unresponsive with shallow breathing at 8/min and weak/absent radial pulse after being ejected; (4) a 6-year-old crying with a scalp laceration, respirations 26/min, capillary refill 2 seconds, follows commands.

  1. The 34-year-old with an open tibia fracture and respirations 22/min
  2. The 70-year-old with chest pain, diaphoresis, and respirations 20/min
  3. The 19-year-old who is unresponsive with respirations 8/min and weak/absent radial pulse (correct answer)
  4. The 6-year-old crying with a scalp laceration and capillary refill 2 seconds

Explanation: This question tests disaster triage and mass casualty principles, specifically the application of START triage in a multi-victim scenario. The START (Simple Triage and Rapid Treatment) protocol prioritizes victims based on respirations, perfusion, and mental status. The correct answer is C because the 19-year-old with respirations of 8/min and weak/absent radial pulse meets RED tag criteria - respirations under 30/min but abnormal (under 10/min), and absent/weak radial pulse indicating poor perfusion. Choice A (open fracture with normal vitals) would be YELLOW tag, Choice B (chest pain with normal respirations) would be YELLOW tag, and Choice D (crying child with normal capillary refill) would be GREEN tag as the child is ambulatory and has normal perfusion. In START triage, victims with respirations under 10/min or over 30/min, absent radial pulse, or failure to follow commands receive immediate (RED) priority. The key strategy is to rapidly assess breathing, perfusion, and mental status in that order to make quick triage decisions.

Question 15

Following a bombing in a crowded public plaza, the nurse is performing START triage at the casualty collection point. Using START triage, how should the nurse categorize this victim: a 28-year-old with a penetrating thigh wound and active bleeding controlled with direct pressure, respirations 24/min, radial pulse absent, capillary refill 4 seconds, anxious but follows commands?

  1. Green tag (minor)
  2. Yellow tag (delayed)
  3. Red tag (immediate) (correct answer)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles using the START triage system. START triage categorizes victims based on respirations, perfusion (radial pulse/capillary refill), and mental status. The correct answer is C (Red tag/immediate) because the victim has absent radial pulse and capillary refill >2 seconds, indicating poor perfusion despite controlled bleeding - this meets RED tag criteria. The victim would not be GREEN (minor) as they have perfusion compromise, not YELLOW (delayed) because absent radial pulse requires immediate intervention, and not BLACK (expectant) because they are conscious and breathing adequately. In START triage, any victim with absent radial pulse or capillary refill >2 seconds receives RED tag priority regardless of other findings. The transferable strategy is to systematically assess respirations first, then perfusion, then mental status, with any critical finding triggering immediate priority.

Question 16

During a city-wide disaster, the emergency department is overwhelmed and the nurse is applying START triage at the entrance. What is the nurse's PRIORITY action on first contact with a victim who is lying supine, not moving, with no obvious chest rise and no palpable carotid pulse?

  1. Begin cardiopulmonary resuscitation and continue until return of spontaneous circulation
  2. Open the airway, assess for breathing, and if still apneic, tag as black/expectant and move on (correct answer)
  3. Obtain blood pressure and oxygen saturation to confirm the absence of perfusion
  4. Place the victim on supplemental oxygen and reassess in 5 minutes

Explanation: This question tests disaster triage and mass casualty principles, specifically the initial assessment steps in START triage. The START protocol begins with checking for signs of life and uses a systematic approach to maximize survivor outcomes. The correct answer is B because in START triage, when encountering an apneic victim, the nurse should open the airway and reassess breathing - if still apneic, the victim is tagged as black/expectant and the nurse moves on to help salvageable victims. Choice A (CPR) is incorrect as START does not include CPR during initial triage, Choice C (obtaining vitals) wastes precious time, and Choice D (oxygen supplementation) is inappropriate for an apneic victim. The fundamental principle is that in mass casualty events, resources must be allocated to victims with the greatest chance of survival. The transferable strategy is to perform only simple airway maneuvers during triage - if unsuccessful, move on to help other victims rather than spending extended time on one patient.

Question 17

After a hurricane, a nurse on a response team is using START triage at a temporary shelter. Which victim should the nurse attend to FIRST? (1) 28-year-old pregnant at 30 weeks with ankle sprain, respirations 18/min, capillary refill 2 seconds, alert; (2) 70-year-old with history of chronic obstructive pulmonary disease, respirations 32/min, audible wheezing, confused; (3) 40-year-old with scalp laceration, respirations 20/min, capillary refill 1 second, oriented; (4) 16-year-old with nausea and vomiting, respirations 22/min, capillary refill 2 seconds, follows commands.

  1. 28-year-old pregnant at 30 weeks with ankle sprain, respirations 18/min, capillary refill 2 seconds, alert
  2. 70-year-old with chronic obstructive pulmonary disease, respirations 32/min, audible wheezing, confused (correct answer)
  3. 40-year-old with scalp laceration, respirations 20/min, capillary refill 1 second, oriented
  4. 16-year-old with nausea and vomiting, respirations 22/min, capillary refill 2 seconds, follows commands

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer B reflects the most appropriate triage decision because the 70-year-old has a respiratory rate of 32/min (greater than 30), audible wheezing, and confusion, indicating immediate (red tag) need due to respiratory distress and altered mental status. The distractors are less appropriate: A is minor (green) or delayed (yellow) with an ankle sprain and stable parameters; C is delayed (yellow) with a laceration but normal vital signs; D is minor (green) with nausea and stable assessments. In triage prioritization, those with abnormal respiratory rates or mental status changes are prioritized to address life-threatening issues promptly. Decision-making principles focus on rapid evaluation to allocate care to those who can benefit most from immediate intervention. A transferable strategy for triage in mass casualty events is to reassess tagged victims periodically as conditions may change.

Question 18

A rural clinic is receiving victims from a bus accident. Which victim should the nurse attend to FIRST using START triage? (1) 41-year-old with respirations 24/min, capillary refill 2 seconds, unable to follow commands; (2) 26-year-old with displaced wrist fracture, respirations 18/min, capillary refill 2 seconds, alert; (3) 67-year-old with minor burns to hands, respirations 20/min, capillary refill 2 seconds, alert; (4) 33-year-old walking with a small forehead laceration, respirations 16/min, oriented.

  1. 41-year-old with respirations 24/min, capillary refill 2 seconds, unable to follow commands (correct answer)
  2. 26-year-old with displaced wrist fracture, respirations 18/min, capillary refill 2 seconds, alert
  3. 67-year-old with minor burns to hands, respirations 20/min, capillary refill 2 seconds, alert
  4. 33-year-old walking with a small forehead laceration, respirations 16/min, oriented

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer A reflects the most appropriate triage decision because the 41-year-old has normal respiratory rate and perfusion but inability to follow commands, indicating altered mental status and immediate (red tag) priority. The distractors are less appropriate: B, C, and D have stable parameters and are delayed (yellow) or minor (green) with fractures, burns, or lacerations. In triage prioritization, altered mental status signals potential neurological or hypoxic threats requiring urgent evaluation. Decision-making principles involve assessing obedience to commands as a quick mental status check. A transferable strategy for triage in mass casualty events is to reassess red-tag victims frequently for changes in status.

Question 19

After a hurricane, a nurse is using START triage at a flooded neighborhood staging area. Using START triage, how should the nurse categorize this victim: a 30-year-old who is walking, has a superficial scalp abrasion, respirations 18/min, radial pulse strong, and is anxious but oriented?

  1. Green tag (minor) (correct answer)
  2. Yellow tag (delayed)
  3. Red tag (immediate)
  4. Black tag (expectant/deceased)

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer A reflects the most appropriate triage decision because the victim is walking with minor injuries, normal vital signs, and oriented mental status, classifying as minor (green tag). The distractors are less appropriate: B (yellow) is for non-walking with stable parameters; C (red) is for immediate life threats; D (black) is for deceased. In triage prioritization, green-tag victims are deferred to focus on more critical ones. Decision-making principles aim to identify those who can wait without compromising outcomes. A transferable strategy for triage in mass casualty events is to direct green victims to a safe area for self-care or later assessment.

Question 20

Following a hurricane, a nurse is triaging multiple casualties using START. Which victim should the nurse attend to FIRST? (1) 50-year-old with respirations 20/min, capillary refill 4 seconds, weak radial pulse, follows commands; (2) 22-year-old walking with minor cuts, respirations 18/min, alert; (3) 5-year-old crying, respirations 26/min, capillary refill 2 seconds, alert; (4) 44-year-old with closed ankle fracture, respirations 18/min, capillary refill 2 seconds, alert.

  1. 50-year-old with respirations 20/min, capillary refill 4 seconds, weak radial pulse, follows commands (correct answer)
  2. 22-year-old walking with minor cuts, respirations 18/min, alert
  3. 5-year-old crying, respirations 26/min, capillary refill 2 seconds, alert
  4. 44-year-old with closed ankle fracture, respirations 18/min, capillary refill 2 seconds, alert

Explanation: This question tests disaster triage and mass casualty principles. The triage framework used is the START (Simple Triage and Rapid Treatment) system. The correct answer A reflects the most appropriate triage decision because the 50-year-old has normal respiratory rate but poor capillary refill and weak pulse, indicating circulatory compromise and immediate (red tag) need. The distractors are less appropriate: B and C are minor (green) with walking ability and stable signs; D is delayed (yellow) with a fracture but normal parameters. In triage prioritization, signs of shock like delayed capillary refill require prompt attention to prevent organ failure. Decision-making principles use perfusion checks to identify hidden bleeding or hypovolemia. A transferable strategy for triage in mass casualty events is to collaborate with team members for efficient victim flow.