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Disaster Triage And Mass Casualty Principles - NCLEX Rn

  1. 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.
    Answer: 37-year-old with respirations 34/min after near-drowning, coughing pink frothy sputum 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.
  2. A rural clinic is triaging victims after a bus accident. Using START triage, how should the nurse categorize this victim: a 29-year-old with respirations 24/min, capillary refill 2 seconds, and is screaming and unable to follow simple commands due to agitation?
    Answer: Red tag (immediate) 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 normal respiratory rate and perfusion but is unable to follow commands due to agitation, indicating altered mental status and immediate (red tag). The distractors are less appropriate: A (green) for stable walkers; B (yellow) for stable non-walkers; D (black) for non-breathers. In triage prioritization, inability to follow commands may signal head injury or hypoxia needing urgent care. Decision-making principles include calm verbal commands to assess mentation accurately. A transferable strategy for triage in mass casualty events is to use standardized tags for clear communication among responders.
  3. 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?
    Answer: Use JumpSTART steps: open the airway, and if still apneic with a pulse, give 5 rescue breaths and reassess breathing 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.
  4. A rural clinic is overwhelmed after a bus accident. What is the nurse's PRIORITY action when a victim is shouting for help, walking, and has a bleeding nose but stable respirations and mentation?
    Answer: Direct the victim to the designated minor-injury area (green) for later evaluation 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 walking victim with minor bleeding and stable parameters is minor (green tag), directing them to a designated area for later care. The distractors are less appropriate: B delays triage with full assessment; C over-triages to red; D initiates advanced care prematurely. In triage prioritization, green victims are low urgency to free resources for others. Decision-making principles promote rapid sorting over detailed exams. A transferable strategy for triage in mass casualty events is to empower green victims with basic first aid instructions.
  5. 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?
    Answer: Red tag (immediate) 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.
  6. In a hospital emergency overflow situation after a city-wide disaster, the nurse is using START triage principles at the door. Which victim should the nurse attend to FIRST? (1) 39-year-old with respirations 10/min after airway repositioning, capillary refill 2 seconds, cannot follow commands; (2) 72-year-old walking with bruised ribs, respirations 22/min, alert; (3) 25-year-old with nausea and dizziness, respirations 18/min, capillary refill 2 seconds, alert; (4) 46-year-old with a closed humerus fracture, respirations 20/min, capillary refill 2 seconds, follows commands.
    Answer: 39-year-old with respirations 10/min after airway repositioning, capillary refill 2 seconds, cannot follow commands 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 39-year-old required airway repositioning to breathe at 10/min and cannot follow commands, classifying as immediate (red tag) due to airway and mental issues. The distractors are less appropriate: B and C are minor (green); D is delayed (yellow) with fracture and stable signs. In triage prioritization, post-intervention breathing with abnormalities demands urgent care. Decision-making principles assess response to airway maneuvers quickly. A transferable strategy for triage in mass casualty events is to document interventions for handover to advanced care.
  7. A bus crash has brought multiple injured people to a rural clinic. Using START triage, how should the nurse categorize this victim: a 52-year-old with a deep forearm laceration and active bleeding controlled with direct pressure, respirations 20/min, capillary refill 2 seconds, able to follow commands and walk with assistance?
    Answer: Yellow tag (delayed) 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 independently, has a deep laceration requiring bleeding control, but has stable respiratory rate, perfusion, and mental status, classifying as delayed (yellow tag). The distractors are less appropriate: A (green) is for walking wounded with minor injuries; C (red) is for immediate threats like abnormal vital signs; D (black) is for non-salvageable victims. In triage prioritization, yellow-tag victims receive care after reds but before greens to optimize outcomes. Decision-making principles involve balancing injury severity with resource availability in overwhelmed settings. A transferable strategy for triage in mass casualty events is to control life-threatening bleeding immediately in yellow or red victims before moving on.
  8. 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?
    Answer: Red tag (immediate) 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.
  9. 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.
    Answer: 41-year-old with respirations 24/min, capillary refill 2 seconds, unable to follow commands 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.
  10. After a bombing, the nurse is using START triage. What is the nurse's PRIORITY action when an adult victim has respirations 0/min and does not start breathing after the nurse opens the airway?
    Answer: Tag the victim black (expectant/deceased) and move to the next victim In START triage, the first filter is airway and breathing. An adult who remains without respirations after the nurse opens the airway is classified as black/expectant/deceased in a mass casualty event, so the priority is to tag that victim and move to the next one. Rescue breathing with a bag-mask device for one minute is wrong because START does not direct one-on-one rescue efforts for an adult who is apneic after airway opening; it would consume resources that should go to salvageable victims. The red-tag and immediate-transport option is wrong because red tags are for survivable patients who need immediate treatment, not for an adult who remains apneic after the airway is opened. Assessing pupillary response and performing a full neurologic assessment is wrong because full neurologic evaluation is not part of START's rapid triage sequence, delays the move to viable patients, and does not address the absent airway. Tagging the victim black/expectant and moving on is therefore the correct START action.
  11. 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?
    Answer: Open the airway, assess for breathing, and if still apneic, tag as black/expectant and move on In START triage during a mass-casualty event, the first encounter with a nonmoving, apneic-appearing victim is brief: open the airway and look/listen for breathing. If breathing does not resume after that single airway maneuver, the victim is categorized as black/expectant, and the nurse immediately moves to the next patient who may be salvageable. This preserves scarce resources for survivable injuries. The option that begins CPR is incorrect because CPR is not part of initial START triage; committing one responder to prolonged resuscitation in a disaster diverts care from many. The option to obtain blood pressure and oxygen saturation is incorrect because a portable monitor cannot restore or confirm meaningful perfusion in a patient with no pulse or chest rise and wastes triage time. The option to give supplemental oxygen by nonrebreather and reassess in 5 minutes is incorrect because an apneic victim cannot move enough room air through a mask, and a 5-minute delay violates the rapid-sorting principle. Only the airway-opening action—then tagging as black/expectant if apnea persists—matches START.
  12. 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.
    Answer: 70-year-old with chronic obstructive pulmonary disease, respirations 32/min, audible wheezing, confused 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.
  13. 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?
    Answer: Apply a tourniquet proximal to the wound and tighten until bleeding stops 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.
  14. 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.
    Answer: The 45-year-old with wheezing and respirations 32/min who speaks in 1–2 word phrases 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.
  15. Following a bombing, the nurse is triaging victims using START. Which intervention should the nurse implement IMMEDIATELY for a RED-tagged individual who has a spurting leg wound and a weak radial pulse?
    Answer: Apply a tourniquet proximal to the wound and document the time applied 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 red-tagged victim has uncontrolled arterial bleeding and signs of shock, requiring immediate tourniquet application to prevent exsanguination. The distractors are less appropriate: B delays intervention with full vitals; C is supportive but not priority over bleeding control; D is for wound care after stabilization. In triage prioritization, life-threatening hemorrhage is addressed first as it can lead to rapid deterioration. Decision-making principles include using simple interventions like tourniquets to stabilize before transport. A transferable strategy for triage in mass casualty events is to document interventions like tourniquet time to guide ongoing care.
  16. 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 and unable to walk, respirations 24/min, radial pulse present, answers questions appropriately, and reports mild shortness of breath but can speak full sentences?
    Answer: Yellow tag (delayed) 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 (under 30/min), 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) because they cannot walk, 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.
  17. 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.
    Answer: The 19-year-old who is unresponsive with respirations 8/min and weak/absent radial pulse 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.
  18. A bus rollover has sent multiple victims to a rural clinic with limited staff and supplies. Using START triage, which victim should the nurse attend to FIRST? Victims include: (1) 34-year-old with open tibia fracture, respirations 22/min, capillary refill 2 seconds, follows commands; (2) 62-year-old with chest pain, respirations 28/min, capillary refill 3 seconds, confused and diaphoretic; (3) 8-year-old crying with forearm deformity, respirations 24/min, radial pulse present, alert; (4) 19-year-old found apneic who begins breathing at 10/min after airway repositioning, capillary refill 2 seconds, does not follow commands.
    Answer: 19-year-old apneic who begins breathing at 10/min after airway repositioning, capillary refill 2 seconds, does not follow commands 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 D reflects the most appropriate triage decision because the 19-year-old victim was initially apneic, began breathing after airway repositioning, has a low respiratory rate of 10/min, and does not follow commands, classifying them as immediate (red tag) due to airway compromise and altered mental status. The distractors are less appropriate: A is delayed (yellow) with stable parameters and an open fracture; B is immediate (red) due to poor perfusion and confusion but less urgent than D without recent apnea; C is delayed (yellow) or minor (green) with a deformity but alert and stable. In triage prioritization, patients requiring immediate life-saving interventions like airway management are attended first to prevent deterioration. Decision-making principles emphasize assessing respiration, perfusion, and mental status to do the greatest good for the most people. A transferable strategy for triage in mass casualty events is to rapidly tag and prioritize red-tag victims while deferring care for stable ones.
  19. After a bombing, the nurse is triaging multiple victims using START. Which victim should the nurse attend to FIRST? (1) 23-year-old with respirations 40/min and weak radial pulse; (2) 31-year-old walking with ringing in ears and mild headache, respirations 18/min; (3) 54-year-old with respirations 22/min, capillary refill 2 seconds, follows commands, deep laceration with controlled bleeding; (4) 6-year-old walking and crying, respirations 26/min, radial pulse present.
    Answer: 23-year-old with respirations 40/min and weak radial pulse 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 23-year-old has a respiratory rate of 40/min (greater than 30) and weak pulse, indicating immediate (red tag) respiratory and circulatory compromise. The distractors are less appropriate: B and D are minor (green) with walking ability; C is delayed (yellow) with controlled bleeding and stable signs. In triage prioritization, abnormal rates and perfusion signal need for rapid intervention. Decision-making principles focus on objective criteria over visible injuries. A transferable strategy for triage in mass casualty events is to scan for hidden dangers like blast lung in bombings.
  20. 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?
    Answer: Yellow tag (delayed) 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.

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