Prioritization (HESI) 1 of 21
Clients with which color triage tag are often referred C. Green
to as the "walking wounded" in a mass casualty
scene?
A. Red
B. Black
C. Green
D. Yellow
For which client condition would the nurse stabilize Flail chest
the cervical spine as the priority nursing intervention? Head injuries
Select all that apply. Facial chemical burns
Flail chest Flail chest = two or more contiguous rib fractures with two or more breaks
Head injuries per rib
Facial chemical burns Contiguous = sharing common border
Renal colic pain
Blunt abdominal pain
2/5/2026 1
,Prioritization (HESI) 2 of 21
In which order would the nurse provide care for 1. Red
clients based on triage tag color? 2. Yellow
3. Green
4. Black
The nurse notes that a child with cystic fibrosis who B. Perform postural drainage
was admitted with a respiratory infection is cyanotic,
has a barrel-shaped chest, and is in the 10th Postural drainage, including percussion and vibration, aids in removal of
percentile for both height and weight. Which action respiratory secretions that provide a medium for further bacterial growth.
would the nurse take? Children with CF must cope with impaired gas exchange that results in
intolerance to activity. No dietary restrictions.
A. Encourage increased physical activities
B. Perform postural drainage
C. Maintenance of dietary restrictions
D. Monitor intake and output
2/5/2026 2
, Prioritization (HESI) 3 of 21
The nurse would expect a client who meets the D. Within 10 minutes
criteria for the emergency severity index level 2 (ESI-
2) to be seen by a health care provider within which
time frame?
A. Immediately
B. Within 1 hour
C. Within 2 hours
D. Within 10 minutes
The nurse would use a tag of which color for a client B. Black
who is expected to die after a disaster with mass
casualties? Red = immediate threat to life and need emergent treatment
Green = minor injuries that do not require immediate tx
A. Red Yellow = major injuries require tx
B. Black
C. Green
D. Yellow
2/5/2026 3
Clients with which color triage tag are often referred C. Green
to as the "walking wounded" in a mass casualty
scene?
A. Red
B. Black
C. Green
D. Yellow
For which client condition would the nurse stabilize Flail chest
the cervical spine as the priority nursing intervention? Head injuries
Select all that apply. Facial chemical burns
Flail chest Flail chest = two or more contiguous rib fractures with two or more breaks
Head injuries per rib
Facial chemical burns Contiguous = sharing common border
Renal colic pain
Blunt abdominal pain
2/5/2026 1
,Prioritization (HESI) 2 of 21
In which order would the nurse provide care for 1. Red
clients based on triage tag color? 2. Yellow
3. Green
4. Black
The nurse notes that a child with cystic fibrosis who B. Perform postural drainage
was admitted with a respiratory infection is cyanotic,
has a barrel-shaped chest, and is in the 10th Postural drainage, including percussion and vibration, aids in removal of
percentile for both height and weight. Which action respiratory secretions that provide a medium for further bacterial growth.
would the nurse take? Children with CF must cope with impaired gas exchange that results in
intolerance to activity. No dietary restrictions.
A. Encourage increased physical activities
B. Perform postural drainage
C. Maintenance of dietary restrictions
D. Monitor intake and output
2/5/2026 2
, Prioritization (HESI) 3 of 21
The nurse would expect a client who meets the D. Within 10 minutes
criteria for the emergency severity index level 2 (ESI-
2) to be seen by a health care provider within which
time frame?
A. Immediately
B. Within 1 hour
C. Within 2 hours
D. Within 10 minutes
The nurse would use a tag of which color for a client B. Black
who is expected to die after a disaster with mass
casualties? Red = immediate threat to life and need emergent treatment
Green = minor injuries that do not require immediate tx
A. Red Yellow = major injuries require tx
B. Black
C. Green
D. Yellow
2/5/2026 3
