Multidimensional Care IV (MDC4)
FINAL EXAM
NUR 2755 - Rasmussen University
2026/2027 Academic Year
200 Questions | 9 Content Sections
25% Recall | 55% Application | 20% Analysis
Section 1: Emergency, Triage, and Disaster Management (1-30)
Section 2: Shock States and Hemodynamic Monitoring (31-55)
Section 3: Burns and Wound Management (56-75)
Section 4: Neurological Disorders and Critical Care (76-100)
Section 5: Cardiac and Respiratory Critical Care (101-130)
Section 6: Renal, Fluid/Electrolyte, and Acid-Base Disorders (131-155)
Section 7: Multisystem and Complex Conditions (156-180)
Section 8: Perioperative and Postoperative Nursing Care (181-195)
Section 9: Psychosocial Integrity and Professional Nursing Practice (196-200)
All questions include detailed rationales with evidence-based clinical reasoning.
,Section 1: Emergency, Triage, and Disaster Management
Triage Systems, Mass Casualty Incidents, Emergency Assessment, and Disaster Response (Q1-30)
Q1: A patient arrives at the emergency department unresponsive with no palpable pulse and apneic after being pulled
from a chemical factory explosion. According to the Emergency Severity Index (ESI) triage system, which level should the
triage nurse assign?
A. ESI Level 5 - Nonurgent
B. ESI Level 3 - Urgent
C. ESI Level 1 - Resuscitation **[CORRECT]**
D. ESI Level 4 - Less Urgent
Correct Answer: C
Rationale: ESI Level 1 (Resuscitation) is reserved for patients who are unresponsive, in cardiac or respiratory arrest, or require
immediate life-saving interventions such as intubation or defibrillation. This patient meets all criteria for Level 1 with apnea, absence of
pulse, and unresponsiveness indicating imminent death without immediate resuscitation. Levels 3 through 5 describe patients who are
hemodynamically stable and do not require immediate intervention, which is clearly inappropriate for this patient. Rapid identification of
ESI Level 1 ensures the patient is taken directly to a resuscitation bay without delay, aligning with evidence-based triage protocols that
prioritize time-critical interventions to maximize survival.
Q2: During a mass casualty incident, the triage officer uses the Simple Triage and Rapid Treatment (START) system and
assigns a patient with a respiratory rate of 36 breaths/min, capillary refill of 3 seconds, and the ability to follow
commands. What color tag should this patient receive?
A. Red tag - Immediate
B. Yellow tag - Delayed **[CORRECT]**
C. Green tag - Minimal
D. Black tag - Expectant
Correct Answer: B
Rationale: Under the START triage algorithm, patients who can follow commands, have a respiratory rate between 10 and 30 breaths/min
(or between 10 and 29 depending on the protocol version), and have capillary refill under 4 seconds are classified as Yellow (Delayed).
This patient follows commands (passing the mental status check) but has a respiratory rate of 36, which exceeds the 30-breath threshold
and would normally push toward Red; however, many START protocols use the "perfusion" criterion of capillary refill ≤2 seconds for Red
versus >2 seconds for Yellow. A Red tag (Immediate) is reserved for patients who cannot follow commands, have respiratory rates above
30 without being able to follow commands, or have capillary refill greater than 2 seconds with abnormal mental status. Green (Minimal)
is for walking wounded patients who can self-evacuate, and Black (Expectant) is for patients with injuries incompatible with survival
given available resources.
Q3: The emergency department charge nurse is explaining the difference between the ESI and START triage systems to a
new graduate nurse. Which statement accurately describes a key difference between these two systems?
A. ESI is designed for daily single-patient triage in emergency departments, while START is designed for rapid field triage
during mass casualty incidents. **[CORRECT]**
B. Both ESI and START use identical five-level classification systems with the same criteria for each level.
C. START is used primarily in hospital emergency departments, while ESI is reserved for prehospital field triage.
D. ESI triage relies exclusively on vital signs, while START triage relies exclusively on anatomical injury patterns.
Correct Answer: A
Rationale: The ESI system is a five-level emergency department triage tool that evaluates resource needs and vital signs for individual
patients arriving at a hospital, whereas START is a rapid field triage algorithm developed for mass casualty incidents that categorizes
patients into four color-coded groups based on respirations, perfusion, and mental status. The two systems are not identical; ESI has five
levels while START uses four color designations, and they were designed for fundamentally different clinical environments. Option C
reverses the settings of each system, which is factually incorrect, and Option D misrepresents both systems since ESI considers acuity and
anticipated resource utilization, not just vital signs, and START does not rely on anatomical patterns alone. Understanding the distinction
is essential for nurses to apply the correct triage methodology based on the clinical context, promoting patient safety through appropriate
resource allocation.
MDC4 Final Exam NUR 2755 | Rasmussen University | Page 2
,Q4: In the START triage system used during a mass casualty incident, which color tag indicates a patient whose injuries
are so severe that survival is unlikely even with available resources?
A. Red
B. Yellow
C. Green
D. Black **[CORRECT]**
Correct Answer: D
Rationale: In the START triage system, the Black tag (Expectant) is assigned to patients with devastating injuries such as uncontrolled
massive hemorrhage, apnea despite airway repositioning, or severe burns covering most of the body, where survival is not expected given
the resources available in a mass casualty setting. Red (Immediate) patients have life-threatening conditions that are survivable with
timely intervention, Yellow (Delayed) patients can wait several hours for care, and Green (Minimal) patients have minor injuries and can
assist with their own care. Misapplying the Black tag to a salvageable patient would be an ethical and patient safety failure, just as
assigning Red to a nonsurvivable patient wastes critical resources that could save others. This categorization follows disaster medicine
principles of doing the greatest good for the greatest number.
Q5: A patient presents to the emergency department triage with a laceration on the forearm that has been bleeding for
30 minutes, a heart rate of 88 bpm, blood pressure of 118/76 mmHg, and no other complaints. According to the ESI
system, which level is most appropriate?
A. ESI Level 1 - Resuscitation
B. ESI Level 2 - Emergent
C. ESI Level 3 - Urgent
D. ESI Level 5 - Nonurgent **[CORRECT]**
Correct Answer: D
Rationale: ESI Level 5 (Nonurgent) is appropriate for patients who require only a single resource such as a simple wound assessment, a
prescription refill, or a basic suture repair, and who have stable vital signs with no high-risk features. This patient has a simple forearm
laceration with normal hemodynamics (HR 88, BP 118/76) and no signs of hemorrhagic shock, requiring only one resource (wound
closure). ESI Level 1 involves imminent life threats requiring resuscitation, Level 2 involves high-risk situations or confused/lethargic
patients, and Level 3 involves patients needing two or more resources or abnormal vital signs, none of which apply here. Accurate ESI
level assignment prevents emergency department overcrowding and ensures that higher-acuity patients receive timely care, which is a
core patient safety objective in emergency nursing practice.
Q6: Which of the following events most clearly meets the criteria for activating a mass casualty incident (MCI) plan at a
hospital?
A. A single patient arrives with a gunshot wound to the chest.
B. A school bus collision on a highway results in 18 pediatric patients requiring simultaneous emergency evaluation.
**[CORRECT]**
C. Two adult patients from a motor vehicle crash present within 10 minutes of each other.
D. A patient with severe burn injuries is transferred from an outlying facility.
Correct Answer: B
Rationale: A mass casualty incident is typically defined as an event that generates more patients than the emergency department can
manage with its standard staffing and resources, and most hospitals use a threshold such as five or more patients arriving simultaneously
or within a short timeframe. A school bus collision producing 18 pediatric patients far exceeds the normal capacity of most EDs and
clearly warrants MCI plan activation to mobilize additional staff, open surge capacity areas, and implement triage protocols. A single
gunshot wound, two patients from an MVC, or a single burn transfer, while clinically serious, can be managed through standard
emergency department operations without activating an MCI protocol. Early MCI activation is a patient safety imperative because
delayed activation leads to disorganized responses, overwhelmed staff, and preventable morbidity or mortality.
Q7: During an MCI using the START triage system, which of the following patients should be assigned the Green
(Minimal) tag?
A. A patient with an open femur fracture and capillary refill of 5 seconds.
B. A patient who is unconscious with a respiratory rate of 8 breaths/min.
C. A patient who can walk to a designated collection point under their own power. **[CORRECT]**
MDC4 Final Exam NUR 2755 | Rasmussen University | Page 3
, D. A patient with massive external bleeding that cannot be controlled with direct pressure.
Correct Answer: C
Rationale: In the START triage system, the first step is to direct all patients who can walk to a designated area, automatically classifying
them as Green (Minimal). These "walking wounded" patients have injuries minor enough that they can ambulate and follow instructions,
meaning their conditions are not immediately life-threatening. The patient in option A has signs of hemorrhagic shock (prolonged
capillary refill) with a major fracture and would likely be tagged Red (Immediate). The patient in option B is unconscious with bradypnea,
requiring airway intervention and a Red tag, while the patient in option D has uncontrolled hemorrhage consistent with an Expectant
(Black) or Immediate (Red) classification depending on resources. Correct application of the Green tag frees responders to focus on more
critically injured patients, which is the foundational principle of disaster triage.
Q8: Following a chemical factory explosion, multiple victims arrive at the emergency department simultaneously. A
triage nurse encounters an adult patient with severe chemical burns over 40% of the body surface area, who is
screaming in pain but is hemodynamically stable with a blood pressure of 130/82 mmHg. Using START triage principles,
which action should the nurse take first?
A. Immediately begin fluid resuscitation and assign the patient to the first available treatment area.
B. Assign a Red (Immediate) tag and move to the next patient without initiating treatment. **[CORRECT]**
C. Assign a Black (Expectant) tag because the burn severity exceeds survival likelihood in a disaster setting.
D. Assign a Green (Minimal) tag because the patient is hemodynamically stable and can wait.
Correct Answer: B
Rationale: In START triage during a mass casualty incident, the primary objective is rapid sorting rather than treatment; patients with
life-threatening but potentially survivable injuries receive a Red (Immediate) tag and are moved to a treatment area, while the triage
officer continues assessing other patients without stopping to deliver care. This patient has severe burns that are survivable with timely
fluid resuscitation (Parkland formula: 4 mL × kg × %TBSA), so a Black tag would be premature and unethical. Although
hemodynamically stable now, the pathophysiology of major burns involves massive capillary leak and hypovolemic shock that develops
over hours, making a Green tag dangerous as the patient would deteriorate without intervention. Starting fluid resuscitation at the triage
point violates START protocol by delaying assessment of other victims, potentially allowing other salvageable patients to die, which
contradicts the disaster ethics principle of doing the greatest good for the greatest number.
Q9: A school bus accident has resulted in 12 injured children arriving at the emergency department. The charge nurse
activates the Hospital Incident Command System (HICS). Which nursing action best demonstrates the principle of
resource allocation during the initial phase of this MCI?
A. Assigning two nurses to stay with one critically injured child to provide continuous one-on-one care.
B. Deploying all available nurses to the triage area to ensure thorough individual assessments.
C. Distributing nursing staff across treatment areas based on patient acuity and available resources, reassigning as conditions
change. **[CORRECT]**
D. Sending all pediatric patients to the operating room immediately to prevent delays in definitive care.
Correct Answer: C
Rationale: Effective disaster resource allocation requires dynamic distribution of personnel based on real-time patient acuity and evolving
resource availability, which is a core function of the HICS operations section chief and nursing leadership. Assigning two nurses to a
single patient (option A) depletes limited staffing needed for other victims, which is inappropriate in an MCI where nurse-to-patient ratios
must expand. Concentrating all nurses in triage (option B) leaves no staff to treat already-identified patients, and sending all patients to
the OR (option D) is both clinically inappropriate and operationally impossible. The pathophysiology of traumatic injuries in children
differs from adults due to smaller blood volumes and higher metabolic rates, meaning pediatric MCI patients can decompensate rapidly,
making efficient but not excessive resource distribution critical for patient safety.
Q10: During a multi-casualty event involving a building collapse, the triage nurse assesses a patient trapped under debris
who has a respiratory rate of 40 breaths/min, cannot follow commands, and has absent radial pulses. Which START
triage action is most appropriate?
A. Apply a Green tag and instruct the patient to walk to the casualty collection point.
B. Apply a Red (Immediate) tag, open the airway, and recheck breathing. **[CORRECT]**
C. Apply a Yellow (Delayed) tag and move to the next patient immediately.
D. Apply a Black (Expectant) tag and document the time of death.
MDC4 Final Exam NUR 2755 | Rasmussen University | Page 4
FINAL EXAM
NUR 2755 - Rasmussen University
2026/2027 Academic Year
200 Questions | 9 Content Sections
25% Recall | 55% Application | 20% Analysis
Section 1: Emergency, Triage, and Disaster Management (1-30)
Section 2: Shock States and Hemodynamic Monitoring (31-55)
Section 3: Burns and Wound Management (56-75)
Section 4: Neurological Disorders and Critical Care (76-100)
Section 5: Cardiac and Respiratory Critical Care (101-130)
Section 6: Renal, Fluid/Electrolyte, and Acid-Base Disorders (131-155)
Section 7: Multisystem and Complex Conditions (156-180)
Section 8: Perioperative and Postoperative Nursing Care (181-195)
Section 9: Psychosocial Integrity and Professional Nursing Practice (196-200)
All questions include detailed rationales with evidence-based clinical reasoning.
,Section 1: Emergency, Triage, and Disaster Management
Triage Systems, Mass Casualty Incidents, Emergency Assessment, and Disaster Response (Q1-30)
Q1: A patient arrives at the emergency department unresponsive with no palpable pulse and apneic after being pulled
from a chemical factory explosion. According to the Emergency Severity Index (ESI) triage system, which level should the
triage nurse assign?
A. ESI Level 5 - Nonurgent
B. ESI Level 3 - Urgent
C. ESI Level 1 - Resuscitation **[CORRECT]**
D. ESI Level 4 - Less Urgent
Correct Answer: C
Rationale: ESI Level 1 (Resuscitation) is reserved for patients who are unresponsive, in cardiac or respiratory arrest, or require
immediate life-saving interventions such as intubation or defibrillation. This patient meets all criteria for Level 1 with apnea, absence of
pulse, and unresponsiveness indicating imminent death without immediate resuscitation. Levels 3 through 5 describe patients who are
hemodynamically stable and do not require immediate intervention, which is clearly inappropriate for this patient. Rapid identification of
ESI Level 1 ensures the patient is taken directly to a resuscitation bay without delay, aligning with evidence-based triage protocols that
prioritize time-critical interventions to maximize survival.
Q2: During a mass casualty incident, the triage officer uses the Simple Triage and Rapid Treatment (START) system and
assigns a patient with a respiratory rate of 36 breaths/min, capillary refill of 3 seconds, and the ability to follow
commands. What color tag should this patient receive?
A. Red tag - Immediate
B. Yellow tag - Delayed **[CORRECT]**
C. Green tag - Minimal
D. Black tag - Expectant
Correct Answer: B
Rationale: Under the START triage algorithm, patients who can follow commands, have a respiratory rate between 10 and 30 breaths/min
(or between 10 and 29 depending on the protocol version), and have capillary refill under 4 seconds are classified as Yellow (Delayed).
This patient follows commands (passing the mental status check) but has a respiratory rate of 36, which exceeds the 30-breath threshold
and would normally push toward Red; however, many START protocols use the "perfusion" criterion of capillary refill ≤2 seconds for Red
versus >2 seconds for Yellow. A Red tag (Immediate) is reserved for patients who cannot follow commands, have respiratory rates above
30 without being able to follow commands, or have capillary refill greater than 2 seconds with abnormal mental status. Green (Minimal)
is for walking wounded patients who can self-evacuate, and Black (Expectant) is for patients with injuries incompatible with survival
given available resources.
Q3: The emergency department charge nurse is explaining the difference between the ESI and START triage systems to a
new graduate nurse. Which statement accurately describes a key difference between these two systems?
A. ESI is designed for daily single-patient triage in emergency departments, while START is designed for rapid field triage
during mass casualty incidents. **[CORRECT]**
B. Both ESI and START use identical five-level classification systems with the same criteria for each level.
C. START is used primarily in hospital emergency departments, while ESI is reserved for prehospital field triage.
D. ESI triage relies exclusively on vital signs, while START triage relies exclusively on anatomical injury patterns.
Correct Answer: A
Rationale: The ESI system is a five-level emergency department triage tool that evaluates resource needs and vital signs for individual
patients arriving at a hospital, whereas START is a rapid field triage algorithm developed for mass casualty incidents that categorizes
patients into four color-coded groups based on respirations, perfusion, and mental status. The two systems are not identical; ESI has five
levels while START uses four color designations, and they were designed for fundamentally different clinical environments. Option C
reverses the settings of each system, which is factually incorrect, and Option D misrepresents both systems since ESI considers acuity and
anticipated resource utilization, not just vital signs, and START does not rely on anatomical patterns alone. Understanding the distinction
is essential for nurses to apply the correct triage methodology based on the clinical context, promoting patient safety through appropriate
resource allocation.
MDC4 Final Exam NUR 2755 | Rasmussen University | Page 2
,Q4: In the START triage system used during a mass casualty incident, which color tag indicates a patient whose injuries
are so severe that survival is unlikely even with available resources?
A. Red
B. Yellow
C. Green
D. Black **[CORRECT]**
Correct Answer: D
Rationale: In the START triage system, the Black tag (Expectant) is assigned to patients with devastating injuries such as uncontrolled
massive hemorrhage, apnea despite airway repositioning, or severe burns covering most of the body, where survival is not expected given
the resources available in a mass casualty setting. Red (Immediate) patients have life-threatening conditions that are survivable with
timely intervention, Yellow (Delayed) patients can wait several hours for care, and Green (Minimal) patients have minor injuries and can
assist with their own care. Misapplying the Black tag to a salvageable patient would be an ethical and patient safety failure, just as
assigning Red to a nonsurvivable patient wastes critical resources that could save others. This categorization follows disaster medicine
principles of doing the greatest good for the greatest number.
Q5: A patient presents to the emergency department triage with a laceration on the forearm that has been bleeding for
30 minutes, a heart rate of 88 bpm, blood pressure of 118/76 mmHg, and no other complaints. According to the ESI
system, which level is most appropriate?
A. ESI Level 1 - Resuscitation
B. ESI Level 2 - Emergent
C. ESI Level 3 - Urgent
D. ESI Level 5 - Nonurgent **[CORRECT]**
Correct Answer: D
Rationale: ESI Level 5 (Nonurgent) is appropriate for patients who require only a single resource such as a simple wound assessment, a
prescription refill, or a basic suture repair, and who have stable vital signs with no high-risk features. This patient has a simple forearm
laceration with normal hemodynamics (HR 88, BP 118/76) and no signs of hemorrhagic shock, requiring only one resource (wound
closure). ESI Level 1 involves imminent life threats requiring resuscitation, Level 2 involves high-risk situations or confused/lethargic
patients, and Level 3 involves patients needing two or more resources or abnormal vital signs, none of which apply here. Accurate ESI
level assignment prevents emergency department overcrowding and ensures that higher-acuity patients receive timely care, which is a
core patient safety objective in emergency nursing practice.
Q6: Which of the following events most clearly meets the criteria for activating a mass casualty incident (MCI) plan at a
hospital?
A. A single patient arrives with a gunshot wound to the chest.
B. A school bus collision on a highway results in 18 pediatric patients requiring simultaneous emergency evaluation.
**[CORRECT]**
C. Two adult patients from a motor vehicle crash present within 10 minutes of each other.
D. A patient with severe burn injuries is transferred from an outlying facility.
Correct Answer: B
Rationale: A mass casualty incident is typically defined as an event that generates more patients than the emergency department can
manage with its standard staffing and resources, and most hospitals use a threshold such as five or more patients arriving simultaneously
or within a short timeframe. A school bus collision producing 18 pediatric patients far exceeds the normal capacity of most EDs and
clearly warrants MCI plan activation to mobilize additional staff, open surge capacity areas, and implement triage protocols. A single
gunshot wound, two patients from an MVC, or a single burn transfer, while clinically serious, can be managed through standard
emergency department operations without activating an MCI protocol. Early MCI activation is a patient safety imperative because
delayed activation leads to disorganized responses, overwhelmed staff, and preventable morbidity or mortality.
Q7: During an MCI using the START triage system, which of the following patients should be assigned the Green
(Minimal) tag?
A. A patient with an open femur fracture and capillary refill of 5 seconds.
B. A patient who is unconscious with a respiratory rate of 8 breaths/min.
C. A patient who can walk to a designated collection point under their own power. **[CORRECT]**
MDC4 Final Exam NUR 2755 | Rasmussen University | Page 3
, D. A patient with massive external bleeding that cannot be controlled with direct pressure.
Correct Answer: C
Rationale: In the START triage system, the first step is to direct all patients who can walk to a designated area, automatically classifying
them as Green (Minimal). These "walking wounded" patients have injuries minor enough that they can ambulate and follow instructions,
meaning their conditions are not immediately life-threatening. The patient in option A has signs of hemorrhagic shock (prolonged
capillary refill) with a major fracture and would likely be tagged Red (Immediate). The patient in option B is unconscious with bradypnea,
requiring airway intervention and a Red tag, while the patient in option D has uncontrolled hemorrhage consistent with an Expectant
(Black) or Immediate (Red) classification depending on resources. Correct application of the Green tag frees responders to focus on more
critically injured patients, which is the foundational principle of disaster triage.
Q8: Following a chemical factory explosion, multiple victims arrive at the emergency department simultaneously. A
triage nurse encounters an adult patient with severe chemical burns over 40% of the body surface area, who is
screaming in pain but is hemodynamically stable with a blood pressure of 130/82 mmHg. Using START triage principles,
which action should the nurse take first?
A. Immediately begin fluid resuscitation and assign the patient to the first available treatment area.
B. Assign a Red (Immediate) tag and move to the next patient without initiating treatment. **[CORRECT]**
C. Assign a Black (Expectant) tag because the burn severity exceeds survival likelihood in a disaster setting.
D. Assign a Green (Minimal) tag because the patient is hemodynamically stable and can wait.
Correct Answer: B
Rationale: In START triage during a mass casualty incident, the primary objective is rapid sorting rather than treatment; patients with
life-threatening but potentially survivable injuries receive a Red (Immediate) tag and are moved to a treatment area, while the triage
officer continues assessing other patients without stopping to deliver care. This patient has severe burns that are survivable with timely
fluid resuscitation (Parkland formula: 4 mL × kg × %TBSA), so a Black tag would be premature and unethical. Although
hemodynamically stable now, the pathophysiology of major burns involves massive capillary leak and hypovolemic shock that develops
over hours, making a Green tag dangerous as the patient would deteriorate without intervention. Starting fluid resuscitation at the triage
point violates START protocol by delaying assessment of other victims, potentially allowing other salvageable patients to die, which
contradicts the disaster ethics principle of doing the greatest good for the greatest number.
Q9: A school bus accident has resulted in 12 injured children arriving at the emergency department. The charge nurse
activates the Hospital Incident Command System (HICS). Which nursing action best demonstrates the principle of
resource allocation during the initial phase of this MCI?
A. Assigning two nurses to stay with one critically injured child to provide continuous one-on-one care.
B. Deploying all available nurses to the triage area to ensure thorough individual assessments.
C. Distributing nursing staff across treatment areas based on patient acuity and available resources, reassigning as conditions
change. **[CORRECT]**
D. Sending all pediatric patients to the operating room immediately to prevent delays in definitive care.
Correct Answer: C
Rationale: Effective disaster resource allocation requires dynamic distribution of personnel based on real-time patient acuity and evolving
resource availability, which is a core function of the HICS operations section chief and nursing leadership. Assigning two nurses to a
single patient (option A) depletes limited staffing needed for other victims, which is inappropriate in an MCI where nurse-to-patient ratios
must expand. Concentrating all nurses in triage (option B) leaves no staff to treat already-identified patients, and sending all patients to
the OR (option D) is both clinically inappropriate and operationally impossible. The pathophysiology of traumatic injuries in children
differs from adults due to smaller blood volumes and higher metabolic rates, meaning pediatric MCI patients can decompensate rapidly,
making efficient but not excessive resource distribution critical for patient safety.
Q10: During a multi-casualty event involving a building collapse, the triage nurse assesses a patient trapped under debris
who has a respiratory rate of 40 breaths/min, cannot follow commands, and has absent radial pulses. Which START
triage action is most appropriate?
A. Apply a Green tag and instruct the patient to walk to the casualty collection point.
B. Apply a Red (Immediate) tag, open the airway, and recheck breathing. **[CORRECT]**
C. Apply a Yellow (Delayed) tag and move to the next patient immediately.
D. Apply a Black (Expectant) tag and document the time of death.
MDC4 Final Exam NUR 2755 | Rasmussen University | Page 4
