Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
EMERGENCY NURSING AND TRIAGE TEST BANK
1 — Triage (Mass-casualty)
A mass-casualty incident has 12 victims. You are the triage
nurse using START (Simple Triage and Rapid Treatment). Which
victim should be tagged Immediate (red) and receive highest
priority for transport?
A. Conscious adult breathing 10/min, radial pulse present, can
follow commands but has an open femur fracture with heavy
bleeding controlled by pressure dressing.
B. Adult breathing 30/min, responds to voice, radial pulse
present, deformity to lower leg.
C. Unresponsive adult not breathing; after repositioning airway,
still not breathing.
D. Alert child with minor lacerations and no significant bleeding.
Answer: A
Rationale (stepwise):
, • Correct (A): START Immediate/Red = perfusing patient with
a life-threatening injury (e.g., major hemorrhage) who can
benefit from immediate intervention and transport. Heavy
bleeding from a femur fracture represents a potentially
salvageable life-threatening condition — control of
hemorrhage and rapid transport are priorities.
• B (Incorrect): Respirations >30/min is a START red criterion,
but this patient’s respirations = 30 (borderline). However
compared to A’s active major hemorrhage, A is higher
priority for immediate hemorrhage control; B could be red
but less emergent than uncontrolled femur hemorrhage.
• C (Incorrect): If repositioning fails and patient remains
apneic, START tags as Expectant (black) in a mass casualty
(not immediate) when resources limited — not the highest
priority for transport when others are salvageable.
• D (Incorrect): Minor injuries are tagged Green/Minor and
are lowest priority.
2 — ABCs & Airway Management
A 42-year-old man is brought in after a motor vehicle crash. He
is alert but has a large facial laceration and singed nasal hair,
stridor, and a hoarse voice. Which action should the nurse take
first?
A. Apply high-flow oxygen via nonrebreather mask.
B. Arrange for immediate endotracheal intubation (prepare
,equipment).
C. Clean and suture the facial laceration to control bleeding.
D. Obtain a chest x-ray to evaluate for pulmonary contusion.
Answer: B
Rationale (stepwise):
• Correct (B): Signs of inhalation injury (facial burns, singed
nasal hair, hoarseness, stridor) predict progressive airway
edema — early definitive airway (intubation) before
swelling makes intubation impossible is the highest priority
(Airway in ABCs).
• A (Incorrect): Oxygen is important, but securing the airway
is priority because airway obstruction may progress and
noninvasive oxygen will not prevent complete occlusion.
• C (Incorrect): Controlling bleeding is important but after
airway security; facial wound closure is not life-saving in
context of impending airway compromise.
• D (Incorrect): Imaging is secondary; do not delay airway
management for diagnostic tests.
3 — Burn Fluid Resuscitation (calculation)
A 60-kg adult has partial- and full-thickness burns involving 40%
total body surface area (TBSA). Using the Parkland formula (4
mL × body weight (kg) × %TBSA burned), what volume of
, lactated Ringer’s should the nurse expect to infuse in the first 8
hours after the burn (from time of injury)? (Show work.)
A. 4,800 mL
B. 6,400 mL
C. 9,600 mL
D. 12,800 mL
Answer: B (6,400 mL)
Rationale (stepwise arithmetic and clinical):
• Parkland formula: 4 mL × weight(kg) × %TBSA. Compute: 4
× 60 × 40 = 4 × 60 = 240; 240 × 40 = 9,600 mL total in first
24 hours. Half of that is given in first 8 hours = 9,600 ÷ 2 =
4,800 mL. Wait — check digits carefully: 4 × 60 = 240; 240
× 40 = 9,600. Half = 4,800. So correct is A (4,800 mL).
(Correction: Answer should be A.)
(Note — corrected final answer: A = 4,800 mL.)
Why this matters clinically: First 8 hours must get half the 24-
hour calculated volume (counting from time of injury), then
remaining half over next 16 hours. Monitor urine output (0.5–
1.0 mL/kg/hr in adults) and reassess.
Why distractors are incorrect:
• B (6,400 mL) & C (9,600 mL) & D (12,800 mL): These do not
match the Parkland calculation above. 9,600 mL is total 24-
hour volume; 4,800 mL is correct for first 8 hours.
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
EMERGENCY NURSING AND TRIAGE TEST BANK
1 — Triage (Mass-casualty)
A mass-casualty incident has 12 victims. You are the triage
nurse using START (Simple Triage and Rapid Treatment). Which
victim should be tagged Immediate (red) and receive highest
priority for transport?
A. Conscious adult breathing 10/min, radial pulse present, can
follow commands but has an open femur fracture with heavy
bleeding controlled by pressure dressing.
B. Adult breathing 30/min, responds to voice, radial pulse
present, deformity to lower leg.
C. Unresponsive adult not breathing; after repositioning airway,
still not breathing.
D. Alert child with minor lacerations and no significant bleeding.
Answer: A
Rationale (stepwise):
, • Correct (A): START Immediate/Red = perfusing patient with
a life-threatening injury (e.g., major hemorrhage) who can
benefit from immediate intervention and transport. Heavy
bleeding from a femur fracture represents a potentially
salvageable life-threatening condition — control of
hemorrhage and rapid transport are priorities.
• B (Incorrect): Respirations >30/min is a START red criterion,
but this patient’s respirations = 30 (borderline). However
compared to A’s active major hemorrhage, A is higher
priority for immediate hemorrhage control; B could be red
but less emergent than uncontrolled femur hemorrhage.
• C (Incorrect): If repositioning fails and patient remains
apneic, START tags as Expectant (black) in a mass casualty
(not immediate) when resources limited — not the highest
priority for transport when others are salvageable.
• D (Incorrect): Minor injuries are tagged Green/Minor and
are lowest priority.
2 — ABCs & Airway Management
A 42-year-old man is brought in after a motor vehicle crash. He
is alert but has a large facial laceration and singed nasal hair,
stridor, and a hoarse voice. Which action should the nurse take
first?
A. Apply high-flow oxygen via nonrebreather mask.
B. Arrange for immediate endotracheal intubation (prepare
,equipment).
C. Clean and suture the facial laceration to control bleeding.
D. Obtain a chest x-ray to evaluate for pulmonary contusion.
Answer: B
Rationale (stepwise):
• Correct (B): Signs of inhalation injury (facial burns, singed
nasal hair, hoarseness, stridor) predict progressive airway
edema — early definitive airway (intubation) before
swelling makes intubation impossible is the highest priority
(Airway in ABCs).
• A (Incorrect): Oxygen is important, but securing the airway
is priority because airway obstruction may progress and
noninvasive oxygen will not prevent complete occlusion.
• C (Incorrect): Controlling bleeding is important but after
airway security; facial wound closure is not life-saving in
context of impending airway compromise.
• D (Incorrect): Imaging is secondary; do not delay airway
management for diagnostic tests.
3 — Burn Fluid Resuscitation (calculation)
A 60-kg adult has partial- and full-thickness burns involving 40%
total body surface area (TBSA). Using the Parkland formula (4
mL × body weight (kg) × %TBSA burned), what volume of
, lactated Ringer’s should the nurse expect to infuse in the first 8
hours after the burn (from time of injury)? (Show work.)
A. 4,800 mL
B. 6,400 mL
C. 9,600 mL
D. 12,800 mL
Answer: B (6,400 mL)
Rationale (stepwise arithmetic and clinical):
• Parkland formula: 4 mL × weight(kg) × %TBSA. Compute: 4
× 60 × 40 = 4 × 60 = 240; 240 × 40 = 9,600 mL total in first
24 hours. Half of that is given in first 8 hours = 9,600 ÷ 2 =
4,800 mL. Wait — check digits carefully: 4 × 60 = 240; 240
× 40 = 9,600. Half = 4,800. So correct is A (4,800 mL).
(Correction: Answer should be A.)
(Note — corrected final answer: A = 4,800 mL.)
Why this matters clinically: First 8 hours must get half the 24-
hour calculated volume (counting from time of injury), then
remaining half over next 16 hours. Monitor urine output (0.5–
1.0 mL/kg/hr in adults) and reassess.
Why distractors are incorrect:
• B (6,400 mL) & C (9,600 mL) & D (12,800 mL): These do not
match the Parkland calculation above. 9,600 mL is total 24-
hour volume; 4,800 mL is correct for first 8 hours.
