NORCET 3 - 2022 (Shift-1)
Medical & Surgical Nursing
Medium
After school bus accident a nurse should give the first priority to?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- The presence of clear fluid leaking from the ear (otorrhea) is a cardinal sign of a basilar skull fracture, a severe and life-threatening head injury.
- This condition indicates a tear in the dura mater, creating a direct opening between the brain and the external environment.
- This poses an immediate, high risk for central nervous system infection (meningitis) and indicates significant brain trauma.
- According to triage principles (e.g., Emergent, Urgent, Non-urgent), this patient falls into the emergent (Category I) category, requiring immediate medical intervention to prevent further disability or death.
Why Other Options Were Wrong
- Option B: A hematoma on the head, without further signs of neurological compromise (like altered consciousness or pupillary changes), is considered less critical than an active CSF leak.
- Option C: A scalp laceration, while it may bleed profusely, is an external injury. The bleeding is typically compressible and manageable, making it a lower priority than a severe, internal head injury.
- Option D: A clear pupillary reaction to light is a reassuring sign of intact brainstem function. This indicates the patient is neurologically stable at the moment and is therefore the lowest priority.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Triage and Prioritization in Emergency Nursing in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- In any mass casualty incident (MCI), the nurse's ability to perform rapid and accurate triage is critical to saving lives. This involves quickly identifying the most life-threatening injuries.
- Recognizing subtle but critical signs like CSF otorrhea allows the nurse to prioritize care effectively, ensuring that patients with the highest risk of mortality receive immediate attention.
- Nursing protocol for suspected basilar skull fracture is strict: immobilize the spine, do not pack draining orifices, avoid nasal intubation, and monitor neurological status closely.
How to Approach the Question
- First, identify the question as a prioritization or triage problem. The keywords are 'first priority' and 'school bus accident' (implying multiple victims).
- Recall the principles of emergency triage, which prioritize patients with immediate life-threatening conditions (often categorized as Red Tag or Emergent).
- Systematically evaluate each option using the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) framework.
- Analyze Option A: Clear fluid from the ear points to a basilar skull fracture, a severe head injury. This falls under 'D' for Disability and is a major life threat.
- Analyze Options B and C: A hematoma and a laceration are less immediately life-threatening than a confirmed severe skull fracture, unless they are causing hemodynamic instability (Circulation issue).
- Analyze Option D: Clear pupils are a sign of stability, making this patient the lowest priority.
Concept Tested & Keywords
- Concept Tested: Triage and Prioritization in Emergency Nursing
- Stem keywords: school bus accident, nurse, first priority
- Lead-in keywords: first priority
- Clinical cues: Mass casualty incident (school bus accident) requiring triage
- Negative lead-in flag: false
Question ID
Q9egZcHR9M-HH2b2xrShBD
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 pp. 113-115, 120-122
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 619-621
Practise the full NORCET 3 - 2022 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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