# Several clients arrive after a building collapse. Which client should the triage nurse classify as needing immediate treatment?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397126&lang=en  
> language: en  
> subject: Establishing Priorities  
> category: MOC

## Question

Several clients arrive after a building collapse. Which client should the triage nurse classify as needing immediate treatment?

## Option

1. A client with an open forearm fracture and palpable radial pulse.
2. A client walking and reporting anxiety and minor abrasions.
3. A client with absent respirations after airway repositioning.
4. A client with severe respiratory distress and capillary refill of 4 seconds. **✔ Correct answer**

**Correct answer: 4**

## Explanation

In disaster triage, immediate treatment is prioritized for clients with life-threatening but potentially survivable airway, breathing, or circulation problems. Severe respiratory distress with delayed perfusion requires immediate intervention. A client who remains apneic after airway repositioning is categorized as expectant in many disaster triage systems.

## In-depth explanation

Clinical Judgment
Use the client cues, timing, labs, and safety risks to select the response that best fits Mass casualty triage.

Memory Tip
Match the strongest cue cluster to the safest nursing judgment.

KR vs US
NCLEX items reward cue-based priority thinking rather than isolated recall.

## Clinical scenario

Clinical Practice Guide
For Mass casualty triage, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.

Caution
Do not choose an action from one isolated cue when the full scenario changes priority or safety.

## Key concepts

- **Disaster Triage** — Rapid sorting of clients during a mass casualty event to maximize survival.
- **Immediate Category** — A triage priority for life-threatening but treatable problems.
- **Capillary Refill** — A quick assessment of peripheral perfusion.

## Related questions

- [The nurse receives report on four clients. Which client should the nurse assess first?](https://mymerci.kr/pages/nclex_q.php?qn_id=393674&lang=en)
- [The nurse receives report on four clients. Which client should the nurse assess first?](https://mymerci.kr/pages/nclex_q.php?qn_id=393675&lang=en)
- [Four hours after open reduction and internal fixation of a fractured tibia, a client repor…](https://mymerci.kr/pages/nclex_q.php?qn_id=394046&lang=en)
- [Four hours after open reduction and internal fixation of a fractured tibia, a client repor…](https://mymerci.kr/pages/nclex_q.php?qn_id=394047&lang=en)
- [The nurse receives reports on four clients. Which client should the nurse assess first?](https://mymerci.kr/pages/nclex_q.php?qn_id=394076&lang=en)
- [During a mass casualty incident, which client should be assigned a delayed priority rather…](https://mymerci.kr/pages/nclex_q.php?qn_id=394136&lang=en)
- [During disaster triage, a client is not breathing after the airway is opened and repositio…](https://mymerci.kr/pages/nclex_q.php?qn_id=394166&lang=en)
- [Four clients arrive at an urgent care clinic. Which client should the nurse assess first?](https://mymerci.kr/pages/nclex_q.php?qn_id=396577&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=397126&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=397126&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=397126&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=397126&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=397126&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._