An elderly patient is found unconscious and unresponsive. His heart rate is 30 beats per minute, blood pressure is 70/40 mmHg, and his skin is pale and cool. Which intervention should be performed first?

Correct Answer: B

Rationale: The correct answer is B: Establish transcutaneous pacing. This intervention is vital to address the patient's symptomatic bradycardia and hemodynamic instability. Transcutaneous pacing will quickly increase the heart rate and improve perfusion. Atropine may be used if pacing is not immediately available. Administering dopamine or a fluid bolus are not the first-line interventions in this scenario. Dopamine would take time to titrate and may not be as effective as pacing in rapidly stabilizing the patient. Providing a fluid bolus may worsen the situation by increasing the intravascular volume without addressing the underlying bradycardia.

Correct Answer: B

Rationale: The correct answer is B: A P-R interval greater than five small boxes (0.20 seconds) wide on the electrocardiogram tracing. In first-degree AV block, there is a delay in conduction from the atria to the ventricles, resulting in a prolonged P-R interval on the EKG. This delay is represented by a P-R interval greater than 0.20 seconds. This finding is characteristic of first-degree AV block. Now, let's analyze why the other choices are incorrect: A: There are more than one P wave for each QRS complex - This describes a condition called atrial fibrillation, where multiple P waves are present but not associated with QRS complexes. C: The P-R intervals become progressively longer until a QRS complex is dropped altogether - This describes a Mobitz Type II second-degree AV block, where there is a sudden block of conduction without a progressive increase in P-R intervals. D: The P waves are present but

Correct Answer: D

Rationale: The correct answer is D: To help lower dangerous potassium levels. High-dose nebulized albuterol is recommended for hyperkalemic patients because it activates beta-2 adrenergic receptors, leading to an intracellular shift of potassium, thereby decreasing serum potassium levels. Albuterol does not directly address ventilatory status (choice A), metabolic acidosis (choice B), or increase available calcium at the cellular level (choice C). It is essential to focus on treating the underlying cause of hyperkalemia, which is the dangerously high potassium levels in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Milfeasance. Negligence is divided into three categories: malfeasance (performing an act that is wrongful), misfeasance (performing a lawful act in a wrongful manner), and nonfeasance (failing to perform a required duty). "Milfeasance" is not a recognized term in negligence law and does not fit into any of the established categories. Therefore, it is not a valid category of negligence. Malfeasance, misfeasance, and nonfeasance are the only recognized categories in negligence law.

Correct Answer: C

Rationale: The correct answer is C: Central cord syndrome. This syndrome is typically caused by hyperextension injuries in older individuals, resulting in motor weakness and sensory loss, often more pronounced in the upper extremities. In this case, the man's prolonged unconsciousness and lack of lower extremity movement fit the clinical presentation of central cord syndrome due to the mechanism of injury. The other choices are less likely as an epidural hematoma would present with focal neurological deficits, a pelvic fracture with lower extremity symptoms but not unconsciousness, and intracerebral hemorrhage with altered mental status and focal neurological deficits.