Priority Decision: A patient is admitted to the emergency department with a possible cervical spinal cord injury following an automobile crash. During admission of the patient, what is the highest priority for the nurse?

Correct Answer: B

Rationale: In the scenario of a patient admitted with a possible cervical spinal cord injury after an automobile crash, the highest priority for the nurse is maintaining immobilization of the cervical spine (Option B). This is crucial to prevent further damage to the spinal cord, which could result in irreversible neurological deficits or even paralysis. By stabilizing the cervical spine, the nurse helps to minimize the risk of exacerbating the initial injury. Maintaining a patent airway (Option A) is important but comes after securing the cervical spine, as airway management can be accomplished once the spine is immobilized. Assessing the patient for head and other injuries (Option C) is important but not the highest priority when the primary concern is preventing further harm to the spinal cord. Assessing the patient's motor and sensory function (Option D) is essential but should come after immobilization to prevent movement that could worsen the injury. Educationally, this scenario highlights the critical nature of prioritizing care in emergency situations, especially when dealing with potential spinal cord injuries. Nurses need to be able to quickly assess and address the most urgent needs of the patient to provide effective and timely care that can impact outcomes significantly. Understanding the rationale behind prioritizing interventions can help nurses make informed decisions in high-stress environments where quick thinking and action are paramount.

Correct Answer: C

Rationale: The most common diagnostic test used to assess musculoskeletal disorders is a standard x-ray (Option C). This is the correct answer because x-rays are readily available, cost-effective, and provide detailed images of bones and some soft tissues, making them ideal for initial evaluation of musculoskeletal conditions like fractures, arthritis, or dislocations. X-rays can reveal abnormalities in bone structure and density, joint alignment, and can help identify potential issues. Option A, Myelogram, is primarily used to evaluate spinal cord or nerve root compression, not musculoskeletal disorders. Option B, Arthroscopy, is a minimally invasive procedure where a camera is inserted into a joint to visualize and treat issues like torn cartilage or inflammation, not a diagnostic test. Option D, Magnetic Resonance Imaging (MRI), is useful for soft tissue evaluation and can provide more detailed images, but it is not as commonly used as standard x-rays due to higher cost and limited availability. In an educational context, understanding the appropriate use of diagnostic tests is crucial for healthcare providers to make accurate diagnoses and treatment decisions. Teaching students the indications, limitations, and benefits of various diagnostic tests helps develop their clinical reasoning skills and enhances their ability to provide quality patient care.

Correct Answer: A

Rationale: The correct answer is A) The use of a footboard to prevent plantar flexion. This intervention is indicated for a patient with hemiplegia to prevent foot drop, a common issue due to weakness of dorsiflexion muscles. Using a footboard helps maintain the foot in a neutral position, preventing contractures and promoting proper alignment of the ankle joint. Option B) Immobilization of the affected arm against the chest with a sling is incorrect because it does not address the specific issue of hemiplegia, which involves paralysis of one side of the body, usually the arm and leg. Immobilization could lead to further complications like joint stiffness and muscle atrophy. Option C) Positioning the patient in bed with each joint lower than the joint proximal to it is incorrect for a patient with hemiplegia. This position could potentially increase the risk of contractures and pressure injuries due to poor circulation and prolonged pressure on bony prominences. Option D) Having the patient perform passive ROM of the affected limb with the unaffected limb is incorrect because passive ROM exercises do not actively engage the weakened muscles on the affected side, which are essential for preventing muscle atrophy and maintaining function. Educationally, understanding the rationale behind each option helps to reinforce the importance of evidence-based nursing interventions tailored to specific patient conditions like hemiplegia. Implementing the correct interventions can improve patient outcomes and prevent complications associated with immobility.

Correct Answer: C

Rationale: The correct answer is C) Typical absence. In the context of pediatric neurology, typical absence seizures, also known as petit mal seizures, are characterized by brief episodes of staring or unresponsiveness lasting a few seconds. These seizures are common in children and often go unnoticed or are mistaken for daydreaming due to their subtle nature. A) Atonic seizures involve a sudden loss of muscle tone and are not characterized by the staring spell seen in absence seizures. B) Simple focal seizures typically involve abnormal electrical activity in one specific area of the brain, resulting in localized symptoms such as twitching or sensory changes. They do not present with the hallmark staring spell of absence seizures. D) Atypical absence seizures are similar to typical absence seizures but last longer and may be associated with other features like eye blinking or slight jerking movements. They are not the same as the brief staring spells seen in typical absence seizures. Understanding the different types of seizures is crucial for healthcare professionals working with children, as accurate identification and management of seizures can significantly impact a child's quality of life. Recognizing the specific features of absence seizures, like the staring spell described in this question, helps in making an accurate diagnosis and providing appropriate care and support to affected children and their families.

Correct Answer: B

Rationale: In diagnosing a cholinergic crisis, it is essential to understand the pharmacological effects of edrophonium (Tensilon). The correct answer is B) Administration of edrophonium (Tensilon) increases muscle weakness. Edrophonium is a cholinesterase inhibitor that temporarily increases the levels of acetylcholine at the neuromuscular junction. In patients experiencing a cholinergic crisis, which is an overdose of cholinergic medication like pyridostigmine, administration of edrophonium exacerbates muscle weakness due to the excess acetylcholine causing overstimulation of nicotinic receptors. Option A is incorrect because impaired respiration due to muscle weakness is a general symptom that can occur in various neuromuscular conditions, not specific to a cholinergic crisis. Option C is incorrect because improved muscle contractility would be expected in conditions where acetylcholine levels are low, not in a cholinergic crisis where there is an excess. Option D is incorrect because EMG findings in a cholinergic crisis would typically show increased response to repeated stimulation due to the excess acetylcholine. Understanding these nuances is crucial for healthcare professionals, especially nurses and nurse educators, to accurately assess and manage patients with neurological conditions and medication overdoses.