ATI RN
Basic Care of a Paraplegic Patient Questions
Question 1 of 5
The nurse is caring for a patient in the operating suite who is experiencing hypercarbia, tachypnea, tachycardia, premature ventricular contractions, and muscle rigidity. Which condition does the nurse suspect the patient is experiencing?
Correct Answer: A
Rationale: The correct answer is A: Malignant hyperthermia. This is characterized by the symptoms described - hypercarbia, tachypnea, tachycardia, premature ventricular contractions, and muscle rigidity. Malignant hyperthermia is a rare but life-threatening reaction to certain medications used during anesthesia, leading to an uncontrolled increase in skeletal muscle metabolism. This causes an increase in carbon dioxide production (hypercarbia), leading to respiratory compensation (tachypnea). The increased metabolism also causes tachycardia, premature ventricular contractions, and muscle rigidity. The other choices (B: Fluid imbalance, C: Hemorrhage, D: Hypoxia) do not align with the given symptoms and clinical presentation of malignant hyperthermia.
Question 2 of 5
You are on-scene with a 12-year-old trauma patient who has a large laceration on the inner aspect of his upper right arm with an estimated blood loss of around 15%. The bleeding has now decreased while the patient remains conscious, alert, and anxious. His skin is warm; his heart rate is 96 bpm, and his blood pressure is 108/50. After assessing the child, you believe the patient may be in hypovolemic shock. If so, which stage of shock is the patient most likely experiencing?
Correct Answer: B
Rationale: The correct answer is B: Stage 2. In stage 2 of hypovolemic shock, the body compensates for the blood loss by increasing heart rate and maintaining blood pressure. This is seen in the patient's presentation with a heart rate of 96 bpm and a blood pressure of 108/50. The decreased bleeding and the patient being conscious, alert, and anxious also indicate early signs of shock. In stage 1, there would be no significant physiological changes yet, and in stage 3 and 4, the patient would exhibit more severe symptoms such as altered mental status, profound hypotension, and organ failure, which are not present in this case. Therefore, based on the patient's vital signs and symptoms, the most likely stage of shock the patient is experiencing is stage 2.
Question 3 of 5
You are on-scene with an adult patient who was found with an extremely altered level of consciousness, and a small amount of blood noted on his lips. There are no other obvious signs of trauma during the primary assessment other than a small tongue laceration. After ensuring an adequate airway, you discover the patient's small tongue laceration appears consistent with biting his tongue. He also has obviously swollen gums that do not appear to be caused by trauma. His vital signs are found to be within normal limits, and his pupils react to light, but his level of consciousness continues to be decreased to painful stimuli only. With the limited findings, which of the following conditions is most likely to cause the patient presentation?
Correct Answer: C
Rationale: The correct answer is C: An epileptic seizure is likely responsible for causing the patient's condition. The rationale for this is as follows: 1. Tongue biting is a common occurrence during seizures, which is consistent with the small tongue laceration observed in the patient. 2. Swollen gums that are not caused by trauma can be a sign of oral injury during a seizure due to forceful clenching of the jaw. 3. The patient's decreased level of consciousness to painful stimuli is typical after a seizure, known as the postictal state. 4. Normal vital signs and reactive pupils suggest no immediate life-threatening emergency like a diabetic seizure, metabolic coma, or cerebrovascular accident. Summary: A: A diabetic seizure is unlikely due to the absence of associated signs such as altered blood sugar levels or diabetic history. B: A metabolic coma is unlikely as vital signs are normal, and the presentation is more indicative of a seizure. D: A cerebrovascular accident is unlikely as
Question 4 of 5
You are working in a pre-hospital setting and are called for a 40-year-old male who was the victim of a stabbing. The patient has a blood pressure of 87/50 and a heart rate of 130. There is a large amount of blood on the scene. After applying direct pressure to the wound on the patient's arm and stopping the bleeding, of the following what would be the best intervention to mitigate the patient's blood pressure?
Correct Answer: D
Rationale: Correct Answer: D Rationale: Establishing an IV and administering fluid to keep the patient's BP at or near 90 systolic is the best intervention. This approach aims to increase the patient's blood volume, improve tissue perfusion, and support vital organ function. The goal is to stabilize the patient's blood pressure within a safe range to prevent further complications. This approach is a standard practice in managing hypotension due to hemorrhage. Summary: A: Administering 2 liters of fluid may be excessive and could lead to fluid overload in this scenario. B: Norepinephrine is a vasopressor and should only be considered if fluid resuscitation fails to improve the patient's blood pressure. C: Dopamine is also a vasopressor and is typically used in more severe cases of hypotension. It is not the first-line intervention in this scenario.
Question 5 of 5
Your adult trauma patient has a potential internal injury allowing bleeding into the thoracic cavity. As a general rule, where should the patient's mean arterial pressure (MAP) be maintained while treating and transporting the patient to the hospital?
Correct Answer: D
Rationale: The correct answer is D: MAP of 60 mmHg to 65 mmHg. Maintaining a MAP within this range is crucial for perfusing vital organs adequately, especially in a trauma patient with potential internal bleeding. A MAP below this range (choices A, B) can lead to inadequate tissue perfusion and organ damage. A MAP above this range (choice C) may increase the risk of exacerbating bleeding in the thoracic cavity. Therefore, maintaining a MAP of 60-65 mmHg strikes a balance between ensuring adequate organ perfusion and minimizing the risk of worsening bleeding.