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. Hypercarbia, tachypnea, tachycardia, premature ventricular contractions, and muscle rigidity are characteristic signs of malignant hyperthermia, a rare but life-threatening reaction to certain anesthetics. This condition is triggered by an abnormal response to specific anesthetic agents, leading to increased muscle metabolism, hyperthermia, and potentially fatal complications. Prompt recognition and treatment, including discontinuation of triggering agents, administration of dantrolene, and supportive care, are crucial. B: Fluid imbalance is incorrect because the symptoms described are not typically associated with fluid imbalance. C: Hemorrhage is incorrect as it does not typically present with the combination of symptoms mentioned. D: Hypoxia is incorrect as it usually presents with different clinical manifestations such as cyanosis, confusion, and respiratory distress.
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 hypovolemic shock, the body experiences inadequate blood volume due to significant blood loss. In Stage 2, compensatory mechanisms are activated to maintain blood pressure and perfusion to vital organs. The patient's initial anxiety, normal skin temperature, increased heart rate, and slightly decreased blood pressure indicate compensatory responses. Stage 1 (pre-shock) is characterized by increased heart rate with normal blood pressure. Stage 3 involves decreased blood pressure and altered mental status. Stage 4 is the irreversible stage with multi-organ failure. In this case, the patient's vital signs and clinical presentation align with Stage 2, making it the most likely stage of shock the patient is experiencing.
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. 1. Tongue biting is a common sign seen in patients experiencing an epileptic seizure due to uncontrolled muscle movements. 2. Swollen gums without obvious trauma could be a result of clenching or grinding of teeth during a seizure. 3. Altered level of consciousness to painful stimuli is consistent with post-ictal state after a seizure. 4. Normal vital signs and reactive pupils suggest a non-metabolic cause. Summary: A: Diabetic seizure is less likely as the patient's vital signs are normal. B: Metabolic coma is less likely due to the absence of metabolic abnormalities. D: Cerebrovascular accident is less likely as there are no focal neurological deficits present.
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: The correct answer is D because in this scenario, the patient is hypotensive (BP 87/50) and tachycardic (HR 130) likely due to hypovolemic shock from blood loss. The goal is to maintain perfusion to vital organs by increasing the blood pressure. Administering fluid to keep the BP at or near 90 systolic is the best initial intervention as it helps restore intravascular volume. Option A (2 liters of fluid) may be excessive without reassessment, potentially leading to fluid overload. Option B (norepinephrine drip) is more appropriate for refractory shock. Option C (dopamine drip) is not the first-line treatment for hypovolemic shock. Thus, option D is the best choice to address the patient's condition effectively.
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. This range ensures perfusion to vital organs while balancing the risk of exacerbating bleeding. A MAP below 60 mmHg may compromise organ perfusion, leading to further injury. Choice A (MAP of 50-55 mmHg) is too low and may result in inadequate perfusion. Choice B (MAP of 35-40 mmHg) is dangerously low, risking organ failure. Choice C (MAP of 85-90 mmHg) is too high, potentially increasing bleeding in the thoracic cavity. Maintaining a MAP of 60-65 mmHg is the optimal balance for this trauma patient.