To establish a diagnosis of shock, which is true?

Correct Answer: C

Rationale: Step 1: Establishing a diagnosis of shock involves assessing for clinical evidence of inadequate organ perfusion, such as altered mental status, tachycardia, and cool clammy skin. Step 2: This clinical evidence is crucial as it indicates the body's organs are not receiving enough oxygen and nutrients due to poor perfusion. Step 3: Identifying inadequate organ perfusion helps differentiate shock from other conditions with similar symptoms. Step 4: The other choices are incorrect because systolic blood pressure alone is not sufficient for diagnosing shock (A), closed head injury is not a defining feature of shock (B), and response to fluid infusion is important but not the sole criterion (D). Summary: Choice C is correct as it focuses on the key clinical feature of inadequate organ perfusion, while the other choices either focus on single parameters or unrelated conditions.

Correct Answer: D

Rationale: The correct answer is D: Performing lower extremity fasciotomies. In this scenario, the man's leg was trapped under the car for a prolonged period, leading to potential compartment syndrome. Fasciotomies can release pressure in the compartments, improving blood flow and potentially salvaging the limb. A: Applying skeletal traction may help stabilize the leg, but it does not address the underlying compartment syndrome. B: Administering anticoagulant drugs is not indicated for compartment syndrome and may increase the risk of bleeding. C: Administering thrombolytic therapy is not appropriate for compartment syndrome and may lead to further complications. In summary, lower extremity fasciotomies are the most appropriate intervention to improve chances for limb salvage in this case.

Correct Answer: D

Rationale: The correct answer is D: Presence of hemotympanum. Hemotympanum is indicative of a basilar skull fracture, which can lead to intracranial bleeding and brain injury. CT scan is necessary to evaluate for intracranial injuries in this case. A: Blood alcohol concentration is not an indication for CT in this scenario. B: A scalp laceration alone does not warrant a CT scan for traumatic brain injury. C: Mandibular fracture does not directly indicate traumatic brain injury and is not a reason for CT in this case.

Correct Answer: A

Rationale: The correct answer is A because initial resuscitation in adult patients should focus on restoring intravascular volume, which is effectively achieved with 1-2L of crystalloid fluids. This helps improve tissue perfusion and overall hemodynamics. Monitoring the patient's response (choice B) is important but secondary to the immediate need for volume replacement. Using crystalloid to normalize blood pressure (choice C) is not recommended as the sole goal, as other factors like tissue perfusion also need to be considered. Permissive hypotension (choice D) is contraindicated in patients with head injury as it can worsen brain perfusion.

Correct Answer: A

Rationale: The correct answer is A: The nurse. Nurses are trained to assess residents, monitor their progress, and administer treatments and medication. They have the expertise and knowledge to provide comprehensive care. Nursing assistants (B) assist with daily living activities but do not have the same scope of practice. Medical social workers (C) focus on social and emotional aspects of care. Registered dietitians (D) specialize in nutrition management, not direct patient care like assessing and administering treatments. Thus, the nurse is the most appropriate member of the care team for these responsibilities.