ATI RN
Basic Care of a Paraplegic Patient Questions
Question 1 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 2 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 3 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.
Question 4 of 5
A 6-year-old boy is struck by an automobile and brought to the E The preferred route of venous access in this patient is:
Correct Answer: D
Rationale: The correct answer is D: Percutaneous peripheral veins in the upper extremities. In a pediatric patient with trauma, percutaneous peripheral veins in the upper extremities are preferred due to easier accessibility, lower risk of complications compared to femoral vein cannulation, less invasive than intraosseous catheter placement, and more practical than saphenous vein cutdown since it allows for rapid IV access. In emergencies, quick and efficient venous access is crucial for administering fluids and medications, making peripheral veins in the upper extremities the preferred choice in this scenario.
Question 5 of 5
A cross-table lateral x-ray of the cervical spine:
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct: 1. A cross-table lateral x-ray of the cervical spine is crucial for evaluating cervical spine injuries. 2. It allows visualization of all 7 cervical vertebrae and the C-7 to T-1 relationship. 3. This comprehensive view helps in identifying any fractures or dislocations accurately. 4. Missing any part of the cervical spine can lead to overlooking potential injuries. 5. Therefore, ensuring visualization of all 7 vertebrae and the C-7 to T-1 relationship is essential for an accurate assessment. Summary of why other choices are incorrect: - Choice A is incorrect because obtaining the x-ray does not necessarily have to precede endotracheal intubation. - Choice B is incorrect because a cross-table lateral x-ray does not always exclude serious cervical spine injuries; it helps in identifying them. - Choice D is incorrect because even unconscious patients with penetrating cervical injuries may require a cross-table lateral x-ray for accurate