ATI RN
A Review of Basic Patient Rights in Psychiatric Care Questions
Question 1 of 5
You are on-scene with a 55-year-old cardiac history patient who suddenly collapsed during dinner with his family. He is found to be pulseless and apneic with his family performing adequate CPR on arrival. His wife is distraught and hands you a legal DNR order signed by his physician. She states that he does not have a terminal illness and begs you to ignore the legal order and 'do everything in your capabilities to save him!' Which of the following would be most appropriate in this situation?
Correct Answer: D
Rationale: The correct answer is D: Initiate full resuscitation efforts including advanced cardiac life support, and contact medical control. Rationale: 1. Patient is pulseless and apneic, indicating cardiac arrest. 2. Legal DNR order does not apply in this scenario as patient's collapse is sudden and not anticipated. 3. The priority is to provide immediate life-saving measures. 4. Advanced cardiac life support increases chances of successful resuscitation. 5. Contacting medical control ensures appropriate guidance and documentation. Summary: A: Waiting for approval could delay critical interventions. B: Stopping resuscitation based solely on the legal DNR order is inappropriate in this emergency. C: Allowing the family to override the legal order puts the patient at risk and is not recommended.
Question 2 of 5
Which one of the following signs necessitates a definitive airway in severe trauma patients?
Correct Answer: C
Rationale: The correct answer is C: Severe maxillofacial fractures. These fractures can lead to airway compromise due to obstruction by displaced bone fragments or soft tissue swelling. Definitive airway management is crucial in these cases to ensure adequate oxygenation. Facial lacerations (A) may require suturing but do not necessarily indicate the need for a definitive airway. Repeated vomiting (B) can be managed with positioning and antiemetics, not always requiring an airway intervention. Sternal fracture (D) may cause pain and difficulty breathing but does not directly impede the airway, making it less likely to necessitate definitive airway management.
Question 3 of 5
The least likely cause of a depressed level of consciousness in the multisystem injured patient is:
Correct Answer: C
Rationale: The correct answer is C: Hyperglycemia. In a multisystem injured patient, hyperglycemia is the least likely cause of a depressed level of consciousness because it typically does not directly affect brain function or consciousness. Shock (A), head injury (B), and impaired oxygenation (D) are more likely to cause a depressed level of consciousness in this patient population due to their direct impact on brain perfusion, injury, and oxygen delivery, respectively. Hyperglycemia, although an important consideration in the critically ill patient, is not a primary driver of altered consciousness in the setting of multisystem trauma.
Question 4 of 5
A 40 year old obese patient with GCS of 8 requires a CT scan. Before transfer to the scanner, you should:
Correct Answer: B
Rationale: The correct answer is B: Insert a definitive airway. In a patient with a GCS of 8, airway management is a priority. Inserting a definitive airway ensures proper oxygenation and ventilation during the CT scan, reducing the risk of hypoxia or respiratory compromise. This step takes precedence over giving more sedative drugs (A), as ensuring adequate oxygenation is critical in a patient with altered mental status. Inserting a multilumen esophageal airway (C) is not indicated in this scenario, as it is primarily used for airway management during surgery. Requesting a lateral cervical spine film (D) is not necessary before a CT scan in this case, as securing the airway takes precedence over ruling out cervical spine injury.
Question 5 of 5
A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed in the chest. There is a 3cm wound just medial to the left nipple. His BP is 70/33 and HR is 140. Neck and arm veins are distende Breath sounds are normal. Heart sounds are diminished, IV access has been established and warm crystalloid is infusing. The next most important aspect of immediate management is:
Correct Answer: C
Rationale: The correct answer is C: "FAST exam." In this scenario, the patient presents with signs of hypovolemic shock likely due to internal bleeding from the chest wound. FAST exam (Focused Assessment with Sonography in Trauma) is a rapid bedside ultrasound used to assess for free fluid in the abdomen or pericardium, which can help identify the source of bleeding. This is crucial for immediate management as it can guide further interventions such as surgery or angiography. Choice A: "CT scan of the chest" is not the most immediate step as it takes time and may not provide rapid information needed for immediate management. Choice B: "12 lead ECG" is not the priority in this situation as the patient is hemodynamically unstable and requires rapid assessment for potential life-threatening bleeding. Choice D: "Begin infusion of RBCs" is important, but identifying the source of bleeding is crucial before deciding on the need for blood transfusion.