Which of the following signs of increased intracranial pressure (ICP) would appear first after head trauma?
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Solution
The earliest sign of increased ICP is a change in mental status.
Option A: Bradycardia and widened pulse pressure occur later.
Option B: The patient may void a lot of very dilute urine if his posterior pituitary is damaged.
Which of the following nursing interventions should you use to prevent footdrop and contractures in a patient recovering from a subdural hematoma?
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Solution
High-top sneakers are used to prevent foot drop and contractures in patients with neurologic conditions.
Option C: A consult with physical therapy is important to prevent foot drop, but you can use high-top sneakers independently.
Which of the following measures best determines that a patient who had a pneumothorax no longer needs a chest tube?
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Solution
The chest tube isn’t removed until the patient’s lung has adequately re-expanded and is expected to stay that way. One indication of reexpansion is the cessation of fluctuation in the water-seal chamber when suction isn’t applied.
Option A: Drainage should be minimal before the chest tube is removed.
Option B: An ABG test isn’t necessary if clinical assessment criteria are met.
Option C: The chest X-ray should show that the lung is re-expanded.
A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions has he most likely developed?
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Solution
Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren’t typically associated with smoke inhalation.
A 19-year-old patient comes to the ED with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should you take first?
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Solution
The patient having an acute asthma attack needs more oxygen delivered to his lungs and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered.
Options A and D: Important but not a priority as of the moment; emotional support can help calm the patient but can be done after medical intervention.
Option C: The patient may not need cardiac monitoring because he’s only 19 years old unless he has a medical history of cardiac problems.
A 20-year-old patient is being treated for pneumonia. He has a persistent cough and complains of severe pain on coughing. What could you tell him to help him reduce his discomfort?
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Solution
Showing this patient how to splint his chest wall will help decrease discomfort when coughing.
Option A: Holding in his coughs will only increase his pain.
Option B: Placing the head of the bed flat may increase the frequency of his cough and his work of breathing.
Option C: Increasing fluid intake will help thin the secretions, making it easier for him to clear them.
A patient infected with human immunodeficiency virus (HIV) begins zidovudine therapy. Which of the following statements best describes this drug’s action?
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Solution
Zidovudine inhibits DNA synthesis in HIV, thus interfering with viral replication. The drug doesn’t destroy the viral wall, stimulate the immune system, or promote HIV antibody excretion.
Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?
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Solution
Corticosteroids suppress eosinophils, lymphocytes, and natural-killer cells, inhibiting the natural inflammatory process in an infected or injured part of the body. This helps resolve inflammation, stabilizes lysosomal membranes, decreases capillary permeability, and depresses phagocytosis of tissues by white blood cells, thus blocking the release of more inflammatory materials. Excessive corticosteroid therapy can lead to Cushing’s syndrome.
A 16-year-old patient involved in a motor vehicle accident arrives in the ED unconscious and severely hypotensive. He’s suspected to have several fractures of his pelvis and legs. Which of the following parenteral fluids is the best choice for his current condition?
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Solution
In a trauma situation, the first blood product given is unmatched (O negative) packed red blood cells.
Option A: Fresh frozen plasma often is used to replace clotting factors.
Options B and C: Lactated Ringer’s solution or 0.9% sodium chloride is used to increase volume and blood pressure, but too much of these crystalloids will dilute the blood and won’t improve oxygen-carrying capacity.
A pregnant woman arrives at the emergency department (ED) with abruptio placentae at 34 weeks’ gestation. She’s at risk for which of the following blood dyscrasias?
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Solution
Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage.
Option A: Thrombocytopenia results from decreased production of platelets.
Option B: ITP doesn’t have a definitive cause.
Option D: A patient with abruptio placentae wouldn’t get heparin and, as a result, wouldn’t be at risk for HATT.