A 20-year-old male client arrives at the emergency department. He is conscious, coherent, and ambulatory, but his shirt and pants are covered with blood. He and his hysterical friends are yelling and trying to explain that they were playing around and he got poked in the abdomen with a stick. Which of the following comments should be given first consideration?

"He's a diabetic, so he needs attention right away."

"There was a lot of blood and we used three bandages."

"The stick was really dirty and covered in mud."

"He pulled the stick out, just now, because it was hurting him."

Answer and Explanation

The Correct Answer is D

Rationale:
A. Knowing a patient is diabetic is important for overall care and monitoring for complications like delayed wound healing or hypoglycemia, but it is not the most urgent factor in assessing immediate injury.

B. Information about the amount of blood and bandages provides context but does not specify the mechanism of injury or internal risk, which is critical in trauma assessment.

C. A contaminated stick increases the risk for infection, but infection is a delayed concern compared to the potential for internal bleeding or organ injury from the stick penetrating the abdomen.

D. The fact that the patient pulled the stick out himself is the most critical information. Removal of an impaled object in the field or before proper medical evaluation can lead to sudden hemorrhage, organ damage, or shock. This comment indicates a high risk of ongoing internal bleeding, which requires immediate assessment and intervention.

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Correct Answer is D

Explanation

Rationale:
A. Preventing infarcts or emboli is not the primary purpose of vasoactive medications. While some anticoagulants may reduce clot formation, vasoactive drugs are focused on hemodynamic support, not clot prevention.

B. Limiting stroke volume and cardiac output is counterproductive in shock. Shock occurs due to inadequate tissue perfusion, and decreasing cardiac output would worsen hypoperfusion and organ dysfunction.

C. Preventing pulmonary and peripheral edema is a secondary concern. While careful fluid management and some medications can reduce edema, vasoactive agents do not primarily target fluid accumulation.

D. The primary goal of vasoactive medications (such as dopamine, norepinephrine, or phenylephrine) is to maintain adequate mean arterial pressure (MAP) to ensure perfusion of vital organs. In shock, blood pressure may fall due to hypovolemia, vasodilation, or cardiac dysfunction. Vasoactive drugs constrict blood vessels and/or increase cardiac output, supporting MAP and improving tissue oxygen delivery. Maintaining an adequate MAP (usually ≥65 mm Hg) is crucial to prevent organ ischemia and progression to multi-organ failure.

A. Anaphylactic shock B. Neurogenic shock C. Septic shock D. Hypovolemic shock

Correct Answer is B

Explanation

Rationale:
A. Anaphylactic shock is incorrect because it typically presents with hypotension, tachycardia, and warm, flushed skin, often accompanied by airway compromise, urticaria, or angioedema. The patient’s bradycardia and mechanism of injury do not support anaphylaxis.

B. Neurogenic shock is correct because the patient has a spinal cord injury (neck injury) with hypotension and bradycardia, and warm, dry skin. Neurogenic shock occurs due to loss of sympathetic tone, leading to vasodilation (causing hypotension) and unopposed parasympathetic activity (causing bradycardia). Skin is warm and dry because there is loss of vasoconstriction and inability to sweat below the injury level.

C. Septic shock is incorrect because septic shock usually presents with hypotension, tachycardia, and warm, flushed skin, often after infection. This patient’s scenario is acute trauma, not infection, and bradycardia is not typical in septic shock.

D. Hypovolemic shock is incorrect because hypovolemic shock is usually associated with tachycardia, hypotension, and cool, clammy skin due to peripheral vasoconstriction. The patient’s warm, dry skin and bradycardia are inconsistent with hypovolemic shock.

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Naxlex Comprehensive Predictor Exams

The critical care nurse is preparing to initiate an infusion of a vasoactive medication to a patient in shock. The nurse knows that vasoactive medications are given in all forms of shock. What is the primary goal of this aspect of treatment?

Correct Answer is D

Explanation

Correct Answer is B

Explanation

Ten minutes following administration of an antibiotic, the nurse assesses a patient to have edematous lips, hoarseness, and expiratory stridor. Vital signs assessed by the nurse include blood pressure 70/40 mm Hg, heart rate 130 beats/min, and respirations 36/min. What is the priority intervention?

A nurse assessing a client determines that he is in the compensatory stage of shock. Which of the following findings support this conclusion?

A nurse is caring for a client who is in the compensatory stage of shock. Which of the following findings should the nurse expect?

A patient is admitted to the ED after being involved in a motor vehicle crash. The patient has multiple injuries. After establishing an airway and adequate ventilation, the ED team should prioritize what aspect of care?

You have just admitted a patient to the ED following a fall from a first floor hotel balcony. The patient is 22 years old and smells of alcohol. The patient begins to vomit in the ED. Which of the following interventions is most appropriate?

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention?

The nurse is caring for a patient admitted to the burn unit with burns to 45% of the body. After 3 days, the nurse notes that the patients temperature is newly elevated at 100.2F (37.9C), and the patient exhibits new-onset agitation and confusion. What should the nurse do first?