A 43 year old male presents to the ER following an MVC with paralysis of the arms and legs and loss of sensation below the shoulders. VS: BP 70/40; HR 48; RR 16; SpO2 81%. When anticipating treatment for this patient's condition, the nurse recognizes the priority goal of treatment is to:

Increase afterload

Decrease afterload

Increase preload

Decrease preload

Answer and Explanation

The Correct Answer is A

Rationale:
A. Increase afterload is correct because the patient is experiencing neurogenic shock, a type of distributive shock caused by spinal cord injury. Loss of sympathetic nervous system tone leads to vasodilation, hypotension, and bradycardia. Increasing afterload with vasopressors helps restore vascular tone and maintain perfusion to vital organs.

B. Decrease afterload is incorrect because the patient’s vascular tone is already too low due to vasodilation. Further decreasing afterload would worsen hypotension and tissue hypoperfusion.

C. Increase preload is incorrect because although fluids may support cardiac output, the primary problem is loss of vascular tone, not inadequate blood volume. Without restoring afterload, increasing preload alone will not effectively raise blood pressure.

D. Decrease preload is incorrect because reducing preload would lower cardiac output and further compromise tissue perfusion in an already hypotensive patient.

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Correct Answer is B

Explanation

Rationale:
A. Inserting an indwelling urinary catheter may be necessary for accurate monitoring of urine output in burn patients, but it is not the immediate priority in the emergency assessment. Urinary monitoring is important after airway and breathing have been assessed and stabilized.
B. Inspecting the mouth for signs of inhalation injury is the priority action. Burns involving the face, neck, and chest place the client at high risk for airway compromise from edema, soot, or inhaled heat and smoke. Airway management follows the “Airway, Breathing, Circulation” (ABC) approach, and early identification of inhalation injury can be life-saving.
C. Administering intravenous pain medication is important for comfort and to reduce stress response, but it does not take priority over assessing and securing the airway in a burn patient. Pain management should be initiated after life-threatening conditions are addressed.
D. Drawing blood for a CBC helps assess hemoglobin, hematocrit, and infection risk, but laboratory evaluation is not an immediate life-saving intervention. It is secondary to airway assessment and stabilization.

A. A 35 year old pregnant client with placenta previa B. A 42 year old client with a pulmonary embolus C. A 60 year old client receiving hemodialysis 3 days a week D. A 78 year old client with septicemia

Correct Answer is D

Explanation

Rationale:
A. Placenta previa involves abnormal placental implantation and bleeding, but it is not commonly associated with DIC unless complicated by abruptio placentae or massive hemorrhage. While obstetric complications can trigger DIC, placenta previa alone is a lower risk factor.
B. Pulmonary embolus involves vascular obstruction by a clot, but it does not typically trigger the widespread activation of clotting and fibrinolysis seen in DIC. PE primarily causes localized thrombotic events rather than systemic coagulation.
C. Clients receiving hemodialysis may be at risk for bleeding or clotting issues due to anticoagulation during dialysis, but this is not a major precipitating factor for DIC.
D. Septicemia is one of the most common causes of DIC. In severe sepsis, widespread infection triggers systemic inflammation, endothelial damage, and uncontrolled activation of the coagulation cascade. This results in both microvascular clot formation and bleeding tendencies, which are hallmark features of DIC. Therefore, the 78-year-old client with septicemia is at the highest risk.

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A 43 year old male presents to the ER following an MVC with paralysis of the arms and legs and loss of sensation below the shoulders. VS: BP 70/40; HR 48; RR 16; SpO2 81%. When anticipating treatment for this patient's condition, the nurse recognizes the priority goal of treatment is to:

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Naxlex Comprehensive Predictor Exams

A nurse in an emergency room is caring for the client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?

Correct Answer is B

Explanation

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)?

Correct Answer is D

Explanation

The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's central venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are clear, and jugular veins are flat. Which of these actions is most appropriate for the nurse to take?

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?

A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first?

Four victims of an automobile crash are brought by ambulance to the emergency department. The triage nurse determines that the victim who has the highest priority for treatment is the one with

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?

You are the RN caring for a multiple truama victim in the ICU. The patient's vital signs are as follows: BP: 100/60; HR: 110; RR 20. Calculate the mean arterial pressure.

Which of the following clinical manifestations are suggestive of the systemic inflammatory response syndrome (SIRS)? Select all that apply.

Why are narcotics given intravenously to manage pain during initial management of the patient with burns?