A 45-year-old male patient is admitted to the emergency department following a severe motor vehicle accident. He is hypotensive (BP 85/50 mmHg tachycardic (HR 120 bpm), and showing signs of confusion. His skin is cold, pale, and clammy, and his urine output has significantly decreased. The patient is in distress, and an initial assessment suggests a lack of perfusion to the organs.
Which component of the cardiovascular system is most likely involved in this patient's shock symptoms?
Blood volume
Blood flow
Myocardial contractility
Vascular resistance
The Correct Answer is A
A. Blood volume: The patient exhibits hypotension, tachycardia, cold clammy skin, decreased urine output, and confusion, all consistent with hypovolemic shock. Hypovolemic shock results from a significant loss of circulating blood or fluid, leading to inadequate perfusion of organs.
B. Blood flow: Blood flow is affected downstream by factors such as blood volume, cardiac output, and vascular resistance. While perfusion is compromised, the primary issue here is volume loss rather than intrinsic flow obstruction.
C. Myocardial contractility: Impaired myocardial contractility can cause cardiogenic shock. The patient’s history of trauma and fluid loss points more toward hypovolemic shock rather than primary heart failure.
D. Vascular resistance: Abnormal vascular resistance is the main factor in distributive shock (e.g., septic or anaphylactic). The clinical presentation of trauma, hypotension, and signs of volume depletion indicates volume deficit rather than vasodilation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. NIH Stroke Scale: The National Institutes of Health Stroke Scale (NIHSS) is used to assess the severity of neurological deficits in stroke patients. It evaluates level of consciousness, language, visual fields, motor function, and sensory abilities, providing a standardized score to guide treatment decisions and monitor progression.
B. Cincinnati Stroke Scale: The Cincinnati Prehospital Stroke Scale is a quick screening tool used by emergency responders to identify possible strokes in the field. It assesses facial droop, arm drift, and speech abnormalities but does not quantify stroke severity.
C. Glasgow Outcome Scale: The Glasgow Outcome Scale measures functional recovery and long-term outcomes after brain injury, not the acute severity of stroke symptoms at presentation.
D. Hemorrhage Scale: Hemorrhage scales, such as the Fisher scale, are used to grade the extent of bleeding on imaging studies. They do not provide a structured assessment of neurological deficits in acute stroke patients.
Correct Answer is C
Explanation
A. Infuse 1 unit of platelet: Platelet transfusion is indicated for thrombocytopenia or active bleeding related to low platelet counts. Acute adrenal insufficiency does not involve platelet depletion or coagulation defects. This intervention does not address the underlying hormonal crisis.
B. Restrict daily fluid intake: Clients with acute adrenal insufficiency are at risk for hypovolemia and hypotension due to aldosterone deficiency. Fluid restriction would worsen dehydration and circulatory collapse. Fluid replacement is typically required rather than restriction.
C. Admin hydrocortisone sodium: Acute adrenal insufficiency requires immediate glucocorticoid replacement to restore cortisol levels. Hydrocortisone sodium provides both glucocorticoid and some mineralocorticoid effects, helping stabilize blood pressure and metabolism. Prompt administration is critical to prevent adrenal crisis complications.
D. Give oral spironolactone: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. In adrenal insufficiency, aldosterone levels are already low, making this medication inappropriate. Its use could worsen hyperkalemia and hypotension.
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