A nurse is caring for a patient who experienced a cervical spine injury 12 hours ago and is experiencing spinal shock. Which of the following medications should the nurse anticipate giving?
Albumin
Nitroprusside
Dexamethasone
Furosemide
The Correct Answer is C
Choice A reason: Albumin is a plasma expander and is typically used to restore blood volume in cases of shock, burns, or trauma. However, it is not specifically indicated for managing spinal shock. Albumin helps in maintaining osmotic pressure and fluid balance but does not directly address the underlying pathophysiology of spinal shock.
Choice B reason: Nitroprusside is a potent vasodilator used to manage hypertensive crises. It works by rapidly reducing blood pressure through vasodilation. In the context of spinal shock, where hypotension is a concern, administering nitroprusside would be inappropriate as it could exacerbate the hypotensive state and worsen the patient's condition.
Choice C reason: Dexamethasone, a corticosteroid, is used to reduce inflammation and edema around the spinal cord following an injury. The anti-inflammatory properties of dexamethasone help to mitigate secondary damage caused by swelling and pressure on the spinal cord tissue. It is commonly administered in cases of acute spinal cord injuries to improve neurological outcomes and manage symptoms of spinal shock.
Choice D reason: Furosemide is a diuretic used to manage fluid overload and edema. It works by increasing urine output, which can help reduce fluid retention in various conditions, such as heart failure and renal impairment. However, it is not specifically indicated for the management of spinal shock and does not address the underlying causes of spinal cord injury-related inflammation and edema.
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Correct Answer is D
Explanation
Choice A reason: Suctioning the patient immediately is not the appropriate intervention in this context. Suctioning can be necessary if the patient has secretions obstructing the airway, but it does not address the issues of bradycardia (low heart rate) and hypotension (low blood pressure) which are critical in a spinal cord injury.
Choice B reason: Administering normal saline (NS) at 25 cc/hr is not sufficient to address the patient's hypotension. In a patient with a spinal cord injury at the T5 level, hypotension is likely due to neurogenic shock, and more aggressive fluid resuscitation or pharmacological support is needed.
Choice C reason: Raising the head of the bed is not appropriate for managing the patient's condition. In fact, keeping the head elevated can worsen hypotension by reducing venous return to the heart. The focus should be on stabilizing blood pressure and heart rate.
Choice D reason: The correct intervention is starting a dopamine IV drip. Dopamine is a vasopressor that helps increase blood pressure and heart rate, which is crucial in managing neurogenic shock. By administering dopamine, the nurse can help stabilize the patient's cardiovascular status and improve perfusion to vital organs.
Correct Answer is A
Explanation
Choice A reason: Arterial Blood Gas (ABG) analysis is the best method to determine the effectiveness of treatments for a client in acute respiratory failure who is receiving mechanical ventilation. ABG provides essential information about the patient's oxygenation status, carbon dioxide levels, and acid-base balance. It allows healthcare providers to assess how well the lungs are oxygenating the blood and removing carbon dioxide. By analyzing the ABG results, the effectiveness of the mechanical ventilation and any necessary adjustments can be made to improve the client's respiratory status.
Choice B reason: Blood pressure monitoring is important for evaluating the overall cardiovascular status of a patient but is not the most specific assessment for determining the effectiveness of treatments in acute respiratory failure. While blood pressure can provide indirect information about cardiac output and perfusion, it does not directly reflect the patient's oxygenation and ventilation status, which are critical in the context of respiratory failure.
Choice C reason: Heart rate monitoring is useful for assessing the patient's hemodynamic status and detecting potential arrhythmias or other cardiac issues. However, it does not provide specific information about the effectiveness of treatments for acute respiratory failure. Heart rate alone cannot indicate how well the lungs are functioning or how effectively mechanical ventilation is supporting the patient's respiratory needs.
Choice D reason: Capillary refill is a simple and quick assessment of peripheral perfusion, indicating how well the blood is flowing to the extremities. While it can provide some information about the patient's circulatory status, it is not a reliable method for determining the effectiveness of treatments in acute respiratory failure. Capillary refill does not provide direct information about oxygenation, ventilation, or the overall respiratory status of the patient.
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