A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiraton. What action by the healthcare professional is the priority?

Assist with a chest tube insertion

Give the patient low-flow oxygen

Assess for clubbing of fingernails

Draw arterial gases

Answer and Explanation

The Correct Answer is A

A. Assist with a chest tube insertion: A gunshot wound to the chest with a one-way valve pleural rupture indicates a tension pneumothorax, a life-threatening condition. Air enters the pleural space with each breath but cannot escape, leading to increased intrathoracic pressure, lung collapse, and mediastinal shift, which can compromise venous return and cardiac output. Immediate chest tube insertion or needle decompression is necessary to relieve pressure and restore normal lung function.

B. Give the patient low-flow oxygen: Oxygen therapy may help improve oxygenation, but it does not address the underlying issue of trapped air causing intrathoracic pressure buildup. Without intervention to release the trapped air, respiratory distress and cardiovascular collapse can occur.

C. Assess for clubbing of fingernails: Clubbing is a sign of chronic hypoxia seen in long-term respiratory diseases but is not relevant in the acute management of a tension pneumothorax. The priority is to relieve the trapped air and restore normal lung expansion.

D. Draw arterial gases: While arterial blood gases can help assess oxygenation and ventilation status, they do not treat the underlying tension pneumothorax. Immediate decompression is required before diagnostic tests to prevent rapid deterioration and potential cardiac arrest.

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Correct Answer is A

Explanation

A. Hospital-acquired pneumonia: Pneumonia that develops 48 hours or more after hospital admission is classified as hospital-acquired pneumonia (HAP). It is caused by pathogens acquired in the hospital setting, often involving multidrug-resistant organisms such as Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA), and Klebsiella pneumoniae. Patients who are intubated, have prolonged hospital stays, or have weakened immune defenses are at higher risk.

B. Immunocompromised pneumonia: Pneumonia in immunocompromised patients occurs due to weakened host defenses, such as in individuals with HIV/AIDS, those undergoing chemotherapy, or transplant recipients on immunosuppressive therapy. While these patients can develop HAP, pneumonia due to opportunistic infections like Pneumocystis jirovecii or fungal infections is categorized separately.

C. Community-acquired pneumonia: Pneumonia acquired outside the hospital or within the first 48 hours of admission is classified as community-acquired pneumonia (CAP). Typical pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae. CAP is usually less resistant to antibiotics compared to HAP.

D. Viral pneumonia: Pneumonia caused by viral pathogens such as influenza, respiratory syncytial virus (RSV), or SARS-CoV-2 is classified based on the causative agent rather than the setting in which it was acquired. Although viruses can cause both CAP and HAP, the classification of pneumonia is determined by the timing of onset and exposure risks.

A. Atherosclerotic lesion B. Myocardial necrosis C. Myocardial ischemia D. Hyperlipidemia

Correct Answer is C

Explanation

A. Atherosclerotic lesion: An atherosclerotic lesion can lead to reduced blood flow to the myocardium, but it is not the direct trigger for angina pectoris. Rather, it is a contributing factor to the development of conditions that cause angina.

B. Myocardial necrosis: Myocardial necrosis refers to irreversible cell damage due to prolonged ischemia, such as in a myocardial infarction. This is not a trigger for angina pectoris but rather a consequence of severe and prolonged ischemia.

C. Myocardial ischemia: Myocardial ischemia is the primary trigger for angina pectoris. It occurs when there is an imbalance between the oxygen supply and demand in the heart muscle, typically due to narrowed coronary arteries. This insufficient blood flow results in chest pain or discomfort characteristic of angina.

D. Hyperlipidemia: Hyperlipidemia is a risk factor for atherosclerosis and subsequent coronary artery disease but does not directly trigger angina pectoris. It contributes to the underlying processes that lead to myocardial ischemia.

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Naxlex Comprehensive Predictor Exams

A pneumonia that occurs 48 hours or more after admission to the hospital is considered:

Correct Answer is A

Explanation

What is the trigger for angina pectoris?

Correct Answer is C

Explanation

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