A patient presents to the Level I trauma center after being involved in a 70-car pile-up on Interstate 35. He has multiple injuries and was crushed between several cars. This is a life-threatening injury, and he has severe muscle trauma. What is your suspicion regarding the possible complications this patient might be experiencing? (Select all that apply)
Hydration to prevent kidney injury from myoglobin
Rhabdomyolysis
Electrolyte monitoring, especially for potassium, to manage the risk of hyperkalemia
Acute kidney injury (AKI)
Monitoring kidney function, including creatinine, BUN, and urine output
Correct Answer : B,C,D,E
Choice A reason: Hydration is a treatment, not a complication. Rhabdomyolysis, hyperkalemia, and AKI are complications of crush injuries, with kidney function monitoring essential. This describes an intervention, not a complication, so it’s incorrect.
Choice B reason: Rhabdomyolysis is likely from severe muscle trauma in a crush injury, releasing myoglobin and electrolytes, risking kidney damage. This matches the patient’s injury, making it a correct complication.
Choice C reason: Electrolyte monitoring, especially potassium, is critical due to hyperkalemia risk from muscle breakdown. This can cause arrhythmias, making it a correct selection for complications.
Choice D reason: Acute kidney injury (AKI) is common in rhabdomyolysis, as myoglobin damages kidneys. Given the crush injury, AKI is likely, making this a correct complication.
Choice E reason: Monitoring kidney function (creatinine, BUN, urine output) detects AKI from rhabdomyolysis. This ensures timely intervention, making it a correct choice for complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Active lifestyle and community engagement are protective, not risk factors, for hip fractures. Small frame and age-related bone loss increase fracture risk, so this misidentifies beneficial factors as risks and is incorrect.
Choice B reason: Active lifestyle and social engagement may reduce risk, but the question asks for risk factors. Small frame and age-related bone loss are primary risks for Ms. Major’s fracture, so this is incorrect.
Choice C reason: Healthy diet and social support are protective, not risk factors. Ms. Major’s small frame and age (60) increase bone density loss, elevating fracture risk, so this is incorrect.
Choice D reason: Small frame and age-related bone density loss (at 60) increase Ms. Major’s hip fracture risk, as lower bone mass and aging weaken bones. These are key risk factors, making this correct.
Correct Answer is ["A","B","D"]
Explanation
Choice A reason: Yellowing of the sclera (icterus) is expected with high bilirubin in cirrhosis, as impaired liver function causes bilirubin accumulation. Conjugated bilirubin deposits in the sclera, visible early due to its vascularity, making this a correct clinical finding.
Choice B reason: Dark brown urine results from excess conjugated bilirubin excreted by the kidneys in cirrhosis. High bilirubin levels overwhelm liver clearance, leading to bilirubinuria, which darkens urine, making this a correct and common finding in this condition.
Choice C reason: Frothy light-colored urine is not associated with high bilirubin. Light urine suggests dilute urine or low bilirubin excretion, opposite to the dark urine seen in cirrhosis, making this an incorrect finding for this patient’s condition.
Choice D reason: Jaundice of the skin occurs with elevated bilirubin in cirrhosis, as bilirubin deposits in tissues. This yellowish discoloration is a hallmark of liver dysfunction, reflecting impaired bilirubin metabolism, making this a correct clinical manifestation.
Choice E reason: Bluish mucous membranes suggest cyanosis from hypoxemia, not related to high bilirubin. Cirrhosis causes jaundice, not oxygenation issues, unless complicated by other conditions, making this an incorrect finding for this patient.
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