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

controlled bleeding of facial and head lacerations (no blood in oropharynx).

an open femur fracture with controlled bleeding.

a tension pneumothorax.

a pneumothorax.

Answer and Explanation

The Correct Answer is C

Rationale:
A. Controlled bleeding of facial and head lacerations is incorrect because while facial lacerations require care, the bleeding is controlled and there is no airway compromise, making it a lower priority than life-threatening injuries.

B. Open femur fracture with controlled bleeding is incorrect because even though femur fractures can lead to significant blood loss, the bleeding is controlled, and the patient is hemodynamically stable, so airway or circulation threats take priority.

C. Tension pneumothorax is correct because it is a life-threatening emergency. Signs include respiratory distress, hypotension, absent breath sounds on the affected side, and distended neck veins. Immediate intervention with needle decompression followed by chest tube placement is required to prevent cardiac arrest and death.

D. Pneumothorax is incorrect because a simple pneumothorax may be serious but is usually less immediately life-threatening than a tension pneumothorax. It can often be monitored and treated after emergent life-threatening conditions are addressed.

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Correct Answer is B

Explanation

Rationale:

A. There is no strict requirement for the patient’s heart rate to be below 100 before starting norepinephrine. Tachycardia is a normal compensatory mechanism in hypovolemic shock, as the body attempts to maintain cardiac output in the setting of decreased circulating volume. Administering norepinephrine will increase vascular resistance, which may further elevate heart rate temporarily. Focusing solely on heart rate without addressing volume status would not correct the underlying problem.

B. This is the most critical step. Hypovolemic shock is caused by a significant loss of circulating blood or fluid, resulting in low preload (the volume of blood returning to the heart), decreased stroke volume, and hypotension. Vasopressors like norepinephrine act primarily to constrict blood vessels and raise systemic vascular resistance, which increases blood pressure. However, if the intravascular volume is severely depleted, vasoconstriction alone cannot restore adequate cardiac output or tissue perfusion. Administering norepinephrine before fluid resuscitation can worsen organ ischemia, particularly in the kidneys, heart, and gastrointestinal tract, because there is not enough circulating volume to perfuse tissues despite the increased vascular tone. Therefore, ensuring adequate fluid replacement through IV boluses is a prerequisite to safely and effectively using norepinephrine in hypovolemic shock.

C. Urine output is an important indicator of renal perfusion and organ function. While monitoring it is essential in shock management, it is not a requirement before starting norepinephrine. Urine output may already be low in hypovolemic shock due to reduced renal perfusion, and fluid resuscitation is aimed at improving it. Norepinephrine can help maintain blood pressure and organ perfusion, but it cannot correct volume depletion alone.

D. Concurrent use of other sympathomimetics can increase the risk of excessive vasoconstriction, arrhythmias, or hypertension. While this is important to consider, the priority in hypovolemic shock is restoring circulating volume, not avoiding drug interactions, because volume replacement is the cornerstone of treatment.

A. Blood pressure 92/50 mm Hg B. Heart rate 92/min C. Abdominal pain rated 6 on a scale of 0 to 10 D. Respiratory rate 22/min

Correct Answer is A

Explanation

Rationale:
A. Blood pressure of 92/50 mm Hg is the priority finding because it indicates hypotension, which may be a sign of internal bleeding or shock following blunt abdominal trauma. Maintaining perfusion to vital organs is the highest priority according to the ABCs (Airway, Breathing, Circulation). Early hypotension in trauma is a late and critical sign of blood loss, making this the most urgent concern.

B. Heart rate of 92/min is slightly elevated for an adolescent but not critically abnormal. While tachycardia can indicate early shock, it is a compensatory response and less immediately life-threatening than hypotension.

C. Abdominal pain rated 6/10 indicates tissue injury or internal trauma, but pain severity alone does not guide immediate life-saving interventions. Monitoring and pain management are important but secondary to assessing circulation.

D. Respiratory rate of 22/min is slightly elevated but within mild tachypnea range for an adolescent. While important to monitor for respiratory compromise, it is not as urgent as hypotension in the context of trauma.

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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

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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