It is the summer season, and patients with signs and symptoms of heat-related illness present in the ED. Which patient needs attention first?
An elderly person complains of dizziness and syncope after standing in the sun for several hours to view a parade.
A marathon runner complains of severe leg cramps and nausea. Tachycardia, diaphoresis, pallor, and weakness are observed.
A previously healthy homemaker reports broken air conditioner for days. Tachypnea, hypotension, fatigue, and profuse diaphoresis are observed.
A homeless person, poor historian, presents with altered mental status, poor muscle coordination, and hot, dry, ashen skin. Duration of exposure is unknown.
The Correct Answer is D
Rationale:
A. The elderly person with dizziness and syncope is experiencing heat exhaustion or early heat-related illness. While they require care, this condition is less immediately life-threatening than heat stroke.
B. The marathon runner with leg cramps, nausea, tachycardia, diaphoresis, pallor, and weakness is likely experiencing heat cramps or heat exhaustion. These patients are seriously uncomfortable and at risk, but they retain mental status and perfusion, making them lower priority than someone with altered mental status.
C. The homemaker with tachypnea, hypotension, fatigue, and profuse diaphoresis is experiencing progressive heat exhaustion. Although this is serious, the patient is still conscious and sweating, indicating that thermoregulation is still somewhat intact.
D. The homeless person with altered mental status, poor muscle coordination, hot, dry, ashen skin, and unknown duration of heat exposure is experiencing classic heat stroke, a life-threatening emergency. Heat stroke is characterized by central nervous system dysfunction and inability to regulate body temperature. Immediate intervention is required to cool the patient and prevent multi-organ failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is B
Explanation
Rationale:
A. Increasing oral fluids may support hydration, but in a patient with burns covering 45% of the body, the patient may already have complex fluid and electrolyte needs. Fluid management alone does not address the possibility of a life-threatening infection such as sepsis.
B. Notifying the primary care provider is the priority. Burns covering a large body surface area significantly increase the risk of infection and sepsis. A new fever accompanied by acute changes in mental status (agitation and confusion) are early signs of sepsis or systemic infection. Early recognition and prompt intervention, including possible blood cultures, antibiotics, and supportive care, are critical to prevent rapid deterioration.
C. Monitoring for further changes in mental status is important, but it is not the first action. Waiting to see if the patient worsens delays essential medical intervention for a potential life-threatening infection.
D. Administering acetaminophen can reduce fever temporarily, but it does not treat the underlying infection and could mask a key early indicator of sepsis. Treating the symptom without addressing the cause could delay urgent care.
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