Ms. Jonus, an 82-year-old female presents to the Emergency Department (ED) after being involved in a motor vehicle collision (MVC). Ms. Jonus was stopped at a stop sign when she was rear-ended by a vehicle at a high speed. The MVC occurred across the street from the hospital, and the elderly woman was able to extricate herself from the vehicle and stumble into the ED with the assistance of the paramedic. She appears pale, diaphoretic, and disoriented. She has an abnormal breathing pattern, which is rapid and shallow, and her level of consciousness is decreased. The paramedic reports that the car was totaled, the windshield and driver's side windows were smashed, and the driver's side seat belt had been torn off, and the steering wheel has been pushed into the dashboard. The paramedic suspects the patient might have sustained significant internal injuries due to the force of the collision.
Pulmonary embolism
Acute myocardial infarction (MI)
Pneumothorax or hemothorax
Traumatic brain injury (TBI)
The Correct Answer is C
Rationale:
A. Pulmonary embolism can cause sudden shortness of breath and tachypnea; however, in this trauma context, a PE is less likely immediately upon arrival unless the patient had a pre-existing clot. The acute presentation of trauma with hypotension and low hemoglobin makes internal thoracic or pulmonary injury more probable.
B. MI may cause dyspnea, chest pain, and hypotension, but the mechanism of injury (high-speed MVC with dashboard impact) and the rapid, shallow breathing pattern suggest trauma-related thoracic injury rather than a primary cardiac event.
C. The patient’s shallow, rapid respirations, hypotension, tachycardia, hypoxia, and decreased level of consciousness are classic signs of thoracic injury such as pneumothorax or hemothorax. The mechanism of injury—a high-speed frontal impact with steering wheel intrusion and seat belt trauma—places her at high risk for rib fractures, lung contusions, and accumulation of air or blood in the pleural space. These injuries restrict lung expansion, leading to rapid, shallow respirations as the patient attempts to maintain oxygenation. The low hemoglobin further suggests blood loss, consistent with hemothorax.
D. While TBI can alter breathing patterns (e.g., Cheyne-Stokes, irregular respirations), the patient’s primary pattern is rapid and shallow, more consistent with thoracic compromise rather than central neurologic injury. Additionally, the hypotension and low hemoglobin support blood loss as a primary factor rather than isolated neurologic dysfunction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. This is a correct IPEC competency. Effective communication among healthcare professionals is essential for safe, coordinated, and patient-centered care. IPEC emphasizes skills such as clear information exchange, active listening, and shared decision-making.
B. This is a correct IPEC competency. Understanding and respecting the roles and responsibilities of different healthcare professionals helps prevent duplication, ensures accountability, and improves patient outcomes.
C. This is a correct IPEC competency. IPEC promotes shared values and ethical principles, including respect, integrity, and patient-centered care, as the foundation for collaborative practice.
D. This is incorrect. While teamwork is a central concept in IPEC, “Teams and individual responsibilities” is not listed as a separate competency. The IPEC framework focuses on the four core competencies: Values/Ethics, Roles/Responsibilities, Interprofessional Communication, and Teams and Teamwork, making option D an inaccurate representation of IPEC competencies.
Correct Answer is A
Explanation
Rationale:
A. Diffuse axonal injury (DAI) is primarily caused by rotational or acceleration-deceleration forces, which produce shearing stress on axons. This mechanism disrupts axonal integrity, leading to widespread neuronal injury and is a hallmark feature of DAI.
B. DAI often involves microscopic or small hemorrhagic lesions in areas such as the corpus callosum, brainstem, and gray-white matter junction. The statement that there are no hemorrhagic lesions is false.
C. While this statement is true about the pathophysiology of DAI, the question asks which statement is true among false statements. This option is misleading without the context of mechanism. The primary defining feature is the shearing from rotational forces.
D. DAI is more common than 20%, accounting for a significant proportion of severe traumatic brain injuries, particularly those resulting from high-speed motor vehicle accidents. The exact prevalence varies by study but is generally higher than 20% in severe TBI populations.
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