Patient: David Lee, 58-year-old male
Given the above scenario, identify the priority patient condition, the most critical parameters to monitor, and the key interventions to perform.
The Correct Answer is []
Rationale for Correct Choices
- Cardiac Arrest: The client presents with the clinical triad of cardiac arrest: unresponsiveness, apnea (not breathing), and pulselessness. The sudden collapse during physical exertion in a patient with cardiovascular risk factors (hypertension, high cholesterol) is highly suggestive of a primary cardiac event.
- Begin CPR: High-quality chest compressions are the immediate priority to maintain systemic perfusion and provide blood flow to the heart and brain until advanced life support or defibrillation is available.
- Send someone to retrieve the AED: Early defibrillation is the most critical link in the "Chain of Survival" for witnessed cardiac arrest, as the most common cause in this setting is a shockable rhythm like Ventricular Fibrillation (VF).
- Palpate Pulse: Regular pulse checks (limited to 10 seconds) during rhythm analysis are necessary to determine if Return of Spontaneous Circulation (ROSC) has occurred.
- Compression Effectiveness: Monitoring the depth (at least 2 inches), rate (100–120/min), and allowing full chest recoil is vital to ensure that the manual pumping of the heart is actually circulating blood.
Rationale for Incorrect Choices
- Hypoglycemia: While it can cause loss of consciousness, it does not typically cause a sudden "clutching of the chest" and immediate loss of a pulse in a witnessed collapse.
- MVC Trauma: There is no evidence of a Motor Vehicle Collision; this was an atraumatic medical collapse during exercise.
- Narcotic Overdose: Typically presents with pinpoint pupils and a slow, shallow respiratory rate (respiratory depression) rather than sudden-onset pulselessness during physical activity.
- Administer ordered Pain medication for Angina: The patient is pulseless and unresponsive; oral or standard IV pain medications are contraindicated and useless in a state of circulatory collapse.
- Apply Non-Rebreather: Oxygen therapy via mask is ineffective if the patient is not breathing and has no circulation to transport the oxygen. The priority is ventilation (via Bag-Valve-Mask) and compressions.
- Apply Icepacks to Reduce Inflammation: This is irrelevant in a life-threatening cardiac emergency.
- Administer D50W 12.5mg IVP: This is the treatment for hypoglycemia; there is no evidence the patient is hypoglycemic, and CPR/defibrillation must come first.
- Assess for power of attorney / Monitor I&Os / Pain Score: These are non-urgent or impossible tasks (the patient cannot report pain) during an active resuscitation.
- Examine Extremities for Fall Injuries: While secondary injuries can occur, checking for broken bones is a lower priority than restoring a pulse (the "C-A-B" sequence).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Visual acuity is measured using the Snellen chart, which compares the distance at which a patient can read letters to the standard distance a person with normal vision can read the same letters. It reflects the clarity and resolving power of the retina and central visual pathways.
Rationale:
A. 20/200 indicates the patient can read at 20 feet what a person with normal vision can read at 200 feet. This represents severe visual impairment consistent with significant reduction in visual acuity. The ratio is standardized with 20 feet as the testing distance.
B. 200/10 reverses the standard Snellen notation format. Visual acuity is always expressed with the testing distance (20 feet) as the numerator. This option is not clinically valid and does not represent correct ophthalmologic documentation.
C. 10/200 incorrectly uses 10 feet as the testing distance, which is not standard for Snellen chart interpretation. It does not reflect the correct ratio definition and therefore is not an accepted visual acuity measurement format.
D. 200/20 incorrectly reverses numerator and denominator values. This would imply abnormal scaling opposite of Snellen convention. It does not represent proper documentation of visual acuity and is not clinically interpretable.
Correct Answer is ["A","D","E"]
Explanation
Hyperthyroidism is endocrine disorder characterized by excessive thyroid hormone secretion (T3, T4) from Graves disease, toxic multinodular goiter or thyroiditis causing hypermetabolic state with weight loss, tachycardia, heat intolerance, diarrhea.
Rationale:
A. Diarrhea reflects increased gastrointestinal motility in thyrotoxicosis state often present. Excess thyroid hormones accelerate intestinal transit via sympathetic stimulation effects. Common in Graves disease and toxic nodular goiter patients seen. Leads to fluid loss, dehydration, and electrolyte imbalance clinically observed.
B. Constipation indicates reduced gastrointestinal motility typical of hypothyroidism state presentation. Decreased thyroid hormones slow intestinal peristalsis causing stool retention clinically. Opposite of hyperthyroidism which increases bowel frequency and motility signs. Not consistent with thyrotoxicosis therefore incorrect diagnostic indicator finding present.
C. Bradycardia reflects slowed heart rate seen in hypothyroidism cases commonly. Hyperthyroidism typically causes tachycardia due to increased metabolic demand state. Excess thyroid hormones enhance beta adrenergic receptor sensitivity clinically observed. Therefore bradycardia contradicts expected sympathetic overactivity findings in hyperthyroidism state present here.
D. Unintentional weight loss results from increased basal metabolic rate state. Thyroid hormones increase lipolysis and protein catabolism significantly clinically evident. Seen in Graves disease and toxic nodular hyperthyroidism conditions present. Patients often exhibit weight loss despite increased appetite intake state.
E. Heat intolerance occurs due to hypermetabolic state and thermogenesis increase. Excess thyroid hormones increase oxygen consumption and heat production levels. Patients experience sweating, warm skin, and heat sensitivity frequently seen. Classic finding in hyperthyroidism distinguishing from hypothyroid cold intolerance state.
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