The nurse is the first person on the scene of a motor vehicle crash. The victim was the driver and is in the driver's seat unconscious. The driver is breathing, has a pulse, and has minor lacerations on the head and face. What action should the nurse implement first?
Use the head tilt chin lift method to maintain the airway
Control any external bleeding
Do not move the victim from the accident
Stabilize the cervical spine until help arrives
The Correct Answer is D
A. The head tilt chin lift method should be avoided due to the risk of aggravating a spinal injury; the jaw-thrust maneuver is safer if airway management is necessary.
B. While controlling bleeding is important, cervical spine stabilization takes priority in trauma with suspected spinal injury.
C. Not moving the victim is appropriate, but stabilizing the cervical spine provides active support to avoid further injury.
D. Stabilizing the cervical spine is crucial to prevent potential spinal cord damage in an unconscious trauma victim, particularly in a motor vehicle accident. This action helps prevent exacerbation of any spinal injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. 28 units only accounts for the NPH insulin dosage and does not include the regular insulin dosage.
B. Adding 14 units of regular insulin and 28 units of NPH insulin results in a total of 42 units, the correct dose to prepare in the syringe.
C. 14 units only accounts for the regular insulin dosage and does not include the NPH insulin dosage.
D. 32 units is not the correct total dose; it underestimates the combined dosage.
Correct Answer is D
Explanation
A. Anesthetic eye drops can help with pain, but irrigation is the priority to prevent further damage.
B. A visual acuity exam is part of the assessment but should be performed after initial irrigation to prevent further damage.
C. Determining the pH of the chemical splash can guide further treatment but is secondary to immediate irrigation to dilute and remove the chemical.
D. Irrigating both eyes with normal saline is the priority action to dilute and flush out the chemical, reducing the risk of further injury.
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