While in the emergency department, a client with C8 quadriplegia develops a blood pressure of 80/44 mmHg, pulse of 48 beats per minute, and respiratory rate of 18 breaths per minute. Which condition should the nurse suspect?

Autonomic dysreflexia.

Hemorrhagic shock.

Pulmonary embolism.

Neurogenic shock.

Answer and Explanation

The Correct Answer is D

Rationale:

A. This is incorrect because it usually occurs in clients with spinal cord injuries at T6 or above and is triggered by noxious stimuli such as bladder distention or constipation. Its hallmark is sudden, severe hypertension, pounding headache, flushed skin above the lesion, and bradycardia. Since the client in this scenario has hypotension, autonomic dysreflexia is unlikely.

B. This is incorrect because it results from significant blood loss, leading to decreased circulating volume. The body typically compensates with tachycardia and vasoconstriction. The client’s bradycardia is inconsistent with the typical compensatory response to hemorrhagic shock.

C. This is incorrect because it usually presents with sudden shortness of breath, chest pain, tachycardia, hypotension, and hypoxia. While hypotension may occur, bradycardia is uncommon. The client’s low blood pressure with bradycardia and normal respiratory rate points toward a different cause.

D. Neurogenic shock is a type of distributive shock that occurs after a spinal cord injury above T6, including C8, due to loss of sympathetic nervous system control. This causes vasodilation, leading to hypotension, and unopposed parasympathetic activity, causing bradycardia. The client may also have warm, dry skin and relative hypothermia due to impaired thermoregulation, while the respiratory rate may remain normal if the diaphragm is unaffected.

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Correct Answer is ["13"]

Explanation

Step 1: Convert weight from pounds to kilograms
Weight (kg) = 193 ÷ 2.2
Weight ≈ 87.7 kg

Step 2: Calculate the ordered dose in mcg/min
Dose (mcg/min) = 2.5 mcg/kg/min × 87.7 kg
Dose ≈ 219.25 mcg/min

Step 3: Convert mcg/min to mg/hr
219.25 mcg/min × 60 min/hr = 13,155 mcg/hr
13,155 mcg/hr ÷ 1,000 mcg/mg = 13.155 mg/hr

Step 4: Determine concentration of IV solution
250 mg in 250 mL
Concentration = 1 mg/mL

Step 5: Calculate mL/hr
mL/hr = 13.155 mg/hr ÷ 1 mg/mL
mL/hr ≈ 13.155 mL/hr

Step 6: Round to the nearest whole number
13.155 = 13 mL/hr

Final Answer: 13 mL/hr

A. Three-way Foley with warmed lavage fluid B. Bag-valve-mask with warmed humidified oxygen C. Cardiopulmonary bypass machine D. Several warm blankets and warming pads.

Correct Answer is D

Explanation

Rationale:

A. This method (bladder or gastric lavage with warmed fluids) is considered a core rewarming technique, but it is invasive and typically reserved for unconscious or severely unstable clients. It is not the first choice for a conscious client who can still regulate airway and tolerate noninvasive warming.

B. While warmed, humidified oxygen can help raise body temperature, the bag-valve-mask is primarily for respiratory support in clients who are not breathing adequately. A conscious client with stable breathing usually does not need this equipment.

C. This is an invasive, high-risk method used only in extreme hypothermia with cardiac instability or failure. It is not appropriate for a conscious client who can be managed with less invasive methods.

D. For a conscious client with severe hypothermia, external warming methods such as warm blankets, heating pads, or forced-air warming devices are the safest and most effective first-line interventions. They allow gradual, controlled warming while maintaining comfort and safety, and they reduce the risk of complications such as arrhythmias that can occur with rapid core warming.

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While in the emergency department, a client with C8 quadriplegia develops a blood pressure of 80/44 mmHg, pulse of 48 beats per minute, and respiratory rate of 18 breaths per minute. Which condition should the nurse suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse prepares to administer dobutamine 2.5 mcg/kg/min IV for a client who weighs 193 pounds. The nurse receives dobutamine 250 mg in 250 mL of 5% dextrose from the pharmacy. The IV pump should be set to deliver how many mL/hr? Round to a whole number.

Correct Answer is ["13"]

Explanation

The health care provider prescribes core warming methods for a conscious client with severe hypothermia. What equipment should the nurse obtain?

Correct Answer is D

Explanation

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