Your patient in the Emergency Room states he is a 62-year-old male and is here with a chief complaint of left-sided arm weakness and left facial droop. The patient smells strongly of alcohol, and labs show a Blood-alcohol level of 0.2%. The patient has several scrapes and bruises in various stages of healing on his arms, face, and head.
What is the MOST likely cause of his symptoms?
Epidural hematoma.
Chronic subdural hematoma.
Contusion.
Concussion.
The Correct Answer is B
Choice A rationale
An epidural hematoma typically results from arterial bleeding, often after head trauma, leading to rapid accumulation of blood between the dura mater and the skull. This compression can cause acute neurological deterioration, but the chronic presentation and presence of multiple bruises in various healing stages are less consistent with an acute epidural bleed.
Choice B rationale
A chronic subdural hematoma involves venous bleeding into the subdural space, often occurring after minor trauma, especially in elderly individuals or those with brain atrophy, like chronic alcoholics. Blood accumulates slowly, causing gradual neurological symptoms such as weakness and facial droop over weeks to months, aligning with the patient's presentation and history of falls.
Choice C rationale
A cerebral contusion is a bruise on the brain tissue, typically caused by direct impact. While it can cause localized neurological deficits, it's an acute injury. The chronic nature of the patient's symptoms and the presence of multiple scrapes in various healing stages suggest a more insidious and recurring process rather than a single contusion.
Choice D rationale
A concussion is a mild traumatic brain injury resulting in transient brain dysfunction, often without structural damage. Symptoms are typically temporary and include headache, dizziness, and confusion. It does not typically cause focal neurological deficits like arm weakness and facial droop that are progressive or chronic in nature.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale
Placing the patient in Trendelenburg position on their left side is the priority intervention for a suspected air embolism. This position traps the air in the apex of the right ventricle, preventing it from entering the pulmonary circulation and causing a pulmonary embolism, which can be fatal. The left lateral position further aids in keeping the air bubble within the right ventricle.
Choice A rationale
Ambulation would be contraindicated as it could facilitate the movement of the air embolism through the circulatory system, potentially leading to a more severe and widespread impact, including cerebral or pulmonary embolism. The goal is to isolate and prevent the air from progressing, not to mobilize it.
Choice C rationale
Reverse Trendelenburg position elevates the head of the bed, which would cause the air embolism to travel towards the brain, increasing the risk of a cerebral air embolism, a life-threatening complication. This position is actively harmful in the context of an air embolism.
Choice D rationale
McRoberts maneuver is used in obstetrics to aid in shoulder dystocia during childbirth by hyperflexing the mother's thighs toward her abdomen. This maneuver has no physiological relevance or benefit in the management of an air embolism and would not prevent or mitigate its effects.
Correct Answer is A
Explanation
Choice A rationale
The non-rebreather mask delivers the highest possible fraction of inspired oxygen (FiO2) among conventional oxygen delivery devices, often reaching 85-90%. This high concentration is achieved by a one-way valve system that prevents exhaled air from mixing with the inspired oxygen and a reservoir bag that stores a high concentration of oxygen. This mechanism minimizes room air entrainment, maximizing oxygen delivery to the patient's respiratory system.
Choice B rationale
A non-rebreather mask is designed to deliver high concentrations of oxygen and prevent rebreathing of exhaled gases, including carbon dioxide. The one-way valves direct exhaled air out of the mask, ensuring that the patient inhales nearly pure oxygen from the reservoir bag, thereby minimizing CO2 retention, not increasing it. This physiological effect ensures efficient gas exchange.
Choice C rationale
While a simple mask may appear less complex in its physical design, its operation still requires proper fitting and flow rate adjustment for effective oxygen delivery. The perceived simplicity does not outweigh the significant physiological advantage of a non-rebreather mask in delivering higher oxygen concentrations, which is the primary goal of oxygen therapy.
Choice D rationale
Non-rebreather masks, due to their tight seal and large reservoir bag, can exacerbate feelings of claustrophobia in some patients. Similarly, the mask's design might induce or worsen nausea in individuals prone to it, making simpler face masks or nasal cannulas often more tolerable options for these patient populations. Patient comfort and tolerance are crucial considerations in oxygen therapy.
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