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 A rationale
Metabolic acidosis is characterized by a primary decrease in bicarbonate (HCO3), typically below the normal range of 22-26 mmol/L, leading to a reduction in pH. Partial compensation would involve a compensatory decrease in PaCO2, normally 35-45 mm Hg. The given arterial blood gas values do not align with these characteristics, as the pH is elevated and HCO3 is within normal limits.
Choice B rationale
Respiratory alkalosis is defined by a primary decrease in PaCO2, below the normal range of 35-45 mm Hg, resulting in an elevation of pH above 7.45. Uncompensated respiratory alkalosis means the bicarbonate level (normal range 22-26 mmol/L) remains within normal limits as the kidneys have not yet had time to excrete bicarbonate to compensate. The provided pH of 7.6 and PaCO2 of 31 mm Hg, with HCO3 of 25 mmol/L, perfectly match these criteria.
Choice C rationale
Respiratory acidosis is characterized by a primary increase in PaCO2, above the normal range of 35-45 mm Hg, leading to a decrease in pH below 7.35. Partial compensation would involve a compensatory increase in bicarbonate. The given arterial blood gas values, particularly the elevated pH and decreased PaCO2, directly contradict the definition of respiratory acidosis.
Choice D rationale
Metabolic alkalosis is defined by a primary increase in bicarbonate (HCO3), typically above the normal range of 22-26 mmol/L, leading to an elevation of pH above 7.45. Partial compensation would involve a compensatory increase in PaCO2. The given arterial blood gas values do not show an elevated bicarbonate level that would indicate a primary metabolic issue.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale
Obtaining informed consent is a fundamental ethical and legal requirement before any invasive medical procedure, including a bronchoscopy. This ensures patient autonomy, allowing them to make an educated decision based on understanding the procedure's risks, benefits, and alternatives. The patient's signature indicates their voluntary agreement after a thorough discussion with the healthcare provider, demonstrating adherence to patient rights.
Choice B rationale
Flumazenil is a benzodiazepine receptor antagonist used to reverse the sedative effects of benzodiazepines. While benzodiazepines like midazolam are commonly used for conscious sedation during bronchoscopy, flumazenil is generally not kept readily available for routine use. It is an emergency reversal agent reserved for severe respiratory depression or over-sedation.
Choice C rationale
Ensuring the client is NPO (nil per os) for at least 6 hours prior to a bronchoscopy is crucial to prevent aspiration. The procedure involves manipulating the airway, which can stimulate the gag reflex and potentially lead to regurgitation of gastric contents into the lungs, causing aspiration pneumonia or acute respiratory distress. Fasting significantly reduces this risk.
Choice D rationale
Continuous monitoring of heart rate and oxygen saturation via a bedside heart monitor and pulse oximeter is essential during and after a bronchoscopy. This allows for immediate detection of adverse events such as hypoxemia, arrhythmias, or respiratory depression, enabling prompt intervention. Constant vigilance ensures patient safety throughout the procedure.
Choice E rationale
Midazolam, a short-acting benzodiazepine, is commonly used for conscious sedation during bronchoscopy. Its anxiolytic, sedative, and amnestic properties help to reduce patient anxiety, promote comfort, and minimize recall of the procedure. Its rapid onset and short duration of action make it suitable for outpatient procedures.
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