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A 70-year-old alcoholic patient with acute lethargy, confusion, and incontinence is admitted to the hospital ED. His wife tells you that he fell down the stairs about a month ago, but 'he didn't have a scratch afterward.' She feels that he has become gradually less active and sleepier over the last 10 days or so. Which of the following collaborative interventions will you implement first?
- A. Place on the hospital alcohol withdrawal protocol.
- B. Transfer to radiology for a CT scan.
- C. Insert a retention catheter to straight drainage.
- D. Give phenytoin (Dilantin) 100 mg PO.
Correct Answer: B
Rationale: A CT scan is needed to rule out a subdural hematoma, which could explain the symptoms.
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The patient works on a computer 8 hours each day. What kind of repetitive strain injury would be expected in this patient?
- A. Meniscus injury
- B. Rotator cuff injury
- C. Radial-ulnar fracture
- D. Carpal tunnel syndrome
Correct Answer: D
Rationale: Carpal tunnel syndrome is a common repetitive strain injury associated with prolonged computer use.
The septum of the nasal cavity is innervated by
- A. Nasopalatine nerve from cranial nerve V2
- B. Posterior ethmoidal nerve from V1
- C. Greater palatine nerve from V2
- D. Lesser palatine nerve from V2
Correct Answer: A
Rationale: The nasopalatine nerve, a branch of the maxillary division (V2) of the trigeminal nerve, supplies sensation to the nasal septum. It is important in nasal surgeries and anesthesia.
The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process are happening at this stage (select one that doesn't apply)?
- A. Radiologic union
- B. Absorption of excess cells
- C. Return to preinjury strength and shape
- D. Semisolid blood clot at the ends of fragments
Correct Answer: D
Rationale: During the remodeling stage, radiologic union occurs, excess cells are absorbed, and the bone returns to its preinjury strength and shape.
Which technique is used to assess the cerebellum?
- A. Application of a pointed tip of a paper clip to lightly prick various areas of the upper and lower extremities for pain
- B. Having the patient walk on the heels and hen on the toes to test for balance
- C. With the patient's eyes closed, grasping his or her finger or toe and moving its position up or down to determine if the patient perceives that the digit has moved
- D. Having the patient lie supine and flex the hips and knees to test for mobility
Correct Answer: B
Rationale: Assessing the cerebellum involves testing balance and coordination. Having the patient walk on their heels and toes evaluates cerebellar function. Pain sensation, proprioception, and mobility are assessed through other techniques.
Mrs. C. has a right hemiplegia secondary to a cerebrovascular accident. To avoid aspiration during meals she would be instructed to avoid
- A. swallowing with her head slightly flexed
- B. placing food in the left side of her mouth
- C. eating in an upright position
- D. lying down immediately after eating
Correct Answer: A
Rationale: Head flexion can impair swallowing mechanics.