Nokea
A client is monitored for complications after having surgery to repair a fracture. Which of the following symptoms would indicate an arterial obstruction in the affected area?
- A. Rapid capillary refill
- B. Warm skin
- C. Cool skin
- D. Numbness
Correct Answer: C
Rationale: Cool skin suggests reduced blood flow, indicating arterial obstruction.
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At the scene of the accident in which position should Joe be placed before being transported by ambulance to the emergency room?
- A. The position in which he was found
- B. Lateral position with arms flexed
- C. Supine position with head in neutral position
- D. Supine position with head flexed
Correct Answer: C
Rationale: Neutral head position prevents further spinal injury.
The medilla oblongata:
- A. lies between the midbrain and pons
- B. has only one cranial nerve emerging from it (the trigeminal nerve)
- C. has pyramids lateral to the olives
- D. passes through the foramen magnum
Correct Answer: D
Rationale: The medulla oblongata passes through the foramen magnum and connects the brainstem to the spinal cord. It contains vital centers for regulating heart rate, breathing, and blood pressure.
A previously healthy 26-year-old male is brought to the emergency department due to muscle weakness. He reports mild weakness in his legs that has progressively worsened over a few days to the point that he can barely move his legs. He has some numbness in his legs and his arms feel weak. He has recently recovered from a respiratory infection. 1/5 muscle strength is noted throughout the lower extremities, as well as absent patellar and ankle reflexes. 3 to 4-/5 muscle strength is appreciated throughout his upper extremities. A lumbar puncture is performed, which shows the following: Cell count: 4 cells/mm3, Glucose: 67 mg/dL, Protein: 187 mg/dL Gram stain: no organisms Spirometry is performed, which shows a forced vital capacity of 0.85 L. Which of the following is the best next step in management?
- A. Intravenous (IV) immunoglobulin
- B. Intubation
- C. IV corticosteroids
- D. Immunomodulating agent
Correct Answer: B
Rationale: The patient's presentation of rapidly progressive weakness, areflexia, and elevated cerebrospinal fluid protein with normal cell count (albuminocytologic dissociation) is classic for Guillain-Barre syndrome (GBS). The forced vital capacity of 0.85 L indicates respiratory failure, necessitating immediate intubation to protect the airway and provide mechanical ventilation. Intravenous immunoglobulin and plasma exchange are treatments for GBS but are secondary to securing the airway in this critically ill patient.
The nurse practitioner is assessing an adult patient with a seizure disorder that is well controlled on phenytoin (Dilantin). What new finding indicates that a phenytoin drug level assessment is needed?
- A. Hypertrophic gums
- B. Vitamin D supplements
- C. BP 125/78 mmHg and pulse 95 bpm
- D. Flat affect and anxiety
Correct Answer: D
Rationale: The correct answer is D because a flat affect and anxiety can indicate potential phenytoin toxicity, which warrants a drug level assessment. Phenytoin toxicity can manifest as neurological symptoms such as mood changes and cognitive impairment. Options A and B are unrelated to phenytoin levels. Option C indicates normal vital signs and is not a specific indicator of phenytoin toxicity.
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.