A nurse is assisting the provider to care for trauma patient who has been diagnosed with a hemothorax. Which of the following actions should the nurse perform first to treat this cause of obstructive shock?

Prepare for chest tube insertion

Chart assessment findings

Administer lorazepam

Initiate IV fluid resuscitation

Answer and Explanation

The Correct Answer is A

A) Prepare for chest tube insertion:
The priority treatment for a hemothorax, which is a collection of blood in the pleural space, is to address the loss of intravascular volume and to relieve the pressure on the lungs. The insertion of a chest tube is the first step in draining the blood and restoring proper lung function and ventilation. This intervention directly addresses the cause of obstructive shock (increased pressure on the lungs and impaired cardiac output) by re-expanding the lung and preventing further complications such as respiratory distress or cardiovascular collapse.

B) Chart assessment findings:
While accurate documentation of the patient's condition is important for ongoing care and legal purposes, it is not the priority action in this situation. Immediate treatment to address the hemothorax, such as chest tube insertion, takes precedence over documentation. Charting should be done after stabilizing the patient.

C) Administer lorazepam:
Lorazepam is an anxiolytic medication that might be used for anxiety or agitation, but it is not an immediate priority in this situation. The patient's life-threatening condition (hemothorax) needs to be addressed first, and sedation or anxiety management should be considered once the patient is stabilized and receiving appropriate interventions.

D) Initiate IV fluid resuscitation:
While fluid resuscitation is essential in trauma patients with hypovolemic shock, the primary concern in hemothorax is relieving the intrathoracic pressure by draining the blood from the pleural space. IV fluid resuscitation should be initiated shortly after or simultaneously with the chest tube insertion, but addressing the hemothorax directly is the first priority in treating obstructive shock.

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Correct Answer is D

Explanation

A) Gradual onset of several hours:
Hemorrhagic strokes, particularly those caused by a ruptured cerebral aneurysm, typically present with sudden onset of symptoms rather than a gradual onset. The symptoms of a hemorrhagic stroke generally occur immediately or within minutes after the rupture.

B) Maintains consciousness:
While some patients may remain conscious initially after a cerebral aneurysm rupture, it is common for individuals with a ruptured cerebral aneurysm to experience loss of consciousness, or at least a decreased level of consciousness. The rupture causes an increase in intracranial pressure and often results in symptoms such as nausea, vomiting, and confusion, and may progress to coma or unresponsiveness.

C) Neurologic deficits resolved in 1 hour:
In the case of a hemorrhagic stroke, neurologic deficits do not typically resolve quickly, particularly after the rupture of a cerebral aneurysm. Neurological deficits associated with hemorrhagic strokes may include hemiparesis, aphasia, visual disturbances, and confusion. The concept of deficits resolving within 1 hour is more indicative of a transient ischemic attack (TIA).

D) Complaints of the "worst headache of my life":
One of the classic and most characteristic symptoms of a ruptured cerebral aneurysm (leading to hemorrhagic stroke) is a severe headache, often described by the patient as the "worst headache of my life." This sudden and intense headache occurs due to the bleeding into the subarachnoid space from the aneurysm rupture, which irritates the meninges and causes intense pain.

A. Prolonged prothrombin time (PT) B. Elevated fibrinogen level C. Decreased platelet court D. Decreased D-dimer level

Correct Answer is D

Explanation

A) Prolonged prothrombin time (PT):
A prolonged PT is a sign of impaired coagulation, which is common in DIC as the clotting factors are consumed. In DIC, both clotting and bleeding occur, leading to prolonged PT. Therefore, a prolonged PT does not reflect a positive outcome. A positive outcome would show normalization or improvement of the clotting profile.

B) Elevated fibrinogen level:
Fibrinogen is often decreased in DIC because it is consumed in the process of forming clots. An elevated fibrinogen level would not indicate a positive outcome in DIC. Instead, fibrinogen levels typically fall in DIC due to widespread clotting activity. A positive outcome would involve a normalization or increase in fibrinogen levels as the condition improves.

C) Decreased platelet count:
Platelet count typically decreases in DIC because platelets are used up in the formation of clots, leading to thrombocytopenia. A decreased platelet count reflects ongoing consumption of platelets and would not be a positive indicator of improvement. In a positive outcome, the platelet count would increase toward normal levels.

D) Decreased D-dimer level:
D-dimer is a product of fibrin degradation and is elevated in conditions like DIC, where abnormal clotting and fibrinolysis are occurring. A decreased D-dimer level indicates that the coagulation process is resolving, and fibrin degradation is returning to normal, reflecting a positive outcome. Monitoring the D-dimer level is a key indicator of improvement in DIC.

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