A patient presents to the emergency room complaining of vomiting ...

[stephzh]

A patient presents to the emergency room complaining of vomiting with severe back and leg pain. The patient's home medications include daily oral corticosteroids.
 
  Vital signs reveal a low blood pressure and there are peaked T waves on the electrocardiogram. What is the nurse's priority intervention?
  a. Start an intravenous line
  b. Collect urine specimen
  c. Administer antiemetic
  d. Administer narcotic analgesia

Question 2

After shunt procedure, the nurse would monitor the patient's neurologic status by using which test?
 
  a. Electroencephalogra m
  b. Glasgow Coma Scale
  c. National Institutes of Health Stroke Scale
  d. Monro-Kellie doctrine

[Ksanderson1296]

Answer to Question 1

ANS: A
The patient is exhibiting signs of adrenal insufficiency (Addison's disease) given the regular use of corticosteroids. Cortisone, hydrocortisone (Cortef), prednisone, and fludrocortisone (Florinef) are used for the treatment of adrenocorticoid deficiency. Treatment of Addisonian crisis includes administration of hydrocortisone, saline solution, and sugar (dextrose) to correct the insufficiency. The priority intervention is to start an intravenous line so that appropriate treatments may be administered. A urine specimen may be collected but is not the priority intervention. Since the patient is vomiting, administration of antiemetics or analgesia would be given through an intravenous line. The nurse should also assess for changes in the level of consciousness; so administration of analgesia may be contraindicated if any decrease in level of consciousness occurs.

Answer to Question 2

ANS: B
The GCS gives a standardized numeric score of the neurologic patient assessment. An electroencephalogra m is used in diagnosing and localizing the area of seizure origin. This scale is an example of one type of specific tool for nurses to use when assessing a patient following stroke. The Monroe-Kellie doctrine is not an assessment or monitoring strategy; it describes the interrelationship of volume and compliance of the three cranial components, brain tissue, cerebral spinal fluid, and blood.

[stephzh]

TYSM

[scottmt]

Excellent