The nurse suspects that a patient who was in a motor vehicle crash does not have a cervical spine injury. What did the nurse assess to come to this conclusion?
1. alert without midline cervical tenderness
2. lacking motor response in lower extremities
3. lacking deep tendon reflexes
4. lethargic and confused
Correct Answer: 1
There is a decreased probability of a cervical spine injury if the following criteria are met: absence of midline cervical spine tenderness; normal alertness; absence of intoxication; absence of a painful distracting injury; and no focal neurological deficits. A lack of motor response, lack of deep tendon reflexes, and the presence of lethargy and confusion would be indications of a cervical spine injury.
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a. aortic; aorta b. mitral; right atrium c. tricuspid; right ventricle d. pulmonic; pulmonary arteries
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