08-10-2017, 11:29 AM
You are called by the staff of a skilled nursing facility to see an 82-year-old resident who was
found to be unresponsive in her bed 20 minutes ago. She had been awake and alert 1 hour ago; at
that time, she said she felt well. The patient has a history of multiple strokes, hypertension, type
2 diabetes mellitus, and osteoarthritis. Medications include metformin, hydrochlorothiazide,
enalapril, acetaminophen, and 81 -mg aspirin daily. She is fed via a gastrostomy tube. Vital signs
are temperature 38.0°C (100.4°F), pulse 92/min and irregularly irregular, respirations 14/min,
and blood pressure 220/140 mm Hg. Pulse oximetry on room air shows an oxygen saturation of
92%. The patient is unresponsive to voice or light touch. Fingerstick glucose concentration is
250 mg/dL. She had recently revised her advance directive to "do not transfer to the hospital"
status. The advance directive also states that she does not want cardiopulmonary resuscitation,
intubation, or mechanical ventilation. Which of the following factors in this patient most strongly
indicates a poor prognosis?
A) Age
B) Blood pressure
C) Mental status
D) Pulse
E) Temperature
C is CORRECT by N
found to be unresponsive in her bed 20 minutes ago. She had been awake and alert 1 hour ago; at
that time, she said she felt well. The patient has a history of multiple strokes, hypertension, type
2 diabetes mellitus, and osteoarthritis. Medications include metformin, hydrochlorothiazide,
enalapril, acetaminophen, and 81 -mg aspirin daily. She is fed via a gastrostomy tube. Vital signs
are temperature 38.0°C (100.4°F), pulse 92/min and irregularly irregular, respirations 14/min,
and blood pressure 220/140 mm Hg. Pulse oximetry on room air shows an oxygen saturation of
92%. The patient is unresponsive to voice or light touch. Fingerstick glucose concentration is
250 mg/dL. She had recently revised her advance directive to "do not transfer to the hospital"
status. The advance directive also states that she does not want cardiopulmonary resuscitation,
intubation, or mechanical ventilation. Which of the following factors in this patient most strongly
indicates a poor prognosis?
A) Age
B) Blood pressure
C) Mental status
D) Pulse
E) Temperature
C is CORRECT by N