A 23-year-old man is shot in the lower abdomen. The most appropriate management is to:

Correct Answer: D

Rationale: The correct answer is D. In a gunshot wound to the lower abdomen, there is a high risk of intra-abdominal injuries requiring surgical intervention. Initiating fluid therapy helps stabilize the patient's hemodynamics. Transfer to the operating room is crucial for exploration and management of any internal injuries. Performing a diagnostic peritoneal lavage (choice A) may delay definitive management. Infusion of packed red blood cells (choice B) should be done after initial stabilization. Inserting a nasogastric tube and urinary catheter (choice C) are not the priority in this acute trauma situation.

Correct Answer: D

Rationale: The correct answer is D: Transfer the patient to a neurosurgeon without performing a CT-scan. Rationale: 1. Patient presents with head trauma and neurological symptoms. 2. CT-scan is the gold standard for assessing head injuries. 3. In this case, the patient needs prompt neurosurgical evaluation. 4. Delaying transfer for a CT-scan can worsen the patient's condition. 5. Immediate neurosurgical intervention may be required for intracranial injuries. 6. This decision prioritizes the patient's urgent need for specialized care over diagnostic imaging. Summary: - Choice A: Admitting for observation delays specialist care. - Choice B: X-ray of facial bones is unnecessary for neurological assessment. - Choice C: Complete cervical spine x-ray is not the priority in this scenario.

Correct Answer: D

Rationale: The correct answer is D because in a trauma scenario, ensuring airway patency and oxygenation is the priority to prevent hypoxia, especially in an unresponsive patient. Administering vasopressors (A) is not the initial step as the focus should be on airway management first. Establishing IV access for drug-assisted intubation (B) is important but not the first step. Seeking the cause of decreased level of consciousness (C) can be done after securing the airway and providing oxygen. Thus, applying oxygen and maintaining the airway (D) is the most critical initial intervention.

Correct Answer: C

Rationale: The correct answer is C: "Escharotomy." An escharotomy is a surgical procedure done to release constriction caused by eschar (burned tissue) in order to restore circulation and prevent ischemia. In this case, the patient has circumferential burns on the right arm leading to absent pulses, indicating compromised blood flow. Performing an escharotomy will relieve the pressure, restore blood flow, and prevent further tissue damage and potential limb loss. Choice A: "Fasciotomy" is incorrect as fasciotomy is usually performed in cases of compartment syndrome, which is a different condition from constriction due to burns. Choice B: "Angiography" is incorrect as it is a diagnostic procedure to visualize blood vessels, not a treatment for constriction caused by burns. Choice D: "Heparinization" is incorrect as heparinization is a treatment for blood clotting disorders and not indicated in this scenario of compromised blood flow due to burns.

Correct Answer: A

Rationale: The correct answer is A because accepting gifts from residents can create a conflict of interest or appear as favoritism. By refusing the gift but thanking the resident, the nursing assistant maintains a professional boundary and ethical practice. Choice B is incorrect as it involves blaming the employer and is unprofessional. Choice C is incorrect as confidentiality does not address the ethical concerns of accepting gifts. Choice D is incorrect since accepting the gift without refusal goes against professional boundaries.