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 trauma scenario like a gunshot wound to the lower abdomen, the priority is to transfer the patient to the operating room for surgical exploration and intervention. This is because penetrating abdominal injuries often require urgent surgical exploration to identify and control bleeding, repair organ damage, and prevent complications like peritonitis. Initiating fluid therapy is crucial to stabilize the patient's hemodynamic status. Performing a diagnostic peritoneal lavage (choice A) is outdated and has been replaced by more advanced imaging techniques. Infusing packed red blood cells (choice B) can be done after stabilizing the patient in the operating room. Inserting a nasogastric tube and urinary catheter (choice C) is not the immediate priority in this critical situation.

Correct Answer: D

Rationale: The correct answer is D: Transfer the patient to a neurosurgeon without performing a CT-scan. Rationale: 1. The patient has sustained significant head trauma with neurological symptoms. 2. The patient is not responding to verbal stimuli but localizes to painful stimuli, indicating altered mental status. 3. There is no neurosurgeon at the local hospital, suggesting the need for transfer to a facility with neurosurgical capabilities. 4. Performing a CT-scan may delay necessary intervention, and in this case, immediate neurosurgical evaluation is crucial. Summary: A: Admitting the patient for observation is not appropriate as she requires specialized care. B: Obtaining x-ray of facial bones is not a priority in this scenario and does not address the potential neurological injury. C: While a complete x-ray evaluation of the cervical spine is important, neurosurgical evaluation takes precedence in this case to assess for possible intracranial injuries.

Correct Answer: D

Rationale: The correct answer is D. Applying oxygen and maintaining airway is the first step in treatment for an unresponsive patient to ensure proper oxygenation and ventilation. This step is crucial in preventing hypoxia, which can lead to further complications. Administering vasopressors (choice A) is not necessary initially as the priority is airway management. Establishing IV access for drug-assisted intubation (choice B) is premature without ensuring adequate oxygenation first. Seeking the cause of decreased level of consciousness (choice C) can be done after ensuring airway patency and oxygenation.

Correct Answer: C

Rationale: The correct answer is C: "Escharotomy." In this scenario, the patient has a circumferential burn on the right arm with absent pulses at the wrist, indicating compartment syndrome. Escharotomy involves making incisions through the eschar (burned tissue) to relieve pressure and restore circulation. This is the initial step to prevent tissue damage and potential limb loss. Choice A, "Fasciotomy," is a more invasive procedure that involves cutting through the fascia to relieve pressure. It is typically done if escharotomy is ineffective. Choice B, "Angiography," is used to visualize blood vessels and is not the initial management for compartment syndrome in burns. Choice D, "Heparinization," is not indicated in this situation as the primary concern is restoring circulation and preventing further tissue damage.

Correct Answer: A

Rationale: The correct answer is A because it aligns with ethical standards and professional boundaries in healthcare. Accepting gifts from residents can lead to conflicts of interest or perceptions of favoritism. By refusing the gift but expressing gratitude, the NA maintains professionalism and avoids potential ethical dilemmas. Choice B is incorrect as it involves deflecting responsibility onto the employer and does not address the core issue of maintaining professional boundaries. Choice C is incorrect because confidentiality does not mitigate the ethical concerns of accepting gifts from residents. Choice D is incorrect as it encourages accepting the gift, which can compromise professional integrity.