A 24-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the ED reveals a flail segment of the patient's thorax. Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask

Correct Answer: D

Rationale: The correct answer is D: Endotracheal intubation and mechanical ventilation. In the case of a flail chest, where multiple ribs are fractured causing a segment of the chest wall to move independently from the rest of the thorax, the patient is at high risk of respiratory compromise. Endotracheal intubation and mechanical ventilation are necessary to ensure adequate oxygenation and ventilation, as the flail segment impairs the ability of the chest wall to expand effectively. High-flow oxygen via a nonrebreathing mask alone may not be sufficient to support the patient's respiratory needs. Choice A is incorrect because the patient's confusion is likely due to inadequate oxygenation and ventilation, not fluid resuscitation. Choice B is incorrect because cyanosis is a late sign of respiratory distress and should not be solely relied upon for management decisions. Choice C is incorrect as tachypnea is a compensatory mechanism and not a definitive management strategy for a flail chest.

Correct Answer: D

Rationale: Tension pneumothorax is a life-threatening condition caused by trapped air in the pleural space, leading to increased pressure in the chest cavity. "Flail chest" can result in lung puncture and subsequent pneumothorax. Cardiac tamponade can compress the heart and cause air to enter the pleural space. Clamping a chest tube can prevent air from escaping, leading to tension pneumothorax. Therefore, the correct answer is D, as all choices can potentially cause tension pneumothorax by different mechanisms.

Correct Answer: A

Rationale: The correct answer is A because in the treatment of thermal injuries, immediate removal of clothing is crucial to stop the heat source and prevent further damage to the skin. Removing clothing also allows for a quick assessment of the extent of the burn and initiation of appropriate treatment. Choice B is incorrect as patients with thermal injuries are at risk for hypothermia due to heat loss from damaged skin. Choice C is incorrect as fasciotomies are not typically indicated for circumferential truncal burns unless there is evidence of compartment syndrome. Choice D is incorrect as electrical burns can lead to deep tissue injury but are not always associated with extensive skin necrosis from entry to exit points.

Correct Answer: D

Rationale: The correct answer is D: Care that it determines to be medically necessary. Medicare covers services that are deemed medically necessary based on established guidelines and standards. This ensures that resources are used efficiently and appropriately to improve patient outcomes. Choices A, B, and C are incorrect because Medicare does not cover all care requested by the recipient, doctor, or facility without considering medical necessity. It is crucial for Medicare to prioritize coverage for services that are essential for the patient's health and well-being.

Correct Answer: B

Rationale: The correct answer is B because documenting care accurately and promptly is an essential part of professional and ethical behavior for a nursing assistant. It ensures continuity of care, accountability, and patient safety. By documenting accurately, the nursing assistant provides crucial information for the healthcare team. Choice A is incorrect because keeping quiet about a mistake can lead to potential harm to the patient and goes against ethical principles of honesty and transparency. Choice C is incorrect because sharing details about residents violates patient confidentiality, a fundamental ethical principle in healthcare. Choice D is incorrect because rushing a resident through tasks compromises the quality of care and can jeopardize patient safety, which is not aligned with professional and ethical behavior.