A 28 year old male is brought to the E He was involved in a fight in which he was beaten with a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR is 22, HR is 126 and systolic BP is 90mmHg. Which one of the following should be performed during the primary survey?

Correct Answer: A

Rationale: The correct answer is A: "GCS" (Glasgow Coma Scale). During the primary survey in trauma, assessing the patient's level of consciousness using GCS is crucial to identify any potential brain injury. The patient's airway, breathing, and circulation are already assessed and stable based on the given information. GCS helps determine the severity of head injury and guides further management. B: Cervical spine x-ray is not indicated during the primary survey unless there is suspicion of cervical spine injury based on mechanism of injury or physical exam findings. C: TT-administration (tetanus toxoid) is important but is not a priority during the primary survey. It can be administered later in the secondary survey. D: Blood alcohol level is not necessary during the primary survey for acute trauma management. It can be considered in the secondary survey for further evaluation.

Correct Answer: C

Rationale: The correct answer is C: DPL (Diagnostic Peritoneal Lavage). DPL is the most specific test for evaluating injuries of solid abdominal organs like the liver or spleen. It involves inserting a catheter into the peritoneal cavity to detect the presence of blood or other fluids, indicating internal bleeding. Abdominal x-ray (A) is not specific for solid organ injuries. Abdominal ultrasound (B) is more commonly used for detecting fluid collections or organ abnormalities but may not be as sensitive as DPL for detecting solid organ injuries. Frequent abdominal examination (D) is important for ongoing monitoring but does not provide the same level of specificity as DPL in diagnosing solid organ injuries.

Correct Answer: D

Rationale: The correct answer is D: "Ensuring adequate oxygenation and ventilation" should be performed first in any patient with potential multiple closed extremity fractures. This is because prioritizing oxygenation and ventilation is crucial to prevent hypoxia and respiratory compromise, which can be life-threatening. Once the patient's oxygenation and ventilation are stabilized, further assessments and interventions can be performed. A: "A thorough assessment of four limb perfusion" may be important but ensuring adequate oxygenation and ventilation takes precedence. B: "Maneuvers to prevent necrosis of the skin" is not the immediate priority over ensuring oxygenation and ventilation. C: "Extremity compartment syndrome release" is a critical intervention but should be performed after ensuring adequate oxygenation and ventilation.

Correct Answer: B

Rationale: The correct answer is B because person-centered care emphasizes promoting a resident's personal preferences and individual choices. This approach focuses on tailoring care to meet the unique needs and preferences of each individual. By prioritizing the resident's autonomy and personal values, person-centered care enhances the quality of life and overall well-being. Choice A is incorrect because person-centered care does not involve nursing staff making unilateral decisions for residents. Choice C is incorrect as person-centered care recognizes the importance of individualized care rather than treating all residents the same way. Choice D is incorrect because person-centered care involves respecting residents' choices and preferences, rather than enforcing uniform activities for everyone.

Correct Answer: C

Rationale: The correct answer is C: To encourage people to make decisions about advance directives. The Patient Self-Determination Act (PSDA) aims to empower individuals to express their healthcare preferences in advance through advance directives such as living wills and healthcare proxies. This helps ensure that patients' wishes regarding medical treatment are known and respected. Choice A is incorrect because the PSDA is not related to in-service training for nursing assistants. Choice B is incorrect as the act primarily focuses on patient autonomy rather than the privacy of health information. Choice D is incorrect because the act does not pertain to detailing how abuse should be reported.