A 30-year-old man sustains a severely comminuted, open, distal right femur fracture. Immediate efforts should involve:

Correct Answer: B

Rationale: The correct immediate effort for a severely comminuted, open, distal right femur fracture in a 30-year-old man is to tamponade the wound with a pressure dressing (Choice B). This helps control bleeding and prevent further contamination. Immediate angiography (Choice A) is not necessary as controlling bleeding and stabilizing the patient is the priority. Wound exploration and removal of bony fragments (Choice C) should be done after initial stabilization to prevent further damage. Realignment of the fracture segments with a traction splint (Choice D) should also be done after initial wound management to avoid exacerbating the injury.

Correct Answer: C

Rationale: The correct answer is C: The shock in this scenario is consistent with blood loss from bilateral femoral fracture. Rationale: 1. Bilateral femoral fractures can lead to significant blood loss due to injury to major blood vessels in the thighs, causing hypovolemic shock. 2. The deformities, marked swelling, and absence of open wounds point towards significant internal bleeding. 3. The shock is likely due to the blood loss from the femoral fractures, making choice C the most appropriate. Summary: A: Pelvic fracture may cause shock, but in this case, the femoral fractures are more likely the primary source of blood loss. B: Loss of 15% blood volume is not significant enough to cause the severe shock observed in this patient. D: Applying traction splints may stabilize the fractures but will not directly address the underlying blood loss causing the shock.

Correct Answer: A

Rationale: The correct answer is A: "Gum elastic bougie." When the vocal cords are not visible during intubation, a bougie is valuable for navigating the airway and guiding the endotracheal tube. Step 1: Use the bougie to feel for the tracheal rings. Step 2: Advance bougie until resistance is felt. Step 3: Thread the endotracheal tube over the bougie. Step 4: Remove the bougie. The other choices are incorrect because B (x-ray) does not directly aid in intubation, C (nasopharyngeal airway) is not useful when vocal cords are not visible, and D (oxygen) is important but not a tool for intubation.

Correct Answer: B

Rationale: The correct answer is B because limb-threatening extremity injuries, such as fractures or dislocations, require definitive management to prevent further damage and preserve limb function. Application of a traction splint helps stabilize the injury, reduce pain, and prevent complications like nerve or vascular damage. A tourniquet (choice A) should only be used in life-threatening situations with uncontrolled bleeding. Limb-threatening injuries can present without open wounds (choice C) and may not always involve ischemic or crushed tissue (choice D), making these options incorrect.

Correct Answer: B

Rationale: The correct answer is B: Bathing a resident. Nursing assistants commonly assist with personal care tasks like bathing to ensure residents' hygiene and comfort. They help maintain skin integrity and prevent infections. Administering medication (A) requires a higher level of training and is usually done by nurses. Changing sterile dressings (C) typically falls under the responsibilities of licensed nurses due to the sterile technique involved. Giving tube feedings (D) also requires specialized training and is usually done by licensed healthcare professionals. Bathing residents is a fundamental and routine task that nursing assistants are trained to perform regularly.