A 30-year-old woman fell down four stairs landing on concrete. Unconscious for 5 minutes after the fall, full consciousness during 10 minute transport to hospital, GCS 15, complaint is a slight headache, 30 minutes later she is unresponsive with GCS 6 and left pupil is large.

Correct Answer: D

Rationale: The correct answer is D, less brain contusions. The scenario describes a traumatic brain injury likely due to the fall. The initial GCS of 15 indicates mild TBI, which deteriorated rapidly to GCS 6 and a large left pupil, suggesting brain herniation. The sudden decline in neurological status, particularly with a focal sign like a dilated pupil, is more indicative of diffuse axonal injury (DAI) or brain herniation rather than epidural hematoma or pulmonary contusion. The absence of any mention of focal neurological deficits or direct trauma to the chest makes choices A and C less likely. Choice B is unrelated to the scenario.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. In cases of thermal injury, immediate removal of clothing is crucial to stop the burning process and prevent further damage. 2. Clothing can retain heat and continue to burn the skin, exacerbating the injury. 3. Removing clothing also allows for a thorough assessment of the extent of the burn and enables proper treatment. 4. Prompt removal of clothing is a standard protocol in the initial management of thermal injuries. Summary of why other choices are incorrect: B. Patients with thermal injuries are at higher risk for hypothermia due to loss of skin integrity and body heat, not lower risk. C. Fasciotomies are typically needed for patients with compartment syndrome, not circumferential truncal burns. D. Electrical burns can cause tissue necrosis along the path of the current, not necessarily extensive skin necrosis from entry to exit points.

Correct Answer: D

Rationale: The correct answer is D: Medicare will pay for care that it determines to be medically necessary. Medicare follows guidelines to determine what services are medically necessary based on the patient's condition. This ensures appropriate and effective use of resources. Choices A, B, and C are incorrect because Medicare does not cover all care simply because it is requested by the recipient, doctor, or facility. It must meet the criteria of being medically necessary to be covered by Medicare.

Correct Answer: B

Rationale: The correct answer is B because documenting care accurately and promptly is a crucial aspect of professional and ethical behavior for a nursing assistant. This helps ensure continuity of care, patient safety, and accountability. It is important to maintain accurate records for effective communication among healthcare team members. Choice A is incorrect because staying quiet about mistakes can compromise patient safety and is not transparent or accountable behavior. Choice C is incorrect because sharing confidential information with friends violates patient privacy and confidentiality. Choice D is incorrect because rushing a resident through tasks compromises the quality of care and may lead to errors or neglect.

Correct Answer: D

Rationale: The correct answer is D because cultural background influences communication styles, values, and beliefs. Understanding a resident's cultural background helps the NA communicate effectively by respecting their customs and preferences. It promotes better rapport and trust between the NA and the resident, leading to improved quality of care. Choice A is incorrect as cultural background plays a crucial role in communication. Choice B is incorrect as not all residents may want to share stories about their culture. Choice C is incorrect as personal connections may not always be relevant or appropriate in the caregiving context.