A 36-year-old woman is beaten about the head and face and is brought to the local community hospital in full spinal immobilization. Her BP is 130/88, HR 70/min, and RR 18/min. Pulse oximetry indicated 98% while she was given 100% O2 via a non-rebreather mask. Her airway is clear. She has marked swellings on her face and several lacerations of her scalp that are not actively bleeding. She does not respond to verbal stimuli, but localizes to painful stimuli and opens her eyes. She moves all extremities equally. The remainder of her physical exam is normal. There is no neurosurgeon at the local hospital. After ensuring the patient's airway, the most appropriate course of action is to:

Correct Answer: D

Rationale: The correct answer is D: Transfer the patient to a neurosurgeon without performing a CT-scan. Rationale: 1. Patient presents with head trauma and neurological symptoms. 2. CT-scan is the gold standard for assessing head injuries. 3. In this case, the patient needs prompt neurosurgical evaluation. 4. Delaying transfer for a CT-scan can worsen the patient's condition. 5. Immediate neurosurgical intervention may be required for intracranial injuries. 6. This decision prioritizes the patient's urgent need for specialized care over diagnostic imaging. Summary: - Choice A: Admitting for observation delays specialist care. - Choice B: X-ray of facial bones is unnecessary for neurological assessment. - Choice C: Complete cervical spine x-ray is not the priority in this scenario.

Correct Answer: C

Rationale: The correct answer is C: "Escharotomy." An escharotomy is a surgical procedure done to release constriction caused by eschar (burned tissue) in order to restore circulation and prevent ischemia. In this case, the patient has circumferential burns on the right arm leading to absent pulses, indicating compromised blood flow. Performing an escharotomy will relieve the pressure, restore blood flow, and prevent further tissue damage and potential limb loss. Choice A: "Fasciotomy" is incorrect as fasciotomy is usually performed in cases of compartment syndrome, which is a different condition from constriction due to burns. Choice B: "Angiography" is incorrect as it is a diagnostic procedure to visualize blood vessels, not a treatment for constriction caused by burns. Choice D: "Heparinization" is incorrect as heparinization is a treatment for blood clotting disorders and not indicated in this scenario of compromised blood flow due to burns.

Correct Answer: A

Rationale: The correct answer is A because accepting gifts from residents can create a conflict of interest or appear as favoritism. By refusing the gift but thanking the resident, the nursing assistant maintains a professional boundary and ethical practice. Choice B is incorrect as it involves blaming the employer and is unprofessional. Choice C is incorrect as confidentiality does not address the ethical concerns of accepting gifts. Choice D is incorrect since accepting the gift without refusal goes against professional boundaries.

Correct Answer: A

Rationale: The correct answer is A because sharing personal information about residents violates their right to privacy and confidentiality. Residents have the right to keep their personal information confidential. Choice B is correct as it aligns with the residents' right to voice grievances. Choice C respects the resident's right to be informed. Choice D empowers the resident in making choices, respecting their autonomy.

Correct Answer: C

Rationale: The correct conversion of 7:45 p.m. to military time is 1945 hours. In military time, the hours from 1 p.m. to 11 p.m. are simply expressed by adding 12 to the standard time. Therefore, 7 p.m. + 12 = 19, making it 1900 hours. Then, add the minutes, which remain the same, giving us 1945 hours. Choice A is incorrect as it is missing the "1" in front of the "9". Choice B is incorrect as 975 hours would not be a valid military time format. Choice D is incorrect as it combines the incorrect format of choice A with an incorrect hour value.