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. The patient has sustained significant head trauma with neurological symptoms. 2. The patient is not responding to verbal stimuli but localizes to painful stimuli, indicating altered mental status. 3. There is no neurosurgeon at the local hospital, suggesting the need for transfer to a facility with neurosurgical capabilities. 4. Performing a CT-scan may delay necessary intervention, and in this case, immediate neurosurgical evaluation is crucial. Summary: A: Admitting the patient for observation is not appropriate as she requires specialized care. B: Obtaining x-ray of facial bones is not a priority in this scenario and does not address the potential neurological injury. C: While a complete x-ray evaluation of the cervical spine is important, neurosurgical evaluation takes precedence in this case to assess for possible intracranial injuries.

Correct Answer: C

Rationale: The correct answer is C: "Escharotomy." In this scenario, the patient has a circumferential burn on the right arm with absent pulses at the wrist, indicating compartment syndrome. Escharotomy involves making incisions through the eschar (burned tissue) to relieve pressure and restore circulation. This is the initial step to prevent tissue damage and potential limb loss. Choice A, "Fasciotomy," is a more invasive procedure that involves cutting through the fascia to relieve pressure. It is typically done if escharotomy is ineffective. Choice B, "Angiography," is used to visualize blood vessels and is not the initial management for compartment syndrome in burns. Choice D, "Heparinization," is not indicated in this situation as the primary concern is restoring circulation and preventing further tissue damage.

Correct Answer: A

Rationale: The correct answer is A because it aligns with ethical standards and professional boundaries in healthcare. Accepting gifts from residents can lead to conflicts of interest or perceptions of favoritism. By refusing the gift but expressing gratitude, the NA maintains professionalism and avoids potential ethical dilemmas. Choice B is incorrect as it involves deflecting responsibility onto the employer and does not address the core issue of maintaining professional boundaries. Choice C is incorrect because confidentiality does not mitigate the ethical concerns of accepting gifts from residents. Choice D is incorrect as it encourages accepting the gift, which can compromise professional integrity.

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 private. Choices B, C, and D promote residents' rights by ensuring their well-being, autonomy, and respect for personal choices. Helping a resident resolve a complaint (B) shows advocacy, informing a resident about a change of roommate (C) respects their right to be informed, and encouraging a resident to choose clothing (D) supports their autonomy.

Correct Answer: C

Rationale: The correct conversion of 7:45 p.m. to military time is 1945 hours. In military time, hours go from 0 to 23, so 7 p.m. is 1900 hours. To convert the minutes, simply add them to the hours, making it 1945 hours. Choice A (0745 hours) is incorrect because it represents 7:45 a.m. Choice B (975 hours) is incorrect as military time only goes up to 2359. Choice D (0775 hours) is incorrect because military time does not go beyond 2359.