Contraindication to nasogastric intubation?

Correct Answer: D

Rationale: The correct answer is D: "Fracture of the cribiform plate." Nasogastric intubation involves passing a tube through the nose into the stomach. A fracture of the cribiform plate, located in the skull near the nose, can lead to serious complications like cerebrospinal fluid leakage and infection if the nasogastric tube punctures it. Choices A, B, and C are incorrect because although they are serious conditions, they are not direct contraindications to nasogastric intubation.

Correct Answer: D

Rationale: Step-by-step rationale for why answer choice D is correct: 1. Massive hemothorax involves significant blood accumulation in the pleural space. 2. Shock and unilateral absent breath sounds are classic signs of massive hemothorax. 3. Immediate recognition and treatment are crucial to prevent further deterioration. 4. Prompt diagnosis and intervention are essential in managing massive hemothorax. Summary of other choices: A: Blunt thoracic trauma can cause hemothorax, but not specifically massive hemothorax. B: Pneumothorax involves air in the pleural space, not blood. C: Confirming the diagnosis with an upright chest x-ray may delay urgent treatment.

Correct Answer: B

Rationale: The correct answer is B: Pulmonary contusion. Pulmonary contusion is a common injury following blunt chest trauma and can lead to impaired gas exchange. In this case, the patient's low PaO2 and respiratory alkalosis (low PaCO2 and elevated pH) are indicative of a ventilation-perfusion mismatch caused by pulmonary contusion. The flail chest may also contribute to impaired gas exchange, but the absence of hyperresonance or dullness on auscultation makes a significant pneumothorax less likely. Hypoventilation would typically present with hypercapnia and acidosis, which is not seen in this patient. Hypovolemia would not directly affect blood gas values in this way.

Correct Answer: D

Rationale: The correct answer is D: "Retrograde urethrography." In this case, the patient presents with blood in the external urethral meatus, indicating a possible urethral injury. Retrograde urethrography is the most appropriate initial diagnostic study to evaluate the integrity of the urethra. This procedure involves injecting contrast material into the urethra to visualize any disruptions or strictures. Cystoscopy (choice A) is invasive and not the initial study of choice for evaluating urethral injuries. Cystography (choice B) is used to assess bladder injuries, not urethral injuries. IV pyelography (choice C) is used to assess the kidneys and ureters, not the urethra. Therefore, retrograde urethrography is the most suitable option for this patient's presentation.

Correct Answer: C

Rationale: The correct answer is C: Primary nursing. In primary nursing, the registered nurse takes primary responsibility for the daily care of assigned residents, providing continuity and personalized care. This model promotes a strong nurse-patient relationship and ensures comprehensive, individualized care. Facility nursing (A) involves care provided by various healthcare professionals within a facility setting, not necessarily by registered nurses alone. Team nursing (B) involves a team of healthcare professionals working collaboratively, with responsibilities shared among team members. Functional nursing (D) involves dividing tasks based on specific functions, often leading to fragmented care and less personalized attention compared to primary nursing.