Contraindication to nasogastric intubation?

Correct Answer: D

Rationale: The correct answer is D, "Fracture of the cribiform plate." Nasogastric intubation involves inserting a tube through the nose into the stomach. A fracture of the cribiform plate, which is part of the skull separating the nasal cavity from the brain, can lead to serious complications such as penetrating injury to the brain or leakage of cerebrospinal fluid. This can result in infections or other severe issues. A: "Gastric perforation" is a possible complication of nasogastric intubation but not a contraindication. B: "Diaphragmatic rupture" is not a direct contraindication to nasogastric intubation. C: "Open depressed skull fracture" is a serious condition but not a direct contraindication to nasogastric intubation.

Correct Answer: D

Rationale: Rationale for Correct Answer (D): 1. Massive hemothorax is characterized by the accumulation of blood in the pleural cavity. 2. In situations with shock and unilateral absent breath sounds, there is a high suspicion for massive hemothorax due to significant blood loss and lung collapse. 3. Prompt recognition and treatment are crucial to prevent further complications and stabilize the patient. 4. Immediate interventions such as thoracostomy tube placement may be necessary to evacuate the blood and reexpand the lung. 5. Therefore, choice D is the correct answer as it highlights key clinical features and emphasizes the importance of early diagnosis and management. Summary of Incorrect Choices: A: Massive hemothorax can also be caused by penetrating trauma, not just blunt trauma. B: Pneumothorax involves air accumulation in the pleural cavity, which is different from blood accumulation in hemothorax. C: Delaying treatment for an upright chest x-ray may compromise the patient's condition as

Correct Answer: B

Rationale: The correct answer is B: Pulmonary contusion. Rationale: 1. The patient has a flail chest on the right side, indicating chest wall trauma. 2. Tachypnea suggests respiratory distress to compensate for impaired gas exchange. 3. The ABG shows a low PaO2 (hypoxemia), low PaCO2 (respiratory alkalosis), and high pH (alkalosis), consistent with pulmonary contusion causing ventilation-perfusion mismatch and hypoxemia. 4. Hypoventilation (choice A) would typically show high PaCO2 and low pH. 5. Hypovolemia (choice C) would present with different ABG findings, such as low pH and high bicarbonate. 6. A small pneumothorax (choice D) would not cause such significant gas exchange abnormalities. Summary: Pulmonary contusion is the most likely cause as it fits with the clinical presentation and ABG findings, while the other choices do not

Correct Answer: D

Rationale: The correct initial diagnostic study for evaluating the urinary tract in this patient is "Retrograde urethrography" (Choice D). Rationale: 1. Retrograde urethrography is the appropriate choice because the patient has blood in the external urethral meatus, indicating a possible urethral injury. 2. This imaging technique involves injecting contrast material into the urethra to visualize any urethral abnormalities or injuries. 3. It is a non-invasive and effective method to assess the extent of urethral trauma in cases like this. 4. Cystoscopy (Choice A) is not the initial study of choice in this scenario as it primarily visualizes the bladder and may not provide adequate information about urethral injuries. 5. Cystography (Choice B) and IV pyelography (Choice C) are not appropriate in this case as they focus on assessing the bladder and kidneys, respectively, which are not the primary concerns based on the patient's

Correct Answer: C

Rationale: The correct answer is C: Primary nursing. In primary nursing, the registered nurse takes on the responsibility for the majority of daily care for specific residents. This model promotes continuity of care and allows the nurse to develop a deeper understanding of the residents' needs. Facility nursing (A) refers to care provided by nurses within a healthcare facility without specifying a particular nurse's role. Team nursing (B) involves a team of healthcare providers working together to deliver care, without one nurse taking primary responsibility. Functional nursing (D) assigns specific tasks to different nursing personnel rather than focusing on individualized care by a single nurse.