Electrician electrocuted, exit wound on foot, blood in urine, initial management?: "Immediate angiography"

Correct Answer: A

Rationale: The correct answer is A: "Aggressive fluid infusion." In this scenario, the electrician likely suffered electrical burns leading to muscle breakdown and subsequent release of myoglobin into the bloodstream, causing renal damage. Aggressive fluid infusion helps prevent myoglobin-induced acute kidney injury by maintaining high urine output to flush out myoglobin. This initial management is crucial to prevent further kidney damage. Choice B: "Intravenous pyelography" is incorrect as it is a diagnostic imaging test for the urinary system, not a treatment for acute kidney injury. Choice C: "Debridement of necrotic muscle" is not the immediate priority and can be considered later if necessary. Choice D: "Admission to the ICU for observation" is not sufficient as immediate intervention is needed to prevent renal damage.

Correct Answer: D

Rationale: The correct answer is D because the absence of a palpable prostate on rectal exam is not a direct indicator of urethral injury. A: "Scrotal hematoma" suggests trauma to the genital area. B: Blood in rectal lumen indicates possible urethral or bladder injury. C: Blood in external urethral meatus suggests urethral injury with blood present at the urethral opening. Therefore, D is the only choice that does not directly relate to urethral injury.

Correct Answer: B

Rationale: The correct answer is B: 2L of iv crystalloid and vasopressors if BP does not respond. In this scenario, the patient is likely experiencing spinal shock leading to neurogenic shock, causing hypotension. Initial management should focus on fluid resuscitation with crystalloids to address hypovolemia. If the blood pressure does not respond to fluid resuscitation, vasopressors should be initiated to maintain perfusion. Choice A does not address the potential neurogenic shock, and giving blood transfusions without evidence of active bleeding is not indicated. Choice C with mannitol and steroids is not appropriate for this patient. Choice D with laparotomy is not indicated as there are no signs of abdominal trauma.

Correct Answer: D

Rationale: The correct answer is D: "Surgical consult." In this scenario, the patient has a ruptured spleen with associated hematoma and fluid in the pelvis, indicating active bleeding. A surgical consult is necessary to evaluate the need for surgical intervention such as splenectomy or splenic artery embolization. A surgical approach is crucial to control bleeding and manage potential complications. Choice A, splenic artery embolization, may be a treatment option, but a surgical consult is needed first to assess the patient's overall condition and suitability for this procedure. Choice B, pneumococcal vaccine, is important for patients with splenectomy but is not the immediate priority in this acute setting. Choice C, urgent laparotomy, is too specific without knowing the patient's stability and overall condition, making a surgical consult a more appropriate initial step.

Correct Answer: B

Rationale: The correct answer is B: A watch. A watch is the best type of jewelry for an NA to wear to work because it is functional and professional. A watch helps keep track of time and ensures punctuality, a crucial aspect of any job. A broach, bracelet, or necklace may be distracting, noisy, or not suitable for some work environments. Additionally, a watch is a subtle accessory that complements a professional appearance without being overly flashy or distracting.