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." This is crucial to maintain adequate perfusion to the kidneys and prevent acute kidney injury due to rhabdomyolysis from electric shock. Electroshock can cause muscle breakdown leading to myoglobin release, which can damage the kidneys. Immediate angiography is not indicated as the first step in management. Intravenous pyelography and debridement of necrotic muscle are not relevant in this scenario. Admission to the ICU for observation may be considered after initial fluid resuscitation.

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 palpable prostate is more related to prostate health rather than urethral injury. Scrotal hematoma, blood in the rectal lumen, and blood in the external urethral meatus are all signs that suggest urethral injury due to trauma or other causes. These symptoms are more specific to the urethra and its surrounding structures, making them more relevant indicators of urethral injury compared to the absence of a palpable prostate.

Correct Answer: B

Rationale: The correct answer is B: 2L of iv crystalloid and vasopressors if BP does not respond. This patient presents with symptoms of spinal cord injury with hypotension, which indicates neurogenic shock. Initial management involves fluid resuscitation to maintain perfusion. If the BP does not respond to fluids, vasopressors are indicated to support blood pressure. The other choices are incorrect because the patient does not have signs of hemorrhagic shock, so transfusing pRBCs (choice A) is unnecessary. Mannitol and steroids (choice C) are not indicated in the acute management of spinal cord injury. Laparotomy (choice D) is not indicated based on the clinical presentation.

Correct Answer: D

Rationale: The correct answer is D: "Surgical consult." A ruptured spleen is a surgical emergency that may require splenectomy. A surgical consult is needed to evaluate the patient's condition, determine the need for surgery, and plan the appropriate management. Splenic artery embolization (choice A) may be considered in stable patients, but this patient has a large hematoma and fluid in the pelvis, suggesting active bleeding and hemodynamic instability, which would require surgery. Pneumococcal vaccine (choice B) is important for patients without a spleen post-splenectomy, but it is not the immediate next step in management. Urgent laparotomy (choice C) is too specific without considering the need for surgical evaluation first.

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 both functional and professional. It helps the NA keep track of time during their shift and is a practical accessory in a healthcare setting. A broach, bracelet, and necklace may pose safety hazards or interfere with patient care tasks. A watch is subtle, non-intrusive, and serves a practical purpose without compromising professionalism.