In managing the head-injury patient which is the most initial step:

Correct Answer: A

Rationale: The correct initial step in managing a head-injury patient is to secure the airway. This is crucial to ensure adequate oxygenation and ventilation, which are essential for the patient's survival. Without a patent airway, the patient may suffer from hypoxia and respiratory distress. Obtaining a c-spine film or controlling scalp hemorrhage can be important but are secondary to securing the airway. Supporting the circulation is also vital, but airway management takes precedence as it directly impacts oxygen delivery to the brain. Therefore, securing the airway should be the primary focus in managing a head-injury patient.

Correct Answer: A

Rationale: The correct answer is A: "Gum elastic bougie." When the vocal cords are not visible during intubation, a bougie is valuable for navigating the airway and guiding the endotracheal tube. Step 1: Use the bougie to feel for the tracheal rings. Step 2: Advance bougie until resistance is felt. Step 3: Thread the endotracheal tube over the bougie. Step 4: Remove the bougie. The other choices are incorrect because B (x-ray) does not directly aid in intubation, C (nasopharyngeal airway) is not useful when vocal cords are not visible, and D (oxygen) is important but not a tool for intubation.

Correct Answer: B

Rationale: The correct answer is B because limb-threatening extremity injuries, such as fractures or dislocations, require definitive management to prevent further damage and preserve limb function. Application of a traction splint helps stabilize the injury, reduce pain, and prevent complications like nerve or vascular damage. A tourniquet (choice A) should only be used in life-threatening situations with uncontrolled bleeding. Limb-threatening injuries can present without open wounds (choice C) and may not always involve ischemic or crushed tissue (choice D), making these options incorrect.

Correct Answer: B

Rationale: The correct answer is B: Bathing a resident. Nursing assistants commonly assist with personal care tasks like bathing to ensure residents' hygiene and comfort. They help maintain skin integrity and prevent infections. Administering medication (A) requires a higher level of training and is usually done by nurses. Changing sterile dressings (C) typically falls under the responsibilities of licensed nurses due to the sterile technique involved. Giving tube feedings (D) also requires specialized training and is usually done by licensed healthcare professionals. Bathing residents is a fundamental and routine task that nursing assistants are trained to perform regularly.

Correct Answer: B

Rationale: The correct answer is B. The Omnibus Budget Reconciliation Act (OBRA) was passed in response to reports of abuse and poor care in long-term care facilities. This legislation aimed to improve the quality of care in nursing homes by setting standards for training and competency of staff, ensuring residents' rights, and enhancing the quality of life for residents. Incorrect choices: A: Lack of funding for long-term care facilities - While funding issues may impact the quality of care, OBRA was primarily focused on addressing abuse and poor care. C: Complaints from long-term care facility staff about resident behavior - Staff complaints about resident behavior were not the primary reason for the passage of OBRA. D: Nursing assistants being unable to pass competency examinations - While this could be a concern, OBRA was more about setting standards and regulations to improve care quality, not solely about the competency of nursing assistants.