Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didnt want to go to the emergency room because he didnt want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes

Correct Answer: D

Rationale: In this scenario, the patient presents with a jagged laceration on his forearm that is still open and requires sutures. The appropriate management for this patient involves local anesthesia to reduce pain, thorough cleansing of the wound to prevent infection, and wound exploration to assess for any foreign bodies that may be present. Suturing the wound is necessary to promote proper healing and reduce the risk of complications. Antibiotic therapy may be indicated if signs of infection are present, but it is not mentioned in the scenario as a primary management step. Tetanus prophylaxis should also be considered given the mechanism of injury involving a dirty object.

Correct Answer: C

Rationale: Abdominal pain in pregnancy can be caused by various conditions, but spontaneous hepatic rupture is a rare but life-threatening cause that must be ruled out. Spontaneous hepatic rupture, also known as liver rupture, can occur in pregnancy, though it is extremely rare. It is associated with severe abdominal pain, hypovolemic shock, and can lead to significant maternal and fetal morbidity and mortality. Therefore, the AGACNP should evaluate this possibility when assessing a pregnant patient with abdominal pain to provide timely and appropriate management.HELLP syndrome, placental abruption, and preterm labor are important considerations in the differential diagnosis of abdominal pain in pregnancy but are not specific to the life-threatening nature of spontaneous hepatic rupture.

Correct Answer: C

Rationale: Type A aortic aneurysms require immediate surgical intervention. Type A aortic dissections involve the ascending aorta and are at high risk for complications such as aortic rupture or compromise of coronary artery blood flow. Prompt surgical repair is necessary to prevent potentially fatal outcomes. Types B, C, and symptomatic aneurysms may not require immediate surgical intervention depending on the specific patient presentation and associated risks.

Correct Answer: C

Rationale: Ultrasonography is considered essential in all cases of acute abdomen because it is a valuable tool in evaluating various abdominal organs non-invasively. It can quickly identify common causes of acute abdomen such as cholecystitis, pancreatitis, appendicitis, and other intra-abdominal pathologies. Ultrasonography also has the advantage of being radiation-free and can be performed rapidly at the bedside, making it a preferred initial diagnostic modality in the evaluation of acute abdominal pain. Abdominal radiograph, contrast radiography, and chest radiography may have limited utility in the evaluation of acute abdomen compared to ultrasonography.

Correct Answer: A

Rationale: A crescent-shaped fluid collection on a head CT scan typically represents an acute subdural hematoma. Acute subdural hematomas result from the tearing of bridging veins that lie between the dura mater and arachnoid mater layers of the meninges. This injury often occurs due to significant head trauma, such as a motor vehicle accident. As blood accumulates within the potential space between the dura and arachnoid layers, it forms a crescent-shaped collection that can compress the underlying brain tissue, leading to symptoms such as altered mental status, headache, focal neurological deficits, and signs of increased intracranial pressure. Treatment may involve surgical intervention to evacuate the hematoma and relieve the pressure on the brain.