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: C

Rationale: The correct answer is C: Local anesthesia, cleansing, and suture repair. 1. Local anesthesia is needed to numb the area before suturing. 2. Cleansing is necessary to prevent infection and remove debris. 3. Suture repair is required for a jagged laceration to promote proper wound healing and minimize scarring. Other choices are incorrect: A: Antibiotic therapy is not indicated for clean, non-infected wounds like this laceration. B: Wound exploration for foreign bodies is not necessary in this case as the mechanism of injury is known and there is no indication of foreign bodies. D: Tetanus prophylaxis is important but not directly related to the immediate management of the laceration.

Correct Answer: A

Rationale: The correct answer is A because the Brain Trauma Foundation recommends intracranial pressure monitoring for patients with traumatic brain injury and a GCS of 3 to 8, regardless of the head CT findings. Intracranial pressure monitoring helps in the management of elevated intracranial pressure, which can be life-threatening. Abnormal head CT findings may indicate the need for immediate intervention, but intracranial pressure monitoring is still recommended for all patients in this GCS range to guide treatment decisions. Choices B, C, and D are incorrect because hypotension, age > 40 years old, and bradycardia are not factors that would exclude a patient from needing intracranial pressure monitoring in the presence of a GCS of 3 to 8.

Correct Answer: B

Rationale: Step 1: Puerperal pyrexia refers to fever occurring after childbirth. Step 2: Causes can be obstetric (infection) or non-obstetric (e.g., urinary tract infection). Step 3: Non-obstetric causes are also common postpartum. Step 4: Therefore, puerperal pyrexia is not entirely obstetrically related. Step 5: Hence, the correct answer is B (FALSE).

Correct Answer: D

Rationale: The correct answer is D: Prevent excessive traction being applied. This is because in a breech delivery, excessive traction can lead to complications such as fetal injuries or umbilical cord prolapse. The midwife should avoid pulling on the baby's legs or body to prevent undue stress on the baby. The other choices are incorrect because: A: Ascertain the fetal wellbeing in utero - this is typically done through other means such as fetal monitoring. B: Allow enough room for the fetus to pass - this should be done by ensuring proper positioning and allowing natural descent. C: Allow gravitating descent of the fetus - this is not a recommended practice as it can cause complications.

Correct Answer: D

Rationale: The correct answer is D because deep transverse arrest occurs when the level of the occiput and the sinciput is the same, leading to a failure of descent of the fetal head through the pelvis. This alignment issue hinders the progress of labor despite adequate contractions. A: Incorrect. Flexion being well maintained is not a defining characteristic of deep transverse arrest. B: Incorrect. While strong uterine contractions can contribute to labor challenges, deep transverse arrest is specifically related to the alignment of the fetal head. C: Incorrect. The curvature of the sacrum is not directly related to deep transverse arrest.

Correct Answer: C

Rationale: The correct answer is C: Importance of early ambulation. After a cesarean section, early ambulation is crucial to prevent complications like blood clots and promote circulation. It helps prevent post-operative complications. Choice A is important for respiratory health but not the priority right after surgery. Choice B focuses on perineal care which is important but not the immediate priority. Choice D is important, but recognizing signs of infection can wait until the client is more stable. Early ambulation is key to preventing complications and aiding in recovery.

Correct Answer: A

Rationale: Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy due to damage to the lower brachial plexus. This results in weakness of the hand and forearm muscles. Erb's palsy is from injury to C5-C6 roots causing upper brachial plexus damage. Phrenic injury affects the diaphragm due to C3-C5 roots. Radial palsy involves the radial nerve, typically from injury at the spiral groove of the humerus. Therefore, the correct answer is A as it directly correlates with the specific nerve roots affected in Klumpke's palsy.

Correct Answer: C

Rationale: The correct answer is C: Hyperemesis gravidarum. This condition is characterized by severe nausea, vomiting, weight loss, dehydration in pregnancy. It is more severe than typical morning sickness (choice A) and is not specific to multiple gestation (choice B). Hypertensive disorders (choice D) typically present with high blood pressure, proteinuria, and edema, not just nausea and vomiting. Hyperemesis gravidarum requires medical intervention due to potential complications from dehydration and malnutrition.

Correct Answer: C

Rationale: The correct answer is C because establishing an intravenous line is essential for immediate access to administer fluids, medications, and blood products during the emergency cesarean section. This step ensures that the patient's vital signs can be supported, and any emergent interventions can be readily delivered. A: While informed consent is important, in an emergency situation, the priority is to ensure the patient's immediate medical needs are met. B: Inserting a Foley's catheter may be necessary during the procedure, but it is not the most critical assessment prior to the cesarean section. D: Shaving the perineal area is not a priority in an emergency situation and may be done during the preparation for surgery.