what must the Emergency Room Nurse do FIRST?

Correct Answer: B

Rationale: When a patient arrives in the emergency room, the nurse's first priority is to assess the patient's airway, breathing, and circulation, following the ABCs of emergency care. In this scenario, positioning the patient with the head lower than the extremities ensures proper blood flow to vital organs, especially the brain. This position helps to maintain perfusion to the brain and prevent complications such as hypotension and shock. Once the patient's position is optimized, the nurse can proceed with further interventions such as starting an intravenous line, stopping bleeding, and requesting laboratory examinations as needed.

Correct Answer: C

Rationale: The nurse does not need to determine the age of Excel when planning for Sonny's oxygen therapy. This information is irrelevant to the specific care requirements of Sonny's oxygen therapy. Sonny's age, medical history, respiratory status, and oxygen needs are the key considerations in planning for his oxygen therapy. The nurse should focus on factors such as the need for a humidifier, length of tubing, and the manner of administering oxygen (continuous or intermittent) to ensure effective and safe delivery of oxygen therapy to Sonny.

Correct Answer: C

Rationale: Rapid capillary refill is a sign indicative of shock in a trauma patient. Shock is a life-threatening condition where the body's organs and tissues do not receive adequate blood flow and oxygen, leading to cellular damage and eventual organ failure. In a trauma patient, rapid capillary refill suggests poor perfusion, which is a common feature of shock. The capillary refill time is an important clinical assessment that measures the time it takes for color to return to the nail bed after pressure is applied. In cases of shock, the refill time is faster than normal, indicating a systemic circulatory disturbance. Other signs of shock may include tachycardia (increased heart rate), hypotension (not hypertension), and hypothermia (not hyperthermia).

Correct Answer: C

Rationale: In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.

Correct Answer: C

Rationale: The color black is commonly used for general waste or non-recyclable materials, which includes papers and other waste products typically found in an office setting. By designating a black trash bin for the proper disposal of these items, it helps in efficient waste management and ensures that they are disposed of correctly. This color coding system helps individuals easily identify which type of waste goes in which bin, promoting recycling and proper waste segregation practices in the office environment.

Correct Answer: C

Rationale: The symptoms described in the scenario - chest pain, dyspnea, and cyanosis - are indicative of a potential air embolism. Air embolism occurs when air enters the bloodstream, leading to blockages in blood vessels and impeding oxygen delivery to tissues. In patients receiving Total Parenteral Nutrition (TPN) through intravenous lines, the risk of air embolism exists during line manipulations, disconnections, or improper priming of the tubing. The sudden onset of symptoms like chest pain and cyanosis in a patient on TPN should raise suspicion for an air embolism, as it requires immediate intervention to prevent further complications such as cardiac arrest or stroke.

Correct Answer: C

Rationale: The APCAR (Appearance, Pulse, Grimace, Activity, Respiration) score is used to evaluate a newborn's condition in the first few minutes after birth. This assessment typically occurs within the first 1 to 3 minutes after the baby is born. The score helps healthcare providers quickly assess the baby's overall well-being and determine if any immediate interventions or further monitoring are necessary.

Correct Answer: A

Rationale: The bioethical issue described in option A revolves around the concept of advance directives. Advance directives are legal documents that outline a person's wishes regarding medical treatment in the event that they are unable to communicate those wishes themselves. In this scenario, the issue pertains to the withholding of food and treatment based on a written advance directive that was made before the patient suffered permanent brain damage. This raises important ethical considerations about respecting a patient's autonomy and adhering to their previously expressed wishes, even in difficult circumstances. The decision to withhold treatment in such a situation is a complex bioethical issue that needs to be handled carefully while balancing the principles of autonomy and beneficence.

Correct Answer: C

Rationale: Medico-legal charts are typically stored for a minimum of 10 years after the case is closed to ensure compliance with legal requirements and to provide a comprehensive record of the medical care provided. This duration allows for potential future reference, follow-up treatment, or legal purposes that may arise within the specified timeframe. It is important to maintain these records for an extended period to protect both the patient's rights and the healthcare provider's accountability. Additionally, storing medico-legal charts for 10 years aligns with standard retention practices in the healthcare industry.