You are transporting a 20-year-old pregnant female from a local hospital to a medical facility that specializes in high-risk pregnancies when you note the patient is experiencing unexplained hypotension and bradycardia. The patient has a patent IV and is being administered magnesium that was initiated by hospital staff. On the cardiac monitor, the patient presents with a lengthening PR interval and signs of an impending high-degree nodal block. Which of the following interventions would be most appropriate in this case?

Correct Answer: B

Rationale: The correct answer is B: Stop the magnesium sulfate infusion immediately, and administer the appropriate dose of calcium chloride to correct the adverse effects of magnesium toxicity. Rationale: 1. Magnesium toxicity can lead to hypotension, bradycardia, and cardiac conduction abnormalities. 2. Stopping the magnesium infusion is crucial to prevent further adverse effects. 3. Calcium chloride is the antidote for magnesium toxicity as it competes with magnesium for binding sites on cardiac cells, restoring normal cardiac function. 4. Administering a normal saline bolus (choice A) would not address the underlying cause of magnesium toxicity. 5. Administering potassium chloride (choice C) is not appropriate as it can exacerbate the cardiac effects of magnesium toxicity. 6. Reducing the magnesium infusion and administering dextrose 50% (choice D) would not address the magnesium toxicity and may not reverse the cardiac effects.

Correct Answer: A

Rationale: The correct answer is A because a 10-year-old patient with superficial burns over 60% of the body is considered a critical burn due to the extent of body surface area involved and the age of the patient. Young children have less physiological reserve and are more prone to fluid loss and complications. Superficial burns over a large body surface area can lead to significant fluid loss, electrolyte imbalances, and potential systemic complications. Choice B is incorrect as full-thickness burns are more severe than superficial burns, but the extent of burns on the left upper/lower arm is limited compared to Choice A. Choice C is incorrect because although the patient has partial-thickness burns over 25% of the body, the age of the patient is not as critical as in Choice A. Choice D is incorrect for the same reasons as Choice C; the extent of burns is similar but the age of the patient is different, and the patient's age is a crucial factor in determining the severity of burns.

Correct Answer: C

Rationale: The correct answer is C: An advanced directive. This legal document allows an individual to specify their preferences for medical treatments in case they are unable to make decisions. It includes instructions on what treatments to receive or avoid. A DNR order (choice A) specifically pertains to resuscitation preferences only. A will (choice B) outlines the distribution of assets after death, not medical care decisions. Personal directive (choice D) is not a commonly used term for this type of legal document.

Correct Answer: C

Rationale: The correct answer is C: Control internal hemorrhage operatively. In cases of gunshot wounds to the abdomen, the priority is to control internal bleeding through surgical intervention. This is crucial to prevent hypovolemic shock and potential complications. Administering O-negative blood (choice A) is important for resuscitation but is not the definitive treatment. Applying external warming devices (choice B) is not the primary concern in this scenario. Using a pneumatic antishock garment (PASG) (choice D) may be used in some cases but is not the definitive treatment for managing internal hemorrhage. Operating to control the bleeding is essential for the patient's survival.

Correct Answer: D

Rationale: The correct answer is D: Endotracheal intubation and mechanical ventilation. In the case of a flail chest, where multiple ribs are fractured causing a segment of the chest wall to move independently from the rest of the thorax, the patient is at high risk of respiratory compromise. Endotracheal intubation and mechanical ventilation are necessary to ensure adequate oxygenation and ventilation, as the flail segment impairs the ability of the chest wall to expand effectively. High-flow oxygen via a nonrebreathing mask alone may not be sufficient to support the patient's respiratory needs. Choice A is incorrect because the patient's confusion is likely due to inadequate oxygenation and ventilation, not fluid resuscitation. Choice B is incorrect because cyanosis is a late sign of respiratory distress and should not be solely relied upon for management decisions. Choice C is incorrect as tachypnea is a compensatory mechanism and not a definitive management strategy for a flail chest.