ATCN EXAM LATEST 2024-2025 ACTUAL EXAM 80 QUESTIONS & CORRECT DETAILED ANSWERS & RATIONALE, Exams of Health sciences

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ATCN EXAM LATEST 2024-2025 ACTUAL EXAM 80

QUESTIONS & CORRECT DETAILED ANSWERS &

RATIONALES (VERIFIED ANSWERS). ALREADY GRADED

A+

• ANSepidural hematoma
• Administer IV fluids -Administer Sodium Bicarb -Close monitoring of renal perfusion/health (rhabdo) -Close monitoring of compartment syndrome - ANSThe management of a crush injury -Acidosis
• Hypothermia
• Coagulopathy (blood can't clot resulting in continued bleeding) - ANStriad of death -assess pulses, color, temperature, and sensation o the extremity distal to the injury before and after splinting

-stabilize the joint proximal and distal to the fracture site - ANSThe basic principles of applying splints to extremity fractures include -His pulse pressure will narrow -He will be tachycardic - ANSA previously healthy 70-kg man suffers an estimated blood loss of 1 liter. What applies to this patient: -remove damp clothing -warm fluids orally if pt can drink -placing the injured extremity in warm circulating water at 40 C - ANSManagement of Frostbite -uterine tenderness or rigidity -abdominal pain or cramping -easy palpation of fetal parts - ANSWhat signs and symptoms indicate possible uterine rupture?

20 sustained - ANSWhat ICP warrants physician notification? 0-10 mmHg - ANSNormal ICP at rest

0-total paralysis 1-palpable of visible contraction 2-active movement with full ROM against gravity 3-active movement with full ROM against gravity AND some resistance 4-active movement, full ROM against gravity and Moderate resistance 5-normal active movement, full ROM against gravity and resistance - ANSmuscle function test results 1- No difficulty 2- No difficulty but less of an opening 3- Moderate difficulty, only base of uvula visible 4- Severe difficulty, only hard palate visible - ANSMallampti Scores

1. Becks Triad= increased venous pressure(distended neck veins), decreased arterial pressure(hypotension), muffled heart tones
2. PEA
3. JVD &/or Kussmauls sign
4. Use FAST to dx - ANSSigns and sx of cardiac tamponade

1. Needle decompression- large bore needle 2nd intercostal space midclavicular line 2. chest tube 4 or 5th intercostal space mid axillary - ANSTx of tension pneumothorax
2. Normal -2 to 2
3. Mild -5 to -
4. Moderate -9 to -6*** (-6 or more indicates severe injury and significant mortality)
5. Severe -10 or more - ANSBase deficit chart 1. normal 2. mild 3. moderate 4. severe
6. Respiratory distress
7. Asymmetry of breath sounds
8. Deviation of trachea to the opposite side of the defect
9. Marked decreased in cardiac output
10. Hypotension
11. Muffled heart sounds - ANSsigns of tension pneumothorax 1.chest pain

2.air hunger 3.respiratory distress 4.tachycardia 5.hypotension 6.tracheal deviation away from injury 7.unilateral absence of breath sounds 8.elevated hemithorax w/out respiratory movement 9.neck vein distention 10.cyanosis (late sign) - ANS10 Signs and sx of tension pneumothorax 1.Metabolic acidosis is corrected by control of hemorrhage and admin of fluids and blood 2.The degree of metabolic acidosis is measured by the base deficit from the abg's. The base deficit helps estimate level of perfusion and pt's response to resuscitation - ANSAcid base balance, base deficit and shock 30% - ANSA child can lose what percent of their blood before SBP decreases? 70-100 mmHg - ANSNormal CPP for adults

A- Allergies M-Medications currently used P-Past illnesses or Pregnancy? L-Last meal E- Eevents/Environment r/t injury - ANSSecondary Survey absent distal pulses and poor capillary refill - ANSNot reliable in diagnosing compartment syndrome adequate urinary output - ANSWhich of the following would provide the nurse with the best indication of the effectiveness of fluid resuscitation in the burn patient alcohol seizures drugs chronic resp. conditions - ANSPatient condiitons which will alter the base deficit value

altered level of consciousness nausea and vomiting headache restlessness, change in speech NOT: Dilated or non-reactive pupil - ANSIn the head injured patient all of the following are considered early signs and symptoms of increased ICP an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. Reduced tissue perfusion causes cellular hypoxia-> cellular conversion from aerobic to anaerobic metabolism ->leads to accumulation of lactic acid -> metabolic acidosis - ANSdefine shock Anterior/Posterior Head - 9% Each Anterior/Posterior Torson - 18% Each Anterior/Posterior Arms - 4.5% Each Anterior/Posterior Legs - 7% Each - ANSRule of 9's - Pediatric anticipate the need for volume replacement due ti osmotic diuresis - ANSWhen using Mannitol for ICP elevation remember to

bradycardia and cardiac arrest - ANSHypoxia is the most common cause of ________ in childred burns that destroy the entire thickness of the skin -dark leathery appearance -mottled, or wax like appearance -painless -dry surface - ANSthird degree burns Careful assessment of the pt's breath sounds is paramount to differentiate the two - ANStension pneumothorax can often be confused with cardiac tamponade, how do you differentiate? coagulation abnormalities - ANSPatients with TBI's are particularly prone to control hemorrhage and restore blood flow - ANSThe best way to restore cellular and organ perfusion in hemorrhagic shock is to CPP= MAP-ICP - ANSCentral Perfusion Pressure (CPP)

decrease elevated intracranial pressure In the acutely neurological deteriorating patient - ANSFor the head trauma patient with cerebral edema, hyperventilation should only be used cautiously for limited periods of time to: devices capable of warming and rapid infusion - ANSFluid and blood should be administered through direct pressure to area of EXTERNAL active bleeding - ANSInitial management of external life-threatening hemorrhagic shock includes: Early signs and sx

1. increased pain, greater than expected and out of proportion to the injury
2. Palpable tenseness of the compartment
3. asymmetry of the muscle compartment
4. pain on passive stretch 5.altered sensation

Note: Absent distal pulses and poor cap refill are not reliable in dx compartment syndrome. May be a very late sign of C.S. possibility of proximal vascular injury should be considered - ANSsigns and symptoms of compartment syndrome forceful manual compression and pelvic rock of the pelvis to determine instability

• ANSFor pelvic fractures NEVER goggles gloves face mask water-impervious gown - ANSWhat is considered a standard precaution: Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper/mid/low back and buttocks = 18% Each arm = 9% (front = 4.5%, back = 4.5%) Groin = 1% Each leg = 18% total (front = 9%, back = 9%) - ANSrule of 9's adult

hypoxia - ANSIn Ped's bradycardia is often sign of Increase heat in room Minimize draft, keep doors closed' Administer humidified and warm O2 (41C) in ET Remove all wet clothing Minimize body exposure Apply warm blankets Wrap child's head in warm towels Promote use of convective air heating devices Monitor temperature (core if possible) Administer fluids and blood through warmer (42C) - ANSTrauma Resuscitation Room increasing HR - ANSChildren only have one compensatory mechanism infusion of IV crystalloid fluids judicious use of vasopressors

close monitoring of the patient's BP and pulse anticipate invasive hemodynamic monitoring - ANSTreatment of neurological shock infusion of warm fluids peripheral IV access short, large caliber IV catheters infusion rates of 20 ml/kg - ANSInitial fluid resuscitation may include: intubation of the patient assessment of the arterial blood gasses the need for chest tube placement - ANSThe intervention that the nurse must anticipate in a patient who has sustained a severe crush injury to the chest and is SOB include: L-Look externally E-Evaluate (3-3-2) for oral cavity spacing M-Mallampti score O-Obstruction of airway

N-Neck mobility - ANSLEMON for intubation Lactate levels help determine organ perfusion. Obtain lactate levels and correct to less than 2 - ANSLactate levels and shock Late sign of compartment syndrome - ANSLoss of pulses in injured limbs late sign of ICP, systolic will go up diastolic will go down, pulse drops, resp drop, temp goes up - ANSCushings triad measured from bottom of chin to top of shoulder - ANSAppropriate C-collar size mild: 13- moderate: 9- severe disability: 3- vegatative state: <3 - ANSGCS scores muffled heart sounds distended neck veins

hypotension - ANSS/S of cardiac tamponade (Beck's triad) pain with passive stretch of the muscle swelling of the affected extremity paresthesias and loss of function pain out of proportion to the injury - ANSS/S of compartment syndrome Patient with RR of 10 blood or vomit in the oral cavity cervical spine injury - ANSPotential indications for nasal intubation patients with cardiac arrest - ANSC02 detector reading may be inaccurate in place an occlusive dressing over the wound (taped on three sides) - ANSFor an open bubbling chest wound retrograde urethrogram - ANSRadiographic procedure to r/o urethral injury

secure a patent airway with C-spine immobilization - ANSWhich of the following responses is the most important initial step in providing nursing care of the head injured patient? spine radiographs including cervical, thoracic, lumbar, and sacral vertebra - ANSA young conctruction worker falls 2 stories from a building and sustains bilateral calcaneal fractures. After a primary survery the stable patient should receive sx can be slow and gradual and silent. hypotension, tachycardia, arrhythmias and dysrhythmias, visible trauma, distended neck veins, muffled heart sounds, and other signs of shock. Note: rapid deceleration - ANSblunt cardiac injury s and sx tachycardia and hypotension - ANSSymptoms of compression of the vena cava in the pregnant trauma patient include: tearing of a bridging vein between the cerebral cortex and a draining venous sinus

• ANSMost common underlying cause of a subdural hematoma? the airway with cervical spine control - ANSWhen multiple victims are present at the scene of a major motor vehicle crash, the highest priority is given to

The approach to trauma care typically begins with what? - ANSnotification that a trauma patient is arriving the neck muscles are strong - ANSWhat is NOT an anatomical difference of children? thoracotomy is indicated when output exceeds 1500 mL within 24 hours, THE INDICATIONS for thoracotomy after traumatic injury typically include shock, arrest at presentation, diagnosis of specific injuries (such as blunt aortic injury), or ongoing thoracic hemorrhage. - ANSIndications for thoracotomy Trauma primary survey for "A"? - ANSairway and alertness with simultaneous cervical spinal stabilization Trauma primary survey for "B"? - ANSbreathing and ventilation Trauma primary survey for "C"? - ANScirculation and hemorrhage control Trauma primary survey for "D"? - ANSdisability (neurological status: AVPU/GCS)

Trauma primary survey for "E"? - ANSexposure and environmental control Trauma primary survey for "F"? - ANSfull set of vital signs and family presence Trauma primary survey for "G"? - ANSget resuscitation adjuncts (LMNOP) Trauma primary survey for "H"? - ANShistory and head to toe assessment Trauma primary survey for "I"? - ANSinspect posterior surfaces type A - ANSNew universal plasma type? Urine output measures organ perfusion and adequate resuscitation Adults- 0.5 ml/kg/hr Peds- 1 ml/kg/hr baby- 2 ml/kg/hr - ANSUrine output and hypovolemic shock

What does "Safe care" mean when receiving trauma patients? - ANSthat the patient is going to the right hospital, in the right time, for the right care What does "Safe practice" mean when receiving trauma patients? - ANStake into consideration the protection of the team (universal precautions/PPE/preparing equipment prior to patient arrival) When preparing to receive a trauma patient, what should you keep in mind? - ANSsafe practice, safe care Which resuscitation adjunct under the "G" primary assessment is this? -"L" - ANSlaboratory studies (ABG's/Type and cross) Which resuscitation adjunct under the "G" primary assessment is this? -"M" - ANSmonitor for continuous cardiac rhythm and rate assessment Which resuscitation adjunct under the "G" primary assessment is this? -"N" - ANSnaso/orogastric tube consideration Which resuscitation adjunct under the "G" primary assessment is this?

-"O" - ANSoxygenation and ventilation analysis (pulse oximetry/ETCO2/capnography) Which resuscitation adjunct under the "G" primary assessment is this? -"P" - ANSpain assessment and management