ATCN EXAM LATEST 2024-2025 ACTUAL EXAM 80 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RA, Exams of Nursing

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ATCN EXAM LATEST 2024-2025 ACTUAL EXAM 80

QUESTIONS AND CORRECT DETAILED ANSWERS WITH

RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED

A+

The approach to trauma care typically begins with what? ANSWER>>>> notification that a

trauma patient is arriving

When preparing to receive a trauma patient, what should you keep in mind? ANSWER>>>> safe

practice, safe care

What does "Safe practice" mean when receiving trauma patients? ANSWER>>>> take into

consideration the protection of the team (universal precautions/PPE/preparing

equipment prior to patient arrival)

What does "Safe care" mean when receiving trauma patients? ANSWER>>>> that the patient is

going to the right hospital, in the right time, for the right care

Trauma primary survey for "A"? ANSWER>>>> airway and alertness with simultaneous

cervical spinal stabilization

Trauma primary survey for "B"? ANSWER>>>> breathing and ventilation

Trauma primary survey for "C"? ANSWER>>>> circulation and hemorrhage control

Trauma primary survey for "D"? ANSWER>>>> disability (neurological status: AVPU/GCS)

Trauma primary survey for "E"? ANSWER>>>> exposure and environmental control

Trauma primary survey for "F"? ANSWER>>>> full set of vital signs and family presence

Trauma primary survey for "G"? ANSWER>>>> get resuscitation adjuncts (LMNOP)

Which resuscitation adjunct under the "G" primary assessment is this?

• "L" ANSWER>>>> laboratory studies (ABG's/Type and cross) Which resuscitation adjunct under the "G" primary assessment is this?
• "M" ANSWER>>>> monitor for continuous cardiac rhythm and rate assessment Which resuscitation adjunct under the "G" primary assessment is this?
• "N" ANSWER>>>> naso/orogastric tube consideration Which resuscitation adjunct under the "G" primary assessment is this?
• "O" ANSWER>>>> oxygenation and ventilation analysis (pulse

oximetry/ETCO2/capnography)

Which resuscitation adjunct under the "G" primary assessment is this?

• "P" ANSWER>>>> pain assessment and management

Trauma primary survey for "H"? ANSWER>>>> history and head to toe assessment

Trauma primary survey for "I"? ANSWER>>>> inspect posterior surfaces

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) ANSWER>>>> 10 Signs and sx of tension pneumothorax

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 ANSWER>>>> Signs and sx of cardiac tamponade

Careful assessment of the pt's breath sounds is paramount to differentiate the two

ANSWER>>>> tension pneumothorax can often be confused with cardiac tamponade,

how do you differentiate?

1. Needle decompression- large bore needle 2nd intercostal space midclavicular line 2. chest tube 4 or

5th intercostal space mid axillary ANSWER>>>> Tx of tension pneumothorax

• Acidosis
• Hypothermia
• Coagulopathy (blood can't clot resulting in continued bleeding) ANSWER>>>> triad of death 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%) ANSWER>>>> rule of 9's adult

Anterior/Posterior Head - 9% Each Anterior/Posterior Torson - 18% Each Anterior/Posterior Arms - 4.5% Each

Anterior/Posterior Legs - 7% Each ANSWER>>>> Rule of 9's - Pediatric

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 ANSWER>>>> signs

and symptoms of compartment syndrome

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. ANSWER>>>> Indications for

thoracotomy

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 ANSWER>>>> blunt cardiac injury s and sx

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 ANSWER>>>> Acid base balance,

base deficit and shock

1. Normal - 2 to 2

2. Mild - 5 to - 3
3. Moderate - 9 to - 6*** (-6 or more indicates severe injury and significant mortality)

4. Severe - 10 or more ANSWER>>>> Base deficit chart 1. normal 2. mild 3. moderate 4.

severe

Lactate levels help determine organ perfusion. Obtain lactate levels and correct to less than 2

ANSWER>>>> Lactate levels and shock

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 ANSWER>>>>define shock Urine output measures organ perfusion and adequate resuscitation Adults- 0.5 ml/kg/hr Peds- 1 ml/kg/hr baby- 2 ml/kg/hr ANSWER>>>>Urine output and hypovolemic shock ANSWER>>>>epidural hematoma the airway with cervical spine control ANSWER>>>>When multiple victims are present at the scene of a major motor vehicle crash, the highest priority is given to spine radiographs including cervical, thoracic, lumbar, and sacral vertebra ANSWER>>>>A young conctruction worker falls 2 stories from a building and sustains bilateral calcaneal fractures. After a primary survery the stable patient should receive goggles gloves face mask water-impervious gown ANSWER>>>>What is considered a standard precaution:

secure a patent airway with C-spine immobilization ANSWER>>>>Which of the following responses is the most important initial step in providing nursing care of the head injured patient?

• His pulse pressure will narrow
• He will be tachycardic ANSWER>>>>A previously healthy 70-kg man suffers an estimated blood loss of 1 liter. What applies to this patient:
• uterine tenderness or rigidity
• abdominal pain or cramping
• easy palpation of fetal parts ANSWER>>>>What signs and symptoms indicate possible uterine rupture? control hemorrhage and restore blood flow ANSWER>>>>The best way to restore cellular and organ perfusion in hemorrhagic shock is to adequate urinary output ANSWER>>>>Which of the following would provide the nurse with the best indication of the effectiveness of fluid resuscitation in the burn patient direct pressure to area of EXTERNAL active bleeding ANSWER>>>>Initial management of external life- threatening hemorrhagic shock includes: decrease elevated intracranial pressure In the acutely neurological deteriorating patient ANSWER>>>>For the head trauma patient with cerebral edema, hyperventilation should only be used cautiously for limited periods of time to: altered level of consciousness nausea and vomiting headache restlessness, change in speech NOT: Dilated or non-reactive pupil ANSWER>>>>In the head injured patient all of the following are considered early signs and symptoms of increased ICP

tachycardia and hypotension ANSWER>>>>Symptoms of compression of the vena cava in the pregnant trauma patient include: intubation of the patient assessment of the arterial blood gasses the need for chest tube placement ANSWER>>>>The intervention that the nurse must anticipate in a patient who has sustained a severe crush injury to the chest and is SOB include: forceful manual compression and pelvic rock of the pelvis to determine instability ANSWER>>>>For pelvic fractures NEVER place an occlusive dressing over the wound (taped on three sides) ANSWER>>>>For an open bubbling chest wound tearing of a bridging vein between the cerebral cortex and a draining venous sinus ANSWER>>>>Most common underlying cause of a subdural hematoma?

1. Respiratory distress
2. Asymmetry of breath sounds
3. Deviation of trachea to the opposite side of the defect
4. Marked decreased in cardiac output
5. Hypotension
6. Muffled heart sounds ANSWER>>>>signs of tension pneumothorax the neck muscles are strong ANSWER>>>>What is NOT an anatomical difference of children? burns that destroy the entire thickness of the skin

• dark leathery appearance
• mottled, or wax like appearance

• painless
• dry surface ANSWER>>>>third degree burns muffled heart sounds distended neck veins hypotension ANSWER>>>>S/S of cardiac tamponade (Beck's triad) retrograde urethrogram ANSWER>>>>Radiographic procedure to r/o urethral injury Patient with RR of 10 blood or vomit in the oral cavity cervical spine injury ANSWER>>>>Potential indications for nasal intubation infusion of IV crystalloid fluids judicious use of vasopressors close monitoring of the patient's BP and pulse anticipate invasive hemodynamic monitoring ANSWER>>>>Treatment of neurological shock
• remove damp clothing
• warm fluids orally if pt can drink
• placing the injured extremity in warm circulating water at 40 C ANSWER>>>>Management of Frostbite
• Administer IV fluids
• Administer Sodium Bicarb
• Close monitoring of renal perfusion/health (rhabdo)
• Close monitoring of compartment syndrome ANSWER>>>>The management of a crush injury infusion of warm fluids peripheral IV access

short, large caliber IV catheters infusion rates of 20 ml/kg ANSWER>>>>Initial fluid resuscitation may include: pain with passive stretch of the muscle swelling of the affected extremity paresthesias and loss of function pain out of proportion to the injury ANSWER>>>>S/S of compartment syndrome

• 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 ANSWER>>>>The basic principles of applying splints to extremity fractures include A- Allergies M-Medications currently used P-Past illnesses or Pregnancy? L-Last meal E- Eevents/Environment r/t injury ANSWER>>>>Secondary Survey Late sign of compartment syndrome ANSWER>>>>Loss of pulses in injured limbs L-Look externally E-Evaluate (3- 3 - 2) for oral cavity spacing M-Mallampti score O-Obstruction of airway N-Neck mobility ANSWER>>>>LEMON for intubation 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 ANSWER>>>>Mallampti Scores patients with cardiac arrest ANSWER>>>>C02 detector reading may be inaccurate in coagulation abnormalities ANSWER>>>>Patients with TBI's are particularly prone to type A ANSWER>>>>New universal plasma type? devices capable of warming and rapid infusion ANSWER>>>>Fluid and blood should be administered through 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) ANSWER>>>>Trauma Resuscitation Room alcohol seizures drugs chronic resp. conditions ANSWER>>>>Patient condiitons which will alter the base deficit value CPP= MAP-ICP ANSWER>>>>Central Perfusion Pressure (CPP)

70 - 100 mmHg ANSWER>>>>Normal CPP for adults 0 - 10 mmHg ANSWER>>>>Normal ICP at rest late sign of ICP, systolic will go up diastolic will go down, pulse drops, resp drop, temp goes up ANSWER>>>>Cushings triad mild: 13- 15 moderate: 9- 12 severe disability: 3- 8 vegatative state: <3 ANSWER>>>>GCS scores anticipate the need for volume replacement due ti osmotic diuresis ANSWER>>>>When using Mannitol for ICP elevation remember to

20 sustained ANSWER>>>>What ICP warrants physician notification? 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 ANSWER>>>>muscle function test results measured from bottom of chin to top of shoulder ANSWER>>>>Appropriate C-collar size absent distal pulses and poor capillary refill ANSWER>>>>Not reliable in diagnosing compartment syndrome

increasing HR ANSWER>>>>Children only have one compensatory mechanism 30% ANSWER>>>>A child can lose what percent of their blood before SBP decreases? hypoxia ANSWER>>>>In Ped's bradycardia is often sign of bradycardia and cardiac arrest ANSWER>>>>Hypoxia is the most common cause of ________ in childred