SOAL POST TEST-with 100% verified solutions-2024-2025.docx, Exams of Nursing

Download SOAL POST TEST-with 100% verified solutions-2024-2025.docx and more Exams Nursing in PDF only on Docsity! SOAL POST TEST-with 100% verified solutions- 2024-2025 1. Cardiac tamponade after trauma a. is seldom life-threatening b. can be excluded by an upright, AP chest x-ray c. can be confused with a tension pneumothorax d. causes a fall in systolic pressure of > 15 mm Hg with expiration e. most commonly occurs after blunt injury to the anterior chest wall 2. Which one of the following statements regarding patients with thoracic spine injuries is TRUE? a. Log-rolling may be destabilizing to fractures from T-12 to L-1. b. Adequate immobilization can be accomplished with the scoop stretcher. c. Spinal cord injury below T-10 usually spares bowel and bladder function. d. Hyperflexion fractures in the upper thoracic spine are inherently unstable. e. These patients rarely present with spinal shock in association with cord injury. 3. Absence of breath sounds and dullness to percussion over the left hemithorax are fmdings best explained by a. Left hemothorax. b. c. d. e. f. g. cardiac contusion h. left simple pneumothorax i. left diaphragmatic rupture j. right tension pneumothorax. 4. A young man sustains a gunshot wound to the abdomen and is brought promptly to the emergency department by prehospital personnel. His skin is b. aggressive fluid infusion. c. intravenouspyleography. d. debridement of necrotic muscle. e. admission to the intensive care unit for observation. 8. An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in this child a. is most likely a central cord syndrome. b. must be diagnosed by magnetic resonance imaging. c. can be excluded by obtaining a CT of the entire spine. d. may exist in the absence of objective findings on x-ray studies. e. is unlikely because of the incomplete calcification of the vertebral bodies. 9. Immediate chest tube insertion is indicated for which of the following conditions? a. Pneumothorax b. Pneumomediastinum c. Massive hemothorax d. Diaphragmatic rupture e. Subcutaneous emphysema 10.A 32-year-old man is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the emergency department, he has no apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is unsuccessful. Examination of his mouth reveals a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial management of his airway should consist of a. inserting an oropharyngealairvvay. b. inserting a nasopharyngeal airway. c. performing a surgical cricothyroidotomy. d. performingfiberoptic-guided nasotracheal intubation. e. performingorotracheal intubation after obtaining a lateral c-spine x- ray. 11.The primary indication for transferring a patient to a higher level trauma center is a. unavailability of a surgeon or operating room staff. b. multiple system injuries, including severe head injury. c. resource limitations as determined by the transferring doctor. d. resource limitations as determined by the hospital administration. e. widened mediastinum on chest x-ray following blunt thoracic trauma. 12.A young man sustains a ritle wound to the mid-abdomen. He is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate step is to perform a. celiotomy. b. an abdominal CT scan. c. diagnostic laparoscopy. d. abdominal ultrasonography. e. a diagnostic peritoneal lavage. 13.A teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to a. obtain a lateral cervical spine x-ray. b. insert a central venous pressure line. c. administer 2 liters of crystalloid solution. d. perform endotracheal intubation and ventilation. e. apply the PASG and inflate the leg compartments. 14.An 8-year-old boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24-hour-a-day operating room capabilities. The most appropriate management of this patient would be to a. type and crossmatch for blood. b. request consultation of a pediatrician. c. transfer the patient to a trauma center. d. admit the patient to the intensive care unit. e. prepare the patient for surgery the next day. 15.A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following EXCEPT a. air splints. b. bolstering devices. c. a long spine board. d. a scoop-style stretcher. e. A semirigid cervical collar. e. initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage. 22.A 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: a. perform a urethrogram and cystogram. b. perform external fixation of the pelvis. c. obtain abdominal and pelvic CT scans. d. perform arterial embolization of the pelvic vessels. e. perform diagnostic peritoneal lavage or abdominal ultrasound. 23. Regarding shock in the child, which of the following is FALSE? a. Vital signs are age-related. b. Children have greater physiologic reserves than do adults. c. Tachycardia is the primary physiologic response to hypovolemia. d. The absolute volume of blood loss required to produce shock is the same as in adults. e. An initial fluid bolus for resuscitation should approximate 20 mL/kg of Ringer's lactate 24.A 30-year-old man sustains a severely comminuted, open distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalispedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve a. immediate angiography. b. tamponade of the wound with a pressure dressing. c. wound exploration and removal of bony fragments. d. realignment of the fracture segments with a traction splint. e. fasciotomy of all four compartments in the lower extremity. 25. A crosstable, lateral x-ray of the cervical spine a. must precede endotracheal intubation. b. excludes serious cervical spine injury. c. is an essential part of the primary survey. d. is not necessary for unconscious patients with penetrating cervical injuries. e. is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. 26.An 18-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash. Prehospitalpersormel report that he was thrown 15 meters (50 feet) off his bfice. He has a history of hypotension prior to arrival in the emergency department, but is now awake, alert, and conversational. Which of the following statements is TRUE? a. Cerebral perfiision is intact b. Intravascular volume status is normal. c. The patient has sensitive vasomotor reflexes. d. Intraabdominal visceral injuries are unlikely. e. The patient probably has an acute epidural hematoma. 27.Which one of the following is the recommended method for initially treating frostbite? a. Vasodilators b. Anticoagulants c. Warm (40°C) water d. Padding and elevation e. Topical application of silvasulphadiazine 28.The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head injury and determine that the patient is unable to protect his airway. In the emergency department, the patient demonstrates decorticate posturing bilaterally. He is being ventilated with a bag-valve device, but his breath sounds are absent in the left hemithorax. His blood pressure is 160/88 mm Hg, heart rate is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96% . The next step in assessing and managing this patient should be to a. determine the arterial blood gases. b. obtain a lateral cervical spine x-ray. c. assess placement of the endotracheal tube. d. perform needle decompression of the left chest. e. insert a thoracostomy tube in the left hemithorax. 29.Early central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a a. patient with a splenic laceration. b. patient with an inhalation injury. c. 6-year-old child with a pelvic fracture. d. patient with a severe cardiac contusion. e. 24-year-old man with a massive hemothorax. 30.The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in a. placental abruption. a. obtain a CT scan of the head. b. administerdecadron 20 mg IV. c. perform endotracheal intubation. d. initiate an W line and administer Mannitol 1 g/kg. e. perform an emergency linar hole on the side of the dilated pupil. 37.Contraindication to nasogastric intubation is the presence of a a. gastric perforation. b. diaphragmatic rupture. c. open depressed skull fracture. d. fracture of the cervical spine. e. fracture of the cribriform plate. 38.A 24-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the emergency department reveals a flail segment of the patient's thorax. Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask, and initiation of Ringer' s lactate solution. The patient exhibits progressive confusion, cyanosis, and tachypnea. Management at this time should consist of a. intravenous sedation. b. external stabilization of the chest wall. c. increasing the F102 in the inspired gas. d. intercostal nerve blocks for pain relief. e. endotracheal intubation and mechanical ventilation. 39.During resuscitation, which one of the following is the most reliable as a guide to volume replacement? a. Pulse rate b. Hematocrit c. Blood pressure d. Urinary output e. Jugular venous pressure 40.Which one of the following physical findings suggests a cause of hypotension other than spinal cord injury? a. priapism. b. bradycardia. c. diaphragmatic breathing. d. presence of deep tendon reflexes. e. ability to flex forearms but inability to extend them.