TCRN Exam 130 Questions with Verified Answers, Exams of Nursing

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TCRN Exam 130 Questions with Verified Answers Primary cause of spinal cord injuries - CORRECT ANSWER direct trauma Secondary cause of spinal cord injuries - CORRECT ANSWER decreased perfusion or oxygenation to the site of injury Neurogenic shock - CORRECT ANSWER loss of both vasomotor tone and sympathetic innervations Neurogenic shock is seen with a spinal cord injury at the level of BLANK or higher - CORRECT ANSWER T5 Complete spinal cord injury - CORRECT ANSWER When the patient exhibits a complete absence of sensation and voluntary motor function below the level of the injury Incomplete spinal cord injury - CORRECT ANSWER patients who still have some sensation or motor function or a combination of both below the level of injury Types of incomplete spinal cord injuries - CORRECT ANSWER -Anterior Cord Syndrome -Central Cord Syndrome -Brown Sequard Syndrome Examples of penetrating head wounds - CORRECT ANSWER -GSW -Stabbing/piercing Examples of blunt head wounds - CORRECT ANSWER Falls, MVC, bicycle, pedestrian incidents, assaults ETCO2 - CORRECT ANSWER -End tital carbon dioxide -Ideally kept at 35 -This measures CO2 at the end of an exhaled breath and provides information regarding adequacy of circulatory flow Normal ICP level - CORRECT ANSWER 0-15mmHg Three components of the Glasgow Coma Scale - CORRECT ANSWER 1. Eye Opening (4-1) 2. Verbal Response (5-1) 3. Motor Response (6-1) Coma - CORRECT ANSWER Defined as a GCS of 8 or less and REQUIRES definitive airway management Adequate CPP - CORRECT ANSWER 60-70mmHg Cushing's Triad - CORRECT ANSWER Hypertension, bradycardia, and irregular respirations -Signs of herniation and require immediate attention Classification of Brain injuries - CORRECT ANSWER Mild (GCS of 14-15) Moderate (GCS of 9-13) Severe (GCS of 3-8) Focal intracranial lesions - CORRECT ANSWER localized lesions that may expand and cause damage to other areas of the brain or result in secondary injury Cerebral contusion - CORRECT ANSWER When capillaries in the brain tissue are damaged and cause hemorrhage, infarction, or necrosis Intracerebral Lesion - CORRECT ANSWER Occur deep within the brain tissue and can have single lesions or multiple. Can cause complications such as mass effect, increased ICP, or neurologic deterioration. Epidural Hematoma - CORRECT ANSWER -Arterial bleed often caused by a direct blow to the head causing ruptured blood vessels in close proximity to the fracture -bleeding between the skull and dura -"talk and die" syndrome -Treated with evacuation of blood (burr hole) Obtunded - CORRECT ANSWER very drowsy when not stimulated, response is minimally obtained Stuporus - CORRECT ANSWER minimal spontaneous movement, arousable only with vigorous and continuous external stimuli Comatose - CORRECT ANSWER vigorous stimulation fails to produce any voluntary neural response First sign of neurological deterioration - CORRECT ANSWER changes in orientation (first to go is event, last to go is person) Anisocoria - CORRECT ANSWER difference of 1mm or more in pupil size Euglycemia - CORRECT ANSWER Keep blood sugar between 80-180 Avoid fluids mixed with D5W Indicator of Anterior skull fx - CORRECT ANSWER Raccoon eyes Indicator of posterior skull fx - CORRECT ANSWER battle sign (bruise behind ear) Subarachnoid Hemorrhage - CORRECT ANSWER -Bleeding between the arachnoid and pia mater -Described as the worst headache ever -Treat with calcium channel blockers and reduce vasospasms Second impact syndrome - CORRECT ANSWER Occurs when the patient suffers a 2nd mild TBI before recovery from the first Treatment for dental fractures - CORRECT ANSWER Apply calcium hydroxide to protect the tooth from further injury or exposure to saliva or air which can lead to pulpitis Subconjunctival Hemorrhage - CORRECT ANSWER Disruption of the conjunctival blood vessels but resolves spontaneously within 2 weeks Conjunctival Abrasion - CORRECT ANSWER Treat with erythromycin ointment for 2-3 days Intraocular foreign body - CORRECT ANSWER Considered a true ocular emergency -Elevate HOB -Immobilize foreign body -Protect or shield the eye -Opthalmology consult Hyphema - CORRECT ANSWER Blood in the anterior chamber of the eye that causes pain, photophobia, blurred vision, or increased ICP Treatment of Hyphema - CORRECT ANSWER Elevate HOB, Total bed rest for 3-5 days, metal shield over eye, eye rest, avoid NSAIDS or ASA, ophthalmology consult, timolol to prevent rebleeding Treatment of ocular burns - CORRECT ANSWER Irrigate until pH returns to normal range 7.0-7.3 Absolute indications for a pelvic binder - CORRECT ANSWER 1. HD unstable patient with a mechanically unstable pelvis 2. HD unstable patient with a suspected pelvic fx Compartment Syndrome - CORRECT ANSWER Develops when the pressure within the myofascial compartment of muscle increases to the point that it restricts blood flow resulting in ischemia and subsequent necrosis Key indicator of compartment syndrome - CORRECT ANSWER PAIN OUT OF PROPORTION WITH THE INJURY Signs and symptoms of compartment syndrome - CORRECT ANSWER -Pain out of proportion to injury -Palpable tenseness of the compartment -Asymmetry to the muscle compartment -Pain on passive stretch -Altered sensation Special considerations for Pediatric soft tissue injuries - CORRECT ANSWER 1. Mechanism: MVC, child maltreatment, blunt trauma involving the brain (apnea, hypoventilation and hypoxia), small body mass resulting in greater force applied per unit of body area 2. Head injury: Head is larger proportionately resulting in higher frequency of blunt brain injuries 3. Spine: large heads and weak neck muscles potentially cause higher incidence of flexion/extension injuries (SCIWORA) 4. Skeletal: incompletely calcified leading to more pliable bones resulting in internal organ injury without bony fracture Contusion - CORRECT ANSWER Rupture of subQ vessels with extravasation of erythrocytes that causes bleeding under the skin but not a break in the skin, usually caused by blunt forces Hematoma - CORRECT ANSWER Rupture of an artery or vein that will continue to expand until the pressure in the tissue exceeds the pressure in the ruptured vessel Treatment for frostbite - CORRECT ANSWER -Quickly rewarm affected part in warm water (DO NOT LET REFREEZE) -Avoid friction or rubbing -Administer ASA to decrease risk of thrombus formation Abrasion - CORRECT ANSWER Partial or full thickness wound that denudes the skin, caused by friction when a body part rubs or scrapes across a rough surface Laceration - CORRECT ANSWER open wound resulting from shearing forces through the dermis and epidermis with potential involvement of underlying structures -***FIRST PRIORITY IS TO CONTROL BLEEDING Avulsion - CORRECT ANSWER Separation of layers of soft tissue, can detach completely or hang as a flap Treatment of a puncture wound - CORRECT ANSWER soak in abx agent or water 2- 3x per day for 2-4 days Zone of Coagulation of a burn injury - CORRECT ANSWER NONVIABLE area of tissue at the epicenter of the burn Zone of Stasis of a burn injury - CORRECT ANSWER Surrounding tissues to the coagulated areas that potentially are salvageable with correct resuscitation Zone of Hyperemia of a burn injury - CORRECT ANSWER Peripheral tissues that undergo vasodilatory changes but are not injured thermally and remain viable Poikilothermy - CORRECT ANSWER Body assumes room temperature Developmental stage for ages Birth to 2 years - CORRECT ANSWER trust vs. mistrust Developmental stage for ages 2-4 years - CORRECT ANSWER autonomy vs. shame and doubt Developmental stage for Pre-school - CORRECT ANSWER initiative vs. guilt Developmental stage for grade school - CORRECT ANSWER industry vs. inferiority developmental stage for adolescent to young adult - CORRECT ANSWER identity vs. role confusion Formula for Cardiac Output - CORRECT ANSWER CO = HR x SV What is the earliest measurable sign of shock? - CORRECT ANSWER Tachycardia Clinical findings of compensated shock - CORRECT ANSWER -Tachycardia -Vasoconstriction -Sodium and water retention -Increased rate and depth of respirations Clinical findings of decompensated shock - CORRECT ANSWER -Hypotension with narrow pulse pressure -Tachycardia -Acute renal failure -Decreasing LOC -Pulmonary edema -Peripheral edema -Hypoxemia Pulse pressure - CORRECT ANSWER Systolic - diastolic BP Clinical findings of Irreversible shock - CORRECT ANSWER -Organ damage and enormous discharge of endogenous catecholamines Tranexamic Acid - CORRECT ANSWER synthetic version of amino acid lysine that inhibits activation of plasminogen (opposite of TPA) Permissive Hypotension - CORRECT ANSWER -When minimal fluid resuscitation is used to allow BP to remain low (SBP around 80) -decreases likelihood of coagulopathy -Less hypothermia -Less risk for acidosis -Diminishes clot dislodgement Damage Control Resuscitation - CORRECT ANSWER Minimizes the amount of crystalloid used (1:1:1 of PRBC, plasma, and platelets) Lactate Level - CORRECT ANSWER Byproduct of inadequate tissue perfusion. Levels greater than 4 indicate widespread tissue hypoperfusion Base Deficit - CORRECT ANSWER measures buffering capacity of the blood reflecting metabolism and depth of hemorrhagic shock. Base deficit of greater than 6 is a marker of severe injury Hallmark sign of cardiogenic shock - CORRECT ANSWER JVD due to large amount of volume! (pulmonary HTN with crackles) Clinical findings in cardiogenic shock - CORRECT ANSWER -hypotension -Tachycardia -Increased respirations -Decreased UOP -Cool, pale skin Inotropes to treat right sided cardiogenic shock - CORRECT ANSWER Milrinone, Dobutamine Obstructive Shock - CORRECT ANSWER Hypoperfusion of tissue due to an obstruction in either the vasculature or heart Distributive Shock - CORRECT ANSWER An abnormality in the vascular system that produces a maldistribution of blood flow (blood vessels dilate without subsequent increase in volume) SIRS Criteria - CORRECT ANSWER -Temp >38 or <36 -HR >90 -RR >20 -AMS -Hyperglycemia without DM *Pts need TWO or more of the following combined with signs of infection!!!! Primary prevention of trauma - CORRECT ANSWER elimination of the trauma incident completely Secondary prevention of trauma - CORRECT ANSWER reduce the severity of the injury after it has occured tertiary prevention of trauma - CORRECT ANSWER reduce the long term consequences after an injury 4 E's of injury prevention - CORRECT ANSWER Education Enactment Engineering Economics Epidemiology triad of causal factors - CORRECT ANSWER 1. Agent 2. Host 3. Environment