Download TCRN Exam Questions and Answers and more Exams Nursing in PDF only on Docsity! TCRN EXAM QUESTIONS AND ANSWERS List three effects of inflammatory mediators - Answers -Diaphoresis, glycogeonolysis, bronchodilation, increased: HR, contractility, automasticity, RR Describe the technique for inserting IO into distal femur - Answers -Anterior midline above the external epicondyles, 1 - 3cm above the femoral plateau; the knee slightly flexed and the hip externally rotated and flexed Describe the technique for inserting IO into distal tibia - Answers -just proximal to the medial malleolus Describe the technique for inserting IO into humerus - Answers -Directly above the greater tuberosity Describe the technique for inserting IO into proximal tibia - Answers -2cm distal and slightly medial to the tibial tuberosity Recognize adequate fluid resuscitation using four end points to resuscitation - Answers -Traditional - Vital signs, urinary output (>0.5mg/kg/hr), Mental status Treatment goals for patients with PTSD - Answers -Restore sense of control Diminish power of the traumatic event Reduce chronic hyperarousal Reduce feelings of guilt/self-blame Restore sense of equilibrium List three patient dispositions allowed by COBA/EMTALA legislation - Answers - Admission to the facility Stabilizing care, followed by transfer to qualified facility Treated and discharged What is the performance improvement loop? - Answers -Identify the outcomes Determine plan Measure progress Describe quantitative research - Answers -A deductive process that utilizes numeric findings examples: randomized controlled trials, cohort studies Describe qualitative research - Answers -an inductive process where words are used to give meaning to data, involves interactions between researcher and the subject. examples: data collected by observation, questionnaires, or interviews, data is reported using words as opposed to numbers Five ethical principals utilized in trauma care - Answers -Autonomy Beneficence Non-malficence Veracity (honesty) Justice List three complications associated with a contusion and/or hematoma - Answers - Compartment syndrome Risk for infection Risk of hypovolemia The four interventions used to control hemorrhage in amputations - Answers -Direct pressure Pressure point Elevation Tourniquet Describe primary wound closure - Answers -Immediate wound closure Describe secondary wound closure - Answers -Allowed to close on own over time (for clean wounds with significant tissue loss) Describe tertiary wound closure - Answers -Closure is delayed for a period of time (wounds with significant bacterial contamination) The Rule of Nines - adult - Answers -Head 9% Chest 9% Abdomen 9% upper back 9% lower back 9% Arm 9% upper leg 9% lower leg and foot 9% Genitals 1% Rule of Nines - pediatric - Answers -Head 18% Chest 9% Abdomen 9% upper back 9% lower back 9% arm 9% upper leg 7% lower leg and foot 7% Invasive hemodynamic monitoring - Central Venous Pressure (normal 2-6mmHg), Pulmonary wedge pressure (8-10mmHg), Cardiac Index (2.5 - 4.0L/minute/m^2), Delivery of oxygen (DO2) (500-600mL O2/min/m^2) WBC ↑ Define primary injury prevention - Answers -designed to prevent occurrence of injury Define secondary injury prevention - Answers -designed to reduce the severity of the injury Define tertiary injury prevention - Answers -improvement in outcomes related to traumatic injuries Advantages of ground transport - Answers -Larger payloads Readily available Advantages of helicopter transport - Answers -Rapid point to point transfer Can reach areas of difficult terrain Usually has advanced care crew Advantages of fixed wing transport - Answers -Can travel long distances rapidly Cabin is pressurized and roomy Can transport multiple patients Not limited by weather Disadvantages of ground transport - Answers -Slow Affected by weather Disadvantages of helicopter transport - Answers -Expensive Limited by: - weight - distance - weather Loud Cabin not pressurized Disadvantages of fixed wing transport - Answers -Expensive Limited accessibility due to landing strip Usually requires ground support to complete transport Four factors that increase risks of falls - Answers -Muscle weakness Drugs which increase sleepiness Use of cane or walker Need to use bathroom frequently Members of rehab team - Answers -Patient and family Nurse Physical therapist Respiratory therapist Occupational Therapist Speech pathologist Physiatrist Conditions of brain death - Answers -Irreversible Body temp > 35C Fixed pupils Apnea in presence of hypercarbia (PaCO2 > 60) No reflex activity: oculocephalic, oculovestibular, cough, gag, and corneal Describe corneal reflex - Answers -Brush a wisp of cotton against the cornea, or apply a small drop of saline; normal response is rapid closing of eyelid Gag reflex - Answers -Stimulate back of pharynx, normal response is to gag Swallow reflex - Answers -Stimulate uvula, normal response is elevation of uvula What is oculocephalic reflex - Answers -Dolls eyes; if eyes move opposite direction of head movement, it is abnormal finding What is oculovestibular reflex - Answers -Water is instilled in ear canal. Warm water - eyes deviate towards tested side; Cold water - eyes deviate towards opposite side; Lack of eye movement is consistent with brain death. Indications for ICP monitoring - Answers -Salvageable patients with severe injury GCS of 3 to 8 after resuscitation Abnormal CT findings Unconscious Contraindications for ICP monitoring - Answers -Awake patients Coagulopathies Pupillary response in brain injured patients - Answers -Irregular or oval shaped pupils Anisocoria (unequal pupil size) Slow or unequal or lack of pupillary response List five nursing activities that reduce cerebral metabolism - Answers -Maintain dark and quiet room Limit visitors Speak softly Cluster nursing activities Limit dialogue Regular sedation/analgesia List symptoms associated with diffuse axonal injury - Answers -Coma Increased ICP Posturing Hypertension Increased temperature Hyperhydrosis from nipple line up No pupillary signs Describe deficits associated with anterior cord injuries - Answers -Loss of motor function, pain & temperature perception, crude touch and pressure Intact - fine touch, fine pressure, and vibration Describe deficits associated with posterior cord injuries - Answers -Loss of proprioception, vibration, fine touvhm fine pressure Intact - motor function, pain, temperature, crude touch, crude pressure Treatment for an avulsed tooth - Answers -Handle by crown Do not clean, rub, scrape, or disinfect Store in Hank's solution ( or milk or normal saline) Define penetrating globe injury - Answers -Entrance without an exit Define perforating globe injury - Answers -complete disruption of the sclera and cornea, through and through