TCRN Exam Questions and Answers, Exams of Nursing

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TCRN Exam Questions and

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A transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrhage. The doppler is positive for vasospasm. The trauma nurse would expect which of the following medications to be prescribed? Correct answer A vasospasm is a known complication of subarachnoid hemorrhages. Calcium channel blockers are used to prevent or reverse vasospasms and are frequently used in the treatment of a subarachnoid hemorrhage. Metoprolol, Hydralazine and Lisinopril are not calcium channel blockers and would not be effective to prevent and treat vasospasms caused by a subarachnoid hemorrhage" "Which chamber of the heart is most likely to be affected in blunt cardiac injuries? Correct answer Given the anatomical position of the heart in the chest, the right ventricle is most exposed to the anterior portion of the chest wall and is most likely to be injured in a blunt cardiac injury. Patients with blunt cardiac injuries frequently experience signs of right ventricular failure. Additional findings that are associated with blunt cardiac injuries include hypotension, atrial fibrillation, unexplained sinus tachycardia, multiple PVCs, ST segment changes and right bundle branch blocks. The left atrium, right atrium and left ventricle are less likely to be injured in a blunt cardiac injury." "A widened mediastinum is noted on the chest x-ray of a traumatically injured hypotensive patient. The trauma nurse would anticipate gathering which of the following pieces of equipment as the highest priority in this scenario? Correct answer A widened mediastinum on chest x-ray, accompanied by hypotension, is strongly indicative of an aortic injury. One of the most life-threatening complications of an aortic injury is blood loss, which can be treated by giving blood products via a rapid transfuser. Although patient assessment may be enhanced by inserting an arterial line, this is less of a priority than giving fluids rapidly. A chest tube is placed in the pleural space rather than the mediastinum and is therefore not indicated in this scenario. Similarly, there is nothing in this scenario that indicates a pericardiocentesis is indicated so this is not a higher priority than preparing a rapid transfuser." "A properly applied pelvic binder sits across the: Correct answer A properly applied pelvic binder is applied across the greater trochanters of the femur. This allows for optimal compression of the pelvis to control bleeding. Applying it across the midshaft of the femur is too low and would provide no therapeutic benefit. Applying it across the

pelvic ring or the iliac crests is too high and could actually separate the pelvis further, increasing bleeding and internal damage." "Treatment for an extraperitoneal bladder rupture will most likely include: Correct answer Bladder lacerations that are located below the pelvic peritoneum are diagnosed as an extraperitoneal bladder rupture. If a laceration is found along with pelvic peritoneum, it would then be classified as an intraperitoneal bladder rupture. Management of an extraperitoneal bladder rupture involves urinary catheterization (urethral or suprapubic) to facilitate urinary drainage from the bladder. Intraperitoneal bladder ruptures require surgical intervention for definitive closure. An isolated extraperitoneal bladder rupture does not require emergent surgical repair or interventional radiology." "Hyperextension of the neck is known to cause: Correct answer Hyperextension of the neck (the head snapping backwards commonly seen in "whiplash" injuries) causes compression and damage to the posterior portion of the spinal cord. In anterior cord syndrome, the mechanism of injury is the opposite of posterior cord syndrome (a hyperflexion injury where the neck hyperextends forward - chin to chest) causing injury to the anterior portion of the spinal cord. A cauda equina syndrome causes injury to the sacral nerve roots within the spinal canal and is caused by falling directly on the sacrum. Brown-Sequard Syndrome caused by penetrating trauma to the lateral aspect of the spinal cord will cause a left to right phenomenon instead of a top down phenomenon." "A patient has a Zone II penetrating neck injury with penetration through the platysma. The trauma nurse knows that this patient is at increased risk of injury to: Correct answer The platysma is a muscle in the neck that gives support and protection to the vital structures underneath it. Any time there is penetration through the platysma, there is an increased risk of damage to the underlying structures in the neck. The neck is divided into three zones. Zone I extends from the sternal notch and clavicle up to the cricothyroid cartilage. Zone II extends from the cricothyroid cartilage upward to the angle of the mandible. Zone III extends from the angle of the mandible to the base of the skull. Structures found in Zone I include the subclavian artery, vertebral artery, lung apices, trachea, thyroid and esophagus. Zone II includes the internal jugular vein, esophagus, larynx, vagus nerve, carotid artery and vertebral artery. Zone III includes the salivary and parotid glands, cranial nerves IX-XII, vertebral artery, distal carotid artery, and distal jugular vein." "A pregnant patient's fundal height is palpated 6 cm above the umbilicus. What is the estimated gestational age of the fetus? Correct answer Fundal height is defined as the distance from the pubic bone to the top of the uterus in centimeters. In general, the fundus reaches the umbilicus by 20 weeks. Every centimeter past that point is measured as 1 week. If every one centimeter above the umbilicus equals one week, then the patient is approximately 26 weeks gestation."

"Appropriate care for an amputated body part includes: Correct answer When caring for an amputated body part, the trauma nurse should clean the part removing any dirt and debris, wrapping the part in a slightly saline moistened gauze, and then placing it in a sealed plastic bag. At this time, the part should be placed in a second bag containing a mixture of ice and water. It is imperative that the part does not freeze or does not come into contact with water (which is hypotonic to body tissue). Also ensure that the amputated part is properly labeled with the patient information." "Decontamination with water is discouraged in patients exposed to powdered: Correct answer Dry chemicals that should not be irrigated with water include dry lime, elemental metals (including sodium, potassium, magnesium lithium and phosphorus) and phenol. When exposed to water these substances will cause a harmful exothermic or "heat producing" reaction burning the patient's skin. They may also release possible hazardous byproducts into the air. Sulfuric acid, muriatic acid and cement can all be irrigated with copious amounts of water (although a much of the dry chemical as possible should be brushed off before irrigation with water is initiated)" "Hypovolemic shock is most likely to be caused by: Correct answer Hypovolemic shock is caused by fluid loss (e.g. bleeding or diarrhea) or third spacing of fluids. The inflammatory response caused by a burn leads to capillary permeability resulting in the third spacing of fluids which results in hypovolemic shock. Cervical spinal injuries contribute to neurogenic rather than hypovolemic shock. Although an epidural hematoma causes blood loss, the epidural space is relatively small, so blood accumulation would not be enough to result in hypovolemic shock. A tension pneumothorax would cause obstructive shock." "The best method for assessing capillary refill on a two-week old traumatically injured neonate is to blanch the: Correct answer The circulatory system of the neonate is not well developed and perfusion to the fingers is not complete, therefore using the tip of the finger is reserved for older children, adolescents and adults. It is generally recommended to use the forehead, sole of the foot, the sternum or the palm of the hand as opposed to the skin over the iliac crest or the tip of the child's tongue" "Enteral feedings are initiated on a traumatically injured patient and several days later, the trauma nurse notes a significant elevation in serum blood urea nitrogen (BUN) and creatinine. The trauma nurse should suspect this may be caused by: Correct answer One of the effects of overfeeding the traumatically injured patient is azotemia (elevated BUN and creatinine) and the dietician should be notified of azotemia if it is noted so that an adjustment in calories may be made. Insufficient protein in the diet does not cause azotemia. Although bleeding ulcers may cause elevations in blood urea nitrogen, they do not tend to cause elevations in creatinine. Feeding a patient too quickly after trauma does not cause elevations in BUN and creatinine"

"A trauma center refers a challenging case to an outside reviewer to validate their review of deficiencies associated with the care of the traumatically injured patient. What type of performance review process is this? Correct answer The first stage of performance improvement is a primary review. The goal at this level of review is to be able to provide immediate feedback and resolution of any deficiencies in care provided. Events that require further investigation will follow into the category of a secondary review and these reviews are done in a step-by-step approach, usually by the trauma medical director or designee. Immediate resolution and feedback can be possible at the end of secondary review, and the issue may be resolved. If the issue is not resolved, it should be referred for a multidisciplinary committee review for further analysis. This type of analysis would be classified as a tertiary review. If further escalation of review is required this would be considered a quaternary review. A quaternary review is either performed by the hospital quality committee, or it is sentfor an external peer review. This type of review is reserved for extraordinary cases or to validate the current trauma hospitalsperformance improvement and patient safety (PIPS)process." "The trauma nurse performs supraglottic suctioning on an intubated patient. The most likely rationale for this intervention is to: Correct answer Supraglottic suctioning (or using endotracheal tubes with supraglottic secretion drainage) is considered a best-practice to reduce the incidence of ventilator assisted pneumonia. It is not used to assess the readiness for extubation and will not decrease intracranial pressure. It is not associated with changing the positive end-expiratory pressure on the ventilator." "When discharging a patient after a splenectomy, the trauma nurse should encourage the patient to get meningococcal and pneumococcal vaccines every: Correct answer Patients who undergo a splenectomy have difficulty eliminating encapsulated bacteria including Streptococcus Pneumonia, Neisseria Meningitides, and Hemophilus Influenzae. Knowing this, patients are encouraged to receive an annual influenza vaccination, along with meningococcal and pneumococcal vaccines every 5 years." "After an x-ray of the neck, a patient is diagnosed with a spinal cord injury without radiological abnormality (SCIWORA). The trauma nurse should expect the patient will require: - Correct answer Although a spinal cord injury without radiological abnormality (SCIWORA) will not be identified on x- ray or computerized tomography, it will be identified using magnetic resonance imaging. This injury does not require surgery nor will it benefit from the administration of intravenous solumedrol" "The trauma nurse knows that a subdural hematoma is an accumulation of blood between the: - Correct answer The prefix "sub" means "below". So, a "subdural" hematoma occurs below the dura mater. The arachnoid mater is below the dura mater, so the subdural hematoma will be between the dura and the arachnoid mater. The skull is above the dura mater, so blood from a subdural bleed will

not be in contact with the skull. The pia mater is below the arachnoid mater, so blood from a subdural bleed will not be in contact with the arachnoid mater" "Which of the following treatment goals is most pertinent in the critical care unit when caring for a trauma patient with a rupture of the large bowel? - Correct answer Rupture of the large bowel causes the release of intestinal contents into the peritoneum. Since the large bowel contains a large amount of anaerobic bacteria, a rupture of the bowel usually causes immediate and significant peritoneal infections. Therefore, a major goal of care in the treatment of large bowel ruptures is to prevent and treat infections. This may be accomplished by early administration of antibiotics and surgical intervention to clean out the peritoneum and repair defects. Both resumption of oral nutrition and prevention of adhesions are desirable, but these are less dependent on the care provided and not as high of a priority as reducing the incidence of and treating an infection. The goal of caring for patients with abdominal injuries to maintain a healthy abdominal perfusion pressure rather than decreasing it." "A patient has electrical burns on the surface of the right hand and the left hand. Which arrhythmia is most common with this mechanism of injury? - Correct answer 60% of patient who sustain an electrical injury with entry to one hand and exit through the other will present with ventricular fibrillation. Other arrythmias are far less common." "Which of the following interventions is recognized as a way to reduce catheter associated urinary tract infections (CAUTI)? - Correct answer .Guidelines on reducing catheter associated urinary tract infections (CAUTI) include properly securing catheters to prevent movement and urethral traction. There is no evidence that regular administration of diuretics will reduce CAUTI and many trauma patients are fluid depleted and diuretics would not be appropriate for them. Irrigation of the bladder has been demonstrated to increase rather than decrease bladder infections and should be avoided when possible. Current guidelines recommend using the smallest bore catheter possible to minimize bladder neck and urethral trauma" "Which of the following members of the rehabilitation team would be most heavily involved in improving perceptual deficits after a traumatic brain injury? - Correct answer Speech pathologist has numerous roles on the rehabilitation team including: Promoting stimulation from coma, Cognitive rehabilitation, Communication through alternate methods and devices, Improvement of perceptual deficits. The physical therapist is involved in lower extremity mobility, rehabilitation and transfers. The occupational therapist is involved in upper extremity rehabilitation and learning to perform activities of daily living instead of improving perceptual deficits" "Disaster triage occurs in which of the following stages of disaster management? - Correct answer Response stage of disaster management begins after the disaster has occurred and this is when triaging patients happens. Mitigation and preparedness occur before the disaster occurs. Recovery occurs after the disaster is completed, restoring both damages that occurred to the hospital along with the psychological impact that occurred this to staff members who responds to a disaster."

"Inspection reveals a patient to have bilateral flank bruising. The trauma nurse knows this is a: - Correct answer Flank bruising (also known as Gray Turner's Sign) is indicative of a late sign of retroperitoneal bleeding. Bleeding in the retroperitoneal space allows blood to accumulate against the skin of the flanks and after some time, the blood will discolor causing bruising. Until the blood discolors, it may not be obvious. Bleeding in the peritoneum prevents blood from coming into the contact with the skin, therefore bruising, either early or late, is unlikely." "The trauma nurse knows that the ability to flex the fingers and form a fist is innervated at what level of the spinal cord? - Correct answer The nerve bundles labelled as C8 allow a patient to make a fist, therefore an injury at this level will cause a loss of the ability to flex the fingers and make a fist. Injuries at C6 cause loss of ability to extend the wrist. Injuries at T2 cause loss of intercostal muscle movement at this level. Injuries at T4 cause loss of intercostal muscle movement at the level of T4" "The trauma nurse would expect that the area around a flail chest injury will: - Correct answer A flail chest segment is defined as two or more fractures of three or more adjacent ribs. This injury may cause paradoxical chest wall movement. In paradoxical chest wall movement, the flail segment moves the opposite of the rest of the chest wall. So when the chest wall expands during inhalation, the flail segment will sink and when the chest wall retracts during expiration, the flail segment will bulge." "Two days after being admitted with fractures of ribs three through seven, a patient's blood gases show declining oxygen levels. Crackles are noted upon auscultation. These findings are most consistent with a: - Correct answer Pulmonary contusions tend to develop in the days following trauma. Damage to the lung parenchyma causes bleeding and an inflammatory response within the lung tissue causing the patient to become increasingly hypoxic. The accumulation of fluid within the lung cause crackles to auscultation. Additional symptoms include ecchymosis to the chest wall, ineffective cough and dyspnea. Hemothoraces, pneumothoraces and pericardial tamponades are evident much earlier." "The laboratory reports that a traumatically injured trauma patient has a positive Kleihauer-Betke test. The trauma nurse knows the significance of this finding is that: - Correct answer A positive Kleihauer-Betke test indicates that there is fetal blood in the maternal circulation is frequently associated with fetal injury when it is positive as part of a traumatic incident. A positive Kleihauer- Betke test does not mean that delivery is imminent or that the amniotic sac has ruptured. Fetal age is better determined by assessing fundal height" "Fascial compartment pressures are measured at 35mm Hg. The trauma nurse knows this is: - Correct answer Normal compartment pressures are 10-12 mmHg. Readings of 30-40 mmHg are significantly elevated indicating there is both ischemia to muscles and nerves requiring emergent intervention. To relieve the pressure in the compartment, a fasciotomy may be performed. There is no pressures considered abnormally low. Pressures between 20 and 30 mm Hg are considered

elevated and may be treated with interventions such as elevation of the extremity to the level of the heart, removing ice and compressive dressings and possible diuresis" "Which of the following actions is most appropriate immediately after placement of a right internal jugular line? - Correct answer The correct answer is to obtain a chest x-ray to ensure proper placement, prior to central line use. The line should not be used until placement has been verified." "Which of the following interventions is contraindicated for a patient with a high riding prostate? - Correct answer Foley catheters are contraindicated is patients who have a high riding prostate or perineal hematomas. Both are signs of urethral injury, which would beworsened by Foley catheter insertion. Urethrography is used to diagnose injuries to the urethra and should be performed if urethral injury is suspected. Placement of a suprapubic catheter is an appropriate intervention for a patient with a urethral injury. Bladder ultrasound is not contraindicated for patients with suspected urethral injury" "The priority intervention for a patient with bleeding from a scalp laceration is: - Correct answer Bleeding from a scalp laceration is treated the same as bleeding from other lacerations and would include control of bleeding with direct pressure. While initiating an intravenous catheter, obtaining a type and screen, and transporting the patient to radiology for computerized tomography of the head are all appropriate, they are not more important than controlling blood loss with direct pressure" "The trauma nurse anticipates resuscitative endovascular balloon occlusion of the aorta (REBOA) may be used as an intervention in a patient with: - Correct answer REBOA is used to reduce or even occlude blood flow in the aorta to control bleeding in patients with severe blood loss secondary to subdiaphragmatic bleeding (e.g. bleeding from pelvic fractures). It is not used for bleeding above the diaphragm (e.g. disruption of the aortic arch). REBOA is unlikely to be therapeutic in patients with blunt cardiac injuries (cardiogenic shock) or diaphragmatic ruptures (obstructive shock)" "The wife of a patient with a traumatic brain injury expresses feelings of hopelessness and helplessness. What dimension of grief is she expressing? - Correct answer Human response following grief is broken down into somatic, cognitive, affective and behavioral expressions. Examples of somatic expressions of grief includes lack of appetite, sleep disturbances, fatigue and overeating/weight gain. Affective expression includes feelings of anxiety, depression, loneliness, guilt, resentment and self-blame. Behavioral expressions of grief include agitation, crying and social withdrawal. Cognitive expressions of grief include low self-esteem, inability to concentrate or remember, depersonalization (a feeling of a current situation being unreal) and feelings of hopelessness and helplessness. Therefore, this woman is experiencing cognitive expressions of grief" "Advanced directives embody which of the following ethical principles? - Correct answer Autonomy is the ethical principle which states that a person has the innate right to have their own opinions, perspectives, values and beliefs. Advanced directives allow a patient to make their opinions,

perspectives, values or beliefs known either through their own words (e.g. living will) or by asking others to speak on their behalf (e.g. durable power of attorney for healthcare). Veracity is being completely truthful to patients. Advanced directives do not capture this ethical principle. Justice is the equal distribution of healthcare, but this does not describe advanced directives. Beneficence is an ethical principle that states all actions should benefit a patient. Advanced directives are not captured in the ethical principle of beneficence." "Which of the following elements would be included in a tertiary trauma exam? - Correct answer A tertiary trauma exam takes place 24 to 72 hours after the initial resuscitation and involves a repeat of the primary and secondary survey as well as a review of the patient's diagnostic tests. The review may be repeated if the patient, who was initially unable to participate in the primary and secondary survey due to altered levels of consciousness is now able to participate. The purpose of this review is to find injuries which may have originally been missed. Convenings a trauma peer review committee to review a case is part of performance improvement but is not part of the tertiary trauma exam. Similarly, while it is appropriate to assess for post-traumatic stress disorder and to assess a patient's readiness for rehabilitation, these are different assessments that are not included in the tertiary exam" "The blood pressure cuff used to measure the blood pressure of an obese patient is too small. The trauma nurse knows that this will cause falsely: - Correct answer Blood pressure cuffs that are too small cause falsely elevated blood pressure readings. This would cause a falsely elevated mean arterial pressure (rather than a low mean arterial pressure) and a falsely elevated diastolic pressure rather than a low diastolic pressure. An inappropriately sized cuff does not affect the pulse pressure" "Buprenorphine is most likely to be considered to: - Correct answer Buprenorphine is a partial opioid agonist and antagonist that has been approved by the Food and Drug Administration as an alternative to opioids and may be used to reduce the risk of withdrawal. It has no therapeutic effects in sedating patients with increased intracranial pressure, will not alter bleeding in patients with coagulopathies and does not elevate the blood pressure" "Inspection reveals bruising behind the ear. This is consistent with a fracture of the: - Correct answer Bruising behind the ear is consistent with bleeding caused by a fracture of the occipital bone. The blood from this fracture gathers between the occipital bone and the skin causing bruising in this area. The maxillary and zygomatic bones are on the face and bruising with these fractures would occur in the facial area. Mandibular fractures usually cause bruising to the lower face or in the area of the tongue and submandibular space" "The trauma registry may be a good source of information for: - Correct answer A trauma registry is a disease-specific data collection composed of a file of uniform data elements that describe the injury event, demographics, prehospital information, diagnosis, care, outcomes, and costs of treatment of injured patients. One of the pieces of information available from the trauma registry is length of stay for patients within the registry. A hazards vulnerability analysis is an exercise which identifies

disasters a hospital may be at risk for. This information is not available in the trauma registry. Information for the trauma registry is nearly always entered after patient discharge so it is not useful to monitor the care of hospitalized patients. The trauma registry collects data on traumatically injured patients but is not a source of information about current research." "A trauma nurse researches the incidence of injuries in a community and decides to implement an education-based secondary injury prevention program. The first educational event is held. What is the next most appropriate step? - Correct answer After implementing an injury prevention program, the next step is to evaluate its effectiveness before beginning to work on future events. It is essential to determine if the program met its goal. Injury prevention programs are not entered into the data registry. The data registry is designed to collect data on patients that are treated for traumatic injuries. Injury prevention programs do not need to be reported as part of the secondary performance improvement process. Secondary performance improvement involves reviewing a medical record to evaluate the care that is given. Although future injury prevention educational events should be considered, the planning of future events should occur after the current event has been evaluated and modified if the evaluation demonstrates deficiencies." "When discharging a patient with a mild concussion, the patient should be encouraged to avoid contact sports for what length of time? - Correct answer Patients should be instructed to avoid contact sports until they have no post-concussion symptoms in the absence of either over the counter or prescription medications. Once diagnosed with a concussion, the patient must be medically cleared by a licensed healthcare professional rather than the patient's coach. Waiting 24 hours or even three days may be insufficient time after a concussion. They should be instructed to avoid contact sports until released by a licensed healthcare provider." "The INR of a patient with a subdural hematoma is found to be elevated. The trauma nurse would anticipate which of the following treatments? - Correct answer An elevated INR (frequently related to coumadin) can cause delays in clotting and significantly blood loss and should be addressed. This is especially true of an intracranial bleed such as a subdural hematoma.as uncontrolled bleeding can result in significant neurological impairment or even death. The most rapid way to reverse the effects of coumadin and elevate the INR (hence enhancing clotting and reducing bleeding) would be the infusion of a prothrombin complex. This treatment works within 15 minutes of completion of the infusion While Vitamin K could also elevate the INR, it can take 6 to 24 hours to work which is too long in the face of an intracranial hemorrhage. Fresh frozen plasma could also be administered but could take upwards of 2 to 4 L to work. It would need to be given along with the Vitamin K. Packed red blood cells carry no clotting factors, only hemoglobin and would not be effective to control intracranial bleeding." "Which of the following techniques are most appropriate to temporarily secure the airway of a patient with maxillofacial trauma? - Correct answer The chin-lift maneuver and jaw-thrust maneuver are the safest way to maintain the patient's airway prior to intubation because they open the airway without manipulating the cervical spine and increasing the risk of spinal cord injury. The head-tilt chin-lift maneuver manipulates the cervical spine. The insertion of a nasopharyngeal airway is

contraindicated in any trauma patient with maxillofacial injuries due to the potential of a fracture to the cribriform plate potentially allowing the nasopharyngeal airway to enter the skull." "A small pneumothorax is noted on chest x-ray although the patient demonstrates no respiratory distress. The patient's vital signs are:

• Respiratory Rate: 16 breaths per minute• Sp02: 99% on room air• Heart rate: 82 beats per minute• Blood pressure: 110/70 mm Hg• Temperature: 98.4 degrees F• Pain: 2 on a scale of 1 to 10 The most appropriate intervention at this time is: - Correct answer This clinical scenario depicts a patient with a simple asymptomatic small pneumothorax. Management for this type of pneumothorax would include clinical observation, and application of supplemental oxygen. Needle decompression is reserved for patient who are showing signs of obstructive shock and tracheal deviation. Placement of a chest tube is reserved for a larger and symptomatic pneumothoraxes. Thoracic surgery consultation is not needed for the management of a simple, small, asymptomatic pneumothorax." "The petechial rash associated with fat embolism syndrome tends to be most prominent on the: - Correct answer Patients with fat embolism syndrome may develop a petechial rash that is intermittent and appears on the chest, the base of the neck, the conjunctiva, the mucous membranes and the axilla. It does not generally appear on the face, the soles of the feet or the lower back and buttocks." "A sign of effective resuscitation includes a: - Correct answer One of the goals of resuscitation is a core body temperature above 35 C (95F). Temperatures below this are associated with decreased heart rate and cardiac output, increased systemic vascular resistance, decreased urinary output, depressed level of consciousness and decreased coagulation. Normal base levels in the body are - to +2. A base excess of +2 is outside of normal limits and may indicate alkalosis. A BUN to creatinine ratio of 1:40 is associated with fluid deficits and may indicate insufficient fluid resuscitation. Normal pulse pressures are close to 40 mm Hg. A pulse pressure of 20 mm Hg is narrow and likely indicates inadequate fluid resuscitation." "Which of the following activities is required of all hospitals verified as trauma centers? - Correct answer The American College of Surgeons, which verifies hospitals as trauma hospitals, establishes minimum requirements for that verification. This includes an injury prevention community outreach program. Although mass transfusion protocols, medical trauma directors with appropriate board certification and prompt availability of a surgical suite are desirable they are not required in all levels of trauma center verification"

"Jackson Pratt drain removes fluid through: - Correct answer Jackson Pratt drains may be placed to actively remove fluid from the abdominal cavity post-operatively. The Jackson Pratt drain is a soft and compressible bulb that removes fluid through the utilization of negative pressure. This is achieved by squeezing the bulb, removing air, then closing it. This will cause negative pressure in the bulb, causing any excess fluid to be removed from the abdominal cavity and into the bulb. A Jackson Pratt drain does not work using oncotic, positive or osmotic pressure." "Which of the following descriptions is most consistent with the initial presentation of a patient with a diffuse axonal injury? - Correct answer A patient with a diffuse axonal injury will present with a Glasgow Coma Score of 3 (comatose) but in the absence of other injuries, will have a normal intracranial pressure." "Immediately following a disaster, which of the following reactions is most concerning in the survivor? - Correct answer Some reactions to disasters and loss are considered normal. These include denial and anger. Muted emotions such as numbness, indifference or feeling spaced out can also be normal immediately after a stressful situation These reactions become concerning when the patient's activities of daily living become affected such as regular disruptions in eating, sleeping, decision-making or being able to care for dependents" "Which of the following interventions is inappropriate when packaging a patient for transport via helicopter to a higher level of care? - Correct answer Air tends to expand in altitude. Air splints will expand in a helicopter and can cause compartment syndrome, therefore they should not be utilized for air transport. It would be appropriate to perform fasciotomies for compartment syndrome prior to air transport. There is no contraindication to the use of colloids to combat hypovolemia prior to air transport. If there is a chance of air-sickness, prophylactic antiemetics should be administered to improve patient comfort and decrease the risk of aspiration." "A patient has indications of abdominal trauma and is hypotensive, pale and clammy. The abdomen is firm to palpation and tender with reduced bowel sounds. The patient's pulse is 72 beats per minute. The trauma nurse knows that: - Correct answer Patients who are hypotensive due to hypovolemia are also tachycardic. The pulse may not increase on patients taking beta-blockers, so looking at the medication history may be helpful in determining why the pulse is not increased as expected. A spinal cord injury tends to cause bradycardia; this patient is normocardic. Normally, pulses do decrease with fluid resuscitation but if the patient has a normal pulse due to a beta- blocker, it is unlikely to change with fluid resuscitation" "Neurogenic shock causes loss of: - Correct answer The fibers of the sympathetic nervous system are carried down the spinal cord, so a spinal cord injury will disrupt this system leading to loss of sympathetic stimulation. One of the roles of the sympathetic nervous system is maintenanceof venous and arterial vascular tone, therefore a disruption of this system also leads to loss of venous and vascular tone. An increase in arterial tone would be expected with increased rather than decreased sympathetic tone"

"The trauma nurse is caring for a 3-year-old child who has sustained burns to the entire back, posterior aspect of both legs, and posterior aspects of both arms. When using the Rule of Nines, the trauma nurse calculates the total body surface area burned to be: - Correct answer When using the rule of nines to calculate a total body surface area burned in a pediatric patient, the following percentages are used: head 18%, chest and abdomen 18%, back 18%, each upper extremity 9%, each lower extremity is 14% and the perineum is 1%. For our patient, the entire back is burned (18%), the posterior aspects of the patient upper extremities are burned (4.5% + 4.5% = 9%), plus the posterior aspects of both lower extremities are burned (7% + 7% = 14%). 18+9+14= 41%" "A patient with a sternal fracture is hypotensive and tachycardic with low oxygen saturation. An emergency focused assessment with sonography in trauma (FAST exam) is negative for a cardiac tamponade and the chest radiograph is negative for a pneumothorax. What diagnostic exam will most likely need to be facilitated? - Correct answer This patient demonstrates signs of a blunt cardiac injury, often associated with a sternal fracture. The combination of shock symptoms, absence of pneumothorax, and absence of cardiac tamponade indicate that a transthoracic echocardiogram should be performed to determine the presence of a blunt cardiac injury. In the setting of a blunt cardiac injury, further evaluation of the structure of the heart, contractility, and valvular stability needs to be determined rapidly and at the bedside and would be best achieved by a transthoracic echocardiogram. Computerized tomography of the chest, with or without contrast, would be able to evaluate the structure of the heart, but would not be able to adequately assess the blood flow through the heart and valvular integrity and would require a decompensating patient to travel outside of the department. A transesophageal echocardiogram would be beneficial, but this would require time, sedation, and given the patients hemodynamic instability, may be inappropriate." "A patient has a blood pressure of 100/60 mmHg and an intra-abdominal pressure of 31 mmHg. What is the calculated abdominal perfusion pressure? - Correct answer To calculate an abdominal perfusion pressure, the trauma nurse will need to know the patient's mean arterial pressure (MAP) and intraabdominal pressure. To calculate the MAP, the diastolic pressure is doubled then added to the systolic pressure. The resulting number is then divided by three-73 mmHg in this scenario. Once the MAP is known, abdominal perfusion pressure (APP) can be calculated by subtracting the intraabdominal pressure (IAP) from the MAP ( APP=MAP-IAP). For this patient APP= 73 mmHg - 31 mmHg which equates to 42 mm Hg. Best outcomes are noted in patients with APP above 60 mm Hg." "A patient is transferred to the trauma center with a basilar skull fracture and is admitted to an inpatient unit. Which of the following symptoms is most likely to develop on the inpatient unit? - Correct answer Otorrhea (discharge from the ears), rhinorrhea (discharge from the nose), hemotympanum (blood behind the tympanic membrane) and periorbital ecchymosis (accumulation of blood around the eyes) are all symptoms associated with basilar skull fracture. Otorrhea, rhinorrhea and hemotympanum usually occur shortly after the injury whereas blood around the eyes takes time to discolor and become evident so periorbital ecchymosis is the most likely symptom to develop on the inpatient unit"

"Which of the following statements, made by a patient being discharged with a hyphema, indicates the need for FURTHER teaching? - Correct answer A hyphema is a collection of blood in the anterior chamber of the eye. One of the risks of a hyphema is continued bleeding which can cause loss of vision. NSAIDs increase the risk of bleeding and should be discouraged rather than encouraged. Wearing a metal shield and avoiding things that cause eye strain are appropriate to reduce further bleeding. Nausea and vomiting may be an indication of increased intraocular pressure and the patient should be encouraged to seek additional medical care if those symptoms develop" "After interventions for a brain injury have been implemented, the patient's cerebral perfusion pressure is calculated to be 50 mmHg. The trauma nurse knows that: - Correct answer Normal cerebral perfusion pressures (calculated by subtracting the intracranial pressure from the mean arterial pressure) are 80 to 100 mm Hg. Treatment for brain injuries should result in a cerebral perfusion pressure of at least 70 mm Hg (and preferably 80 mm Hg). A cerebral perfusion pressure of 50 mm Hg is dangerously low and is consistent with poor oxygen perfusion in the brain, which can lead to secondary hypoxic brain damage. Aggressive interventions to either elevate the patient's mean arterial pressure or reduce the patient's intracranial pressure need to be undertaken" "The trauma nurse knows that preterm labor may be caused by: - Correct answer Preterm labor is the most common complication of trauma during pregnancy and may be caused by hypoxia, hypovolemia or abruption placenta. Aggressive fluid resuscitation does not cause preterm labor and may correct hypoxia thus reducing that risk. Increased intracranial pressure and elevations in maternal carbon dioxide levels are not associated with preterm labor (they may occur along with preterm labor but are not considered causes of preterm labor)" "Which of the following findings indicates that the goal for treatment of urethral trauma has been met? - Correct answer The two main goals when caring for a patient with urethral trauma is to control and treat blood loss and maintain the patency of the urethra. This may be accomplished by avoiding catheterization until the patency has been confirmed (usually through a retrograde urethrogram) or placement of a suprapubic catheter when suspicion of a urethral tear is high. Red blood cells in the urinalysis may be associated with urethral trauma, but the goal of treatment is not to reduce these red blood cells but rather replace blood lost and stem further bleeding. Although bruising in the perineal area is frequently observed with urethral trauma, treatment does not reduce this bruising, therefore this is not a goal of treatment. A more accurate goal of treatment would be to prevent an increase in bruising in the perineal area. The BUN:creatinine ratio is related to renal rather than urethral trauma, so this is less likely to be a goal in care of the patient with urethral trauma. The normal BUN:creatinine ratio should be 10:1 as opposed to 5:1. Operative intervention may be required for severe urethral injuries regardless of the care given, therefore the goal of care is not to prevent operative intervention but to facilitate it when it is needed" "Chance fractures of the vertebral column are most likely to be associated with: - Correct answer A chance fracture, also known as a "seatbelt fracture" is caused by hyperflexion of the mid-body. The hyperflexion is caused by a lapbelt holding the lower body in place, but lack of a shoulder restraint allowing the upper body to move violently forward. This causes strain on the lower thoracic and

upper lumbar vertebrae and may cause fractures known as "Chance fractures". Falling from a great height and landing onboth feet is called vertical axial compression and causes burst fractures of the lumbar vertebrae. Hitting the head after diving headfirst into water is known as axial loading and is known to cause cervical spinal injuries but not Chance fractures. A hyperextension of the vertebral column in a rear-end collision is known as whiplash, not Chance fractures" "A patient with an elbow fracture has loss of sensation to the fifth finger. This would indicate impingement of which nerve? - Correct answer Following a fracture to the elbow, loss of sensation to the 5th finger would indicate damage or impingement to the ulnar nerve. If the patient was to lose sensation to the first dorsal web space, this would indicate a radial nerve injury. If the patient was to lose sensation to the lateral shoulder, this would indicate damage to the axillary nerve. Loss of sensation to the index finger would indicate a medial nerve injury" "Warming blood products administered during fluid resuscitation will help prevent the trauma patient from becoming: - Correct answer A decrease in body temperature is associated with an increased risk of developing coagulopathies. Because many blood products are cool, improper warming may increase the risk of the patient developing coagulopathies. Warming blood products prior to administration does not prevent alkalosis, hypokalemia or hypernatremia. Excessive blood product administration, regardless of temperature does increase the risk of acidosis and hyperkalemia" "What is a relative contra-indication to providing enteral feedings to a traumatically injured patient? The patient: - Correct answer High dose vasopressors reduce blood flow to the gastrointestinal tract and may decrease the ability of the patient to digest enteral feedings. Feedings may have to be temporarily stopped or alternate methods of feeding may have to be considered while the patient is on high-dose vasopressors. Although blood sugar needs to be maintained within normal limits while on enteral feedings, often with the use of insulin, this is not a relative contraindication to enteral feedings. Coagulopathies and a body mass index above 30 kg/m2 are not relative contraindications to enteral feedings" "One of the goals of rehabilitation in the traumatically injured patient has been reached if the patient: - Correct answer The three goals of rehabilitation include one or more of the following:Restoration - The ability to recover normal functionCompensation - Replacement of normal function with alternate strategiesAdaptation - A change in lifestyle, roles and expectations to adapt to the disability.If the patient changes their expectations and lifestyle to adapt to the deficits they have encountered, they have met the goal of adaptation. The goal of rehabilitation is to start the process as early as possible, ideally on arrival of pre-hospital personnel to the scene. Therefore delaying the rehabilitative phase until the patient is in the intensive care unit is not a goal of rehabilitation. Although it is ideal for traumatically injured patients to work towards goals in rehabilitation, exceeding pre-established goals is not considered a goal of rehabilitation. The amount of function the patient has at the time of discharge is individualized. A person with a complete spinal cord injury may never return to 75% of their pre-injury level of functioning, yet an individual with an

extremity fracture may return to 100% of pre-injury functioning. Therefore a goal of returning to 75% of pre-injury functioning prior to discharge is not an appropriate goal of rehabilitation" "The purpose of a hazard vulnerability analysis is to: - Correct answer A hazard vulnerability analysis (HVA) is the stage of disaster planning and management where an institution seeks to recognize potential disasters that could befall the institution. This is known as a hazards vulnerability analysis. Once the hazards vulnerability analysis is complete, the hospital will undertake activities to reduce vulnerabilities that are uncovered. Studying negative patient outcomes to prevent recurrence is a performance improvement activity rather than a hazards vulnerability analysis. Although a hospital should recognized and minimize factors that could increase patient falls, a patient fall is not a disaster. A hazards vulnerability analysis is meant to recognize potential disasters. Similarly, hospitals should identify medications which can be mistaken for one another and take steps to reduce those types of errors but this is not part of a hazards vulnerability analysis since this is not considered a disaster situation." "A primary review of the care of a traumatically injured patient is completed by the trauma program manager and action plans are initiated to address deficiencies noted. In following up, the trauma program manager ensures the corrective action is continuing to have the desired effect through continuous monitoring and evaluation. This process as an example of: - Correct answer The final stage of performance improvement is sometimes referred to as "loop closure." This step of performance improvement involves monitoring to ensure that changes recommended in early states of performance improvement have been completed. For example, as part of the performance review process, a new clinical pathway may be devised and even implemented. But performance improvement is not complete until it is determined that this clinical pathway is addressing the deficiencies that led to its initial creation. This requires continued monitoring and evaluation. A clinical pathway is a guideline that may be created to ensure consistency in a process. It often arises out of deficiencies uncovered during review of patient care records. The review of patient care records is known as "secondary review". If the secondary review uncovers deficiencies, then modifications to the process, including as an example, development of a clinical pathway, may be undertaken. So secondary review sometimes leads to the modification phase of performance improvement and one modification that can be considered is a clinical pathway. But these processes must occur first before their effects can be followed to determine if they had their intended improvement (loop closure)." "Which of the following examples describes a primary engineering injury prevention strategy? - Correct answer A primary injury prevention program focuses on reducing an injury from occurring. An engineering injury prevention program focuses on the development of products that will reduce injuries or improve outcomes. Developing fluorescent dividing lines is an example of an engineering program because it involves the development of products. The fact that the dividing lines will help reduce a motor vehicle collision from occurring the first place makes it a primary injury prevention strategy. Although the development of side impact airbags is an example of an engineering strategy, side impact airbags are not designed to reduce the incidence of an injury (primary injury prevention) but rather to reduce the severity of the injury after it occurs (secondary injury prevention). Similarly, advocating for 0-negative blood on pre-hospital units will not prevent injury but rather improve

outcomes after the injury (tertiary injury prevention). Because 0-negative blood is not something that is developed, it is not an engineering strategy. While installing motion sensors is primary prevention since it would prevent the injury from occurring, working with insurance companies to encourage usage is an example of an enforcement injury prevention strategy as opposed to an engineering injury prevention strategy" "Fluid resuscitation is underway for a trauma patient weighing 88 kg. The trauma nurse knows that the minimum acceptable hourly urinary output should be: - Correct answer Regardless of the method used to calculate the amount of fluid administered to a patient, further fluid management should be guided by the patient's urine output. The minimum hourly urinary output for patient a weighing greater than 30 kg is 0.5 ml/kg/hr. Therefore a patient weighing 88 kg should have a minimum hourly urinary output of 44 ml/hr. Anything greater than 44 ml/hr would be acceptable but above the minimal acceptable hourly urinary output." "Which of the following injuries is most likely to be associated with cardiogenic shock? - Correct answer Cardiogenic shock is defined as pump failure. Mechanisms of injury that can result in pump failure includes a blunt cardiac injury that may be sustained from blunt trauma to the chest (e.g fractured ribs after being kicked in the chest by a horse). An aortic injury is more likely to cause hypovolemic shock due to blood loss (or obstructive shock if there is an obstruction in the aorta following the trauma). A stab wound to the chest resulting in a sucking chest wound may cause respiratory distress but does not cause pump failure. A pericardial tamponade compresses the ventricles resulting in obstructive rather than cardiogenic shock." "A properly applied splint for a tibial fracture immobilizes the: - Correct answer deally, splints immobilize the joints above and below the fracture. For a tibial fracture, that would include the lower thigh, knee and ankle. If joints on either side of the splint are not immobilized, there is increased movement of the extremity which can exacerbate secondary injuries" "The trauma nurse knows that eschar over a wound: - Correct answer Eschar over a wound delays healing and should be debrided. Although eschar may be present in infected wounds, it is also present in wounds that are not infected. Eschar is not part of the normal wound healing process and does not promote underlying wound healing." "When obtaining an intraabdominal pressure, the trauma nurse knows the transducer needs to be level with the: - Correct answer When obtaining an intraabdominal pressure reading, the transducer must be level with the midaxillary line. The phlebostatic axis is where the transducer should be placed when measuring for a central venous pressure and arterial blood pressure. Having the transducer level with the top of the umbilicus will falsely elevate the intraabdominal pressure reading. Use of the midclavicular line is a guide for needle decompression in the setting of a pneumothorax, not for measurement for an intraabdominal pressure."

"Despite stability after administration of one liter of crystalloids in the resuscitation room, a patient is diagnosed with a grade two liver laceration. The trauma nurse should anticipate which of the following dispositions? - Correct answer Patients with low grade liver lacerations who are hemodynamically stable are treated nonoperatively with serial abdominal examinations. The patient has the potential to deteriorate rapidly and should not be discharged home. The patient could be transferred to the surgical suite or require further interventional radiology after admission to the inpatient unit if there is a drop in hemoglobin or new onset hemodynamic instability" "A patient with suspected pancreatic trauma has normal serum amylase levels. The trauma nurse know this finding requires: - Correct answer The pancreas can be injured with blunt force to the epigastric region of the abdomen. Injuries to the pancreas may result in elevated amylase levels but may not change for up to 12 hours post injury, so they must be monitored. If serum amylase levels continue to trend upward, CT imaging of the abdomen should be obtained, and if a significant finding is noted on CT, a prompt surgical consult should be facilitated. Suspected pancreatic injuries should always be reassessed since these injuries may not be evident initially." "Which of the following findings is most consistent with a chylothorax? - Correct answer A chylothorax is caused by the transection of the thoracic duct. In trauma, this often occurs with significant neck or chest trauma. Chyle may accumulate in the mediastinum, the pleural cavity or the pericardium. Chyle is a milky white lymphatic substance that is drained from the gastrointestinal tract back into the central circulation. If chyle accumulates in the pleural space, it may drain into the chest drainage set and will appear milky white. Because chyle is a thick liquid, it is more likely to cause hyporesonance rather than hyperresconance on percussion of the chest. A chylothorax, in and of itself, does not cause pink frothy sputum. Breath sounds would be reduced over the chylothorax where the lung no longer exchanges air. Wheezing throughout all lung fields is not consistent with a chylothorax" "Nimodipine is prescribed to a patient admitted to the neurological intensive care unit after a subarachnoid hemorrhage. The trauma nurse knows that the purpose of this treatment is to: - Correct answer Patients with subarachnoid bleeding may have vasospasms in the area which can reduce blood flow around the injury. Drugs like Nimodipine can reduce vasospasms and improve blood flow to the area. Nimodipine does not elevated serum glucose levels, nor does it reduce blood flow to the area. Nimodipine would decrease rather than increase a patient's blood pressure." "Trauma to the tracheobronchial area is more likely to be caused by which mechanism of injury? - Correct answer The tracheobronchial tree is protected behind the sternum and rib cage and is rarely injured by blunt trauma. Penetrating trauma is more likely to effect the tracheobronchial tree, especially gunshot wounds with expanding bands of energy that can blow out hollow organs such as the tracheobronchial tree. Drowning and thermal injuries are not likely to cause tracheobronchial injuries."

"A ruptured diaphragm causes the greatest disruption to the: - Correct answer A ruptured diaphragm causes abdominal contents to spill into the thoracic cavity causing compression of the lungs. This negatively impacts the respiratory system. Although the cardiovascular and gastrointestinal system may be affected, they do not cause as great of a disruption as the respiratory system does. The hepatobiliary system is generally not significantly impacted by a ruptured diaphragm" "Which of the following tools is most likely to assist the trauma nurse in determining if a needle has made contact with or punctured the pericardium during a pericardiocentesis? - Correct answer The trauma nurse should monitor Lead V for ST and PR elevation during a pericardiocentesis. This will be indicative of the needle coming in contact the myocardium and the physician should be notified to withdraw the needle to prevent cardiac rupture. A stethoscope, blood pressure cuff or pulse oximetry probe are unlikely to contribute useful information about potential complications of inserting a needle into the pericardial space." "Three days after admission to the trauma unit, ecchymosis associated with the lapbelt is noted to the patient's lower abdomen, along with rebound tenderness. Radiographs previously identified a transverse fracture of L4. This scenario is consistent with injuries to the: - Correct answer These assessment findings are consistent with the seatbelt sign (rebound tenderness on palpation, as well as a transverse fracture to L4 also called a Chance Fracture).The seatbelt sign is consistent with injury to the small bowel. Further validating this suspicion is the fact the patient was injured three days previously. The contents of the small bowel are relatively sterile with having a neutral pH, so small bowel injuries may have few symptoms and not be initially evident. Stomach injuries cause spillage of gastric contents that are acidic. This is more likely to cause immediate rather than delayed rebound tenderness. Esophageal injuries cause spillage of gastric contents into the mediastinum and chest cavity causing respiratory symptoms as opposed to rebound tenderness in the abdomen. The large bowel contains significant bacteria which causes immediate rather than delayed rebound tenderness." "When applying a knee immobilizer on a patient, how many degrees of flexion should be allowed? - Correct answer When applying a knee immobilizer on a patient, the splint should allow for 10 degrees of flexion to allow for reduced tension on the neurovascular structures within the joint. If the patient was to be in complete extension, or 0 degrees, it would cause too much tension on the neurovascular structures of the knee. Any further movement beyond 10 degrees increases the risk of further damage secondary to increased movement." "Which of the following factors increases the risk of a patient developing a state of crisis after a traumatic injury? - Correct answer Factors known to influence whether a patient or a patient's loved ones go into a state of crisis after a traumatic event include the perception of the event (a distorted perception increases the risk of crisis), situational supports (inadequate situational supports increases the risk of crisis), and coping mechanisms (lack of coping mechanisms or inappropriate coping mechanisms increases the risk of crisis). Both anger and denial are normal stages of response to trauma and do not necessarily increase the risk of developing a state of crisis. The length of

hospitalization is not associated with whether the patient will develop a state of crisis. Typically, a state of crisis will develop within three days of the event." "The trauma nurse knows that core causes of compassion fatigue include: - Correct answer Core causes of compassion fatigue include secondary traumatic stress and burnout. Symptoms of compassion fatigue may be work related (e.g. calling into work frequently, lacking empathy, not wanting to take care of specific patient types), physical (headaches, gastrointestinal symptoms, difficulty sleeping, palpitations, fatigue, and muscle tension), and emotional symptoms (irritability, mood swings, oversensitivity, anxiety, depression, memory issues, poor concentration, and excessive use of substances). Secondary traumatic stress symptoms include intrusion (recurrent thoughts about patient's, dreaming about the negative impacts of the workday), avoidance (emotionless, disconnected from others, staying away from people and crowded places), and arousal (irritability, inability to focus, nervousness). Burnout symptoms include emotional exhaustion (gastrointestinal discomfort, hypertension, sleep disorders), depersonalization (anxiety, irritability, hopelessness, sadness) and personal accomplishment (absenteeism, considering quitting work, decreased job satisfaction, lack of medication to career)." "Seizures are associated with acute intoxication of: - Correct answer Acute intoxication with cocaine and methamphetamines may cause seizures. Although alcohol withdrawal may be associated with seizures, seizures are rarely associated with acute intoxication. Acute intoxication with opioids and marijuana do not cause seizures" "When applying a tourniquet, how many inches above the wound should the tourniquet be applied?

• Correct answer Application of a tourniquet to the arm or leg should be applied about 2-3 inches above the bleeding site. Special attention sound also be made that the tourniquet is not applied over a joint and that the tourniquet is made as tight as possible until the bleeding stops" "Absence of tactile fremitus in the apical aspect of a lung is strongly indicative of: - Correct answer Vibrations, noted during the assessment of fremitus, will be reduced or absent over air (pneumothorax) or fluid (hemothorax). Since air rises, the lack of fremitus will be in the apices with a pneumothorax and the lower chest wall with a hemothorax. When the vibrations come in contact with a dense structure like a consolidation of pneumonia or a mass like a tumor, the vibrations will be increased over these areas. A pulmonary contusion has little effect on the ability to assess fremitus" "According to pre-hospital report, a patient had a positive loss of consciousness after a head injury but was awake and alert when EMS arrived on scene. The patient loses consciousness shortly after arriving in the trauma unit. This history is consistent with: - Correct answer The sequence of events described in this question is consistent with an epidural hematoma: trauma, followed by loss of consciousness, then a period of being lucid followed by neurological deterioration. A patient with a mild concussion will most likely present with confusion, amnesia, and possibly a loss of consciousness. Patients who suffer a diffuse axonal injury will present in an unconsciousness state

which lasts longer than six hours, sometimes remaining in a persistent vegetative state for the rest of their lives. When patients present with a subarachnoid hemorrhage, they frequently have the chief complaint of a sudden, severe headache, often described as the "worst headache of their life," possible loss of consciousness, nausea, vomiting, and signs of meningeal irritation." "A patient falls from a significant height landing on the buttocks. The patient is incontinent of urine after the injury. This scenario is most consistent with: - Correct answer Cauda equina syndrome is an injury to the sacral nerve roots. This area of the spinal cord is most likely injured when landing on the buttocks. Cauda equina syndrome causes weakness or even paralysis to the upper legs, bowel and bladder dysfunction and sexual dysfunction. Therefore incontinence of urine is consistent with this injury. Posterior cord syndrome is caused by hyperextension of the neck (commonly seen in a rear- end collision) and causes loss of sensation to touch and proprioception below the level of the injury but maintenance of temperature, pain and motor function. Anterior cord syndrome, caused by hyperflexion of the neck, causes the opposite symptoms of a posterior cord syndrome. Brown- Sequard syndrome is an unusual spinal cord injury often caused by penetrating trauma to the spinal cord causing a left-to-right phenomenon. Patients will have ipsilateral (same side) hemiplegia (loss of motor function), and contralateral (opposite) hemianalgesia (loss of sensation)" "After experiencing a retrobulbar hematoma, a patient's intraocular pressure is measured at 45 mm Hg. Which of the following interventions is most appropriate? - Correct answer An intraocular pressure of 45 mm Hg is well above the normal range of 10 - 20 mm Hg. One of the initial interventions for patients with increased intraocular pressure is elevation of the head of the bed. Ketorolac is a non-steroidal anti-inflammatory medication that would not be appropriate for this patient and may increase the risk for further bleeding. Although cryoprecipitate may be used for patients who are bleeding, a retrobulbar hematoma does not usually involve enough blood loss to warrant the administration of clotting factors. In a retrobulbar hematoma, the eye is pushed forward out of the head and applying an eye patch which produces direct pressure could cause damage to the extruding eye." "Despite being alert and oriented, a significant subdural hematoma is noted on a patient's computerized tomography scan. Based on this patient's condition and diagnosis, who would be the primary decision maker should this patient require consent for further treatment? - Correct answer Even though the patient has been diagnosed with a subdural hematoma, this diagnosis alone does not exclude the patient from making his own medical decisions.Without any subjective or objective neurological deficits, the patient will be able to give direction to staff regarding his wishes for resuscitation and end-of-life care. Therefore the patient remains the primary decision maker, not the son's wife, son or brother." "A decision is made to withdraw life support and allow a traumatically injured patient to die a natural death. The trauma nurse should inform the family that a symptom commonly encountered near death is: - Correct answer Numerous symptoms are common at the time of death. In the pulmonary system, these include dyspnea, cough, head/nasal congestion, the "death rattle" and respiratory

distress or respiratory depression. Excessive flatus, excitable reflexes and conjunctival hemorrhages are not associated with palliative care and should cause the trauma nurse to look for other causes" "A patient presents with petechiae to the face, scalp and neck and a reduced level of consciousness. Strangulation is suspected as the cause of these symptoms. Which of the following symptoms would be consistent with this suspicion? - Correct answer Damage to blood vessels of the neck during strangulation can lead to neurological deficits such as ptosis, facial droop, unilateral weakness, loss of sensation, paralysis or seizures). The incidence of gingival bleeding and orbital blowout fractures is not higher in patients who have been strangulated. Clear fluid draining from the ears tends to be associated with basilar skull fractures and strangulation does not increase the risk of this injury." "A 3-year-old is brought to the emergency department refusing to move the left arm after being pulled up vertically by both arms. The trauma nurse suspects that an x-ray will confirm this injury is caused by a subluxation of the: - Correct answer Nursemaid's elbow is caused when axial traction is placed on a pronated forearm with extension of the elbow. This occurs most frequently in children who are under 5 years of age. When this occurs, a portion of the annular ligament slips off the head of the radius and slides into the radiohumeral joint where it becomes trapped causing a dislocation of the radial head" "Subcutaneous emphysema on the chest wall is most closely associated with: - Correct answer Subcutaneous emphysema occurs when air escapes from air-containing organs or structures like the lungs, esophagus or trachea into the subcutaneous tissue. An open pneumothorax involves communication with the lung (an air-containing organ), the pleural space and subcutaneous tissue, and can cause subcutaneous emphysema. A hemothorax is a collection of blood in the pleural space. It does not contain air does not communicate with the subcutaneous tissue, therefore it won't cause subcutaneous emphysema. A sternal fracture and a ruptured diaphragm do not involve air- containing organs and wouldn't cause subcutaneous emphysema" "A diffuse axonal injury is caused by: - Correct answer A diffuse axonal injury is caused by shearing forces as different areas of the brain slide across each other during a traumatic incident. Blunt forces to the skull are more likely to cause contusions or bleeding. Thermal injury causes burns, and penetrating trauma causes direct injury to the brain but neither results in a diffuse axonal injury" "Which of the following symptoms are most consistent with a mandibular fracture? - Correct answer Patients who have a mandibular fracture will have malocclusion (malalignment of the upper and lower teeth when biting down), trismus (an inability to open the mouth), pain upon movement and facial asymmetry. Periorbital bruising (raccoon eyes) are associated with a basilar skull fracture. Diplopia, or double vision, is a finding in a patient with fractures of the bones of the orbit" "The lab reports myoglobin in the urine of a patient who has sustained a crush injury. The trauma nurse knows this finding puts the patient at risk for: - Correct answer The correct answer is renal

failure. Myoglobin is a molecule found the muscles that stores oxygen within the muscles for later use. When a patient has a severe muscle damage, this molecule is released into the blood stream and is carried to the kidneys where it may cause obstruction of the glomeruli resulting in renal failure. Myoglobin in the urine is not associated with cardiac, hepatic or respiratory failure." "