TCRN Exam Review Questions and Answers: Trauma Nursing, Exams of Nursing

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List three effects of inflammatory mediators - correct answer ✅Diaphoresis, glycogeonolysis, bronchodilation, increased: HR, contractility, automasticity, RR Describe the technique for inserting IO into distal femur - correct answer ✅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 - correct answer ✅just proximal to the medial malleolus Describe the technique for inserting IO into humerus - correct answer ✅Directly above the greater tuberosity Describe the technique for inserting IO into proximal tibia - correct answer ✅2cm distal and slightly medial to the tibial tuberosity Recognize adequate fluid resuscitation using four end points to resuscitation - correct answer ✅Traditional - Vital signs, urinary output (>0.5mg/kg/hr), Mental status 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) Metabolic parameters - Lactate (>4 is severe), Base Deficit (>6mmol/L indicates severe injury)

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Treatment for neurogenic shock - correct answer ✅1 -2 L bolus (often insufficient and may cause pulmonary edema) Vasopressors (Epi, Norepi, dopamine, phenylephrine, or vasopressin) MAP 85-90mmHg Atropine respiratory support as needed List 6 effects that a state of crisis may have on a trauma patient - correct answer ✅Disruption of family Depression Failure to return to pre-event life Economic problems Social isolation Decreased pleasure in activities PTSD Treatment goals for patients with PTSD - correct answer ✅Restore sense of control Diminish power of the traumatic event Reduce chronic hyperarousal Reduce feelings of guilt/self-blame Restore sense of equilibrium

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List three patient dispositions allowed by COBA/EMTALA legislation - correct answer ✅Admission to the facility Stabilizing care, followed by transfer to qualified facility Treated and discharged What is the performance improvement loop? - correct answer ✅Identify the outcomes Determine plan Measure progress Describe quantitative research - correct answer ✅A deductive process that utilizes numeric findings examples: randomized controlled trials, cohort studies Describe qualitative research - correct answer ✅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 - correct answer ✅Autonomy Beneficence Non-malficence Veracity (honesty) Justice

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List three complications associated with a contusion and/or hematoma - correct answer ✅Compartment syndrome Risk for infection Risk of hypovolemia The four interventions used to control hemorrhage in amputations - correct answer ✅Direct pressure Pressure point Elevation Tourniquet Describe primary wound closure - correct answer ✅Immediate wound closure Describe secondary wound closure - correct answer ✅Allowed to close on own over time (for clean wounds with significant tissue loss) Describe tertiary wound closure - correct answer ✅Closure is delayed for a period of time (wounds with significant bacterial contamination) The Rule of Nines - adult - correct answer ✅Head 9% Chest 9% Abdomen 9% upper back 9% lower back 9%

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Arm 9% upper leg 9% lower leg and foot 9% Genitals 1% Rule of Nines - pediatric - correct answer ✅Head 18% Chest 9% Abdomen 9% upper back 9% lower back 9% arm 9% upper leg 7% lower leg and foot 7% Four treatment strategies for electrical burns - correct answer ✅Fluid replacement using Modified Parkland Formula Consider starting with 20ml/kg bolus and adjust to maintain 1ml/kg/hr Continuous cardiac monitoring Osmotic diuretics Sodium bicarb (to alkalinize urine) Monitor for compartment syndrome Two complications associated with exposure to hydrocarbons - correct answer ✅Respiratory failure

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Hepatic injury (delayed) Describe Volkmann's contracture - correct answer ✅muscle contraction distal to nerve impingement injury List injuries commonly associated with blunt cardiac injury - correct answer ✅Pericardial tamponade Cardiac contusion

• Electrical disturbances
• Chest pain
• Heart failure, primarily right sided HF Great vessel injuries Care for pulmonary contusion - correct answer ✅Pain management Maintain respiratory rate, ventilation Adequate gas exchange - ETCO2, SaO Mobilize and clear blood and secretions Define Acute Respiratory Distress Syndrome (ARDS) - correct answer ✅Non- cardiogenic pulmonary edema Describe components of ABD assessment on a traumatically injured patient - correct answer ✅FAST - Focused Abdominal Sonography Assessment DPA - Diagnostic Peritoneal Lavage

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List common complications with splenic trauma - correct answer ✅Gastric perforation Recurrent bleeding Acute gastric dilation Pancreatitis Post-op elevated WBC Spontaneous rupture Prioritize treatments for patients with rectal trauma - correct answer ✅Early recognition and control of fecal contamination ABx therapy early to prevent sepsis Surgical irrigation Primary bowel repair Signs associated with NOT placing a urethral catheter in trauma patient - correct answer ✅Rebound tenderness in suprapubic area Urge to urinate with inability to do so Blood in urinary meatus High-riding prostate Pelvic, perineal, or scrotal hematoma (butterfly ecchymotic area) Complications of renal trauma - early onset - correct answer ✅Hemorrhage Abcess

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Infected urinoma AV fistula Prolonged extravasation of urine Infection (wound or UTI) Complications of renal trauma - late onset - correct answer ✅Hypertension Change in lab values associated with pregnancy - correct answer ✅Alkaline phosphatase ↑ Albumin ↓ Calcium ↓ BUN ↓ Creatinine ↓ Fibrinogen ↑ PT/PTT ↓ Hgb/Hct ↓ Sed rate ↑ WBC ↑ Define primary injury prevention - correct answer ✅designed to prevent occurrence of injury Define secondary injury prevention - correct answer ✅designed to reduce the severity of the injury

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Define tertiary injury prevention - correct answer ✅improvement in outcomes related to traumatic injuries Advantages of ground transport - correct answer ✅Larger payloads Readily available Advantages of helicopter transport - correct answer ✅Rapid point to point transfer Can reach areas of difficult terrain Usually has advanced care crew Advantages of fixed wing transport - correct answer ✅Can travel long distances rapidly Cabin is pressurized and roomy Can transport multiple patients Not limited by weather Disadvantages of ground transport - correct answer ✅Slow Affected by weather Disadvantages of helicopter transport - correct answer ✅Expensive Limited by:

• weight
• distance

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• weather Loud Cabin not pressurized Disadvantages of fixed wing transport - correct answer ✅Expensive Limited accessibility due to landing strip Usually requires ground support to complete transport Four factors that increase risks of falls - correct answer ✅Muscle weakness Drugs which increase sleepiness Use of cane or walker Need to use bathroom frequently Members of rehab team - correct answer ✅Patient and family Nurse Physical therapist Respiratory therapist Occupational Therapist Speech pathologist Physiatrist Conditions of brain death - correct answer ✅Irreversible Body temp > 35C

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Fixed pupils Apnea in presence of hypercarbia (PaCO2 > 60) No reflex activity: oculocephalic, oculovestibular, cough, gag, and corneal Describe corneal reflex - correct answer ✅Brush a wisp of cotton against the cornea, or apply a small drop of saline; normal response is rapid closing of eyelid Gag reflex - correct answer ✅Stimulate back of pharynx, normal response is to gag Swallow reflex - correct answer ✅Stimulate uvula, normal response is elevation of uvula What is oculocephalic reflex - correct answer ✅Dolls eyes; if eyes move opposite direction of head movement, it is abnormal finding What is oculovestibular reflex - correct answer ✅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 - correct answer ✅Salvageable patients with severe injury GCS of 3 to 8 after resuscitation Abnormal CT findings Unconscious

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Contraindications for ICP monitoring - correct answer ✅Awake patients Coagulopathies Pupillary response in brain injured patients - correct answer ✅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 - correct answer ✅Maintain dark and quiet room Limit visitors Speak softly Cluster nursing activities Limit dialogue Regular sedation/analgesia List symptoms associated with diffuse axonal injury - correct answer ✅Coma Increased ICP Posturing Hypertension Increased temperature Hyperhydrosis from nipple line up No pupillary signs

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Describe deficits associated with anterior cord injuries - correct answer ✅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 - correct answer ✅Loss

of proprioception, vibration, fine touvhm fine pressure Intact - motor function, pain, temperature, crude touch, crude pressure Treatment for an avulsed tooth - correct answer ✅Handle by crown Do not clean, rub, scrape, or disinfect Store in Hank's solution ( or milk or normal saline) Define penetrating globe injury - correct answer ✅Entrance without an exit Define perforating globe injury - correct answer ✅complete disruption of the sclera and cornea, through and through