TCRN EXAM WITH 100% CORRECT ANSWERS | LATEST VERSION EXPERT VERIFIED, Exams of Advanced Education

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TCRN EXAM WITH 100% CORRECT ANSWERS |

LATEST VERSION EXPERT VERIFIED

Shock - Correct Answer-Lack of oxygen to the cells Hypovolemic Shock - Correct Answer-Lack of volume ex: hemorrhage, burns Distributive Shock - Correct Answer-Maldistribution of blood (pooled in extremities) Decreased preload ex: neurogenic shock Cardiogenic Shock - Correct Answer-Inadequate cardiac output ex: blunt cardiac trauma Obstructive Shock - Correct Answer-Inability of blood to enter or exit heart properly ex: tamponade, tension pneumothorax Systemic Inflammatory Response Syndrome (SIRS) - Correct Answer- Severe tissue trauma activates an inflammatory response leading to vasodilation, capillary permeability, and coagulation

Early (Compensated) Shock - Correct Answer-Normal BP Weak, thready pulse Deep and rapid RR Normal lactic levels Anxious Late (Decompensated) Shock - Correct Answer-Decreased BP Tachycardia Shallow and rapid RR Increased Lactic Decreased LOC Decreased urinary output BUN to Creatinine Ratio - Correct Answer-Normal - 10: Indicated effective renal function Trauma Triad of Death - Correct Answer-Hypothermia Acidosis Coagulopathies Effects of Acidosis - Correct Answer-Increased ICP

Exacerbates coagulopathies Depressed myocardial contractility DIC - Correct Answer-Excessive clotting > all clotting factors used > no more clotting > excessive bleeding Effects of coagulopathies - Correct Answer-Decreased platelet count Decreased fibrinogen Decreased HnH Increased PT, PTT Increased Ddimer Multi-Organ Dysfunction Syndrome (MODS) - Correct Answer- Irreversible Shock resulting from Triad of Death Symptoms start within the first week after trauma Steps to control hemorrhage - Correct Answer-Tourniquet TXA REBOA Permissive Hypotension

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) - Correct Answer-Occlusion of the Aorta below the diaphragm to reduce bleeding Type A - Correct Answer-RBC: Type A, O Plasma: Type A, AB Type B - Correct Answer-RBC: Type B, O Plasma: Type B, AB Type AB - Correct Answer-RBC: Type A, B, AB, O Plasma: AB Type O - Correct Answer-RBC: Type O Plasma: Type A, B, AB, O Universal Donor of RBC and Plasma - Correct Answer-Universal donor of RBC: O negative Universal donor of Plasma: AB negative Cryoprecipitate - Correct Answer-Concentrate of coagulation factors obtained from fresh frozen plasma Increases fibrinogen in the bloodstream

Blood Transfusion in Peds - Correct Answer-One unit of blood is 10ml/kg Complications of MTP - Correct Answer-Hypothermia - warm all fluids and blood Hypocalcemia - replace calcium Acidosis - sodium bicarb TRALI - stop transfusion, supplemental oxygen Transfusion-Related Acute Lung Injury (TRALI) - Correct Answer- Pulmonary edema due to rapid blood administration MTP Protocol - Correct Answer-1 : 1 : 1 RBC : Plasma : Platelet Blood Loss Grades - Correct Answer-I - Loss of 15% with normal BP II - Loss of 15 - 30% with normal BP III - Loss: of 31-40% with lowered BP IV - Loss > 40% with hemodynamic instability Permissive Hypotension - Correct Answer-Maintaining BP as low as 70/40 so allow for clotting.

Contra-indicated in head injuries, peds, and elderly SCIWORA - Correct Answer-Spinal Cord Injury WithOut Radiological Abnormality Common in Age < 2 yrs Significance of Bariatric Patients - Correct Answer-Increased HR and RR at baseline Increased abdominal pressures Increased risk of coagulopathies SBIRT - Correct Answer-Comprehensive intervention to deliver treatment for substance use disorders Screening Brief Intervention Referral to Treatment Triad of Abusive Brain Injury - Correct Answer-Subdural Hemorrhage Retinal Hemorrhage Decreased LOC Types of Stress Disorders - Correct Answer-State of Crisis - Immediately after event

Acute Stress Disorder - Lasting at least three days Post Traumatic Stress Disorder - Lasting one month or longer Three things to identify state of crisis - Correct Answer-1. Perception of the event

2. Support System
3. Coping mechanisms Steps of Research - Correct Answer-1. Research question
4. Literature Review
5. Research Methodologies
6. Institutional Review Board (IRB) Quantitative Research Methods - Correct Answer-Descriptive - Describe current status of variable Correlational Retrospective - Chart review association of variables Quasi-experimental - Comparison of independent and dependent variable, but no control group Experimental - Comparison of variable and control group Qualitative Research Methods - Correct Answer-Phenomenology - Describe experiences of the subjects in the study

Grounded Theory - Collecting a hypothesis by discussing the viewpoints from the subjects Ethnography - Observations of behavioral patterns Tool Reliability vs Validity - Correct Answer-Reliability - Consistency of the tool to measure what it is supposed to Validity - Extent to which tool measures what it is supposed to measure Role of the IRB - Correct Answer-Ensure informed consent is obtained Subjects can make independent decisions Sentinel Event - Correct Answer-An unexpected occurrence involving death or serious physical or psychological injury, not related to the natural course of the patient's illness Best Studied using Root Cause Analysis Trauma Center Designation vs Verification - Correct Answer- Designated by the state Verified by American College of Surgeons Qualifications to be Trauma Center - Correct Answer--Treatment protocols for resuscitation

• Data Reporting

• Active outreach program in community
• Disaster planning National Trauma Data Bank - Correct Answer-A collection of trauma data research and benchmarking COBRA / EMTALA - Correct Answer-Patient must be offered medical screening exam > discharge, admitted, or transfer to another facility > Must have a receiving facility, accepting physician, and signed certification EMTALA also covers that consent can be waived in case of emergency Types of Review - Correct Answer-Primary - review of patient's chart in real time Secondary - Review after patient is discharged Tertiary - Peer Review (via committee or M&Ms) Quaternary - Hospital's quality committee, or external review Steps of Disaster Management - Correct Answer-Mitigation Preparedness Response Recovery

Compassion Fatigue - Correct Answer-Loss of nurse's ability to empathize and provide compassionate care to patients Secondary Traumatic Stress leading to Burnout Autonomy - Correct Answer-Ability of individual to determine his/her own course of action ex: not receiving blood due to religious reasons Beneficence - Correct Answer-Duty of health care providers to be a benefit to the patients ex: prevent or remove harm from the patient Non-maleficence - Correct Answer-Do no harm ex: honor DNR status of patient Veracity - Correct Answer-Honesty, providing all information needed to make balanced decision ex: review all risks and benefits of surgery prior to consent Justice - Correct Answer-Fair distribution of goods in society ex: medicare/medicaid

Protected Health Information may be shared to: - Correct Answer- Past, present or future providers Law enforcement Medical reviews Intracranial Pressure Measurements - Correct Answer- 0 - 15 Normal 20 - 40 Elevated Above 40 Severely Elevated Deficits in Elevated ICP (20-40) - Correct Answer-Ipsilateral - deficits above the neck on same side of bleed Contralateral - deficits below the neck on opposite side of blood Vomiting Disorientation Restlessness Deficits in Severely Elevated ICP (Above 40) - Correct Answer-LOC Posturing Cushing's Triad Decorticate vs Decerebrate - Correct Answer-DeCORticate - Hands are pulled towards the CORE (Early) DEcErEbratE - Extension of the arms and legs (Late)

Extraventricular Device (EVD) - Correct Answer-Allows drainage of CSF fluid Keep HOB 30 degrees Keep transducer level with the Foramen of Monro (Ear canal) Excessive drainage could lead to subdural hematoma Basilar Skull Fractures - Correct Answer-Anterior Fossa fracture - Around eyes and forehead (Could affect eyes and nose) Middle Fossa - Around ears (Could affect hearing) Posterior Fossa - Posterior portion of the head (Could lose gag reflex, or movement of the neck or tongue) Cerebral Contusion - Correct Answer-Bruising on the surface of the brain Three Meninges - Correct Answer-Pia Arachnoid Dura Meninges PAD the brain Epidural Bleed - Correct Answer-Between the skull and dura mater Arterial

Symptoms: Unconscious then brief lucid period, then rapid decline of LOC Treatment: Burr hole Subdural Bleed - Correct Answer-Between the dura and arachnoid mater Venous Symptoms: Similar to epidural, but slower onset Treatment: Craniectomy Sub arachnoid Bleed - Correct Answer-Between the arachnoid and pia mater Symptoms: Worst headache of my life Treatment: Surgery Diffuse Axonal Injury - Correct Answer-Disruption of the axons in the cerebrum Symptoms: Posturing, Coma, Hyperthermia Levels of Consciousness - Correct Answer-Alert Lethargic - sleepy Obtunded - responses to loud voice or shaking Stuporous - Responds to painful stimuli

Comatose - Not responding to painful stimuli Full Outline of UnResponsiveness (FOUR) - Correct Answer-Eye response Motor response Brainstem reflexes Respirations Cushing's Triad - Correct Answer-Signs of increased intracranial pressure: Hypertension with a widened pulse pressure Bradycardia Irregular respirations Tests for CSF leakage - Correct Answer-"Halo" test Reagent strip - test for glucose Cerebral Perfusion Pressure (CPP) - Correct Answer-CPP = MAP - ICP Indirect measurement of cerebral oxygen delivery CPP Measurements - Correct Answer- 80 - 100: Healthy Above is 60: Required for consciousness Less than 50: Critical reduction in brain tissue oxygenation

Less than 30: Irreversible brain ischemia MAP - Correct Answer-Mean Arterial Pressure MAP = (2D + S) / 3 Treatment of Elevated ICP - Correct Answer-Reducing volume of the brain (mannitol, hypertonic saline) Reducing the volume of the blood (elevated HOB, reduce cerebral activity, Anti-seizure medication) Reducing the volume of CSF (EVD) Maximize oxygenation (Reduction in CO2 in critical situations) Normalize blood glucose level Normalize temperature Spinal Cord Inuries - Correct Answer-C1-C4 - breathe no more C5-T1 - upper extremities T4 - Nipple line T7 and above - lose the ability to cough T10 - Hip line L2-L5 - lower extremities S3 - That's the end Anterior Cord Injury - Correct Answer-Descending (Brain to Body)

Loss of motor function Posterior Cord Injury - Correct Answer-Ascending (Body to Brain) Loss of proprioception, vibration, fine touch Lateral Cord - Correct Answer-Ascending (Body to Brain) Controls pain, temperature, crude touch Central Cord Injury - Correct Answer-Greater loss of motor function in upper vs lower extremities More likely to affect lateral cord Brown-Sequard Injury - Correct Answer-Loss of motor function on same side of injury Loss of pain and temp on opposite side of injury Cauda-Equina Syndrome - Correct Answer-Damage to lower spinal cord, resulting in problems with bowel and bladder control Spinal Shock - Correct Answer-Temporary neurological deficits immediately after spinal injury

Islands of Sparing - Correct Answer-Areas without deficits due to a partial cord injury Sensory Assessment in SCI - Correct Answer-Start from areas of decreased sensation and move towards areas of increased sensation Neurogenic Shock - Correct Answer-Activation of parasympathetic nervous system causing vasodilation, hypotension and bradycardia Treat with fluids, and vasopressors Autonomic Dysreflexia symptoms - Correct Answer-Hypertension Bradycardia Headache Goose bumps (piloerection) Sweating above the level of the spinal injury Cool clammy skin below the level of the spinal injury Mandibular Fracture - Correct Answer-Malocclusion of the jaw Dental involvement Le Fort Fractures - Correct Answer- Orbital Fracture - Correct Answer-Concerned for ocular entrapment

Treatment for Maxillofacial Trauma - Correct Answer-Allow patient to assume position that they can tolerate Suction as needed Assess for surgical airway Intraocular Pressure - Correct Answer-Above 20 is elevated Normal Ocular pH - Correct Answer-7.0 - 7. Hyphema - Correct Answer-Bleeding in the anterior chamber of the eye due to ruptured vessel in the iris High risk of secondary bleeding occurring on the 3-4 day Vitreous Hemorrhage - Correct Answer-Bleeding in the eye Result in "cobwebs" or "floaters" Ruptured Globe - Correct Answer-Can lead to tear-shaped pupils Use metal shield on affected eye Ocular Foreign Object - Correct Answer-Secure protruding object and cover unaffected eye

Retrobulbar Hemorrhage - Correct Answer-Blood clot behind globe pushing it forward Use paper cup on affected eye Globe Luxation - Correct Answer-Extrusion of eye ball from the socket Ocular entrapment - Correct Answer-Orbital of the eye is stuck due to fracture Eye is angled downward toward the feet Rib Fractures - Correct Answer-1st and 2nd - Tracheal trauma, great vessel injury 3rd through 9th - Lung trauma 9th through 12th on the left - Splenic injury, left kidney 9th through 12th on the right - Liver injury, right kidney Sternum Fractures - Correct Answer-Blunt cardiac injury, esophageal trauma Laryngeal trauma Symptoms - Correct Answer-Hoarse voice Subcutaneous emphysema

Flail Chest Segment - Correct Answer-Three or more rib fractures in two or more locations causing a free-floating segment of the rib cage Paradoxical chest wall movement - Correct Answer-Sinking of the flail segment during inspiration, and bulging of the flail chest segment during exhalation (opposite of normal) Treatment for Rib Fractures - Correct Answer-Pain management Oxygenation Euvolemia Chest Physiotherapy Suctioning Aortic Trauma Symptoms - Correct Answer-Higher systolic in the right upper extremity compared to the left upper. Difference of 20. Precordial Systolic Murmur Treatment for Aortic Injuries - Correct Answer-Permissive Hypotension Beta-blockers Surgery Ankle Brachial Index - Correct Answer-Ratio to determine severity of peripheral vascular disease

ABI = Ankle SBP / Brachial SBP ABI Measurements - Correct Answer-Greater than 0.9 : Normal 0.6 - 0.9 : Mild 0.3 - 0.6 : Moderate Less than 0.3 : Critical Ischemia Pericardial Tamponade - Correct Answer-Collection of fluid in the pericardial sac Symptoms: Beck's Triad, Pulsus Alternans, Paradoxical pulse, Narrowed pulse pressure, PEA Treatment: Pericardiocentesis, Open thoracotomy Beck's Triad - Correct Answer-Muffled heart tones Systemic Hypotension Distended neck veins Paradoxical Pulse - Correct Answer-Decrease of more than 10 in arterial pressure during inspiration Pulsus Alternans - Correct Answer-Alternating morphology of the QRS complex

Blunt Cardiac Injury - Correct Answer-Symptoms: CP, ST elevation, Right sided heart failure Treatment: Positive Inotropes (Ex: Dobutamine) Pneumothorax - Correct Answer-Air in the pleural cavity May cause a "sucking sound" on inhalation Treatment: Three-sided occlusive dressing Tension Pneumothroax - Correct Answer-Pneumo with excessive pressure, pushing the heart over to opposite side of injury. Obstructive shock Treatment: Needle thoracostomy, then chest tube Hemothorax - Correct Answer-Collection of blood in the pleural cavity Hypovolemic shock and obstructive shock Treatment: Chest tube, blood loss replacement Chest Drainage Set - Correct Answer-Maintain set below the level of the chest Bubbling should occur in the water seal chamber, and suction chamber

Pulmonary Contusion - Correct Answer-Ruptured blood vessels in the lungs causing inflammatory response leading to respiratory acidosis Acute Respiratory Distress Syndrome (ARDS) - Correct Answer- Inflammatory response causing Progressive alveolitis and fibrosis leading to Respiratory infections resulting in Stiff, non-compliant lungs with high pressures on the ventilator P:F ratio - Correct Answer-Indirect measurement of the degree of oxygenation across the alveolar membrane P:F ratio = Oxygen in the blood (PaO2) / Oxygen delivered (FiO2) Healthy Adult = 400 Mild ARDS = 200- 300 Moderate ARDS = 100- 200 Severe ARDS = Less then 100 Treatment of ARDS - Correct Answer-Euvolemia Lower Tidal Volume Elevated PEEP Prone Positioning ECMO

Extracorporeal Membrane Oxygenation (ECMO) - Correct Answer- System that circulates the blood through an oxygenation system, to allow for the heart and lungs to recover Ruptured Diaphragm - Correct Answer-Symptoms: Heart sounds shift to the right side Pain to LEFT shoulder Signs of obstructive shock Dysphagia Dyspnea Confirmed by laparotomy Treatment: Surgery Seatbelt Sign - Correct Answer-Bruising along the lower abdomen Concern for small bowl injury and fractures of the lumbar spine Steps for Abdominal Assessment - Correct Answer-Visualization Auscultation Percussion Palpation

Tympany vs Dullness - Correct Answer-Tympany - Hyperresonance, Air, Hollow organs Dullness - Hyporesonance, Fluid, Solid organs Narrowed vs Widened Pulse Pressure - Correct Answer-Narrowed - Concerned for bleeding Widened - Concerned for head injuries Rebound Tenderness - Correct Answer-Pain that increases when pressure is removed due to irritation caused by presence of blood, enzymes, and bacterial contaminants Hollow Organs - Correct Answer-Esophagus, Stomach, Small intestine, Large intestine Complications of Hollow Organ Injuries - Correct Answer-Hematomas can cause obstructions hours or days after trauma Expected elevated WBC count, amylase, and lactic acid levels Escaping air can cause tympany and abdominal distention Rebound Tenderness Solid Organs - Correct Answer-Spleen, Liver, Pancreas, Kidneys Injury to the Spleen - Correct Answer-LUQ pain, Left shoulder pain