Tcrn Practice Questions: Trunk Part 1 (Thoracic & Abdominal Trauma), Exams of Nursing

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Tcrn Practice Questions: Trunk Part 1

(Thoracic & Abdominal Trauma)

Questions With Correct Detailed

Answers.

When should impaled objects be removed? - ANSWER- Preferably in the OR, under controlled circumstances. True or false: Bullet wounds follow a predictable pattern of injury? - ANSWER- False: A bullet wound is an example of a "blast" wound which has an unpredictable trajectory and must consider path of tissue injury related to shock/stress waves. Name six life-threatning chest injuries: - ANSWER- 1. Laryngeotracheal Injury/Airway Obstruction

2. Tension Pneumothorax
3. Open Pneumothorax 4.Flail chest and pulmonary contusion
4. Massive hemothorax
5. Cardiac tamponade What are the four pathophysiological consequenses of life-threatning chest injuries? - ANSWER- 1. Hypoxia
6. Hypoventilation
7. Respiratory/metabolic acidosis
8. Inadequate tissue perfusion What alternative should you consider with an abusive and/or belligerant patient? - ANSWER- Hypoxia (beyond intoxication of alcohol and drugs) Is cyanosis an early or late finding of hypoxemia? - ANSWER- Late During a tension pneumothorax the mediastinal structures shift where? - ANSWER- Opposite the affected side A needle thoracentesis is performed where anatomically? - ANSWER- 2nd-3rd intercostal space, mid-clavicular line A tube thoracostomy (chest tube insertion) is performed where anatomically? - ANSWER- 4th-5th intercostal space, mid-axillary line

How should an open pneumothorax initally be managed? What should you be cautious of? - ANSWER- Application of a sterile 3-sided dressing. Caution exercised to avoid creating an occlusive dressing which can lead to a tension pneumothorax. True or false: blood from a massive hemothorax can be transfused? - ANSWER- True, autotranfusion can be done if a facility uses autotransfusion equipment. How can the discomfort of flail chest be managed during pulmonary toileting? Does flail chest always require surgical repair? - ANSWER- Splinting the chest with a supportive device (ex. pillow, folded and taped towel). No, flail chest is usually managed non- operatively. How much fluid does it take to distend the pericardial sac and lead to cardiac tamponade? - ANSWER- 75-100 ml. Patient's report a "feeling of impending doom" A widened mediastinum on xray is concerning for? - ANSWER- Traumatic aortic disruption What drug drip would you anticipate to be running a patient with an aortic injury awaiting operative management? - ANSWER- Esmolol (short-acting beta blocker): decreases vessel wall tension and keeps patient's blood pressure lower until patient stabilized for operative procedure. What is the most common symptom of a tracheobronchial injury? - ANSWER- Subcutaneous emphysema True or false: An esophageal perforation is a surgical emergency? - ANSWER- True What is the most common mechanism of abdominal trauma? - ANSWER- Blunt trauma via Motor vehicle crashes (75%) A positive seatbelt sign across the lower abdomen should raise suspicion for? - ANSWER- Small bowel injury *Seatbelt should be low and close-fitting to hips Blunt duodenal injuries are the result of? - ANSWER- Compression injuries *Commonly seen with Chance fracture, transverse process fractures, etc. Trauma to the stomach is most common in what group? - ANSWER- Rare, more common in children What is the most common cause of trauma to the large intestine? - ANSWER- Penetrating trauma

Trauma to the liver places the patient at greatest risk for? - ANSWER- Severe hemorrhage True or false: Treatment of spleen injury requires splenectomy? - ANSWER- False, splenectomy is avoided if at all possible related to resulting immunocompetence. You are discharging a patient who had a splenectomy during this hospitalization. What must be done prior to discharge? - ANSWER- Administration of vaccinations: Pneumococcal, H. influenza, and meningococcal What percentage of the pancreas can be removed without concern for resulting diabetes? - ANSWER- 90% Retroperitoneal injuries are commonly seen with what other injury? - ANSWER- Pelvic fractures True or false: Abdominal vascular injury can lead to abdominal compartment syndrome?

• ANSWER- True, the retroperitoneal space can hold up to 4L

of blood