TCRN Review Challenge Questions with answers and rationales 2023, Exams of Nursing

Download TCRN Review Challenge Questions with answers and rationales 2023 and more Exams Nursing in PDF only on Docsity! TCRN Review Challenge Questions with answers and rationales 2023 Fluid resuscitation is undertaken for the patient in late, decompensatory hypovolemic shock. Which of the following findings indicates that this treatment is having its intended effect? An elevation in the: A. Pulse pressure B. Urinary output C. Respiratory rate D. Serum lactate levels ✔B A decrease in urinary output is associated with decompensatory hypovolemic shock, therefore an increase in this parameter is an indication of successful treatment. Pulse pressure, respiratory rate and serum lactate levels all increase with decompensatory shock, therefore an elevation in these levels is not associated with successful treatment. A patient receives 2 units of whole blood during the resuscitation phase of trauma. When documenting intake for the resuscitation, the trauma nurse will record what volume of fluid to account for those two units of while blood? A. 400 mL B. 500 mL C. 800 mL D. 1000 mL ✔D Which of the following factors is considered the most accurate indicator of successful resuscitation in the patient with hypovolemic shock? A. Base deficit B. Mental status C. Urinary output D. Blood pressure ✔A Tissue hypoxia causes the base deficit to decrease. Since tissue hypoxia is associated with inadequate fluid resuscitation, normalization of the base deficits associated with successful treatment. Alteration of mental status and an elevation in blood pressure are associated with successful treatment of hypovolemic shock but these parameters may be altered by many other factors including the use of beta- blocker medication, vasoconstriction associated with shock and use of alcohol or other illicit substances. Therefore, these indicators are less accurate than the base deficit. Similarly, an increase in urinary output is associated with successful resuscitation but may be altered by pre-existing renal failure, diabetes insipidus and other confounding factors. Therefore arterial base deficit is the most accurate indicator of adequate fluid resuscitation in the patient with hypovolemic shock. The trauma nurse knows that an elevation of which of the following laboratory values is associated with disseminated intravascular coagulation? A. D-Dimer B. Hematocrit C. Platelet count D. Fibrinogen levels ✔A Disseminated intravascular coagulation (DIC) results in abnormal increase in clotting. Fibrin degradation products are released from the breakdown of formed clots therefore increasing the D-dimer. The bleeding associated with DIC would cause the hematocrit to decrease rather than elevate. Consumption of clotting factors caused by abnormal clotting would cause the platelet count and fibrinogen level to drop rather than elevate. The trauma nurse knows that a patient who successfully deals with the crisis of a traumatic event shortly after the injury is more likely to: A. Handle future crisis effectively B. Avoid complications such as sepsis during the recovery phase C. Become alienated from family members who are not dealing with the crisis. D. Decompensate emotionally and fail to progress during the rehabilitation phase of recovery. ✔A One of the advantages of effective crisis management is the development of new skills which allows the individual to handle future crisis more effectively. The onset of sepsis is independent of the ability of the patient to handle crisis early. A patient who is able to handle the crisis of a traumatic injury is more likely to assist the family to deal with the crisis rather than alienate them. Patients who deal with the crisis immediately after the injury do not have a higher rate of decompensation during the rehabilitation phase of recovery. The trauma nurse knows that the most common onset of symptoms of post-traumatic stress disorder occurs at what time frame following the traumatic event? A. 4 weeks B. 3 months C. 1 year D. 3 years ✔B Although the onset of post-traumatic stress disorder can occur at any time interval following a traumatic event, the most likely time of onset is approximately 3 months after the event. It generally does not appear as early as 4 weeks after the event and frequently occurs before one or three years. A patient is admitted to the trauma unit after being extricated from underneath a concrete slab following an explosion. As part of the patient's treatment plan, the trauma nurse administers intravenous insulin and dextrose. Which of the following findings indicates that this treatment is having its intended effect? The patient's: A. Urine returns to an amber color A patient has been admitted to the inpatient unit after falling two stories from a roof, sustaining a pulmonary contusion and hemothorax treated with a chest tube. 24 hours after admission, the trauma nurse notes bruising in the patient's flanks. This finding should raise the index of suspicion that the patient may also have which of the following injuries which may have been originally missed? A. Liver laceration B. Pancreatic injury C. Diaphragmatic tear D. Rupture of the small bowel ✔B The pancreas is located in the retroperitoneum and bleeding secondary to pancreatic injuries may accumulate in the retroperitoneal space. Retroperitoneal bleeding generally manifests as bruising in the flanks but may be delayed by twelve hours or more. Furthermore, the symptoms of pancreatic trauma are often absent on initial presentation and may show up 6 or more hours after injury. Liver lacerations and ruptures of the small bowel are more likely to bleed into the peritoneum causing abdominal distension as opposed to bruising in the flanks. A diaphragmatic tear is more likely to cause dyspnea then bruising in the flanks. Which of the following mechanisms of injury is most likely to result in trauma to the stomach? A. Gunshot wound to the mid-abdomen B. Fall from 25 feet landing on the left side C. Airbag deployment resulting in sternal fractures D. Increase in intra-abdominal pressure from a lapbelt ✔A Although gastric trauma should be suspected in all patients with significant mechanisms of injury, the stomach is well protected under the rib cage and is rarely injured in blunt trauma such as falls and motor vehicle collisions. 20% of all gastric trauma is related to penetrating trauma such as a gunshot wound to the abdomen. Even if the external wound from the gunshot is not directly over the stomach, pressure waves from the projectile moving through the abdomen can cause ruptures of hollow organs such as the stomach. The projectile can also ricochet off bony structures once inside the body, injuring organs far from its entry point. A scrotal hematoma should alert the trauma nurse to a strong possibility of: A. Rectal trauma B. Femur fracture C. Shattered kidney D. Intraperitoneal bladder rupture ✔A Bleeding from rectal trauma frequently accumulates in the pelvic space. This blood can then run into the scrotum causing a scrotal hematoma. Blood from a femur fracture will accumulate in the thigh as opposed to the pelvis. Blood from a shattered kidney will accumulate in the retroperitoneal space causing bruising of the flanks as opposed to a scrotal hematoma. Blood and urine from an intreperitoneal bladder rupture will accumulate in the peritoneum causing rebound tenderness and abdominal distension rather than a scrotal hematoma. Extraperitoneal bladder rupture can cause urine to extravasate into the scrotum causing scrotal swelling. Which of the following symptoms is most likely to be noted initially in the patient with renal trauma? A. Abdominal distension B. A palpable flank mass C. Flank bruising at the 11th and 12th ribs D. Referred shoulder pain on the same side as the injured kidney ✔B A palpable flank mass is a strong indication of a tamponaded renal hematoma. Although bruising at the 11th and 12th ribs is also an indication of renal trauma, more likely renal trauma with capsular rupture, it will take several hours or longer for the blood to discolor and appear as blank bruising, therefore this is likely to noted later than a palpable flank mass. Abdominal distension is more likely to occur with intraperitoneal organ damage and the kidneys are in the retroperitoneum. Referred shoulder pain is associated with irritation of the diaphragm, which occurs with damage to the organs inside the peritoneum, not in retroperitoneal injuries. Injuries to which of the following organs is less common during pregnancy when compared to non-pregnant women? A. Liver B. Spleen C. Bladder D. Small bowel ✔D The small bowel is displaced by the gravid uterus and small bowel injuries actually decrease during pregnancy. Liver and splenic injuries are 25% more common when comparing the pregnant patient to the non-pregnant patient. The bladder tends to be elevated out of the pelvic ring during pregnancy increasing injury to this organ during pregnancy. When caring for a traumatically injured pregnant patient who is actively bleeding, the trauma nurse knows that: A. signs of fetal distress may appear before signs of maternal blood loss B. In the pregnant patient, the first indicator of hypovolemic shock will be hypotension C. Indications of maternal blood loss show up earlier during pregnancy than in the non-pregnant patient D. Fetal bradycardia is an early indicator of maternal blood loss, fetal tachycardia is a later indicator of maternal blood loss. ✔A During pregnancy, a woman's blood volume increases and signs of hypovolemia associated with blood loss, including hypotension, may be delayed, especially when compared to the patient's non-pregnant counterpart. Selective uterine vasoconstriction, a response to blood loss, is more likely to cause fetal distress, as evidenced by changes in fetal heart rate before maternal signs of blood loss. Fetal heart tones tend to increase in early distress and decrease as an indication of later, more serious distress. A patient sustains a traumatic brain injury resulting in cerebral edema. At what point following this injury is the patient's intracranial pressure most likely to spike? A. 30-60 minutes B. 4-6 hours C. 48-72 hours D. 5-7 days ✔C On average, intracranial pressure tends to spike 48 to 72 hours after a traumatic brain injury. Although each patient is individual and some may spike earlier than this or even after this time frame, the average time frame for the intracranial pressure to elevated to its highest point after an injury is 48 to 72 hours. Subdural hematomas tend to: A. be asymptomatic B. Have a delayed onset of symptoms C. Result in an immediate unconscious state D. Cause immediate excruciating headaches ✔B Subdural hematomas are usually venous in nature which means that the accumulation of blood which will cause the symptoms may take time. Therefore the onset of symptoms may be delayed by hours or even days. Most subdural bleeds will ultimately cause some degree of symptoms ranging from headaches to confusion or an alteration in the level of consciousness. An immediate unconscious state is more consistent with a diffuse axonal injury. An immediate excruciating headache is more likely associated with a subarachnoid bleed. During shift report, the trauma nurse learns that a patient with a traumatic brain injury is exhibiting "apneustic respirations". Which of the following respiratory patterns would the trauma anticipate seeing based on this report when assessing the patient? A. A slow but regular respiratory pattern B. Regular, sustained respirations with an increased rate and depth C. Clusters of slow irregular breaths with periods of apnea at irregular intervals D. A pause of 2-3 seconds noted after a full or prolonged gasping inspiration followed by a brief expiration ✔D Apneustic breathing is associated with lesions in the lower pons and is defined as a breathing pattern with a pause of 2 - 3 seconds noted after a full or prolonged gasping inspiration followed by an inefficient brief expiration. Bradypnea is defined as a slow but regular respiratory pattern. Central neurogenic hyperventilation is frequently associated with lesions in the pons and mid-brain and is described as a regular, sustained, increased rate and depth of respirations with forced inspiration and expiration. Cluster breathing is also associated with lesions in the pons and