TCRN Review Questions: Trauma and Emergency Care, Exams of Medicine

Download TCRN Review Questions: Trauma and Emergency Care and more Exams Medicine in PDF only on Docsity! TCRN Review Questions And Answers Which of the following techniques is used for initial control of hemorrhage to an extremity? A. Apply direct pressure to the open wound B. Apply pressure to the affected pulse point C. Elevate the extremity above the heart D. Apply a tourniquet 4 inches above the open wound - correct answer A Injury prevention programs should NOT include which of the following? A. Non-measurable outcomes B. Partnerships with communities C. Monitoring and supporting D. Intervention strategies - correct answer A Fluid coming from the nose or the ear after a traumatic injury to the head should raise concern for: A. LeFort I fracture B. Occipital fracture C. Perforated tympanic membrane D. Basilar skull fracture - correct answer D TCRN Review Questions And Answers A patient is coming to the ED following a high-speed MVC. EMS is reporting a GCS of 3; vital signs: HR 65, BP 85/50, RR assisted at 12, O2 sats 94%. Which parameter increases the risk for long-term disability? A. Blood pressure 85/50 B. GCS 3 C. HR 65 D. O2 94% even with assistance - correct answer A When greeting the family of a 23 year old male being resuscitated in the trauma bay, which approach is not an effective way of delivering the patient's condition? A. Inform at first possible opportunity once patient arrives to ED either by phone or in person B. Provide good news first C. Outline the nature of injuries, what has been done so far, and predict patient course D. Immediately allow the family into the room during resuscitation - correct answer D What is the development stage/goal for the preschool age child? A. Industry vs. inferiority B. Trust vs. mistrust C. Initiative vs. guilt D. Autonomy vs. shame - correct answer C TCRN Review Questions And Answers B. Arteriogram C. Chest CT without contrast D. Doppler study - correct answer B A 35 year old male is brought to the ED for a blunt blow to the neck. Patient is hoarse, experiencing hemoptysis and subcutaneous emphysema. Knowing the anatomy of the trachea, the nurse knows that the trachea splits at the _____ to form the ______. A. Cricoid cartilage, secondary bronchi B. Thyroid cartilage, primary bronchi C. Carina, primary bronchi D. Hilum, secondary bronchi - correct answer C The same patient with a tracheobronchial tear is developing air in his pleural cavity at a rapid rate. A tension pneumothorax is forming. This is known to cause: A. Obstructive shock B. Respiratory alkalosis C. A widening pulse pressure D. Unilateral stabbing chest pain - correct answer A What is the most common site of injury in the trachea and bronchial area? A. Cricoid cartilage TCRN Review Questions And Answers B. Thyroid cartilage C. Tracheal cartilage D. Carina - correct answer D A patient comes to the ED with dysphonia and dyspnea after aspirating a fish bone. The physician suspects tracheal rupture and begins to prepare for intubation. What is the most definitive way to confirm the diagnosis of a tracheal rupture? A. Bronchoscopy B. Chest xray C. CT of the chest D. Ultrasound - correct answer A A 54 year old female is on 41 North. She is 2 days post MVC with blunt injury and multiple rib fractures. Her ABG shows: pH: 7.49, pCO2 49, HCO3 22. How would you interpret this? A. Normal B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis - correct answer C When should impaled objects in the thoracic cavity be removed? A. Prior to arrival TCRN Review Questions And Answers B. In the trauma bay C. Never D. In the OR - correct answer D Which of the following is not a pathophysiological consequence of a life-threatening thoracic injury? A. Hypoxia B. Hyperventilation C. Respiratory/metabolic acidosis D. Inadequate tissue perfusion - correct answer B The chest tube was inserted correctly for a relatively small pneumothorax, however, 1 day later the bubbling in the water seal chamber has stopped. What should the nurse do? A. Nothing, this is normal B. Begin looking for an air leak C. Alert the surgeon, set up a new drainage system D. Turn the patient on their affected side - correct answer A A trauma patient has been identified as having a sternal fracture. What is the most common cardiac injury after a significant blunt force impact to the chest? A. Aortic dissection TCRN Review Questions And Answers A geriatric trauma patient with multisystem injuries is now being managed by palliative care as they are end of life. The patient has nausea and decreased appetite and the family is very concerned about nutritional status. What is the LEAST correct in regards to end of life and nutrition? A. Obtain an order for zofran B. Comfort the family by informing them that at this stage, going without food and water is not painful C. Instruct the family to bring in the patient's foods from home so that the patient may be forced to eat them D. Comfort and educate the family that this is a common and normal finding in the dying process - correct answer C When obtaining a history for an injured patient, understanding energy transfer through biomechanical information helps the nurse to: A. Anticipate the types of injury that may be present B. Decide if law enforcement should be notified C. Determine needed laboratory tests D. Predict the need for a surgical procedure - correct answer A The major preventable cause of death in the trauma patient is: A. Airway compromise B. Ineffective ventilation C. Secondary head injury TCRN Review Questions And Answers D. Uncontrolled hemorrhage - correct answer D What is the best position to maintain an open airway in the bariatric patient? A. Prone B. Supine C. Reverse Trendelenburg D. Right lateral recumbent - correct answer C Your patient has a subdural hematoma sustained while falling down a flight of stairs after drinking. He is going to the OR in the morning, however, overnight he became anxious and stated he could not sleep. He vomited once. What is your priority concern for this patient? A. Alcohol withdrawal B. Acute stroke C. Increased intracranial pressure - correct answer C A patient from the ED has been transferred to your unit. They were resuscitated in the trauma bay and sustained an open femur fracture that is now immobilized. When the patient bends her knee on her uninjured leg she has intense left shoulder pain. What is this called and what does it indicate? A. Cullen's sign; abdominal bleeding B. Kehr's sign; undiagnosed PE TCRN Review Questions And Answers C. Kehr's sign; spleen injury D. Cullen's sign; undiagnosed spine injury - correct answer C A patient involved in an MVC suffered a splenic laceration requiring a splenectomy. Which vaccine would you expect to administer prior to the surgery? A. Recombivax HB B. Tetanus toxoid C. Attenuvax D. Pneumovax 23 - correct answer D A patient from the ED has been transferred to the ICU. The patient is hypovolemic and needs fluid. Which replacement fluid would be indicated without causing significant fluid shifts across the cellular membranes or vessels? A. D5 1/2 NS B. D5W C. NS D. 3%NS - correct answer C A patient with a history of a shoulder and elbow dislocation is most likely to experience which complication? A. Median nerve damage B. Brachial plexus injury TCRN Review Questions And Answers C. Neurons need time to regenerate so stating the injury early is not predictive of how the patient progresses D. Necrosis of gray and white matter does not occur until days after the injury - correct answer B Which of the following nursing actions is appropriate for preventing skin breakdown in a patient who has recently undergone a laminectomy? A. Provide patient with rotating air mattress B. Place pillows under patient to help turn C. Teach patient to grasp side rail to turn D. Use the log roll to turn patient to the side - correct answer D A patient was thrown through the windshield during a car crash impaling him with a large shard of glass through his left chest. He has some bleeding around the site with a bandage in place. He is hypotensive and it is becoming more difficult to auscultate the heart sounds. What type of shock is he most likely suffering from? A. Hypovolemic B. Cardiogenic C. Obstructive D. Neurogenic - correct answer C Which of the following patients needs neurovascular checks routinely performed by the nurse? TCRN Review Questions And Answers A. Patient with an extremity injury B. Patient with a post-op hip repair C. Patient with known pelvic fracture D. All of the above - correct answer D The nurse knows the compartment pressure that indicates compartment syndrome is greater than what number? A. 10 B. 30 C. 40 D. 60 - correct answer B Patient with suspected compartment syndrome should have the extremity placed in what position? A. Elevated above the heart B. Below the level of the heart C. At the level of the heart D. It doesn't matter - correct answer C A patient enters the trauma bay with a large piece of glass in his chest. EMS stabilized the object and brought him to the ED. Patient is hemodynamically stable, no hemorrhaging is noted. When should the impaled object be removed from the chest? TCRN Review Questions And Answers A. ASAP B. It should have been removed on scene C. After imaging, in the trauma bay D. In the OR - correct answer D How much fluid does it take to distend the pericardial sac and lead to cardiac tamponade? A. 75-100 mL B. 100-200 mL C. 5-15 mL D. 250-300 mL - correct answer A Why is a widened mediastinum on x-ray concerning? A. Pneumothorax B. Cardiac tamponade C. Aortic disruption D. Hemothorax - correct answer C Which pneumonic helps nurses troubleshoot tubes/drains? A. FOCA B. AVPU C. DOPE TCRN Review Questions And Answers Which of the following BEST describes a superficial burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - correct answer B Which of the following BEST describes a superficial partial-thickness burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - correct answer D Which of the following BEST describes a deep partial-thickness burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - correct answer A Which of the following BEST describes a full thickness burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches TCRN Review Questions And Answers C. Leathery, gray/black wound D. Blisters with wet/pink - correct answer C Which blood product would you give if you needed to fix the patient's hemoglobin? A. Platelets B. FFP C. PRBC's - correct answer C Which blood product would you give if the patient is bleeding from the nares and gums continuously? A. Platelets B. FFP C. PRBC's - correct answer A Which blood product would you give if the patient needs volume? A. Platelets B. FFP C. PRBC's - correct answer B Which of the following products is richest in fibrinogen? A. Albumin TCRN Review Questions And Answers B. Whole blood C. Cryoprecipitate D. Fresh frozen plasma - correct answer C When should you administer platelets during the resuscitation of a trauma patient? A. Deferred until you have the coagulation tests back from lab B. Initiated simultaneously with the administration of PRBC's C. You only need to if your patient is on a blood thinner D. Reserved only for patients with 40% or greater blood volume loss - correct answer B Which patient should NOT receive whole blood? A. 36 year old male with a GSW B. 52 year old female with a grade IV liver laceration C. 3 year old with open femur fracture D. 14 year old male with pelvic fracture from a bicycle crash - correct answer C When assessing a neurologically impaired patient, which of the following is the most helpful to identify the patient's issue? A. Head CT B. MRI TCRN Review Questions And Answers A patient with major thermal burns needs a large volume of IV fluids during the initial 24 hours. Regardless of the calculation formula selected, fluid administration in adults is most appropriately titrated to: A. Central venous pressure, with a goal of 5-8 mmHg B. Urinary output, with a goal of 0.5-1.0 mL/kg/hr C. Mean arterial pressure, with a goal of 55 mg Hg D. Urinary output with a goal of 30-50 mL/hr - correct answer B A patient who touched a live electrical wire is admitted for electrical burn treatment. The entire palmar surface of both hands are charred and dry. Anticipating fluid requirements for this patient, the nurse knows: A. To apply the Parkland burn fluid calculation formula B. The patient's palms represent 1% body surface area (BSA) C. To use the Consensus burn fluid calculation formula D. BSA calculations do not predict electrical burn fluid needs - correct answer D Changes in a patient's ability to speak are often associated with an injury to what part of the brain? A. Frontal lobe B. Parietal lobe C. Broca's area D. Wernicke's area - correct answer C TCRN Review Questions And Answers A patient has slower, venous bleeding in the brain- what is the most common type of brain bleed that involves the veins? A. Subdural B. Epidural C. Subarachnoid D. Sub-pia - correct answer A Which structure in the brain communicates the need to drink water? A. Thalamus B. Hypothalamus C. Amygdala D. Hippocampus - correct answer B What structure brings the two hemispheres of the brain together? A. Cerebellum B. Cerebrum C. Corpus callosum D. Cerebral cortex - correct answer C The most common complication associated with intracranial pressure monitoring is: TCRN Review Questions And Answers A. Infection B. Herniation C. Intracranial bleeding D. Cerebrospinal fluid leak - correct answer A Which of the following patients is a likely candidate for intracranial pressure monitoring? A. Patient with cerebral contusion and a GCS of 12 B. Patient with a GCS of 7 and intracerebral hemorrhage on CT C. Patient with GSW to the head and GCS of 3 upon arrival to the trauma bay D. Patient with mental status change from alert and oriented to drowsy and confused over a 60 minute period - correct answer B Which of the following statements are true regarding external ventricular drains? A. They can monitor only and are placed in the lateral ventricles B. They can monitor and drain and are placed in the third ventricle C. They can monitor only and are placed in the third ventricle D. They can monitor and drain and are placed in the lateral ventricle - correct answer D TCRN Review Questions And Answers A. 5 mm Hg B. 10 mm Hg C. 15 mm Hg D. 20 mm Hg - correct answer C A patient with extensive facial fractures presents with copious bleeding from the oropharynx and is unable to maintain a patent airway. Endotracheal intubation has been unsuccessful. a nurse should anticipate a bedside: A. Needle cricothyrotomy B. Surgical tracheostomy C. Video laryngoscopy D. Surgical cricothyrotomy - correct answer D An intubated patient is being transferred to the ICU after a motor vehicle crash. He received aggressive fluid resuscitation. Results of a FAST exam are negative in the ED. Assessment at this time reveals marked abdominal distention, oliguria, and significant tachycardia with hypotension. In investigating the most likely etiology, the nurse would expect to obtain: A. Chest radiograph B. Bladder pressure measurement C. Abdominal radiograph D. Renal ultrasound - correct answer B TCRN Review Questions And Answers The decrease of venous return and cardiac output in neurogenic shock is caused by: A. Loss of deep tendon reflexes B. Massive vasoconstriction C. Release of norepinephrine D. Inhibition of sympathetic innervation - correct answer D A patient presents with pelvic instability and a GCS of 14 after being hit by a car. Vital signs are: BP 88/57, HR 127, RR 12, temp 97F. The patient remains hypotensive and tachycardic despite initiation of the massive transfusion protocol. A chest radiograph is normal, and results of a FAST exam are negative. The nurse should anticipate an order for transfer to: A. Surgery B. ICU C. Interventional radiology D. CT - correct answer C Which of the following best describes the focus of secondary injury prevention? A. Enhancement of outcomes related to the traumatic injury B. Reduction in the severity of the injury that has occurred C. Prevention of the occurrence of the injury TCRN Review Questions And Answers D. Improvement of outcomes related to non-traumatic injuries - correct answer B Compared to a patient who is exposed to a highly acidic liquid, a patient who is exposed to a highly alkaline liquid requires: A. Decontamination before treatment is initiated B. The nurse to don safety equipment before treating the patient C. Application of a neutralizing agent D. Continuous irrigation for more than 20 minutes - correct answer D A child is admitted for upper respiratory symptoms. The nurse notes circumferential bruising around the ankle. The parents say it was caused by jumping rope with a sibling. The nurse's most appropriate course of action is to: A. Contact child protective services B. Document findings in the nursing notes C. Separate the parents from the child immediately D. Notify hospital security to monitor the child's safety - correct answer A Administering IV crystalloids and vasopressin (pitressin) to a patient who has been declared brain dead is to: A. Stabilize body temperature B. Stop cerebral salt wasting