TCRN Test 1 Questions with answers 2023, Exams of Nursing

Download TCRN Test 1 Questions with answers 2023 and more Exams Nursing in PDF only on Docsity! TCRN Test 1 Questions with answers 2023 Fluid resuscitation is administered to a traumatically injured patient. After resuscitation, the trauma nurse evaluates the patient's response to that resuscitation to determine whether additional fluids should be administered. Which of the following factors is most likely to impact this evaluation? ✔Beta-blockers blunt changes in the pulse and blood pressure. This may both reduce changes associated with recognizing hypovolemia but it can also reduce changes associated with the response to treatment. Many times the blood pressure falls and the pulse rises with hypovolemia and the opposite happens after fluid resuscitation. When the patient is on beta-blockers, these changes may not occur. Although it is more difficult to assess for changes in skin color in dark-skinned individuals, skin changes are generally not used to evaluate the effectiveness of fluid resuscitation and further resuscitation would not be based on changes in skin color. The presence of lower extremity trauma does not influence evaluation of fluid resuscitation nor the need for additional fluids. A body mass index of 21 kg/m2 is within normal limits and is unlikely to affect resuscitation or the evaluation of resuscitation 50% polyethylene glycol will be used as part of the treatment for: ✔50% polyethylene glycol is known to increase the solubility of phenols in water and should be used as part of the decontamination process in patients exposed to phenols. It will have no therapeutic effect for patients with pancreatic trauma, carbon monoxide poisoning (treated with 100% oxygen) or acute respiratory distress syndrome (treated with appropriate ventilator management and prone positioning) A reagent strip that tests for glucose is used in the assessment of a traumatically injured patient. What injury is likely suspected? ✔A basilar skull fracture may result in leakage of cerebrospinal fluid, which is rich in glucose. Reagent strips that test for glucose can be used to assist the diagnosis of basilar skull fracture by checking fluid coming from the nose or ears for glucose. A reagent strip that tests for glucose will not be therapeutic in assessing for a bladder rupture, diffuse axonal injury or a ruptured amniotic sac. When administering large volumes of blood products, the trauma nurse should monitor for which of the following findings which could indicate hypocalcemia? ✔A classic finding associated with hypocalcemia is QT prolongation. ST elevation is more common with cardiac ischemia and not associated with hypocalcemia. Tall peaked T waves and flattening of the P wave are both associated with hyperkalemia, not hypocalcemia The trauma nurse knows that treatment for a patient with non-operative abdominal trauma has been effective if: ✔A goal of treatment after abdominal trauma is a return of the base deficit to normal. This indicates adequate fluid resuscitation and is associated with positive outcomes. Although serum amylase levels should be monitored because elevations in these levels may indicate pancreatic or bowel trauma, changes in serum amylase levels are not associated with effective treatment, but rather associated with the injuries themselves. Intraabdominal pressures should be below 10 mm Hg. An intaabdominal pressure above 12 mm Hg indicates intraabominal hypertension, indicating a need for further. Hyperrresonance to percussion in the abdomen is an indication of hollow organ injury and is not a goal of treatment Which of the following statements, made by a patient being discharged home with the diagnosis of a hyphema, indicates FURTHER teaching is warranted? ✔A hyphema is a collection of blood in the anterior chamber of the eye. An isolated hyphema may be treated at home but the patient should be encouraged to rest and avoid any activities which could increase intraocular pressure and cause further bleeding. Patients will be encouraged to keep their head elevated 30 to 45 degrees on pillows, to rest their eyes (avoid activities such as watching television or reading) and to watch for signs of new bleeding (which can include vagal stimulation in the form of nausea and vomiting.) Ibuprofen and other medications which can increase the risk of bleeding should be avoided. A Kleihauer-Betke test may be used to determine: ✔A Kleihauer-Betke test is used to determine the presence of fetal blood in maternal circulation and is often positive in patients with placental abruption. The Kleihauer- Betke test is not useful in determining pain levels nor will it help determine the presence of pancreatic trauma. It is not associated with acute respiratory distress syndrome Adoption of a mass transfusion protocol should help reduce the incidence of: ✔A mass transfusion protocol may prevent the onset of a systemic inflammatory response syndrome (SIRS). The onset of SIRS is related to tissue trauma and prolonged tissue hypoxia. Early, aggressive fluid and blood resuscitation may decrease tissue hypoxia. Fat emboli are the result of a large bone fracture and the incidence of these is not affected by MTP. Post-renal failure is caused by obstructions in the lower genitourinary tract and the incidence of this complication is not altered by MTP. Abdominal compartment syndrome is the result of excessive fluid in the peritoneum. While MTP is not directly associated with abdominal compartment syndrome, the fluids administered during activation of MTP could worsen rather than reduce the incidence of abdominal compartment syndrome Which of the following goals of care is most appropriate for a patient with a maxillary fracture? ✔A maxillary fracture causes loss of bony structure to the mid-face which can cause loss of integrity of the airway. This can be exacerbated by bleeding and edema in the airway, further putting the ability to maintain the airway in jeopardy. When caring for According to the Health Insurance Portability and Accountability Act (HIPAA), release of a patient's protected health information without patient consent is: ✔According to HIPAA, protected health information may be released to meet statutory reporting requirements (such as mandatory reporting of suspected abuse). This is one of a number of instances when protected health information can legally be released without fear of fines or imprisonment. Patient consent is required before protected health information is released to lawyers, even in cases of civil litigation. Although protected health information may be released to law enforcement officers, there are limits in when the information may be released and how much may be released. Not all protected health information can be released to law enforcement in all cases Treatment for acute kidney injury is undertaken in the trauma unit. Which of the following findings indicates that this treatment is having its intended effect? ✔Acute kidney injury results in renal insufficiency. This in turn causes elevated potassium, a classic sign of acute kidney injury. Effective treatment should therefore reduce serum potassium. Flank pain is not associated with acute kidney injury and treatment will therefore not reduce this pain. Acute kidney injury causes the retention of fluid, often resulting in the elevation of the blood pressure, so treatment would reduce instead of elevate the mean arterial pressure. The BUN to creatinine ratio should remain unaffected at approximately 10:1 in acute kidney injury, therefore an increase in the BUN to creatinine ratio is not an indication of effective treatment A patient with known carbon monoxide poisoning has been given 100% oxygen via non-rebreather mask for one hour but no other treatments have been undertaken. The patient's carboxyhemoglobin level is drawn and determined to be 20%. Based on this information, what was the patient's carboxyhemoglobin level when the oxygen therapy was initiated? ✔Although carboxyhemoglobin has a half-life of 4 - 6 hours on room air, that half-life diminishes to one hour on 100% oxygen. Therefore, if a patient's carboxyhemoglobin level is 20% after being on 100% oxygen for one hour and the half-life is one hour, the original carboxyhemoglobin level was likely about 40%. If oxygen therapy is continued for an additional hour, the patient's carboxyhemoglobin will likely be 10% Which of the following factors is most likely to exacerbate coagulopathies associated with trauma? ✔Although coagulopathies are believed to be initiated shortly after a traumatic event by activation of the inflammatory cascade, factors such as acidosis (such as with a serum pH of 7.08), hypothermia and dilution with crystalloid fluids are all known to exacerbate the condition. Tachycardia is not associated with worsening of coagulopathies. Although it is important to manage a trauma patient's pain, failure to manage that pain is not associated with coagulopathies. Similarly, exposure to high concentrations of oxygen can lead to oxygen toxicity which is not desirable, but oxygen toxicity does not directly exacerbate coagulopathies Which of the following complications is most likely in a patient who sustains deep abrasions to more than 20% of the body surface area? ✔An abrasion, especially a deep one, causes loss of skin. One of the purposes of skin is temperature maintenance, so loss of a large amount of skin may cause evaporative heat loss and hypothermia. Sodium levels are generally not affected by abrasions, but fluid losses associated with a large abrasion may cause dehydration which leads to hypernatremia not hyponatremia. Rhabdomyolysis is caused by the destruction of a large amount of muscle but an abrasion affects skin, not muscle. Compartment syndrome requires intact skin over the area to collect fluid. With an abrasion, the skin cannot hold fluid making compartment syndrome unlikely An appropriately applied splint for a forearm fracture will immobilize the: ✔An effective splint immobilizes the joints above and below a fracture when possible. For a forearm fracture, this includes the wrist and elbow. By allowing mobility of one of the joints, there is increased risk of movement around the fracture which can cause further bleeding, neurovascular damage and increase the risk of fat emboli Assessment of a patient suspected of having an epidural bleed under the left parietal bone is most likely to reveal: ✔An epidural bleed on the left side of the head will result in ipsilateral weakness to the left side of the body above the neck as well as left sided pupillary changes (as opposed to right sided pupillary changes). Areas of the body below the neck (e.g. pronator drift and leg lifts) will occur on the contralateral or opposite side as the epidural bleed (the right side in this example) A trauma nurse is developing a trauma injury prevention program and notes that a specific mechanism of injury has a high incidence rate but a very low prevalence rate within the community. What is the significance of this finding? ✔An incidence rate measures how frequently an injury occurs within a population during a specific time period. Prevalence is the number of persons affected by a specific mechanism of injury divided by the total number of people in the population. If prevalence is high, one can summarize that many people survived the injury; if prevalence is low, the injury had a lower survivability. A high incidence rate indicates a large portion of the population was affected by the mechanism of injury. If patients survived the injury, then the prevalence would also be high. But because the incidence is high and the prevalence is low, one can surmise a high mortality rate. An injury prevention program focusing on this mechanism of injury would save lives and potentially reduce healthcare costs Application of a splint is most likely to be considered for which of the following injuries? ✔An injury to the back of the hand that occurs from a tooth puncturing the skin when one person punches another is known as a "closed fist injury." This injury has a high rate of infection because bacteria transfers from the other person's mouth to the wound, and then movement of the hand pulls the bacteria along the tendon sheaths deep in the hand. It is common to splint the patient's hand with a closed fist injury in anatomical position to reduce the incidence of bacteria being pulled deeper into the hand. Splints are not used for LeFort fractures, orbital fracture and flail chest segments The most likely level of consciousness associated with an intracranial pressure of 50 mm Hg is: ✔An intracranial pressure above 40 mm Hg is considered a severe elevation and will result in unresponsiveness. Pressures below 20 mm Hg are considered normal and the patient will be alert and oriented. Pressures between 20 and 40 mm Hg are abnormally high and will result in altered levels of consciousness, such as lethargy or being obtunded "Halo sign" (blood surrounded by yellow fluid) is noted on the sheet underneath a patient who has head trauma. This should alert the trauma nurse to the strong possibility of: ✔An open skull fracture is an injury that results in both a skull fracture and a scalp laceration. These fractures can also result in a dural tear. A tear in the dura would allow cerebrospinal fluid to leak from the fracture site. Since blood is made from water but cerebrospinal fluid is oily, they separate, causing a halo sign (blood in the center surrounded by the oily cerebrospinal fluid that appears yellow). Coagulopathies may cause excessive bleeding but will not cause cerebrospinal fluid leakage and a halo sign. A ruptured globe may result in visual disturbances and an odd shaped pupil but does not cause a halo sign. Damage to the parotid gland may cause saliva to collect outside of the mouth but saliva is clear colored or blood- tinged, not yellow or oily A patient sustains a laceration to the calf from the spokes of a bicycle. The wound is closed via primary intention with sutures. The trauma nurse should encourage the patient to have the sutures removed in what time frame after initial treatment? ✔Areas of the body with lower blood flow tend to heal slower and sutures should remain in place for longer periods of time. The surface of the arms and legs have less blood flow and may heal slower than other areas of the body, therefore sutures should remain in place for at least 10 - 14 days. Sutures of the face can often be removed in 3 - 5 days as the face is very vascular. Sutures on the scalp and trunk can be removed in 7 - 10 days Which of the following interventions is most appropriate in a patient with burns on both the hands caused by contact with an electrical source? ✔As many a 25% of patients who sustain significant electrical burns may develop arrythmias following the burn. Although most of these arrythmias are benign and occur right after the burn, some may be more serious and can start as long as 12 hours after the burn. Therefore, patients with significant burns from an electrical source should have continuous cardiac monitoring. Electrical burns cause fluid extravasation resulting hypovolemia and possible vasoconstriction. Therefore, Which of the following findings is most likely to be noted in conjunction with bruising around the umbilicus? ✔Bruising around the umbilicus and bruising to the flanks are both associated with retroperitoneal bleeding. While they can occur independently, they may also occur together. There is no direct association between bruising around the umbilicus and blood in the urinary meatus (often related to bladder or urethral trauma), loss of bowel or bladder control (often associated with a spinal cord injury) or subcutaneous emphysema of the chest and neck (often associated with tracheal or esophageal injuries or a pneumothorax) The trauma nurse knows that a patient with bruising in the rectal area which assumes the shape of a butterfly may also have which symptom often associated with this? ✔Bruising in the rectum that assumes the shape of a butterfly is a sign of bleeding into the pelvic space, especially with injuries to the urethra or bladder. Injuries to the urethra and bladder are also associated with hematuria. Intrascapular pain may be associated with cardiac ischemia or back injuries but is not associated with peri- rectal bruising. Peri-rectal bruising indicates blood loss and blood loss causes a narrowed, rather than widening pulse pressure. The loss of ability to dorsiflex the foot is associated with peroneal nerve damage which in turn is associated with injury to the lower leg but is not associated with peri-rectal bleeding A patient's cerebral perfusion pressure is measured at 60 mm Hg. The trauma nurse knows this is: ✔Cerebral perfusion pressure is an indirect measurement of oxygenation of the brain and is determined by subtracting a patient's intracranial pressure from their mean arterial pressure. Ideally, cerebral perfusion pressure should exceed 80 mm Hg. In brain injured patients, the goal is to maintain it above 70 mm Hg. Therefore 60 mm Hg is considered too low and indicates a reduction in cerebral blood flow. Cerebral perfusion pressure is a significant pressure to trend as it directly correlates to cerebral oxygenation and patient outcome Education and supportive leadership are known to reduce: ✔Compassion fatigue, secondary traumatic stress and burnout may all be reduced by education of healthcare workers about how to recognize and avoid these syndromes and supportive leadership that ensures that resources are available to reduce these syndromes. Education and supportive leadership are unlikely to have any effect on the need for pain medication. Although education may help individuals work through the grief stage after trauma, effective leadership is unlikely to influence this. Education and effective leadership do not influence the onset of the systemic inflammatory response syndrome A patient presents to the resuscitation room with a compound fracture of the lower leg. The bone remains exposed at the site of injury. The most appropriate way to handle this wound until definitive treatment is initiated is: ✔Compound fractures should be covered with a dressing soaked with saline or another crystalloid solution to prevent further contamination of the wound and to keep the tissue moist. A dry dressing is not indicated as this can dry out the wound and may also stick to the wound and bone edges, making removal more difficult. The wound should not be left exposed as this increases the risk of infection. Solutions such as iodine, peroxide or chlorhexidine should not be applied to wounds, especially wounds that may have exposed bone ends because these solutions may delay or prevent healing of bone ends A traumatically injured patient develops alcohol withdrawal in the trauma intensive care unit. The trauma nurse knows that this may make the recognition of which complication more difficult? ✔Continued bleeding would normally cause symptoms of hypovolemia like hypotension, diaphoresis and tachycardia to become more pronounced. But hypotension, diaphoresis and tachycardia are associated with withdrawal and may mask the symptoms of hypovolemia. Wound infections are usually evident by increased redness or exudate in the area and this is not likely to be altered by alcohol withdrawal. Trauma-induced coagulopathies are likely to be noted by changes in the coagulation blood studies and this is not affected by alcohol withdrawal. Acute respiratory distress syndrome is marked by increased dyspnea and failing oxygen saturation, which is unlikely to be affected by alcohol withdrawal A traumatically injured patient is declared brain dead and is awaiting the arrival of the organ procurement team. Which of the following interventions is most appropriate in this scenario? ✔Depletion of catecholamines following brain death can result in variable blood pressures. The blood pressure frequently drops and fluids and vasopressors are often needed to maintain a systolic blood pressure of at least 100 mm Hg. There is no need to put the patient's head in Trendelenburg's position. This may increase intrathoracic pressure, making appropriate ventilation more difficult. Although serum electrolytes may become altered after brain death and should be monitored and corrected, hourly monitoring is not required. Tidal volume is used to correct serum carbon dioxide rather than serum oxygen levels. Higher tidal volumes are generally not required in patients who have experienced brain death and are awaiting organ procurement Which of the following forms of shock would have a decreased preload as one its initial findings? ✔Distributive shock (anaphylaxis, sepsis and neurogenic shock) is caused by vasodilation of arteries and veins. Vasodilation of the arterial system decreases the return of blood to the heart (preload). Obstructive shock, cardiogenic shock and hypovolemic shock all cause vasoconstriction of the venous system, which would increase rather than decrease preload, especially initially. [as these forms of shock progress, loss of volume (hypovolemia), loss of contractility (cardiogenic) and obstruction (obstructive) may cause a loss of preload, but these would be later findings rather than initial. Draining excessive cerebrospinal fluid from an extra-ventricular device may cause: ✔Draining cerebrospinal fluid from an extra-ventricular device can be used to reduce intracranial pressure. Excessive drainage however, can cause collapse of the ventricles that may cause tearing of the bridging veins of the brain, resulting in headache, pneumocephalus, subdural hematoma and death. Periorbital hematomas are associated with frontal skull fractures but are not associated with over-drainage of cerebrospinal fluid. Damage to the optic disc is more likely from intraocular pressure but is not associated with overdrainage of cerebrospinal fluid. Over- drainage of cerebrospinal fluid causes collapse of the ventricles that would prevent rather than cause cerebral herniation A patient presents with a dry powdered chemical on his clothing and skin. The patient complains of feeling short of breath and is dyspneic. The appropriate treatment for this patient is to redirect the patient to the decontamination area, remove all clothing then: ✔Dry chemicals should be brushed off before beginning the showering process. Some dry chemicals can react with water causing a thermal reaction that can cause a thermal burn on top of a chemical burn. Aside from brushing off the chemical, it is essential that the patient be showered before being moved to the resuscitation area to stop burning on the skin and to reduce the risk of exposing rescuers to the chemical Which of the following interventions is most likely to reduce intracranial pressure? ✔Elevated serum glucose levels are associated with elevated intracranial pressure. Intravenous insulin is administered with the goal of maintaining serum glucose levels between 80 and 120 mg/dL. Patients with intracranial trauma often have elevated temperatures. Normalization of those temperatures, rather than warming measures, are used to decrease intracranial pressure. Flexion of the hips is associated with increased intraabdominal pressure, which in turn is associated with increased intrathoracic pressure. Increased intrathoracic pressure causes increased intracranial pressure. Therefore, flexion of the knees will increase rather than decrease intracranial pressure. Reducing mean arterial pressure does not decrease intracranial pressure but it can exacerbate hypoxia and extend brain damage, therefore this is an inappropriate intervention When possible, enteral feedings, as opposed to parenteral feedings, are preferred in the traumatically injured patient to: ✔Enteral feedings improve gut barrier protection and immunity, reduce bacterial translocation reducing the risk of infections and sepsis. Parenteral feedings also increase the risk of intravenous line infections and sepsis. Although early nutrition is associated with improved wound healing, this is not affected by enteral as opposed to parenteral feedings. Enteral feedings do not reduce the need for analgesia and are not associated with decreases in ventilator assisted pneumonia not constitute a higher priority than the low blood pressure. Similarly, the subcutaneous emphysema will need further investigation, but the fact that oxygen is being delivered via bag-mask device without difficulty and the patient's oxygen saturations are above 92% indicates that this is a lower priority than the low blood pressure. The dilated, non-reactive pupil indicates significant elevated intracranial pressure, which must be treated, but this will occur after the blood pressure is stabilized Family presence in the trauma room should be facilitated: ✔Ideally, family resuscitation should be facilitated as soon as possible as this will likely benefit both the patient and family. Education about what will be experienced and the role of the family when they are in the room, should however be reviewed with the family before entering the room. Ushering the family into the trauma room does not need to occur during any specific portion of the resuscitation (e.g. after the secondary survey or between obtaining vital signs and laboratory tests). Family presence in the resuscitation room does not require consent forms During resuscitation of a traumatically injured unconscious pregnant patient, who is at 38 weeks gestation, the trauma nurse pulls back the sheet covering the patient and notes that the child's head has delivered vaginally. The nurse assures that there is no cord around the child's neck. The next step in the process is to push the head gently towards the: ✔Ideally, the anterior shoulder should be delivered first. This may be facilitated by gently pushing the child's head downward towards the stretcher. Once the anterior shoulder is delivered, delivery of the posterior shoulder may be facilitated by gently pushing the child's head up towards the mother's perineum The trauma nurse knows that reduction for which of the following injuries is most time-sensitive? ✔If a dislocated hip is not reduced in a timely manner (six hours), femoral head necrosis may occur. This may result in the need for a hip replacement; therefore, reduction of this injury is time sensitive. A scaphoid fracture is not reduced and the treatment for this injury is not as time sensitive as a hip dislocation. Similarly, fractures of the calcaneus are not time sensitive. Repair of this injury may be delayed for days to allow edema to reduce. Although a dislocated patella can be easily reduced and is often done in a timely manner, reduction of this injury is not as time sensitive as a hip dislocation A tourniquet, applied tightly just above the source of bleeding on a mangled limb, does not effectively control bleeding. What is the next most appropriate step? ✔If a tourniquet, applied correctly, does not control bleeding, a second tourniquet should be applied two inches above the first tourniquet. The original tourniquet should never be released and there is no advantage in applying it several inches higher. It is preferable to apply a second tourniquet to control bleeding from a mangled limb rather than giving large volumes of crystalloids. While some crystalloids may need to be given, large volumes may induce coagulopathies. A second tourniquet is more likely to control bleeding in a mangled limb than applying ice to the bleeding area. Because there is a tourniquet in place, the bleeding area is already hypoxic and ice may cause secondary tissue damage During secondary review of a patient's chart, it is noted that a patient had a urethral disruption that was not noted until the patient had been in the trauma intensive care unit for five days, resulting in secondary complications. This injury can be defined as: ✔In performance improvement, injuries found after admission but prior to discharge are defined as "delayed injuries." A "missed injury" is an injury which is not found until after the patient is discharged. Injuries that are missed initially are not defined as "secondary" or "consequential." A patient has a complete spinal cord injury at the level of C7. Which of the following statements about this injury is accurate? The patient will: ✔Injuries above T7 lose the ability to cough and are unable to clear their own airways, therefore suctioning and other airway assistance should be anticipated. Generally, patients with injuries below C4 can breathe unassisted although respirations will be less effective if the injury is in the high thoracic or lower cervical nerves. An injury at C7 is likely to cause neurogenic shock, which will cause slow, rather than rapid respirations. The ability to shrug the shoulders without arm movement is more consistent with an injury at C5. Patients with injuries at C7 have arm movement but are unable to use their hands A patient's intraabdominal pressures are obtained. Based on the results obtained, the only intervention was the administration of a bolus of intravenous fluid. What was the patient's intrabdominal pressure before the bolus? ✔Intraabdominal pressures above 12 mm Hg are considered elevated and often result in a decrease in blood pressure (due to compression of the vena cava and decreased preload). In pressures between 12 and 15 mm Hg, the goal is to maintain euvolemia. When pressures are between 16 and 20 mm Hg, intravenous fluid boluses are often given to maintain an adequate blood pressure and therefore maintain abdominal perfusion pressure. When pressures exceed 20 mm Hg in the abdomen, further action will be required to reduce intraabdominal pressure (such as insertion of a percutaneous drain into the abdomen, surgical opening of the peritoneum or another means of decompression). If the pressures were 2 or 9 mm Hg, there would be no need to administer a fluid bolus. If the pressures were 30 mm Hg, a fluid bolus may have been considered as needed to maintain the blood pressure but this would not have been the only intervention. Other interventions, such as insertion of a percutaneous drain or abdominal decompression would also have been done The trauma nurse expects diuretics may be used as part of the treatment plan for a patient with: ✔Intrarenal kidney injury leaves a patient with insufficient glomerular function and may result in azotemia (elevated BUN and creatinine). This may be treated with diuretics which will maximize functioning of uninjured glomerular units in an effort to make up for the insufficient functioning of injured glomerular units. The only effective treatment for obstructive shock is to relieve the obstruction, which is not accomplished with diuretics. Pancreatic trauma is more likely to be treated with insulin and blood products and there is no therapeutic reason to give diuretics to someone with pancreatic trauma. Although a patient with a bladder rupture may not make urine, the problem is not because of lack of urine production but rather because of leakage of urine into the tissue from the bladder trauma or from blockage of the bladder outlet from blood and clots. Neither of these conditions will be effectively treated with diuretics Left-sided facial weakness is noted on a patient with a suspected left-sided epidural bleed. This would be documented as: ✔Ipsilateral means "same side as", so if the weakness is on the same side of the body as the injury it is "ipsilateral". If the weakness were on the opposite side of the body, it would be described as "contralateral". The suffix "-plegia" refers to weakness and the suffix "-paresis" refers to paralysis. So weakness to one side of the face would be referred to as "hemiplegia" Which of the following parameters should be most closely monitored in a patient receiving mannitol? ✔Mannitol, an osmotic diuretic, is known to alter serum electrolytes, especially sodium, which may be lost during the diuresis process. Mannitol does not alter liver enzymes, serum troponin or the white blood cell count in the same way it effects serum sodium The trauma nurse expects a metal eye shield will be used in the treatment of: ✔Metal shields may be used to protect a ruptured globe from further damage. The shield should be taped to the bony surfaces around the eye to ensure that no pressure is applied directly to the globe. In a globe luxation as well as an object protruding from the eye, a raised object (such as a paper cup) should be placed over the object or injury since it protrudes beyond the bony socket. Applying a metal shield over these types of injuries could exacerbate the injury. Eye coverings, including metal shields, are not recommended for corneal abrasions. These can alter the patient's vision, increase the risk for further injury and may encourage the growth of bacteria under the shield Which of the following factors has the greatest likelihood of exerting a negative impact on the rehabilitation stage of trauma care? ✔Motivation in the rehabilitative stage of trauma is partially driven by having realistic goals for rehabilitation. If the patient does not know what the final rehabilitation potential is, they may not work towards that goal. But if the patient has goals for rehabilitation in mind that exceed what is possible, they may lose motivation because of constant failure to achieve desired goals. Younger patients often have a greater capacity to learn and may do better in rehabilitation than older patients. Involvement of the family in rehabilitation may increase a patient's motivation to rehabilitate and will also allow the family to learn the skills necessary to assist the patient after peritoneal cavity as well as hypotension from pressure exerted on the vena cava (reducing preload). Effective treatment of abdominal compartment syndrome should relieve pressure on the kidneys and elevate the blood pressure, both of which should increase urinary output. Although patients with abdominal compartment syndrome may experience pain, this is not always the case, therefore, this is not a goal of treatment. Reducing pressure on the vena cava by reducing pressure in the peritoneum should reduce rather than increase systemic vascular resistance. Treating abdominal compartment syndrome should increase, rather than decrease abdominal perfusion pressure An early finding associated with fat embolism syndrome (FES) is: ✔One of the early findings often noted in patients who develop fat embolism syndrome is a change in neurological status (e.g. restlessness, agitation, disorientation, etc.) Reduction in blood flow through the pulmonary circulation related to fat globules in the capillaries of the lungs means less blood return to the left ventricle and the blood pressure tends to decrease rather than increase. A reduction in blood flow around the alveoli causes PaO2 to decrease and PaCO2 to increase (rather than decrease). Fat emboli affect the circulation in the lung as opposed to ventilation, so lung sounds will tend to be unaffected, especially early in the syndrome The trauma nurse knows that a goal of treatment for rhabdomyolysis has been met if the: ✔One of the main goals in treating rhabdomyolysis is to ensure adequate urinary output which indicates that kidneys are functioning and increases clearance of myoglobin through the kidneys. A goal of treatment should be 200 - 300 mL per hour. A goal of care in treatment rhabdomyolysis is not pain control. Although pain should be treated appropriately, it is generally not associated with rhabdomyolysis and is not a treatment goal for this condition. One treatment for rhabdomyolysis is alkalization of the urine with sodium bicarbonate. The ideal urine pH would be above 8.0 rather than below 6.0. Rhabdomyolysis does not affect level of consciousness and increasing level of consciousness is not a goal of treatment Which of the following performance improvement measures would be appropriate to track to reduce catheter associated urinary tract infections (CAUTI) in traumatically injured patients? ✔One of the recognized risk factors for catheter associated urinary tract infections (CAUTI) is the length of time that a urinary catheter is in place and the sooner the catheter is removed, the less likely the patient is to develop CAUTI. (The risk of CAUTI increases 3 - 7% each day the catheter is in place). Therefore tracking the number of days a catheter is in place to determine if it is longer than the national average may help determine the core of the problem so it can be addressed. It is unlikely that tracking the number of days after catheter placement an infection develops, the types of antibiotics the patient is on or the injuries that patients with CAUTI have can be used to reduce the incidence of CAUTI A traumatically injured patient is intubated with a 7.0 endotracheal tube. After intubation, the trauma nurse auscultates the chest, noting clear breath sounds with compression of the bag-mask device over the right lung, but absent breath sounds over the left lung. Chest rise and fall is also noted to be absent on the left, yet the trauma team does not act to correct this finding. Based on the information provided, which injury does this patient most likely have? ✔One treatment considered in patients with either tracheal or bronchial tears is to intubate beyond the tear, then inflate the endotracheal cuff. If the cuff is beyond the tear, this effectively seals off the tear and allows ventilation of the lung without escape of air through the tear. If the tear is near the bifurcation of the right and left bronchi or in one of the bronchi, then the endotracheal tube may be passed into one bronchus to allow ventilation of the unaffected lung temporarily until the defect can be surgically repaired. The fact that the trauma team knows that the patient only has breath sounds and chest rise and fall on one side of the chest and not the other and does not take action to fix it correlates with this treatment. If the patient had a hemothorax, a pulmonary contusion or a diaphragmatic rupture and the endotracheal tube were in one of the bronchi, the team would likely pull back on the endotracheal tube to ensure both lungs were ventilated If a child, prescribed to receive one unit of blood, is given 120 mL of packed red blood cells, how much does the child weigh? ✔One unit of blood in the pediatric patient, is 10 mL/kg. If a child weighs 12 kg, then one unit of blood would be 120 ml An effective program designed to reduce workplace violence includes: ✔One way to reduce workplace violence is to support employees who are assaulted or put into dangerous situations by ensuring that the action of the perpetrator is reported to appropriate authorities. If the employee knows that they will be supported after the incident, they are more likely to report either actual or potential violence and this will allow the institution to understand vulnerabilities in the system to help reduce it in the future. There is no evidence to support that light-colored paint and linens reduces violence. Although a rested employee is more likely to provide safe care, it does not prevent a perpetrator from becoming violent. Limiting visiting hours has not been shown to reduce violence and may not be therapeutic for the patient and the family. Family centered care may reduce rather than increase violence in most situations A trauma nurse initiates a dobutamine infusion on a trauma patient. What is the most likely reason for this patient's admission? ✔Patient's with blunt cardiac injuries frequently develop right ventricular failure which can cause hypotension. This may be treated with positive inotropic drugs such as dobutamine. Positive inotropic drugs are contraindicated in patients with aortic injuries. In fact, beta-blockers are often used in the treatment of these injuries. Even post-operatively, aortic injuries are frequently hypertensive and a positive inotrope would not be indicated. Patients with pelvic fractures and placental abruption tend to be hypovolemic and treatment would include fluid administration as opposed to a positive inotropic drug After sustaining bladder trauma and before catheter placement, which of the following statements regarding voiding is most accurate? The patient: ✔Patients with both bladder and urethral trauma will often complain of a strong need to void, yet when provided the opportunity to void, are unable to do so. It is not uncommon for the patient to experience pain while attempting to void. The loss of sensation to void with involuntary incontinence is more likely associated with a spinal cord injury as opposed to bladder trauma. Burning pain is more likely to accompany a bladder infection as opposed to a bladder injury. The sensation to void when pressure is applied over the suprapubic area is a normal finding that occurs regardless of bladder injury A patient presents to the trauma unit with a spinal cord injury. Bilateral leg movement is noted after arrival, but the patient cannot move or feel the upper extremities. The trauma nurse should suspect the patient has which type of spinal cord injury? ✔Patients with central cord syndrome have motor and sensory deficits to the upper body but maintain lower body function. With anterior cord syndrome, the patient loses motor function and cannot move the legs. With posterior cord syndrome, the patient loses sensory function but maintains motor function and would therefore be able to move the arms. In Brown-Sequard syndrome, the patient may be able to move one side, but not the other A one liter bolus of crystalloid should be expected as part of the treatment plan of a trauma patient with: ✔Patients with complete spinal cord injuries above the level of T2 - T4 are at risk of vasodilation from neurogenic shock. This condition is treated initially with fluid boluses and if these are ineffective, then vasopressors may be considered. Crystalloids are avoided in patients with pulmonary contusions as the fluid may contribute to acute respiratory distress syndrome. Fluid boluses are not part of the treatment plan for a basilar skull fracture and should be minimized, especially crystalloid solutions, in patients with increased intracranial pressure Patient positioning following a flail chest injury is best guided by: ✔Patients with rib fractures, including flail chest segments, should be positioned in a way that maximizes gas exchange. This can be guided by factors such as oxygen saturation or arterial blood gases. Urinary output and level of consciousness are unlikely to provide any assistance in determining the optimal position for a patient with a flail chest segment. Some patients find that lying with the area of the flail segment of the chest against the bed or stretcher provides splinting and improves pain and breathing but other patients find this position increases pain and may worsen oxygenation. Therefore, the location of the injury is not used to determine the patient position ✔Silver has anti-microbial properties and this is the reason it is used in dressings. It does not have analgesic properties, does not induce clotting and does not stimulate tissue granulation Initiation of the Systemic Inflammatory Response Syndrome (SIRS) may be recognized by: ✔SIRS is marked by vasodilation and capillary permeability, both of which can decrease the patient's mean arterial pressure. One of the classic findings in SIRS is a reduction in mean arterial pressure. Diaphoresis is not associated with SIRS. Although patients with SIRS may have elevated white blood cell counts and increased core body temperatures, those would be related to other contributing to SIRS but are not related to SIRS itself. In fact, in many cases of SIRS, the white count and core body temperature does not elevate Which of the following actions, carried out by the trauma nurse on a pregnant patient, can be used to assess for a placental abruption? ✔Some women with a placental abruption will have obvious vaginal bleeding but others, especially with a partial plancental abruption, may have concealed bleeding within the uterus. This can be noted by monitoring for an increased fundal height associated with accumulation of blood within the uterus. By marking the fundal height on patient arrival and monitoring for that fundal height to increase over the ink mark, an abruptio placentae may be detected. Auscultation for a venous hum and monitoring serum progesterone levels will not assist in the detection of a placental abruption. Testing fluid found in the vaginal canal with nitrazine paper may be useful for detecting premature rupture of the membranes but is not useful in detecting a placental abruption Which type of fracture is more likely to be associated with intentional injury as opposed to unintentional injury? ✔Spiral fracture, which may be caused by pulling on a child's limb, increases the suspicion for abuse. Torus and compression fractures are more likely to be caused by falling and are generally associated with normal play. Greenstick fractures typically occur with normal activities in the pediatric patient and they are not associated with abuse Which of the following descriptions is most consistent with a full-thickness burn? ✔Superficial burns appear reddened and blanch with pressure. Superficial partial- thickness burns blister and blanch. The skin beneath the burn tends to appear wet and pink. A deep partial-thickness burn may appear mottled pink or white and may or may not blister. A deep partial-thickness burn does not blanch. A full-thickness burn may be described as "leathery," "firm," "depressed compared to adjoining skin." It does not blanch or blister The trauma nurse knows that a supraglottic airway is most likely to be used to: ✔Supraglottic airways can be inserted blindly without the use of a blade and without altering the position of the head, so they are ideal to temporarily manage the airway. The large balloons can also tamponade bleeding in the airway and block blood from the upper airways from getting into the lower airways. So, they are often used to temporarily manage the airways of patients with maxillofacial fractures. Supraglottic airways are considered temporary and should not be used definitively in any age group. Supraglottic airways will not reduce cerebrospinal fluid leakage nor with they prevent herniation of the brain in patients with increased intracranial pressure. Effective treatment for obstructive shock should cause: ✔Symptoms of obstructive shock include hypotension, altered level of consciousness, decreased urinary output, tachycardia, cool clammy skin, and metabolic acidosis with a significant base deficit; Effective treatment would result in a decrease in heart rate and base deficit. The pulse pressure narrows with obstructive shock, so effective treatment should cause the pulse pressure to widen rather than narrow A trauma nurse initiates a campaign to teach tourniquet application in the case of severe bleeding to community members. What type of injury prevention program is this? ✔Teaching tourniquet application to reduce bleeding is meant to improve outcomes related to a traumatic injury. This is an example of a tertiary injury prevention program. Primary injury prevention programs aim to reduce the injury from occurring in the first place (e.g. lobbying city council to install a stop light to reduce motor vehicle collisions at a busy intersection). A secondary injury prevention program is meant to reduce the severity of injury (e.g. handing out bicycle helmets which won't reduce the incidence of bicycle injuries but may reduce the severity of the head injury from the bicycle incident). Quaternary injuries are not recognized in injury prevention. The trauma registry can be an excellent source of information regarding: ✔The aggregation of data found in the trauma registry provides insight into injury patterns common to a geopolitical region which can be important information for departments of health. Data regarding compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA), availability of blood products and hospital privilege for specific providers is not entered into the trauma registry, therefore the trauma registry will not provide this information Magnesium is administered to a traumatically injured patient who goes into preterm labor. Shortly thereafter, signs of magnesium toxicity become evident. The trauma nurse would anticipate administering intravenous: ✔The antidote for magnesium toxicity is intravenous calcium chloride. Benzodiazepines, Dexamethasone and aluminum hydroxide have no therapeutic value for a patient with magnesium toxicity When performing a needle decompression for a tension pneumothorax, the needle should be placed immediately above the: ✔The appropriate placement for a needle decompression is the second intercostal space between ribs two and three. Because bundles of nerves and blood vessels run below ribs, the decompression should be accomplished directly above the lower rib, in this case, the third rib. If tracheal deviation occurs, it will deviate AWAY from the tension pneumothorax, so the needle decompression should occur on the opposite side as tracheal deviation A trauma nurse learns that a patient with a head injury is displaying signs associated with "Cushing's triad". If this is true, the nurse would expect which of the following findings when assessing the patient? ✔The components of Cushing's triad (which are indicative of significant elevations in intracranial pressure) include bradycardia, hypertension with a widened pulse pressure and irregular respiratory patterns. Although alterations in core body temperature are not described in Cushing's triad, a person with elevated intracranial pressure often develops some degree of hyperthermia rather than hypothermia Acute stress disorder includes signs of a stress reaction following exposure to a traumatic event that lasts at least: ✔The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines an acute stress disorder after a traumatic event as signs of a stress reaction that lasts at least three days. If the symptoms have only been present for 24 hours, the individual should be supported to prevent exacerbation of the condition but will not be diagnosed as having an acute stress disorder. If the symptoms persist at least a month, then the condition is called post-traumatic stress disorder (PTSD). If the symptoms persist for three months, it continues to support a diagnosis of PTSD. A trauma nurse wants to assess the temperature of a limb in which compartment syndrome is suspected. This is best accomplished with the: ✔The dorsum of the hand is the most sensitive part of the hand for temperature assessment and should be used when assessing skin temperature. The skin of the affected extremity should be compared to the skin of the opposite extremity. The thumb, fingertips and palm of the hand are not as sensitive to temperature changes A patient sustains a fracture of the ulna and is treated in the Emergency Department. The patient is discharged with instructions to follow up with an orthopedic specialist for further treatment. This scenario is a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA): ✔The Emergency Medical Treatment and Active Labor Act (EMTALA) requires a medical screen exam thorough enough to rule out an emergency medical condition. If an emergency medical condition is uncovered, then the patient must be stabilized, admitted or transferred. If a patient has tingling distal to an orthopedic injury, this could indicate either nerve damage or compartment syndrome, both of which would require stabilization, admission or transfer instead of discharge. There is no Giving a child a higher triage priority even though the child has less severe injuries does not meet the requirement that the good effect (saving the child's life) outweighs the bad effect (the older person may have a poorer outcome). Providing care to a patient who may not be able to pay better encompasses the ethical principal of "justice" where healthcare is equally distributed to all members of society, regardless of the ability to pay. Withholding blood products to ensure an adequate supply is not ethically appropriate and does not meet the definition of "principal of double effect" A patient presents with an expanding hematoma in the neck secondary to trauma to the carotid artery with significant respiratory distress. The initial treatment for this condition is: ✔The priority of care is always to stem life-threatening blood loss followed by activities to protect the airway. In this scenario, there is significant blood loss and indications that the airway is compromised. Both deficits may be temporarily managed by applying direct pressure over the site of bleeding to stem the loss of blood and reduce the size of the expanding hematoma. A nasopharyngeal airway does not extend into the neck and would not stem bleeding nor protect from airway collapse. While elevating the head of the bed 90 degrees is not wrong, it would not take higher priority over stemming blood loss from the application of direct pressure. Similarly, the initiation of 100% oxygen via non-rebreather mask is not inappropriate but would not stem blood loss nor protect the collapsing airway, therefore it is not a higher priority than the application of direct pressure over the site of bleeding What is the most likely reason that an institutional review board (IRB) would reject a research proposal? ✔The purpose of the IRB is to guard the rights of the subjects. The IRB will ensure that the study does not put any vulnerable populations in harm, that subjects are not put into any unnecessary danger, that subjects are made aware of the risks and benefits of being in the study, that they consent to the study and that they can withdraw at any point. If these things are not proven to the IRB, then the IRB may reject the study. The IRB focuses on the protection of subjects rather than the logistics of the study itself (e.g. the hypothesis, the number of subjects or the literature review) The trauma nurse knows that the symptoms of multi-organ dysfunction syndrome often starts within: ✔The symptoms of multi-organ dysfunction syndrome (MODS) often start a week to ten days after the onset of trauma. Although factors, such as hypoxia and inadequate fluid resuscitation, which contribute to MODS may occur shortly after the traumatic event, the actual onset of symptoms is usually delayed The symptoms of spinal shock are most likely to occur: ✔The symptoms of spinal shock (flaccid paralysis, absent reflexes, lack of sensory function, impaired thermoregulation, bowel distension/ileus) tend to occur immediately after the injury but resolve within minutes, hours or days after the injury. Spinal shock does not occur intermittently for the remainder of the patient's life. Once it resolves, it does not recur. Goals of effective prehospital trauma care include initiating resuscitation, providing safe and timely transport and: ✔The third goal of effective prehospital trauma care is preventing further injury to the patient. This may be accomplished by utilizing appropriate treatment protocols and being involved in local performance improvement programs. Although education may be provided to patients as part of pre-hospital care, this is not a recognized goal and is often difficult in the field because the type and extent of injuries is not known. The goal of prehospital trauma care is not to provide definitive care but rather to provide life-saving care involving maintenance of airway and breathing, hemorrhage control, stabilization of fractures and spinal motion restriction if appropriate for the patient. Not all patient's require spinal motion restriction so it is not a goal of prehospital trauma care to provide this to all patients A trauma nurse is collecting data from the hospital trauma registry. Which of the following tasks is she most likely working on? ✔The trauma registry contains community specific data about exact injury patterns that have presented to that trauma center. This can be used to determine what areas of focus are appropriate to develop an injury prevention program for a community. The trauma registry does not collect specific data on patient hand-off. This information may have to be gleaned by reviewing written records of report or observing patient handoff encounters. The trauma registry does not generally contain financial data that can be used to determine appropriate funding. This information is more likely to be obtained from hospital financial records. Although outcomes of trauma resuscitation may be gleaned from the trauma registry, it would be difficult to assess if those outcomes are related to the number of trauma team members present in the resuscitation based on trauma registry information alone The incorporation of evidence-based practice into care may increase patient safety by: ✔The use of evidence-based practice allows standardization of care which in turn reduces individual practitioner practices. This can increase patient safety because if all practitioners practice in the same way, caregivers become accustomed to that care and do not have to learn different ways to do things for each practitioner. This decreases the risk for errors. Although research may uncover new drugs and treatments, the use of evidence-based practice is utilization of research, not carrying it out, therefore, it does not involve the discovery of new drugs and treatments. Although family involvement in care may increase safety, increased family involvement is not an outcome of utilizing evidence-based care. The use of evidence-based care does not necessarily reduce the number of invasive diagnostic tests; in fact, if evidence shows that those tests would be beneficial, the use of them could increase Goals of an effective dressing over an open wound are to prevent contamination and: ✔Three goals of an effective dressing are to prevent contamination, keep the wound moist (a dry wound is not desired as it does not provide an environment for cells to migrate and resurface the wound) and remove excess exudate (excess exudate or a "wet wound' macerates healthy skin and impedes healing). The purpose of a dressing is not to encourage scab formations nor reduce movement in the area- that is the purpose of a splint A patient develops thyroid storm after neck trauma affecting the thyroid gland. Which of the following findings indicates that treatment for this condition is having its intended effect? ✔Thyroid storm causes an increase in metabolism causing vital signs (e.g. temperature, pulse, blood pressure, respirations) to increase. Therefore, effective treatment would cause a reduction in vital signs (including pulse). The increased metabolism of a thyroid storm often causes global hypoxia, resulting in metabolic acidosis. Effective treatment would include an increase in pH. Serum glucose levels tend to be elevated in this condition, so effective treatment would decrease rather than increase serum glucose levels Which diagnostic tool would be most beneficial to determine the effectiveness of treatment for transfusion related acute lung injury? ✔Transfusion related acute lung injury (TRALI) results in pulmonary edema and resolution of this condition may be noted on chest x-ray. TRALI has minimal effect on air movement so a peak flow meter will have far less information on resolution of TRALI compared to a chest x-ray. TRALI does not affect body temperature nor does it change the hematocrit so these tools are unlikely to be effective Verification of a hospital as a trauma center is carried out by the: ✔Trauma system verification is carried out by the American College of Surgeons. State Trauma Systems designate, rather than verify, institutions as trauma centers. The Joint Commission and the Federal Government are not involved in either designating or verifying institutions as trauma centers Which of the following findings indicates that treatment for intracranial pressure is having its intended effect? ✔Treatment for intracranial pressure is meant to reduce intracranial pressure while elevating mean arterial pressure (rather than decreasing it). This will cause an elevation in the cerebral perfusion pressure, an indirect measurement of the amount of oxygen reaching the brain. Generally, increased intracranial pressure results in a widened pulse pressure with an elevated systolic blood pressure and a low diastolic blood pressure, so effective treatment should reduce the systolic blood pressure and increase diastolic blood pressure The trauma nurse administers tricyclic antidepressants to a traumatically injured patient. What is the most likely reason that this medication is being administered? ✔When determining the presence or absence of brain death when withdrawing ventilator support, a change of 10% (not 5%) or more in a patient's pulse oximetry, pulse or blood pressure is an indication that the test should be stopped and the patient should be put back on ventilator support. A widening pulse pressure alone does not constitute a need to stop this test. If the vital signs do not change by more than 10% and the patient does not have any respiratory effort, the test will be continued for ten minutes (rather than two minutes) When assessing a patient with a reduced level of consciousness, the patient is unable to comprehend questions asked that are meant to determine orientation to time, place, person or event. What assessment should the trauma nurse carry out next? ✔When performing a neurological assessment, the patient should be asked questions around orientation to person, place, time and event to determine degree of consciousness. If the patient cannot respond to these questions, the next step is to state the patient's name loudly and determine if the patient responds. If this doesn't elicit a response, then the patient should be gently shaken and the response noted. If there is no response, then painful stimuli (such as applying firm pressure to the nail-bed) should be attempted. Sternal rubs are a form of painful stimuli but they are discouraged because repeated attempts can cause excoriation of the skin over the sternum A properly applied traction splint for a femur fracture should: ✔When the femur is fractured, the thigh muscles tend to contract causing the upper leg to shorten. This makes the thigh the shape of a sphere rather than a cylinder. Spheres can hold more volume than a cylinder. But applying a traction splint, the leg is brought back into its cylindrical shape which may help tamponade bleeding. Immobilizing the fractured bone ends will also reduce the risk of further damage to neighboring blood vessels causing further blood loss. The tibial nerve is in the lower leg and will not be affected by application of a femur traction splint. The purpose of a femur traction splint is not to align the bone ends for healing; this is done operatively. A properly applied femur traction splint does not affect the incidence of rhabdomyolysis. A 4-year-old child weighing 16 kg arrives in the trauma unit shortly after being burned. The Modified Parkland Burn formula is used to calculate fluid requirements for this child and fluid resuscitation is initiated at 150 mL per hour. What percentage of this child's body is burned? ✔When using the Modified Parkland Burn formula for pediatric patients, the child's weight in kilograms is multiplied by 3 mL which is then multiplied by the total body surface area that is burned. This calculates the total fluid recommended in the first 24 hours after a patient is burned. One-half of this total should be delivered in the first 8 hours after the burn. So if a child receives 150 mL of fluid in the first hour of resuscitation, that means the child would receive 1200 mL in the first eight hours after the burn (150 mL times 8). If that is half of the total calculated using the Modified Parkland Burn formula, then the total amount would be 2400 mL (1200 mL times 2). To get to the number 2400 mL, the child's weight in kilogram (16 kg) would have been multiplied by 3 mL and then by the total body surface area burned. So if 2400 mL (24 hour total) is divided by the weight (16 kg) and that is divided by 3 mL - the resulting number is 50 meaning that 50% of the child's body is burned A trauma nurse uses the Modified Parkland Burn Formula to calculate fluid requirements on an adult patient weighing 65 kg and determines that the patient requires 6600 mL of fluid in the 24 hours after the burn. If the patient arrived in the trauma unit shortly after the burn and remains in the resuscitation room for 2 hours, how much fluid should the patient receive? ✔When using the Modified Parkland Burn formula, one-half of the calculated 24 hour fluid requirement should be given in the first eight hours after the burn. If the patient requires 6600 mL of fluid, one half of that is 3300 mL (therefore, the patient should receive 3300 mL in the first eight hours after the burn). This should be equally distributed over those eight hours, so 3300 mL divided by eight hours is 412.5 mL per hour. If the patient is in the resuscitation room for 2 hours, they will require 825 mL of fluid (412.5 times two). 275 mL, 412, mL and 550 mL are all inadequate amounts using the Modified Parkland Burn formula