TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank, Exams of Nursing

Download TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank and more Exams Nursing in PDF only on Docsity! TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ 1.Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? A. Principles of PHTLS B. The Golden Period C. The XABCDE assessment D. Critical thinking process - ansQuestion 1: D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient. 1. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? A. Superficial (first degree) B. Partial thickness (second degree) C. Full thickness (third degree) D. Subdermal (fourth degree) - ansQuestion 1: B Scald burns are the most common burns seen in the pediatric population ages 1 to 5 years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters are present or popped. It is also the most painful type of burn. 1. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? A. Immediately begin triaging patients. B. Treat the patient with the most visible blood loss. C. Determine the need for additional resources. D. Assess the scene and ensure it is safe. - ansQuestion 1: D Ensure safety for responders, bystanders, and patient(s). The first consideration when approaching any scene is the safety of all emergency responders. When EMS personnel become victims, they not only can no longer assist others, but also add to the number of patients. 1. You are called to the scene of an explosion and fire at a chemical plant where you find multiple casualties.Triage has begun. Your first patient is a 40-year-old man who was near the source of the explosion. He is unconscious and has extensive injuries. You note gurgling respirations. TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Why should you use the trauma jaw thrust maneuver first when dealing with a trauma patient? A. It's an easy technique that always works to open the airway. TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Venous bleeding typically results in a steady flow of dark red blood. TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ 2. During primary survey, you find the following: . LOC: alert and oriented; speaking in full sentences . GCS: 15 . Airway: good air entry to bases . Breathing: bilateral . Circulation: skin warm, flushed, dry . Pulse rate: 112 bpm, strong andregular . BP: 90/42 mm Hg . Pain: Patient complains of severe pain at clavicle site and pain on inspiration at site of possible fractured ribs. No other injuries detected. What is your next step? A. Apply a cervical collar and in-line immobilization device. B. Treat for hypovolemic shock. C. Apply an arm sling for the clavicle injury. D. Administer pain medication. - ansQuestion 2: A Although the patient's GCS is normal, she does have a distracting injury, and the state of her helmet indicates possible spinal compression/flexion, so you should immobilize the patient. 2. The patient becomes apneic. You suspect he has a cervical injury. Which type of airway should you use? A. Supraglottic airway B. Blind nasotracheal intubation C. Oropharyngeal airway D. Surgical airway - ansQuestion 2: A The supraglottic airway's greatest advantage is that it can be inserted independent of the patient's position, which may be especially important in trauma patients with high suspicion of cervical injury. 2. The patient's care giver is a babysitter who reports the child was crawling on the counter and placed his hand in a pot of water that was boiling on the stove. She is applying ice to the burn and the child is shivering. What is your next step? A. Administer analgesia for pain. B. Cover the patient with a blanket to stop the shivering. C. Start IV for fluid resuscitation. D. Stop the burning process and remove the ice pack. - ansQuestion 2: D A common error that results in damage to the zone of stasis is the application of ice by a bystander or prehospital care practitioner. When ice is applied to a burn, the patient will experience some reduction in pain; however, the pain relief will be at the expense of additional tissue destruction. 2. The patient's respiration improves markedly, but he remains confused. He has an absent radial pulse, and his carotid pulse is fast and thready. Your partner asks if he can let the compression go to put in an IV. How TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ should you respond? TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ A. Preoxygenate to maximize oxygen saturation. B. Place the patient in a "sniffing"position. C. Clear the mouth of any obstructions. D. Prepare the patient for immediate transport. - ansQuestion 2: A Before insertion of any invasive airway, the patient is preoxygenated with a high concentration of oxygen using a simple airway adjunct or manual airway procedure. 3. After exposing the patient, no other burn injuries were found, but blisters have started to form on the hand and the child is crying from pain. How should you manage the blisters? A. Lance the blisters to drain the fluidand relieve the pressure. B. Cover the injury with a dry, loose, sterile dressing, being sure to leave the blisters intact. C. Use a topical antibiotic ointment and firmly wrap the burn injury. D. Establish an IV for fluid resuscitation. - ansQuestion 3: B In the prehospital setting, blisters are generally best left alone during the relatively short transport time. Blisters that have already ruptured should be covered with a clean, dry dressing. 3. What does the GCS score indicate? A. Mild TBI B. Moderate TBI C. Severe TBI D. No TBI - ansQuestion 3: B A total GCS score of 13 to 15 likely indicates a mild TBI whereas a score of 9 to 12 is indicative of moderate TBI. A GCS score of 3 to 8 suggests severe TBI. 3. What is the best way to control the bleeding? A. Direct pressure B. Elevation of the arm above the heart C. Tourniquet D. Occlusive dressing - ansQuestion 3: A With venous bleeds, direct pressure isusually sufficient to stop the flow. 3. When securing a patient to a backboard, which body part should you secure first? A. Head B. Torso C. Legs D. Pelvis - ansQuestion 3: B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis. 3.Which of the following is the basis on which a patient's chance of TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ survival is maximized? TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ A. Preferences B. Phases C. Principles D. Transport - ansQuestion 3: C The science of medicine provides the principles of medical care. Simply stated, principles define the duties required of the prehospital care practitioner in optimizing patient survival and outcome. 3. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still confused, and you still have no radial pulse. Your next move is to: A. give 1-L fluid bolus. B. give one 250-mL fluid bolus, and then stop. C. give fluid until you get a radial pulse. D. administer TXA. - ansQuestion 3: C Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids. 3. Why might it be more difficult to deal with an airway obstruction in a child? A. Children have longer tracheas. B. Children have larger heads and tongues so there is a greater potential for airway obstruction. C. Children have smaller heads, so there is less room to clear the obstruction. D. A child's epiglottis is smaller and stiffer than an adult's. - ansQuestion 3: B Children have larger heads and tongues as compared to an adult so there is a greater potential for airway obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric patient to maintain a patent airway. 3. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze-release-release" timing technique. As you watch for the rise and fall of the chest, you check end-tidal CO2 (ETCO2) monitoring aiming to maintain what level? A. Between 40 and 45 mm Hg B. Between 30 and 35 mm Hg C. Between 35 and 40 mm Hg D. The level is irrelevant because capnography is inaccurate in pediatric patients. - ansQuestion 3: C The proper level to maintain is between 35 and 40 mm Hg. 3. You are transporting a 37-year-old male patient with a suspected intraabdominal bleed. His blood pressure is 70/50 mm Hg (MAP 57), and his skin is pale and diaphoretic. How will you manage fluid resuscitation TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ 4.What type of padding should you provide for this patient? A. Use compressible padding under the shoulders and torso to prevent hyperflexion. B. Use firm padding between the back of the head and the backboard to prevent hyperextension. C. Do not use any padding. It can cause extension or flexion in the neck. D. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral position. - ansQuestion 4: B Because the patient is an adult, you should use firm padding between the back of the head and the backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion, and you would tip the backboard for a pregnant patient to prevent decreased venous return. 4.When you examine the patient's pupils, you notice the right one is dilated significantly and her motor response on the left is delayed. What does this suggest? A. Coup-countercoup injury B. Hyphema C. Hypoxia D. Uncal herniation - ansQuestion 4: D When the medial portion of the temporal lobe (uncus) is pushed toward the tentorium and puts pressure on the brain stem, herniation compresses CN III, the motor tract, and the reticular activating system on the same side, resulting in a dilated or blown pupil on the same side, motor weakness on the opposite side, and respiratory dysfunction, progressing to coma. 4.Which of the following is a goal of the Golden Period? A. Provide written documentation from field care to receiving hospital. B. Expedite the field care and transport of the patient. C. Use a team approach for optimal patient care. D. Use the XABCDE approach to patient assessment. - ansQuestion 4: B One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the time from injuryto arrival at the appropriate site fordefinitive care is critical to survival. 4.Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient? A. Shorter tracheas in geriatric patients create the need for ventilation assistance. B. Laxity of the rib cage makes hyperventilation more likely. C. Geriatric patients have greatly limited physiologic reserve. D. Geriatric patients have a greater alveolar surface area of the lungs. - ansQuestion 4: C TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Early mechanical ventilation via bag mask device or advanced airway measures should be considered in geriatric trauma patients because of their greatly limited physiologic reserve. 5.Which of the following signs would be most concerning at this point? A. A drop in systolic blood pressure to 88 mm Hg B. SpO₂ of 93% C. A field GCS motor score of 4 D. Hemiplegia on the left side - ansQuestion 5: A A systolic blood pressure of less than 90 mm Hg indicates secondary brain injury. Her SpO2 is > 90%, and a motor score of 4 is not as concerning. 5.While attempting to lay the patient supine for spinal motion restriction she becomes increasingly distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to move distally and increases the difficulty of breathing as the patient lies back. What should you do? A. Tip the backboard to a left lateral position. B. Raise the back of the stretcher. C. Let her sit up in a position of comfort. D. Administer morphine. - ansQuestion 5: B Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues. 5. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful? A. No, he should stop talking and breathe. B. Yes, he should see a cardiologist once in the local hospital. C. Yes, he will need platelets and a heart surgeon ASAP. D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ansQuestion 5: C Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent platelet transfusion. 6. According to the Monro-Kellie doctrine, what happens to the brain when it is still in a compensated state after a TBI? A. CSF, ICP, heart rate, and blood pressure are still within normal range. B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases. C. CSF and blood volume decrease, while heart rate and blood pressure are still within normál range. D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases. - ansQuestion 6: C TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY ch. 5, p. 45 , which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. - ansHYPERVENTILATION ch. 7, p. 74 55% of spinal injuries occur to which part of spine? - anscervical ch. 13, p. 179 A rapid, thready pulse may indicate (a. ), and an irregular pulse may warn of potential (b. ). - ansa. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the resuscitation. An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation of hydrogen ions and metabolic acidosis. ch. 5, p. 46 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility (potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use) - NOREPINEPHRINE increases heart rate, vascular tone through alpha- adrenergic receptor activation, and blood flow to skeletal muscle and triggers the release of glucose from energy stores. TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - If patient hemodyanmically unstable for CT, a single-infusion IVP can be performed at bedside followed by complete study once patient is stable - Positive urine dipstick for microscopic blood or leukocyte esterase - Abnormal or elevated BUN and creatinine 90% of injuries are minor. Anticipate nephrology consultation in more severe injures; surgical repair is required within 12 hours to salvage an ischemic kidney ch. 12, p. 167 Assessment findings of a CHRONIC SUBDURAL HEMATOMA - ans- ALTERED or STEADY DECLINE IN LOC - HEADACHE - LOSS OF MEMORY or ALTERED REASONING - MOTOR DEFICIT: CONTRALATERAL HEMIPARESIS, HEMIPLEGIA, OR ABNORMAL MOTOR POSTURING OR ATAXIA - APHASIA - IPSILATERAL UNILATERAL FIXED and DILATED PUPIL - INCONTINENCE - SEIZURES Ch. 9, p. 114 Assessment findings of a DIFFUSE INJURY - ansInjuries that occur over a wide spread area, not always identifiable on CT because damage involves contusions or hearing and stretching of micro vascular, not a localized hematoma. These injuries commonly follow a direct blow to the head and are often sports-related. Patients can have varying degrees of symptoms that last minutes to hours. Assessment findings include: - TRANSIENT LOC - HEADACHE, DIZZINESS - NAUSEA, VOMITING - CONFUSION, DISORIENTATION - MEMORY LOSS and CONCENTRATION DIFFICULTY - IRRITABILITY and FATIGUE Ch. 9, p. 115 Assessment findings of a EPIDURAL HEMATOMA - ans- TRANSIENT LOC followed by lucid period lasting minutes to hours - HEADACHE, DIZZINESS - NAUSEA, VOMITING - CONTRALATERAL HEMIPARESIS - HEMIPLEGIA TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - ABNORMAL MOTOR POSTURING (FLEXION/EXTENSION) Extension is associated with brainstem HERNIATION and poor outcomes - IPSILATERAL UNILATERAL FIXED, DILATED PUPIL - RAPID DETERIORATION IN NEURO STATUS Ch. 9, p. 114 Assessment findings of a HERNIATION SYNDROME - ans- ASYMMETRIC PUPILLARY REACTIVITY - UNILATERAL or BILATERAL PUPILLARY DILATION - ABNORMAL MOTOR POSTURING - other evidence of neurologic deterioration (loss of normal, reflexes, paralysis, or change in LOC) Ch. 9, p. 115 Assessment findings of a INTRACEREBRAL HEMATOMA - ans- PROGRESSIVE, RAPID DECLINE IN LOC - HEADACHE - SIGNS OF INCREASING ICP - PUPIL ABNORMALITIES - CONTRALATERAL HEMIPARESIS - HEMIPLEGIA - ABNORMAL POSTURING Ch. 9, p. 114 Assessment findings of an ACUTE SUBDURAL HEMATOMA - ans- SEVERE HEADACHE - CHANGES IN LOC - IPSILATERAL DILATED or NONREACTIVE PUPIL - CONTRALATERAL HEMIPARESIS Ch. 9, p. 114 Assessment findings of DIFFUSE AXONAL INJURY - ans- UNCONSCIOUSNESS Mild DAI lasts 6-24 hrs Severe DAI lasts weeks to months - INCREASED ICP - ABNORMAL POSTURING - HTN (systolic BP between 140-160) - HYPERTHERMIA (104-105 F) - EXCESSIVE SWEATING TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - MILD TO SEVERE MEMORY LOSS; COGNITIVE, BEHAVIORAL, and INTELLECTUAL DEFICITS Ch. 9, p. 116 AXIAL LOADING - ansetiology/cause- direct force transmitted along the length of vertebral column rest of injury- deformity of vertebral column, secondary edema of spinal cord resulting in neurologic effects example- diver striking head on bottom of pool ch. 13, p. 179 Because calcium is a vital part of the clotting casade, hypocalcemia, as a result of a massive transfusion, can actually worsen hypovolemic shock by... - ansPermitting continued bleeding Signs of hypocalemia include- dysrhythmias, muscle tremors, and seizures ch. 7, p. 81 BLUNT ESOPHAGEAL INJURY - ansInjury to esophagus, rare, results form blunt trauma Assessment findings include - AIR in MEDIASTINUM with possible widening - CONCURRENT LEFT PNEUMOTHORAX or HEMOTHORAX - ESOPHAGEAL MATTER IN CHEST TUBE - SUBCUTANEOUS EMPHYSEMA Interventions - Prepare for surgery Ch. 11, p. 143 Brown-squared syndrome - ansContralateral loss of pain and temperature sensation and ipsilateral paralysis with reduced touch sensation ch. 13, p. 182 CARDIAC TAMPONADE - ansAssessment findings TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Components of DESC and its purpose - ansD: Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7 Components of SBAR and its purpose - ansS: Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 Compression may occur from the effects of chemical substances and can cause.. - ansEdema, restricting or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33-34 Compression strength refers to the tissue's ability to: - ansResist crush force - Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 Consider ABGs. A decreased level of consciousness may be an indicator of... - ansDecreased cerebral perfusion, hypoventilation, or acid-base imbalance. ch. 5, p. 46 TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Define biomechanics - ansThe general study of forces and their effects p. 25 Define kinematics - ansThe study of energy transfer as it applies to identifying actual or intentional injuries p. 25 Define mechanism of injury (MOI) - ansHow external energy forces in the environment are transferred to the body p. 25 Define trauma - ans- Trauma is injury to living tissue caused by extrinsic agent - Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to compensate p. 9 Depending on the motorcycle design and rider positioning, the lower extremities can collide with the handlebars, resulting in... - ansFemur and pelvis fractures and hip dislocations p. 31 Describe ANAPHYLACTIC SHOCK - ansResults from release of inflammatory mediators (e.g. histamine) which contracts bronchial smooth muscles and increases vascular permeability and vasodilation. ch. 7, p. 75 Describe DISTRIBUTIVE SHOCK - ansOccurs as result of maldistribution of an adequate circulating blood volume with loss of vascular tone or increased permeability. ch. 7, p. 75 Describe energy forms - ans- Mechanical (energy transfer from one object to another in the form of motion) - Thermal (energy transfer of heat in environment to the host) - Chemical (heat energy transfer from active chemical substances such as chlorine, drain cleaner, acids, or plants) - Electrical (energy transfer from light socket, power lines, or lightning) TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 Describe FOCAL BRAIN INJURIES - ansOccur in localized area with grossly observable and identifiable brain lesions. They include... - CEREBRAL CONTUSION - INTRACEREBRAL HEMATOMA - EPIDURAL HEMATOMA - SUBDURAL HEMATOMA - HERNIATION SYNDROMES Ch. 9, p. 113 Describe NEUROGENIC SHOCK - ansOccurs with SCI results in the loss of SNS control of vascular tone, which produces venous and arterial vasodilation. ch. 7, p. 75 Describe SEPTIC SHOCK - ansCaused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe the MOI associated with brain, cranial, and maxillofacial trauma - ansBLUNT injury - falls, MVCs, sports-related injuries, recreation PENETRATING injury - firearms or exploding objects or projectiles Ch. 9, p. 108 Describe the three E's of injury control - ansEngineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ bodies, and debris from eye - ansCONTRAINDICATED in patients who may have RUPTURED GLOBE TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - Prior to procedure, check eye pH then instill anesthetic drops unless contraindicated. - Use warmed NS or LR, warmed to body temp 37 C to limit risk of thermal injury - Morgan lens or intravenous tubing may be used to direct flow, remember the shorter the tubing, the greater the flow and pressure - Direct stream across eye from inner to outer eye - Irrigation continued until eye pH reaches neutral (7.0-7.3) Ch. 10, p. 133 Explain GLOBE RUPTURE - ans- Considered a genuine EMERGENCY - Occurs when full thickness injury occurs to cornea or sclera or both -Once Dx is confirmed, it is important to protect eye from further injury Assessment findings include: - ANTERIOR CHAMBER APPEARING FLAT/SHALLOW - IRREGULAR or TEARDROP-SHAPED PUPILS or PRESENCE of what looks like a secondary pupil due to a tear in the ciliary body (traumatic iridodialysis) - PERIORBIAL ECCHYMOSIS - DECREASED VISUAL ACUITY and EOM - SEVERE SUBCONJUNCTIVAL HEMORRHAGE - NAUSEA - PAIN Treatment includes: - AVOID ANY TYPE OF PRESSURE TO GLOBE - DO NOT PERFORM TONOMETRY - APPLICATION OF RIGID SHIELD to protect affected eye - Administration of antiemetics - AVOID USE OF OPHTHALMIC DROPS or MEDICATIONS - CONSULTS * Pain not always present in globe penetration Ch. 10, p. 131 Ch. Ch. 10, p. 131-132 Explain how to assess circulation and control of hemorrhage in relation to thoracic trauma - ansAuscultation for: - MUFFLED HEART SOUNDS or MURMURS Palate for: - CENTRAL PULSES compare quality between left and right and lower and upper TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ extremities - EXTERNAL JUGULAR VEIN DISTENTION - EXTREMITIES FOR MOTOR and SENSORY function Lower extremity paresis or paralysis may indicate an aortic injury Ch. 11, p. 142 Explain HYPHEMA - ansCollection of blood in anterior chamber of eye - classified as spontaneous or traumatic Assessment findings include: - PAIN, PHOTOPHOBIA - NOTICEABLE COLLECTION OF BLOOD IN EYE CHAMBER - BLURRY VISION due to blood in chamber - INCREASED IOP, NAUSEA, and SEVERE PAIN with grade 4 Treatment includes: - ELEVATING HOB 30 degrees - protecting eye with METAL SHIELD - TOPICAL OPHTHALMIC CYCLOPLEGICS and OPHTHALMIC STEROIDS, OPHTHALMIC BETA-BLOCKERS if IOP is ELEVATED - Avoid aspirin and NSAIDs as they increase risk of re-bleeding - Risk of re-bleeding greatest 3-5 days after injury Ch. 10, p. 131 Explain NEUROGENIC SHOCK and what are the assessment findings - ansOccurs with SC damage at T6 or higher, resulting in sympathetic regulation disruption of vagal tone leading to loss of vascular resistance and generalized vasodilation Assessment findings - BRADYCARDIA - HYPOTENSION - WARM, NORMAL COLOR SKIN - CORE TEMPERATURE INSTABILITY ch. 13, p. 181 Explain OBITAL FRACTURE - ans- NOT CONSIDERED OPHTHALMOLOGIC EMERGENCY unless there is IMPAIRED VISION or GLOBE RUPTURE - Usually result from DIRECT BLOW TO EYE - Complication of this type of fracture is ENTRAPMENT OF THE INFERIOR RECTUS or INFERIOR OBLIQUE MUSCLE TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Explain the Cushing response - ansLoss of auto regulation (cerebral blood flow) can result in cerebral and brainstem ischemia, initiating a central nervous system response known as Cushing response. It is characterized by a triad of assessment findings: - widening pulse pressure - reflex bradycardia - diminished respiratory effort Ch. 9, p. 107 Explain the LMNOP mnemonic - ansUsed to remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch) - Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm - Dysrhythmias (PVCs, a fib, or ST segment changes) may indicate blunt cardiac trauma - PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia N - Naso- or orogastric tube consideration: insertion provides stomach content evacuation and relief of gastric distention O - Oxygenation and ventilation assessment - Pulse ox may only be accurate if there is adequate peripheral perfusion - ETCO2 monitoring (capnography) provides instantaneous information about the ventilation, perfusion, and metabolism of carbon dioxide (35-45 is normal) ch. 5, p. 47 Explain the MARCH mnemonic - ansM: MASSIVE HEMORRHAGE A: AIRWAY R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41-42 Explain TRACHEOBRONCHIAL INJURY and what are the assessment findings and interventions - ansUsually caused by penetrating mechanisms, occurring in proximal trachea. Direct blows to neck or clothesline-type injuries common mechanisms for blunt trauma. Dx based on assessment findings and confirmed with BRONCHOSCOPY or CT. TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Assessment findings include: - DYSPNEA, TACHYPNEA - HOARSENESS - SUBCUTANEOUS EMPHYSEMA in neck, face, upper thorax - PNEUMOTHORAX, tension pneumothorax - HEMOPTYSIS - DECREASED OR ABSENT BREATH SOUNDS - SIGNS and SYMPTOMS of AIRWAY OBSTRUCTION Interventions include: - Attempts at ET placement may cause further damage, anesthesiology if available may reduce risk of intubation injury - Other approaches include flexible endoscopy, or smaller ET tube Ch. 11, p. 143 Explain what second impact syndrome is - ansRefers to a condition that occurs when patient suffers a mild second TBI before recovery from the first. Rare but usually fatal. The second impact causes LOSS OF AUTO REGULATION LEADING TO CEREBRAL EDEMA Ch. 9, p. 115 Explain what Tranexamic acid (TXA) is - ansA synthetic version of the amino acid lysine. It is an antifibrinolytic that inhibits activation of plasminogen, a substance responsible for dissolving clots. ch. 7, p. 81 Explain why antipyretics are not effective in treating hyperthermia in acute brain injury. - ansFever is result of a change in thermoregulatory set point. A cooling blanket or ice packs may be used. Avoid causing shivering, it increases cerebral metabolic rate and may cause ICP to rise Ch. 9, p. 118 External energy forces can be exerted on the body by the following forces - ans- Deceleration forces: include those applied in falls and collisions where injuries are caused by sudden stop of the body's motion - Acceleration forces: not as common as deceleration forces and result from a sudden and rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed) - Compression force is an external force applied at times of impact, explains include: TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ + Stationary objects such as dashboards or steering wheels, that collide with or push up into a person + Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or heavy falling objects + Blast forces p. 27 FLAIL CHEST - ansClassified as 2 or more fractures of 3 or more adjacent ribs and/or sternal fractures, creating free-floating segment Assessment findings include - PARADOXICAL CHEST MOVEMENT drawing in with chest expansion and pushing out with exhalation - DYSPNEA - CHEST WALL PAIN, CONTUSIONS Interventions - prepare for intubation Ch. 11, p. 144 Following the primary survey, FAST examination may be used to rapidly assess for bleeding from damage to the... - ansHeart, liver, kidneys, and spleen. FAST also increasingly used to detect pneumothorax, especially tension pneumothorax. ch. 7, p. 84 For skin, the immediate goal in treating surface trauma is to... and this is accomplished by... - ansOBTAIN AND MAINTAIN HEMOSTASIS, APPLY DIRECT PRESSURE TO SITE ch. 14, p. 208 HEMOTHORAX - anscaused by blood accumulating in the intrapleural space. Results from injury to lung, costal blood vessels, great vessels and from laceration to liver or spleen combined with diaphragm injury. Assessment findings include - ANXIETY or RESTLESSNESS - DYSPNEA, TACHYPNEA - CHEST PAIN - SIGNS OF SHOCK- tachycardia, cyanosis, diaphoresis, hypotension - DECREASED BREATH SOUNDS ON INJURED SIDE TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ If patient's airway is NOT patent: - ans1. Suction airway - Avoid stimulating gag reflex - Use rigid suction device if obstructed by blood, vomitus, or secretions - Remove any foreign bodies carefully with forceps 2. If suctioning does not relieve airway obstruction, tongue may be cause. Insert airway adjunct. - Use jaw-thrust maneuver to open airway while maintaining manual stabilization - A nasopharyngeal airway can be used in patients who are conscious or unconscious - An oropharyngeal airway can be used in patients without gag reflex 3. Consider a definitive airway (ET tube securely placed in trachea with cuff inflated) - The following conditions or situations require a definitively secured airway --apnea -- GCS score < 8 -- severe maxillofacial fractures -- evidence of inhalation injury/facial burns -- laryngeal or tracheal injury or neck hematoma -- high risk of aspiration and patient's inability to protect airway -- compromised or ineffective ventilation -- anticipated of deterioration of neurological status ch. 5, p. 43 Imaging studies for bladder and urethral injuries include - ans- CT cystogram used to dx intraperitoneal or extraperitoneal bladder rupture - Urethrogram usually performed prior to insertion of urinary catheter when injury is suspected; contrast instilled at meatus. Detection of contrast media within bladder indicates adequate instillation, leakage demonstrates urethral disruption ch. 12, p. 168 Increased or bounding central pulses may indicate increased cardiac output. Peripheral pulses do not demonstrate a similar effect in the presence of hypovolemia due to vasocontriction. Thus, strong central pulses combined with weak peripheral pulses may be... - ansIndicative of Shock ch. 7, p. 82 Initial assessment - approach to trauma patient care that requires a process to identify and treat or stabilize life-threatening injuries in an efficient and timely manner. It is divided into the following process points: - ans- Preparation and triage - Primary survey (ABCDE) with resuscitation adjuncts (FG) - Reevaluation (consideration of transfer) - Secondary survey (HI) with reevaluation adjuncts TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - Reevaluation and post resuscitation care TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - Definitive care of transfer to an appropriate trauma center ch. 5, p. 39 Interventions for INTRAOCULAR FOREIGN BODY include - ans- Elevating HOB - CONSULT - IMMOBILIZE FOREIGN BODY IF LARGE WITH POTENTIAL to become unstable - PATCH UNAFFECTED EYE to LIMIT concomitant eye movement - PEFORM GLOBE CLOSURE ASAP - ADMINISTER SYSTEMIC and TOPICAL ANTIBIOTICS - SYSTEMIC ANALGESICS Ch. 10, p. 130 Late assessment findings of increased ICP include: - ans- DILATED, NON- REACTIVE PUPILS - UNRESPONSIVENESS to verbal/painful stimuli - ABNORMAL POSTURING - CUSHING RESPONSE Widening pulse pressure Reflex bradycardia Decreased respiratory effort Ch. 9, p. 109 Lateral impacts (T-bone) are associated with - ansShear injuries to aorta and other organs, fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury p. 30 Law of Conservation of Energy - ansEnergy can neither be created nor destroyed, but it can change form p. 26 Leading cause of death for ages 1. over 65 2. 5 to 24 3. 25 to 64 - ans1. Falls 2. MVCs 3. poisoning p. 9 Penetrating injury to the chest wall and lacerated lung tissue can cause the loss of . Thus, the collection of air or blood in the pleural TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - HYPOXIA and HYPERCARBIA - ICP Ch. 9, p. 108 B. LUNG COLLAPSE Ch. 11, p. 141 Pertaining to abdominal trauma, What does non-operative management include? When does operative management occur? - ansNon- serial abdominal exams Op- occurs in patients who exhibit signs of peritonitis or hemodynamic instability ch. 12, p. 164 Physiologic effects of pain by system: Cardiovascular - ansHYPERCOAGULATION INCREASED CARDIAC WORKLOAD INCREASED OXYGEN DEMAND ch. 8, p. 97 Physiologic effects of pain by system: Endocrine - ansINCREASED RELEASE OF HORMONES AND MEDIATORS ch. 8, p. 97 Physiologic effects of pain by system: Gastrointestinal - ansDECREASED MOTILITY ch. 8, p. 97 Physiologic effects of pain by system: Genitourinary - ansDECREASED URINARY OUTPUT URINARY RETENTION FLUID OVERLOAD ch. 8, p. 97 Physiologic effects of pain by system: Immune - ansDECREASED RESPONSE TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - ansGLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Musculoskeletal - ansIMPAIRED MUSCLE FUNCTION IMMOBILITY FATIGUE MUSCLE SPASM ch. 8, p. 97 Physiologic effects of pain by system: Respiratory - ansSPLINTING HYPOVENTILATION HYPERCARBIA RESPIRATORY ACIDOSIS INCREASED RISK OF ATELECTASIS & PNEUMONIA ch. 8, p. 97 POSTCONCUSSIVE SYNDROME assessment findings include: - ans- NAUSEA - DIZZINESS, PERSISTENT HEADACHE - MEMORY and JUDGEMENT IMPAIRMENT as well as ATTENTION DEFICITS - INSOMNIA and SLEEP DISTURBANCES - LOSS OF LIBIDO - ANXIETY, IRRITABILITY, DEPRESSION, EMOTIONAL LIABILITY - Noise and light over sensitivity - ATTENTION or CONCENTRATION PROBLEMS Ch. 9, p. 115-116 Prophylactic administration of what can reduce the risk of contrast-induced nephropathy when patients serum creatinine is above 1.2mg? - ansN- acetylcysteine along with hydration ch. 12, p. 170 TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ PULMONARY CONTUSION - anscommonly occur from rapid deceleration or direct blunt impact such as MVCs or falls - it develops when capillary blood leaks into lung parenchyma with edema and inflammation, it may be localized or diffuse The subtle assessment findings associated with pulmonary contusions usually develop over time rather than immediately after injury. Assessment findings - DYSPNEA - INEFFECTIVE COUGH - INCREASED WORK OF BREATHING - HYPOXIA - CHEST PAIN - CHEST WALL CONTUSIONS or ABRASIONS Interventions - Maintain SpO2 between 94-98% - Minimize or use IV fluids judiciously - Prepare for possible intubation ch. 11, p. 146 Replacement with packed cells and saline without also transfusing with and further dilutes the patient's ability to clot blood. - ansPLATELETS and PLASMA ch. 7, p. 79 Resuscitation-associated coagulopathy is associated with the trauma triad of death. It includes... - ansHYPOTHERMIA impairs thrombin production and platelet function ACIDOSIS impairs thrombin production COAGULOPATHY results in depletion of clotting factors through hemodilution and impaired ability to produce clotting factors ch. 7, p. 78 RHABDOMYOLYSIS - ansSignficant muscle damage and cellular destruction releases MYOGLOBIN, a muscle protein, into bloodstream. Since myoglobin is excreted in the kidneys, risk of acute renal failure is high in patients with crush injury. Classic triad of assessment findings include: - MUSCLE PAIN, NUMBNESS, CHANGES in SENSATION TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - Bowel and bladder dysfunction - Return of sacral reflexes, bladder tone, and presence of hyperreflexia indicates resolution of spinal shock - Presence of rectal tone and intact perineal sensation indicates sacral sparing ch. 13, p. 181 Stage I: Compensated Shock - ans- Anxiety, lethargy, confusion, restlessness from oxygen being shunted to brainstem - Systolic BP usually within normal range - Rising diastolic BP, results in narrowed pulse pressure, which is a reflection of peripheral constriction - A bounding and/or slightly tachycardic pulse - Increased RR - Decreased urine output ch. 7, p. 79 Stage II: Decompenstated or Progressive Shock - ans- LOC deteriorates patient becomes obtunded or unconscious as cell switch to anaerobic metabolism with increasing levels of lactic and pyruvic acids - Normal or slightly decreased systolic BP - Narrowing pulse pressure that continues until peripheral vascular vasoconstriction fails to provide cardiovascular support - HR > 100 beats/min - Weak, thready pulses - Rapid, shallow respirations - Cool, clammy, cyanotic skin - Base excess not within normal range of -2 to +2 - Serum lactate levsl > 2 to 4 ch. 7, p. 79 Stage III: Irreversible Shock - ans- Obtunded, stuporous, comatose - Marked hypotension and HF - Bradycardia with possible dysrhythmias - Decreased and shallow RR - Pale, cool, clammy skin - Kidney, liver, and other organ failure - Severe acidosis, elevated lactic acid levels, and worsening base excess on ABGs - Coagulopathies with petechiae, purpura, or bleeding ch. 7, p. 79 TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Structural strengths of tissue are described in what three ways? - ans- Compression -Tensile -Shear p. 27 Sudden vision changes may indicate in the cerebral vascular - ansA POSSIBLE FAT EMBOLISM ch. 14, p. 199 Tears or lacerations of the tracheobronchial tree disrupt the... - ansIntegrity of the upper and lower airways... Patients initially present with dramatic symptoms, such as... - SIGNS OF AIRWAY OBSTRUCTION - HEMOPTYSIS - CYANOSIS - SUBCUTANEOUS EMPHYSEMA from massive air leaks into tissues of face, chest, and neck Ch. 11, p. 141 Tensile strength describes the tissue's ability to: - ansResist pulling apart when stretched - Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon) p. 27 TENSION PNEUMOTHORAX - ansOccurs when air enters INTRAPLEURAL space but cannot escape on expiration, increasing pressure causes lung on injuries side to collapse. If pressure not relieved, mediastinum can shift toward the uninjured side compressing heart, great vessels, and ultimately the opposite lung. As pressure rises, venous return is hampered, cardiac output decreases, and hypotension occurs. Assessment findings include: - ANXIETY, SEVERE RESTLESSNESS - SEVERE RESPIRATORY DISTRESS - SIGNIFICANTLY DIMINISHED OR ABSENT BREATH SOUNDS on injured side - HYPOTENSION - DISTENDED NECK, HEAD, UPPER EXTREMITY VEINS (may not be evident if patient has experienced significant blood loss) - TRACHEAL DEVIATION or shift toward injured side TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - CYANOSIS (late sign) Interventions - Immediate chest X-RAY if pt somewhat stable - prepare for immediate needle thoracentesis 14 g needle inserted into 2nd intercostal space in mid clavicular line on affected side over the top of the rib to avoid neurovascular bundle that runs under rib - prepare for chest tube placement, which is the definitive treatment ch. 11, p. 145 The A-I mnemonic helps the trauma nurse rapidly assess for and intervene in life- threatening injuries and identify all injuries in a systematic manner. - ansA: airway and alertness with simultaneous cervical spinal stabilization B: breathing and ventilation C: circulation and control of hemorrhage D: disability (neurological status) E: exposure and environmental control F: full set of vital signs and family presence G: get resuscitation adjuncts: L - lab studies (ABGs) and obtain specimen for blood type and cross match M - monitor for continuous cardiac rhythm and rate assessment N - naso or orogastric tube consideration O - oxygenation and ventilation analysis: pulse oximetry and end-tidal carbon dioxide (ETCO2) monitoring and capnography P - pain assessment and management H: history and head- to-toe assessment I: inspect posterior surfaces ch. 5, p. 39 The assessment of circulation during the primary survey includes... - ansEarly evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient who has sustained blunt trauma. In those cases, an emergent abdominal or pelvic assessment may be preformed to include a focused assessment with sonography for trauma (FAST) examination or a radiograph of the pelvis. ch. 5, p. 44 TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ Up to 25% of the general population have UNEQUAL PUPILS, called ANISOCORIA; this is benign and caused by... - ans- TRAUMA - INCAL HERNIATION - OCULOMOTOR NERVE (CN III) PALSY - MEDICATIONS - SOME NEBULIZERS (IPRATROPIUM) Ch. 10, p. 126 Use the DOPE mnemonic to troubleshoot ventilator or capnography alarms - ansD - Displaced tube O - Obstructed or kinked tube P - Pneumothorax E - Equipment failure, such as patient becoming detached from equipment or loss of capnography waveform ch. 6, p. 66 Use the jaw-thrust maneuver to open airway and assess for obstruction when the patient is... - ansUnable to open the mouth, responds only to pain, or is unresponsive. ch. 5, p. 42 What are causes of peritoneal membrane irritation? - ans- presence of blood - chemical peritonitis as result of gastric content leakage - possible enzyme spillage from pancreas into bowel and/or peritoneal cavity - bacterial contamination from bowel contents ch. 12, p. 158 What are complications related to crush injuries? - ansCompartment syndrome, hyperkalemia, rhabdomyolysis K levels peak 12 hours after injury ch. 14, p. 198 What are late signs of MEDIASTINAL SHIFT? - ansNECK VEIN DISTENTION from increased intrathroatic pressure and TRACHEAL DEVIATION Ch. 11, p. 141 What are odors you want to be sure to document? - ansAlcohol, gasoline, other chemicals TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ ch. 5, p. 48 What are signs of worsening hypoxia with nerve injuries? - ansIncreased pain even when pulses remain present, often the first sign of increased compartment pressures ch. 14, p. 196 What are some assessment findings for patients who sustain a pancreatic injury? - ans- Serial serum amylase levels increasing over time may indicate but this does not constitute a definitive diagnosis - Serial abdominal exams are preformed in conjunction with serial serum amylase levels to appropriately confirm pancreatic injury - slight abdominal pain and tenderness becoming more significant within 48 hours of injury - epigastric pain radiating to back - abdominal pain tenderness on deep palpation - increasing or worsening abdominal wall muscle rigidity, spasm, or involuntary guarding ch. 12, p. 16 What are some circumstances that may lead to unreliable pulse ox readings? - ans- Poor peripheral perfusion - BP cuff inflated above sensor - CO poisoning (carboxyhemoglobin) - Methemoglobinemia - Severe dehydration Pulse ox provides evidence of SaO2 but not PaO2. The non-liner relationship between the two measurements is reflected in the oxyhemoglobin-dissociation curve. ch. 6, p. 65 What are the late signs that may indicate a tension pneumothorax? - ansJVD and tracheal deviation ch. 5, p. 43 What are the rules concerning standard imaging in relation to eye injury - ans- If wood or a vegetative foreign body is suspected, MRI most appropriate imaging method to use, however, it is minimally useful in acute setting - CT scans not helpful if vegetative foreign bodies are suspected - the GOLD STANDARD for evaluation of mid-face and orbit trauma is a CT scan TNCC Trauma Nursing Core Course 11th Edition ENA Test Bank |Graded A+ - Plain films are used to assess foreign bodies and fractures of facial structures, excluding orbits Ch. 10, p. 133-134 What are the two priorities in treating patients with TBI? - ansFacilitating OXYGENATION and VENTILATION Ch. 9, p. 120 What are two examples of obstructive shock that may result from trauma? - ansTENSION PNEUMOTHORAX and CARDIAC TAMPONADE ch. 7, p. 73 What can you assess to ensure the brainstem is intact? - ansEXTRAOCULAR EYE MOVEMENTS (EOMs) - tests functions of CNs III, IV, and VI In presence of facial fractures, the inability to perform EOMs may indicate a trapped nerve Ch. 9, p. 113 What can you do to easily see eyes that have abrasions? - ansStain them with fluorescein Ch. 10, 129 What diagnostic exam is helpful to inspect abdominal spaces for spillage and to examine loops of bowel? - ansLaparoscopy ch. 12, p. 164 What do you do with open wounds? - ansCover in saline-soaked dressings ch. 14, p. 201 What does 'safe care' mean? - ansMeans assuring the patient is getting to the right hospital in the right amount of time for the right care. American College of Surgeons Committee on Trauma (ACS-COT) developed trauma triage criteria that serves at the international standard to identify the trauma patient who would benefit from resuscitation and care at the right trauma facility with the appropriate resources.