Trauma Assessment and Management, Exams of Nursing

Download Trauma Assessment and Management and more Exams Nursing in PDF only on Docsity! TNCC final exam test 2022 open book with 100% correct answers Study You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? A) 1000 mL/hr B) 500 mL/hr C) 250 mL/hr D) 125 mL/hr B) 500 mL/hr A patient has been in the ED for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and c/o leg pain. His wife reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. the patient is exhibiting signs of symptoms commonly associated with which of the following conditions? A) acute lung injury B) fat embolism C) PTX D) pulmonary contusion B) fat embolism Which pulse pressure description is an indication of early hypovolemic shock? A) widened B) narrowed C) bounding D) weak B) narrowed Which of the following considerations is most important when caring for a geriatric trauma patient? A) head to to exam B) medical history C) incontinence D) falls B) medical history Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? A) increased work of breathing B) unilaterally diminished breath sounds C) pleuritic chest pain D) hypotension that worsens with inspiration D) hypotension that worsens with inspiration. A) compensated B) Progressive C) irreversible D) decompensated A) compensated Why is a measure of serum lactate obtained in the initial assessment of the trauma patient? a) to measure oxygenation and ventilation b) to quantify the base deficit for the adequacy of cellular perfusion c) to gauge end-organ perfusion and tissue hypoxia d) to determine the underlying cause of shock c) to gauge end-organ perfusion and tissue hypoxia EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? A) Alert with no neurologic deficits B) Multiple abrasions to the extremities C) Multiple requests of water D) Smell of alcohol on breath D) Smell of alcohol on breath Which of the following occurs during the third impact of a motor vehicle crash? A) The driver of the vehicle collides with the steering wheel B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger C) the aorta is torn at its attachment with the ligamentum arteriosum A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? A) initiate transfer to a trauma center B) provide report to the operating room nurse C) Obtained imaging studies D) Place a gastric tube A) initiate transfer to a trauma center Which of the following injuries is LEAST likely to be promptly identified? A) spleen B) lung C) bowel D) brain C) bowel Patients with a crush injury should be monitored for which of the following conditions? A) Hypernatremia B) Hypercalcemia C) Dysrhythmias D) polyuria C) Dysrhythmias What finding raises suspicion of complete spinal cord injury? A) Weakness in the lower extremities B) Priapism C) voluntary anal sphincter tone D) intact reflexes distal to the injury B) Priapism A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? A) Bradycardia and ipsilateral absences of motor function B) Tachycardia and respiratory depression C) Tachycardia and absent motor function below the level of injury D) Bradycardia and absent motor function below the level of the injury D) Bradycardia and absent motor function below the level of the injury A 5-year old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention? A) report your suspicion of the maltreatment in accordance with local regulations B) apply ice to the bruises and consult wound care C) engage in therapeutic communication to determine the MOI D) provide the family with injury prevention recourses A) report your suspicion of the maltreatment in accordance with local regulations A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? C) decreased WBC D) elevated GFR A) elevated creatine kinase Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and crying with increased work of breathing and pale skin. which of the following interventions has the highest priority? A) padding the upper back while stabilizing the cervical spine *** B) applying a tight-fitting NRB mask with an attached resevior C) establishing intravenous access and administering a 20mL/kg bolus D) preparing for drug assisted intubation A) padding the upper back while stabilizing the cervical spine A 35-year old male presents with facial trauma after bring struck in the face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? A) oculomotor nerve palsy B) globe rupture *** C) Uncal herniation D) retinal detachment B) globe rupture Which of the following is true about the log roll maneuver? A) it causes less spinal motion than the lift and slide maneuver B) it is recommended for patients with unstable pelvic fractures C) it can worsen cord damage from an unstable spinal injury *** D) it does not increases the risk of life threatening hemorrhage from unstable injuries C) it can worsen cord damage from an unstable spinal injury EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar? A) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan *** B) after physician evaluation if the patient has not neurologic abnormalities on exam C) after palpation of the spine if the patient has no point tenderness the the vertebral column D) after physical examination if the patient has not neck pain with movement A) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? A) potassium B) magnesium C) sodium D) calcium D) calcium Tearing of the bridging veins is most frequently associated with which brain injury? A) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma B) subdural hematoma A trauma patient is en route to a rural ED. Radiology notifies the charge nurse that the CT scanner will be out of service for several of hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication? A) Brief B) loop C) debrief D) huddle D) huddle An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions? A) call for a portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement D) confirm ET tube placement What factor contributes most the kinetic energy of a body in motion? A) acceleration B) mass C) velocity D) inertia C) velocity During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next? A) open the airway with the head-tilt/chin lift maneuver B) auscultate bilateral breath sounds to assess ventilatory status C) Tissue oxygenation (PaO2) increases D) Hemoglobin molecule saturation (SaO2) decreases A) Hemoglobin does not readily release oxygen for use by the tissues A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? A) Fast exam B) CT scan C) straight cath for urine sample D) ice and elevation of the scrotum C) straight cath for urine sample Which of the following is possible complication of positive-pressure ventilation? A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure A) worsening pneumothorax Which of the following is NOT considered goal-directed therapy of cardiogenic shock? A) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis D) cardiac cath C) pericardiocentesis What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? A) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry A) pulse oximetry and capnogaphy Which of the following values indicates the need for alcohol withdrawal interventions? A) CIWA-Ar of 36 *** B) GCS 13 C) ETCo2 of 48 mm Hg D) heart rate of 45 beats/min A) CIWA-Ar of 36 An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, and dusky skin. the trauma team has administered medications for drug assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? A) Ventilate with a BVM B) Prepare for cricothyroidotomy C) administer reversal medications D) contact anesthesia for assistance A) Ventilate with a BVM The trauma nurse knows that placing a bariatric patients in a "ramped position" provides better visualization during the insertion of which device? A) Intraosseous line B) orogastric tube C) ET tube *** D) urinary catheter C) ET tube You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal high at the costal margin, and some dark bloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent with which of the following? A) placental abruption B) preterm labor C) uterine rupture D) fetal demise A) placental abruption