Trauma Assessment and Management, Exams of Public Health

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Why is a measure of serum lactate obtained in the initial assessment of the trauma patient?

Answer: c correct answer 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

A trauma patient is restless and repeatedly asking "where am I?" vital signs upon arrival were BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and symptoms of which stage of shock?

Answer: A correct answer A) compensated **

B) Progressive

C) irreversible

D) decompensated

An elderly patient with a history of anticoagulant use presents after a fall at home that day. she denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. Which is a most likely cause of her symptoms?

Answer: D correct answerA) epidural hematoma

B) diffuse axonal injury

C) post-concussive syndrome D) subdural hematoma ***

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? Answer: D correct answer A) Alert with no neurologic deficits

B) Multiple abrasions to the extremities

C) Multiple requests of water

D) Smell of alcohol on breath ***

Which of the following injuries is LEAST likely to be promptly identified?

Answer: C correct answer A) spleen

B) lung

C) bowel ***

D) brain

Patients with a crush injury should be monitored for which of the following conditions?

Answer: C correct answer A) Hypernatremia

B) Hypercalcemia

C) Dysrhthmias **

D) polyuria

What finding raises suspicion of complete spinal cord injury?

Answer: B correct answer

A) Weakness in the lower extremities

B) Priapism ***

C) voluntary anal sphincter tone

D) intact reflexes distal to the injury

A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs?

Answer: D correct answer A) Bradycardia and ipsilateral absences of motor function

B) Tachycardia and respiratory depression

Answer: C correct answer A) elevating the extremity above the level of the heart

B) repositioning and apply ice

C) Elevating the extremity to the level of the heart ***

D) Preparing the patient for ultrasound

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?

Answer: B correct answer A) apply a sling and elevate the extremity to the level of the heart.

B) apply a splint and ELEVATE ABOVE THE LEVEL OF THE HEART

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C) Apply a sling and elevate the extremity above the level of the heart

D) apply a splint and elevate the extremity to the level of the heart.

Which of the following is a late sign of increased intracranial pressure?

Answer: C

Cushing

Response

Widening

pulsepressure

Reflex

bradycardia

Decreased RR correct answerA) Restlessness or drowsiness

B) Nausea and vomiting

C) Decreased respiratory effort**

D) amnesia and anxiety

Answer: A correct answerA) initiate two large caliber intravenous lines for Ringers lactate solution administration ***

B) Administer Dilaudid for pain control and provide comfort care

C) Place the patient in an observation area for care within the next few hours

D) Contact the command center for the personnel to notify next of kin.

A patient arrives with a large open chest wound after being assault ed with a machete, Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3 sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate interventions?

Answer: C correct answerA) needle decompression

B) tube thoracostomy

C) dressing removal **

D) surgical repair

A patient is found lying on the floor after falling 13 hours ago. Which of the following lab values is expected with a musculoskeletal complication associated with this

presentation?

Answer: A correct answerA) elevated creatine kinase ***

B) decreased potassium level

C) decreased WBC

D) elevated GFR

A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows:

BP 98/

HR 125 beats/min

D) preparing for drug assisted intubation

Which of the following is a component of the trauma triad of death?

Answer: A

hypothermia, metabolic acidosis, coagulopathy correct answerA) Acidosis **

B) hyperthermia

C) hemorrhage

D) sepsis

A 35-year old male presents with facial trauma after bring struck inthe face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected?

Answer: B correct answerA) oculomotor nerve palsy

B) globe rupture ***

C) uncal herniation

D) retinal detachment

Which of the following is true about the log roll maneuver?

Answer: C correct answerA) it causes less spinal motion than the lift and slide manuever

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

EMS arrives with the intoxicated driver of a car involved in a

Tearing of the bridging veins is most frequently associated with which brain injury?

Answer: B correct answerA) epidural hematoma

B) subdural hematoma ***

C) diffuse axonal injury D) intracerebral hematoma

If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation?

Answer: D correct answerA) potassium B) magnesium

C) sodium

D) calcium ***

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?

Answer: D correct answerA) Brief B) loop

C) debrief D) huddle ***

The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours?

(upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA.

120 kg x (2 mL) x (19% TBSA) = 4560 mL

4560 / 2 (half of fluids given in first 8 hours) = 2280 mL

Answer: A correct answerA) 2280 mL *** B) 3840 mL

C) 4560 mL

D) 7680 mL

Which of the following assessment findings differentiates a tension PTX from a simple PTX?

answer: D

Assessment findings associated with tension pneumothorax include anxiety, severe restlessness, severe respiratory distress, and absent breath sounds on the injured side. Hypotension due to compression of the heart and great vessels is consistent with obstructive shock. Hypotension worsens with inspiration due to increased intrathoracic pressure. Late signs include distended neck veins, tracheal deviation, and cyanosis. correct answerA) increased work of breathing

B) unilaterally diminished breath sounds

C) pleuritic chest pain

D) hypotension that worsens with inspiration ***

Which of the following considerations is most important when caring for a geriatric trauma

Answer: B correct answerA) head to to exam

B) medical history ** C) incontinence

D) falls

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?

Answer: D correct answerA) 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

What factor contributes most the kinetic energy of a body in motion?

answer: C correct answerA) acceleration

B) mass

C) velocity *** D) inertia

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?

Answer: D correct answerA) open the airway with the head-tilt/chin lift maneuver

B) auscultate bilateral breath sounds to assess ventilatory status

C) assist respirations using a BVM D) insert an oropharyngeal airway if there is no gag reflex ***

Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of future disaster. Which phase of the disaster life cycle does this describe?

Answer: A correct answerA) mitigation ***

B) preparedness

C) response

D) recovery

Which pulse pressure description is an indication of early hypovolemic shock?

Answer: B correct answerA) widened B) narrowed ***

C) bounding

D) weak

The most reassuring finding for a male patient with hop pain after a fall is which of the following?

Answer: D correct answerA) a normal prostate exam

B) absence of abdominal distension C) a normal fast exam

D) pelvic stability ***