Trauma Management and Assessment, Exams of Nursing

Download Trauma Management and Assessment and more Exams Nursing in PDF only on Docsity! HOSMERIT PHTLS-POST EXAM QUESTIONS AND CORRECT ANSWERS {VERIFIED} ANSWERS// GRADED A+ The displacement of tissue away from the path of a projectile, both temporarily and permanently, is known as: A. Conization B. Cavitation C. Crepitation D. Contusion - ANSWER-B. Cavitation The single most important factor in determining the potential for injury due to energy exchange is: A. Mass of the bodies involved B. Velocity of the bodies involved C. Density of the tissues involved D. Surface area of the impact involved - ANSWER-B. Velocity of the bodies involved In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because: A. The protein molecules in crystalloid solutions act as volume expanders B. These fluids draw interstitial fluid into the vascular space to enhance volume C. These solutions will stay in the vascular space longer than water solutions, such as D5W D. Their pH enhance oxygen delivery to the tissues - ANSWER-C. These solutions will stay in the vascular space longer than water solutions, such as D5W With respect to the distance of a fall, which of the following is a guideline for determining a critical fall? A. 3 times the height of the patient B. 2 times the height of the patient C. 5 times the height of the patient D. 1 ½ times the height of the patient - ANSWER-A. 3 times the height of the patient The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the phase. A. Tertiary phase B. Quaternary phase C. Secondary phase D. Primary phase - ANSWER-D. Primary phase During the primary survey and management of a trauma patient, the E in ABCDE stands for ? A. Edema B. Eyes & ears C. Expose/Environment D. Electrical therapy - ANSWER-C. Expose/Environment The time in which surgical intervention can make a difference in patient outcome is the ? ‘A. Golden period B. Golden time C. Golden era D. Golden minutes - ANSWER-A. Golden period (hour) In the absence of extenuating circumstances, the maximum amount of time it should take to identify and manage immediate threats to life, prepare the patient for transport and begin transport is ? A. 5 minutes C. Frontal impact vehicle crash D. Gunshot wound to the chest - ANSWER-A. Stab wound to the chest Which of the following is the preferred site for needle decompression of a tension pneumothorax? A. 4th intercostal space, midclavicular line, just over the top of the 5th rib B. 4th intercostal space, midclavicular line, just below the 4th rib C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib D. 2nd intercostal space, midclavicular line, just below the 2nd rib - ANSWER-C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation? A. Inability to generate negative intrapleural pressure B. Decrease in vital capacity due to collapse of the flail segment C. Increased intrathoracic pressure D. Blood and fluid in the alveoli and interstitial spaces of the lung - ANSWER-D. Blood and fluid in the alveoli and interstitial spaces of the lung Your patient is a 55 year old male who was struck in the right side of the chest with a piece of steel pipe. He presents with uncooperative behavior, his skin is pale and moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds are decreased on the right side. The trachea is midline and jugular veins are flat while the patient is supine. There is isolated crepitus over the 4th and 5th ribs in the midaxillary line on the patient's right side. Based on the mechanism of injury and the assessment findings, which of the following is the most likely cause of the patient's signs and symptoms? A. Tension pneumothorax B. Simple pneumothorax C. Pulmonary contusion D. Hemothorax - ANSWER-D. Hemothorax Deterioration of ventilation and oxygenation after inflation of a PASG in a patient who has sustained a high-pressure compression injury of the abdomen, such as a sudden deceleration with the lap belt placed across the abdomen, most likely represents which of the following injuries? A. Abdominal aortic aneurysm B. Ruptured diaphragm C. Ruptured esophagus D. "Paper bag" syndrome of the lungs - ANSWER-B. Ruptured diaphragm Which of the following is NOT a component of the Fick Principle? A. Adequate number of platelets in the blood B. Oxygenation of red blood cells C. Transportation of red blood cells to the tissues of the body D. Off-loading oxygen from the red blood cells to the tissues - ANSWER-A. Adequate number of platelets in the blood One of the earliest signs of hypovolemic shock is: A. Hypotension B. Bradycardia C. Anxiety D. Reduced urine output - ANSWER-C. Anxiety Which of the following characterizes the washout phase of shock? A. Systemic acidosis B. Localized tissue acidosis C. Edema D. Reduced capillary blood flow - ANSWER-A. Systemic acidosis A trauma patient who has fallen 20 feet from an apartment balcony is alert with warm, dry, pink skin, with normal capillary refilling time to the lower extremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the following injuries should be suspected? A. Aortic dissection B. Liver laceration C. Fractured pelvis D. Spinal cord injury - ANSWER-D. Spinal cord injury Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagic shock? A. Inability of fluids to carry oxygen B. Pulmonary edema C. Increased hemorrhage D. All of the above - ANSWER-D. All of the above Which of the following statements regarding signs of intraabdominal injury is NOT true? You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury? A. Circumference of the vehicle B. Diameter of the tree C. Mass of the vehicle D. Speed of the vehicle - ANSWER-D. Speed of the vehicle Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting? A. Abdomen B. Blood pressure C. Neurologic status D. Skin - ANSWER-D) Skin Survival of the fetus in a trauma situation is most dependent upon which of the following factors? A. Gestational age of the fetus B. Prenatal care C. Immediate cesarean section D. Good resuscitation of the mother - ANSWER-D. Good resuscitation of the mother A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to which area of the brain? A. Frontal and occipital B. Occipital C. Parietal D. Frontal - ANSWER-B. Occipital (probably too low velocity for Coup & Contre Coup) In the context of the caring for an adult patient with traumatic brain injury who is deteriorating and exhibiting signs of herniation, hyperventilation means ventilating with a BVM and 100% oxygen at a rate of: A. 12 to 16 per minute B. 32 to 40 per minute C. 8 to 12 per minute D. 20 per minute - ANSWER-D. 20 In the United State, which of the following mechanisms most frequently causes spinal cord injury in adults? A. Shallow water diving B. Vehicle crashes C. Falls D. Pedestrian struck by a vehicle - ANSWER-B. Vehicle crashes The premise of PHTLS is that: A. EMTs must treat all trauma patient based on protocols B. EMTs are capable of sound patient care judgment, given an adequate knowledge base C. EMTs must work only under on-line medical direction when caring for trauma patients D. EMTs are capable of working independently of medical direction - ANSWER-B. EMTs are capable of sound patient care judgment, given an adequate knowledge base A 20 year old female was ejected from her vehicle during a high speed roll-over motor vehicle collision. She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic blood pressure of 70 mm Hg and pupils that are equal but respond sluggishly to light. After establishing two large bore IV lines, you should titrate the infusion rate to achieve a target blood pressure of at least A. 60 mm Hg. B. 70 mm Hg. C. 80 mm Hg. D. 90 mm Hg. - ANSWER-D) 90 mm Hg. Which of the following presentation indicate spinal cord injury? A. Complete loss of sensory and motor function below the site of injury B. Weakness and parethesia in the upper extremities, but normal function in the lower extremities C. Complete loss of function on one side of the body and loss of pain and temperature sensation on the opposite side D. All of the above - ANSWER-D. All of the above Of the following, which is the earliest indication of compartment syndrome? A. Paralysis of the affected muscles B. Loss of pulses The preferred method of dressing burns in the prehospital setting is: A. Dry sterile dressing B. Moist sterile dressing C. Wet dressings D. Petroleum gauze - ANSWER-A. Dry sterile dressing In assessing the hypothermic patient in the prehospital setting, the most reliable indicator of the severity of hypothermia is: A. Rectal temperature B. Oral temperature C. Heart rate < 60 D. Presence or absence of shivering - ANSWER-A. Rectal temperature In the normal child, which general statement is most accurate in comparison with the adult patient? A. Blood pressure is higher, hear rate is higher, and ventilatory rate is higher B. Blood pressure is lower, heart rate is lower, and ventilatory rate is higher C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher D. Blood pressure is lower, heart rate is higher, and ventilatory rate is lowe - ANSWER-C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher A patient who withdraws from painful stimuli, opens eyes on verbal command, and cannot speak because of intubation has a Glasgow Coma Scale of which of the following: A. 8 B. 8T C. 7 D. 7T - ANSWER-B. 8T (E-3, V-T, M-4) The earliest site for intraosseous infusion is: A. Anterior tibia, just above the tibial tuberosity B. Anterior fibula C. Anterior tibia, just below the tibial tuberosity D. Posterior fibula - ANSWER-C. Anterior tibia, just below the tibial tuberosity Which of the following behaviors is the most reliable indication of confusion in the elderly trauma patient? A. Inability to recall his/her name B. Inability to recall the day of the week C. Inability to identify his/her present location when out of his/her normal residence D. Focus on repeated retelling of events that occurred years ago - ANSWER-A. Inability to recall his/her name Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which of the following? A. Dual lumen airway B. Endotracheal intubation C. Laryngeal mask airway D. Oropharyngeal airway - ANSWER-D) Oropharyngeal airway Your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening the airway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. Which of the following is the most appropriate next intervention? A. Apply a non-rebreather mask B. Begin ventilation with a BVM C. Insert an endotracheal tube D. Perform a needle decompression - ANSWER-B) Begin ventilation with a BVM An 18-year-old female was struck by a car and has sustained an apparent left femur fracture. Communication with her is hampered because she only speaks a foreign language. Which finding, by itself, does not mandate immobilization of the cervical spine? A. Fracture of the femur B. Inability to communicate C. Mechanism of injury D. Tenderness over the cervical spine - ANSWER-C) Mechanism of injury Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting? A. 5% dextrose in water B. 7.5% hypertonic saline A. Herbal preparations may enhance blood clotting B. Anti-inflammatory agents may enhance blood clotting C. Beta blockers may prevent tachycardia with blood loss D. Calcium channel blockers may slow the onset of shock - ANSWER-C) Beta blockers may prevent tachycardia with blood loss An adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from the wound. Direct pressure is not controlling the bleeding. What is the most appropriate next step? A. Apply a topical hemostatic agent and transport B. Apply a tourniquet and tighten it until bleeding stops C. Elevate the leg and apply pressure to the femoral artery D. Maintain direct pressure and transport immediately - ANSWER-B) Apply a tourniquet and tighten it until bleeding stops The target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is which of the following? A. 60 - 70mm Hg B. 80 - 90 mm Hg C. 100 - 110 mm Hg D. 120 - 130 mm Hg - ANSWER-B) 80 - 90 mm Hg Which best describes shock? A. Decreased Glasgow Coma Scale (GCS) B. Flushed, dry, hot skin combined with bradycardia C. Generalized inadequate tissue perfusion D. Low blood pressure combined with tachycardia - ANSWER-C) Generalized inadequate tissue perfusion Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action? A. Apply a tourniquet B. Apply direct pressure C. Initiate rapid transport D. Restore blood volume - ANSWER-B) Apply direct pressure Which best explains the mechanism by which gas exchange is impaired in pulmonary contusion? A. Blood in the alveoli B. Collapse of the alveoli C. Compression of the lung tissue D. Partial occlusion of the bronchi - ANSWER-A) Blood in the alveoli In the elderly trauma patient a high index of suspicion for shock should occur beginning when the systolic blood pressure is less than: A. 90 mmHg B. 150 mmHg C. 120 mmHg D. 100 mmHg - ANSWER-C. 120 mmHg In an adult patient, blood loss into the tissue from a fractured femur may be as much as which of the following? A. 150 to 500 mL B. 500 to 1000 mL C. 1000 2000 mL D. 2500 to 5000 mL - ANSWER-C. 1000 2000 mL Delayed death due to trauma is usually a result of: A. Biochemical and pathophysiological effects of inadequate initial resuscitation B. Acute circulatory failure C. Brain injury D. Acute hypoxia - ANSWER-A. Biochemical and pathophysiological effects of inadequate initial resuscitation A regional resource center with a full spectrum of trauma services from prevention to rehabilitation which serves as the leader in trauma care for a geographical region is a: A. Level IV trauma center B. Level III trauma center C. Level II trauma center D. Level I trauma center - ANSWER-D. Level I trauma center Which of the following patients is not indicated for spinal immobilization?