Trauma Nursing Care: Principles and Practices, Exams of Advanced Education

Download Trauma Nursing Care: Principles and Practices and more Exams Advanced Education in PDF only on Docsity!

TCRN Exam Review Questions With 100%

Correct Answers| Latest Update

Which of the following techniques is used for initial control of hemorrhage to an extremity? A. Apply direct pressure to the open wound B. Apply pressure to the affected pulse point C. Elevate the extremity above the heart D. Apply a tourniquet 4 inches above the open wound - Correct Answer-A Injury prevention programs should NOT include which of the following? A. Non-measurable outcomes B. Partnerships with communities C. Monitoring and supporting D. Intervention strategies - Correct Answer-A Fluid coming from the nose or the ear after a traumatic injury to the head should raise concern for: A. LeFort I fracture B. Occipital fracture C. Perforated tympanic membrane

D. Basilar skull fracture - Correct Answer-D A patient is coming to the ED following a high-speed MVC. EMS is reporting a GCS of 3; vital signs: HR 65, BP 85/50, RR assisted at 12, O sats 94%. Which parameter increases the risk for long-term disability? A. Blood pressure 85/ B. GCS 3 C. HR 65 D. O2 94% even with assistance - Correct Answer-A When greeting the family of a 23 year old male being resuscitated in the trauma bay, which approach is not an effective way of delivering the patient's condition? A. Inform at first possible opportunity once patient arrives to ED either by phone or in person B. Provide good news first C. Outline the nature of injuries, what has been done so far, and predict patient course D. Immediately allow the family into the room during resuscitation - Correct Answer-D What is the development stage/goal for the preschool age child? A. Industry vs. inferiority B. Trust vs. mistrust

C. Initiative vs. guilt D. Autonomy vs. shame - Correct Answer-C Performance improvement and patient safety plans (PIPS) identify loop closure to be an essential component to ensure that actions and goals have been set in motion. Which of the following is not an expected result? A. Monitoring for effectiveness B. Immediate improvement in patient care C. Re-evaluation to ensure goals are met D. Benchmarking to move away from individual blame - Correct Answer-B Which of the following are examples of performance improvement issues? A. Patient care issues B. Trauma related death C. Transfer to higher level of care D. All of the above - Correct Answer-D A 28 year old male is brought to the ED after a suspected assault. Breath sounds are diminished on the right. Vitals are: HR 120, BP 122/88, RR 36 with shallow effort and O2 sats 88% on a non- rebreather. What is the trauma team's most appropriate next step in the management of this patient?

A. Prep for an emergent thoracotomy B. Order stat chest xray C. Place a chest tube D. Perform a pericardiocentesis - Correct Answer-C Fractures to the first and second ribs require a very large amount of force to the trunk area. Remember- when a thoracic injury occurs- we have to think of all the underlying structures to rule out subsequent injuries. Which of the following would NOT be a potential injury to consider? A. Pulmonary contusion B. Bronchial injury C. Ruptured globe D. Myocardial infarction - Correct Answer-C Which of the following laboratory tests is the MOST useful in identifying cardiac injury following blunt chest trauma in CHILDREN? A. Lactate dehydrogenase B. Cardiac myoglobins C. Creatinine phosphokinase D. Cardiac troponins - Correct Answer-D What diagnostic exam should be considered in patients with fractures of the first rib?

A. Angiogram B. Arteriogram C. Chest CT without contrast D. Doppler study - Correct Answer-B A 35 year old male is brought to the ED for a blunt blow to the neck. Patient is hoarse, experiencing hemoptysis and subcutaneous emphysema. Knowing the anatomy of the trachea, the nurse knows that the trachea splits at the _____ to form the ______. A. Cricoid cartilage, secondary bronchi B. Thyroid cartilage, primary bronchi C. Carina, primary bronchi D. Hilum, secondary bronchi - Correct Answer-C The same patient with a tracheobronchial tear is developing air in his pleural cavity at a rapid rate. A tension pneumothorax is forming. This is known to cause: A. Obstructive shock B. Respiratory alkalosis C. A widening pulse pressure D. Unilateral stabbing chest pain - Correct Answer-A What is the most common site of injury in the trachea and bronchial area?

A. Cricoid cartilage B. Thyroid cartilage C. Tracheal cartilage D. Carina - Correct Answer-D A patient comes to the ED with dysphonia and dyspnea after aspirating a fish bone. The physician suspects tracheal rupture and begins to prepare for intubation. What is the most definitive way to confirm the diagnosis of a tracheal rupture? A. Bronchoscopy B. Chest xray C. CT of the chest D. Ultrasound - Correct Answer-A A 54 year old female is on 41 North. She is 2 days post MVC with blunt injury and multiple rib fractures. Her ABG shows: pH: 7.49, pCO2 49, HCO3 22. How would you interpret this? A. Normal B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis - Correct Answer-C When should impaled objects in the thoracic cavity be removed?

A. Prior to arrival B. In the trauma bay C. Never D. In the OR - Correct Answer-D Which of the following is not a pathophysiological consequence of a life-threatening thoracic injury? A. Hypoxia B. Hyperventilation C. Respiratory/metabolic acidosis D. Inadequate tissue perfusion - Correct Answer-B The chest tube was inserted correctly for a relatively small pneumothorax, however, 1 day later the bubbling in the water seal chamber has stopped. What should the nurse do? A. Nothing, this is normal B. Begin looking for an air leak C. Alert the surgeon, set up a new drainage system D. Turn the patient on their affected side - Correct Answer-A A trauma patient has been identified as having a sternal fracture. What is the most common cardiac injury after a significant blunt force impact to the chest?

A. Aortic dissection B. Diaphragmatic rupture C. Cardiac contusion D. Pericardial tamponade - Correct Answer-C Which side (right or left) of the diaphragm is more likely to be injured following chest trauma? A. Left B. Right C. No difference - Correct Answer-A What is the most common injury that can occur after blunt trauma to the chest? A. Cardiac contusion B. Pulmonary contusion C. Rib fracture D. Pericardial tamponade - Correct Answer-C Which cardiac chamber is most likely to be injured in a blunt mechanism of injury to the chest? A. Right ventricle B. Left ventricle C. Right atrium

D. Left atrium - Correct Answer-A This type of incomplete spinal cord injury is the most common in the geriatric population: A. Central cord B. Anterior cord C. Brown-Sequard cord D. Complete - Correct Answer-A Geriatric patients are most likely to sustain which type of head bleed? A. Subarachnoid hemorrhage B. Intraventricular hemorrhage C. Epidural hematoma D. Subdural hematoma - Correct Answer-D An 80 year old patient fell down 4 steps dislocating her knee. The patient is not complaining of any pain, she states she can't really feel it. What injury should the nurses suspect that could explain this? A. Peroneal nerve injury B. Popliteal vein involvement C. Popliteal artery involvement D. Avascular necrosis - Correct Answer-A

A geriatric trauma patient with multisystem injuries is now being managed by palliative care as they are end of life. The patient has nausea and decreased appetite and the family is very concerned about nutritional status. What is the LEAST correct in regards to end of life and nutrition? A. Obtain an order for zofran B. Comfort the family by informing them that at this stage, going without food and water is not painful C. Instruct the family to bring in the patient's foods from home so that the patient may be forced to eat them D. Comfort and educate the family that this is a common and normal finding in the dying process - Correct Answer-C When obtaining a history for an injured patient, understanding energy transfer through biomechanical information helps the nurse to: A. Anticipate the types of injury that may be present B. Decide if law enforcement should be notified C. Determine needed laboratory tests D. Predict the need for a surgical procedure - Correct Answer-A The major preventable cause of death in the trauma patient is: A. Airway compromise B. Ineffective ventilation C. Secondary head injury

D. Uncontrolled hemorrhage - Correct Answer-D What is the best position to maintain an open airway in the bariatric patient? A. Prone B. Supine C. Reverse Trendelenburg D. Right lateral recumbent - Correct Answer-C Your patient has a subdural hematoma sustained while falling down a flight of stairs after drinking. He is going to the OR in the morning, however, overnight he became anxious and stated he could not sleep. He vomited once. What is your priority concern for this patient? A. Alcohol withdrawal B. Acute stroke C. Increased intracranial pressure - Correct Answer-C A patient from the ED has been transferred to your unit. They were resuscitated in the trauma bay and sustained an open femur fracture that is now immobilized. When the patient bends her knee on her uninjured leg she has intense left shoulder pain. What is this called and what does it indicate? A. Cullen's sign; abdominal bleeding B. Kehr's sign; undiagnosed PE

C. Kehr's sign; spleen injury D. Cullen's sign; undiagnosed spine injury - Correct Answer-C A patient involved in an MVC suffered a splenic laceration requiring a splenectomy. Which vaccine would you expect to administer prior to the surgery? A. Recombivax HB B. Tetanus toxoid C. Attenuvax D. Pneumovax 23 - Correct Answer-D A patient from the ED has been transferred to the ICU. The patient is hypovolemic and needs fluid. Which replacement fluid would be indicated without causing significant fluid shifts across the cellular membranes or vessels? A. D5 1/2 NS B. D5W C. NS D. 3%NS - Correct Answer-C A patient with a history of a shoulder and elbow dislocation is most likely to experience which complication? A. Median nerve damage B. Brachial plexus injury

C. Radial nerve damage D. Humeral head fracture - Correct Answer-B Your patient has just returned from the OR following a complex right tibia-fibula fracture repair with ORIF and one-compartment fasciotomy. Patient has a well known low tolerance for pain and is on PCA narcotics for pain control. Upon assessment patient continues to complain of increased pain, and decreased ability to dorsiflex his right foot. The nurse believes: A. Normal post-operative pain and presentation-- call trauma for increased pain meds B. Deep vein thrombosis C. Fat embolism syndrome D. Compartment syndrome - Correct Answer-D A patient on your unit is unable to cooperate verbally with your assessment (either intubated or has baseline dementia). Which of the following assessments help determine the risk for compartment syndrome in a patient that cannot verbalize pain/sensation? A. Pulselessness B. Paresthesia C. Paralysis D. Pressure - Correct Answer-D

A patient is admitted to your unit with previous SCI. The patient begins to have signs and symptoms of autonomic dysreflexia. Which of the following would indicate a possible cause for this condition? Select all that apply: A. Hypertension B. Kinked catheter tubing C. New onset wheezing D. Diarrhea - Correct Answer-B and E A patient with a spinal cord injury at level C3-4 is on your unit. What is the priority assessment- to start? A. Determine the level at which patient has intact sensation B. Assess the level at which the patient has retained mobility C. Check blood pressure and pulse for signs of neurogenic shock D. Monitor respiratory effort and oxygen saturation levels - Correct Answer-D The nurse understands that when the spinal cord is injured, ischemia results and edema occurs. How should the nurse explain to the patient the reason that the extent of the injury cannot be determined for several days to a week? A. Tissue repair does not being for 72 hours B. The edema extends to the level of the injury for two cord segments above and below the affected level

C. Neurons need time to regenerate so stating the injury early is not predictive of how the patient progresses D. Necrosis of gray and white matter does not occur until days after the injury - Correct Answer-B Which of the following nursing actions is appropriate for preventing skin breakdown in a patient who has recently undergone a laminectomy? A. Provide patient with rotating air mattress B. Place pillows under patient to help turn C. Teach patient to grasp side rail to turn D. Use the log roll to turn patient to the side - Correct Answer-D A patient was thrown through the windshield during a car crash impaling him with a large shard of glass through his left chest. He has some bleeding around the site with a bandage in place. He is hypotensive and it is becoming more difficult to auscultate the heart sounds. What type of shock is he most likely suffering from? A. Hypovolemic B. Cardiogenic C. Obstructive D. Neurogenic - Correct Answer-C Which of the following patients needs neurovascular checks routinely performed by the nurse?

A. Patient with an extremity injury B. Patient with a post-op hip repair C. Patient with known pelvic fracture D. All of the above - Correct Answer-D The nurse knows the compartment pressure that indicates compartment syndrome is greater than what number? A. 10 B. 30 C. 40 D. 60 - Correct Answer-B Patient with suspected compartment syndrome should have the extremity placed in what position? A. Elevated above the heart B. Below the level of the heart C. At the level of the heart D. It doesn't matter - Correct Answer-C A patient enters the trauma bay with a large piece of glass in his chest. EMS stabilized the object and brought him to the ED. Patient is hemodynamically stable, no hemorrhaging is noted. When should the impaled object be removed from the chest?

A. ASAP

B. It should have been removed on scene C. After imaging, in the trauma bay D. In the OR - Correct Answer-D How much fluid does it take to distend the pericardial sac and lead to cardiac tamponade? A. 75-100 mL B. 100-200 mL C. 5-15 mL D. 250-300 mL - Correct Answer-A Why is a widened mediastinum on x-ray concerning? A. Pneumothorax B. Cardiac tamponade C. Aortic disruption D. Hemothorax - Correct Answer-C Which pneumonic helps nurses troubleshoot tubes/drains? A. FOCA B. AVPU C. DOPE

D. GCS - Correct Answer-C Which pneumonic helps nurses properly assess output from a drain? A. FOCA B. AVPU C. DOPE D. GCS - Correct Answer-A You have just emptied the contents from a JP drain. How would you re-establish the active part of this drain? A. Hook up to suction B. Close the cap on the device C. Ensure no kinks D. Squeeze the collection chamber - Correct Answer-D A goal for caring for the patient with ARDS who is on the ventilator is: A. An FiO2 below 60% B. A tidal volume of 10mL/kg C. A respiratory rate of 10 breaths/minute D. A positive end-expiratory pressure above 5 - Correct Answer-A Upon arrival to the ED, a patient s/p fall from horse complains of left shoulder pain, increased with inspiration. Decreased breath sounds to

the left upper chest but no other abnormalities. Blood pressure is 138/80, pulse is 90, respirations are 24, shallow and rapid, and O2% is 94 on room air. Which of the following interventions is most likely to be considered in this scenario? A. Insertion of chest tube in the 5th intercostal space at the midaxillary line B. Initiation of 100% oxygen via non-rebreather and continued observation C. Performance of needle decompression in the second intercostal space at the midclavicular line D. Intubation with mechanical ventilation utilizing a low tidal volume with high peak-end-expiratory pressure strategy - Correct Answer-B Patient is found to have a pneumothorax on the left with fractured ribs 4, 5, 6, 7, and 8. She is admitted to the STICU per the rib fracture protocol. On day 2 she is intubated for increased respiratory distress. Which of the following findings is highly indicative of an evolving pulmonary contusion? A. Elevating tidal volume B. An increase in the PaO2: FiO2 ratio C. Increasing plateau pressures on the ventilator D. Bulging of the intercostal muscles on exhalation - Correct Answer-C Which of the following BEST describes a superficial burn? A. Mottled pink, or white immediately, usually dry, does not blanch

B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - Correct Answer-B Which of the following BEST describes a superficial partial-thickness burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - Correct Answer-D Which of the following BEST describes a deep partial-thickness burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - Correct Answer-A Which of the following BEST describes a full thickness burn? A. Mottled pink, or white immediately, usually dry, does not blanch B. Redness, no blisters, blanches C. Leathery, gray/black wound D. Blisters with wet/pink - Correct Answer-C

Which blood product would you give if you needed to fix the patient's hemoglobin? A. Platelets B. FFP C. PRBC's - Correct Answer-C Which blood product would you give if the patient is bleeding from the nares and gums continuously? A. Platelets B. FFP C. PRBC's - Correct Answer-A Which blood product would you give if the patient needs volume? A. Platelets B. FFP C. PRBC's - Correct Answer-B Which of the following products is richest in fibrinogen? A. Albumin B. Whole blood C. Cryoprecipitate D. Fresh frozen plasma - Correct Answer-C

When should you administer platelets during the resuscitation of a trauma patient? A. Deferred until you have the coagulation tests back from lab B. Initiated simultaneously with the administration of PRBC's C. You only need to if your patient is on a blood thinner D. Reserved only for patients with 40% or greater blood volume loss - Correct Answer-B Which patient should NOT receive whole blood? A. 36 year old male with a GSW B. 52 year old female with a grade IV liver laceration C. 3 year old with open femur fracture D. 14 year old male with pelvic fracture from a bicycle crash - Correct Answer-C When assessing a neurologically impaired patient, which of the following is the most helpful to identify the patient's issue? A. Head CT B. MRI C. Neuro exam D. EEG - Correct Answer-C

A patient has widespread hemiplegia and decreased sensation on the entire left side of their body. Does this indicate an issue with the central nervous system or the peripheral nervous system? A. Central nervous system B. Peripheral nervous system - Correct Answer-A Which cranial nerve assesses for facial symmetry when you ask a patient to smile? A. 4 B. 5 C. 7 D. 9 - Correct Answer-C Which cranial nerve assesses for facial sensation when you touch their cheeks? A. 4 B. 5 C. 7 D. 9 - Correct Answer-B When asking a patient to stick out their tongue, which cranial nerve are you assessing? A. 4

B. 5

C. 7

D. 9 - Correct Answer-D A patient who received 27% total body surface area burns in a house fire was directly admitted to a burn unit. Which of the following findings is the most sensitive early indicator of inhalation injury? A. Hoarse voice B. Cyanotic oral mucosa C. Lethargy D. Singed eyebrows - Correct Answer-A In the intermediate phase of burn care, patients are at greatest risk for complications related to: A. Silver sulfadiazine (silvadene) toxicity B. Iatrogenic infections C. Altered capillary permeability D. Curling's ulcer formation - Correct Answer-C A patient with major thermal burns needs a large volume of IV fluids during the initial 24 hours. Regardless of the calculation formula selected, fluid administration in adults is most appropriately titrated to: A. Central venous pressure, with a goal of 5-8 mmHg

B. Urinary output, with a goal of 0.5-1.0 mL/kg/hr C. Mean arterial pressure, with a goal of 55 mg Hg D. Urinary output with a goal of 30-50 mL/hr - Correct Answer-B A patient who touched a live electrical wire is admitted for electrical burn treatment. The entire palmar surface of both hands are charred and dry. Anticipating fluid requirements for this patient, the nurse knows: A. To apply the Parkland burn fluid calculation formula B. The patient's palms represent 1% body surface area (BSA) C. To use the Consensus burn fluid calculation formula D. BSA calculations do not predict electrical burn fluid needs - Correct Answer-D Changes in a patient's ability to speak are often associated with an injury to what part of the brain? A. Frontal lobe B. Parietal lobe C. Broca's area D. Wernicke's area - Correct Answer-C A patient has slower, venous bleeding in the brain- what is the most common type of brain bleed that involves the veins? A. Subdural