TNCC 9th Edition TNP

SPECIAL POPULATIONS/LGTBQ+

A person who is in the process of transitioning from male to female will usually be taking female hormones such as estrogen/estradiol to assist with the transition. This can cause a decrease in muscle mass, increased risk of thromboembolism, and possibly increased bone density. These patients would not be taking testosterone.

PRIMARY ASSESSMENT/INITIAL ASSESSMENT

Approximately one third of trauma patients arrive in the emergency department with some degree of coagulopathy due to depletion of clotting factors from whole blood loss. Some may also have been on medications that can impair platelet function or anticoagulation prior to their injury.

-During which part of the primary survey would there be anticipation for intubation, insertion of OPA/NPA, removal of any loose teeth or foreign objects, or suctioning?

Assessing patency and protection of the airway, Step 7 of "Alertness and Airway with Simultaneous Cervical Spinal Stabilization"

Which of the following situations could cause functional grief? A.Inability to live at home B.Amputation of a limb C.Loss of one's self-image D.Destruction of the patient's car

B.Amputation of a limb

An unconscious patient arrives following a motor vehicle collision. The patient is on a backboard with a cervical collar in place and one intravenous line running. Respirations are shallow and there is active brisk bleeding from a large leg wound. What is the priority intervention for this patient? A.Check for a patent airway B.Control the bleeding C.Start a second intravenous line D.Ventilate with a bag-mask device

B.Control the bleeding

When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns? A.As soon as the patient arrives B.During the secondary survey C.Should only be done at a burn center D.During the primary survey

B.During the secondary survey

*A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? A.Oculomotor nerve palsy B.Globe rupture C.Retrobulbar hematoma D.Retinal detachment

B.Globe rupture

Treatment for frostbite can include which of the following interventions? A. Warm the affected part over 30 to 60 minutes B. Use gentle friction to improve circulation C. Administer tissue plasminogen activator D. Drainage of all large and small blisters

C. Administer tissue plasminogen activator With frostbite, thrombus formation is a risk. Tissue plasminogen activator, a thrombolytic medication, has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming.

*While caring for a child who has been injured, what nursing intervention is consistent with a family-center approach? A.Identifying a single family member to speak with B.Having the family make all the care decisions C.Allowing family to participate in the care of the patient D.Limiting dissemination of complex information

C.Allowing family to participate in the care of the patient

*A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention? A.Initiate two intravenous access sites B.Place the patient on supplemental oxygen C.Apply direct pressure to the wound D.Use a tourniquet to control the bleeding

C.Apply direct pressure to the wound

A severely injured patient has been intubated and is being mechanically ventilated. The patient has received a balanced resuscitation including multiple blood products. Under which circumstance will it be harder for the hemoglobin to release oxygen to the tissues? A.Decreased pH B.Elevated carbon dioxide level C.Decreased body temperature D.Increased metabolic demand

C.Decreased body temperature

*A trauma patient is being held in the emergency department because there are no available inpatient beds. The patient sustained a femur fracture and required multiple blood products. The patient now has blood oozing from abrasions, IV sites, the nose, and gums. What condition is most consistent with these findings?

C.Disseminated intravascular coagulopathy

A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention? A.Elevating the leg above the level of the heart B.Repositioning the leg and applying ice C.Elevating the leg to the level of the heart D.Preparing the patient for ultrasound of the leg

C.Elevating the leg to the level of the heart

*A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most likely an indication of the body's response to these findings? A.Reflex hypotension B.Increased respiratory effort C.Reflex tachycardia D.Widening pulse pressure

D.Widening pulse pressure

-What are examples of nonpharmacologic measures? (must identify at least one during testing)

Distraction, family presence, padding bony prominences, repositioning, splinting, verbal reassurance

-When should 2 IV sites be established?

During "Circulation" assessment

-What three items are obtained during the pertinent history assessment?

Medical records, prehospital report, SAMPLE

-For whom is capnography highly recommended?

all patients

-If the patient is intubated and you've already assessed ETT placement, what else needs to be done with the ETT? (step 10)

assess ETT position by noting the number at teeth/gums AND secure ETT

-What is sometimes deferred at the end of the head-to-toe?

inspecting posterior

-What do you do when alterations are identified in any of the steps in the primary survery?

intervene as appropriate and reassess

—What does the J stand for at the end of the secondary survery?

just keep evaluating - vipp

-What should you verbalize after completing all ETT assessments?

moving patient from assisted ventilation to mechanical

An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The patient was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness and a hematoma is noted to the forehead. The patient is currently on anticoagulant therapy. What is most likely the cause of their symptoms? A.Intracerebral hemorrhage B.Epidural hematoma C.Diffuse axonal injury D.Post-concussive syndrome

post-concussive syndrome

If c-spine stabilization is necessary, what need should be stated?

the need for a second person to provide manual c-spine stabilization

—During the head-to-toe, where would you find Cullen's sign?

umbilicus

While caring for a trauma patient in the emergency department, what finding raises suspicion of a complete spinal cord injury? A.Weakness in the lower extremities B.Urinary incontinence C.Sacral sparing D.Spastic paralysis of the legs

urinary incontinence

—What does VIPP stand for?

vital signs, injuries/interventions, primary survey, pain

*An adult pedestrian was struck on the right side by a sport utility vehicle traveling at 40 mph. The patient is awake and alert and the right leg is shortened. Following initial resuscitation with fluids, the patient remains hypotensive. What would be the priority intervention? A.Send blood for type and crossmatch B.Apply a pelvic binder C.Prepare the patient for surgery D.Insert a urinary catheter

B.Apply a pelvic binder

A trauma patient who is 30-weeks pregnant arrives at the emergency department following a motor vehicle collision. Which normal physiologic change should be considered when assessing ventilatory status? A.Increased functional reserve capacity B.Increased oxygen consumption C.Decreased minute ventilation D.Slower desaturation rates with apnea

B.Increased oxygen consumption

*Which of the following is a late sign of increased intracranial pressure? A.Restlessness B.Vomiting C.Decreased respiratory effort D.Narrowing pulse pressure

C.Decreased respiratory effort

A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. The patient is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? A.Needle decompression B.Tube thoracostomy C.Dressing removal D.Surgical repair

C.Dressing removal

An adult patient involved in a motor vehicle collision is brought to the emergency department of a rural critical access facility. They complain of neck pain, shortness of breath, and diffuse abdominal pain. The Glasgow Coma Score is 15. Vital signs are: BP 98/71 mm Hg, HR 125 beats/minute, RR 26 breaths/minute, and SpO2 94% on high-flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient?

C.Expedite transfer to the closest trauma center

-During which part of the primary survey would you anticipate the need for a chest tube, intubation, decompression of pneumothorax, oxygen, or BVMs?

"Breathing and Ventilation"

-What three assessments must be done if the patient is intubated?

1. attach CO2 detector and assess for evidence of exhaled CO2; 2. observe for rise and fall of the chest w/ assisted ventilations; 3. auscultate over epigastrium for gurgling AND lungs for bilateral breath sounds

-To assess circulation, you must do these two main tasks:

1. inspect AND palpate skin color, temp, moisture and 2. palpate a pulse

Which of the following accurately describes ventilation principles associated with use of a bag-mask device for an adult? A. Compress the bag-mask device at a rate of one breath every 6 seconds B. Delivers 100% oxygen C. Squeeze the bag-mask device completely for each breath D. Maintain the oxygen saturation levels between 92% and 94%

A. Compress the bag-mask device at a rate of one breath every 6 seconds

*A patient is thrown against a car during a tornado and presents with obvious bilateral femur fractures. The patient is pale, alert, disoriented, and has delayed capillary refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principles? A.Initiate two large-caliber intravenous lines for isotonic crystalloid administration. B.Administer intravenous medications for pain. C.Place the patient in an observation area for care within the next few hours D. Cotnact the command center for personnel to notify next of kin

A.Initiate two large-caliber intravenous lines for isotonic crystalloid administration.

A patient is brought to the emergency department following a snowmobile crash with prolonged exposure time prior to transport. The patient is confused. Vital signs are BP 96/54 mm Hg, HR 114 beats/minute, RR 24 breaths/minute, T 34.6oC (94.2oF) and an SpO2 of 90% on oxygen at 15L per non-rebreather mask. Other findings include ETCO2 24, serum lactate of 6 mmol/L, and a pH of 6.8. Based on these findings, what is the most appropriate intervention? A.Initiate warming measures B.Titrate oxygen to 6L per nasal cannula C. Bolus with 500mL isotonic crystalloids D. Vigorously massage the extremities

A.Initiate warming measures

*A 5-year-old child presents to the emergency department 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 maltreatment in accordance with local regulations

What position optimizes ventilation in the obese patient with a lumbar fracture? A.Reverse Trendelenburg B.Supine C.Prone D.Fowler's

A.Reverse Trendelenburg

-Antibiotics, consults, head CT, imaging, law enforcement, mandatory reporting, psychosocial support, social services, splinting, tetanus, and wound care are all interventions that you do AFTER and before WHAT?

AFTER head-to-toe, BEFORE J (VIPP)

What is the appropriate technique for palpating the pelvis for stability?

B. Apply gentle pressure over the iliac crests, downward and medially

Which of the following is true about use of the focused assessment sonography for trauma exam for a patient with abdominal trauma? A.It has a higher sensitivity than diagnostic peritoneal lavage for fluid detection B.It can be used in hypotensive patients too unstable for computed tomography scan C.It can detect as little as 30 mL of fluid in the abdominal cavity D.It has high sensitivity in pediatric patients for identifying fluid in the peritoneum

B.It can be used in hypotensive patients too unstable for computed tomography scan

A patient is diagnosed with a T12 spinal cord injury following a 20-foot fall. Which finding is consistent with spinal shock? A.Bradycardia B.Loss of reflexes C.Widened pulse pressure D.Warm skin

B.Loss of reflexes

What is the priority intervention for a child who has been diagnosed with an atlanto-occipital dislocation following a high-speed motor vehicle collision? A.Initiating a second large caliber intravenous line B.Maintaining spinal motion restriction C.Placing the patient on pulse oximetry D.Turning the patient to remove the backboard

B.Maintaining spinal motion restriction

*What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries? A.They are likely to be fearful in the emergency department B.Medical history including current medications C.Availability of support systems after discharge D.Accessibility to a primary care physician

B.Medical history including current medications

*Your patient is a pedestrian struck by a car and thrown 35 feet. They were unconscious at the scene but became responsive with initial and subsequent Glasgow Coma Scale (GCS) scores of 13 (E-3, V-4, M-6). The patient has bilateral subdural hematomas and is awaiting transfer to the ICU. Your next assessment reveals a GCS of 9 (E-2, V-2, M-5). What is the priority nursing intervention? A. Hold all pain medication B. Notify the provider of the change C. Repeat the GCS in 30 minutes D. Place the patient in Trendelenburg position

B.Notify the provider of the change

What is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient? A.Measures oxygenation and ventilation B.Assesses the degree of alkalosis and base deficit C.Gauges end-organ perfusion and tissue hypoxia D.Determines the underlying cause of shock

C.Gauges end-organ perfusion and tissue hypoxia

The trauma nurse is caring for an unrestrained driver who struck their head on the windshield following a high-speed MVC. The patient has been diagnosed with an anterior spinal cord injury at the level of C6. Which assessment finding would be most concerning? A.Distension of the bladder B.Incontinence of stool C.Increasing work of breathing D.Inability to move the legs

C.Increasing work of breathing

*A driver involved in a high-speed motor vehicle collision arrives in the emergency department. The vehicle's air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain with ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. Which of the following is the most appropriate intervention for this patient?

C.Inotropic support

Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about injury to which organ? A.Transverse colon B.Pancreas C.Liver D.Spleen

C.Liver

*An obese trauma patient requires intubation. Assuming there are no contraindications, which position will provide the best visualization for insertion of the endotracheal tube? A.Reverse Trendelenburg B.Lying on side C.Ramped D.Supine

C.Ramped

*An adult was thrown against a concrete wall during a factory explosion and sustained a femur fracture, liver laceration, and a small subdural hematoma. These injuries most likely occurred during what level of blast trauma? A.Primary B.Secondary C.Tertiary D.Quaternary

C.Tertiary

An adult patient was brought to the emergency department following a motorcycle crash. On arrival, the patient is only responsive to pain, has bleeding from the nose, and multiple abrasions and contusions to the face. What is the priority intervention? A.Use a bulb syringe to suction out secretions from the mouth. B.Insert a nasopharyngeal airway to maintain an open airway. C.Use a jaw thrust to open the airway and look for signs of obstruction. D.Ask the patient to open their mouth to inspect

C.Use a jaw thrust to open the airway and look for signs of obstruction.

*A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate sacral sparing? A.Involuntary flexion of the great toe B.Priapism C.Voluntary anal sphincter tone D.Numbness to the perianal area

C.Voluntary anal sphincter tone

*Following a motor vehicle collision, a patient presents with decreased level of consciousness and snoring restorations. It has been determined that it is safe to insert a nasopharyngeal airway. What is most important to consider when preparing to insert the nasopharyngeal airway? A. Measurement should go from bridge of nose to mandible B. Use the smallest diameter that is easy to insert C. It can only be inserted in an unconscious patient D. Improper sizing can cause gastric distention

D. Improper sizing can cause gastric distention

A teenaged patient presents to the emergency department with left arm pain after a grand level fall. The patient identifies as transgender and shares that they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is most consistent with human trafficking? A. The individual appears well nourished B. Those who are being trafficked rarely seek medical care. C. It is infrequently associated with substance abuse D. Those experiencing human trafficking rarely self-disclose

D. Those experiencing human trafficking rarely self-disclose

What is the lead cause of preventable death for the trauma patient in the prehospital environment? A. Airway compromise B. Ineffective ventilation C. Secondary head injury D. Uncontrolled external hemorrhage

D. Uncontrolled external hemorrhage Uncontrolled external hemorrhage is the leading cause of preventable death after injury in the prehospital environment; assessment to identify uncontrolled external hemorrhage is key to the initial assessment process, beginning with the general impression.

Following a gun shot wound, pre-hospital providers report diminished breath sounds bilaterally. Upon emergency department arrival, the patient is unresponsive with shallow respirations and an O2 sat of 88%. What is the priority intervention for this patient? A.Administer 15 L oxygen via nonrebreather mask B.Attach patient to a CO2 detector C.Prepare for a definitive airway D.Assist ventilation with a bag-mask device

D.Assist ventilation with a bag-mask device

*A patient who sustained severe injuries was brought to the emergency department following a high-speed motor vehicle collision. Interventions for hypovolemic shock have been initiated. What component of the trauma triad of death is most likely to have begun at the time of injury?

D.Coagulopathy

During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing intervention should be performed next? A.Open the airway with the head-tilt/chin-lift maneuver B.Auscultate bilateral breath sounds C.Assist respirations using a bag-mask device D.Insert an oropharyngeal airway if there is no gag reflex

D.Insert an oropharyngeal airway if there is no gag reflex

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

It should be avoided with a suspected spine injury prior to imaging

PRIMARY ASSESSMENT/SHOCK

Patients in decompensated (also known as progressive) shock exhibit a deteriorating level of consciousness, hypotension, narrowing pulse pressure, and clammy, cyanotic skin

HEAD AND TORSO TRAUMA/THORACIC AND NECK TRAUMA

Positive pressure ventilation in a patient with even a small pneumothorax can increase the risk of worsening the pneumothorax, or possibly developing a tension pneumothorax. Increasing respiratory distress along with severely diminished of absent breath sounds on the affected side would be noted.

PRIMARY ASSESSMENT/AIRWAY AND VENTILATION

Pre-oxygenation for at least 3 minutes (not 1 minute) with high flow oxygen prior to intubation attempts, prolong the time to hypoxia when bag-mask ventilations are stopped for insertion of the endotracheal tube

The vital signs of a pregnant trauma patient at 30 weeks include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? a. Decompensated shock b. Normal vital signs in pregnancy c. Compensated shock d. Supine hypotension syndrome

b. Normal vital signs in pregnancy In pregnancy, the resting heart rate increases by 10 to 20 beats/minute. This is also a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance. Normal fetal heart rate is between 120 and 160 beats/minute

-In Step 16 of "Exposure and Environment", you must name at least one of these interventions:

blankets, room temp increase, warmed fluids, warming lights

-Four of these must be identified to assess patency and protection of the airway:

bony deformity, loose teeth, edema, inhalation injury, sounds, tongue obstruction, burns, fluids, foreign objects, vocalization

-What can be applied in step 12 of "Circulation and Control of Hemorrhage" for which credit is given in the LMNOP section?

cardiac monitor

—During the head-to-toe, where would you find Grey-Turner's sign?

flank

Understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma care provider in which of the following? A. Anticipating the types of injuries the may be present B. Deciding whether law enforcement should be notified C. Determining needed laboratory tests D. Predicting the need for a surgical procedure

A. Anticipating the types of injuries the may be present Mechanism of injury and energy transfer can assist the provider in anticipating and evaluation the types of injuries that may be present and their severity.

A trauma patient is restless and repeatedly asking "Where am I?" Vital signs upon arrival were BP 110/60 mmHg, HR 96 beats/minute, and RR 24 breaths/minute. Skin is cool and moist. Current vital signs are BP 86/68 mmHg, HR 118 beats/minute, and RR 28 breaths/minute. The patient is demonstrating signs and symptoms of which stage of shock? A. Compensated B. Refractory C. Irreversible D. Decompensated

A. Compensated

An adult patient sustained a knife injury to the neck. The airway is intact and the patient is hemodynamically stable. They complain of difficulty swallowing and speaking. What is the most likely cause of these symptoms? A. Damage to the cervical spine B. An expanding pneumothorax C. Laceration of the carotid artery D. Injury to the thyroid gland

A. Damage to the cervical spine Penetrating neck trauma may include concurrent injuries to the cereal spine and cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the cervical spine

A patient is brought to the emergency department of a rural hospital, following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what is the priority intervention? A. Initiate transfer to a trauma center B. Attempt family notification C. Obtain additional imaging studies D. Place an indwelling urinary catheter

A. Initiate transfer to a trauma center

A patient with a spinal cord injury at C5 is being cared for in the emergency department while awaiting transport to a trauma center. Which of the following represents the highest priority for ongoing assessment and management for this patients? A. Maintain adequate respiratory status B. Administer balanced resuscitation fluid C. Perform serial assessments of neurologic function D. Maintain core temperature

A. Maintain adequate respiratory status Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function, resulting in paralyzed diaphragm and inability to breathe. Maintenance of respiratory function is the highest priority.

*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 a future disaster. Which phase of the disaster life cycle does this describe? A. Mitigation B. Preparedness C. Response D. Recovery

A. Mitigation Mitigation involves many facets including an initial hazard vulnerability analysis to help recognize potential issues for a particular community. This is different for each area of the country and can involve technological concern, man-made structures, natural geographic landscapes, and potential hazardous materials.

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. Stabilize the cervical spine B. Applying a nonrebreather mask C. Establishing intravenous access D. Preparing for drug-assisted intubation

A. Stabilize the cervical spine

A trauma nurse cared for a child with devastating burns two weeks ago. The nurse called in sick for a couple of days and is now back working on the team. Which of the following behaviors would indicate this nurse is coping well? A. They are talking about taking the emergency nursing certification examination B. They keep requesting to be assigned to the walk-in/ambulatory area C. They are impatient and snap at their coworkers D. They are thinking about transferring out of the emergency department

A. They are talking about taking the emergency nursing certification examination This is an indication the nurse is taking positive steps to advance their own practice, a sign of resilience.

An unresponsive patient has an oropharyngeal airway in place, sallow and labored respiration, and dusky skin. Medication for drug-assisted intubation, including a paralytic agent, have been administered but intubation was unsuccessful. What is the most appropriate next step? A. Ventilate with a bag-mask device B. Prepare for a cricothyroidectomy C. Administer reversal medications D. Contact anesthesia for assistance

A. Ventilate with a bag-mask device

???*Using the American College of Surgeons screening guidelines, what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? A.Alert with no neurologic deficits or neck pain B.Multiple abrasions to the extremities C.Ecchymosis to the flank D.Responds to verbal stimulation using AVPU

A.Alert with no neurologic deficits D.Responds to verbal stimulation using AVPU Clinical decision tools are available to assess the patient's need for cervical spine imaging following suspected spinal cord trauma: The Canadian C-Spine Rule, the National Emergency X-Radiography Utilization Study (NEXUS), and the American College of Surgeons have cervical spine screening guidelines. All tools and guidelines require the patient to be awake, alert, (A on the AVPU) not under the influence of any substances, and without neurological abnormalities.

A patient is brought to the emergency department with chest pain and shortness of breath following a high-speed motor vehicle collision in which they were the unrestrained driver. There is crepitus to the left chest with clear and equal breath sounds. The vital signs are BP 80/40 mmHg, HR 140 beats/minute, and RR 40 breaths/minute. Cardiac monitor shows sinus tachycardia with premature ventricular contractions. These findings are most consistent with which type of shock? A.Cardiogenic B.Neuroge

A.Cardiogenic

*An adult patient who sustained a severe head trauma has been intubated and is being manually ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to manage the cerebral blood flow?

A.Decrease the rate of manual ventilation.

HEAD AND TORSO TRAUMA/THORACIC AND NECK TRAUMA

Assessment findings associate with tension pneumothorax include anxiety, severe restlessness, severe respiratory distress, absent breath sounds on the injured side, and hypotension due to compression of the heart and great vessels.

A patient fell two weeks ago, striking his head. He came to the emergency department with a persistent headache and nausea. He was diagnosed with a small subdural hematoma and has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports he has been anxious, restless, and shaky. he vomited twice during the night. He tells the day shift nurse he couldn't sleep because a young child kept coming into his room. What is a likely cause for these signs and symptoms? A. Increased intracranial pressure B. Alcohol withdrawal C. Rhabdomyolysis D. Pulmonary embolus

B. Alcohol withdrawal Alcohol withdrawal is a common delayed condition because symptoms are difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures.

A 36-year-old patient has a deformity of the left wrist after a fall. The patient is reluctant to move their hand due to pain. Which of the following is the most appropriate intervention? A. Apply a sling and elevate the extremity to the level of the heart B. Apply a splint and elevate the extremity above the level of the heart C. Apply a sling and elevate the extremity above the level of the heart C. Apply a splint and elevate the extremity to the level of the heart

B. Apply a splint and elevate the extremity above the level of the heart

*A patient presents with chest pain and shortness of breath, following a motor vehicle collision. An electrocardiogram shows sinus tachycardia and ischemic changes within an elevated troponin. The nurse should be highly suspicious for which injury?

B. Blunt cardiac injury

A patient involved in a MVC has sustained a fracture to the second rib of the anterior left chest. Which concurrent injury is most commonly associated with this fracture? A. Blunt Cardiac Injury B. Brachial plexus injury C. Pneumothorax D. Hemothorax

B. Brachial plexus injury First and second rib fractures are most commonly associated with great vessel, head and spinal cord, and brachial plexus injuries.

A patient who jumped out of a second floor window, landing on their feet is diagnosed with a lumbar spinal fracture. What is the most likely concurrent injury to have occurred? A. Patella fracture B. Calcaneus fracture C. Odontoid fracture D. Distal radius fracture

B. Calcaneus fracture

In a motor vehicle collision, which injury pathway is most likely to increase the patient's morbidity and mortality? A. Rotational B. Ejection C. Lateral D. Rollover

B. Ejection

*A patient has been in the emergency department for several hours waiting to be admitted. They sustained multiple rib fractures and a femur fracture after a fall. The patient has been awake, alert, and complaining of leg pain. Their spouse reported that the patient suddenly became anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions? A. Acute lung injury B. Fat embolism C. Pneumothorax D. Pulmonary contusion

B. Fat embolism

A patient arrives with a 3-inch laceration to their forearm from a tree branch. Which of the following methods will the nurse use to remove small piles of debris from the wound? A. Low pressure irrigation B. High pressure irrigation C. Scrubbing with normal saline D. Scrubbing with tap water

B. High pressure irrigation High-pressure irrigation is the best method to remove smaller contaminants and bacteria from a wound. Low pressure can be used for larger contaminants.

An adult patient weighing 75 kg sustained partial and full thickness burns to 32% of their body 2 hours prior to arrival. Intravenous fluid resuscitation was calculated to be 400 mL/hour. The urine output over the last hour was 15 mL. What intervention should the nurse anticipate? A. Add blood products to the resuscitations B. Increase isotonic crystalloid infusion rate C. Administer an intravenous diuretic D. Switch to a hypertonic saline solution

B. Increase isotonic crystalloid infusion rate

A patient arrives at the emergency department by private vehicle after sustaining an injury to the right lower extremity while using a saw. There is a large gaping wound to the right thigh area with significant bleeding. What is the priority intervention? A. Elevate the extremity to the level of the heart B. Initiate direct pressure C. Apply a tourniquet D. Cover the ope wound with sterile saline dressings

B. Initiate direct pressure The first step in controlling any bleeding is application of direct pressure.

*Which blood pressure finding is associated with early or compensated hypovolemic shock?

B. Rising diastolic In the compensated stage of shock, the diastolic blood pressure rises causing a narrowed pulse pressure in a attempt to compensate for compromised circulation. Systolic blood pressure is usually within a normal range.

Following a bomb explosion, fragmentation injuries from the bomb or objects in the environment are examples of which phase of injury? A. Primary B. Secondary C. Tertiary D. Quaternary

B. Secondary The primary phase of a blast results from impact of the pressurization wave on body surfaces. injuries include blast lung, tympanic membrane rupture, abdominal hemorrhage, globe rupture, and mild traumatic brain injury. The secondary phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries. The tertiary phase of a blast results from individuals being thrown b the blast and impacting walls, ground, or any hard object The quaternary phase of blast results from any explosion-related illness or injury including hyperglycemia, hypertension, angina, asthma, CPOD, or sepsis.

Based on fall mechanism, which patient warrants prehospital transfer to a trauma center? A.A 35-year-old lands on a wooden porch from an 8-foot ladder B.A 2-year-old lands on grass from a second-story balcony C.A 14-year-old forcefully pushed onto cement from standing D.A 50-year-old lands on a carpeted floor after tripping

B.A 2-year-old lands on grass from a second-story balcony

A patient involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small penetrating wound to the sixth intercostal space in the left lateral chest. Which finding is most consistent with an injury to the diaphragm?

Bowel sounds heard in the left lower chest A ruptured diaphragm is a potentially life-threatening injury. The patient will most likely have decreased breath sounds on the affected side along with pain, which may radiate to the left shoulder. However, these signs do not specifically implicate an injury to the diaphragm. Auscultation of bowel sounds in the chest indicates that abdominal contents have herniated up into the chest through a defect in the diaphragm.

-Four of these must be identified to assess breathing effectiveness:

Breath sounds, depth/pattern/rate, spontaneous breathing, subcutaneous emphysema, increased work of breathing, symmetrical chest rise and fall, tracheal deviation/JVD, open wounds/deformities, skin color

What is the best measure of the adequacy of cellular perfusion and can help to predict the outcome of resuscitation? A. End-tidal carbon dioxide B. Hematocrit level C. Base deficit D. Oxygen saturation

C. Base deficit Base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and, when used in conjunction with serum lactate, helps predict the success of the resuscitation

*An adult arrives at the emergency department with superficial burns to the extremities following a house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is the most likely cause of these symptoms? A. Capillary leak syndrome B. Rhabdomyolysis C. Carbon monoxide poisoning D. Hypothermia

C. Carbon monoxide poisoning

*Three adults present at different times during a one-hour period with a high fever, fatigue, and headache. All three patients have a rash which started on their mouth, face, and arms with progression to the chest and abdomen. They all visited the same grocery store within the last week. What is the most appropriate intervention from triage for these patients? A. Move them to a decontamination area B. Mask the patients and send them to the waiting room C. Immediately initiate isolation precautions D. Send them to the waiting room without a mask

C. Immediately initiate isolation precautions The fact that multiple people with different demographics are appearing with similar signs and symptoms would alert the nurse to a possible biological exposure. These patients should be placed in isolation to prevent possible spread until further determination can be made.

A patient has a closed fracture to the left lower leg. Which symptoms are consistent with compartment syndrome? A. Shortness of breath, tachypnea, petechieae B. Pain, numbness, bounding peripheral pulses C. Pain, diminished pedal pulse, pressure D. Erythema, warmth, pupura

C. Pain, diminished pedal pulse, pressure

*An adult patient involved in an assault presents with shortness of breath, BP 88/50 mmHg, heart rate of 130 beats/minute, and RR 32 breaths/minute. The patient has muffled heart sounds and is cyanotic. What is the priority intervention? A. Needle thoracotomy B. Chest tube insertion C. Pericardiocentesis D. Tracheal intubation

C. Pericardiocentesis

*An intubated trauma patient has just been transported back from CT scan. Upon arrival to their room in the emergency department, resistance is noted with bag-mask ventilations and auscultation reveals unequal breath sounds. What is the most appropriate initial intervention for this patient? A. Place the patient back on the ventilator B. Extubate the patient C. Reposition the endotracheal tube D. Suction the endotracheal tube

C. Reposition the endotracheal tube

The general impression step in the initial assessment provides the opportunity to do which of the following? A. Assess for uncontrolled internal hemorrhage B. Accurately triage the patient C. Reprioritize circulation before airway or breathing D. Activate the trauma team

C. Reprioritize circulation before airway or breathing The general impression is formed at the beginning o fate riorary survey to rapidly assess the need to reprioritize circulation before airway or breathing. this is done if uncontrolled external hemorrhage is identified.

*What is the best position for maintaining an open airway in the obese patient? A. Prone B. Supine C. Reverse Trendelenburg D. Right lateral recumbent

C. Reverse Trendelenburg

A patient is brought to the emergency department following a motor vehicle rollover and is complaining of left upper abdominal pain and left shoulder pain. This presentation is most consistent with an injury to which organ? A. Kidney B. Liver C. Spleen D. Pancreas

C. Spleen

*A patient who weighs 120 kg is brought to the emergency department after sustaining partial thickness burns to both upper extremities and chest with a total body surface area burned of 27%. How much intravenous fluid should be administered in the first 8 hours?

C.3240 mL (2ml LR x kg x %TBSA) = total volume in 24 hours. Half of calculated total should be given in first 8 hours.

A patient presents, after a 25-foot fall, with paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention? A. Surgical intervention B. Chest tube insertion C. Needle decompression D. Airway and ventilation support

D. Airway and ventilation support

*What technique is most appropriate when obtaining a history from a patient who has experienced a sexual assault? A. Sitting next to the patient B. Ensuring the patient answers all the questions C. Asking for information only related to the assault D. Applying active listening

D. Applying active listening Therapeutic communication techniques such as active listening decrease unintentional distress during the interaction

A patient with a complete spinal cord injury who is in neurogenic shock will demonstrate hypotension and which other clinical signs? A. Bradycardia and ipsilateral absence of motor function B. Tachycardia and respiratory depression C. Tachycardia and poikilothermia D. Bradycardia and absent motor function below the level of injury

D. Bradycardia and absent motor function below the level of injury

A patient has received multiple transfusions of banked blood in the past two hours. The patient has now developed muscle tremors and short runs of ventricular tachycardia. Which of the following medications does the nurse anticipate administering? A. Hypertonic saline B. Calcitonin C. Insulin and glucose D. Calcium Gluconate

D. Calcium Gluconate

In a patient with severe traumatic brain injury, hypocapnia causes which condition? A. Respiratory acidosis B. Metabolic acidosis C. Neurogenic shock D. Cerebral vasoconstriction

D. Cerebral vasoconstriction Hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the cerebral vasculature.

A patient with a chest tube is being transported to the intensive care unit and fluctuation is noted in the water seal chamber during inspiration and expiration. What is the best action for the nurse to take? A. Clamp the chest tube B. Return to the emergency department C. Assist ventilation with bag-mask device D. Continue to the intensive care unit

D. Continue to the intensive care unit

While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a sign of possible altered mental status? A. Sunken fontanel B. Crying, but consolable C. Spontaneous movement of arms and legs D. Cooperation with the assessment

D. Cooperation with the assessment An alert older infant or toddler will recognize their caregiver, be cautious of strangers, and may not respond to commands or cooperate, which are normal

Which o the following is considered a cornerstone of a high-performance trauma team? A. Individual goals B. Use of TeamSTEPPS C. Identification of a single decision maker D. Effective communication

D. Effective communication Skilled communication, cooperation, and coordination are the cornerstones of high-performance teams and high-quality trauma care

A seriously injured patient is noted to have a weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpation and blood at the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What is the priority diagnostic intervention? A. Retrograde urethrogram B. Plain pelvic radiographs C. Abdominal computerized tomography scan D. Focused assessment sonography for trauma

D. Focused assessment sonography for trauma

A patient arrives following prolonged exposure of their left hand to the cold. The patient is awake and alert and complains of a tingling sensation to the fingers. Assessment reveals swelling and bright red skin to the left hand and a 1-inch round clear blister to the dorsum of that hand. Which of the following nursing interventions is most appropriate for this patient? A.Massage the injured areas to promote circulation B.Drain and debride the blister on the hand C.Immerse in water between 37.5

D.Gently rewarm over 15 to 30 minutes

*A nurse verbalizes guilt and remorse after caring for multiple severely injured patients during a staffing crisis. The nurse expresses anger stating that the patients did not receive quality care and begins exhibiting aggression toward colleagues. This is most consistent with which condition?

D.Moral injury

A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which intervention is most appropriate for this patient? A.Remove the rod immediately to facilitate cleansing. B.Apply a tourniquet to the leg above the metal rod. C.Hold antibiotics until after the rod is removed. D.Prepare the patient for surgery to remove the rod.

D.Prepare the patient for surgery to remove the rod.

A restrained driver involved in a motor vehicle collision is brought to the emergency department with abdominal, pelvic, and bilateral lower extremity pain. Vital signs are BP 114/78 mm Hg, HR 98 beats/minute, RR 22 breaths/minute. A FAST exam is negative for fluid in the abdominal and peritoneal cavities. Which of the following should the nurse anticipate? A.Diagnostic peritoneal lavage B.Angiography C.Operative management D.Serial abdominal assessments

D.Serial abdominal assessments

HEAD AND TORSO TRAUMA/HEAD TRAUMA

Diffuse axonal injury (DAI) is widespread microscopic damage, primarily to the axons. DAI results from diffuse shearing, tearing, or compressive stresses from a rational or acceleration/deceleration mechanism of injury. Deeper brain structures, the brain stem, and the reticular activating system are most at risk for injury. Assessment findings can include unconsciousness, abnormal motor posturing, signs of increased ICP, hyperthermia, and excessive sweating.

PRIMARY ASSESSMENT/SHOCK

Diltiazem is a calcium channel blocker and in combination with the citrate used as a preservative in blood products, put the patient at a higher risk for significant hypocalcemia and cardiac dysrhythmias.

-In step M of "Get Adjuncts", what else might be indicated besides cardiac monitor?

EKG

PRIMARY ASSESSMENT/AIRWAY AND VENTILATION

If the blood is not sufficiently warmed when transfused, it can produce hypothermia. In the oxyhemoglobin dissociation curve, a shift to the left increases the affinity of hemoglobin for oxygen making it harder to release for use by the tissues. Factors that can cause this shift include an elevated pH, decreased carbon dioxide, decreased temperature, and low metabolic demand.

PRIMARY ASSESSMENT/SHOCK

This patient has signs of hypovolemic shock from a probable closed femur fracture. The patient needs fluid resuscitation while maintaining a minimum urine output of 0.5 mL/kg/hour which is a good indicator or adequate fluid resuscitation and end organ perfusion