Trauma Questions

During the assessment of a patient after a high-speed motor vehicle crash, which of the following findings would increase the nurse's suspicion of a pulmonary contusion? (Select all that apply.) a. chest wall ecchymosis b. signs of hypoxia on room air c. diminished or absent breath sounds d. pink-tinged or blood secretions e. fractured ribs

a. chest wall ecchymosis b. signs of hypoxia on room air d. pink-tinged or blood secretions e. fractured ribs

During the treatment and management of the trauma patient, maintaining tissue perfusion, oxygenation, and nutritional support are strategies to prevent what potential complication? a. DIC b. MODS c. septic shock d. wound infection

b. MODS

A burn patient in the rehabilitation phase of injury is increasingly anxious and unable to sleep. The nurse should consult with the provider to further assess the patient for what possible mental health condition? a. bipolar disorder d. suicidal ideations c. acute delirium d. PTSD

PTSD

Nursing priorities to prevent ineffective coagulation include which of the following? (Select all that apply.) a. administration of calcium as ordered b. administration of potassium as ordered c. administration of fresh frozen plasma as ordered d. prevention of hypothermia e. prevention of infection

a. Administration of calcium as ordered c. Administration of fresh frozen plasma as ordered d. Prevention of hypothermia

The nurse is caring for patient who has been struck by lightning. Because of the nature of the injury, the nurse assesses the patient for which possible complication? a. CNS deficits b. contractures c. infection d. stress ulcers

a. CNS deficits

When paramedics report singed hairs in the nose of a burn patient, it is recommended that the patient be intubated. What is the reasoning for the immediate intubation? a. Inhalation injury above the glottis may cause significant edema that obstructs the airway b. The patient will have a copious amount of mucus that will need to be suctioned. c. Carbon monoxide poisoning always occurs when soot is visible. d. The singed hairs and soot in the nostrils will cause dysfunction of cilia in the airways.

a. Inhalation injury above the glottis may cause significant edema that obstructs the airway

Which of the following findings require immediate nursing interventions related to the assessment of a patient with a traumatic brain injury? (Select all that apply.) a. MAP 48 mmHg b. RR of 10 breaths/min c. Hx of PTSD d. non-reactive pupils e. elevated serum blood alcohol level

a. MAP 48 mmHg b. RR of 10 breaths/min d. non-reactive pupils

The nurse is having difficulty inserting a large caliber intravenous catheter to facilitate fluid resuscitation to a hypotensive trauma patient. The nurse recommends which of the following emergency procedures to facilitate rapid fluid administration? a. Placement of an intraosseous catheter b. Placement of a central line placement c. Insertion of a femoral catheter by a trauma surgeon d. Rapid transfer to the operating room

a. Placement of an intraosseous catheter

The nurse is caring for a patient who has undergone skin grafting of the face and arms for burn wound treatment. What is a primary nursing diagnosis for this patient? a. body image disturbance b. altered nutrition, less than body requirements c. decreased cardiac output d. fluid volume deficit

a. body image disturbance

It is important to prevent hypothermia in the trauma patient because hypothermia is associated with which of the following? (Select all that apply.) a. coagulopathies b. reduced tissue perfusion c. acute respiratory distress syndrome (ARDS) d. dysrhythmias e. myocardial dysfunction

a. coagulopathies b. reduced tissue perfusion d. dysrhythmias e. myocardial dysfunction

Which of the following patients would require greater amounts of fluid resuscitation to prevent acute kidney injury associated with rhabdomyolysis? (Select all that apply.) a. crush injury to the right arm b. gunshot wound to the abdomen c. second degree to 40% d. lightning strike of the left arm and chest e. pulmonary contusion and rib fracture

a. crush injury to the right arm b. gunshot wound to the abdomen d. lightning strike of the left arm and chest

Which of the following factors increase the burn patient's risk for venous thromboembolism? (Select all that apply.) a. delayed fluid resuscitation b. electrical burn injury c. burn injury less than 10% d. bedrest e. burns to lower extremities

a. delayed fluid resuscitation d. bedrest e. burns to lower extremities

Which interventions can the nurse implement to assist the patient's family in coping with the traumatic event? (Select all that apply.) a. establish a family spokesperson b. provide an effective communication system between the staff and family c. coordinate a family conference d. limit visitation to set times throughout the day e. ask the family about their normal coping mechanisms

a. establish a family spokesperson b. provide an effective communication system between the staff and family c. coordinate a family conference e. ask the family about their normal coping mechanisms

An autograft is used to optimally treat a partial- or full-thickness wound that meets what criteria? (Select all that apply.) a. involves a joint b. involves the face, hands, or feet c. is infected d. involves very large surface areas e. requires more than 2 weeks for healing

a. involves a joint b. involves the face, hands, or feet e. requires more than 2 weeks for healing

An 18-year-old unrestrained passenger who sustained multiple traumatic injuries from a motor vehicle crash has a blood pressure of 80/60 mm Hg at the scene. This patient should be treated at which level trauma center? a. level I b. level II c. level III d. level IV

a. level I

The nurse is caring for a patient who sustained rib fractures after hitting the steering wheel of a car. The patient is spontaneously breathing and receiving oxygen via a face mask; the oxygen saturation is 95%. During the nurse's assessment, the oxygen saturation drops to 80%. The patient's blood pressure has dropped from 128/76 mm Hg to 84/60 mm Hg. The nurse assesses that breath sounds are absent throughout the left lung fields. The nurse notifies the physician and anticipates what prescribed intervention? a. needle thoracotomy and chest tube insertion b. ET tube and mechanical ventilation c. administration of LR solution (1 L) wide open d. chest XR study to determine the etiology of the symptoms

a. needle thoracotomy and chest tube insertion

What is the priority nursing intervention for a patient who experienced a chemical burn injury? a. remove the pt's clothes and flush the area with water b. remove all jewelry c. contact a poison control center for directions on neutralizing agents d. apply saline compresses

a. remove the pt's clothes and flush the area with water

Which complication may manifest after an electrical injury? (Select all that apply.) a. seizures b. acute cataract formation c. peptic ulcer disease d. dark brown urine e. long bone fractures f. cardiac dysrhythmias g. HTN h. compartment syndrome of extremities

a. seizures b. acute cataract formation d. dark brown urine e. long bone fractures f. cardiac dysrhythmias h. compartment syndrome of extremities

The need for fluid resuscitation can be assessed best in the trauma patient by monitoring and trending which of the following tests? a. serum lactate levels b. MAP c. hourly urine output d. arterial oxygen saturation

a. serum lactate levels

The patient asks the nurse if the placement of the autograft over a full-thickness burn will be the only surgical intervention needed to close the wound. What is the nurse's best response? a. "An autograft is a biological dressing that will eventually be replaced by your body generating new tissue." b. "Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound." c. "Unfortunately, autografts frequently do not adhere well to burn wounds and a xenograft will be necessary to close the wound." d. "Unfortunately, an autograft skin is a temporary graft and a second surgery will be needed to close the wound."

b. "Yes, an autograft will transfer your own skin from one area of your body to cover the burn wound."

A 75 kg client who has sustained partial thickness burns over the anterior trunk and both arms is receiving IV fluids. Which rates of administration will the nurse anticipate for fluid resuscitation? a. 500 ml/hr for the first 12 hours, 416 ml/hr for the next 12 hours b. 675ml/hr for the first 8 hours, 338 ml/hr for the next 16 hours c. 675ml/hr for the first 4 hours, 338 ml/hr for the next 20 hours d. 400ml/hr for the first 8 hours, 247 ml/hr for the next 16 hours

b. 675ml/hr for the first 8 hours, 338 ml/hr for the next 16 hours

Which of the following injuries would result in a greater likelihood of internal organ damage and risk for infection? a. A fall from a 6-foot ladder onto the grass b. A shotgun wound to the abdomen c. A knife wound to the right chest d. A motor vehicle crash in which the driver hits the steering wheel

b. A shotgun wound to the abdomen

Which statement about mass casualty triage during a disaster is true? a. Priority treatments and interventions focus primarily on young victims. b. Disaster victims with the greatest chances for survival receive priority for treatment. c. Once interventions have been initiated, healthcare providers cannot stop the treatment of disaster victims. d. Color-coded systems in which green indicates the patient of greatest need are used during disasters.

b. Disaster victims with the greatest chances for survival receive priority for treatment.

Fluid resuscitation is an important component of managing the trauma patient. Which of the following statements are true regarding the care of a trauma patient? (Select all that apply.) a. 5% Dextrose is recommended for rapid crystalloid infusion b. IV fluids may need to be warmed to prevent hypothermia. c. Massive transfusions should be avoided to improve patient outcomes. d. Only fully cross-matched blood products are administered. e. Type O blood can be administered in emergency situations.

b. IV fluids may need to be warmed to prevent hypothermia. c. Massive transfusions should be avoided to improve patient outcomes. e. Type O blood can be administered in emergency situations.

Why is silver is used as an ingredient in many burn dressings? a. stimulates tissue granulation b. It is effective against a wide spectrum of wound pathogens. c. provides topical pain relief d. stimulates wound healing

b. It is effective against a wide spectrum of wound pathogens.

The nurse has admitted a patient to the ED following a fall from a first-floor hotel balcony. The patient, 22 years old and smelling of alcohol, begins to vomit. Which intervention is most appropriate? a. Insert an oral airway to prevent aspiration and to protect the airway. b. Prepare to suction the oropharynx while maintaining cervical spine immobilization. c. Offer the patient an emesis basin so that you can measure the amount of emesis. Prepare to suction the oropharynx while maintaining cervical spine immobilization. d. Send a specimen of the emesis to the laboratory for analysis of blood alcohol content.

b. Prepare to suction the oropharynx while maintaining cervical spine immobilization.

The nurse understands that negative-pressure wound therapy may be used in the treatment of partial-thickness burn wounds to accomplish what outcome? a. maintain a closed wound system to decrease the risk of infection b. Remove excessive wound fluid and promote moist wound healing. c. increase patient mobility with large burn wounds d. Quantify wound drainage amount for more accurate output assessment.

b. Remove excessive wound fluid and promote moist wound healing.

The nurse is caring for a patient with burns to the hands, feet, and major joints. The nurse plans care to include which intervention? (Select all that apply.) a. Administering muscle relaxants around the clock b. Wrapping fingers and toes individually with bandages c. Implementing passive or active range-of-motion exercises d. Keeping the limbs as immobile as possible e. Applying splints that maintain the extremity in an extended position

b. Wrapping fingers and toes individually with bandages c. Implementing passive or active range-of-motion exercises e. Applying splints that maintain the extremity in an extended position

The nurse is caring for a patient who has circumferential full-thickness burns of his forearm? What is the priority intervention in the plan of care? a. Keeping the extremity in dependent position b. active ROM every hour c. preparing for an escharotomy as a prophylactic measure d. splinting the forearm

b. active ROM every hour

What is the most likely site to have a sheet graft applied? a. arm b. face c. leg d. chest

b. face

In patients with extensive burns, what process is responsible for edema occurring in both burned and unburned areas? a. loss of integument barrier b. increased capillary permeability c. decreased glomerular filtration d. catecholamine-induced vasoconstriction

b. increased capillary permeability

A patient admitted with severe burns to the face and hands is showing signs of extreme agitation. The nurse should explore the mechanism of burn injury possibly related to what data noted in the patient's medical history? a. excessive alcohol use b. methamphetamine use c. PTSD d. subacute delirium

b. methamphetamine use

What is an initial symptom of a suspected compartment syndrome? a. absence of pulse in affected extremity b. severe, throbbing pain in affected area c. pallor in affected area d. paresthesia in affected area

b. severe, throbbing pain in affected area

The nurse is assisting the patient who is recovering from moderate burns to select foods from the menu that will promote wound healing. Which statement indicates the nurse's knowledge of nutritional goals? a. "Select foods that have lots of fiber, such as whole grains and fruits. These will promote removal of toxins from the body that interfere with healing." b. "It is important to choose foods like bread and pasta that are high in carbohydrates. These foods will give you energy and help you to heal faster." c. "Choose foods that are high in protein, such as meat, eggs, and beans. These help the burns to heal." d. "Avoid foods that have saturated fats. Fats interfere with the ability of the burn wound to heal."

c. "Choose foods that are high in protein, such as meat, eggs, and beans. These help the burns to heal."

Treatment and/or prevention of rhabdomyolysis in at-risk patients include aggressive fluid resuscitation to achieve how much urine output? a. 30 mL/hr b. 50 mL/hr c. 100 mL/hr d. 300 mL/hr

c. 100 mL/hr

A patient who weighs 154 pounds has a burn injury that covers 50% of body surface area. The nurse calculates the intravenous (IV) fluid needs for the first 24 hours after a burn injury using a standard fluid resuscitation formula. The nurse plans to administer what amount of fluid in the first 24 hours? a. 2800 mL b. 7000 mL c. 14 L d. 28 L

c. 14 L

Which of the following statements about the pain management of a burn victim are true? (Select all that apply.) a. oral meds is the preferred administration b. the IM route is preferred for pain medication administration c. Additional pain medication may be needed because of rapid body metabolism. d. Patients with a history of drug and alcohol abuse will require higher doses of pain medication. e. Pain medication should be given before procedures such as debridement, dressing changes, and physical therapy.

c. Additional pain medication may be needed because of rapid body metabolism. d. Patients with a history of drug and alcohol abuse will require higher doses of pain medication. e. Pain medication should be given before procedures such as debridement, dressing changes, and physical therapy.

A 24-year-old unrestrained driver who sustained multiple traumatic injuries from a motor vehicle crash has a blood pressure of 80/60 mm Hg at the scene. What should the primary survey of this patient upon arrival to the ED include? a. A cervical spine x-ray study to determine the presence of a fracture. b. Turning the patient from side to side to get a look at his back. c. Getting a baseline assessment and establish priorities. d. A methodical head-to-toe assessment identifying injuries and treatment priorities.

c. Getting a baseline assessment and establish priorities.

Trauma patients are at high risk for multiple complications not only due to the mechanism of injury but also due to the patients' long-term management. Which of the following statements apply to trauma patients? (Select all that apply.) a. Wounds require sterile dressings to prevent infection. b. Early ambulation is critical to achieving desired outcomes. c. Indwelling urinary catheters are a source of infection. d. Pneumonia is often an adverse outcome of mechanical ventilation. e. Patients often develop infection and sepsis secondary to central line catheters.

c. Indwelling urinary catheters are a source of infection. d. Pneumonia is often an adverse outcome of mechanical ventilation. e. Patients often develop infection and sepsis secondary to central line catheters.

Which patient has the greatest risk of developing acute respiratory distress syndrome (ARDS) after traumatic injury? a. a patient who has a closed head injury with decreased LOC b. a patient who has a fractured femur and is currently in traction c. a patient who received large volumes of fluid and/or blood replacement d. a patient who has underlying COPD

c. a patient who received large volumes of fluid and/or blood replacement

What is the optimal measurement of intravascular fluid status during the immediate fluid resuscitation phase of burn treatment? a. BUN b. daily weight c. hourly I&O d. serum potassium

c. hourly I&O

A patient with a 60% burn in the acute phase of treatment develops a tense abdomen, decreasing urine output, hypercapnia, and hypoxemia. Based on this assessment, the nurse anticipates interventions to evaluate and treat the patient for what complication? a. AKI b. ARDS c. intraabdominal HTN d. DIC

c. intraabdominal HTN

A 63-year-old patient is admitted with new onset fever; flulike symptoms; blisters over her arms, chest, and neck; and red, painful, oral mucous membranes. The patient should be further evaluated for which possible non-burn injured skin disorder? a. graft versus host disease b. staphylococcal scalded skin syndrome c. toxic epidermal necrolysis d. necrotizing soft tissue infection

c. toxic epidermal necrolysis

Range-of-motion exercises, early ambulation, and adequate hydration are interventions to prevent this common complication observed in trauma patients? a. catheter-associated infection b. fat embolism c. venous thromboembolism d. nosocomial pneumonia

c. venous thromboembolism

What type of burn is capable of producing either a superficial cutaneous injury or a cardiopulmonary arrest and transient but severe central nervous system deficits? a. infection b. heat burn c. chemical burn d. electrical burn

d. electrical burn

In the trauma patient, what is the most common cause of symptoms of decreased cardiac output? a. cardiac contusion b. cardiogenic shock c. pericardial tamponade d. hypovolemia

d. hypovolemia

When providing information on trauma prevention, it is important to realize that individuals age 25 to 44 years are most likely to experience which type of trauma incident? a. high speed motor vehicle crashes b. violent or domestic traumatic alterations c. work-related falls d. poisonings from prescription or illegal drugs

d. poisonings from prescription or illegal drugs

The nurse caring for a patient with an electrical injury understands that patients with electrical injury are at a high risk for acute kidney injury secondary to what related process? a. hypervolemia from burn resuscitation b. increased incidence of ureteral stones c. nephrotoxic antibiotics for prevention of infection d. release of myoglobin from injured tissues

d. release of myoglobin from injured tissues

Which intervention is a strategy to prevent fat embolism syndrome? a. provide prophylaxis with low-molecular weight heparin d. administer lipid lowering statin and medications c. intubate the patient early after the injury to provide mechanical ventilation d. stabilize extremity fractures early

d. stabilize extremity fractures early

The nurse is providing care to a patient with burns whose care of plan care includes a prescription for opiates to be given intramuscularly for pain. Why would the nurse contact the primary care provider (PCP) to change the order to intravenous administration? a. IM injections cause additional skin disruption b. burn pain is so severe it requires relief by the fastest route available c. hypermetabolism limits effectiveness of medications administered IM d. tissue edema may interfere with drug absorption of injectable routes

d. tissue edema may interfere with drug absorption of injectable routes