TCAR POST TEST

9. Normalizing a trauma patient's body temperature helps control bleeding because hypothermia produces shivering and makes platelets hyperactive. causes platelet dysfunction and clotting system failure. stimulates the clotting cascade and reduces blood pressure. increases tissue oxygen consumption and cold diuresis.

causes platelet dysfunction and clotting system failure.

17. What is the usual intervention for a patient with subcutaneous emphysema? Chest tube insertion Emergent surgical repair Needle decompression Observation and reassessment

Observation and reassessment

16. Pulmonary contusions cause a problem at what point on the tissue oxygenation cascade? Hemoglobin availability Cardiac output Diffusion Ventilation

Ventilation

49. A patient who sustained a complete C7 spinal cord injury nine days ago is being transferred from bed to a reclining wheelchair. This maneuver is likely to cause respiratory arrest. autonomic dysreflexia. postural hypotension. neurogenic bladder.

autonomic dysreflexia.

5. Shock occurs when the sodium-potassium pump fails. ATP levels are less than lactic acid levels. cellular oxygen demand is greater than supply. aerobic metabolism exceeds anaerobic metabolism.

cellular oxygen demand is greater than supply.

44. A patient sustained a cribriform plate fracture. Which of the following is an expected assessment finding? Cerebral spinal fluid rhinorrhea. flow obstruction. otorrhea. accumulation.

rhinorrhea.

18. 15 hours after a motor vehicle collision, an unrestrained driver is experiencing frequent, irregular heartbeats. The most likely cause of this finding is injury to the left atrium. left ventricle. right atrium. right ventricle.

right atrium.

46. Which triad of symptoms are LATE signs of deterioration in a traumatic Agitation, bradycardia, and narrowing pulse pressure Tachycardia, dropping mean pressure, and headache Disorientation, nausea/vomiting, and posturing Bradycardia, irregular respirations, and hypertension

Bradycardia, irregular respirations, and hypertension

28. A jockey was thrown from a running horse and hit the rail. On hospital Day 3, right flank bruising is present. This finding suggests the patient has a subcapsular splenic hematoma. renal laceration. aortic rupture. pancreatic contusion.

renal laceration.

19. In the patient with chest trauma, which of these findings is the earliest indicator of cardiac tamponade? Elevated heart rate Systolic hypotension Jugular vein distention Unilateral breath sounds

Elevated heart rate

13. Trauma resuscitation is considered complete when hemorrhage is controlled, the patient has normal vital signs, and body temperature has been stabilized. hemoglobin level is greater than 8 g/dL. aerobic metabolism is reestablished. the Glasgow Coma Scale score exceeds 13.

aerobic metabolism is reestablished.

37. A construction worker crushed by a falling beam has compartment syndrome of the left thigh. This patient will be closely monitored for signs of rhabdomyolysis, including dark-colored urine and dropping urine output. dilute urine and an elevated creatine kinase level. increasing urine output and myoglobinemia. diminished urine output and hypokalemia.

dark-colored urine and dropping urine output.

36. A patient has a positive "seat belt sign" across the epigastrium. This patient is at greatest risk for trauma to the colon, kidneys, and stomach. duodenum, mesentery, and pancreas. T-spine, urethra, and gallbladder. spleen, pelvis, and bladder.

duodenum, mesentery, and pancreas.

30. The goals of damage control surgery in the trauma patient include each of the following EXCEPT restoration of normal physiology. repair of all traumatic injuries. early blood product transfusion. active hemorrhage control.

repair of all traumatic injuries.

21. A hemorrhaging patient is receiving 1:1:1 transfusion. This man will also need cryoprecipitate to boost his ________ level. tranexamic acid fibrinogen platelet factor VIII

fibrinogen

27. A young adult who fell from a third-floor balcony has a blood pressure of 110/70 mm Hg and a heart rate of 108/min. Pulse pressure is 55 mm Hg 70 mm Hg 40 mm Hg 35 mm Hg

40 mm Hg

31. A hemodynamically stable patient was transfused 500 mL of red blood cells. Approximately how much of that volume will remain in the vascular space 60 minutes later? 250 mL 83 mL 333 mL 500 mL

500 mL

25. In the trauma patient with a blood pressure of 110/70 mm Hg, mean arterial pressure is approximately 83 mm Hg 90 mm Hg 76 mm Hg 40 mm Hg

83 mm Hg

26. A trauma patient has a heart rate of 92/min; systolic blood pressure is 115 mm Hg. This patient's shock index is 0.97 1.25 2.3 0.8

0.8

29. An amateur boxer sustained a powerful punch to the upper abdomen. 36 hours after the event, which of the following findings suggests pancreatic injury? Bowel sounds in the chest Serum lipase elevation Left shoulder pain Blood in the urine

Serum lipase elevation

40. In the patient with an open fracture, IV antibiotics significantly decrease the risk of osteomyelitis if administered within ____ of hospital arrival. 1 hour 4 hours 6 hours 8 hours

1 hour

4. Injury to which body structure is commonly a DELAYED finding in the blast trauma patient? Heart Bladder Bowel Spleen

Bowel

23. Following emergent transfusion, which electrolyte disturbances can be anticipated in the patient who received 12 units of blood products? Hyponatremia and hyperkalemia Hypernatremia and hypomagnesemia Hypochloremia and hypercalcemia Hyperkalemia and hypocalcemia

Hyperkalemia and hypocalcemia

1. Helmets and automobile airbags work because they prevent blows to the head. reduce acceleration injuries. increase deceleration speed. add deceleration distance.

reduce acceleration injuries.

38. Care of the trauma patient with prerenal failure chiefly involves initiating hemodialysis. limiting fluid intake. refilling the vascular space. administering diuretics.

refilling the vascular space.

33. The primary goal of early, small-volume enteral feeding is to support the intestinal mucosa and reduce bacterial and toxin translocation. post-traumatic muscle wasting. the hyperglycemic stress response. protein-calorie malnutrition.

bacterial and toxin translocation.

22. When a patient is receiving multiple blood transfusions, a priority nursing intervention is to prevent hemoconcentration. alkalosis. hypercalcemia. hypothermia.

hypothermia.

48. A patient with a spinal cord injury has no motor function below the T4 level but retains his sense of vibration. Which incomplete cord syndrome does this man have? Saved Central cord syndrome Posterior cord syndrome Anterior cord syndrome Brown-Séquard syndrome

Anterior cord syndrome

20. In a patient with blunt chest trauma, what simple assessment can be used to screen for thoracic aortic injury? Side-to-side pulse oximeter saturation comparisons Bilateral upper extremity BP measurements Pulsus paradoxus calculation BP cuff inflation to elicit carpal spasm

Bilateral upper extremity BP measurements

6. _____ shock is the most common type of shock immediately after traumatic injury. Distributive Septic Cardiogenic Hypovolemic

Hypovolemic

2. Which of the following statements best describes knife wounds? Their velocity is _____, the temporary cavity _____, and damage _____. low; depends on the size of the knife; is usually extensive low; is insignificant; is limited to structures directly in object's path high; will be small; affects structures at some distance from the wound tract high; may be massive; results in widespread tissue destruction

low; is insignificant; is limited to structures directly in object's path

47. Which findings suggest impending herniation in a patient with a right temporal epidural hematoma? Left pupillary dilation, right-sided weakness Right pupillary dilation, right-sided weakness Right pupillary dilation, left-sided weakness Left pupillary dilation, left-sided weakness

Right pupillary dilation, left-sided weakness

43. In the first week after injury, interventions for the patient with a diffuse axonal injury primarily focus on preventing post-traumatic hydrocephalus. initiating cognitive rehabilitation. restoring axonal connections. limiting secondary brain damage.

limiting secondary brain damage.

10. What are the 3 components of the "trauma triad of death"? Coagulopathy, hypothermia, and acidosis Hypothermia, alkalosis, and coagulopathy Alkalosis, hyperthermia, and tissue injury Tissue injury, hyperthermia, and acidosis

Coagulopathy, hypothermia, and acidosis

7. Which findings suggest a trauma patient is experiencing cardiogenic shock? Bradycardia, cyanosis, and elevated mean arterial pressure High shock index, mottling, and hypotension Tachycardia, flushing, and widened pulse pressure Pallor, course breath sounds, and hypertension

High shock index, mottling, and hypotension

14. A patient with posterior rib fractures is at the highest risk for concomitant fractures of the sternum. T-spine. clavicles. ribs 1 and 2.

T-spine.

45. What is the priority intervention for the patient with a large expanding subdural hematoma? Emergent surgery for clot evacuation Craniectomy to increase intracranial pressure Ventriculostomy drainage to remove CSF Hospital admission for hourly neuro checks

Emergent surgery for clot evacuation

24. A trauma patient underwent damage control surgery for major abdominal hemorrhage. Post-operatively, her hand spasms when the blood pressure cuff inflates. Which of the following blood tests is indicated? TEG or ROTEM Lipase level ALT or AST level Ionized calcium

Ionized calcium

34. Clinical findings that suggest sepsis development in the trauma patient include bradycardia, hypertension, and an elevated shock index. tachycardia, a narrowed pulse pressure, and a low shock index. bradycardia, hypotension, and a high mean pressure. tachycardia, a widened pulse pressure, and tachypnea.

tachycardia, a widened pulse pressure, and tachypnea.

50. A patient who was ejected from a moving vehicle has a complete spinal cord injury at the T1 level. Bedside care providers can anticipate this patient will have issues maintaining a stable acid-base balance. urine output. body temperature. intracranial pressure.

urine output.

42. Two days after an episode of intimate partner violence, a patient complains of headache and nausea. She has poor recall of the events leading up to the injury. However, her brain computed tomography scan is normal. These findings suggest which type of brain trauma? Subdural hematoma Concussion Diffuse axonal injury Traumatic stroke

Concussion

39. A previously healthy young adult is recovering from a motorcycle crash that resulted in complex orthopedic injuries. Which of the following dietary discharge instructions is appropriate for this patient? Reduce total carbohydrates and eliminate lactose-containing products. Restrict fats, increase calcium intake, and avoid foods with high-protein content. Take an iron supplement and limit both leafy green vegetables and salty foods. Eat a standard diet but increase total calories, protein, and calcium-rich foods.

Eat a standard diet but increase total calories, protein, and calcium-rich foods.

41. An 82-year-old man was admitted to the hospital after he fell down two steps. The patient is alert and oriented but has several bruises and abrasions. Which vital sign findings would be most concerning? Heart rate 97/min; blood pressure 134/78 mm Hg Heart rate 65/min; blood pressure 108/90 mm Hg Heart rate 94/min; blood pressure 101/82 mm Hg Heart rate 118/min; blood pressure 163/82 mm Hg

Heart rate 118/min; blood pressure 163/82 mm Hg

12. What four factors determine a patient's cardiac output? Pulse pressure, afterload, shock index, and blood pressure Heart rate, preload, contractility, and afterload Preload, mean pressure, heart rate, and central venous pressure Contractility, systolic pressure, shock index, and pulse pressure

Heart rate, preload, contractility, and afterload

15. A motocross racer hit a ditch at high speed. The rider's chest was thrown against the handlebars. Which assessment finding indicates the patient has a flail chest? Paradoxical movement of the right chest wall A bubbling wound located on the upper thorax Subcutaneous emphysema and pain on palpation Chest dissymmetry with unilateral hyperexpansion

Paradoxical movement of the right chest wall

35. On hospital Day 5, a polytrauma patient has the following vital signs: BP 97/50; HR 133/min; RR 22/min. Urine output is 12 mL/hr. Skin is cool and mottled. The pulse oximeter is not sensing dependably. These findings suggest an anaphylactic reaction. hemorrhagic hypovolemia. early sepsis. neurogenic shock.

early sepsis.

11. Compensatory responses to hypovolemic shock include vasoconstriction, tachycardia, and oliguria. immune system activation, water retention, and bradycardia. tachycardia, diuresis, and hypoglycemia. fluid shifts, histamine release, and increased urine output.

vasoconstriction, tachycardia, and oliguria.

8. A multisystem trauma patient has become progressively tachycardic and hypotensive one week after hospital admission. Pulse pressure is wide. The most likely explanation for this finding is dehydration. fat embolism syndrome. surgical site bleeding. sepsis.

sepsis.

32. Common causes of non-hemorrhagic fluid loss in the trauma patient during the post-resuscitation phase of care include mechanical ventilation and isotonic tube feedings. hypometabolism and interstitial fluid shifts. diarrhea and hypertonic enteral formulas. pressure dressings and renal contusions.

hypometabolism and interstitial fluid shifts.