TNCC set
A woman who is 32 weeks pregnant requires radiographic studies to diagnose her injuries. Fetal exposure to the x-ray beam must be less than 5 rad. The most appropriate course of action is to assist with a FAST exam. restrict the x-ray beam to the injuries. request a CT. ensure the fetus is properly shielded.
ensure the fetus is properly shielded. The first goal of the trauma team is to stabilize the mother, keeping in mind maternal demise leads to fetal demise. The appropriate action is to perform radiological imaging while shielding the fetus during procedures as much as possible.
Discharge teaching for a patient with a maxillary sinus fracture and epistaxis has been effective if the patient states, "I shouldn't blow my nose until the bruising disappears." "I shouldn't blow my nose until the doctor tells me I can." "I should blow my nose gently as needed." "I should blow my nose to clear out any blood clots."
"I shouldn't blow my nose until the doctor tells me I can." Blowing one's nose will increase air pressure within the sinus and nasal cavities and greatly increase the likelihood of dislodging any hemostasis that may have occurred as part of the wound healing process. This should be discouraged until complete wound healing has occurred or until deemed safe. Blowing the nose gently will also create risk of bleeding. Blowing to clear clots will be counter-productive and waiting until bruising disappears is to imprecise and vague.
Which of the following patients is MOST likely to sustain a bladder rupture? 75-year-old who has an enlarged prostate 34-year-old who is pregnant 45-year-old who just ate a meal 20-year-old with a bladder distended with urine
20-year-old with a bladder distended with urine Risk of bladder injury increases if the bladder is distended with urine.
The nurse is assessing a 75-year-old female with multiple comorbidities who was involved in a motor vehicle collision. The patient has a Glasgow Coma Scale (GCS) score of 13. The patient's vital signs are: HR 65 beats/minBP 100/72 mmHgRR 26 breaths/min Which of the following would be a PRIORITY for the nurse to take? Administer balanced resuscitation. Transport to CT scan. Administer pain medication. Insert an indwelling urethral catheter.
Administer balanced resuscitation. An SBP < 110 in a patient greater than 65 years old should be considered hypotension, and the nurse should be preparing to administer resuscitation fluids to correct hypotension.
Which of the following types of fluid should a nurse expect to administer during the fluid resuscitation phase for an injured burn patient? lactated Ringer's solution 5% dextrose with lactated Ringer's solution 0.45% normal saline 0.9% normal saline
Lactated Ringer's is the closest solution to normal physiology that we can get. Lactated Ringer's contains physiologic concentrations of major electrolytes, and a lactate may reduce hyperchloremic acidosis. Large volumes of 0.9% normal saline can lead to hyperchloremic acidosis. Large volumes can lead to hyperchloremic acidosis.
Which of the following is a late sign of retroperitoneal hemorrhage? rigid abdomen shock flank discoloration back pain
Retroperitoneal hemorrhage is an accumulation of blood posterior to the peritoneal space. In the trauma setting, a retroperitoneal bleed is commonly associated with pelvic fractures or injuries to other retroperitoneal structures. Back or flank pain is the most common early finding. Ecchymosis around the flanks (Grey-Turner's sign) is a late finding. A rigid abdomen suggests intraperitoneal bleeding.
A female patient is brought to the emergency department following a motorcycle crash. On assessment, the nurse notes ecchymosis of the labia and perineum, and the patient is complaining of shoulder pain. Which of the following injuries should the nurse suspect? vaginal laceration small bowel contusion intraperitoneal bladder rupture rectal tear
intraperitoneal bladder rupture External signs of pelvic trauma should increase the suspicion for a bladder injury. The presence of urine in the peritoneum can manifest as shoulder pain.
Which of the following methods is the most appropriate way to examine possible causes of a sentinel event? incident reports individual case study root cause analysis staff interviews
The Joint Commission requires health care organizations to respond to sentinel events including performing a thorough root cause analysis, implementing process improvements, and evaluating the effectiveness of improvements. Staff interviews and incident reports may be a component of a root cause analysis but do not meet the Joint Commission requirement for responding to a sentinel event. Individual case study is a method of sharing information but does not meet the Joint Commission requirement.
A patient who is 34 weeks pregnant arrives immobilized on backboard. The nurse assesses hypotension and tips the backboard to the side. Following this intervention vital signs are: BP 90/40 mm HgHR 120 beats/minRR 28 breaths/min Glasgow Coma Score scale is 13 (E3, V4, M6) A nurse first anticipates: administering a fluid bolus. immediately transferring the patient to radiology for CT. an immediate C-section. obtaining a specimen for a Kleihauer-Betke test. immediately transferring the patient to radiology for CT.
administering a fluid bolus. Once the inferior vena cava compression by the uterus is addressed and there is no improvement, the next step is to restore potential lost volume. The workup/treatment can come after hemodynamics are restored.
Which of the following assessment findings is associated with abdominal compartment syndrome? bladder pressure of 10 mm Hg peak inspiratory pressure of 25 mm Hg decreased urine output bladder pressure of 10 mm Hg
decreased urine output Decreased urine output is often the first symptom of abdominal compartment syndrome, as the increased abdominal pressure will compress the kidneys, decreasing perfusion. A peak inspiratory pressure of 25 mm Hg is normal. While a bladder pressure of 10 mm Hg is slightly elevated, it may be elevated for a number of reasons. Intermittent borborygmi (audible or auscultated bowel sounds) will be absent in abdominal compartment syndrome because of the increased pressure exerted on the bowels.
A patient reports flank pain following a driver's side impact in a motor vehicle crash. Assessment reveals diminished lung sounds and the presence of bowel sounds in the left chest. A nurse should suspect pericardial tamponade diaphragmatic rupture massive hemothorax tension pneumothorax
diaphragmatic rupture Diminished breath sounds AND the presence of bowel sounds the same side of the chest are characteristic of a ruptured diaphragm. Decreased breath sounds, muffled heart tones, and jugular vein distension are the symptoms associated with pericardial tamponade. A massive hemothorax would be identified by diminished or absent breath sounds and dullness to percussion on the side of the injury. Decreased breath sounds and jugular vein distension are the symptoms associated with tension pneumothorax.
A restrained driver at a stop is hit from behind at a rate of 30 mph. Which of the following types of injuries is most likely to occur? head and neck pelvic and femur shoulder and chest chest and abdomen
head and neck With a restrained driver, the head and neck are most mobile aspects of the body in rear-end crashes and are most vulnerable to injury. The shoulder, chest, abdomen, pelvis, and femur are all relatively well protected when restrained during a rear-end crash.
A patient presents with a distended abdomen and positive seat belt sign after a high-speed motor vehicle collision. Shortly after arrival, the patient decompensates with pulseless electrical activity seen on the cardiac monitor. The priority intervention at this time is inserting a central line. infusing blood products. obtaining a chest radiograph. preparing for a FAST exam.
infusing blood products. With the provided options, the provider should follow the ABCDEs of ATLS, but also recognize limitations of the distractors. Large bore proximal peripheral IVs are preferred over a central line. The FAST exam, although useful in determining the etiology of shock (fluid in the abdomen vs pericardial tamponade), is an adjunct to the primary survey - as is the chest x-ray. With the provided mechanism, administering blood products and restoring intravascular volume losses is the best option.
A patient is exhibiting signs of systemic inflammatory response syndrome (SIRS). Which of the following is the BEST end point of resuscitation? MAP > 55 mm Hg capillary refill > 3 seconds urine output greater than 0.5 mL/kg/h CVP > 5 mm Hg
urine output greater than 0.5 mL/kg/h A urine output of > 0.5 mL/kg/h indicates that the kidneys are adequately perfused and a normal finding. Capillary refill > 3 seconds, MAP > 55 mm Hg, and CVP > 5 mm Hg are all abnormal.
The nurse is preparing to discharge a patient who sustained multiple traumatic injuries. Which of the following statements would indicate the patient is ready for discharge to an inpatient rehabilitation facility? "When I leave the rehabilitation facility, I will be back to my old self." "In the rehabilitation facility, I will get to decide which therapies I need to work on." "It is normal for me to feel overwhelmed at times during my rehabilitation." "My family only needs to be minimally involved in my rehabilitation."
"It is normal for me to feel overwhelmed at times during my rehabilitation." During rehabilitation, it is common for patients to move between progression and regression as they struggle to adjust to the physical limitations caused by their injury. Rehabilitation goals should be developed with input from the patient, family and appropriate therapies (physical, occupational, speech). Family members should be encouraged to actively participate in the rehabilitation plan of care, as it will assist them in accepting and coping with the residual physical limitations of the patient. The outcome goal of rehabilitation is to re-enter the community through maximizing physical functioning while adapting to new physical limitations. A plan specific to the area where the injuries were identified is the best plan. The other options are generalized and may not address the scooter crashes of the college campus.
Muscle necrosis associated with compartment syndrome can occur within how many hours? 20 to 24 8 to 10 4 to 6 12 to 18
4 to 6 Ischemia from acute compartment syndrome can cause irreversible muscle necrosis in as few as 4 hours following the injury. Assessment for compartment syndrome should be performed during initial examination of the trauma patient and at frequent intervals thereafter. Diagnosis of compartment syndrome is a surgical emergency. Returning pressures to normal may preserve function of the limb, or even prevent amputation of the limb itself.
Which of the following patients with hypovolemia is considered a priority to receive O negative blood transfusion? 8-year-old boy 18-year-old woman 68-year-old woman 48-year-old man
8-year-old boy Women of child-bearing age are at risk of isoimmunization if their blood type is Rh-negative and they are exposed to Rh-positive blood. Therefore, until definitive blood typing and screening is performed, type O Rh-negative blood should be administered to women of child-bearing age. Men and post-menopausal women may receive either O-negative or O-positive blood in the setting of an unknown blood type and Rh status.
A patient with a crush injury to bilateral lower extremities has brown urine in the collection bag. IV fluid replacement has been initiated. The urine output goal is: >100 mL/hr. 30-50 mL/hr. 75-100 mL/hr. 50-75 mL/hr.
>100 mL/hr. Treatment of rhabomyolysis focuses on early intervention with aggressive fluid resuscitation to flush out myoglobin to prevent renal failure. Urine output of 100 mL/hour is the recommended target goal until myoglobinuria is resolved.
Which components are included in a tertiary survey? Assessment focused on airway, breathing, circulation, disability, and exposure to identify life-threatening injuries. A complete head-to-toe assessment and initial ordering of additional diagnostic studies to identify less apparent but still life-threatening injuries. A complete head-to-toe assessment and review of all diagnostic studies to identify subtle injuries that are not necessarily life-threatening. Continuing patient resuscitation and therapy with the goal of returning the patient to an optimum functioning state.
A complete head-to-toe assessment and review of all diagnostic studies to identify subtle injuries that are not necessarily life-threatening. A tertiary survey is completed to ensure all injuries are identified and not missed-this process includes an additional complete head to toe assessment and review of all the completed diagnostic studies. This process is sometimes completed the following morning or 24 hours after admission. A secondary survey is completed to identify less apparent but still life-threatening injuries. This includes ordering additional radiologic and laboratory diagnostic studies (e.g., extremity films).The primary survey is completed first utilizing the airway, breathing, circulation, disability, and exposure process to identify immediate life-threatening injuries. Continuing patient resuscitation and therapy with the goal of returning the patient to an optimum functioning state with the involvement of support systems is part of getting the patient to definitive care.
Which of the following is true regarding psychosocial issues among trauma patients? Patients readily adapt to changes in body image after discharge. Anxiety is a normal response to being hospitalized. Feelings of hopelessness will be relieved once the patient leaves the ICU. New coping mechanisms are developed to deal with the trauma.
Anxiety is a normal response to being hospitalized. Patients readily adapt to changes in body image after discharge. After experiencing a traumatic event, patients can be fearful and anxious. The trauma nurse helps the patient to manage and mitigate the negative effects of these emotions. Overall, the provision of clear information delivered in a thoughtful, consistent manner to patients and families can increase the perception of control, diminishing fear and anxiety.
The primary survey has been completed on a patient with a large knee laceration. Which of the following should be completed next? lower extremity immobilization wound closure cleaning the wound assessing the joint
assessing the joint Violation of the knee joint will warrant operative intervention. The joint space should be evaluated prior to closing the laceration.
A patient has been decontaminated by irrigation for approximately 30 minutes post chemical burn. The patient still describes a burning sensation at the burn site. Which of the following should the nurse do next? Provide topical anesthetic. Apply a calcium chloride solution. Dry the patient to remove the residual chemical. Continue irrigation until the burning sensation stops.
Continue irrigation until the burning sensation stops. Irrigation is the most important intervention to limit the depth of dermal burn. Dry decontamination occurs prior to wet decontamination not after. A topical anesthetic may trap the original chemical next to the skin. Hydrofluoric acid burns are treated with a calcium gluconate slurry.
A patient who has hypotension and decreased sensation in the lower extremities after a fall from a ladder is most likely experiencing which of the following types of shock? spinal hypovolemic distributive obstructive
Distributive shock occurs as a result of abnormal distribution of circulating blood volume associated with the loss of vascular tone. Causative factors include anaphylactic shock, septic shock and neurogenic shock.
Which of the following statements about the Health Information Portability and Accountability Act (HIPAA) and the Emergency Medical Treatment and Active Labor Act (EMTALA) is true? EMTALA allows treatment to be provided without patient consent. HIPAA requires that informed consent be obtained before patient transfer. EMTALA requires that only physician notes and laboratory data need to be sent with patient transfer. HIPAA requires that pertinent patient records be sent with patient transfer.
EMTALA allows treatment to be provided without patient consent. One of the major tenants of EMTALA is implied consent in an emergency. HIPAA only addresses issues of patient confidentiality which is not found in any of the answers. EMTALA requires that ALL available records be sent with the patient transfer.
The process of organ donation after cardiac death begins with: the medical examiner's approval. selection of a suitable candidate. determination of brain death. tissue typing of potential donors.
Early determination of suitable donors reduces the incidence of patients' families being approached about donation if the patient is not a candidate for donation. Hospitals are mandated by federal regulation to notify the local Organ Procurement Organization (OPO) prior to any life-limiting decisions. The OPO should be notified as soon as a severely brain injured patient is identified. Brain death determination is not necessary. The OPO will not begin tissue typing a potential donor until after consent is obtained. Medical examiner approval is not necessary if the patient is not a suitable donor.
During the initial evaluation of a multi-injured trauma patient, the patient becomes hypotensive. The team proceeds with the administration of blood and blood products. After administration of blood products, the patient's vital signs return to normal, and then the patient becomes hypotensive again. Based on the initial response to blood resuscitation, the patient has lost a large amount of blood and is in which class of hemorrhage? V I III II
III The patient is considered a transient responder. Transient responders have an estimated blood loss of 15-40%. Class III hemorrhage has an approximate blood loss of 31-40%, and the patient is noted to have decreased blood pressure. Class I hemorrhage has an estimated blood loss of up to 15%, with normal blood pressure. Classes of hemorrhage are I-IV therefore, there is no class V. Class II hemorrhage has an estimated blood loss of 15-30% with a normal blood pressure.
A patient presents to the emergency department with a hoarse voice and subcutaneous emphysema. These symptoms suggest pneumomediastinum. open pneumothorax. tracheobronchial disruption. laryngeal fracture.
laryngeal fracture. The distinguishing characteristic of a laryngeal fracture is a hoarse voice, since the injury may damage the vocal cords. Subcutaneous emphysema may occur with injuries to the intrathoracic trachea, but the patient's voice would not be affected.
In order to prevent escalation and mitigate opportunities for violence in an agitated patient, which of the following tactics is appropriate? Observe body language. Deliver information in privacy. Speak in a firm voice. Use medical terminology for explanations.
Observe body language. As a patient or visitor begins to become agitated the tone and rhythm of speech may change and body language shows muscle tenseness, anger expression, or leaning forward. The nurse should speak in a calm voice using simple language. The safety of the health care team is a priority, and the nurse should avoid being alone with an agitated individual.
The nurse is caring for a patient who sustained a neck soft-tissue injury from a seatbelt as a result of a motor vehicle collision. Which assessment finding would be MOST concerning? progressive difficulty swallowing increasing neck pain deformity of the clavicle Glasgow Coma Scale (GCS) score of 12
Patients who sustain a soft tissue injury as a result of a seatbelt are at risk for an expanding hematoma that could result in a compromised airway. Progressive difficulty in swallowing should be recognized as an indication of a potentially expanding hematoma. Increasing neck pain and a clavicle deformity need to be evaluated, but are not the most urgent finding. A GCS of 12 does not require immediate intervention.
Pelvic binders reduce blood loss by temporarily addressing and treating which of the following two conditions? increased volume of the pelvis; ongoing injury to small vessels decreased volume of the pelvis; temporary injury to small vessels decreased volume of the pelvis; injury to femoral arteries increased volume of the pelvis; injury to arterial vessels
Pelvic binders aim to reduce the abnormal physiological space created by pelvic fractures, most importantly, an open book pelvic fracture, as well as provide tamponade of bleeding vessels. These vessels are classically the venous plexus of the pelvis.
Local high school students are planning an event to address drinking and driving. This is an example of which of the following types of injury prevention programs? quaternary primary secondary tertiary
Primary injury prevention focuses on preventing an injury or event before it occurs; therefore, educating students on the danger of drinking and driving would be an example of primary prevention. Secondary prevention aims to reduce the impact of an injury or event that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress. Tertiary prevention focuses on optimizing the outcome and aims to soften the impact of an ongoing injury through medical interventions and rehabilitation. This is done by helping people manage long-term, often-complex health problems and injuries. Quaternary prevention methods consists of avoiding excessive or unnecessary interventions or cost in the healthcare system.
A patient with a hemothorax requires a chest tube. The tube should be inserted between the: second and third intercostal space at the midaxillary line. second and third intercostal space at the midclavicular line. fourth and fifth intercostal space at the midclavicular line. fourth and fifth intercostal space at the midaxillary line.
The ideal location for draining a hemothorax is above the fifth intercostal space and along the midaxillary line, as it is low enough on the chest to collect blood from the inferior aspect of the pleural space. When the patient is sitting or in semi-Fowler's position, gravity aids the collection of blood. The other locations may work for a simple pneumothorax but are sub-optimal for a hemothorax.
A 100 kg adult male with 80% total body surface area (TBSA) burns is receiving lactated Ringer's solution at 1,500 mL/hr. He is 2 hours post-burn, and his urine output is 50 mL over the past 2 hours. The nurse determines that: the patient is adequately resuscitated. the order rate is too low for his percentage of TBSA burn. his hourly urinary output should be higher. his urinary output will increase as his fluid intake increases.
The patient has not been adequately resuscitated, as the urine output target for an adult burn patient is 0.5 mL/kg/h (50 mL per hour, in this case). Urine output may NOT necessarily increase as the fluid intake increases, as each person responds differently. The ordered IV rate of 1,500 mL/hr is appropriately ordered for this patient, but will need to be increased to meet the urine output goal.
A patient is undergoing initial assessment in the emergency department after being involved in a motor vehicle collision. The trauma team suspects the patient may have a cervical spinal cord injury. The patient has a Glasgow Coma Scale (GCS) score of 15 and is able to participate in the care appropriately. While caring for this patient, the team is observing spinal restriction techniques. An appropriate spinal restriction technique is: maintaining the patient on long spine board throughout the evaluation. preventing spinal movement below the area of the neck. using a team approach to log roll the patient. providing a pillow to decrease discomfort in the patient's neck.
This patient should be log rolled to assess the patient's posterior, as well as to remove clothing and the long spine board. The team consists of one person to restrict motion of the head and neck, other individuals on the same side of the patient to ensure the torso and legs move simultaneously, as well as an additional person to remove the long spine board and assess the patient's posterior. Spinal movement should be prevented both above and below the area of the suspected injury. Long spine boards should only be utilized for extrication and transport. Evidence protection and collection is done after the patient's immediate life threats are treated and the patient is stabilized.
The trauma morbidity and mortality review is considered which level of performance improvement review? tertiary primary secondary loop closure
Trauma morbidity and mortality is considered tertiary review.
A trauma center is on diversion and EMS arrives with a patient without prior notification. Which of the following must the nurse do? Triage the patient and determine if they can be transferred. Instruct them to take the patient to another trauma center. Instruct EMS to take the patient to the nearest hospital. Triage and stabilize the patient prior to transfer.
Triage and stabilize the patient prior to transfer. Instruct EMS to take the patient to the nearest hospital. EMTALA requires that unstable patients be treated prior to transfer of care. If transfer is necessary, the initial providers must attempt to stabilize the patient prior to transfer.
A regional trauma organization has noted an increase in motor vehicle collisions in which the occupants of the vehicle were not wearing seatbelts. Which of the following describes advocacy when addressing this issue? Reviewing previous 12 month data from the trauma registry to identify the rate of patients involved in an motor vehicle collision and not wearing a seatbelt. Reviewing recent research articles to identify reasons why people may not wear seatbelts. Using social media, press releases, and drafting of a position statement to emphasize the importance of seat belt use. Reviewing recent research articles to identify reasons why people may not wear seatbelts.
Using social media, press releases, and drafting of a position statement to emphasize the importance of seat belt use. Advocacy includes participating in the dissemination of public information through media events, as well as eliciting government support. Data collection from a trauma registry could be used to help stress why the topic is important but is not an example of advocacy. Reviewing research articles would be considered a literature review, while educating patients would be a form of injury prevention.
A patient who is 36 weeks pregnant presents to the emergency department after a fall down the stairs 4 hours ago. Which of the following findings would be MOST concerning? vomiting and diarrhea uterine tenderness without vaginal bleeding blood pressure of 143/85 mmHg complaints of intermittent difficulty breathing
Uterine tenderness with or without vaginal bleeding is concerning for placental abruption, an obstetrical emergency. Vomiting and diarrhea can cause dehydration necessitating volume resuscitation. Difficulty breathing in the 3rd trimester is common, as the fetus invades portions of the thoracic cavity. A slightly hypertensive blood pressure reading is concerning but not emergent at this time.
A patient with a traumatic head injury has an intracranial pressure of 22 mm Hg. The nurse should prepare to lower the head of the bed. hyperventilate the patient. administer mannitol (Osmitrol). administer phenytoin (Dilantin).
administer mannitol (Osmitrol). As secondary brain injury associated with hypotension dramatically increases mortality, preventing hypotension is the goal. Intubation should NOT be avoided, if indicated. Paralytics are not first line therapy for reducing ICP and are rarely used as such. Hyperventilation is a temporary rescue maneuver only used to REDUCE increased ICP.
Which of the following is most appropriate for providing support for a patient following an alcohol-related trauma? alcohol use identification tool 12-step recovery program extended period in drug rehabilitation alcohol screening and brief intervention
alcohol screening and brief intervention Given the high number of traumatic injuries that are alcohol-related, the American College of Surgeons views Screening and Brief Intervention and Referral to Treatment (SBIRT), following trauma, as an effective tool in preventing future injuries in this population.
Outdoor bleachers collapse at a local fair and trap several individuals with multiple injuries. Triage is rapidly established by EMS. Which of the following patients should be tagged with a black triage tag? an 18-year-old that is pulseless a 32-year-old with RR of 26 breaths/minute a 48-year-old with a femur fracture a 24-year-old with a large scalp laceration
an 18-year-old that is pulseless a 32-year-old with RR of 26 breaths/minute a 48-year-old with a femur fracture a 24-year-old with a large scalp laceration START Adult Triage categorizes a patient as a black triage tag color if they are expectant; the patient is unlikely to survive given the severity of the injuries - In this case, the patient is pulseless and not likely to survive. The distractors are patients who can be helped with immediate intervention or have injuries that can be stabilized until transferred for care.
As a part of discharge planning for a patient who sustained multiple traumatic injuries, which factors should be considered when deciding whether the patient would benefit from a skilled nursing facility versus a long-term care hospital? anticipated length of stay and complexity of patient needs proximity to support system and visiting policies nutrition and physical therapy needs recovery potential and state accreditation
anticipated length of stay and complexity of patient needs When discerning whether a patient should be discharged from the inpatient setting to a skilled nursing facility or a long-term care hospital, the patient's projected length of stay and complexity of care should be evaluated. At skilled nursing facilities, the anticipated length of stay for post-acute care services is approximately 25 days, while a long-term care hospital is greater than 25 days. Long-term care hospitals provide more complex care when compared to the skilled nursing facility. Both skilled nursing facilities and long-term care hospitals impact recovery potential and have state accreditation. Nutrition and physical therapy can be provided at both institutions. The decision on which facility is appropriate should be based on the patient's needs, not the location of the facility or visiting policies.
A patient sustained a pelvic fracture. Which of the following would indicate appropriate placement of a pelvic binder? application over the greater trochanter application below the symphysis pubis external rotation of the lower limbs rotation of the left lower limb internally and the right lower limb externally
application over the greater trochanter A pelvic binder should be centered over the greater trochanters in order to decrease the volume of the pelvic cavity and applying compression to the small vessels. External rotation of one or both lower extremities implies inadequate reduction of the fracture. Binding the ankles together will prevent external rotation. Applying the binder below the symphysis pubis would result in inferior placement.
An alert, oriented patient presents with pelvic instability after a motor vehicle crash. Vital signs are as follows: BP 85/40 mm HgHR 120 beats/minRR 16 breaths/min EMS established IV access during transport. The nurse should FIRST rapidly obtain a CT scan. apply a pelvic stabilization device. prepare the patient for surgery. transfer to interventional radiology.
apply a pelvic stabilization device. Application of a pelvic stabilization device will help to control bleeding within the pelvis. The patient will need to go to CT and possibly interventional radiology or the OR, but the first step in controlling bleeding is application of the pelvic stabilization device.
During the primary survey of an awake and alert trauma patient, the nurse notices a 3 cm by 1 cm actively bleeding laceration to the right lateral chest. The nurse should: continue the primary survey. initiate volume replacement. prepare for tube thoracostomy. apply direct pressure to the wound.
apply direct pressure to the wound. The initial management of any actively bleeding wound is pressure and elevation. All actively bleeding injuries should be treated upon discovery.
The priority intervention for a large bleeding scalp laceration is to: apply direct pressure. reverse coagulopathy. assist stapling the laceration. use hemostatic dressing.
apply direct pressure. Direct pressure is the first-line intervention for the control of any bleeding from a compressible wound, and frequently results in successful hemostasis. Stapling a laceration should not be done prior to application of direct pressure. Reversing anticoagulation might be of benefit for a patient with multiple traumatic injuries, but it is not the priority intervention for a bleeding scalp laceration. Hemostatic dressings are useful for certain persistently bleeding wounds, but again, direct pressure is the preferred initial intervention.
A patient arrives to the emergency department with thigh deformity. After the traction splint is applied the nurse should administer an opioid analgesic. assess pedal pulses. pad bony prominences. elevate the leg.
assess pedal pulses. Pulses should be assessed before and after all splinting and traction procedures. The affected extremity will be in suspension and therefore does not require padding of body prominences. Opioid administration should occur before traction is applied.
An assessment of a patient reveals periorbital ecchymosis and rhinorrhea. A nurse should suspect which of the following skull fractures? depressed basilar linear comminuted
basilar Classic signs associated with basilar skull fractures include periorbital ecchymosis (raccoon eyes) and rhinorrhea (CSF leak via the nose).
The nurse is caring for a patient who sustained multiple injuries from a motor vehicle collision 2 days ago and is intubated. The patient's temperature is 100.2° F (37.9° C), HR 108 beats/min, and is requiring increasing ventilatory support. The nurse should be MOST concerned with a: hemoglobin of 10 g/dL blood glucose level of 300 mg/dL white blood cell count of 14,000/mm3 hemoglobin of 10 g/dL
blood glucose level of 300 mg/dL Hyperglycemia in the absence of diabetes mellitus or pancreatitis is indicative of a hypermetabolic state. Hypermetabolic state can be the precursor to MODS.
A patient has sustained a sternoclavicular fracture dislocation. During evaluation of the arm, the nurse finds 2 distal pulses, but the limb is flaccid and insensate. The nurse suspects the presence of disruption of the median nerve. cervical nerve root transection. compartment syndrome. brachial plexus injury.
brachial plexus injury. The brachial plexus is formed from five nerves that originate in the spinal cord at the neck. These nerves provide sensation to the skin and permit movement in the muscles of the arm and hand. A brachial plexus injury involves sudden damage to these nerves, and may cause weakness, loss of feeling, or loss of movement in the shoulder, arm, or hand. Signs of compartment syndrome include diminished or absent pulses. Transection would result in bilateral loss of movement and sensation. Median nerve injuries are associated with elbow injuries.
Early evaluation of a burn patient with facial swelling and carbonaceous sputum should include peak expiratory flows. chest CT scan. bronchoscopy. sputum cultures.
bronchoscopy. Bronchoscopy may be required in patients with inhalation injury to assist with clearance of secretions and debris and decrease the risk of bronchial obstruction.
Before flushing a chemical burn with copious amounts of water, a nurse should: apply a neutralizing agent to affected areas. inquire about the concentration of the chemical agent. debride any open blisters caused by the exposure. brush any remaining dry chemical away from the body.
brush any remaining dry chemical away from the body. Preventing further injury is the priority when dealing with chemical burns. The first step would be to remove any remaining chemicals through decontamination or simply brushing the chemicals off the patient while ensuring safety of staff.
The injury pattern commonly seen in patients with axial loading forces is lamina or pedicle fractures. subluxation of spinal column. burst fractures of vertebral body. vertebral wedge fractures.
burst fractures of vertebral body. As the vertebral body transfers weight from one vertebrae to another, it is more likely to fractured by axial loading. Vertebral wedge and pedicle/lamina fractures are more commonly associated with spinal hyperflexion/extension. Subluxation is typically caused by rotation injuries.
The nurse in a trauma unit is evaluating a patient who was pulled to safety from inside a garage fire. The patient's symptoms include headache, nausea, and cherry-red skin. The condition MOST likely to cause these findings is: cyanide exposure. a partial-thickness burn. a superficial burn. carbon monoxide poisoning.
carbon monoxide poisoning. A superficial or partial-thickness burn should not cause a headache or nausea. Although cyanide and carbon monoxide can result in nausea and a headache, only carbon monoxide poisoning will manifest as cherry-red skin. A fire within a closed space, where oxygen is being consumed, can lead to carbon monoxide poisoning.
An elderly, unrestrained driver involved in a high-speed motor vehicle crash arrives at the emergency department. The patient is hypotensive with dysrhythmias. EMS reports that the steering wheel is bent. Which of the following conditions is most likely the cause of the hypotension? cardiogenic shock distributive shock pulmonary contusions flail chest
cardiogenic shock Cardiogenic shock, in the presence of blunt chest trauma and dysrhythmias, fits with blunt cardiac injury as an etiology. Pulmonary contusions typically take at least 24 hours to blossom. Flail chest and distributive shock are feasible, but not enough information is provided.
In patients with a diffuse axonal injury, outcomes may improve when maintaining: mean arterial pressures greater than 60 mm Hg mean arterial pressures under 40 mm Hg. cerebral perfusion pressure under 40 mm Hg. cerebral perfusion pressure greater than 60 mm Hg.
cerebral perfusion pressure greater than 60 mm Hg. Cerebral autoregulation will maintain cerebral vascular blood flow as long as there is adequate cerebral perfusion pressure. With this type of injury, a normal mean arterial pressure may not be enough to deliver oxygen and nutrients to the brain. A CPP of less than 60 mm Hg is associated with poor outcomes.
After completion of the initial assessment reveals significant chest injuries, a trauma team leader determines a patient needs to be transferred for definitive care. The nurse should next: communicate with the receiving facility. obtain copies of all medical records. proceed to the secondary survey. clean and dress all wounds.
communicate with the receiving facility. Once the need for transfer is recognized, arrangements should be expedited and not delayed for non-lifesaving interventions and/or diagnostic procedures that do not change the plan of care. The initial assessment includes the primary and secondary survey.
A nurse receives an order to monitor a patient's bladder pressure every 6 hours. Upon obtaining a result of 10 mm Hg, the nurse should: ensure that the transducer is leveled at the phlebostatic axis. compare with earlier measurement. notify the physician about possible intra-abdominal hypertension. instill 50 mL of saline solution into the bladder.
compare with earlier measurement. Although a reading of 10 mm Hg is elevated, it is not physiologically significant. An isolated number is not useful as the overall trend. Intra-abdominal hypertension is diagnosed with a pressure greater than 12 mm Hg.
Which of the following is a contraindication to hypotensive resuscitation for a patient with blunt trauma? ongoing hemorrhage concomitant traumatic brain injury trauma-induced coagulopathy history of coronary artery disease
concomitant traumatic brain injury Hypotension in traumatic brain injury is a poor prognostic indicator and should be avoided. Hemorrhage, particularly in the setting of penetrating trauma, can be managed with permissive hypotension and balanced resuscitation while attempting definitive hemorrhage control.
A 22-year-old presents with a Glasgow Coma Scale of 5 (E1,V1 M3) after sustaining a traumatic brain injury from a motor vehicle crash. The patient is intubated. Hemodynamics are normal, and a head CT demonstrated a large subdural hematoma. Which of the following is the next intervention for this patient? angiography ventriculostomy burr hole craniectomy
craniectomy This patient's large subdural hematoma should be immediately surgically evacuated to relieve intracranial pressure. Placement of a burr hole would not be sufficient to evacuate a large collection of blood, and although fluid can be drained and pressure monitored through a ventriculostomy, it does not address the pressure of the hematoma. Angiography is not indicated, since the CT was diagnostic.
A woman brings her 75-year-old mother to the emergency department for evaluation of a traumatic injury sustained one week ago. Which of the following caregiver behaviors is suggestive of elder abuse? allowing patient to answer questions reporting increased number of falls providing report consistent with diagnosed injury delaying evaluation of injuries allowing patient to answer questions
delaying evaluation of injuries Delaying care for suspected injuries should be viewed as suspicious, especially if the injuries are atypical. Injuries found on physical exam should match the reported mechanism of injury. Older adults with cognitive impairments can often describe the mechanism of traumatic injuries. Caregivers should allow older adults to fully answer emergency department staff questions before interjecting with clarifying information. An increased number of falls can be common in older adults. Caregivers should be educated on home safety interventions to help minimize falls.
The nurse is caring for a patient who sustained a subdural hematoma with an associated midline shift and is receiving warfarin (Coumadin) for a past medical history of atrial fibrillation. The nurse should intervene if the patient is prescribed which of the following medications to reverse the effects of Coumadin? desmopressin (DDAVP) prothrombin complex concentrate (PCC) phytonadione (AQUA-MEPHYTON) fresh frozen plasma (FFP)
desmopressin (DDAVP) Due to the patient's significant subdural hematoma and past medical history, prompt reversal is needed to prevent further injury by decreasing the effect of the anticoagulant. FFP, PCC and vitamin K are all agents that may be used to reverse Coumadin. DDAVP may be used to reverse anti-platelet agents such as clopidogrel (Plavix).
A CT scan of a patient's abdomen reveals a grade II spleen laceration without contrast extravasation. The most appropriate plan of action should be to anticipate consent for interventional embolization. request a pneumococcal vaccine. draw serial hemoglobin and hematocrits. begin pre-operative preparation.
draw serial hemoglobin and hematocrits. Non-surgical treatment is the most common method of management for patients with spleen injuries. Lab studies include serial hemoglobin and hematocrit.
A patient is admitted after being pinned under a warehouse crate for eight hours. Ongoing evaluation of this patient should include monitoring for: dysrhythmias. hypervolemia. pink-colored urine. hypokalemia.
dysrhythmias. Patients that sustain crush-type injuries are at risk for rhabdomyolysis. Signs and symptoms of rhabdomyolysis include hyperkalemia, elevated creatinine kinase levels, tea colored urine, dysrhythmias, myalgias, muscle weakness, and loss of sensation. Patients may also have extensive soft tissue edema, which is evidence of hypovolemic shock.
A patient with facial trauma from a baseball reveals bloody fluid leaking from the nose, periorbital swelling, and crepitus on palpation of the facial bones. The patient is restless. The priority intervention is to: elevate the head of the bed. prepare the patient for CT. administer isotonic crystalloids. control the bleeding from the nose.
elevate the head of the bed. The priority intervention is to elevate the head of the bed to prevent aspiration of fluid, compromising breathing. As breathing takes precedence, all other listed interventions are secondary.
A patient presenting with an injury to the middle meningeal artery is at risk for epidural hematoma subdural hematoma ischemic cerebral infarct basilar skull fracture
epidural hematoma The middle meningeal artery is directly associated with epidural hematoma as a known pattern of injury due to anatomical location.
A traumatic brain injury characterized by a loss of consciousness followed by a lucid interval before rapid deterioration of mental status is concerning for: subarachnoid hemorrhage. epidural hematoma. diffuse axonal injury. subdural hematoma.
epidural hematoma. The rapid deterioration seen with epidural hematoma is most commonly due to injury to the middle meningeal artery. Since the source of bleeding is arterial, blood may accumulate rapidly, creating compression of the underlying brain tissue.
Post-splenectomy discharge instructions have been understood by a patient who states, "I will: eat foods high in iron." no longer play contact sports." get a flu shot every year." need to monitor my blood sugar."
get a flu shot every year." As the spleen has many important immunological functions, an annual flu shot is necessary. Iron and blood sugar levels are not affected by a splenectomy. After complete recovery, contact sports are not prohibited.
The nurse is caring for a patient who was recently extubated and is now experiencing dysphagia. The care team is ready to assess the patient's ability to handle oral intake. The nurse anticipates a referral for which therapy? speech physical occupational nutritional
speech A speech therapist will assess the exact nature of the swallowing problem and make recommendations regarding consistency and ability to handle oral intake.
A patient has a subdural hematoma. Despite surgical intervention, the intracranial pressure continues to increase, and the patient is unresponsive and requires ongoing mechanical ventilation. The organ procurement agency should be notified when the patient: is withdrawn from life support. is declared brain dead. has a poor prognosis identified. exhibits positive doll's eyes.
has a poor prognosis identified. Timely notification of the organ procurement agency for patients that are or may progress to brain death is essential. A patient with a neurological injury requiring ventilator support should be referred to the organ procurement agency as early as possible. Notification of the organ procurement organization is at time when brain death is declared or when the decision is made in order to withdraw care, which may decrease chances of becoming an organ donor and participating in organ donation.
Which of the following is the best position for a patient who has sustained a traumatic brain injury without spinal injury? reverse Trendelenburg with neck in mild flexion head of bed flat with head in neutral, midline position head of bed elevated to 30 degrees with head in neutral, midline position high Fowler's position with neck in mild extension
head of bed elevated to 30 degrees with head in neutral, midline position Elevating the head of the bed to at least 30 degrees facilitates venous flow and decreases intracranial pressure (ICP). Head should be midline to also facilitate venous flow, but the head of bed being flat would cause an increase in ICP. Having the neck flexed or extended can decrease venous outflow causing an increase in ICP.
Epidural analgesia has been an effective pain treatment for a blunt chest wall injury if the patient exhibits which of the following responses? increased heart rate improved capillary refill decreased cardiac output improved respiratory effort
improved respiratory effort Epidural analgesia would block the exceedingly painful chest wall injury at a central location in the spinal canal. This would allow pain-free, or at least diminished, pain, with respiratory excursion thus allowing improved respiratory effort. An epidural analgesic block should have no direct effect on the hemodynamics of cardiac output, rate or capillary refill.
Which of the following components of the incident command structure is reported to be the highest risk during a disaster? expected span of control absence of hazard vulnerability analysis presence of non-modular organization inadequate communication
inadequate communication Communication has been shown to be the largest vulnerability during a disaster. Modular organization is the ability to activate only the necessary components of the incident command structure. Unity of command refers to there being only one person in charge. Each agency may have their own incident commander, but all work under the direction of the highest level incident commander. A focused and manageable span of control is essential. It is recommended that each supervisor have no more than seven subordinates to allow for adequate supervision and efficient communication during an incident.
A patient presents with pelvic pain and severe hypotension following a motor vehicle crash. Imaging studies reveal an open-book pelvic fracture. Application of a pelvic binder has been effective if reassessment reveals: worsening pelvic pain. increased blood pressure. external rotation of the lower limbs. a narrowing pulse pressure.
increased blood pressure. Reducing the pelvic volume with a binder can reduce bleeding, resulting in an increased blood pressure. Pain may occur with initial placement but usually has no correlation to the effective use of a binder. External rotation of the lower limbs is finding of an open-book pelvic fracture and not indicative of effective placement of a binder. A narrow pulse pressure is a sign of worsening hemodynamic status and would not indicate effective placement.
Which of the following findings associated with a closed fracture of the tibia and fibula signals the need for an immediate fasciotomy? capillary refill of two seconds increased pain with passive motion persistent burning sensation bounding distal pulses
increased pain with passive motion A hallmark sign of compartment syndrome is pain out of proportion to the extent of the injury. Pain with passive range of motion of the affected compartment can indicate development of or existing compartment syndrome. Ischemia pain is often described as 'burning' and is typically intense and severe.
A patient with systemic inflammatory response syndrome (SIRS) has a lactate level that increases from 6 mg/dL to 10 mg/dL. This change indicates the need for tranexamic acid fluid volume overload increasing tissue hypoxia a respiratory acidosis
increasing tissue hypoxia A buildup of lactate is a product of anaerobic metabolism usually from under resuscitation or ongoing shock state.
A patient arrives with chest pain after being kicked in the chest by a horse. The patient is alert and has received 2L of isotonic crystalloid. The FAST exam and chest x-ray are negative, and the patient remains hypotensive. Monitor displays sinus tach with frequent PVCs. The nurse should prepare to administer: additional crystalloid, and assess for underlying cause. inotropic medication and additional crystalloids, and prepare for surgery. inotropic and antidysrhythmic, and limit IV fluids. antidysrhythmic and additional crystalloid, and prepare for ICU admission.
inotropic and antidysrhythmic, and limit IV fluids. Blunt injury to the chest and failure to respond to fluid resuscitation, along with the negative FAST exam and chest x-ray, suggest this patient has a cardiac injury. With myocardial contusions, dysrhythmias and cardiogenic shock can be life-threatening. Administration of additional IV fluids could be harmful.
A 6-month-old infant is brought via EMS receiving bag-mask ventilation. Endotracheal intubation is performed on arrival and tube placement is confirmed. The NEXT priority is to obtain an arterial blood gas. insert a gastric tube. place a central line. assess central pulses.
insert a gastric tube. Gastric decompression is part of securing the ETT to prevent aspiration of stomach contents into the lungs.
The nurse is caring for patient who sustained recent multi-system injuries. Which of the following should the nurse recognize would predispose the patient to the development of coagulopathy? large fluid and blood administration absence of head injury hyperthermia alkalosis
large fluid and blood administration Massive fluid and blood administration can predispose the patient to coagulopathies within a few hours of administration. Head injuries, hypothermia and acidosis may predispose the patient to coagulopathies.
The nurse is examining a 5-month-old child who was brought into the emergency department by the mother. The mother states the patient was dropped and hit their head on a table one hour prior to arrival. The patient is now inconsolable and vomited a bottle given 30 minutes prior. A workup reveals fractures of the femur and skull. Which of the following would alert the nurse to questionable child abuse? mechanism of injury long bone fracture delay in obtaining medical care skull fracture
long bone fracture Fractures of long bones in children younger than three years of age warrant further investigation for suspected child abuse. In this scenario, the mechanism of injury may be plausible, and the patient was brought for a medical examination soon after the event occurred.
Which unstable vertebral fracture is associated with lap belt restraint use and retroperitoneal injury? thoracic sacral lumbar cervical
lumbar Chance fractures are transverse fractures through the vertebral body. They are caused by flexion about an axis anterior to the vertebral column and are most frequently seen following motor vehicle crashes in which the patient was restrained by only a lap belt. Chance fractures may be associated with retroperitoneal and abdominal visceral injuries.
A patient sustains bilateral calcaneus fractures after a 20-foot fall. The nurse should suspect which concurrent injury? bladder rupture femur fracture splenic rupture lumbar fractures
lumbar fractures A fall from a height, resulting in calcaneus fracture, is an additional pattern of injury associated with compression fractures of the lumbar vertebrae.
A patient involved in a motor vehicle collision has been unable to void since arriving 5 hours ago. CT scan findings indicate free fluid in the pelvic cavity. A transurethral catheter is inserted, and antibiotics are initiated. To decrease morbidity, the nurse should promote urine alkalinization. maintain adequate urine drainage. instill urinary methenamine hippurate (Hiprex). ensure effective bladder irrigation.
maintain adequate urine drainage. Patients with extraperitoneal bladder ruptures are treated with passive drainage alone. If inadequate drainage occurs, the bladder will be unable to heal, and persistent urinary leak will occur.
Goals for managing traumatic brain injury in the prehospital setting include: avoiding intubation so hospital providers can assess neurologic status. reducing intracranial pressure during intubation with the use of paralytics. maintaining adequate blood pressure with isotonic or hypertonic fluids. reducing intracranial pressure during intubation with the use of paralytics.
maintaining adequate blood pressure with isotonic or hypertonic fluids. As secondary brain injury associated with hypotension dramatically increases mortality, preventing hypotension is the goal. Intubation should NOT be avoided, if indicated. Paralytics are not first line therapy for reducing ICP and are rarely used as such. Hyperventilation is a temporary rescue maneuver only used to REDUCE increased ICP.
The American College of Surgeons Committee on Trauma requires all trauma centers to monitor and evaluate the performance of its trauma program to identify care gaps, outcomes, and benchmarking. optimize care delivery, timelines, and response. measure, evaluate, and improve care. modify interventions, procedures, and tracking.
measure, evaluate, and improve care. The American College of Surgeons Committee on Trauma (ACS-COT) calls for each trauma program to demonstrate a continuous process of monitoring, assessment, and management directed at improving care.
A 30-year-old patient recently underwent splenectomy. Which of the following vaccinations should be administered before discharge? herpes zoster hepatitis B varicella meningococcus
meningococcus Post-splenectomy patients require vaccination for encapsulated organisms. These vaccines include meningococcus, haemophilus influenza, and pneumococcus.
Cellular hypoxia is evident in which of the following blood gas interpretations? respiratory acidosis respiratory alkalosis metabolic alkalosis metabolic acidosis
metabolic acidosis Tissue hypoxia due to low arterial oxygenation results in a switch to anaerobic metabolism at the cellular level. Reduced blood flow results in an increase in serum lactate - lactic acidosis or metabolic acidosis.
Which of the following actions is the PRIORITY for a patient with a crush injury? positioning the extremity above the level of the heart initiating serial renal function studies administering IV colloids monitoring for compartment syndrome
monitoring for compartment syndrome Crush injuries can result in several complications, including compartment syndrome, hyperkalemia, and rhabdomyolysis.
Which ethical principle is a physician practicing when explaining the prognosis of a surgical procedure for a devastating traumatic brain injury to a patient's family? utility beneficence justice nonmaleficence
nonmaleficence Beneficence is the act of doing good to prevent harm. Nonmaleficence is the act of avoiding harm. Justice is the act of treating all patients equally. Utility is the act of maximizing overall good.
Which of the following is a role of the trauma performance improvement coordinator? direct interface with liaisons to resolve care deficits primary care providers notification of patient admission participation in case selection for multidisciplinary reviews education and counseling for provider-related issues
participation in case selection for multidisciplinary reviews The trauma medical director provides education and counseling to other physicians as well as directly communicates with liaisons to address care deficits. The trauma performance coordinator is prominently involved in case selection for multidisciplinary reviews. Primary care providers should be notified directly by the inpatient team.
A patient is undergoing initial assessment in the emergency department after being involved in a motor vehicle collision. The trauma team suspects the patient may have a spinal cord injury. The patient has a Glasgow Coma Scale (GCS) score of 15 and is able to participate in the assessment appropriately. Which nursing documentation is imperative in the continuing care of this patient? rationale for not using steroids time the patient was removed from long spine board patient's level of sensation and strength arrival time of spinal surgery consult
patient's level of sensation and strength Thorough documentation of the patient's sensation and strength is vital in a diagnosed or potential spinal cord injured patient to identify any neurological improvement or deterioration on sequential assessments. While documentation of long spine board removal and spinal surgery arrival time is important, these events are not imperative to the continuing care of the patient, but rather may be reviewed as part of the performance improvement process. Additionally, there is insufficient evidence to support the use of steroids in patients with a spinal cord injury, the rationale for not using steroids is not needed.
A 12-month-old infant believed to have a spinal cord injury is placed in a rigid cervical collar on presentation. Airway positioning should include securing the patient to a long spine board. placing padding under the patient's torso. tipping the patient 25 degrees to the side. placing patient in sniffing position.
placing padding under the patient's torso. The large occiput of an infant will result in anterior displacement of the face and occlusion of the trachea when lying flat. Padding beneath the torso will prevent anterior displacement.
A patient sustains an open distal radius fracture, a tibial shaft fracture, and a knee dislocation after being thrown from a motorcycle. The patient is at risk for which of the following associated injuries? brachial artery injury popliteal artery injury femoral neck fracture calcaneal fracture
popliteal artery injury Popliteal artery injuries are frequently seen with traumatic dislocations of the knee. For a patient who presents with a knee dislocation, a high index of suspicion should help caregivers rapidly diagnose trauma to the popliteal artery and provide treatment to maintain blood supply to the lower leg.
Initial assessment of an adult patient who fell from a riding lawnmower reveals an abrasion to the left temporal region. The patient continues to vomit despite administration of 8 mg of ondansetron (Zofran) IV. The nurses priority is to: repeat the antiemetic. insert a nasogastric tube. prepare the patient for CT. administer a fluid bolus.
prepare the patient for CT. Continuous vomiting in a head injured patient could be indicative of an intracerebral hemorrhage. A head CT would be the priority to rule out head bleed. Since the patient received 8 mg of Zofran, the nurse should wait approximately 4 hours to repeat Zofran. A fluid bolus would be appropriate, but it is not the priority, and an NG tube would be contraindicated until any facial trauma or fractures are ruled out.
A patient is undergoing an initial assessment following a motorcycle collision. The patient is noted to be hypotensive. The physician palpates the patient's pelvis and states the pelvis is unstable. An appropriate next step would be to: place a pelvic binder over the iliac crests. ask a second physician to confirm the pelvic instability. palpate the prostate gland to assess for associated urethral injury. prepare the patient for transport to undergo pre-peritoneal packing.
prepare the patient for transport to undergo pre-peritoneal packing. Angiographic embolization is one method to stop hemorrhage related to pelvic fractures. If a facility does not have interventional radiology available, or there is a delay in getting the team to the institution, the patient should be prepared to undergo pre-peritoneal packing in the operative suite to stop bleeding. A pelvic binder should be placed over the greater trochanters rather than the iliac crests. Once pelvic instability is palpated, the pelvis should not be palpated again. Palpation of the prostate gland is not a dependable sign of urethral injury.
A patient with a body mass index of 45 is undergoing initial evaluation after sustaining injuries in a motor vehicle collision. The nurse should be aware of which of the following considerations when taking care of this patient? a negative FAST exam can exclude the possibility of an abdominal injury the patient is not at risk for significant blood loss in the soft tissue in the absence of a fracture circulating blood volume is estimated based on actual body weight rapid administration of fluid may exacerbate potential cardiopulmonary comorbidities
rapid administration of fluid may exacerbate potential cardiopulmonary comorbidities Obese patients often have associated comorbidities, including cardiopulmonary disease. Rapid fluid administration may lead to cardiac overload. Obese patients are at risk for extensive blood loss into soft tissues, even in the absence of fractures. A negative FAST exam does not exclude the possibility of an abdominal injury in any patient population. Circulating blood volume should be estimated based on the patient's ideal body weight.
A 30-year-old patient sustained multiple gunshot wounds and has had multiple surgeries. He is now stable, but the nurse notes he has a flat affect and has been disinterested in participating with physical therapy. The nurse should: encourage friends and family to take a break from visiting. suggest the patient relocate to a safer community. work with physical therapy to arrange group therapy sessions. recommend screening for post-traumatic stress disorder.
recommend screening for post-traumatic stress disorder. suggest the patient relocate to a safer community. Patients who have survived significant injury are at increased risk for development of PTSD. Symptoms may vary from avoidance of reminders of the event to nightmares or reliving the event. Sadness or numbness may make it difficult for the person to feel or express happiness or other positive emotions.
A patient presents with decreased vision in the right eye and exophthalmos following isolated blunt force trauma to the face. Heart rate is 82 beats/min, and a cervical collar is in place. The next most appropriate intervention is to: remove any overlying dressing to the affected eye. remove the cervical collar to facilitate venous drainage. apply dry gauze dressing to the affected eye. administer narcotic pain medication and antiemetics.
remove any overlying dressing to the affected eye. Care should be taken to avoid any pressure over an eye or orbital injury.
One key component that distinguishes an American College of Surgeons Verified Level 1 Trauma Center from Level 2 or Level 3 trauma centers is: research. trauma registry data collection. injury prevention activities. performance improvement initiatives.
research. Research is a fundamental component of a successful trauma program in an American College of Surgeons (ACS) Level 1 Trauma Center. Performance improvement initiatives, injury prevention activities, and trauma registry data collection is mandated in all ACS trauma centers regardless of level.
A patient with an unstable open-book pelvic fracture and blood at the urinary meatus should be prepared for which of the following studies? IV pyelogram CT cystogram retrograde urethrogram renogram
retrograde urethrogram An open-book pelvic fracture is a disruption of the pelvic ring and has a high likelihood of associated trauma to structures anatomically located within the pelvis. A retrograde urethrogram would assess for injuries to the urethra, which are commonly diagnosed along with a severe pelvic fracture. An IV pyelogram, CT cystogram, and renogram are all diagnostic studies associated with an injury of the pelvis.
The nurse is caring for a patient who has been struck by lightning and notes dark brown urine in the collection bag. The MOST likely cause for the urine color is glomerulonephritis. urinary tract infection. hypovolemia. rhabdomyolysis.
rhabdomyolysis. When a person is struck by lightning, they suffer an electrical burn. This leads to tissue damage and cellular destruction, releasing myoglobin into circulation. The urine will appear dark red to brown-colored, which is specific to a diagnosis of rhabdomyolysis.
An injury prevention program with the MOST potential for decreasing the number of injuries in a trauma center's population involves the use of: national injury prevention statistics. the trauma center's data registry. private trauma prevention consultants. local educational institutions.
the trauma center's data registry. Trauma centers must have an organized and effective approach to injury prevention and must prioritize those efforts based on local trauma registry and epidemiologic data. National trauma injury data, private consultants and local educational institutions will not be able to provide the epidemiological information that is relevant to the local community.
A patient sustained a hemothorax and is being prepared for insertion of a chest tube. The nurse should notify the physician when: there is 250 mL/hr of bloody chest tube drainage for 3 hours. admission orders include keeping the chest tube unclamped. bubbling in the chest tube chamber stops after insertion. the patient no longer has distended neck veins after chest tube placement.
there is 250 mL/hr of bloody chest tube drainage for 3 hours. Patients who sustain a hemothorax may require a thoracotomy. Indications for a thoracotomy include > 1500 mL initial bloody output or > 200 mL/hr of bloody drainage for 2-4 hours. Small to moderate air leaks will usually seal during the first few hours to days after trauma. The physician should be notified if a major air leak (bubbling in the chest tube chamber) persists. With a hemothorax, chest tubes should not be clamped as this may result in a tension pneumothorax. Distended neck veins (if present) should subside after chest tube placement.
Pre-hospital trauma care principles indicate that all trauma patients should be transported with spinal motion restriction protocols. by helicopter to expedite patient transport. to the closest facility for stabilization. to the most appropriately equipped trauma designated facility.
to the most appropriately equipped trauma designated facility. The closest facility may not be the best facility for the care of the acutely injured patient if a trauma center is nearby. Helicopter transport has weather limitations and is not always necessary. Spinal motion restriction applies mostly to blunt trauma patients. Each region's trauma system determines the appropriate trauma centers for injured patients.
Assessment of a patient who sustained a clothesline-type injury to the neck reveals dyspnea, tachypnea, subcutaneous emphysema in the neck and face, and decreased breath sounds bilaterally. These assessment findings are consistent with: bilateral pneumothoraces. blunt esophageal injury. great vessel injury of the neck. tracheobronchial injury.
tracheobronchial injury. All of these symptoms and the mechanism of injury are indicative of a tracheobrochial injury. None of the symptoms are usually found in injuries to the great neck vessels. While bilateral pneumothoraces may produce these symptoms, the mechanism of injury is not consistent with this injury. Blunt esophageal injury is NOT usually associated with dyspnea or tachypnea.
The National Trauma Data Bank is a collection of trauma organization guidelines. evidence-based practice studies for performance improvement. demographic data of trauma surgeons in the United States. trauma data for research and benchmarking.
trauma data for research and benchmarking. Nationally, trauma centers submit a specified data set to the National Trauma Data Bank. This data is then analyzed by the American College of Surgeons for trends, outcomes, and trauma center performance.
Multiple diagnostic tests are ordered prior to transfer of a severely injured patient from a rural hospital to a trauma center. The nurse should treat life-threatening injuries and initiate transfer. disregard the physician orders and call transport. initiate the physician orders. delay the transfer until all tests are completed.
treat life-threatening injuries and initiate transfer. Diagnostic tests, such as radiological imaging, should not delay transfer unless absolutely necessary.
Damage control resuscitation is characterized by: use of permissive hypotension as a treatment strategy. administration of at least 2 L of crystalloid. early definitive surgical repair. waiting until surgery to initiate a transfusion.
use of permissive hypotension as a treatment strategy. administration of at least 2 L of crystalloid. Damage control resuscitation involves early blood transfusion as well as control of hemorrhage and is a temporizing measure until the source of bleeding is stopped. Studies have shown that the practice of damage control resuscitation, which includes permissive hypotension to help prevent coagulopathies and hypothermia, leads to improved outcomes in trauma care.
Which of the following techniques is MOST appropriate for identifying community education priorities for a trauma program? surveying local trauma surgeons for program recommendations selecting areas of focus based on recent trauma cases asking staff for recommendations using trauma registry data to establish program priorities
using trauma registry data to establish program priorities Trauma outreach community education should be prioritized starting with trauma registry information. Trauma registry data will provide accurate statistics of injuries patterns for the population served. Surveying staff or trauma surgeons has potential bias. Similarly selecting areas of focus based on recent trauma cases may fail to accurately identify patterns of injuries or mechanisms of injury.
The nurse is caring for patient who sustained a blow to the orbit from a fist. An open globe rupture is not suspected. The nurse is assessing the patient for potential ocular injury and should include which three vital signs of the eye? dye test, vision, pupils pH test, pupils, extraocular movement pupils, fundoscopic examination, intraocular pressure vision, pupils, intraocular pressure
vision, pupils, intraocular pressure The three vital signs of the eye include vision, pupils, and intraocular pressure. A dye test may be obtained in addition to these three measurements if there is concern for an eye laceration. A pH test would be beneficial if there was concern for a burn to the eye. Intraocular pressure should not be performed if there is a concern for an open globe rupture. Fundoscopic evaluation is an evaluation of the fundus, which gives a picture of the patient's overall vasculature and includes dilation of the pupil. Fundoscopic evaluation should not be completed in patients with a potential head injury.
