TRAUMA
1. When opening the airway of an unresponsive trauma patient in the emergency department, which of the following considerations is correct? a. Airway assessment must incorporate cervical spine immobilization. b. Hyperextension of the neck is the only acceptable technique. c. Flexion of the neck protects the patient from further injury. d. Airway patency takes priority over cervical spine immobilization.
A
1. A patient sustained injuries in a motor vehicle accident and is in the Emergency Department. A CT scan of the head and neck have been ordered. What part of the survey is this? A) Primary B) Secondary C) Tertiary D) Initial
B
22. Fat embolism syndrome can occur as a complication of a. liver trauma. b. burns. c. orthopedic trauma. d. spleen trauma.
C
9. In the trauma patient, symptoms of decreased cardiac output are most commonly caused by: a. cardiac contusion. b. cardiogenic shock. c. hypovolemia. d. pericardial tamponade.
C
17. The most important aspect of a secondary survey is to a. check circulatory status. b. check electrolyte profile. c. insert a urinary catheter. d. obtain patient history.
D
10. A community-based external disaster is initiated after a tornado moved through the city. A nurse from the medical records review department arrives at the emergency department asking how she can assist. The best response by a nurse working for the trauma center would be to: a. assign the nurse administrative duties, such as obtaining patient demographic information. b. assign the nurse to a triage room with another nurse from the emergency department. c. thank the nurse but inform her to return to her department as her skill set is not a good match for patients needs. d. have the nurse assist with transport of patients to procedural areas.
A
10. The nurse is caring for the patient with chest tubes. Which observation by the nurse is a priority concern? A) 250 mL/hr of blood in drainage collection system B) Pulse oximetry of 94% C) Blood pressure of 104/62 D) 30 mL/hr of urine output
A
12. A patient was thrown 30 feet from an open-top Jeep and straddled a row of mailboxes before she landed on the ground. She has an open pelvic fracture. The nurse admitting the patient into the ICU knows that a. aggressive fluid and blood replacement will probably be needed. b. the patient will probably be able to walk as soon as she is hemodynamically stable. c. she will probably not need surgery to stabilize her fracture. d. there is little likelihood of damage to the genitourinary or gastrointestinal tracts.
A
13. A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture. The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains. The patients hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7 C; CVP, 5 cm H2O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dynes/sec. What is the most likely cause of this hemodynamic picture? a. Septic shock b. Hemorrhagic shock c. Cardiogenic shock d. Neurogenic shock
A
17. A patient is admitted to the CCU after experiencing blunt trauma to the chest. Among other injuries, the patient has a flail chest on the left and several extremity fractures. About 12 hours after admission, the patient is tachypneic and complaining of shortness of breath. Breath sounds are present bilaterally with scattered fine crackles. Chest radiograph shows an ill-defined, patchy, ground-glass area of density on the left. If the patient has a pulmonary contusion, what is the nursing priority? A) Monitor pulse oximetry and arterial blood gases closely. B) Place an oral endotracheal tube immediately. C) Increase the amounts of intravenous crystalloid administration. D) Obtain sputum culture and sensitivity and Gram stain.
A
2. A patient who is in the Emergency Department was attacked in a parking lot and suffered several stab wounds to various areas on the chest and abdomen; BP 100/60, heart rate 108, respiratory rate 20, pulse oximetry 98%. In order to counteract the blood loss and restore circulating volume for this patient, what priority intervention will the nurse perform? A) Start lactated Ringers at 150 mL/hr. B) Start dopamine at 5 mcg/kg/min. C) Start an albumin infusion wide open. D) Start a unit of uncrossmatched blood.
A
20. A patient has experienced multiple fractures, including pelvic and long bone fractures. After 72 hours, the patient complains of tachypnea and dyspnea and is found to have cyanosis, tachycardia, confusion, and fever. Laboratory analysis reveals a normal complete blood count except for thrombocytopenia and progressive respiratory insufficiency. What is the nursing care priority? A) Administer oxygen and monitor pulse oximetry. B) Initiate low-molecular-weight heparin therapy. C) Obtain cultures of all body substances. D) Initiate fall and seizure precautions.
A
20. A patients condition has deteriorated. Changes in condition include trachea shift, absence of breath sounds on the left side, and hypotension. A chest tube was inserted on the left side with 1800 mL of blood removed. The nurse expects that the patient will be taken to surgery for a a. thoracotomy. b. cardiac tamponade. c. splenectomy. d. pneumothorax.
A
21. During assessment of a patient who is new to the critical unit, the nurse observes perianal ecchymosis. The nurse suspects the patient has a a. pelvic fracture. b. bladder trauma. c. rectal laceration. d. spleen laceration.
A
22. As part of a multiple trauma injury, a patient developed hemorrhagic hypovolemic shock, necessitating fluid resuscitation with massive amounts of intravenous crystalloid fluids and blood products as well as extensive surgical repair under general anesthesia. Twenty-four hours later, the patient develops hypoxia unresponsive to oxygen therapy and diffuse white, ground-glass infiltrates of the lung fields on a chest radiograph. Development of this complication has what effect on the patients recovery? A) Significantly greater chance of death B) No change in outcome expectations C) Outcome depends on treatment. D) Lower chance of death
A
3. A patient has sustained an epidural hematoma after a 10-foot fall from a roof. Which of the following is true about epidural hematomas? a. They are usually arterial in nature. b. They typically have a worse mortality rate than subdural hematomas. c. They are associated with a permanent loss of consciousness. d. Clinical signs and symptoms include bilateral pupil dilation.
A
3. 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
7. Which of the following interventions would not be appropriate for a patient who is admitted with a suspected basilar skull fracture? a. Insertion of a nasogastric tube b. Insertion of an indwelling urinary catheter c. Endotracheal intubation d. Placement of an oral airway
A
8. 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
9. A patient who was an unrestrained driver in a high-speed, head-on motor vehicle collision presents with dyspnea, tachycardia, hypotension, jugular venous distention, tracheal deviation to the left, and decreased breath sounds on the right side. What is the most likely diagnosis? a. Tension pneumothorax b. Cardiac tamponade c. Simple pneumothorax d. Ruptured diaphragm
A
2. 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. Indwelling urinary catheters are a source of infection. b. Patients often develop infection and sepsis secondary to central line catheters. c. Pneumonia is often an adverse outcome of mechanical ventilation. d. Wounds require sterile dressings to prevent infection.
A, B, C
3. Signs and symptoms of compartment syndrome in the lower extremities include (Select all that apply.) a. paresis. b. increased pain. c. pain in the affected extremity. d. swelling in the affected extremity. e. decrease pulses and capillary refill. f. increase urinary output.
A, B, C, D
6. Which interventions can the nurse implement to assist the patients family in coping with the traumatic event? (Select all that apply.) a. Establish a family spokesperson and communication system. b. Ask the family about their normal coping mechanisms. c. Limit visitation to set times throughout the day. d. Coordinate a family conference.
A, B, D
7. Nursing priorities to prevent ineffective coagulation include which of the following? (Select all that apply.) a. Prevention of hypothermia b. Administration of fresh frozen plasma as ordered c. Administration of potassium as ordered d. Administration of calcium as ordered
A, B, D
5. 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 right arm b. Gunshot wound to the abdomen c. Lightning strike of the left arm and chest d. Pulmonary contusion and rib fracture
A, C
3. During the assessment of a patient after a high-speed motor vehicle crash, which of the following findings would increase the nurses suspicion of a pulmonary contusion? (Select all that apply.) a. Chest wall ecchymosis b. Diminished or absent breath sounds c. Pink-tinged or blood secretions d. Signs of hypoxia on room air
A, C, D
8. 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. Mean arterial pressure 48 mm Hg b. Elevated serum blood alcohol level c. Non-reactive pupils d. Respiratory rate of 10 breaths per minute
A, C, D
4. Clinical manifestations of abdominal compartment syndrome include which of the following?(Select all that apply.) a. Decreased cardiac output b. Decreased peripheral vascular resistance c. Decreased urine output d. Hypoxia e. Bradycardia f. Hypotension
A, C, D, F
11. A patient is admitted to the emergency department after he was hit by a car. The car was going about 30 mph and was braking at the time of impact. The patient was struck just above the right knee, fell forward over the hood of the car, striking his anterior chest, and then slipped off the hood of the car and hit the pavement head first. Based on the mechanism of injury and transfer of force, what injuries does the nurse most expect? Select all that apply. A) Fracture of left femur and damage to left knee B) Fractures of thoracic and lumbar spine C) Fractured ribs and cardiac and lung contusion D) Bilateral radial and humerus fractures E) Closed head injury and cervical spine fracture F) Bilateral clavicle and scapular fractures
A, C, E
1. Major trauma patients are at a high risk of developing deep venous thrombosis and pulmonary embolism because of (Select all that apply.) a. blood stasis. b. hypernatremia. c. injury to the intimal surface of the vessel. d. hyperosmolarity. e. hypercoagulopathy. f. immobility.
A, C, E, F
11. A patient is admitted to the ICU for observation of his grade II splenic laceration. Which of the following signs and symptoms would suggest that he has had a delayed rupture of his splenic capsule and is now in hemorrhagic shock? a. BP, 110/70 mm Hg; HR, 120 beats/min; Hct, 42 mg/dL; UO, 40 mL/hr; skin that is pink, warm, and dry with capillary refill of 3 seconds b. BP, 90/70 mm Hg; HR, 140 beats/min; Hct, 21 mg/dL; UO, 10 mL/hr; pale, cool, clammy skin; confused c. BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 35 mg/dL; UO, 30 mL/hr; pale, cool, dry skin; alert and oriented d. BP, 110/60 mm Hg; HR, 118 beats/min; Hct, 38 mg/dL; UO, 60 mL/hr; flushed, warm, diaphoretic skin; agitated and confused
B
13. A patient was in a serious motor vehicle crash. At the scene, what is the highest priority of care? A) Extrication from the vehicle B) Cervical spine protection C) Establishing two large-bore intravenous lines D) Collecting information about the crash
B
15. A patient has been admitted to the emergency department after being in a severe motor vehicle crash. The patient was a passenger and had a lap and seat belt in place. The patient is lethargic and moaning. Initial exposure and head-to-toe examination reveals scattered minor abrasions and contusions and bruising over the upper abdomen. The patient moans more when the abdomen is palpated, and the abdomen is rigid. Heart rate is 110, capillary refill is greater than 4 seconds, and blood pressure is 140/88 mm Hg. What is the nursing priority of care? A) Administer intravenous opioid for pain. B) Increase rate of intravenous crystalloid. C) Obtain CT of the abdomen. D) Prepare for immediate endotracheal intubation.
B
16. A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture. The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains. The patients hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7 C; CVP, 5 cm H2O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dyns/sec. The patient is at the greatest risk to develop a. respiratory failure. b. infection. c. venous thromboembolism d. fat embolism syndrome.
B
16. During the treatment and management of the trauma patient, maintaining tissue perfusion, oxygenation, and nutritional support are strategies to prevent: a. disseminated intravascular coagulation. b. multisystem organ dysfunction. c. septic shock. d. wound infection.
B
17. Range-of-motion exercises, early ambulation, and adequate hydration are interventions to prevent: a. catheter-associated infection. b. venous thromboembolism. c. fat embolism. d. nosocomial pneumonia.
B
18. Motor vehicle crashes (MVCs) and falls are the greatest cause of a. spinal shock. b. blunt thoracic trauma. c. maxillofacial injuries d. penetrating thoracic injuries.
B
19. A patients condition has deteriorated. Changes in condition include trachea shift, absence of breath sounds on the left side, and hypotension. The nurse suspects that the patient has developed a(n) a. cardiac tamponade. b. hemothorax. c. open pneumothorax. d. ruptured diaphragm.
B
19. As part of a multiple trauma injury, the patient has suffered a closed fracture of the radius. What nursing assessment finding indicates a significant complication warranting immediate treatment? A) Swelling and pain over the fracture B) Loss of pulses distal to the fracture C) Ecchymosis over the fracture D) Deformity of forearm
B
2. When providing information on trauma prevention, it is important to realize that individuals age 35 to 54 years are most likely to experience which type of trauma incident? a. High-speed motor vehicle crashes b. Poisonings from prescription or illegal drugs c. Violent or domestic traumatic altercations d. Work-related falls
B
20. Which of the following statements 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
21. A 36-year-old driver was pulled from a car after it collided with a tree and the gas tank exploded. What assessment data suggest the patient suffered tissue damage consistent with a blast injury? a. Blood pressure 82/60, heart rate 122, respiratory rate 28. b. Crackles (rales) on auscultation of bilateral lung fields. c. Responsive only to painful stimuli. d. Irregular heart rate and rhythm.
B
4. A patient has been involved in a motor vehicle accident. The patient, who was driving, was unrestrained by a seat belt when hitting the car in front of him. The patient is complaining of midsternal pain, restlessness, and difficulty breathing. What is the priority nursing diagnosis for this patient? A) Anxiety B) Impaired gas exchange C) Impaired circulation D) Pain
B
4. 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
6. A patient is admitted to the ICU with a C5C6 subluxation fracture. He is able to move his legs better than he can move his arms. Caring for the patient would include which of the following interventions? a. Keeping the room cool, dark, and quiet b. Administering intravenous methylprednisolone for the first 24 hours after the injury c. Elevating the head of the bed 45 degrees d. Resuscitating low blood pressure by only using intravenous fluid
B
6. A patient sustained an injury to the right arm after falling off a motorcycle. The patient is complaining of severe pain and is unable to feel the fingers of the right hand. Radial pulse is absent. What is the priority intervention by the nurse? A) Elevate the right arm above the level of the heart. B) Notify the physician. C) Apply ice packs to the affected area. D) Place the patient in Trendelenburg position.
B
1. 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.
B, C
4. It is important to prevent hypothermia in the trauma patient because hypothermia is associated with which of the following? (Select all that apply.) a. ARDS b. Coagulopathies c. Dysrhythmias d. Myocardial dysfunction
B, C, D
5. A patient has suffered a mild pulmonary contusion from a jet ski accident. What nursing interventions are appropriate for this patient? Select all that apply. A) Maintenance of chest tubes B) Frequent pulse oximetry monitoring C) Assessment of lung sounds every 2 hours D) Continuous epidural analgesia E) Maintainance of ventilatory support
B, C, D
2. Which mechanisms caused by circulating myoglobin can lead to the development of kidney failure? (Select all that apply.) a. Dark teacolor urine b. Decreased renal perfusion c. Cast formation with tubular obstruction d. Administration of diuretics e. Rapid screening for serum creatine kinase level f. Toxic effects of myoglobin in the kidney tubules
B, C, F
1. Which of the following best defines the term traumatic injury? a. All trauma patients can be successfully rehabilitated. b. Traumatic injuries cause more deaths than heart disease and cancer. c. Alcohol consumption, drug abuse, or other substance abuse contribute to traumatic events. d. Trauma mainly affects the older adult population.
C
10. Which of the following statements is true about a patient with a blunt cardiac injury/cardiac contusion? a. It will probably be diagnosed by pericardiocentesis. b. Hemodynamic parameters will most likely show a low cardiac output and low systemic vascular resistance. c. Treatment can require insertion of a temporary pacemaker for conduction control. d. The only accurate way to evaluate cardiac contusion is to check the creatine phosphokinase fraction.
C
11. A near-infrared spectroscopy (NIRS) probe is placed in a trauma patient during the resuscitation phase to: a. assess severity of metabolic acidosis. b. determine intraperitoneal bleeding. c. determine tissue oxygenation. d. prevent complications of over-resuscitation.
C
12. The patient has received a gunshot wound. To help predict the amount of damage, what information does the nurse collect? A) Location of the shooting B) Information about the shooter C) Type of weapon and caliber of bullet D) Whether the injury involved a felony
C
14. On initial admission of a trauma victim to the emergency department, the nurse completes a primary survey. The patient is awake and tachypneic, is using accessory muscles of respiration, has unequal chest expansion, and is very anxious. There are absent breath sounds on the right and cyanosis on 100% oxygen, and the trachea is deviated to the left. What action takes the highest priority during the primary survey? A) Jaw thrust maneuver B) Suctioning the oral pharynx C) Chest tube insertion D) Assisting ventilation with bag-mask device
C
14. Which of the following patients have the greatest risk of developing acute respiratory distress syndrome (ARDS) after traumatic injury? a. A patient who has a closed head injury with a decreased level of consciousness b. A patient who has a fractured femur and is currently in traction c. A patient who has received large volumes of fluid and/or blood replacement d. A patient who has underlying chronic obstructive pulmonary disease
C
15. The majority of falls accounting for traumatic injury occur in what population? a. Construction workers b. Adolescents c. Older adults d. Young adults
C
16. As part of a major trauma, a patient has suffered a flail chest injury. What hallmark sign of flail chest does the nurse expect to find? A) Flail segment elevation during inhalation B) Evidence of rib fractures on chest radiograph C) Flail segment depression during inhalation D) Hypoxemia evident on arterial blood gases
C
19. Treatment and/or prevention of rhabdomyolysis in at-risk patients includes aggressive fluid resuscitation to achieve urine output of: a. 30 mL/hr. b. 50 mL/hr. c. 100 mL/hr. d. 300 mL/hr.
C
21. During a motor vehicle accident, a patient sustained blunt trauma to the head and face, resulting in hairline skull fracture and a LeFort III maxillofacial fracture. The patient also has bruising across the chest and upper abdomen and multiple small superficial bleeding abrasions and lacerations. On admission to the emergency department, what is the nursing care priority? A) Apply direct pressure to bleeding areas. B) Assess neurologic status. C) Perform endotracheal intubation. D) Administer tetanus booster immunization.
C
3. The nurse is assigned to a patient in the Emergency Department who exhibits paradoxical chest movement. What intervention by the nurse can help improve oxygenation in this patient? A) Elevate the head of the bed 30 degrees. B) Splint the chest with 3-inch surgical tape. C) Turn the patient with the injured side down. D) Place the patient in the prone position.
C
4. The nursing care plan of a patient with a diffuse axonal injury (DAI) would involve which of the following considerations? a. Neurologic assessments should be performed only once a shift. b. The patient will need a computed tomography scan for definitive diagnosis of the injury. c. Blood pressure and temperature elevations are common. d. The patient is at risk for volume overload because of syndrome of inappropriate antidiuretic hormone.
C
5. 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. The primary survey of this patient upon arrival to the ED: a. includes a cervical spine x-ray study to determine the presence of a fracture. b. involves turning the patient from side to side to get a look at his back. c. is done quickly in the first few minutes to get a baseline assessment and establish priorities. d. is a methodical head-to-toe assessment identifying injuries and treatment priorities.
C
6. The nurse has admitted a patient to the ED following a fall from a first-floor hotel balcony. The patient is 22 years old and smells of alcohol. The patient begins to vomit in the ED. Which of the following interventions is most appropriate? a. Insert an oral airway to prevent aspiration and to protect the airway. b. Offer the patient an emesis basin so that you can measure the amount of emesis. c. 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.
C
7. Signs and symptoms associated with a flail chest include a. tracheal deviation toward the unaffected side. b. jugular venous distention. c. paradoxical respiratory movement. d. respiratory alkalosis.
C
7. The nurse is caring for a patient with deep vein thrombosis of the left lower extremity. The patient exhibits a decrease in pulse oximetry readings from 98% to 86%, shortness of breath with a respiratory rate of 34, and is now disoriented to place. The nurse recognizes that these findings are caused by what complication? A) Pulmonary edema B) Cardiac tamponade C) Pulmonary embolus D) Tension pneumothorax
C
9. A patient has been brought into the Emergency Department via ambulance with resuscitation efforts being performed. It is unlikely that the patient will survive the severe injuries sustained. Two adult children of the patient are present and are requesting to be with the patient at this time. What is the best response by the nurse? A) I dont think you should see your loved one like this. Wouldnt you rather remember him the way he was? B) Our hospital doesnt allow more than one family member in with a patient. One of you can come in and one of you will have to wait in the waiting area. C) You may come in with your parent and I will have someone stay with you to explain what is happening. D) I have been through this many times and I promise you, it is a sight that you dont want to remember.
C
1. The correct order of actions in the management of the postoperative surgical trauma patient who has been admitted to the critical care unit after surgery is: _______________, _______________, _______________,_______________. (Put a comma and space between each answer choice.) a. Connect the patient to bedside monitor and mechanical ventilator. b. Obtain vital signs, rhythm, oxygen saturation, and neurological status. c. Assess airway, breathing, and circulation. d. Reassess and evaluate patency of IV lines, and adjust rate of fluid administration as ordered.
C, A, B, D
12. The need for fluid resuscitation can be assessed best in the trauma patient by monitoring and trending which of the following tests? a. Arterial oxygen saturation b. Hourly urine output c. Mean arterial pressure d. Serum lactate levels
D
13. The nurse is caring for a patient who sustained rib fractures after hitting the steering wheel of his car. The patient is spontaneously breathing and receiving oxygen via a face mask; the oxygen saturation is 95%. During the nurses assessment, the oxygen saturation drops to 80%. The patients 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: a. administration of lactated Ringers solution (1 L) wide open. b. chest x-ray study to determine the etiology of the symptoms. c. endotracheal intubation and mechanical ventilation. d. needle thoracostomy and chest tube insertion.
D
14. Which of the following physiologic changes caused by aging is the most likely contributor to the high mortality rate in older trauma patients compared with younger trauma patients? a. Deterioration of cerebral and motor skills b. Poor vision and hearing c. Diminished pain perception d. Limited cardiovascular physiologic reserve in the elderly
D
15. Patients with musculoskeletal injury are at increased risk for compartment syndrome. What is an initial symptom of a suspected compartment syndrome? a. Absence of pulse in affected extremity b. Pallor in the affected area c. Paresthesia in the affected area d. Severe, throbbing pain in the affected area
D
18. A patient has suffered severe blunt trauma to the abdomen with bruising, diffuse pain, guarding, and rigidity evident. Damage to which structure is most likely? A) Stomach B) Bladder C) Large intestine D) Liver
D
18. Which of the following interventions is a strategy to prevent fat embolism syndrome? a. Administer lipid-lowering statin medications. b. Intubate the patient early after the injury to provide mechanical ventilation. c. Provide prophylaxis with lowmolecular weight heparin. d. Stabilize extremity fractures early.
D
2. A strategy to minimize secondary brain injury in head-injured patients is a. hyperventilation to keep PCO2 less than 30. b. fluid restriction to keep central venous pressure less than 6 cm H2O. c. maintaining body temperature more than 37.5 C. d. fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg.
D
5. A patient is admitted to the ICU with a C5C6 subluxation fracture. He is able to move his legs better than he can move his arms. Which of the following statements is true about his spinal cord injury? a. He is likely to be in supraventricular tachycardia. b. Hyperthermia is common in patients with spinal cord injury. c. These patients do not usually require mechanical ventilation. d. The patient has a central cord syndrome.
D
8. The nurse is assigned to care for a patient who was admitted 2 days previous after a four-wheeler accident. The patient sustained a closed fracture to the left femur and had an open reduction with internal fixation the same day. What is a priority for the nurse to assess for this patient? A) White blood count B) Urinary output C) Cardiac output D) Pulse oximetry
D
8. Which of the following will cause a nurse to suspect that a patients pulmonary contusion is worsening? a. A pulmonary artery catheter showing a central venous pressure of 6 cm H2O and a wedge pressure of 8 mm Hg b. An increased need for pain medication c. An arterial blood gas value that demonstrates respiratory alkalosis d. Increased peak airway pressures on the ventilator
D
2. Prevention of hypothermia is crucial in caring for trauma patients. The correct order of actions for the preparation for the trauma patient is: _______________, _______________, _______________, _______________. (Put a comma and space between each answer choice.) a. Remove wet clothing. b. Warm fluids and blood products before administration. c. Cover the patient with an external warming device. d. Warm the ED or intensive care unit (ICU) room before the patients arrival.
D, A, C, B
