TNCC

Initiate 2 large-caliber IV lines for LR administration.

A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented and has delayed capillary refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principles?

Bradycardia and absent motor function below the level of injury

A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs?

Huddle

A trauma patient is en route to a rural emergency department. Radiology notifies the charge nurse that the computerized tomography (CT) scanner will be out of service for several hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma team communication?

Compensated

A trauma patient is restless and repeatedly asking "where am I? "Vital signs upon arrival were BP 110/60 mmHg. Heart rate 96 bpm and respiratory rate 24 breaths per minute. Her skin is cool and dry. Current vital signs are BP 104/84, HR 108, RR 28,. The patient is demonstrating signs and symptoms of which stage of shock?

Calcium

If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation?

Elevating the extremity to the level of the heart

Patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention?

dysrhythmias

Pts with a crush injury should be monitored for which of the following conditions?

Worsening pneumothorax

Which of the following is a possible complication of positive pressure ventilation?

Fluctuation in the water seal chamber

Which of the following is an expected finding in a patient with a tube thoracostomy connected to a chest drainage system?

pericardiocentesis

Which of the following is not considered goal directed therapy for cardiogenic shock?

It can worsen cord damage from an unstable spinal injury

Which of the following is true about log roll?

MARCH (massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia)

Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage?

The aorta is torn at its attachment with the ligamentum arteriosum

Which of the following occurs during the third impact of a motor vehicle crash?

A 52-year-old diabetic male with a partial thickness burn to the left lower leg

Which of the following patients warrants referral to a burn center?

CIWA-Ar of 36

Which of the following values indicates the need for alcohol withdrawal interventions?

narrowed pulse pressure

Which pulse pressure description is an indication of early hypovolemic shock?

To gauge and organ perfusion and tissue hypoxia

Why is a measure of serum lactate obtained in the initial assessment of a trauma pt?

Placental abruption

You are caring for a patient who was involved in a motor vehicle crash and is 32 weeks pregnant. Findings of your secondary survey include abdominal pain on palpation, fundal height at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cardiotocography. These findings are most consistent with which of the following?

500 mL/hr

You are treating a 27-year-old male in respiratory distress who was involved in a house fire. Calculating total body surface area burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation?

pulse oximetry and capnography

What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation?

Velocity

What factor contributes most to the kinetic energy of a body in motion?

Priapism

What finding raises suspicion of a complete spinal cord injury?

Hemoglobin does not readily release oxygen for use by the tissues

What is the effect of hypothermia an oxyhemoglobin dissociation curve?

Hypotension that worsens with inspiration

Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax?

A pertinent medical history is crucial

Which of the following considerations is the most important when caring for a geriatric trauma patient?

Bowel

Which of the following injuries is least likely to be promptly identified?

Elevated creatinine phosphokinase

A patient is found lying on the floor after falling 13 hours ago. Which of the following laboratory values is expected with a musculoskeletal complication associated with this presentation?

Acidosis

Which of the following is a component of the trauma a triad of that?

Decreased respiratory effort

Which of the following is a late sign of increased ICP?

Straight catheter for urine sample

A 20-year-old male presents to the ED complaining of severe lower abdominal pain after landing hard on a bicycle crossbars while performing an aerial BMX maneuver. Secondary assessment reveals lower abdominal tenderness and scrotal ecchymosis. Which of the following orders with the nurse question?

globe rupture

A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop shaped left pupil is noted on exam. What type of injury is suspected?

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

A 36-year-old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention?

Diagnostic Peritoneal Lavage

A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are stable. The nurse can anticipate all of these after a negative FAST exam except which of the following?

Expedite transfer to the closest trauma center

A 56-year-old make pt involved in a MVC is brought to the ED of a rural, critical access facility. He complains of neck pain, SOB, and diffuse abdominal pain. His GCS is 15. His VS are BP 98/71 mmHg, HR 125 bpm, RR 26 bpm, SpO2 94% on high-flow O2 via NRM. Which of the following is the priority intervention for this pt?

Report your suspicions of maltreatment in accordance with local regulations

A five-year-old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention?

Dressing removal

A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a non porous dressing over the chest wound and taped it on three sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreased blood pressure. Which of the following is the MOST appropriate immediate intervention?

Fat embolism

A patient has been in the emergency department for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the patient is restless with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions?

Initiate transfer to a trauma center

A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority intervention?

subdural hematoma

An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms?

Confirm ETT placement

An intubated trauma pt is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. What is the priority intervention?

Ventilate with a bag-mask device

An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiration's, and dusky skin. The trauma team has administered medication for a drug assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step?

Padding the upper back while stabilizing the cervical spine

Caregivers carry in a two year old into the emergency department who fell out of a second-story window. The patient is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority?

insert an oropharyngeal airway if there is no gag reflex

During the primary survey of an unconscious patient with multi system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next?

After a physical examination if the patient has no radiologic abnormalities and CT

EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the driver side of the car. The patient is asking to have the cervical collar removed. When is the appropriate time to remove the cervical collar?

Smell of alcohol on breath

EMS brings a patient who fell while riding his bicycle. Using the American College of surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance?

Mitigation

Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster. Which phase of the disaster lifecycle does this describe?

subdural hematoma

Tearing of the bridging veins is most frequently associated with which brain injury?

Pelvic stability

The most reassuring finding for a male patient with his pain after a fall is which of the following?

2280 ml

The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire service of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total body surface area burned how much IV fluid would be administered in the first eight hours?

ETT

The trauma nurse knows that placing a bariatric patient in a ramped position provides better visualization during the insertion of which device?