Basic Trauma Course
The infusion rate of the resuscitation fluid is as follows: 1/2 in the first 8 hours after you examine the patient 1/2 in the first 8 hours after the burn injury 1/4 in the first 24 hours post-burn none of the above
1/2 in the first 8 hours after the burn injury
Keep in mind 28% of total drug content remains in patch after ______ days. 1 2 3 5
3
Approximately ___% of geriatric patients will have >3 medications? 75% 60% 55% 50%
50%
According to the resuscitation formula, a 70 kg woman sustains burns of 40% TBSA, what is the calculation of the formula? 7800cc 3400cc 5600cc 2000cc LR 2-3cc x Kg body weight x TBSA
5600cc
A carboxyhemoglobin level of _____ is likely to produce obtundation. 60% 25% 10% none of the above
60%
Increased ICP may be indicated by: ICP above 20 mm Hg Pupil changes (late sign) sluggish or absent pupil reaction, photophobic, papilledema Increased Level of Consciousness A & B
A & B
Epidural Hematoma is a result of: Blood accumulating between the skull and dura due to arterial bleed from temporal fracture rupturing the middle meningial artery Widespread shearing damage occurs to ascending and descending axons in white matter of cerebrum and brain stem following blunt trauma (MVA) with severe rotational acceleration of head. Tearing of the bridging veins across the dura or laceration of the cortical arteries during acceleration-deceleration forces Massive brain swelling causing increased ICP
Blood accumulating between the skull and dura due to arterial bleed from temporal fracture rupturing the middle meningial artery
Secondary Brain Injury is best defined as: Injury from the mechanism such as contusion or direct tissue injury Tissue damage caused by Hypoxia Tissue damage caused by Hypotension A & B B & C
B & C
Part of the neurovascular assessment of a musculoskeletal injury includes: Size of the wound Open vs. closed fracture Color and temperature Amount of blood loss
Color and temperature
The treatment goals of an unstable patient with abdominal trauma is: Control of bleeding and intestinal leaks Accurate diagnosis of all injuries Cool patient to decrease O2 demand All of the above
Control of bleeding and intestinal leaks
If you suspect a bladder injury with hematuria you would prepare the patient for a ________? RUG Cystogram Urethrogram Suprapubic Catheter
Cystogram
Recognition of acute post traumatic stress disorder in the trauma patient would include the following: Difficulty falling asleep, hypervigilance, and exaggerated startle response Difficulty staying asleep, preservation and sundowning Difficulty staying asleep, poor concentration and perseveration Difficulty falling asleep, poor concentration and sundowning
Difficulty falling asleep, hypervigilance, and exaggerated startle response
Which patient priority may last the longest, often several months? Circulation Airway Disability Cosmesis
Disability (WRONG)
Beck's triad of clinical findings associated with pericardial tamponade includes which of the following? Hypotension, jugular vein distension, and muffled heart tones Tachycardia, hypertension, and flushed skin Bradycardia, hypertension, and periods of apnea
Hypotension, jugular vein distension, and muffled heart tones
A patient with multiple right rib fractures (5 through 8) was admitted to your floor. Which of the following may best indicate worsening pulmonary function? The patient has pain increasing for 8/10 from 4/10 with repositioning Incentive spirometry volume decrease from 1.5 liters to 750 ml 6 hours after admission HR increase from 100 to 110 bpm with activity The patient has been triggering his PCA device every hour
Incentive spirometry volume decrease from 1.5 liters to 750 ml 6 hours after admission
The most immediate intervention for a left-sided tension pneumothorax is: Supplemental oxygen, chest x-ray, and immediate IV access. Needle decompression of the affected side. Chest x-ray and placement of a chest tube on the affected side. Supplemental oxygen and monitor for worsening respiratory illness.
Needle decompression of the affected side.
Concussion may include all of the following EXCEPT: A transient loss of consciousness, concussion occurs as the result of head trauma Normal findings on neurologic examination Waxing and waning of mental status No restrictions on post-injury activity
No restrictions on post-injury activity
All of the following are clinical finding in inhalation injury except: carbonaceous sputum clubbing of the finger nails flaring nostril singed nasal hairs
flaring nostril
The severity of the burn injury is determined by: the TBSA affected the depth of the burn the concentration of the chemical if involved all of the above
the depth of the burn
The secondary survey does not begin until: the attending surgeon arrives the family has been notified the primary survey is complete and stable none of the above
the primary survey is complete and stable
Straddle injuries may result in _______ injuries? Renal Urethral Ureteral Bladder
Urethral
What is sometimes referred to as a tripod fracture? Orbital fracture Zygomatic arch fracture Maxillary fracture Nasak fracture
Zygomatic arch fracture
What is the most common facial fracture? Nasal Mandibular Maxillary Zygomatic arch
Nasal
Inhalation injury poses a significant mortality rate. True False
True
Males are more likely to sustain musculoskeletal trauma injuries than females. True False
True
Neurovascular injuries associated with dislocations are high especially in the knee and elbow. True False
True
Observation of a patient with grade II renal injury is a good option? True False
True
Patients receiving massive fluid resuscitation can develop upper airway edema. True False
True
The Mangled Extremity Severity Score (MESS) aids the clinician in the decision to salvage the limb versus amputation. True False
True
Trauma Nurses are at high risk for developing compassion fatigue. True False
True
initial assessment of the burn patient is like that of any trauma patient. True False
True
Lactated Ringer's IV solution is the fluid of choice for resuscitation: contains a small amount of Na+ most closely is related to our own intravascular fluid is the cheapest none of the above
most closely is related to our own intravascular fluid
With superficial partial burns, spontaneous healing occurs in approximately how many days? 3-5 7-14 21 60
7-14
A 58 year old unrestrained woman driver was admitted to your trauma intensive care unit after a head-on motor vehicle crash. She sustained a flail chest and pulmonary contusion. She is currently complaining of chest pain, has increased work of breathing and is anxious. HR 140, RR 35, pulse oximetry is 85%. The trauma nurse can anticipate which series of interventions: Encourage incentive spirometry, assess and manage pain, monitor for fever. Administer supplemental oxygen, assess and manage pain, prepare for intubation. Intermittent positive pressure breathing, prepare for chest x-ray, assist with insertion of chest tube. Assist with chest tube insertion, administer antibiotics, and administer supplemental oxygen.
Administer supplemental oxygen, assess and manage pain, prepare for intubation.
A 24 year old female patient involved in a motorcycle crash was diagnosed with a large left pulmonary contusion. She intubated, but with stable oxygen requirements and is hemodynamically stable with good urine output. The intern covering the unit orders a 1 liter fluid bolus of NSS since her BUN was "slightly elevated." You question this intervention because: The patient should receive more fluid than is ordered Lactated Ringers or PRBCs would be preferable for this patient Administration of crystalloid in this patient may worsen edema at the contusion site and further impair gas exchange The patient should have a central line inserted to obtain a CVP reading first
Administration of crystalloid in this patient may worsen edema at the contusion site and further impair gas exchange
Questions about abuse should be incorporated into the trauma nurse's assessment for which of the following adult patients? All pregnant female patients All elderly poor patients All female patients All adult patients
All adult patients
Asymmetry is a sign of which facial fractures? Orbital Nasal Mandibular All of the above
All of the above
Categories of Geriatric Abuse include: Physical/Sexual Neglect/Psychological Financial, violation of rights A & B only All of the above
All of the above
Patients who have had a motor vehicle collision may often have which types of injuries? Blunt trauma Penetrating trauma Associated spinal injuries All of the above
All of the above
Patterns of injury that raise high index of suspicion of potential abuse include: Palms, and Soles Mastoid area Inner arms and thighs All of the above
All of the above
Signs and symptoms of Abdominal Compartment Syndrome include: Tachycardia and hypotension Tachypnea, decreasing tidal volume, rising peak pressures Decreased urine output All of the above
All of the above
Signs and symptoms of Basilar skull fracture include: Raccoon (eyes) sign (lower has more color than upper/blood collects along outer edge of sclera towards the ear) Battles sign (24-48 hours post injury, 1/3 lose hearing in affected ear) Otorrhea/Rhinorrhea (halo sign - blood forms in center with yellow or clear ring around. Use dextrostix if drainage is clear) All of the above None of the above
All of the above
Stress management techniques include: Learning relaxation techniques Talk to a friend, religious leader, or psychologist Believing in YOUR ability to cope All of the above
All of the above
The functions of bone include: Support Protection Mineral bank Blood cell production All of the above
All of the above
The secondary survey for the geriatric patient should also include? (Pick all that apply) Medications History of comorbid conditions Mechanism of injury All of the above
All of the above
Which of the following clinical findings may be associated with blunt aortic injury? Differences in pulse strength between the upper and lower extremities Chest x-ray showing left sided hemothorax Transient episodes of hypotension alternating with hypertension All of the above
All of the above
Which teams are likely to be involved for the care of the craniofacial trauma patient? Plastic surgery Oralmaxillofacial surgery Nutritionists All of the above
All of the above
Cardiac taponade is best defined as: Increased air in the thorax due to blunt trauma Blood or fluid in the pericardial sac causing restriction of the heart and inadequate cardiac output A segment of the chest wall that does not have continuity with the rest of the chest wall Blood or fluid in the thoracic cavity, causing restriction of the heart and inadequate cardiac output
Blood or fluid in the pericardial sac causing restriction of the heart and inadequate cardiac output
A 29 year old male with multiple left rib fractures had a left chest tube placed for a left side pneumothorax. Which clinical finding is most concerning and should be reported immediately to the surgical team? Intermittent bubbling in the water seal chamber of the chest drainage system with patient breathing Left sided chest pain with repositioning and breathing Bloody drainage from the chest tube of 200-300milliliters per hour for the last 3 hours Palpable creptius over the left upper chest
Bloody drainage from the chest tube of 200-300milliliters per hour for the last 3 hours
A 60 year old unrestrained female driver arrives to the trauma bay after MVC. She complains of head and chest pain. She is noted to have sternal bruising and abrasions to the face. She denied loss of consciousness and said she felt fine before the accident. Paramedic noted that she had episodes of sinus tachycardia with occasional PVCs. These preliminary findings may be consistent with: Blunt aortic injury Blunt cardiac injury Flailed chest Pulmonary contusion
Blunt cardiac injury
Which type of trauma is a leading cause of facial injuries? Blunt trauma Penetrating trauma
Blunt trauma
Geriatric patients have a _______cough reflex which places them at a high risk for _______? Increased/Influenza Decreased/Aspiration Increased/Aspiration Decreased/Coughing
Decreased/Aspiration
Structures that may be found in the retroperitoneum include: Duodenum, pancreas, kidneys, vascular structure Liver, spleen, diaphragm, stomach, transverse colon All of the intestinal tract None of the above
Duodenum, pancreas, kidneys, vascular structure
A 21 year-old-male was admitted to the emergency department following a high-speed rollover motor vehicle crash. He was reported to be unconscious at the scene but upon arrival he was awake and lucid with a GCS of 8. The nurse anticipates a STAT CT to rule out the following: Epidural hematoma Subdural hematoma Arachnoid hematoma Pontine hemorrhage
Epidural hematoma
A 20 year old male was riding his bike when a tree limb caught him across the neck throwing him off the bike to the ground. He arrives to you by EMS awake with neck pain. He complains of difficulty swallowing and his voice is very hoarse. He has SQ air noted at the neck, but is not complaining of any difficulty breathing. In addition to possible tracheal injury you should also suspect: Lower rib fractures Esophageal injury Simple pneumothorax Sternal fracture
Esophageal injury
After the first 24 hours, a patient diagnosed with pulmonary contusion should be considered at low risk for deterioration of lung function. True False
False
Annually, approximately 200,000 people suffer thermal burn injuries. True False
False
CT scan is a reliable method to diagnose diaphragmatic injury True False
False
Serially tracking of a patient's H&H is the most accurate way to monitor a patient's response to the burn injury. True False
False
Tachycardia will always be present in the shock in the geriatric population? True False
False
Vaseline is a topical agent that is frequently used in burn wound management. True False
False
You can manage an extraperitoneal bladder injury with a suprapubic catheter? True False
False
All are true regarding the Glasgow Coma Scale EXCEPT: Level of consciousness is the single most important factor in the neurological assessment of a patient GCS equal to or less than 8 should be intubated (41% mortality) GCS total range from 1-16 None of the above
GCS total range from 1-16
A 36 year old female was reported to be an unrestrained driver of a vehicle which struck a tree. She presented to the emergency department with facial trauma. The trauma nurse suspects that she may have a Basilar skull fracture. What intervention may be implemented during her resuscitation? Nasotracheal intubation Nasotracheal suctioning Gastric tube placement through the oral pharynx Nasogastric tube placement
Gastric tube placement through the oral pharynx
An open fracture wound described as 3 cm with some contamination is considered: Grade 1 open fracture Grade 2 open fracture Grade 3 open fracture
Grade 2 open fracture
_________is the most accurate indicator of GU Trauma Pain Peritoneal signs Gross hematuria Nausea
Gross hematuria
Which of the following is TRUE regarding abdominal trauma? 93% of trauma is penetrating Incidence is increased by seatbelts Hollow viscous injury is the most common injury Not a major source of blood loss
Hollow viscous injury is the most common injury
Geriatric patients have a _______ in a large bowel transit time which leads to _______? Increase/Constipation Decrease/Gastric Emptying Decrease/Constipation No Flow/Diarrhea
Increase/Constipation Decrease/Gastric
Rib fracture management requires vigilance in the area of pain management. Effective pain management prevents the triad of: Ineffective pain management, poor cough effort, pooling secretions Decreased vital capacity, hemoptysis, pleuritic chest pain Increased chest splinting, increased respiratory rate, poor cough effort Ineffective pain management, hemoptysis, increased respiratory rate
Increased chest splinting, increased respiratory rate, poor cough effort
To avoid increasing the ICP on a severe brain injury patient the trauma nurse should: Induce Hyperthermia to avoid shivering Administer Hypotonic solutions Maintain CPP range 50-70 mm Hg Monitor ICP/CPP q shift
Induce Hyperthermia to avoid shivering (WRONG)
When questioning a trauma patient about suspected abuse, the trauma nurse should: Interview the patient alone Interview the patient with the spouse present Tell the patient they are a victim Leave literature on abuse lying around the room
Interview the patient alone
A 20 year-old-male has suffered a gun shot wound to the abdomen. Your assessment reveals gross hematuria and an expanding palpable flank mass. He is complaining of flank pain and tenderness. He has had an IVP. HR 140, BP 80/40, RR 35. The trauma nurse should anticipate the following diagnosis: Minor renal trauma Major renal trauma Grade III splenic laceration Grade III liver laceration
Major renal trauma
Proper dental occlusion, or alignment of the patient's teeth, is important to have for which facial feature to heal properly? Zygomatic arch fracture Mandible fracture Orbital fracture Nasal fracture
Mandible fracture
A 30 year old female arrives after being struck by a car. She is awake but with a GCS of 12 (E:3. V:4, M:6), RR: 30 bpm and labored. She keeps repeating, "I can't breathe!" Your initial interventions would be: Obtain a chest x-ray Open/clear the airway, assess breathing sounds and initiate high-flow oxygen Start 2 large bore IVs and hang warm isotonic fluids Needle decompress the chest and prepare for chest tube insertion
Open/clear the airway, assess breathing sounds and initiate high-flow oxygen
What is the primary symptom of compartment syndrome? Pulselessness Pain out of proportion to their diagnosis Paresythesia Pallor
Pain out of proportion to their diagnosis
What is not a necessity to have bedside for a patient in MMF (maxillary mandibular fixation)? Scissors Wire cutters Saline Pen/Paper
Pen/Paper (WRONG)
A 20 year old male patient arrives after sustaining a stab wound to the left chest. He is unresponsive with equal and clear breath sounds. He has a weak central pulse of 140 bpm and BP is 60/40. As you are ventilating him with a bag-valve-mask preparing for intubation, you note bilateral jugular vein distension (JVD). He most likely has developed: A tension pneumothorax Esophageal injury Massive hemothorax Pericardial tamponade
Pericardial tamponade
In regards to retroperitoneal injuries, all of the following are correct EXCEPT: Injuries are hard to detect Physical exam and DPL are reliable Associated with spinal injuries
Physical exam and DPL are reliable
The ureters are located _________? Posterior Retroperitoneal Right of the stomach External
Retroperitoneal
Your patient is a 65 year-old-man who fell down the stairs in his home. HR 100, BP 90/50, RR 28, temp 97. He is complaining of pain in his abdomen, left chest, and left shoulder. The trauma nurse suspects which of the following: Lacerated liver Ruptured pancreas Perforated bowel Ruptured spleen
Ruptured spleen
Initial management of an open pneumothorax includes: Sealing the chest wall defect with a fully occlusive dressing Sealing the chest wall with an occlusive dressing sealed on three sides Leave the defect open to allow airflow through the wound
Sealing the chest wall with an occlusive dressing sealed on three sides
Musculoskeletal injuries typically receive attention during: Primary Survey Secondary Survey
Secondary Survey
The first step in treating a maxillofacial trauma patient is to: Control bleeding Obtain x-ray films/CT scan Assess facial symmetry Secure and maintain an airway
Secure and maintain an airway
Which patient would be most appropriate to consider open thoracotomy on arrival to the trauma bay? A GSW to the left chest without any reported sign of life by EMS at the scene or on arrival to the trauma bay Stab wound to the chest with reported loss of pulses in the ambulance 1 minute prior to arrival and PEA on the monitor at a rate of 60 Unrestrained driver with multiple blunt force injuries to the head and chest who lapsed into cardiac arrest 5 minutes prior to arrival at the trauma center None of the above
Stab wound to the chest with reported loss of pulses in the ambulance 1 minute prior to arrival and PEA on the monitor at a rate of 60
The trauma nurse should consider abuse as a potential cause of injury when: The injuries do not fit the story, patterned injuries, injuries in various stages of healing The injuries do not fit the story, the spouse uses drugs/alcohol, similar injuries occurred several years ago Drug/alcohol use by the patient, patterned injuries, and refusal of treatment Injuries do not fit the story, similar injuries occurred in childhood and refusal of treatment
The injuries do not fit the story, patterned injuries, injuries in various stages of healing
Which is not a patient safety measure for the maxillofacial trauma patient? The patient will lie flat The patient will take antiemetics as prescribed Wire cutters will remain bedside for patient in mandibular maxillary fixation (MMF) Provide patient with suction at bedside
The patient will lie flat
An Intravenous Pyelogram (IVF) can detect a contralateral renal injury? True False
True
Application of the T-Pod is a useful invention to help ER clinicians to reduce open book pelvic fractures. True False
True
Chest injuries account for up to 25% of all trauma deaths. True False
True
Glucose levels should be followed in the younger children due to: limited fat storages limited glycogen storages prevalence of hypothyroidism none of the above
none of the above
The best way to estimate the TBSA affected when the burn injury is scattered is: use your hand as a reference to account for 1% of the patient's TBSA use the patient's hand to account for 1% of the patient's TBSA use post-it notes in various sizes to serve as reference none of the above
use the patient's hand to account for 1% of the patient's TBSA
The most common cardiac dysrhythmia after a patient has sustained an electrical injury is: atrial flutter asystole ventricular fibrillation second degree heart block
ventricular fibrillation
Which of the following information is needed in order to calculate the resuscitation formula? gender ethnicity height weight
weight
