trauma & burns practice questions (ch 20 & 21)

Which intervention is useful for prevention of a venous thromboembolism? Select all that apply. One, some, or all responses may be correct. - encouraging ambulation - hydration evaluation - pneumatic compression devices - pharmacologic prophylaxis - stenting

- encouraging ambulation - hydration evaluation - pneumatic compression devices - pharmacologic prophylaxis

Which item would be used to reduce the risk of contact with body fluids while attending a trauma patient? Select all that apply. One, some, or all responses may be correct. - face mask - eye protection - gown - gloves - hospital shoes

- face mask - eye protection - gown - gloves

Which test result would the nurse monitor to assess for bleeding when caring for a postoperative trauma patient? Select all that apply. One, some, or all responses may be correct. - WBC - hemoglobin - prothrombin time (PT) - ABG - BUN - hematocrit

- hemoglobin - prothrombin time (PT) - hematocrit

Which action is performed by an EMS team member for a patient in a life-threatening condition? Select all that apply. One, some, or all responses may be correct. - immobilize the spine - maintain spinal precautions - provide ventilation - establish airway - conduct a life saving surgery

- immobilize the spine - maintain spinal precautions - provide ventilation - establish airway

Which task would the nurse perform to prepare to admit a postoperative trauma patient to the critical care unit? Select all that apply. One, some, or all responses may be correct. - increase room temperature - zero the bed scale - place suction supplies at bedside - contact the respiratory therapist - obtain IV pumps - perform intubation

- increase room temperature - zero the bed scale - place suction supplies at bedside - contact the respiratory therapist - obtain IV pumps

An autograft is used to optimally treat a partial- or full-thickness wound that meets what criteria? (Select all that apply.) - involves a joint - involves the face, hands, or feet - is infected - involves very large surface areas - requires more than 2 weeks for the healing

- involves a joint - involves the face, hands, or feet - requires more than 2 weeks for the healing

Which sign indicates decreased blood volume? Select all that apply. One, some, or all responses may be correct. - low pulse pressure - tachycardia - tachypnea - vasoconstriction - bradycardia

- low pulse pressure - tachycardia - tachypnea - vasoconstriction

Which measure would be conducted during the initial assessment of a trauma patient? Select all that apply. One, some, or all responses may be correct. - management of airway patency - stabilization of fractures - hemorrhage control - ventilation - providing water to drink

- management of airway patency - stabilization of fractures - hemorrhage control - ventilation

Which complication is part of the lethal triad when complex trauma surgeries are done during the resuscitation phase? Select all that apply. One, some, or all responses may be correct. - metabolic alkalosis - hyperthermia - metabolic acidosis - abnormal blood clotting - hypothermia

- metabolic acidosis - abnormal blood clotting - hypothermia

Which classification is used for disasters? Select all that apply. One, some, or all responses may be correct. - type of disaster - number of victims - cost factors - resources required - environmental factors

- number of victims - resources required

Which sign indicates compromised circulation in a patient? Select all that apply. One, some, or all responses may be correct. - obvious external hemorrhage - weak, thready pulse - HR > 120 beats/min - HR = 70 beats/min - systolic BP < 90 mmHg

- obvious external hemorrhage - weak, thready pulse - HR > 120 beats/min - systolic BP < 90 mmHg

Which status of a patient can be monitored using capnography? Select all that apply. One, some, or all responses may be correct. - hemoglobin staus - perfusion status - ventilation status - consciousness status - GCS status

- perfusion status - ventilation status

Which goal occurs during the rehabilitation phase of trauma care? Select all that apply. One, some, or all responses may be correct. - prevent further injury - improve functionvality - begin discharge planning - prepare the patient to return home - increase independence - increase reliance on nursing staff

- prevent further injury - improve functionvality - prepare the patient to return home - increase independence

Which aspect does an optimal trauma system include? Select all that apply. One, some, or all responses may be correct. - reassimilation - rapid transport - rehabilitation - contracted payers - injury prevention

- reassimilation - rapid transport - rehabilitation - injury prevention

Which diagnostic procedure is conducted during assessment of a trauma patient? Select all that apply. One, some, or all responses may be correct. - ABCDEFG of emergency care - repeat primary and secondary surveys - supportive interventions - consultation with specialty physicians - radiological and ultrasound studies

- repeat primary and secondary surveys - radiological and ultrasound studies

Which complication may manifest after an electrical injury? (Select all that apply.) - seizures - acute cataract formation - peptic ulcer disease - dark brown urine - long bone fractures - cardiac dysrhythmias - hypertension - compartment syndrome of extremities

- seizures - acute cataract formation - dark brown urine - long bone fractures - cardiac dysrhythmias - compartment syndrome of extremities

Which condition indicates a contraindication for nasotracheal intubation? Select all that apply. One, some, or all responses may be correct. - signs of a superficial facial wound - signs of facial fracture - signs of frontal sinus fracture - signs of basilar skull fracture - signs of cribriform plate fracture

- signs of facial fracture - signs of frontal sinus fracture - signs of basilar skull fracture - signs of cribriform plate fracture

Which alternate procedure would be considered if endotracheal intubation is not feasible? Select all that apply. One, some, or all responses may be correct. - surgical cricothyroidotomy - laryngeal mask airway (LMA) - laryngeal tube airway (LTA) - oral endotracheal intubation - nasotracheal intubation

- surgical cricothyroidotomy - laryngeal mask airway (LMA) - laryngeal tube airway (LTA)

Which test would help a clinician understand whether a patient has normal hemostasis? Select all that apply. One, some, or all responses may be correct. - thromboelastography - rotational thromboelastometry - white blood cell counts - red blood cell counts

- thromboelastography - rotational thromboelastometry

Which example is considered a secondary prevention strategy? Select all that apply. One, some, or all responses may be correct. - wearing a seatbelt - attending safety driving class - anti bullying hotlines - wearing cervical spine collar - following speed limits

- wearing a seatbelt - anti bullying hotlines

The nurse is caring for a patient with burns to the hands, feet, and major joints. The nurse plans care to include which intervention? (Select all that apply.) - administering muscle relaxants around the clock - wrapping fingers and toes individually with bandages - implementing passive or active ROM exercises - keeping the limbs as immobile as possible - applying splints that maintain the extremity in an extended position

- wrapping fingers and toes individually with bandages - implementing passive or active ROM exercises - applying splints that maintain the extremity in an extended position

Treatment and/or prevention of rhabdomyolysis in at-risk patients include aggressive fluid resuscitation to achieve how much urine output? - 30 mL/hr - 50 mL/hr - 100 mL/hr - 300 mL/hr

100 mL/hr

Which amount of fluid per kilogram should be initiated for a hemorrhagic shock patient with a systolic blood pressure of 80 to 90 mm Hg? - 90 to 100 mL/kg/hr - 50 to 70 mL/kg/hr - 60 to 80 mL/kg/hr - 20 to 30 mL/kg/hr

60 to 80 mL/kg/hr

Which assessment is most important when admitting the postoperative trauma patient to the critical care unit? - assess the patient's choice for rehabilitation facility - assess the need for splints or assistive devices - assess the amount and type of drainage - assess the patient for foot drop

assess the amount and type of drainage

Which venous access is best in the case of a patient with peripheral vasoconstriction and venous collapse? - central venous catheter - forearm - antecubital veins - bone in the sternum

central venous catheter (a central venous catheter is best in the case of a patient with peripheral vasoconstriction and venous collapse as it allows high flow of fluid if necessary)

The nurse is caring for a trauma patient who is difficult to arouse after surgery. Which intervention would the nurse perform first? - notify the provider - check the patient's pupils for reactivity - contact the radiology department for CT scan - document all findings

check the patient's pupils for reactivity

Which clinical outcome occurs with a pulmonary contusion? - rapid progression of respiratory distress - early detection on xray - harsh, strong cough - commonly seen with rib fractures

commonly seen with rib fractures

What type of burn is capable of producing either a superficial cutaneous injury or a cardiopulmonary arrest and transient but severe central nervous system deficits? - infection - heat burn - chemical burn - electrical burn

electrical burn

A patient arrives in the emergency department with smoke inhalation due to a house fire. What is the priority nursing action for this patient? - checking the oral mucous membranes - checking for any burned areas - obtaining a medical history - ensuring a patent airway

ensuring a patent airway

Which explanation represents FAST in diagnosis procedure for trauma? - focused assessment with sonography for trauma - factored assessment with sonography for trauma - fast assessment with sonography for trauma - first assessment with sonography for trauma

focused assessment with sonography for trauma

Which negative effect is a common result of using banked blood? - hypercalcemia - hypocalcemia - hyponatremia - hypernatremia

hypocalcemia (banked blood products have high levels of citrate, which may induce transient hypocalcemia)

Which clinical signs are associated with a flail chest? - decreased work of breathing - bradypnea - symmetrical chest movement - hypoxemia

hypoxemia (will become evident with a flail chest as the body cannot generate effective changes in intrathoracic pressure for ventilation, leading to decreased oxygenation)

What can be heard if auscultate a pt with pneumothorax? - if auscultate on the depressed side, can hear nothing. If it's an incomplete pneumo, then you'll hear dec breath sounds on side of pneumo - if auscultate on the depressed side, can hear crackles. If it's an incomplete pneumo, then you'll hear wheezes

if auscultate on the depressed side, can hear nothing. If it's an incomplete pneumo, then you'll hear dec breath sounds on side of pneumo

Which symptom is common to patients with a traumatic brain injury? - hypervigilance - impaired judgement - loss of sense of taste - blindness

impaired judgement

Which factor is the most common cause of airway obstruction? - foreign debris in throat - anatomical obstructions - posterior displacement of tongue - change in level of consciousness

posterior displacement of tongue

Which group of patients reacts quickly and remains hemodynamically stable after administration of the initial fluid bolus? - minimal responders - rapid responders - transient responders - nonresponders

rapid responders (rapid responders react quickly and remain hemodynamically stable after administration of the initial fluid bolus. Fluids are then slowed to maintenance rates)

Which symptom can occur with a hemothorax? - increased volume of breath sounds - tympany on percussion of affected lung - hypertension - respiratory distress

respiratory distress

Which risk factor would the nurse identify as a cause for additional injuries in a pregnant trauma patient? - foot drop - first trimester - rh exposure - patient's second pregnancy

rh exposure (hemorrhage is a major complication of trauma. Rh-negative mothers should be closely evaluated and receive rhogam to prevent further complications)

In which peak of traumatic injury does early death occur? - first peak - second peak - third peak - fourth peak

second peak (within minutes to several hours after injury)

Which part of the assessment is included when reviewing a patient with a spinal cord injury? - CT scan of legs - xray of the back and pelvis - urinary output measurement - sensory and motor exam

sensory and motor exam

What is an initial symptom of a suspected compartment syndrome? - absence of pulse in affected extremity - severe, throbbing pain in the affected area - pallor in the affected area - paresthesia in the affected area

severe, throbbing pain in the affected area

Which type of prevalence is seen with trauma? - females are more likely than males to experience traumatic injury - unintentional injuries and deaths peak in the population aged 75+ - teens aged 15-19 account for 8.4% of the total costs of MVC injuries - MVC are the leading cause of death for persons 13-30 years of age

teens aged 15-19 account for 8.4% of the total costs of MVC injuries

Which type of injury may result in a fracture as a result of a blast? - primary injury - secondary injury - tertiary injury - quaternary injury

tertiary injury (tertiary injuries occur as the body is thrown or propelled by the force of the explosion, resulting in blunt tissue trauma including closed head injuries, fractures, and visceral organ injury)

Which statement is accurate about the phases of damage-control surgery? - the goal of the first phase is to identify the pathophysiology of injuries - the surgical repair plan over multiple surgeries is defined in phase 2 - achievement of hemodynamic stability is completed in phase 5 - an abbreviated surgery that focuses its attention on bleeding control occurs in phase 4

the goal of the first phase is to identify the pathophysiology of injuries

A nurse is preparing to discharge a pregnant trauma patient from a rehabilitation facility. Which task would the nurse include in the discharge process? - the patient is screened for domestic violence - the patient is turned to her left side - begin discharge planning on the day the patient leaves - implement the standard discharge plan used with all trauma patients

the patient is screened for domestic violence

Which symptom exacerbates hyperkalemia? - tissue hypoperfusion - alkalosis - cellular proliferation - calcium gluconate administration

tissue hypoperfusion (as tissue cells are destroyed, they release potassium)

A 63-year-old patient is admitted with new onset fever; flulike symptoms; blisters over her arms, chest, and neck; and red, painful, oral mucous membranes. The patient should be further evaluated for which possible non-burn injured skin disorder? - graft vs host disease - staphylococcal scalded skin syndrome - toxic epidermal necrolysis - necrotizing soft tissue infection

toxic epidermal necrolysis

Which patient has the greatest risk of developing acute respiratory distress syndrome (ARDS) after traumatic injury? - a patient who has a closed head injury with a decreased LOC - a patient who has a fractured femur and is currently in traction - a patient who has received large volumes of fluid and/or blood replacement - a patient who has underlying COPD

a patient who has received large volumes of fluid and/or blood replacement

Which intervention is inaccurate while triaging after the patient arrives at the hospital? - identifying patients who need immediate treatment - matching available resources with treatment needs - maintaining readiness of resuscitation room - activating the trauma team, except the operating room team

activating the trauma team, except the operating room team

An older client has suffered a 45% body surface area burn from a house fire. Which complication is the client at greater risk of developing because of age-related changes? - ineffective pain management - acute kidney injury - anxiety - gastric stress ulcers

acute kidney injury

Which description matches that of a blunt injury? - most common mechanism of traumatic injury - vehicular injury often results from shearing forces - obvious to detect - lungs commonly involved because of less resiliency

most common mechanism of traumatic injury

The nurse is assisting the patient who is recovering from moderate burns to select foods from the menu that will promote wound healing. Which statement indicates the nurse's knowledge of nutritional goals? - "select foods that have lots of fiber, such as whole grains and fruits. These will promote removal of toxins from the body that interfere with healing." - "it is important to choose foods like bread and pasta that are high in carbohydrates. These foods will give you energy and help you to heal faster" - "choose foods that are high in protein, such as meat, eggs, and beans. these help the burns to heal." - "avoid foods that have saturated fats. Fats interfere with the ability of the burn wound to heal."

"choose foods that are high in protein, such as meat, eggs, and beans. these help the burns to heal."

The nurse is caring for a client with burns. Which question does the nurse ask the client and family to assess their coping strategies? - "do you support each other?" - "how do you plan to manage this situation?" - "how have you handled similar situations before?" - "would you like to see a counselor?"

"how have you handled similar situations before?" (asking how the client and family have handled similar situations in the past assesses whether the client's and the family's coping strategies may be effective. Yes or no questions such as "Do you support each other?" are not very effective in extrapolating helpful information. The client and family in this situation probably are overwhelmed and may not know how they will manage; asking them how they plan to manage the situation does not assess coping strategies. Asking the client and the family if they would like to see a counselor also does not assess their coping strategies)

Which intervention would be considered for a patient with a GCS score ≤13 in an ED? Select all that apply. One, some, or all responses may be correct. - CT scan - alcohol level check - toxicology screening - ABG for hypoxia evaluation - glucose level check for hypoglycemia

- CT scan - alcohol level check - toxicology screening - ABG for hypoxia evaluation - glucose level check for hypoglycemia

Which diagnostic studies are used for a kidney injury? Select all that apply. One, some, or all responses may be correct. - CT scan - angiography - IV pyelography - cystoscopy - xray - ultrasound

- CT scan - angiography - IV pyelography - cystoscopy

Which of the following statements about the pain management of a burn victim are true? (Select all that apply.) - oral medication is the preferred administration route - the IM route is preferred for pain medication administration - additional pain medication may be needed because of rapid body metabolism - patients with a history of drug and alcohol abuse will require higher doses of pain medication - pain medication should be given before procedures such as debridement and dressing changes and physical therapy

- additional pain medication may be needed because of rapid body metabolism - patients with a history of drug and alcohol abuse will require higher doses of pain medication - pain medication should be given before procedures such as debridement and dressing changes and physical therapy

Which measure can help a patient with hypothermia? Select all that apply. One, some, or all responses may be correct. - provide cold blankets - administer warmed IV fluids - warm the room - cover the patient's head - cover the patient with warm blankets

- administer warmed IV fluids - warm the room - cover the patient's head - cover the patient with warm blankets

Nursing priorities to prevent ineffective coagulation include which of the following? (Select all that apply.) - administration of calcium as ordered - administration of potassium as ordered - administration of fresh frozen plasma as ordered - prevention of hypothermia - prevention of infection

- administration of calcium as ordered - administration of fresh frozen plasma as ordered - prevention of hypothermia

Which interventions would the nurse perform when caring for a postoperative trauma patient experiencing alcohol withdrawal? Select all that apply. One, some, or all responses may be correct. - allow the patient to consume a small amount of alcohol to prevent withdrawal symptoms - assess the time of the patient's last use of alcohol - assess the patient hourly in the presence of increasing anxiety - contact nursing leadership to arrange for a sitter - implement alcohol prevention interventions before discharge - arrange for alcohol prevention interventions to begin after discharge

- assess the time of the patient's last use of alcohol - assess the patient hourly in the presence of increasing anxiety - contact nursing leadership to arrange for a sitter - implement alcohol prevention interventions before discharge

For which reason is trauma a major healthcare concern? Select all that apply. One, some, or all responses may be correct. - consumption of healthcare resources - increased disability - lost productivity - loss of life - financial burden

- consumption of healthcare resources - increased disability - lost productivity - loss of life - financial burden

Which of the following patients would require greater amounts of fluid resuscitation to prevent acute kidney injury associated with rhabdomyolysis? (Select all that apply.) - crush injury to right arm - gunshot wound to the abdomen - second degree burns to 40% of the body - lightening strike of the left arm and chest - pulmonary contusion and rib fracture

- crush injury to right arm - second degree burns to 40% of the body - lightening strike of the left arm and chest

Which intervention is appropriate for a patient with fractured ribs? Select all that apply. One, some, or all responses may be correct. - deep breathing and coughing - pain management - early ambulation - chest percussion therapy - use of 100% oxygen prior to ambulation

- deep breathing and coughing - pain management - early ambulation

Which of the following factors increase the burn patient's risk for venous thromboembolism? (Select all that apply.) - delayed fluid restriction - electrical burn injury - burn injury less than 10% - bedrest - burns to lower extremities

- delayed fluid restriction - bedrest - burns to lower extremities

Which condition indicates a possible cause of impaired oxygenation? Select all that apply. One, some, or all responses may be correct. - emphysema - decrease in inspired air - increased in inspired air - collapsed lung - retained secretions

- emphysema - decrease in inspired air - collapsed lung - retained secretions

A75 kg client who has sustained partial thickness burns over the anterior trunk and both arms is receiving IV fluids. Which rates of administration will the nurse anticipate for fluid resuscitation? - 500 mL/hr for the first 12 hours, 416 mL/hr for the next 12 hours - 675 mL/hr for the first 8 hours, 338 mL/hr for the next 16 hours - 675 mL/hr for the first 4 hours, 338 mL/hr for the next 20 hours - 400 mL/hr for the first 8 hours, 247 mL/hr for the next 16 hours

675 mL/hr for the first 8 hours, 338 mL/hr for the next 16 hours

A burn patient in the rehabilitation phase of injury is increasingly anxious and unable to sleep. The nurse should consult with the provider to further assess the patient for what possible mental health condition? - bipolar disorder - suicidal ideations - acute delirium - PTSD

PTSD

Which task occurs in the final stage of trauma care? - aggressive rewarming and attainment of hemodynamic stability - abbreviated surgery focused on bleeding control - improve functional status and increase independence - identify patient based on injury characteristics and pathophysiology

improve functional status and increase independence (the task goals in the rehabilitation stage of trauma care are to improve functional status, increase independence, and prepare the patient to return home)

Which technique is best to open and assess the airway if a patient is unresponsive? - jaw thrust maneuver - tonsillar tip catheter - nasopharyngeal airways - oropharyngeal airways

jaw thrust maneuver

Which immediate action is appropriate for a patient with a cervical spinal injury? - manually stabilize the cervical spine - move the patient without spinal support - maintain airway with cervical spine protection - keep the patient in a wheelchair

maintain airway with cervical spine protection

Which statement is accurate about alcohol and drug use in trauma patients? - physiological consequences of drug and alcohol use must be addressed prior to addressing injuries - withdrawal from drugs and alcohol increases patient discomfort during trauma care, but it doesn't pose serious risks - most trauma patients with a high blood alcohol level have an alcohol misuse problem - interventions that focus on screenings and interventions for alcohol are put on hold until the rehabilitation phase

most trauma patients with a high blood alcohol level have an alcohol misuse problem

Which patient condition should be treated first in an ED? - a wound in the right limb - a wound on the toe - multiple system injuries - a wound in the left hand

multiple system injuries

During the treatment and management of the trauma patient, maintaining tissue perfusion, oxygenation, and nutritional support are strategies to prevent what potential complication? - disseminated intravascular coagulation - multisystem organ dysfunction - septic shock - wound infection

multisystem organ dysfunction

Which marker indicates rhabdomyolysis? - hematuria - myoglobinuria - proteinuria - lipiduria

myoglobinuria (causes urine to a be dark tea color)

The nurse is caring for a patient who sustained rib fractures after hitting the steering wheel of a car. The patient is spontaneously breathing and receiving oxygen via a face mask; the oxygen saturation is 95%. During the nurse's assessment, the oxygen saturation drops to 80%. The patient's 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 what prescribed intervention? - needle throacostomy and chest tube insertion - endotracheal intubation and mechanical ventilation - administration of lactated ringer's solution (1 L) wide open - chest xray study to determine the etiology of the symptoms

needle throacostomy and chest tube insertion

Which symptom indicates that the patient has a fat embolism? - new onset tachycardia - fever above 40 degrees celsius - bradypnea - sudden pancytopenia

new onset tachycardia

Which patient should be prioritized by EMS personnel based on findings during triaging at an accident site? - patient with wounds on limbs - patient with a fracture - patient with a venous bleed - patient with an arterial bleed

patient with an arterial bleed

Which type of injury results in trauma to the pelvis? - pedestrian vehicle impact - stabbing - gunshot wound - assault with a baseball bat

pedestrian vehicle impact

Which type of trauma commonly causes injuries to the bowel? - blunt - penetrating - drowning - burn

penetrating (commonly affect the hollow organs such as the bowel due to a gunshot wound)

Which element can mask neurological responsiveness and give misleading findings in a patient? - use of fruit juices - use of alcohol - use of a high carb diet - use of a high protein diet

use of alcohol

Which intervention is appropriate for ongoing management of a patient with a spinal cord injury? - vasopressor medications - diuretic medications - antihypertensive medications - calcium channel blockers medications

vasopressor medications (a patient with a spinal cord injury often has hypotension, requires vasopressor medications to increase their blood pressure, and is required to compensate for loss of sympathetic innervation and resultant vasodilation)

Range-of-motion exercises, early ambulation, and adequate hydration are interventions to prevent this common complication observed in trauma patients? - catheter associated infection - fat embolism - venous thromboembolism - nosocomial pneumonia

venous thromboembolism

Which example is an active strategy for warming a hypothermic patient? - warm room - head coverings - warm IV fluids - radiant lights

warm IV fluids (warmed IV fluids are an example of an active internal strategy of warming a hypothermic patient as fluid flows through the blood)