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HOSMERIT
TCAR POST EXAM QUESTIONS AND CORRECT
{VERIFIED} ANSWERS GRADED A+
Helmets and automobile airbags work because they a. prevent blows to the head. b. reduce acceleration injuries. c. increase deceleration speed. d. add deceleration distance. - ANSWER-reduce acceleration injuries. Which of the following statements best describes knife wounds? Their velocity is , the temporary cavity , and damage. a. low; depends on the size of the knife; is usually extensive b. low; is insignificant; is limited to structures directly in object's path c. high; will be small; affects structures at some distance from the wound tract d. high; may be massive; results in widespread tissue destruction - ANSWER-low; is insignificant; is limited to structures directly in object's path Injury to which body structure is commonly a DELAYED finding in the blast trauma patient? a. Heart b. Bladder c. Bowel d. Spleen - ANSWER-Bowel Shock occurs when a. the sodium-potassium pump fails. b. ATP levels are less than lactic acid levels. c. cellular oxygen demand is greater than supply.
d. aerobic metabolism exceeds anaerobic metabolism. - ANSWER-cellular oxygen demand is greater than supply. shock is the most common type of shock immediately after traumatic injury. a. Distributive b. Septic c. Cardiogenic d. Hypovolemic - ANSWER-Hypovolemic Which findings suggest a trauma patient is experiencing cardiogenic shock? a. Bradycardia, cyanosis, and elevated mean arterial pressure b. High shock index, mottling, and hypotension c. Tachycardia, flushing, and widened pulse pressure d. Pallor, course breath sounds, and hypertension - ANSWER-High shock index, mottling, and hypotension A multisystem trauma patient has become progressively tachycardic and hypotensive one week after hospital admission. Pulse pressure is wide. The most likely explanation for this finding is a. dehydration. b. fat embolism syndrome. c. surgical site bleeding. d. sepsis. - ANSWER-sepsis. Normalizing a trauma patient's body temperature helps control bleeding because hypothermia a. produces shivering and makes platelets hyperactive. b. causes platelet dysfunction and clotting system failure. c. stimulates the clotting cascade and reduces blood pressure.
A patient with posterior rib fractures is at the highest risk for concomitant fractures of the a. sternum. b. T-spine. c. clavicles. d. ribs 1 and 2. - ANSWER-T-spine. A motocross racer hit a ditch at high speed. The rider's chest was thrown against the handlebars. Which assessment finding indicates the patient has a flail chest? a. Paradoxical movement of the right chest wall b. A bubbling wound located on the upper thorax c. Subcutaneous emphysema and pain on palpation d. Chest dissymmetry with unilateral hyperexpansion - ANSWER-Paradoxical movement of the right chest wall Pulmonary contusions cause a problem at what point on the tissue oxygenation cascade? a. Hemoglobin availability b. Cardiac output c. Diffusion d. Ventilation - ANSWER-Ventilation What is the usual intervention for a patient with subcutaneous emphysema? a. Chest tube insertion b. Emergent surgical repair c. Needle decompression d. Observation and reassessment - ANSWER-Observation and reassessment
15 hours after a motor vehicle collision, an unrestrained driver is experiencing frequent, irregular heartbeats. The most likely cause of this finding is injury to the a. left atrium. b. left ventricle. c. right atrium. d. right ventricle. - ANSWER-right atrium. In the patient with chest trauma, which of these findings is the earliest indicator of cardiac tamponade? a. Elevated heart rate b. Systolic hypotension c. Jugular vein distention d. Unilateral breath sounds - ANSWER-Elevated heart rate In a patient with blunt chest trauma, what simple assessment can be used to screen for thoracic aortic injury? a. Side-to-side pulse oximeter saturation comparisons b. Bilateral upper extremity BP measurements c. Pulsus paradoxus calculation d. BP cuff inflation to elicit carpal spasm - ANSWER-Bilateral upper extremity BP measurements On hospital Day 5, a polytrauma patient has the following vital signs: BP 97/50; HR 133/min; RR 22/min. Urine output is 12 mL/hr. Skin is cool and mottled. The pulse oximeter is not sensing dependably. These findings suggest
In the patient with an open fracture, IV antibiotics significantly decrease the risk of osteomyelitis if administered within of hospital arrival. a. 1 hour b. 4 hours c. 6 hours d. 8 hours - ANSWER- 1 hour A jockey was thrown from a running horse and hit the rail. On hospital Day 3, right flank bruising is present. This finding suggests the patient has a a. subcapsular splenic hematoma. b. renal laceration. c. aortic rupture. d. pancreatic contusion. - ANSWER-renal laceration. Common causes of non-hemorrhagic fluid loss in the trauma patient during the post- resuscitation phase of care include a. mechanical ventilation and isotonic tube feedings. b. hypometabolism and interstitial fluid shifts. c. diarrhea and hypertonic enteral formulas. d. pressure dressings and renal contusions. - ANSWER-hypometabolism and interstitial fluid shifts. A previously healthy young adult is recovering from a motorcycle crash that resulted in complex orthopedic injuries. Which of the following dietary discharge instructions is appropriate for this patient? a. Reduce total carbohydrates and eliminate lactose-containing products. b. Restrict fats, increase calcium intake, and avoid foods with high-protein content. c. Take an iron supplement and limit both leafy green vegetables and salty foods.
d. Eat a standard diet but increase total calories, protein, and calcium-rich foods. - ANSWER- Eat a standard diet but increase total calories, protein, and calcium-rich foods. Following emergent transfusion, which electrolyte disturbances can be anticipated in the patient who received 12 units of blood products? a. Hyponatremia and hyperkalemia b. Hypernatremia and hypomagnesemia c. Hypochloremia and hypercalcemia d. Hyperkalemia and hypocalcemia - ANSWER-Hyperkalemia and hypocalcemia An amateur boxer sustained a powerful punch to the upper abdomen. 36 hours after the event, which of the following findings suggests pancreatic injury? a. Bowel sounds in the chest b. Serum lipase elevation c. Left shoulder pain d. Blood in the urine - ANSWER-Serum lipase elevation A patient who was ejected from a moving vehicle has a complete spinal cord injury at the T level. Bedside care providers can anticipate this patient will have issues maintaining a stable a. acid-base balance. b. urine output. c. body temperature. d. intracranial pressure. - ANSWER-urine output.
A trauma patient underwent damage control surgery for major abdominal hemorrhage. Post- operatively, her hand spasms when the blood pressure cuff inflates. Which of the following blood tests is indicated? a. TEG or ROTEM b. Lipase level c. ALT or AST level d. Ionized calcium - ANSWER-Ionized calcium In the trauma patient with a blood pressure of 110/70 mm Hg, mean arterial pressure is approximately a. 83 mm Hg b. 90 mm Hg c. 76 mm Hg d. 40 mm Hg - ANSWER- 83 mm Hg A trauma patient has a heart rate of 92/min; systolic blood pressure is 115 mm Hg. This patient's shock index is a. 0. b. 1. c. 2. d. 0.8 - ANSWER-0. A construction worker crushed by a falling beam has compartment syndrome of the left thigh. This patient will be closely monitored for signs of rhabdomyolysis, including a. dark-colored urine and dropping urine output. b. dilute urine and an elevated creatine kinase level.
c. increasing urine output and myoglobinemia. d. diminished urine output and hypokalemia. - ANSWER-dark-colored urine and dropping urine output. Care of the trauma patient with prerenal failure chiefly involves a. initiating hemodialysis. b. limiting fluid intake. c. refilling the vascular space. d. administering diuretics. - ANSWER-refilling the vascular space. A young adult who fell from a third-floor balcony has a blood pressure of 110/70 mm Hg and a heart rate of 108/min. Pulse pressure is a. 55 mm Hg b. 70 mm Hg c. 40 mm Hg d. 35 mm Hg - ANSWER- 40 mm Hg What is the priority intervention for the patient with a large expanding subdural hematoma? a. Emergent surgery for clot evacuation b. Craniectomy to increase intracranial pressure c. Ventriculostomy drainage to remove CSF d. Hospital admission for hourly neuro checks - ANSWER-Emergent surgery for clot evacuation An 82-year-old man was admitted to the hospital after he fell down two steps. The patient is alert and oriented but has several bruises and abrasions. Which vital sign findings would be most concerning? a. Heart rate 97/min; blood pressure 134/78 mm Hg
Which triad of symptoms are LATE signs of deterioration in a traumatic a. Agitation, bradycardia, and narrowing pulse pressure b. Tachycardia, dropping mean pressure, and headache c. Disorientation, nausea/vomiting, and posturing d. Bradycardia, irregular respirations, and hypertension - ANSWER-Bradycardia, irregular respirations, and hypertension A patient who sustained a complete C7 spinal cord injury nine days ago is being transferred from bed to a reclining wheelchair. This maneuver is likely to cause a. respiratory arrest. b. autonomic dysreflexia. c. postural hypotension. d. neurogenic bladder. - ANSWER-autonomic dysreflexia. A hemodynamically stable patient was transfused 500 mL of red blood cells. Approximately how much of that volume will remain in the vascular space 60 minutes later? a. 250 mL b. 83 mL c. 333 mL d. 500 mL - ANSWER- 500 mL Which findings suggest impending herniation in a patient with a right temporal epidural hematoma? a. Left pupillary dilation, right-sided weakness b. Right pupillary dilation, right-sided weakness c. Right pupillary dilation, left-sided weakness
d. Left pupillary dilation, left-sided weakness - ANSWER-Right pupillary dilation, left-sided weakness
