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QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc __________ - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planning to talk with the father the trauma nurse will - ANSdeliver information regarding the son;s care in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest. upon assessment the nurse notes that the patient is in respiratory distress nad has absnet breath sounds on hte affected side. what is the priroruty intervention - ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies any pain and numbness and tinlging. according to NEXUS critera which factors indicate need for radiological - ANSsuspected alcohol abuse B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for - ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision - ANSassist with endotracheal intubation C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury - ANSLumbar fx D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is - ANSplace the bag on ice D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area - ANStracheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage - ANSfocused assessment with sonography for trauma D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritisA a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc __________ - ANSHOB 30 degrees
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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B which of hte following significant assessment findigns is frequently found in a patient with complete cransiofacial separation involving the maxilla, zygoma, orbits, and bones of the cranial base. - ANSdiplopia B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion - ANSjudicios use of IV fluids Bduring the primary survery which of the following has the greatest priority - ANScervical spine injury C 32 wk pregnant lady arrives in er after trapped in a car that flipped. the initial assessment reveals s/s of shock, vaginal bleeding, a palpable asymmetrical uterus, and slowing fetal heart tones what is the most likely cause - ANSuterine rupture C a college student presents to the er stating afterarriving at a party , she awoke in a dorm rom. she didnt recognize with no memory of the previous evening the trauma nurse prepare for what exam. - ANSsexual assult C an adult pt involved in a brush fire arrives to the er. upon initial assessment in the er the most concerning finding is - ANShoarse voice and repeatedly decides to clear throat. C an older adult pt fell in the bathtub 3 days ago. now she is exihibiting decreasd LOC and difficulty with speaking and walking. which of the following injuries is most effective
- ANSsubdural hematoma C effective pain management in hte pt iwth rib fxwill promote what - ANScough with ability to clear secretions C properly restrained 6 wk old kid was involved in a MVC. after the assessment and stabilization the pt becomes more difficult to rouse. responding with a weak cry to painful stimuli. the pupils remain brisk and reactive. the anterior fontanel is soft and flat. what is the most likely cause and pririty interventions - ANShypoglycemia C What are the primary benefits of a team approach to trauma care - ANSit provides a systemic approach to care and organizes care C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision - ANSassist with endotracheal intubation C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury - ANSLumbar fx D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is - ANSplace the bag on ice D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area - ANStracheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage - ANSfocused assessment with sonography for trauma D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritis A 5-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? A) report your suspicion of the maltreatment in accordance with local regulations B) apply ice to the bruises and consult wound care C) engage in therapeutic communication to determine the MOI D) provide the family with injury prevention recourses - ANSA) report your suspicion of the maltreatment in accordance with local regulations A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? A) Fast exam
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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which of the following is the priority intervention for this patient? A) Expedite transport to the CT scanner B) prepare the patient for spinal radiographs C) expedite transfer to the closest trauma center D) notify the patients family - ANSC) expedite transfer to the closest trauma center A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? A) initiate transfer to a trauma center B) provide report to the operating room nurse C) Obtained imaging studies D) Place a gastric tube - ANSA) initiate transfer to a trauma center A patient arrives with a large open chest wound after being assaulted with a machete, Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3 sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate interventions? A) needle decompression B) tube thoracostomy C) dressing removal D) surgical repair - ANSC) dressing removal A patient has been in the ED 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 c/o leg pain. His wife reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. the patient is exhibiting signs of symptoms commonly associated with which of the following conditions? A) acute lung injury B) fat embolism C) PTX D) pulmonary contusion - ANSB) fat embolism A patient is found lying on the floor after falling 13 hours ago. Which of the following lab values is expected with a musculoskeletal complication associated with this presentation? A) elevated creatine kinase B) decreased potassium level
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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C) decreased WBC D) elevated GFR - ANSA) elevated creatine kinase 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 cap refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principle? A) initiate two large bore intravenous lines for Ringers lactate solution administration B) Administer Dilaudid for pain control and provide comfort care C) Place the patient in an observation area for care within the next few hours D) Contact the command center for the personnel to notify next of kin. - ANSA) initiate two large bore intravenous lines for Ringers lactate solution administration A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? A) Bradycardia and ipsilateral absences of motor function B) Tachycardia and respiratory depression C) Tachycardia and absent motor function below the level of injury D) Bradycardia and absent motor function below the level of the injury - ANSD) Bradycardia and absent motor function below the level of the injury A patient with 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? A) elevating the extremity above the level of the heart B) repositioning and apply ice C) Elevating the extremity to the level of the heart D) Preparing the patient for ultrasound - ANSC) Elevating the extremity to the level of the heart A trauma patient is en route to a rural ED. Radiology notifies the charge nurse that the CT scanner will be out of service for several of hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication? A) Brief B) loop C) debrief D) huddle - ANSD) huddle A trauma patient is restless and repeatedly asking "where am I?" vital signs upon arrival were BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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D) preparing for drug assisted intubation - ANSA) padding the upper back while stabilizing the cervical spine During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next? A) open the airway with the head-tilt/chin lift maneuver B) auscultate bilateral breath sounds to assess ventilatory status C) assist respirations using a BVM D) insert an oropharyngeal airway if there is no gag reflex - ANSD) insert an oropharyngeal airway if there is no gag reflex EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar? A) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan *** B) after physician evaluation if the patient has not neurologic abnormalities on exam C) after palpation of the spine if the patient has no point tenderness the the vertebral column D) after physical examination if the patient has not neck pain with movement - ANSA) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan EMS brings a patient who fell 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? A) Alert with no neurologic deficits B) Multiple abrasions to the extremities C) Multiple requests of water D) Smell of alcohol on breath - ANSD) Smell of alcohol on breath 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 future disaster. Which phase of the disaster life cycle does this describe? A) mitigation B) preparedness C) response D) recovery - ANSA) mitigation
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? A) potassium B) magnesium C) sodium D) calcium - ANSD) calcium Patients with a crush injury should be monitored for which of the following conditions? A) Hypernatremia B) Hypercalcemia C) Dysrhythmias D) polyuria - ANSC) Dysrhythmias Tearing of the bridging veins is most frequently associated with which brain injury? A) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma - ANSB) subdural hematoma The most reassuring finding for a male patient with hop pain after a fall is which of the following? A) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability - ANSD) pelvic stability The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours? A) 2280 mL B) 3840 mL C) 4560 mL D) 7680 mL - ANSA) 2280 mL (upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA. 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 / 2 (half of fluids given in first 8 hours) = 2280 mL
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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D) hypotension that worsens with inspiration - ANSD) hypotension that worsens with inspiration. Assessment findings associated with tension pneumothorax include anxiety, severe restlessness, severe respiratory distress, and absent breath sounds on the injured side. Hypotension due to compression of the heart and great vessels is consistent with obstructive shock. Hypotension worsens with inspiration due to increased intrathoracic pressure. Late signs include distended neck veins, tracheal deviation, and cyanosis. Which of the following considerations is most important when caring for a geriatric trauma patient? A) head to to exam B) medical history C) incontinence D) falls - ANSB) medical history Which of the following injuries is LEAST likely to be promptly identified? A) spleen B) lung C) bowel D) brain - ANSC) bowel Which of the following is a component of the trauma triad of death? A) Acidosis B) hyperthermia C) hemorrhage D) sepsis - ANSA) Acidosis hypothermia, metabolic acidosis, coagulopathy Which of the following is a late sign of increased intracranial pressure? A) Restlessness or drowsiness B) Nausea and vomiting C) Decreased respiratory effort D) Amnesia and anxiety - ANSC) Decreased respiratory effort Which of the following is an expected finding in a patient with a thoracostomy connected to a chest drainage system? A) output of 200 mL/hr B) tubing clamp closed for transport C) dependent loops in the tubing to promote drainage
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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D) fluctuations in the water serial chamber - ANSD) fluctuations in the water serial chamber Which of the following is NOT considered goal-directed therapy of cardiogenic shock? A) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis D) cardiac cath - ANSC) pericardiocentesis Which of the following is possible complication of positive-pressure ventilation? A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure - ANSA) worsening pneumothorax Which of the following is true about the log roll maneuver? A) it causes less spinal motion than the lift and slide maneuver B) it is recommended for patients with unstable pelvic fractures C) it can worsen cord damage from an unstable spinal injury *** D) it does not increases the risk of life threatening hemorrhage from unstable injuries - ANSC) it can worsen cord damage from an unstable spinal injury Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? A) ABC B) MARCH C) AVPU D) VIPP - ANSB) MARCH Which of the following occurs during the third impact of a motor vehicle crash? A) The driver of the vehicle collides with the steering wheel B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger - ANSC) the aorta is torn at its attachment with the ligamentum arteriosum Which of the following patients warrants referral to a burn center? A) a 21- year old female with a partial thickness burn to the right forearm B) a 40-year old hypertensive male with a superficial burn to the back
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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D) 125 mL/hr - ANSB) 500 mL/hr A (AVPU) - ANSAlert. Will be able to maintain airway once clear. A (Primary Survey) - ANSAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ANSInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ANSSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ANSA-Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ANSBreathing and Ventilation Breathing and Ventilation Assessment - ANSInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ANSBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST
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Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway C (Primary Survey) - ANSCirculation and Control of Hemorrhage Cardiogenic Shock - ANSResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. Circulation and Control of Hemorrhage Assessment - ANSInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ANSControl and treat external bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented. Classifications of Shock - ANSHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume
