1
TCRN Review - Challenge Questions
Fluid resuscitation is undertaken for the patient in late,
decompensatory hypovolemic shock. Which of the
following findings indicates that this treatment is having
its intended effect? An elevation in the:
A. Pulse pressure
B. Urinary output
C. Respiratory rate
D. Serum lactate levels - Correct answer- B
A decrease in urinary output is associated with
decompensatory hypovolemic shock, therefore an
increase in this parameter is an indication of successful
treatment. Pulse pressure, respiratory rate and serum
lactate levels all increase with decompensatory shock,
therefore an elevation in these levels is not associated
with successful treatment.
A patient receives 2 units of whole blood during the
resuscitation phase of trauma. When documenting intake
for the resuscitation, the trauma nurse will record what
volume of fluid to account for those two units of while
blood?
1
, 2
A. 400 mL
B. 500 mL
C. 800 mL
D. 1000 mL - Correct answer- D
Which of the following factors is considered the most
accurate indicator of successful resuscitation in the
patient with hypovolemic shock?
A. Base deficit
B. Mental status
C. Urinary output
D. Blood pressure - Correct answer- A
Tissue hypoxia causes the base deficit to decrease. Since
tissue hypoxia is associated with inadequate fluid
resuscitation, normalization of the base deficits
associated with successful treatment. Alteration of mental
status and an elevation in blood pressure are associated
with successful treatment of hypovolemic shock but these
parameters may be altered by many other factors
including the use of beta-blocker medication,
vasoconstriction associated with shock and use of alcohol
or other illicit substances. Therefore, these indicators are
less accurate than the base deficit. Similarly, an increase
in urinary output is associated with successful
resuscitation but may be altered by pre-existing renal
2
, 3
failure, diabetes insipidus and other confounding factors.
Therefore arterial base deficit is the most accurate
indicator of adequate fluid resuscitation in the patient
with hypovolemic shock.
The trauma nurse knows that an elevation of which of the
following laboratory values is associated with
disseminated intravascular coagulation?
A. D-Dimer
B. Hematocrit
C. Platelet count
D. Fibrinogen levels - Correct answer- A
Disseminated intravascular coagulation (DIC) results in
abnormal increase in clotting. Fibrin degradation
products are released from the breakdown of formed
clots therefore increasing the D-dimer. The bleeding
associated with DIC would cause the hematocrit to
decrease rather than elevate. Consumption of clotting
factors caused by abnormal clotting would cause the
platelet count and fibrinogen level to drop rather than
elevate.
The trauma nurse knows that a patient who successfully
deals with the crisis of a traumatic event shortly after the
injury is more likely to:
3
TCRN Review - Challenge Questions
Fluid resuscitation is undertaken for the patient in late,
decompensatory hypovolemic shock. Which of the
following findings indicates that this treatment is having
its intended effect? An elevation in the:
A. Pulse pressure
B. Urinary output
C. Respiratory rate
D. Serum lactate levels - Correct answer- B
A decrease in urinary output is associated with
decompensatory hypovolemic shock, therefore an
increase in this parameter is an indication of successful
treatment. Pulse pressure, respiratory rate and serum
lactate levels all increase with decompensatory shock,
therefore an elevation in these levels is not associated
with successful treatment.
A patient receives 2 units of whole blood during the
resuscitation phase of trauma. When documenting intake
for the resuscitation, the trauma nurse will record what
volume of fluid to account for those two units of while
blood?
1
, 2
A. 400 mL
B. 500 mL
C. 800 mL
D. 1000 mL - Correct answer- D
Which of the following factors is considered the most
accurate indicator of successful resuscitation in the
patient with hypovolemic shock?
A. Base deficit
B. Mental status
C. Urinary output
D. Blood pressure - Correct answer- A
Tissue hypoxia causes the base deficit to decrease. Since
tissue hypoxia is associated with inadequate fluid
resuscitation, normalization of the base deficits
associated with successful treatment. Alteration of mental
status and an elevation in blood pressure are associated
with successful treatment of hypovolemic shock but these
parameters may be altered by many other factors
including the use of beta-blocker medication,
vasoconstriction associated with shock and use of alcohol
or other illicit substances. Therefore, these indicators are
less accurate than the base deficit. Similarly, an increase
in urinary output is associated with successful
resuscitation but may be altered by pre-existing renal
2
, 3
failure, diabetes insipidus and other confounding factors.
Therefore arterial base deficit is the most accurate
indicator of adequate fluid resuscitation in the patient
with hypovolemic shock.
The trauma nurse knows that an elevation of which of the
following laboratory values is associated with
disseminated intravascular coagulation?
A. D-Dimer
B. Hematocrit
C. Platelet count
D. Fibrinogen levels - Correct answer- A
Disseminated intravascular coagulation (DIC) results in
abnormal increase in clotting. Fibrin degradation
products are released from the breakdown of formed
clots therefore increasing the D-dimer. The bleeding
associated with DIC would cause the hematocrit to
decrease rather than elevate. Consumption of clotting
factors caused by abnormal clotting would cause the
platelet count and fibrinogen level to drop rather than
elevate.
The trauma nurse knows that a patient who successfully
deals with the crisis of a traumatic event shortly after the
injury is more likely to:
3
