ATI CRITICAL CARE FINAL EXAM 2023 -2024 2023 1. Your patient was a passenger in a motor vehicle crash yesterday and suffered an open fracture of the femur . His condition was stable until an hour ago, when he began to complain of shortness of breath. His heart rate is 104 beats/min, respiratory rate is 30 breaths/min, BP is 90/60 mm Hg, and temperature is now 38.4° C. You suspect that he:
A. has a fat embolism. B. has developed metabolic acidosis. C. is developing systemic inflammatory response syndrome (SIRS). D. is experiencing early multiple organ dysfunction syndrome (MODS). ANS: A
Rationale: These are classic signs and symptoms of a fat embolism. The history of a long-bone fracture adds to the evidence of a fat embolism. The patient may develop metabolic acidosis associated with poor oxygenation from the fat emboli. SIRS possibly progressing to MODS would also be a consequence of the fat emboli
2. Poor patient outcomes after a traumatic injury are associated with:
A. chest tube placement for treatment of a hemothorax. B. immediate decompression of a tension pneumothorax. C. massive transfusions of blood products. D. intraosseous cannulation for intravenous fluid administration. Ans:C
Rationale: Current evidence suggests that patients receiving massive blood transfusions have poorer outcomes. Although a chest tube may be necessary in the treatment of trauma patients, it is not associated with poor patient outcomes. Immediate decompression of a tension pneumothorax is also not associated with poor patient outcomes. Intraosseous cannulation for intravenous fluid administration has not been shown to have adverse patient outcomes.
3. Which condition is a common cause of death after chest trauma?
A. Cardiac tamponade B. Flail chest C. Hemothorax D. Pulmonary contusion ANS: D
Rationale: Pulmonary contusion as a result of blunt chest trauma increases the risk for development of pneumonia, acute lung injury, and/or ARDS. Cardiac tamponade is life threatening if untreated, but it is not a common complication after blunt chest trauma. Flail chest and hemothorax may result with blunt chest trauma, but they are not common causes of death. 4. A trauma patient with a fractured forearm complains of extreme, throbbing pain at the fracture site and paresthesia
in the fingers. Upon further assessment, you note that the forearm is extremely edematous and you are now having difficulty palpating a radial pulse. You notify the physician immediately because you suspect:
A. compartment syndrome. B. fat emboli. C. hypothermia. D. rhabdomyolysis. Ans: A
Rationale: These signs and symptoms are characteristic of late signs of compartment syndrome. Fat emboli are associated with long-bone fractures and typically manifest pulmonary symptoms. These signs and symptoms are characteristic of compartment syndrome, not hypothermia. Rhabdomyolysis is associated with a crush injury and compartment syndrome. A clinical sign that may be noted by the nurse is dark tea-colored urine. 5.The trauma patient presenting with left lower rib fractures develops left upper quadrant tenderness, hypotension, and referred pain to the left shoulder . You suspect:
A.bowel obstruction. B.cardiac tamponade. C.pulmonary contusion. D.splenic injury. Ans: D
Rationale: Splenic injury occurs most often as a result of blunt trauma to the abdomen. However, penetrating trauma to the left upper quadrant of the abdomen or fracture of the anterior left lower ribs also contributes to splenic injuries. The patient may present with left upper quadrant tenderness, peritoneal irritation, and/or referred pain to the left shoulder (Kehr’s sign). Hypotension or signs of hypovolemic shock may also be noted. The patient’s injury and associated signs and symptoms suggest an injury to the spleen rather than cardiac, bowel, or pulmonary injury.
6. Spinal cord injury causes a loss of sympathetic output, resulting in distributive shock with hypotension and bradycardia. Although blood pressure may respond to fluid resuscitation, what other therapy may be required to compensate for loss of sympathetic innervation?
A.Colloids B.Glucocorticoids C.Proton pump inhibitors D.Vasopressors ANS: D
Rationale: Blood pressure may respond to IV fluids, but vasopressor therapy is often required to compensate for the loss of sympathetic innervation and resultant vasodilation. Colloid administration alone will not provide necessary vascular tone to support perfusion. Glucocorticoids are given in the early stages of spinal cord injury to reduce edema associated with injury and to improve outcomes. Proton pump inhibitors may be given to prevent stress ulcers.
7. A restrained patient’s status after a motor vehicle crash includes dyspnea, dysphagia, hoarseness, and complaints of
severe chest pain. Upon assessment you note that the patient has weak femoral pulses. Which of the following complications and related diagnostic test should be considered?
A.Aortic dissection and aortogram B.Cardiac tamponade and pericardiocentesis C.Liver laceration and focused assessment with sonography for trauma (FAST) D.Pulmonary contusion and chest x-ray ANS: A
Rationale: Signs of aortic disruption include weak femoral pulses, dysphagia, dyspnea, hoarseness, and severe pain. A chest x-ray study may demonstrate a widened mediastinum, tracheal deviation to the right, depressed left mainstem bronchus, first and second rib fractures, and left hemothorax. The diagnosis is confirmed by an aortogram. Cardiac tamponade presents with pulsus pardoxus and decreased cardiac output with poor venous return; a pericardiocentesis is the treatment of choice. Depending on the severity of the liver laceration, the patient will present with right upper quadrant abdominal pain and tenderness and hypotension. FAST is used to diagnosis hepatic injury and intraabdominal bleeding. Pulmonary contusion will present primarily with signs and symptoms of poor oxygenation, and a chest x-ray may not be helpful in diagnosing this condition.
8.The primary priority for the critical care nurse with regard to the trauma patient is which of the following?
A.Decrease the patient’s risk for multiple organ dysfunction syndrome. B.Ensure adequate fluid resuscitation. C.Increase the physiological reserve of the trauma patient. D.Provide adequate oxygenation and tissue perfusion. Ans: D
Rationale: The priority is to maintain adequate oxygenation and tissue perfusion through effective fluid resuscitation and management of the patient’s airway and breathing. Decreasing the patient’s risk for MODS is achieved by ensuring tissue perfusion and oxygenation. Increasing physiological reserve is not an initial priority in the management
of the trauma patient.
9.A 72-year-old patient fractured his pelvis in a motor vehicle crash 2 days ago. He suddenly becomes anxious and short of breath. His respiratory rate is 34 breaths per minute, and he is complaining of midsternal chest pain. His oxygen saturation drops to 75%. You suspect:
A.cardiac tamponade. B.myocardial infarction. C.pulmonary embolus. D.tension pneumothorax. Ans: C
Rationale: The patient’s history and respiratory signs and symptoms indicate pulmonary embolus. The patient's signs and symptoms do not suggest a cardiac tamponade; however, given the patient’s age, he may be evaluated for a possible myocardial infarction. His mechanism of injury and 2 days’ post injury make a tension pneumothorax less likely.
10. A 55-year-old trauma patient hit the steering wheel and has a cardiac contusion. Which are potential complications of the injury? (Select all that apply.)
A.Flail chest B.Dysrhythmias C.Hypotension D.Myocardial ischemia ANS: B, C, D
Rationale: A flail chest is commonly associated with rib fractures, which are not present in this patient. Cardiac contusions present with signs and symptoms of ineffective heart functioning, including dysrhythmias, decreased cardiac output (i.e., hypotension), and myocardial ischemia that may progress to infarction.
11.The nurse is assessing a patient for suspected alcohol withdrawal and identifies which signs and symptoms as suspicious? (Select all that apply.)
A.Irritable, confused, hallucinations B.Nausea, vomiting, diarrhea C.Hypotension and tachycardia D.Low body temperature E.Seizures F.Somnolent, difficult to arouse Ans: A, B, E
Rationale: Signs and symptoms of alcohol withdrawal include irritability, agitation, confusion, hallucinations and delusions, insomnia, anxiety and tremors, nausea, vomiting, and diarrhea, diaphoresis, tachycardia and hypertension, fever, and seizures.
12.When obtaining report on a trauma patient, which question would be helpful in determining potential injuries associated with the mechanism of injury? (Select all that apply.)
A. has a fat embolism. B. has developed metabolic acidosis. C. is developing systemic inflammatory response syndrome (SIRS). D. is experiencing early multiple organ dysfunction syndrome (MODS). ANS: A
Rationale: These are classic signs and symptoms of a fat embolism. The history of a long-bone fracture adds to the evidence of a fat embolism. The patient may develop metabolic acidosis associated with poor oxygenation from the fat emboli. SIRS possibly progressing to MODS would also be a consequence of the fat emboli
2. Poor patient outcomes after a traumatic injury are associated with:
A. chest tube placement for treatment of a hemothorax. B. immediate decompression of a tension pneumothorax. C. massive transfusions of blood products. D. intraosseous cannulation for intravenous fluid administration. Ans:C
Rationale: Current evidence suggests that patients receiving massive blood transfusions have poorer outcomes. Although a chest tube may be necessary in the treatment of trauma patients, it is not associated with poor patient outcomes. Immediate decompression of a tension pneumothorax is also not associated with poor patient outcomes. Intraosseous cannulation for intravenous fluid administration has not been shown to have adverse patient outcomes.
3. Which condition is a common cause of death after chest trauma?
A. Cardiac tamponade B. Flail chest C. Hemothorax D. Pulmonary contusion ANS: D
Rationale: Pulmonary contusion as a result of blunt chest trauma increases the risk for development of pneumonia, acute lung injury, and/or ARDS. Cardiac tamponade is life threatening if untreated, but it is not a common complication after blunt chest trauma. Flail chest and hemothorax may result with blunt chest trauma, but they are not common causes of death. 4. A trauma patient with a fractured forearm complains of extreme, throbbing pain at the fracture site and paresthesia
in the fingers. Upon further assessment, you note that the forearm is extremely edematous and you are now having difficulty palpating a radial pulse. You notify the physician immediately because you suspect:
A. compartment syndrome. B. fat emboli. C. hypothermia. D. rhabdomyolysis. Ans: A
Rationale: These signs and symptoms are characteristic of late signs of compartment syndrome. Fat emboli are associated with long-bone fractures and typically manifest pulmonary symptoms. These signs and symptoms are characteristic of compartment syndrome, not hypothermia. Rhabdomyolysis is associated with a crush injury and compartment syndrome. A clinical sign that may be noted by the nurse is dark tea-colored urine. 5.The trauma patient presenting with left lower rib fractures develops left upper quadrant tenderness, hypotension, and referred pain to the left shoulder . You suspect:
A.bowel obstruction. B.cardiac tamponade. C.pulmonary contusion. D.splenic injury. Ans: D
Rationale: Splenic injury occurs most often as a result of blunt trauma to the abdomen. However, penetrating trauma to the left upper quadrant of the abdomen or fracture of the anterior left lower ribs also contributes to splenic injuries. The patient may present with left upper quadrant tenderness, peritoneal irritation, and/or referred pain to the left shoulder (Kehr’s sign). Hypotension or signs of hypovolemic shock may also be noted. The patient’s injury and associated signs and symptoms suggest an injury to the spleen rather than cardiac, bowel, or pulmonary injury.
6. Spinal cord injury causes a loss of sympathetic output, resulting in distributive shock with hypotension and bradycardia. Although blood pressure may respond to fluid resuscitation, what other therapy may be required to compensate for loss of sympathetic innervation?
A.Colloids B.Glucocorticoids C.Proton pump inhibitors D.Vasopressors ANS: D
Rationale: Blood pressure may respond to IV fluids, but vasopressor therapy is often required to compensate for the loss of sympathetic innervation and resultant vasodilation. Colloid administration alone will not provide necessary vascular tone to support perfusion. Glucocorticoids are given in the early stages of spinal cord injury to reduce edema associated with injury and to improve outcomes. Proton pump inhibitors may be given to prevent stress ulcers.
7. A restrained patient’s status after a motor vehicle crash includes dyspnea, dysphagia, hoarseness, and complaints of
severe chest pain. Upon assessment you note that the patient has weak femoral pulses. Which of the following complications and related diagnostic test should be considered?
A.Aortic dissection and aortogram B.Cardiac tamponade and pericardiocentesis C.Liver laceration and focused assessment with sonography for trauma (FAST) D.Pulmonary contusion and chest x-ray ANS: A
Rationale: Signs of aortic disruption include weak femoral pulses, dysphagia, dyspnea, hoarseness, and severe pain. A chest x-ray study may demonstrate a widened mediastinum, tracheal deviation to the right, depressed left mainstem bronchus, first and second rib fractures, and left hemothorax. The diagnosis is confirmed by an aortogram. Cardiac tamponade presents with pulsus pardoxus and decreased cardiac output with poor venous return; a pericardiocentesis is the treatment of choice. Depending on the severity of the liver laceration, the patient will present with right upper quadrant abdominal pain and tenderness and hypotension. FAST is used to diagnosis hepatic injury and intraabdominal bleeding. Pulmonary contusion will present primarily with signs and symptoms of poor oxygenation, and a chest x-ray may not be helpful in diagnosing this condition.
8.The primary priority for the critical care nurse with regard to the trauma patient is which of the following?
A.Decrease the patient’s risk for multiple organ dysfunction syndrome. B.Ensure adequate fluid resuscitation. C.Increase the physiological reserve of the trauma patient. D.Provide adequate oxygenation and tissue perfusion. Ans: D
Rationale: The priority is to maintain adequate oxygenation and tissue perfusion through effective fluid resuscitation and management of the patient’s airway and breathing. Decreasing the patient’s risk for MODS is achieved by ensuring tissue perfusion and oxygenation. Increasing physiological reserve is not an initial priority in the management
of the trauma patient.
9.A 72-year-old patient fractured his pelvis in a motor vehicle crash 2 days ago. He suddenly becomes anxious and short of breath. His respiratory rate is 34 breaths per minute, and he is complaining of midsternal chest pain. His oxygen saturation drops to 75%. You suspect:
A.cardiac tamponade. B.myocardial infarction. C.pulmonary embolus. D.tension pneumothorax. Ans: C
Rationale: The patient’s history and respiratory signs and symptoms indicate pulmonary embolus. The patient's signs and symptoms do not suggest a cardiac tamponade; however, given the patient’s age, he may be evaluated for a possible myocardial infarction. His mechanism of injury and 2 days’ post injury make a tension pneumothorax less likely.
10. A 55-year-old trauma patient hit the steering wheel and has a cardiac contusion. Which are potential complications of the injury? (Select all that apply.)
A.Flail chest B.Dysrhythmias C.Hypotension D.Myocardial ischemia ANS: B, C, D
Rationale: A flail chest is commonly associated with rib fractures, which are not present in this patient. Cardiac contusions present with signs and symptoms of ineffective heart functioning, including dysrhythmias, decreased cardiac output (i.e., hypotension), and myocardial ischemia that may progress to infarction.
11.The nurse is assessing a patient for suspected alcohol withdrawal and identifies which signs and symptoms as suspicious? (Select all that apply.)
A.Irritable, confused, hallucinations B.Nausea, vomiting, diarrhea C.Hypotension and tachycardia D.Low body temperature E.Seizures F.Somnolent, difficult to arouse Ans: A, B, E
Rationale: Signs and symptoms of alcohol withdrawal include irritability, agitation, confusion, hallucinations and delusions, insomnia, anxiety and tremors, nausea, vomiting, and diarrhea, diaphoresis, tachycardia and hypertension, fever, and seizures.
12.When obtaining report on a trauma patient, which question would be helpful in determining potential injuries associated with the mechanism of injury? (Select all that apply.)
