Exam (elaborations) TNCC-Trauma Nursing Core Course

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 team's communication? Answer: D - ANSWER A) Brief B) loop C) debrief D) huddle 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? (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 Answer: A - ANSWER A) 2280 mL *** B) 3840 mL C) 4560 mL D) 7680 mL Which of the following assessment findings differentiates a tension PTX from a simple PTX? answer: D Family-centered nursing care - ANSWER Involves allowing family to participate in the care of the patient Physiologic change in pregnant trauma patient - ANSWER Consideration should be given to decreased minute ventilation Chest pain trauma patient with crepitus - ANSWER Indicates clear and equal breath sounds Crepitus - ANSWER Crackling sensation in the chest Sinus tachycardia - ANSWER Heart rate above 100 bpm with normal rhythm Premature ventricular contractions - ANSWER Extra, abnormal heartbeats Trauma triad of death - ANSWER Concept involving acidosis, hypothermia, and coagulopathy Glasgow Coma Score - ANSWER Neurological scale assessing consciousness Total body surface area - ANSWER Percentage of body affected by burns Neurogenic shock - ANSWER Shock from spinal cord injury causing hypotension Partial thickness burns - ANSWER Burns affecting the epidermis and dermis Intravenous fluid resuscitation - ANSWER Administering fluids via IV for volume replacement FAST exam - ANSWER Focused Assessment with Sonography for Trauma Cavitation - ANSWER Tissues accelerate outward due to energy Needle thoracostomy - ANSWER Emergency procedure to relieve tension pneumothorax Fluctuation in water seal chamber - ANSWER Normal chest tube function during inspiration and expiration Rotational injury - ANSWER Injury pathway in motor vehicle collisions increasing morbidity Tension pneumothorax - ANSWER Differentiated from simple pneumothorax by hypotension Bruises on upper extremities - ANSWER Indication for screening for abuse in elderly patients Increased work of breathing in child - ANSWER Priority intervention after a fall from height Rigid cervical collar removal - ANSWER Criteria for removing the collar after a motor vehicle collision Intravascular solution for burns - ANSWER Most commonly used solution for burn patients Low pressure irrigation - ANSWER Method to remove small debris from a wound Rebound tenderness and fever - ANSWER Indication of injury to the small bowel Paradoxical chest wall movement - ANSWER Priority intervention for a patient with this chest wall finding Immediate intubation - ANSWER Indicated by severe facial injuries and confusion Alcohol Breath - ANSWER Detectable alcohol odor on breath Cervical Spine Stabilization - ANSWER Priority intervention for a confused patient with lower extremity deformity Closed Loop Communication - ANSWER Term describing trauma team's communication planning Pelvic Binder - ANSWER Appropriate intervention for a patient with weak pulse and pelvic instability Crush Injury Monitoring - ANSWER Condition to monitor in patients with crush injuries Massive Transfusion Medication - ANSWER Medication that may worsen complications of massive transfusion Deformity Intervention - ANSWER Appropriate action for a patient with a wrist deformity Abdominal Trauma Intervention - ANSWER Priority intervention for a patient with significant abdominal injuries Disaster Life Cycle Phase - ANSWER Phase involving identification of deficiencies post-disaster Shock Stage Identification - ANSWER Identifying signs of shock stage in a restless trauma patient Burn Patient Fluid Calculation - ANSWER When to calculate IV fluid resuscitation rate for burn patients Confusion Cause - ANSWER Likely cause of headache, nausea, and confusion in a burn patient Thigh Injury Intervention - ANSWER Initial intervention for a patient with swelling and bruising in the thigh 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. - ANSWER A) increased work of breathing B) unilaterally diminished breath sounds C) pleuritic chest pain D) hypotension that worsens with inspiration *** Which of the following considerations is most important when caring for a geriatric trauma patient? Answer: B - ANSWER A) head to to exam B) medical history ** C) incontinence D) falls An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions? Answer: D - ANSWER A) call for a portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement What factor contributes most the kinetic energy of a body in motion? answer: C - ANSWER A) acceleration B) mass C) velocity D) inertia 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? Answer: D - ANSWER 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 *** 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? Answer: A - ANSWER A) mitigation *** B) preparedness C) response D) recovery Which pulse pressure description is an indication of early hypovolemic shock? Answer: B - ANSWER A) widened B) narrowed *** C) bounding D) weak The most reassuring finding for a male patient with hop pain after a fall is which of the following? Answer: D - ANSWER A) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability *** A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following? Answer: A The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage. Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma. - ANSWER A) diagnostic peritoneal lavage *** B) serial fast exams C) abdominal and pelvic CT scans D) serial abdominal assessments Which of the following is an expected finding in a patient with a thoracostomy connected to a chest drainage system? Answer: D - ANSWER A) output of 200 mL/hr B) tubing clamp closed for transport C) dependent loops in the tubing to promote drainage D) fluctuations in the water serial chamber *** Which of the following patients warrants referral to a burn center? Answer: C - ANSWER 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 C) a 52-year old diabetic male with partial thickness burn to the left lower leg *** D) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax. 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? Answer: B - ANSWER A) acute lung injury B) fat embolism *** C) PTX D) pulmonary contusion Which is the effect of hypothermia on the oxyhemoglobin dissociation curve? Answer: A - ANSWER A) Hemoglobin does not readily release oxygen for use by the tissues *** B) The amount of oxygen available to the tissues increases C) Tissue oxygenation (PaO2) increases D) Hemoglobin molecule saturation (SaO2) decreases 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? Answer: C - ANSWER A) Fast exam B) CT scan C) straight cath for urine sample *** D) ice and elevation of the scrotum You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? Answer: B - ANSWER A) 1000 mL/hr B) 500 mL/hr *** C) 250 mL/hr D) 125 mL/hr Which of the following is possible complication of positive-pressure ventilation? Answer: A - ANSWER A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure Which of the following is NOT considered goal-directed therapy of cardiogenic shock? Answer: C - ANSWER A) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis *** D) cardiac cath What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? Answer: A - ANSWER A) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry