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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?
A. 400 mL
B. 500 mL
C. 800 mL
1
, 2
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 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?
2
, 3
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:
A. Handle future crisis effectively
B. Avoid complications such as sepsis during the recovery
phase
C. Become alienated from family members who are not dealing
with the crisis.
D. Decompensate emotionally and fail to progress during the
rehabilitation phase of recovery. - Correct answer- A
One of the advantages of effective crisis management is the
development of new skills which allows the individual to
handle future crisis more effectively. The onset of sepsis is
independent of the ability of the patient to handle crisis early. A
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?
A. 400 mL
B. 500 mL
C. 800 mL
1
, 2
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 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?
2
, 3
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:
A. Handle future crisis effectively
B. Avoid complications such as sepsis during the recovery
phase
C. Become alienated from family members who are not dealing
with the crisis.
D. Decompensate emotionally and fail to progress during the
rehabilitation phase of recovery. - Correct answer- A
One of the advantages of effective crisis management is the
development of new skills which allows the individual to
handle future crisis more effectively. The onset of sepsis is
independent of the ability of the patient to handle crisis early. A
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