Comprehensive TCRN Practice Questions guide with 100% correct answers

1. A transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrhage. The doppler is positive for vasospasm. The trauma nurse would expect which of the following medications to be prescribed? - correct answerA vasospasm is a known complication of subarachnoid hemorrhages. Calcium channel blockers are used to prevent or reverse vasospasms and are frequently used in the treatment of a subarachnoid hemorrhage. Metoprolol, Hydralazine and Lisinopril are not calcium channel blockers and would not be effective to prevent and treat vasospasms caused by a subarachnoid hemorrhage 2. Which chamber of the heart is most likely to be affected in blunt cardiac injuries? - correct answerGiven the anatomical position of the heart in the chest, the right ventricle is most exposed to the anterior portion of the chest wall and is most likely to be injured in a blunt cardiac injury. Patients with blunt cardiac injuries frequently experience signs of right ventricular failure. Additional findings that are associated with blunt cardiac injuries include hypotension, atrial fibrillation, unexplained sinus tachycardia, multiple PVCs, ST segment changes and right bundle branch blocks. The left atrium, right atrium and left ventricle are less likely to be injured in a blunt cardiac injury. 3. A widened mediastinum is noted on the chest x-ray of a traumatically injured hypotensive patient. The trauma nurse would anticipate gathering which of the following pieces of equipment as the highest priority in this scenario? - correct answerA widened mediastinum on chest x-ray, accompanied by hypotension, is strongly indicative of an aortic injury. One of the most life-threatening complications of an aortic injury is blood loss, which can be treated by giving blood products via a rapid transfuser. Although patient assessment may be enhanced by inserting an arterial line, this is less of a priority than giving fluids rapidly. A chest tube is placed in the pleural space rather than the mediastinum and is therefore not indicated in this scenario. Similarly, there is nothing in this scenario that indicates a pericardiocentesis is indicated so this is not a higher priority than preparing a rapid transfuser. 4. A properly applied pelvic binder sits across the: - correct answerA properly applied pelvic binder is applied across the greater trochanters of the femur. This allows for optimal compression of the pelvis to control bleeding. Applying it across the midshaft of the femur is too low and would provide no therapeutic benefit. Applying it across the pelvic ring or the iliac crests is too high and could actually separate the pelvis further, increasing bleeding and internal damage. 5. Treatment for an extraperitoneal bladder rupture will most likely include: - correct answerBladder lacerations that are located below the pelvic peritoneum are diagnosed as an extraperitoneal bladder rupture. If a laceration is found along with pelvic peritoneum, it would then be classified as an intraperitoneal bladder rupture. Management of an extraperitoneal bladder rupture involves urinary catheterization (urethral or suprapubic) to facilitate urinary drainage from the bladder. Intraperitoneal bladder ruptures require surgical intervention for definitive closure. An isolated extraperitoneal bladder rupture does not require emergent surgical repair or interventional radiology. 6. Hyperextension of the neck is known to cause: - correct answerHyperextension of the neck (the head snapping backwards commonly seen in "whiplash" injuries) causes compression and damage to the posterior portion of the spinal cord. In anterior cord syndrome, the mechanism of injury is the opposite of posterior cord syndrome (a hyperflexion injury where the neck hyperextends forward - chin to chest) causing injury to the anterior portion of the spinal cord. A cauda equina syndrome causes injury to the sacral nerve roots within the spinal canal and is caused by falling directly on the sacrum. Brown-Sequard Syndrome caused by penetrating trauma to the lateral aspect of the spinal cord will cause a left to right phenomenon instead of a top down phenomenon. 7. A patient has a Zone II penetrating neck injury with penetration through the platysma. The trauma nurse knows that this patient is at increased risk of injury to: - correct answerThe platysma is a muscle in the neck that gives support and protection to the vital structures underneath it. Any time there is penetration through the platysma, there is an increased risk of damage to the underlying structures in the neck. The neck is divided into three zones. Zone I extends from the sternal notch and clavicle up to the cricothyroid cartilage. Zone II extends from the cricothyroid cartilage upward to the angle of the mandible. Zone III extends from the angle of the mandible to the base of the skull. Structures found in Zone I include the subclavian artery, vertebral artery, lung apices, trachea, thyroid and esophagus. Zone II includes the internal jugular vein, esophagus, larynx, vagus nerve, carotid artery and vertebral artery. Zone III includes the salivary and parotid glands, cranial nerves IX-XII, vertebral artery, distal carotid artery, and distal jugular vein. 8. A pregnant patient's fundal height is palpated 6 cm above the umbilicus. What is the estimated gestational age of the fetus? - correct answerFundal height is defined as the distance from the pubic bone to the top of the uterus in centimeters. In general, the fundus reaches the umbilicus by 20 weeks. Every centimeter past that point is measured as 1 week. If every one centimeter above the umbilicus equals one week, then the patient is approximately 26 weeks gestation. 9. Appropriate care for an amputated body part includes: - correct answerWhen caring for an amputated body part, the trauma nurse should clean the part removing any dirt and debris, wrapping the part in a slightly saline moistened gauze, and then placing it in a sealed plastic bag. At this time, the part should be placed in a second bag containing a mixture of ice and water. It is imperative that the part does not freeze or does not come into contact with water (which is hypotonic to body tissue). Also ensure that the amputated part is properly labeled with the patient information. 10. Decontamination with water is discouraged in patients exposed to powdered: - correct answerDry chemicals that should not be irrigated with water include dry lime, elemental metals (including sodium, potassium, magnesium lithium and phosphorus) and phenol. When exposed to water these substances will cause a harmful exothermic or "heat producing" reaction burning the patient's skin. They may also release possible hazardous byproducts into the air. Sulfuric acid, muriatic acid and cement can all be irrigated with copious amounts of water (although a much of the dry chemical as possible should be brushed off before irrigation with water is initiated) 11. Hypovolemic shock is most likely to be caused by: - correct answerHypovolemic shock is caused by fluid loss (e.g. bleeding or diarrhea) or third spacing of fluids. The inflammatory response caused by a burn leads to capillary permeability resulting in the third spacing of fluids which results in hypovolemic shock. Cervical spinal injuries contribute to neurogenic rather than hypovolemic shock. Although an epidural hematoma causes blood loss, the epidural space is relatively small, so blood accumulation would not be enough to result in hypovolemic shock. A tension pneumothorax would cause obstructive shock. 12. The best method for assessing capillary refill on a two-week old traumatically injured neonate is to blanch the: - correct answerThe circulatory system of the neonate is not well developed and perfusion to the fingers is not complete, therefore using the tip of the finger is reserved for older children, adolescents and adults. It is generally recommended to use the forehead, sole of the foot, the sternum or the palm of the hand as opposed to the skin over the iliac crest or the tip of the child's tongue 13. Enteral feedings are initiated on a traumatically injured patient and several days later, the trauma nurse notes a significant elevation in serum blood urea nitrogen (BUN) and creatinine. The trauma nurse should suspect this may be caused by: - correct answerOne of the effects of overfeeding the traumatically injured patient is azotemia (elevated BUN and creatinine) and the dietician should be notified of azotemia if it is noted so that an adjustment in calories may be made. Insufficient protein in the diet does not cause azotemia. Although bleeding ulcers may cause elevations in blood urea nitrogen, they do not tend to cause elevations in creatinine. Feeding a patient too quickly after trauma does not cause elevations in BUN and creatinine 14. A trauma center refers a challenging case to an outside reviewer to validate their review of deficiencies associated with the care of the traumatically injured patient. What type of performance review process is this? - correct answerThe first stage of performance improvement is a primary review. The goal at this level of review is to be able to provide immediate feedback and resolution of any deficiencies in care provided. Events that require further investigation will follow into the category of a secondary review and these reviews are done in a step-by-step approach, usually by the trauma medical director or designee. Immediate resolution and feedback can be possible at the end of secondary review, and the issue may be resolved. If the issue is not resolved, it should be referred for a multidisciplinary committee review for further analysis. This type of analysis would be classified as a tertiary review. If further escalation of review is required this would be considered a quaternary review. A quaternary review is either performed by the hospital quality committee, or it is sentfor an external peer review. This type of review is reserved for extraordinary cases or to validate the current trauma hospitalsperformance improvement and patient safety (PIPS)process. 15. The trauma nurse performs supraglottic suctioning on an intubated patient. The most likely rationale for this intervention is to: - correct answerSupraglottic suctioning (or using endotracheal tubes with supraglottic secretion drainage) is considered a best-practice to reduce the incidence of ventilator assisted pneumonia. It is not used to assess the readiness for extubation and will not decrease intracranial pressure. It is not associated with changing the positive end-expiratory pressure on the ventilator. 16. When discharging a patient after a splenectomy, the trauma nurse should encourage the patient to get meningococcal and pneumococcal vaccines every: - correct answerPatients who undergo a splenectomy have difficulty eliminating encapsulated bacteria including Streptococcus Pneumonia, Neisseria Meningitides, and Hemophilus Influenzae. Knowing this, patients are encouraged to receive an annual influenza vaccination, along with meningococcal and pneumococcal vaccines every 5 years. 17. After an x-ray of the neck, a patient is diagnosed with a spinal cord injury without radiological abnormality (SCIWORA). The trauma nurse should expect the patient will require: - correct answerAlthough a spinal cord injury without radiological abnormality (SCIWORA) will not be identified on x-ray or computerized tomography, it will be identified using magnetic resonance imaging. This injury does not require surgery nor will it benefit from the administration of intravenous solumedrol 18. The trauma nurse knows that a subdural hematoma is an accumulation of blood between the: - correct answerThe prefix "sub" means "below". So, a "subdural" hematoma occurs below the dura mater. The arachnoid mater is below the dura mater, so the subdural hematoma will be between the dura and the arachnoid mater. The skull is above the dura mater, so blood from a subdural bleed will not be in contact with the skull. The pia mater is below the arachnoid mater, so blood from a subdural bleed will not be in contact with the arachnoid mater 19. Which of the following treatment goals is most pertinent in the critical care unit when caring for a trauma patient with a rupture of the large bowel? - correct answerRupture of the large bowel causes the release of intestinal contents into the peritoneum. Since the large bowel contains a large amount of anaerobic bacteria, a rupture of the bowel usually causes immediate and significant peritoneal infections. Therefore, a major goal of care in the treatment of large bowel ruptures is to prevent and treat infections. This may be accomplished by early administration of antibiotics and surgical intervention to clean out the peritoneum and repair defects. Both resumption of oral nutrition and prevention of adhesions are desirable, but these are less dependent on the care provided and not as high of a priority as reducing the incidence of and treating an infection. The goal of caring for patients with abdominal injuries to maintain a healthy abdominal perfusion pressure rather than decreasing it. 20. A patient has electrical burns on the surface of the right hand and the left hand. Which arrhythmia is most common with this mechanism of injury? - correct answer60% of patient who sustain an electrical injury with entry to one hand and exit through the other will present with ventricular fibrillation. Other arrythmias are far less common. 21. Which of the following interventions is recognized as a way to reduce catheter associated urinary tract infections (CAUTI)? - correct answer.Guidelines on reducing catheter associated urinary tract infections (CAUTI) include properly securing catheters to prevent movement and urethral traction. There is no evidence that regular administration of diuretics will reduce CAUTI and many trauma patients are fluid depleted and diuretics would not be appropriate for them. Irrigation of the bladder has been demonstrated to increase rather than decrease bladder infections and should be avoided when possible. Current guidelines recommend using the smallest bore catheter possible to minimize bladder neck and urethral trauma 22. Which of the following members of the rehabilitation team would