Deck 25: Trauma

Question 1

A strategy to minimize secondary brain injury in head-injured patients is

A) hyperventilation to keep PCO₂ less than 30.
B) fluid restriction to keep central venous pressure less than 6 cm H₂O.
C) maintaining body temperature more than 37.5° C.
D) fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg.

Answer 1

fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg.

Question 2

A patient who was an unrestrained driver in a high-speed, head-on motor vehicle collision presents with dyspnea, tachycardia, hypotension, jugular venous distention, tracheal deviation to the left, and decreased breath sounds on the right side.What is the most likely diagnosis?

A) Tension pneumothorax
B) Cardiac tamponade
C) Simple pneumothorax
D) Ruptured diaphragm

Answer 2

Tension pneumothorax

Question 3

A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Which of the following statements is true about his spinal cord injury?

A) He is likely to be in supraventricular tachycardia.
B) Hyperthermia is common in patients with spinal cord injury.
C) These patients do not usually require mechanical ventilation.
D) The patient has a central cord syndrome.

Answer 3

The patient has a central cord syndrome.

Question 4

The nursing care plan of a patient with a diffuse axonal injury (DAI)would involve which of the following considerations?

A) Neurologic assessments should be performed only once a shift.
B) The patient will need a computed tomography scan for definitive diagnosis of the injury.
C) Blood pressure and temperature elevations are common.
D) The patient is at risk for volume overload because of syndrome of inappropriate antidiuretic hormone.

Question 5

A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Caring for the patient would include which of the following interventions?

A) Keeping the room cool, dark, and quiet
B) Administering intravenous methylprednisolone for the first 24 hours after the injury
C) Elevating the head of the bed 45 degrees
D) Resuscitating low blood pressure by only using intravenous fluid

Question 6

Signs and symptoms associated with a flail chest include

A) tracheal deviation toward the unaffected side.
B) jugular venous distention.
C) paradoxical respiratory movement.
D) respiratory alkalosis.

Question 7

A patient's condition has deteriorated.Changes in condition include trachea shift, absence of breath sounds on the left side, and hypotension.A chest tube was inserted on the left side with 1800 mL of blood removed.The nurse expects that the patient will be taken to surgery for a

A) thoracotomy.
B) cardiac tamponade.
C) splenectomy.
D) pneumothorax.

Question 8

A patient's condition has deteriorated.Changes in condition include trachea shift, absence of breath sounds on the left side, and hypotension.The nurse suspects that the patient has developed a(n)

A) cardiac tamponade.
B) hemothorax.
C) open pneumothorax.
D) ruptured diaphragm.

Question 9

Which of the following statements is true about a patient with a blunt cardiac injury/cardiac contusion?

A) It will probably be diagnosed by pericardiocentesis.
B) Hemodynamic parameters will most likely show a low cardiac output and low systemic vascular resistance.
C) Treatment can require insertion of a temporary pacemaker for conduction control.
D) The only accurate way to evaluate cardiac contusion is to check the creatine phosphokinase fraction.

Question 10

The majority of falls accounting for traumatic injury occur in what population?

A) Construction workers
B) Adolescents
C) Older adults
D) Young adults

Question 11

A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture.The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains.The patient's hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7° C; CVP, 5 cm H₂O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dyns/sec.The patient is at the greatest risk to develop

A) respiratory failure.
B) infection.
C) venous thromboembolism
D) fat embolism syndrome.

Question 12

A patient has sustained an epidural hematoma after a 10-foot fall from a roof.Which of the following is true about epidural hematomas?

A) They are usually arterial in nature.
B) They typically have a worse mortality rate than subdural hematomas.
C) They are associated with a permanent loss of consciousness.
D) Clinical signs and symptoms include bilateral pupil dilation.

Question 13

When opening the airway of an unresponsive trauma patient in the emergency department, which of the following considerations is correct?

A) Airway assessment must incorporate cervical spine immobilization.
B) Hyperextension of the neck is the only acceptable technique.
C) Flexion of the neck protects the patient from further injury.
D) Airway patency takes priority over cervical spine immobilization.

Question 14

Which of the following will cause a nurse to suspect that a patient's pulmonary contusion is worsening?

A) A pulmonary artery catheter showing a central venous pressure of 6 cm H₂O and a wedge pressure of 8 mm Hg
B) An increased need for pain medication
C) An arterial blood gas value that demonstrates respiratory alkalosis
D) Increased peak airway pressures on the ventilator

Question 15

Motor vehicle crashes (MVCs)and falls are the greatest cause of

A) spinal shock.
B) blunt thoracic trauma.
C) maxillofacial injuries
D) penetrating thoracic injuries.

Question 16

The most important aspect of a secondary survey is to

A) check circulatory status.
B) check electrolyte profile.
C) insert a urinary catheter.
D) obtain patient history.

Question 17

A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture.The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains.The patient's hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7° C; CVP, 5 cm H₂O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dynes/sec.What is the most likely cause of this hemodynamic picture?

A) Septic shock
B) Hemorrhagic shock
C) Cardiogenic shock
D) Neurogenic shock

Question 18

Which of the following physiologic changes caused by aging is the most likely contributor to the high mortality rate in older trauma patients compared with younger trauma patients?

A) Deterioration of cerebral and motor skills
B) Poor vision and hearing
C) Diminished pain perception
D) Limited cardiovascular physiologic reserve in the elderly

Question 19

A patient was thrown 30 feet from an open-top Jeep and straddled a row of mailboxes before she landed on the ground.She has an open pelvic fracture.The nurse admitting the patient into the ICU knows that

A) aggressive fluid and blood replacement will probably be needed.
B) the patient will probably be able to walk as soon as she is hemodynamically stable.
C) she will probably not need surgery to stabilize her fracture.
D) there is little likelihood of damage to the genitourinary or gastrointestinal tracts.

Question 20

A patient is admitted to the ICU for observation of his grade II splenic laceration.Which of the following signs and symptoms would suggest that he has had a delayed rupture of his splenic capsule and is now in hemorrhagic shock?

A) BP, 110/70 mm Hg; HR, 120 beats/min; Hct, 42 mg/dL; UO, 40 mL/hr; skin that is pink, warm, and dry with capillary refill of 3 seconds
B) BP, 90/70 mm Hg; HR, 140 beats/min; Hct, 21 mg/dL; UO, 10 mL/hr; pale, cool, clammy skin; confused
C) BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 35 mg/dL; UO, 30 mL/hr; pale, cool, dry skin; alert and oriented
D) BP, 110/60 mm Hg; HR, 118 beats/min; Hct, 38 mg/dL; UO, 60 mL/hr; flushed, warm, diaphoretic skin; agitated and confused

Question 21

Clinical manifestations of abdominal compartment syndrome include which of the following?

A) Decreased cardiac output
B) Decreased peripheral vascular resistance
C) Decreased urine output
D) Hypoxia
E) Bradycardia
F) Hypotension

Question 22

During assessment of a patient who is new to the critical unit, the nurse observes perianal ecchymosis.The nurse suspects the patient has a

A) pelvic fracture.
B) bladder trauma.
C) rectal laceration.
D) spleen laceration.

Question 23

Major trauma patients are at a high risk of developing deep venous thrombosis and pulmonary embolism because of

A) blood stasis.
B) hypernatremia.
C) injury to the intimal surface of the vessel.
D) hyperosmolarity.
E) hypercoagulopathy.
F) immobility.

Question 24

Signs and symptoms of compartment syndrome in the lower extremities include

A) paresis.
B) increased pain.
C) pain in the affected extremity.
D) swelling in the affected extremity.
E) decrease pulses and capillary refill.
F) increase urinary output.

Question 25

Which mechanisms caused by circulating myoglobin can lead to the development of kidney failure?

A) Dark tea-color urine
B) Decreased renal perfusion
C) Cast formation with tubular obstruction
D) Administration of diuretics
E) Rapid screening for serum creatine kinase level
F) Toxic effects of myoglobin in the kidney tubules

Question 26

Fat embolism syndrome can occur as a complication of

A) liver trauma.
B) burns.
C) orthopedic trauma.
D) spleen trauma.