Deck 67: Caring for the Patient With Multisystem Trauma

Question 1

A trauma patient is hemorrhaging from multiple gunshot wounds to the lower abdomen. The nurse provides care based on which priority nursing diagnosis (NDX)?

A) Ineffective Breathing related to shallow respirations
B) Fluid Volume Deficit related to effects of decreased renal perfusion
C) Impaired Ventilation related to airway obstruction
D) Ineffective Tissue Perfusion related to hypovolemia

Answer 1

Ineffective Tissue Perfusion related to hypovolemia

Question 2

A patient was an unrestrained driver in a frontal-impact motor vehicle collision. The nurse would expect which finding?

A) Unstable pelvic structure, causing severe pain on palpation
B) Neck muscle spasms caused by hyperextension of the neck
C) Paradoxical movement of the chest caused by multiple rib fractures
D) Unequal pulses in the lower extremities due to possible femur fracture

Answer 2

Paradoxical movement of the chest caused by multiple rib fractures

Question 3

A patient is admitted with a diagnosis of blunt trauma to the abdomen after a motor vehicle collision. What should the nurse assess first when the patient arrives in the emergency department?

A) Airway patency
B) Abdomen for external signs of injury
C) Cervical spine for tenderness
D) Capillary refill

Answer 3

Airway patency

Question 4

A patient was involved in an automobile accident in which the car left the road and hit a bridge. Which information provided by the paramedics would the nurse evaluate as important in understanding the mechanism of injury?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The speed of the vehicle was estimated at 60 miles per hour when it hit the bridge abutment.
B) The passenger cabin of the vehicle showed no signs of intrusion.
C) It was raining at the time of the crash.
D) Airbags in the car deployed.
E) The patient was wearing a seatbelt.

Question 5

A trauma patient who experienced blunt cardiac injury from a steering wheel should be assessed for cardiac tamponade. The nurse would assess for which clinical manifestations?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Neck vein distention
B) Presence of an S3 heart sound
C) Muffled heart sounds
D) Bounding pulse
E) Hypotension

Question 6

The patient was a restrained front seat passenger in a car crash. Which findings would the nurse evaluate as indicating possible internal injury from the seatbelt?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The patient is unconscious.
B) There are abrasions across the patient's abdomen.
C) There is bruising across the patient's chest.
D) The patient has ecchymosis across both knees.
E) The patient complains of hip pain.

Question 7

A patient presents to the emergency department with brisk hemorrhage from a laceration on the lower leg. How should the nurse address the hemorrhage?

A) Tape ABD pads over the wound and reinforce them when they become saturated.
B) Apply direct manual pressure on the wound.
C) Pack ice directly on the wound to cause vasoconstriction.
D) Apply a tourniquet tight enough to stop all the external bleeding.

Question 8

A patient has been stabbed just below the left nipple. The nurse would assess for damage to which structures?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Lung
B) Heart
C) Spleen
D) Subclavian vein
E) Diaphragm

Question 9

A patient is transported by ambulance with massive hemorrhage from a gunshot injury. Immediate transfusion of packed red blood cells is indicated. Which blood does the nurse anticipate transfusing?

A) Blood of the same type as the patient's
B) Blood indicated by typing and cross-matching the patient's blood
C) Type O blood
D) Type AB blood

Question 10

A gunshot wound victim is "dumped" in the parking lot of the emergency department (ED). What is the nurse's priority action?

A) Notify security.
B) Initiate airway management with cervical spine immobilization.
C) Assess the patient's level of consciousness.
D) Get a stretcher to bring the patient into the ED.

Question 11

The nurse would aggressive fluid resuscitation as an early intervention for which patient?

A) The patient with a serious head injury from a fall
B) The patient whose hands were burned in a kitchen fire
C) The patient whose leg was severed in an industrial accident
D) The patient with an open abdominal wound from a car crash

Question 12

The nurse works in an emergency department in a town with a large proportion of retired persons. The nurse should consider which difference between older and younger adults as it pertains to emergency care?

A) Younger patients are at greater risk for rib fractures and flail chest because their chests are not as compliant as those of older adults.
B) Older patients have a greater capacity to increase their cardiac output on demand, and therefore can tolerate greater blood loss than younger patients.
C) Older patients have an increased incidence of subdural hematomas because their veins are more fragile and less elastic compared to those of younger patients.
D) The aorta is comparatively closer to the surface in younger adults, so they are at greater risk of tearing injuries.

Question 13

A child ran into the street and was struck by a car. Which finding, typical for this mechanism of injury, would the nurse anticipate assessing?

A) Lower extremity fracture caused by the wheels running over the child
B) Kidney injury due to the impact of the vehicle on the lower back
C) Chest or femur injuries where the bumper may have impacted the child
D) Liver injuries on the right side due to impact by the vehicle

Question 14

A patient is brought to the emergency department after being involved in a motor vehicle crash. Which assessment would indicate to the nurse that FAST examination will likely be necessary?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Ecchymoses over the abdomen
B) Complaint of neck pain
C) Report of head-on crash in which the patient was the restrained driver
D) Lower leg lacerations and fractures
E) Complaints of chest wall tenderness

Question 15

A patient sustained multiple fractures and contusions when hit by a car while walking across the street. He says, "How can I be hurt so badly? The car barely hit me." How should the nurse respond?

A) "Your body absorbed a lot of energy from the moving car."
B) "Because you are diabetic, your injuries are worse."
C) "You probably don't remember how hard you were hit."
D) "Because you are older, your injuries are worse."

Question 16

The nurse is teaching a community education class on prevention of neck injury. Which information would the nurse include in this teaching?

A) Be certain the car's headrests are positioned correctly.
B) Wear a helmet when riding a motorcycle.
C) Ride only in the backseat of a car.
D) Disable side curtain airbags

Question 17

A patient is admitted to the hospital with injuries from a motor vehicle collision. During the nurse's initial assessment, the patient develops hypotension and severe jugular distention with a tracheal deviation. The nurse should act quickly to treat which probable condition?

A) Tension pneumothorax
B) Hemorrhage
C) Compensatory shock
D) Hypovolemic shock

Question 18

A patient was the restrained front seat passenger in a slow-speed automobile crash in which the car was struck in the middle of the passenger side. Where would the nurse look first for injuries in this patient?

A) Right head, arm, and hip
B) Left knee and ankle
C) Low back
D) There is no pattern to the potential injury.

Question 19

A patient is brought to the emergency department with a penetrating wound to the neck. The patient is dyspneic and cyanotic, and has evidence of subcutaneous emphysema. Which intervention does the nurse prioritize?

A) Intubation
B) Notification of next of kin
C) X-ray of the cervical spine
D) Administration of an IV beta blocker

Question 20

The nurse should protect the trauma patient's spinal cord. Which action should the nurse take?

A) Keep the patient flat and run a hand underneath to assess for posterior injuries.
B) Keep the patient supine until all diagnostic exams have been completed.
C) Keep the patient on a backboard for the first 24 hours.
D) Apply a rigid cervical collar and logroll the patient.

Question 21

The nurse always treats multiple trauma victims as if a spine injury exists. Which assessment findings would the nurse evaluate as increasing the risk for the presence of a cervical spine injury?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The patient is confused and lethargic.
B) The patient has severe facial bruising and trauma.
C) The patient has severe open abdominal wounds.
D) The patient has an obvious depressed skull fracture.
E) The patient cannot follow commands.

Question 22

A woman who is 14 weeks pregnant presents to the ED after falling down a flight of stairs. What should be the nurse's first intervention?

A) Administer oxygen.
B) Attempt to locate fetal heart tones.
C) Start an IV with a large-bore catheter.
D) Position the patient on her right side.

Question 23

The mechanism of a patient's injury suggests that the patient may have suffered a basilar skull fracture. The nurse would assess for which findings?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Battle's sign
B) Hyphema
C) Raccoon eyes
D) Rigid extension of the forearms
E) Anasarca

Question 24

A patient is admitted to the ED with massive trauma. What nursing intervention will help protect this patient from coagulopathy?

A) Start oxygen immediately.
B) Cover the patient with a blanket.
C) Place a pillow under the patient's feet.
D) Use sterile technique for all invasive procedures.

Question 25

During the secondary survey it is discovered that a trauma patient has pelvic instability. Which nursing actions are indicated?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Recheck stability every hour.
B) Monitor for bleeding.
C) Assist with wrapping a sheet around the pelvis.
D) Turn the patient every 2 hours, alternating sides and back.
E) Place the patient in high Fowler's position.

Question 26

During the resuscitation of a patient with severe multiple trauma, an order for placement of an indwelling urinary catheter is given. The nurse would that order in the presence of which assessment findings?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Distention of the abdomen
B) Blood at the urethral meatus
C) Bruising across the perineum
D) BUN 40 mg/dL
E) Hyphema

Question 27

Which assessment finding would the nurse evaluate as a possible indication that an older adult is being abused?

A) There are injuries in various states of healing over the patient's trunk and extremities.
B) The patient says, "I forgot to get my prescriptions filled and ran out of medicine."
C) The patient fell getting out of a recliner and injured the right knee.
D) The patient says, "I cut my hand when the jar I was washing broke."

Question 28

Which assessment findings would the nurse evaluate as supporting the diagnosis of flail chest?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) An area of the chest wall is depressed when the patient inspires.
B) The patient's cough is weak and causes obvious pain.
C) The patient's chest x-ray reveals a broken rib.
D) The patient's respirations are shallow.
E) The patient has a sucking chest wound.

Question 29

A patient drove himself to the ED after falling from the roof of his one-story home. The nurse assesses the patient, considering that the fall was probably from about _____ feet.

Question 30

A patient was hospitalized 36 hours ago after suffering multiple injuries, including flail chest on the right, in an explosion. This morning the patient has moist crackles in the right lung, and the sputum is streaked with blood. The nurse discusses these findings with the health care provider due to concern about the possibility of which injury?

A) Tension pneumothorax
B) Pulmonary contusion
C) Hemothorax
D) Pneumonia

Question 31

The nurse providing care to a patient with multiple trauma is suspicious that intimate partner violence (IPV) may be the source of the injury. Which findings would increase the nurse's concern?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) This is the patient's fourth ED visit this year for injuries.
B) The patient's partner will not leave the room.
C) The partner is quiet and concerned.
D) The patient says, "I fell because I am so clumsy."
E) The injuries do not match the history given.

Question 32

The emergency services department of a hospital has adopted a policy of tertiary survey for all admitted trauma patients. The nurse understands that this survey will be done within ______ hours of admission.

Question 33

A patient was brought to the ED after falling from a tree. The patient has an open femur fracture and is bleeding from several lacerations across the abdomen and chest. The patient cannot remember what happened, the skin is cool and pale, and the femoral pulses are weak. Which nursing interventions are necessary?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Notify the health care provider immediately.
B) Start two large-bore IV lines if not already in place.
C) Apply pressure to bleeding wounds.
D) Apply a splint to the injured leg.
E) Place the patient on oxygen.

Question 34

A 28-year-old woman is admitted to the ED with trauma sustained when a building collapsed. The nurse would why which test was not ordered?

A) International normalized ratio (INR)
B) Blood alcohol
C) Pregnancy
D) Toxicology screen

Question 35

A patient who sustained massive trauma has just lost consciousness. A cardiac monitor is initiated, and it reveals pulseless electrical activity. The team working on this patient would quickly assess for which conditions?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Loose electrical leads to the monitor
B) Cardiac tamponade
C) Tension pneumothorax
D) Profound hypovolemia
E) Spinal cord injury