Deck 33: Trauma

Question 1

A nurse and a nursing student are discussing management of the trauma patient.The nurse asks the student what the AVPU method is used for during the primary survey.Which response would indicate the new graduate nurse understood the information?

A) Used to assess respiratory status
B) Used to assess circulatory status
C) Used to assess pain status
D) Used to assess level of consciousness

Answer 1

Used to assess level of consciousness

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.The nurse suspects these findings are indicative of which disorder?

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

Answer 2

Tension pneumothorax

Question 3

A patient is admitted with a blunt cardiac injury (BCI)with no evidence of rupture.The nursing management plan should include which intervention?

A) Administer nitroglycerine for chest pain as needed.
B) Monitor the patient for new onset dysrhythmias.
C) Monitor serial biomarkers for evidence of further damage.
D) Do not administer antidysrhythmic medications, as they are ineffective.

Answer 3

Monitor the patient for new onset dysrhythmias.

Question 4

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

A) Blood pressure (BP), 110/70 mm Hg; HR, 120 beats/min; Hct, 42 mg/dL; UO, 40 mL/h; 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/h; pale, cool, clammy skin; confused
C) BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 35 mg/dL; UO, 30 mL/h; pale, cool, dry skin; alert and oriented
D) BP, 110/60 mm Hg; HR, 118 beats/min; Hct, 38 mg/dL; UO, 60 mL/h; flushed, warm, diaphoretic skin; agitated and confused

Question 5

A nurse and a new graduate nurse are discussing the secondary survey of the trauma patient.The nurse asks the new graduate to identify the most important aspect of a secondary survey.Which response would indicate the new graduate nurse understood the information?

A) Check circulatory status.
B) Check electrolyte profile.
C) Insert a urinary catheter.
D) Obtain patient history.

Question 6

A patient with multisystem trauma has been in the intensive care unit (ICU)for 6 days.The patient is still intubated and mechanically ventilated and has a chest tube,urinary drainage catheter,nasogastric tube,and two abdominal drains.The patient's vital signs include blood pressure (BP),92/66 mm Hg; heart rate (HR),118 beats/min; temperature (T),38.7° C; and central venous pressure (CVP),5 mm Hg.What is the most likely cause of this hemodynamic picture?

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

Question 7

A patient has been admitted with a flail chest.What findings would the nurse expect to note supporting this diagnosis?

A) Tracheal deviation toward the unaffected side
B) Jugular venous distention
C) Paradoxical respiratory movement
D) Respiratory alkalosis

Question 8

An unresponsive trauma patient has been admitted to the emergency department.Which statement regarding opening the airway is accurate?

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 9

Older trauma patients have a higher mortality than younger trauma patients.The nurse understands that this fact is probably related to what physiologic change?

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

Question 10

A patient with severe traumatic brain injury has been admitted to the critical care unit.What is one intervention to minimize secondary brain injury?

A) Hyperventilate the patient to keep PCO₂ less than 30.
B) Restrict fluids to keep central venous pressure less than 6 cm H2O.
C) Maintain the patient's body temperature more than 37.5° C.
D) Administer fluids to keep the systolic blood pressure greater than 90 mm Hg.

Question 11

A patient is admitted with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Nursing care for the patient includes which intervention?

A) Keep the room cool, dark, and quiet.
B) Maintain mean arterial pressure (MAP) at 85 to 95 mm Hg.
C) Elevate the head of the bed 45 degrees.
D) Resuscitate low blood pressure by only using intravenous fluid.

Question 12

A patient has been admitted with a flail chest and pulmonary contusion.Which finding will cause a nurse to suspect that the patient's condition is deteriorating?

A) Increased bruising on the chest wall
B) Increased need for pain medication
C) The development of respiratory alkalosis
D) Increased work of breathing

Question 13

The nurse is working on an organization-wide falls prevention project.The nurse understands that the majority of falls accounting for traumatic injury occur in what population?

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

Question 14

A patient is admitted with a severe diffuse axonal injury (DAI)secondary to a motor vehicle crash.The patient's plan of care would involve which nursing action?

A) Perform neurologic assessments once a shift.
B) Obtain a computed tomography (CT) scan every day.
C) Monitor blood pressure and temperature every hour.
D) Initiate warming measures to keep temperature greater than 37.5° C.

Question 15

A patient with a Le Fort III facial fracture has been admitted to the critical care unit.Which statements is true regarding this type of facial fracture?

A) It is frequently associated with cerebrospinal fluid leaks.
B) It is not as severe as Le Forte I and II injuries.
C) The patient's airway is not usually compromised.
D) It is associated with a low risk for hemorrhagic shock.

Question 16

A patient has sustained an epidural hematoma after a 10-foot fall from a roof.The nurse understands that an epidural hematoma is a condition that has which characteristic?

A) Usually arterial in nature
B) Worse mortality rate than subdural hematomas
C) Associated with a permanent loss of consciousness
D) Signs and symptoms include bilateral pupil dilation

Question 17

A patient is admitted with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.The nurse suspects the patient may have which type of injury?

A) Posterior cord syndrome
B) Brown-Séquard syndrome
C) Diffuse axonal injury
D) Central cord syndrome

Question 18

A patient with multisystem trauma has been in the critical care unit for 2 days.The patient is still intubated and mechanically ventilated and has a chest tube,urinary drainage catheter,nasogastric tube,and two abdominal drains.The nurse understands that immobility places the patient at risk for developing which complication?

A) Pneumonia
B) Infection
C) Venous thromboembolism
D) Fat embolism syndrome

Question 19

A patient was thrown 30 feet from an open-top Jeep and straddled a row of mailboxes before landing on the ground.The patient has an open pelvic fracture.What characteristics of this injury are important for the nurse to understand?

A) Aggressive fluid and blood replacement will probably be needed.
B) The patient will probably be able to walk as soon as the patient is stable.
C) The patient 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 with acute abdominal trauma.The patient has a positive Focused Assessment with Sonography for Trauma (FAST scan)and is hemodynamically unstable.What procedure should the nurse anticipate next?

A) Emergency surgery
B) Diagnostic peritoneal lavage (DPL)
C) Computed tomography scan
D) Intraabdominal pressure monitoring

Question 21

The nurse understands that certain trauma patients are at risk for developing fat embolism syndrome.Which group of patients is a high risk for this complication?

A) Patients with liver trauma
B) Patients with burns
C) Patients with orthopedic trauma
D) Patients with spleen trauma

Question 22

Major trauma patients are at high risk of developing deep venous thrombosis and pulmonary embolism.The nurse understands that trauma patients are at risk due to which factors?

A) Blood stasis
B) Hypernatremia
C) Injury to the intimal surface of the vessel
D) Hyperosmolarity
E) Hypercoagulopathy
F) Immobility

Question 23

A patient was admitted after a motor vehicle crash (MVC).The nurse knows that this type of injury is the greatest cause of what type of trauma?

A) Spinal shock
B) Blunt thoracic trauma
C) Maxillofacial injuries
D) Penetrating thoracic injuries

Question 24

A patient has been admitted with muscle trauma and crush injuries.The nurse understands that this patient is at high risk for the development of acute kidney injury secondary to rhabdomyolysis.Which findings would suggest the patient is developing this complication?

A) Dark tea-colored urine
B) Decreased urine output
C) Hypoxemia
D) Diminished pulses
E) Increased serum creatine kinase level

Question 25

During assessment of a new trauma patient,the nurse observes perianal ecchymosis.The nurse suspects the patient has what problem?

A) Pelvic fracture
B) Bladder trauma
C) Rectal laceration
D) Spleen laceration

Question 26

The nurse is caring for a patient with extensive trauma to the lower extremities.The nurse understands that patient is at risk for compartment syndrome.Which findings would the nurse expect to note as evidence of this complication?

A) Paresthesia
B) Decreased pulses
C) Pain in the affected extremity
D) Swelling in the affected extremity
E) Decreases capillary refill

Question 27

The nurse is caring for a patient with blunt abdominal trauma.The nurse understands that patient is at risk for abdominal compartment syndrome.Which findings would the nurse expect to note as evidence of this complication?

A) Decreased cardiac output
B) Increased peak pulmonary pressures
C) Decreased urine output
D) Hypoxemia
E) Bradycardia

Question 28

A trauma patient's condition has deteriorated.The nurse notes changes in patient's condition,including trachea shift,absence of breath sounds on the left side,and hypotension.The nurse suspects that the patient has developed what complication?

A) Cardiac tamponade
B) Hemothorax
C) Open pneumothorax
D) Ruptured diaphragm

Question 29

A patient developed a hemothorax after a blunt chest trauma.The practitioner inserted a chest tube on the left side,and 1800 mL of blood was evacuated from the chest.The nurse expects that the patient will be taken to surgery for what procedure?

A) Thoracotomy
B) Pericardiocentesis
C) Splenectomy
D) Pneumonectomy

Question 30

Patients immobilized because of spinal trauma are at a high risk for contractures.The nursing management plan for these patients should include which preventive measures?

A) Consultation by physical therapist (PT) and occupational therapist (OT) early in the treatment of the patient.
B) Turning and repositioning the patient every 2 hours as ordered by the physician.
C) Range of motion exercises 1 month after the spine has been stabilized.
D) Removal of splints every 4 hours and at bedtime.
E) Hand splints for patients with paraplegia.
F) Hand and foot splints for patients with quadriplegia.