Question 1

It is important to prevent hypothermia in the trauma patient because hypothermia is associated with which of the following? (Select all that apply.)

Accepted Answer

Prolonged hypothermia is associated with the development of myocardial dysfunction,coagulopathies,reduced perfusion,and dysrhythmias (bradycardia and atrial or ventricular fibrillation).ARDS is a complication associated with excessive inflammation and overresuscitation.Fat embolism is often seen with long bone fractures.

Question 2

The nurse working in a trauma center administers blood products to a severely hemorrhaging trauma patient in a 1:1:1 ratio.Which blood products does the nurse include in this transfusion protocol? (Select all that apply.)

Accepted Answer

The 1:1:1 transfusion protocol is an evidence-based practice consisting of transfusions of red blood cells,platelets,and plasma for optimal outcomes.Whole blood and universal donor blood exclusively are not included.

Question 3

Which interventions can the nurse implement to assist the patient's family in coping with the traumatic event? (Select all that apply.)

Accepted Answer

The trauma team can assist the patient and family in crisis by helping them establish a consistent communication process between the health care team and family.Other interventions include exploring the family's perceptions of the event,support systems,and coping mechanisms.Family conferences early in the emergent phase and frequently during the critical care phase assist with communication and with understanding the patient's and family's expectations for care.Limiting visitation will not assist the patient or the family's ability to cope with the traumatic event.

Question 4

Which of the following patients would require greater amounts of fluid resuscitation to prevent acute kidney injury associated with rhabdomyolysis? (Select all that apply.)

Accepted Answer

Causes of rhabdomyolysis include crush injuries,compartment syndrome,burns,and injuries from being struck by lightning.Acute kidney injury may result from a gunshot wound related to prolonged hypotension.Acute kidney injury would not have a direct cause associated with a pulmonary contusion or penetrating wounds.

Question 5

Nursing priorities to prevent ineffective coagulation include which of the following? (Select all that apply.)

Accepted Answer

Ineffective coagulation is a serious complication for a trauma patient that can be prevented by maintaining normothermia,evaluating and treating for hypocalcemia,administering clotting factors found in fresh frozen plasma or platelets,and evaluating and treating metabolic acidosis.Evaluating and treating serum potassium levels is important for effective cardiac muscle function,not coagulation.Monitoring lab values does not prevent an event from occurring although it can allow the nurse to notice it sooner.

Question 6

During the assessment of a patient after a high-speed motor vehicle crash,which of the following findings would increase the nurse's suspicion of a pulmonary contusion? (Select all that apply.)

Accepted Answer

Pulmonary contusion is a serious injury associated with deceleration or blast forces and is a common cause of death after chest trauma.The clinical presentation includes chest wall abrasions,ecchymosis,bloody secretions,and a partial pressure of arterial oxygen (PaO₂)of less than 60 mm Hg while breathing room air.The bruised lung tissue becomes edematous,resulting in hypoxia and respiratory distress.Absence of breath sounds is more suggestive of atelectasis or a collapsed lung.Paradoxical chest wall movement is indicative of flail chest.

Question 7

Which of the following findings require immediate nursing interventions in a patient with a traumatic brain injury? (Select all that apply.)

Accepted Answer

Rapid assessment of patients with neurological injury is vital to the treatment of patients with traumatic brain injury.Preventing hypotension (mean arterial pressure less than 50 mm Hg)is essential to maintain cerebral perfusion; nonreactive pupils are an abnormal finding and require immediate attention to evaluate the cause.Adequate oxygenation and ventilation are necessary to deliver oxygen to the brain; thus,a respiratory rate of 10 requires further evaluation.An open skull fracture leaves the patient extremely vulnerable to infection in the brain.An elevated blood alcohol level interferes with the ability to conduct a neurological examination but does not require immediate intervention.

Question 8

The trauma nurse understands which information related to the older trauma patient? (Select all that apply.)

Accepted Answer

Falls are the leading cause of death in the elderly and frequently result in fractures to many different bones,not just hips.Decreased physiologic reserve leads to poorer outcomes.Hypertension can mask hypotension by the blood pressure appearing to be normal.That is just one example of how chronic disease can complicate the picture of an older trauma patient.

Question 9

Which of the following statements apply to trauma patients and their potential complications? (Select all that apply.)

Accepted Answer

Prevention of infection is essential in the care of trauma and postsurgical patients.Removing invasive devices when they are no longer needed for monitoring and ensuring aseptic care of devices are important nursing care considerations for management of indwelling urinary catheters,central lines,and airway adjuncts.Wounds,other than the immediate postoperative dressing,are not required to be sterile.Aseptic technique is used for wound care.

Question 10

Which of the following statements are true regarding fluid resuscitation during the care of a trauma patient? (Select all that apply.)

Accepted Answer

Lactated Ringer's and normal saline are the crystalloids of choice in trauma resuscitation.Because hypothermia is a concern,fluids should be warmed.Massive blood transfusions are associated with poor outcomes.Crossmatched blood is preferred,but blood type O,universal donor blood,can be administered in an emergency.Isotonic solutions are used predominantly during fluid resuscitation.

Question 11

A 36-year-old driver was pulled from a car after it collided with a tree and the gas tank exploded.What assessment data suggest the patient suffered tissue damage consistent with a blast injury?

Accepted Answer

Explosive blast energy generates shock waves that create changes in air pressure,causing tissue damage.Initially after an explosion,there is a rapid increase in positive pressure for a short period,followed by a longer period of negative pressure.The increase in positive pressure injures gas-containing organs.The tympanic membrane ruptures,and the lungs may show evidence of contusion,acute edema,or rupture.A low blood pressure and corresponding tachycardia are more suggestive of hypovolemia.Lack of response to stimuli suggests a neurological injury.An irregular heart rate and rhythm may be associated with blunt trauma to the heart (e.g.,cardiac contusion).

Quiz 20: Trauma and Surgical Management