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.A 35 - year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? - ansGlobe rupture A teardrop-shaped pupil suggests a globe rupture. .A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? - ansBradycardia and absent motor function below the level of injury Patients with a complete spinal cord injury will have absent motor function below the level of the lesion. They become hypotensive and bradycardic due to loss of autonomic nervous system function. .During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next? - ansInsert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the tongue. Oropharyngeal airways can be used in patients without a gag reflex. 1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve - ansHemoglobin does not readily release oxygen for use by the tissues A shift to the left occurs in an environment of low metabolic demand (hypothermia, hypocapnia, alkalosis), increasing hemoglobin's affinity for oxygen. A 20-year-old male presents to the ED complaining of severe lower abdominal pain after landing hard on the bicycle cross bars while performing an aerial BMX maneuver. Secondary assessment reveals lower abdominal tenderness and scrotal ecchymosis. Which of the following orders would the nurse question? - ansStraight catheter for urine sample Insertion of a urinary catheter is contraindicated if urethral transection is suspected. Signs and symptoms of urethral injury include blood at the meatus, perineal ecchymosis, scrotal ecchymosis, and a high-riding or non-palpable prostate. A 36-year-old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention?
- ansApply a splint and elevate the extremity above the level of the heart Splinting the injured extremity stabilizes the extremity and reduces further injury. Elevation above the level of the heart promotes venous return and may reduce swelling. A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are stable. The nurse can anticipate all of these after a negative FAST exam
EXCEPT which of the following? - ansDiagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for hemodynamically unstable patients or if FAST and CT are not available. A 5-year-old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention? - ansReport your suspicion of maltreatment in accordance with local regulations Nurses are mandated reporters in most jurisdictions. With no alterations in the primary survey, this is the priority intervention. A 56-year-old male patient involved in a motor vehicle crash is brought to the emergency department of a rural critical access facility. He complains of neck pain, shortness of breath, and diffuse abdominal pain. His Glasgow Coma Score is 15. His vital signs are as follows: BP 98/71 mm Hg, HR 125 beats/minute, RR 26 breaths/minute, SpO2 94% on high-flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient? - ansExpedite transfer to the closest trauma center The American College of Surgeons recommends that patients with significant injuries be transported to a trauma center for definitive care. This patient's injuries might not be definitively diagnosed, but his symptoms and vital signs indicate the need for A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? - ansDressing removal This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing A patient has been in the emergency department for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the patient is restless with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions? - ansFat embolism Symptoms of fat embolism include decreased mental status, restlessness,
nonreactive pupil, and unilateral weakness or hemiparesis. These typically occur after a fall or assault. An intubated and sedated patient in the emergency department has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? - ansPressure Pressure can be assessed in the limb by palpation or direct measurement. The compartment or limb will feel tight or tense upon palpation. The skin may also appear taut and shiny. An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? - ansVentilate with a bag-mask device Assist ventilations with a bag-mask device until a definitive airway is obtained is the priority. EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the driver's side of the car. The patient is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? - ansAfter a physical examination if the patient has no radiologic abnormalities on CT A CT is recommended for spinal clearance in an impaired patient. EMS brings a patient from a motor vehicle crash. Vital signs are BP 90/49 mm Hg, heart rate 48 beats/minute, respiratory rate 12 breaths/minute, temperature 97.2°F (36.2° C). The patient exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? - ansComplete Incontinence, priapism, and hypotension with bradycardia are manifestations of a complete spinal cord injury. EMS brings a patient who fell while riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? - ansSmell of alcohol on breath Suspected intoxication warrants radiologic spine clearance. If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? - ansCalcium Hypocalcemia is a concern with massive transfusion because citrate is added to banked blood to prevent coagulation. Citrate chelates (binds with) calcium, rendering it inactive.
Tearing of the bridging veins is most frequently associated with which brain injury? - ansSubdural hematoma Subdural hematomas are usually caused by tearing of the bridging veins and associated with direct injury to the underlying brain tissue. The most reassuring finding for a male patient with hip pain after a fall is which of the following? - ansPelvic stability Uncontrolled hemorrhage is the major cause of preventable death after injury. Unstable pelvic fractures increase the volume of the pelvic cavity and can be life-threatening due to blood loss. The nurse is assessing a patient with a fractured forearm that was splinted three hours ago. Which symptom is of most concern as a late sign of an evolving complication? - ansWeak radial pulse A weak radial pulse is evidence of an actual compromise in circulation. The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total body surface area burned, how much IV fluid would be administered in the first 8 hours? - ans2280 mL Both upper arms = 8%, both lower arms = 6%, and both hands = 5%, yielding 19 * 2 * 120 = 4560 mL. Half of the total is equal to 2280 mL. Superficial burns are not included in the TBSA calculation for fluid resuscitation. The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better visualization during the insertion of which device? - ansEndotracheal tube The ramped position is described as elevation of the head with the external auditory canal parallel with the sternal notch to provide better visualization of pharyngeal landmarks. This position is useful during intubation. There has been a mass casualty incident a block from the hospital. The hospital is receiving dozens of patients. A truck arrives with an unresponsive patient in the back with obvious chest and abdominal trauma. Agonal respirations do not improve with airway positioning. Using the START triage algorithm, you would triage tag this patient as which of the following? - ansBlack This patient is unlikely to survive given the severity of their injuries and is triaged as expectant. Resources should be reserved for individuals considered to be more salvageable. What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? - ansPulse oximetry and capnography Pulse oximetry
Which of the following is a possible complication of positive-pressure ventilation? - ansWorsening pneumothorax Positive-pressure ventilation can lead to increased air in the chest cavity without a route of escape, worsening a pneumothorax and possibly leading to a tension pneumothorax. Which of the following is an expected finding in a patient with a tube thoracostomy connected to a chest drainage system - ansFluctuation in the water seal chamber Fluctuation in the water seal chamber indicates the tube is placed correctly in the pleural space. Which of the following is most likely to contribute to inadequate oxygenation and ventilation? - ansAdvanced age Older patients are more likely to have pulmonary comorbidities and decreased pulmonary reserve. Which of the following is NOT considered a benefit of debriefings? - ansIdentifying individuals who made mistakes during the traumatic event Debriefings are not used to single out individuals who made mistakes. Debriefings are used to provide an opportunity to review performance and identify areas for improvement with a sharing of individual responses. Which of the following is NOT considered goal-directed therapy for cardiogenic shock? - ansPericardiocentesis A pericardial tamponade is a form of obstructive, not cardiogenic, shock. Which of the following is true about the log-roll? - ansIt can worsen cord damage from an unstable spinal injury The log-roll maneuver has been shown to cause spinal motion that can worsen damage from an unstable spinal injury. Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? - ansMARCH The MARCH mnemonic stands for massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. The MARCH mnemonic recognizes uncontrolled hemorrhage as the major cause of preventable death after injury. Which of the following occurs during the third impact of a motor vehicle crash? - ansThe aorta is torn at its attachment with the ligamentum arteriosum This occurs during the third impact.
Which of the following patients warrants referral to a burn center? - ansA 52-year-old diabetic male with a partial-thickness burn to the left lower leg This patient has a 7% TBSA burn with a preexisting medical history that could complicate management, prolong recovery, or affect mortality. "Breathing and Ventilation" - ANSDuring which part of the primary survey would you anticipate the need for a chest tube, intubation, decompression of pneumothorax, oxygen, or BVMs?
- attach CO2 detector and assess for evidence of exhaled CO2; 2. observe for rise and fall of the chest w/ assisted ventilations; 3. auscultate over epigastrium for gurgling AND lungs for bilateral breath sounds - ANSWhat three assessments must be done if the patient is intubated?
- inspect AND palpate skin color, temp, moisture and 2. palpate a pulse - ANSTo assess circulation, you must do these two main tasks: A.Alert with no neurologic deficits - ANSUsing the American College of Surgeons screening guidelines, what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? A.Alert with no neurologic deficits B.Multiple abrasions to the extremities C.Ecchymosis to the flank D.Responds to verbal stimulation A.Cardiogenic - ANSA patient is brought to the emergency department with chest pain and shortness of breath following a high-speed motor vehicle collision in which they were the unrestrained driver. There is crepitus to the left chest with clear and equal breath sounds. The vital signs are BP 80/40 mmHg, HR 140 beats/minute, and RR 40 breaths/minute. Cardiac monitor shows sinus tachycardia with premature ventricular contractions. These findings are most consistent with which type of shock? A.Cardiogenic B.Neurogenic C.Hypovolemic D.Obstructive
C.Prone D.Fowler's AFTER head-to-toe, BEFORE J (VIPP) - ANSAntibiotics, consults, head CT, imaging, law enforcement, mandatory reporting, psychosocial support, social services, splinting, tetanus, and wound care are all interventions that you do AFTER and before WHAT? all patients - ANSFor whom is capnography highly recommended? Apply a pelvic binder - ANSAn adult pedestrian was struck on the right side by a sport utility vehicle traveling at 40 mph. The patient is awake and alert and the right leg is shortened. Following initial resuscitation with fluids, the patient remains hypotensive. What would be the priority intervention? A.Send blood for type and crossmatch B.Apply a pelvic binder C.Prepare the patient for surgery D.Insert a urinary catheter assess ETT position by noting the number at teeth/gums AND secure ETT - ANSIf the patient is intubated and you've already assessed ETT placement, what else needs to be done with the ETT? (step 10) Assessing patency and protection of the airway, Step 7 of "Alertness and Airway with Simultaneous Cervical Spinal Stabilization" - ANSDuring which part of the primary survey would there be anticipation for intubation, insertion of OPA/NPA, removal of any loose teeth or foreign objects, or suctioning? B. Rising diastolic - ANSWhich blood pressure finding is associated with early or compensated hypovolemic shock? A.Rising systolic B.Rising diastolic C.Decreasing diastolic D.Decreasing systolic B.A 2-year-old lands on grass from a second-story balcony - ANSBased on fall mechanism, which patient warrants prehospital transfer to a trauma center? A.A 35-year-old lands on a wooden porch from an 8-foot ladder
B.A 2-year-old lands on grass from a second-story balcony C.A 14-year-old forcefully pushed onto cement from standing D.A 50-year-old lands on a carpeted floor after tripping B.Amputation of a limb - ANSWhich of the following situations could cause functional grief? A.Inability to live at home B.Amputation of a limb C.Loss of one's self-image D.Destruction of the patient's car B.Control the bleeding - ANSAn unconscious patient arrives following a motor vehicle collision. The patient is on a backboard with a cervical collar in place and one intravenous line running. Respirations are shallow and there is active brisk bleeding from a large leg wound. What is the priority intervention for this patient? A.Check for a patent airway B.Control the bleeding C.Start a second intravenous line D.Ventilate with a bag-mask device B.During the secondary surveyt - ANSWhen should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns? A.As soon as the patient arrives B.During the secondary survey C.Should only be done at a burn center D.During the primary survey B.Increased oxygen consumption - ANSA trauma patient who is 30-weeks pregnant arrives at the emergency department following a motor vehicle collision. Which normal physiologic change should be considered when assessing ventilatory status? A.Increased functional reserve capacity B.Increased oxygen consumption C.Decreased minute ventilation D.Slower desaturation rates with apnea
assessment reveals a GCS of 9 (E-2, V-2, M-5). What is the priority nursing intervention? A.Hold all pain medications B.Notify the provider of the change C.Repeat the GCS in 30 minutes D.Place the patient in Trendelenburg position blankets, room temp increase, warmed fluids, warming lights - ANSIn Step 16 of "Exposure and Environment", you must name at least one of these interventions: bony deformity, loose teeth, edema, inhalation injury, sounds, tongue obstruction, burns, fluids, foreign objects, vocalization - ANSFour of these must be identified to assess patency and protection of the airway: Bowel sounds heard in the left lower chest - ANSA patient involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small penetrating wound to the sixth intercostal space in the left lateral chest. Which finding is most consistent with an injury to the diaphragm? A.Severe left-sided abdominal pain B.Bowel sounds heard in the left lower chest C.Pain radiating to the left shoulder. D.Decreased breath sounds on the left side Breath sounds, depth/pattern/rate, spontaneous breathing, subcutaneous emphysema, increased work of breathing, symmetrical chest rise and fall, tracheal deviation/JVD, open wounds/deformities, skin color - ANSFour of these must be identified to assess breathing effectiveness: C.3240 mL - ANSA patient who weighs 120 kg is brought to the emergency department after sustaining partial thickness burns to both upper extremities and chest with a total body surface area burned of 27%. How much intravenous fluid should be administered in the first 8 hours? A.1620 mL B.2160 mL C.3240 mL D.6480 mL
C.Allowing family to participate in the care of the patient - ANSWhile caring for a child who has been injured, what nursing intervention is consistent with a family-center approach? A.Identifying a single family member to speak with B.Having the family make all the care decisions C.Allowing family to participate in the care of the patient D.Limiting dissemination of complex information C.Apply direct pressure to the wound - ANSA patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention? A.Initiate two intravenous access sites B.Place the patient on supplemental oxygen C.Apply direct pressure to the wound D.Use a tourniquet to control the bleeding C.Decreased body temperature - ANSA severely injured patient has been intubated and is being mechanically ventilated. The patient has received a balanced resuscitation including multiple blood products. Under which circumstance will it be harder for the hemoglobin to release oxygen to the tissues? A.Decreased pH B.Elevated carbon dioxide level C.Decreased body temperature D.Increased metabolic demand C.Decreased respiratory effort - ANSWhich of the following is a late sign of increased intracranial pressure? A.Restlessness B.Vomiting C.Decreased respiratory effort D.Narrowing pulse pressure C.Disseminated intravascular coagulopathy - ANSA trauma patient is being held in the emergency department because there are no available inpatient beds. The patient sustained a femur fracture and required multiple blood products. The patient now has
C.Gauges end-organ perfusion and tissue hypoxia - ANSWhat is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient? A.Measures oxygenation and ventilation B.Assesses the degree of alkalosis and base deficit C.Gauges end-organ perfusion and tissue hypoxia D.Determines the underlying cause of shock C.Increasing work of breathing - ANSThe trauma nurse is caring for an unrestrained driver who struck their head on the windshield following a high-speed MVC. The patient has been diagnosed with an anterior spinal cord injury at the level of C6. Which assessment finding would be most concerning? A.Distension of the bladder B.Incontinence of stool C.Increasing work of breathing D.Inability to move the legs C.Inotropic support - ANSA driver involved in a high-speed motor vehicle collision arrives in the emergency department. The vehicle's air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain with ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. Which of the following is the most appropriate intervention for this patient? A.Rapid fluid boluses B.Tranexamic acid administration C.Inotropic support D.Hemostatic resuscitation C.Liver - ANSYour patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about injury to which organ? A.Transverse colon B.Pancreas C.Liver
D.Spleen C.Ramped - ANSAn obese trauma patient requires intubation. Assuming there are no contraindications, which position will provide the best visualization for insertion of the endotracheal tube? A.Reverse Trendelenburg B.Lying on side C.Ramped D.Supine C.Tertiary - ANSAn adult was thrown against a concrete wall during a factory explosion and sustained a femur fracture, liver laceration, and a small subdural hematoma. These injuries most likely occurred during what level of blast trauma? A.Primary B.Secondary C.Tertiary D.Quaternary C.Use a jaw thrust to open the airway and look for signs of obstruction. - ANSAn adult patient was brought to the emergency department following a motorcycle crash. On arrival, the patient is only responsive to pain, has bleeding from the nose, and multiple abrasions and contusions to the face. What is the priority intervention? A.Use a bulb syringe to suction out secretions from the mouth. B.Insert a nasopharyngeal airway to maintain an open airway. C.Use a jaw thrust to open the airway and look for signs of obstruction. D.Ask the patient to open their mouth to inspect the airway. cardiac monitor - ANSWhat can be applied in step 12 of "Circulation and Control of Hemorrhage" for which credit is given in the LMNOP section? D.Assist ventilation with a bag-mask device - ANSFollowing a gun shot wound, pre- hospital providers report diminished breath sounds bilaterally. Upon emergency department arrival, the patient is unresponsive with shallow respirations and an O2 sat of 88%. What is the priority intervention for this patient? A.Administer 15 L oxygen via nonrebreather mask
A.Compassion fatigue B.Vicarious trauma C.Secondary traumatic stress D.Moral injury D.Prepare the patient for surgery to remove the rod. - ANSA patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which intervention is most appropriate for this patient? A.Remove the rod immediately to facilitate cleansing. B.Apply a tourniquet to the leg above the metal rod. C.Hold antibiotics until after the rod is removed. D.Prepare the patient for surgery to remove the rod. D.Widening pulse pressure - ANSA patient with a traumatic brain injury has a mean arterial pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most likely an indication of the body's response to these findings? A.Reflex hypotension B.Increased respiratory effort C.Reflex tachycardia D.Widening pulse pressure Distraction, family presence, padding bony prominences, repositioning, splinting, verbal reassurance - ANSWhat are examples of nonpharmacologic measures? (must identify at least one during testing) During "Circulation" assessment - ANSWhen should 2 IV sites be established? EKG - ANSIn step M of "Get Adjuncts", what else might be indicated besides cardiac monitor? fat embolism - ANSA patient has been in the emergency department for several hours waiting to be admitted. They sustained multiple rib fractures and a femur fracture after a fall. The patient has been awake, alert, and complaining of leg pain. Their spouse reported that the patient suddenly became anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. The patient is
exhibiting signs and symptoms most commonly associated with which of the following conditions? A.Acute lung injury B.Fat embolism C.Pneumothorax D.Pulmonary contusion flank - ANSDuring the head-to-toe, where would you find Grey-Turner's sign? Globe rupture - ANSA 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? A.Oculomotor nerve palsy B.Globe rupture C.Retrobulbar hematoma D.Retinal detachment glucose - ANSIn Step 13 of "Disability", what is assessed if pt is altered? Immediately initiate isolation precautions - ANSThree adults present at different times during a one-hour period with a high fever, fatigue, and headache. All three patients have a rash which started on their mouth, face, and arms with progression to the chest and abdomen. They all visited the same grocery store within the last week. What is the most appropriate intervention from triage for these patients? A.Move them to a decontamination area B.Mask the patients and send them to the waiting room C.Immediately initiate isolation precautions D.Send them to the waiting room without a mask In Step 15 of "Exposure and Environment" - ANSAt what point PRIOR TO the head-to- toe is the patient inspected for obvious injuries? Initiate two large-caliber intravenous lines for isotonic crystalloid administration. - ANSA patient is thrown against a car during a tornado and presents with obvious bilateral femur fractures. The patient is pale, alert, disoriented, and has delayed capillary refill.
