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Page 1 1. Why is a measure of serum lactate obtained in the initial assessment of the trauma patient? Answer: c - correct answer a) to measure oxygenation and ventilation b) to quantify the base deficit for the adequacy of cellular perfusion c) *to gauge end-organ perfusion and tissue hypoxia ** d) to determine the underlying cause of shock 2. Atrauma patient is restless and repeatedly asking "where am |?" vital signs upon arrival were BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and symptoms of which stage of shock? Answer: A - correct answer A) compensated ** B) Progressive C) irreversible D) decompensated 3. Anelderly patient with a history of anticoagulant use presents after a fall at home that day. she denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. Which is a most likely cause of her symptoms? Answer: D - correct answer A) epidural hematoma B) diffuse axonal injury C) post-concussive syndrome D) subdural hematoma *** 4. EMS brings a patient who fell 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? Answer: D - correct answer A) Alert with no neurologic deficits B) Multiple abrasions to the extremities C) Multiple requests of water D) Smell of alcohol on breath *** Page 2 5. Which of the following occurs during the third impact of a motor vehicle crash? Answer: C - correct answer A) The driver of the vehicle collides with the steering wheel B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger *** 6. A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? Answer: A - correct answer A) initiate transfer to a trauma center ** B) provide report to the operating room nurse C) Obtained imaging studies D) Place a gastric tube 7. Which of the following injuries is LEAST likely to be promptly identified? Answer: C - correct answer A) spleen B) lung C) bowel *** D) brain 8. Patients with a crush injury should be monitored for which of the following conditions? Answer: C - correct answer A) Hypernatremia B) Hypercalcemia C) Dysrhthmias ** D) polyuria 9. What finding raises suspicion of complete spinal cord injury? Answer: B - correct answer A) Weakness in the lower extremities B) Priapism *** C) voluntary anal sphincter tone D) intact reflexes distal to the injury 10.A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? Page 4 A) Restlessness or drowsiness B) Nausea and vomiting C) Decreased respiratory effort** D) amnesia and anxiety 15.Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? Answer: B - correct answer A) ABC B) MARCH*** Cc) AVPU D) VIPP 16.A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented, and has delayed cap refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principle? Answer: A - correct answer A) initiate two large caliber intravenous lines for Ringers lactate solution administration *** B) Administer Dilaudid for pain control and provide comfort care C) Place the patient in an observation area for care within the next few hours D) Contact the command center for the personnel to notify next of kin. 17.A patient arrives with a large open chest wound after being assault ed with a machete, Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3 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 interventions? Answer: C - correct answer A) needle decompression B) tube thoracostomy C) dressing removal ** D) surgical repair 18.A patient is found lying on the floor after falling 13 hours ago. Which of the following lab values is expected with a musculoskeletal complication associated with this presentation? Answer: A - correct answer A) elevated creatine kinase *** B) decreased potassium level C) decreased WBC D) elevated GFR Page 5 19.A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows: BP 98/71 HR 125 beats/min RR 26 breaths/min SpO2 94% on high flow 02 via NRB mask 20.which of the following is the priority intervention for this patient? Answer: C - correct answer A) Expedite transport to the CT scanner B) prepare the patient for spinal radiographs C) expedite transfer to the closest trauma center *** D) notify the patients family 21.Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and crying with increased work of breathing and pale skin. which of the following interventions has the highest priority? Answer: A - correct answer A) padding the upper back while stabilizing the cervical spine *** B) applying a tight-fitting NRB mask with an attached resevior C) establishing intravenous access and administering a 20mL/kg bolus D) preparing for drug assisted intubation 22.Which of the following is a component of the trauma triad of death? Answer: A hypothermia, metabolic acidosis, coagulopathy - correct answer A) Acidosis ** B) hyperthermia C) hemorrhage D) sepsis 23.A 35-year old male presents with facial trauma after bring struck inthe face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? Answer: B - correct answer A) oculomotor nerve palsy B) globe rupture *** C) uncal herniation D) retinal detachment C) debrief D) huddle *** 29.The nurse is caring for a 120 kg male is 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 BSA burned, how much IV fluids would be administered in the first 8 hours? (upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA. 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 / 2 (half of fluids given in first 8 hours) = 2280 mL Answer: A - correct answer A) 2280 mL *** B) 3840 mL C) 4560 mL D) 7680 mL 30.Which of the following assessment findings differentiates a tension PTX from a simple PTX? answer: D 31.Assessment findings associated with tension pneumothorax include anxiety, severe restlessness, severe respiratory distress, and absent breath sounds on the injured side. Hypotension due to compression of the heart and great vessels is consistent with obstructive shock. Hypotension worsens with inspiration due to increased intrathoracic pressure. Late signs include distended neck veins, tracheal deviation, and cyanosis. - correct answer A) increased work of breathing B) unilaterally diminished breath sounds C) pleuritic chest pain D) hypotension that worsens with inspiration *** 32.Which of the following considerations is most important when caring for a geriatric trauma patient? Answer: B - correct answer A) head to to exam B) medical history ** C) incontinence D) falls Page 8 33.An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions? Answer: D - correct answer A) call fora portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement 34.What factor contributes most the kinetic energy of a body in motion? answer: C - correct answer A) acceleration B) mass C) velocity *** D) inertia 35. During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next? Answer: D - correct answer A) open the airway with the head-tilt/chin lift maneuver B) auscultate bilateral breath sounds to assess ventilatory status C) assist respirations using a BVM D) insert an oropharyngeal airway if there is no gag reflex *** 36. Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of future disaster. Which phase of the disaster life cycle does this describe? Answer: A - correct answer A) mitigation *** B) preparedness C) response D) recovery 37.Which pulse pressure description is an indication of early hypovolemic shock? Answer: B - correct answer A) widened B) narrowed *** C) bounding D) weak Page 10 C) a 52-year old diabetic male with partial thickness burn to the left lower leg *** D) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax. 43.A patient has been in the ED 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 c/o leg pain. His wife reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. the patient is exhibiting signs of symptoms commonly associated with which of the following conditions? Answer: B - correct answer A) acute lung injury B) fat embolism *** C)PTX D) pulmonary contusion 44.Which is the effect of hypothermia on the oxyhemoglobin dissociation curve? Answer: A - correct answer A) Hemoglobin does not readily release oxygen for use by the tissues *** B) The amount of oxygen available to the tissues increases C) Tissue oxygenation (PaQ2) increases D) Hemoglobin molecule saturation (SaO2) decreases 45.A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? Answer: C - correct answer A) Fast exam B) CT scan C) straight cath for urine sample *** D) ice and elevation of the scrotum 46. You are treating a 27-year old male in respiratory distress who was involved ina house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? Answer: B - correct answer A) 1000 mL/hr B) 500 mL/hr *** C) 250 mL/hr D) 125 mL/hr 47.Which of the following is possible complication of positive-pressure ventilation? Page 11 Answer: A - correct answer A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure 48.Which of the following is NOT considered goal-directed therapy of cardiogenic shock? Answer: C - correct answer A) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis *** D) cardiac cath 49.What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? Answer: A - correct answer A) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry 50.Which if the following values indicates the need for alcohol withdrawal interventions? Answer: A - correct answer A) CIWA-Ar of 36 *** B) GCS 13 C) ETCo2 of 48 mm Hg D) heart rate of 45 beats/min 51.An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, 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? Answer: A - correct answer A) Ventilate with a BVM *** B) Prepare for cricothyroidotomy C) administer reversal medications D) contact anesthesia for assistance 
