Question 1

Which of the following physiologic changes caused by aging is the most likely contributor to the high mortality rate in older trauma patients compared with younger trauma patients?

Accepted Answer

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

Question 2

A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture.The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains.The patient's hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7° C; CVP, 5 cm H2O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dynes/sec.What is the most likely cause of this hemodynamic picture?

Accepted Answer

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

Question 3

The majority of falls accounting for traumatic injury occur in what population?

Accepted Answer

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

Question 4

When opening the airway of an unresponsive trauma patient in the emergency department, which of the following considerations is correct?

Accepted Answer

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. 
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 5

A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Which of the following statements is true about his spinal cord injury?

Accepted Answer

A)  He is likely to be in supraventricular tachycardia. 
B)  Hyperthermia is common in patients with spinal cord injury. 
C)  These patients do not usually require mechanical ventilation. 
D)  The patient has a central cord syndrome. 
A)  He is likely to be in supraventricular tachycardia. 
B)  Hyperthermia is common in patients with spinal cord injury. 
C)  These patients do not usually require mechanical ventilation. 
D)  The patient has a central cord syndrome.

Question 6

Which mechanisms caused by circulating myoglobin can lead to the development of kidney failure?

Accepted Answer

A)  Dark tea-color urine 
B)  Decreased renal perfusion 
C)  Cast formation with tubular obstruction 
D)  Administration of diuretics 
E)  Rapid screening for serum creatine kinase level
F) Toxic effects of myoglobin in the kidney tubules 
A)  Dark tea-color urine 
B)  Decreased renal perfusion 
C)  Cast formation with tubular obstruction 
D)  Administration of diuretics 
E)  Rapid screening for serum creatine kinase level
F) Toxic effects of myoglobin in the kidney tubules

Question 7

Major trauma patients are at a high risk of developing deep venous thrombosis and pulmonary embolism because of

Accepted Answer

A)  blood stasis. 
B)  hypernatremia. 
C)  injury to the intimal surface of the vessel. 
D)  hyperosmolarity. 
E)  hypercoagulopathy.
F) immobility. 
A)  blood stasis. 
B)  hypernatremia. 
C)  injury to the intimal surface of the vessel. 
D)  hyperosmolarity. 
E)  hypercoagulopathy.
F) immobility.

Question 8

Motor vehicle crashes (MVCs)and falls are the greatest cause of

Accepted Answer

A)  spinal shock. 
B)  blunt thoracic trauma. 
C)  maxillofacial injuries 
D)  penetrating thoracic injuries. 
A)  spinal shock. 
B)  blunt thoracic trauma. 
C)  maxillofacial injuries 
D)  penetrating thoracic injuries.

Question 9

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

Accepted Answer

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

Question 10

The most important aspect of a secondary survey is to

Accepted Answer

A)  check circulatory status. 
B)  check electrolyte profile. 
C)  insert a urinary catheter. 
D)  obtain patient history. 
A)  check circulatory status. 
B)  check electrolyte profile. 
C)  insert a urinary catheter. 
D)  obtain patient history.

Question 11

Clinical manifestations of abdominal compartment syndrome include which of the following?

Accepted Answer

A)  Decreased cardiac output 
B)  Decreased peripheral vascular resistance 
C)  Decreased urine output 
D)  Hypoxia 
E)  Bradycardia
F) Hypotension 
A)  Decreased cardiac output 
B)  Decreased peripheral vascular resistance 
C)  Decreased urine output 
D)  Hypoxia 
E)  Bradycardia
F) Hypotension

Question 12

Signs and symptoms of compartment syndrome in the lower extremities include

Accepted Answer

A)  paresis. 
B)  increased pain. 
C)  pain in the affected extremity. 
D)  swelling in the affected extremity. 
E)  decrease pulses and capillary refill.
F) increase urinary output. 
A)  paresis. 
B)  increased pain. 
C)  pain in the affected extremity. 
D)  swelling in the affected extremity. 
E)  decrease pulses and capillary refill.
F) increase urinary output.

Question 13

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.What is the most likely diagnosis?

Accepted Answer

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

Question 14

The nursing care plan of a patient with a diffuse axonal injury (DAI)would involve which of the following considerations?

Accepted Answer

A)  Neurologic assessments should be performed only once a shift. 
B)  The patient will need a computed tomography scan for definitive diagnosis of the injury. 
C)  Blood pressure and temperature elevations are common. 
D)  The patient is at risk for volume overload because of syndrome of inappropriate antidiuretic hormone. 
A)  Neurologic assessments should be performed only once a shift. 
B)  The patient will need a computed tomography scan for definitive diagnosis of the injury. 
C)  Blood pressure and temperature elevations are common. 
D)  The patient is at risk for volume overload because of syndrome of inappropriate antidiuretic hormone.

Question 15

Which of the following will cause a nurse to suspect that a patient's pulmonary contusion is worsening?

Accepted Answer

A)  A pulmonary artery catheter showing a central venous pressure of 6 cm H2O and a wedge pressure of 8 mm Hg 
B)  An increased need for pain medication 
C)  An arterial blood gas value that demonstrates respiratory alkalosis 
D)  Increased peak airway pressures on the ventilator 
A)  A pulmonary artery catheter showing a central venous pressure of 6 cm H2O and a wedge pressure of 8 mm Hg 
B)  An increased need for pain medication 
C)  An arterial blood gas value that demonstrates respiratory alkalosis 
D)  Increased peak airway pressures on the ventilator

Question 16

A patient was thrown 30 feet from an open-top Jeep and straddled a row of mailboxes before she landed on the ground.She has an open pelvic fracture.The nurse admitting the patient into the ICU knows that

Accepted Answer

A)  aggressive fluid and blood replacement will probably be needed. 
B)  the patient will probably be able to walk as soon as she is hemodynamically stable. 
C)  she will probably not need surgery to stabilize her fracture. 
D)  there is little likelihood of damage to the genitourinary or gastrointestinal tracts. 
A)  aggressive fluid and blood replacement will probably be needed. 
B)  the patient will probably be able to walk as soon as she is hemodynamically stable. 
C)  she will probably not need surgery to stabilize her fracture. 
D)  there is little likelihood of damage to the genitourinary or gastrointestinal tracts.

Question 17

Which of the following statements is true about a patient with a blunt cardiac injury/cardiac contusion?

Accepted Answer

A)  It will probably be diagnosed by pericardiocentesis. 
B)  Hemodynamic parameters will most likely show a low cardiac output and low systemic vascular resistance. 
C)  Treatment can require insertion of a temporary pacemaker for conduction control. 
D)  The only accurate way to evaluate cardiac contusion is to check the creatine phosphokinase fraction. 
A)  It will probably be diagnosed by pericardiocentesis. 
B)  Hemodynamic parameters will most likely show a low cardiac output and low systemic vascular resistance. 
C)  Treatment can require insertion of a temporary pacemaker for conduction control. 
D)  The only accurate way to evaluate cardiac contusion is to check the creatine phosphokinase fraction.

Question 18

A strategy to minimize secondary brain injury in head-injured patients is

Accepted Answer

A)  hyperventilation to keep PCO2 less than 30. 
B)  fluid restriction to keep central venous pressure less than 6 cm H2O. 
C)  maintaining body temperature more than 37.5° C. 
D)  fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg. 
A)  hyperventilation to keep PCO2 less than 30. 
B)  fluid restriction to keep central venous pressure less than 6 cm H2O. 
C)  maintaining body temperature more than 37.5° C. 
D)  fluid resuscitation as needed to keep the systolic blood pressure greater than 90 mm Hg.

Question 19

A patient's condition has deteriorated.Changes in condition include trachea shift, absence of breath sounds on the left side, and hypotension.The nurse suspects that the patient has developed a(n)

Accepted Answer

A)  cardiac tamponade. 
B)  hemothorax. 
C)  open pneumothorax. 
D)  ruptured diaphragm. 
A)  cardiac tamponade. 
B)  hemothorax. 
C)  open pneumothorax. 
D)  ruptured diaphragm.

Question 20

Fat embolism syndrome can occur as a complication of

Accepted Answer

A)  liver trauma. 
B)  burns. 
C)  orthopedic trauma. 
D)  spleen trauma. 
A)  liver trauma. 
B)  burns. 
C)  orthopedic trauma. 
D)  spleen trauma.

Exam 25: Trauma

Which of the following physiologic changes caused by aging is the most likely contributor to the high mortality rate in older trauma patients compared with younger trauma patients?

The majority of falls accounting for traumatic injury occur in what population?

When opening the airway of an unresponsive trauma patient in the emergency department, which of the following considerations is correct?

A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Which of the following statements is true about his spinal cord injury?

Which mechanisms caused by circulating myoglobin can lead to the development of kidney failure?

Major trauma patients are at a high risk of developing deep venous thrombosis and pulmonary embolism because of

Motor vehicle crashes (MVCs)and falls are the greatest cause of

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

The most important aspect of a secondary survey is to

Clinical manifestations of abdominal compartment syndrome include which of the following?

Signs and symptoms of compartment syndrome in the lower extremities include

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.What is the most likely diagnosis?

The nursing care plan of a patient with a diffuse axonal injury (DAI)would involve which of the following considerations?

Which of the following will cause a nurse to suspect that a patient's pulmonary contusion is worsening?

A patient was thrown 30 feet from an open-top Jeep and straddled a row of mailboxes before she landed on the ground.She has an open pelvic fracture.The nurse admitting the patient into the ICU knows that

Which of the following statements is true about a patient with a blunt cardiac injury/cardiac contusion?

A strategy to minimize secondary brain injury in head-injured patients is

A patient's condition has deteriorated.Changes in condition include trachea shift, absence of breath sounds on the left side, and hypotension.The nurse suspects that the patient has developed a(n)

Fat embolism syndrome can occur as a complication of

Caring for the Critically Ill Patient

Ethical and Legal Issues

Patient and Family Education

Psychosocial and Spiritual Alterations and Management

Sleep Alterations

Nutritional Alterations

Gerontological Alterations

Pain and Pain Management

Sedation, Agitation and Delirium Management

End of Life Care

Cardiovascular Clinical Assessment and Diagnostic Procedures

Cardiovascular Disorders

Cardiovascular Therapeutic Management

Pulmonary Clinical Assessment and Diagnostic Procedures

Pulmonary Disorders

Pulmonary Therapeutic Management

Neurologic Clinical Assessment and Diagnostic Procedures

Neurologic Disorders and Therapeutic Management

Kidney Clinical Assessment and Diagnostic Procedures

Kidney Disorders and Therapeutic Management

Gastrointestinal Clinical Assessment and Diagnostic Procedures

Gastrointestinal Disorders and Therapeutic Management

Endocrine Clinical Assessment and Diagnostic Procedures

Endocrine Disorders and Therapeutic Management

Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

Hematologic Disorders and Oncologic Emergencies

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