Chapter 55- Trauma. My Nursing Test Banks

 

1.

A patient sustained injuries in a motor vehicle accident and is in the Emergency Department. A CT scan of the head and neck have been ordered. What part of the survey is this?

A)

Primary

B)

Secondary

C)

Tertiary

D)

Initial

2.

A patient who is in the Emergency Department was attacked in a parking lot and suffered several stab wounds to various areas on the chest and abdomen; BP 100/60, heart rate 108, respiratory rate 20, pulse oximetry 98%. In order to counteract the blood loss and restore circulating volume for this patient, what priority intervention will the nurse perform?

A)

Start lactated Ringers at 150 mL/hr.

B)

Start dopamine at 5 mcg/kg/min.

C)

Start an albumin infusion wide open.

D)

Start a unit of uncrossmatched blood.

3.

The nurse is assigned to a patient in the Emergency Department who exhibits paradoxical chest movement. What intervention by the nurse can help improve oxygenation in this patient?

A)

Elevate the head of the bed 30 degrees.

B)

Splint the chest with 3-inch surgical tape.

C)

Turn the patient with the injured side down.

D)

Place the patient in the prone position.

4.

A patient has been involved in a motor vehicle accident. The patient, who was driving, was unrestrained by a seat belt when hitting the car in front of him. The patient is complaining of midsternal pain, restlessness, and difficulty breathing. What is the priority nursing diagnosis for this patient?

A)

Anxiety

B)

Impaired gas exchange

C)

Impaired circulation

D)

Pain

5.

A patient has suffered a mild pulmonary contusion from a jet ski accident. What nursing interventions are appropriate for this patient? Select all that apply.

A)

Maintenance of chest tubes

B)

Frequent pulse oximetry monitoring

C)

Assessment of lung sounds every 2 hours

D)

Continuous epidural analgesia

E)

Maintainance of ventilatory support

6.

A patient sustained an injury to the right arm after falling off a motorcycle. The patient is complaining of severe pain and is unable to feel the fingers of the right hand. Radial pulse is absent. What is the priority intervention by the nurse?

A)

Elevate the right arm above the level of the heart.

B)

Notify the physician.

C)

Apply ice packs to the affected area.

D)

Place the patient in Trendelenburg position.

7.

The nurse is caring for a patient with deep vein thrombosis of the left lower extremity. The patient exhibits a decrease in pulse oximetry readings from 98% to 86%, shortness of breath with a respiratory rate of 34, and is now disoriented to place. The nurse recognizes that these findings are caused by what complication?

A)

Pulmonary edema

B)

Cardiac tamponade

C)

Pulmonary embolus

D)

Tension pneumothorax

8.

The nurse is assigned to care for a patient who was admitted 2 days previous after a four-wheeler accident. The patient sustained a closed fracture to the left femur and had an open reduction with internal fixation the same day. What is a priority for the nurse to assess for this patient?

A)

White blood count

B)

Urinary output

C)

Cardiac output

D)

Pulse oximetry

9.

A patient has been brought into the Emergency Department via ambulance with resuscitation efforts being performed. It is unlikely that the patient will survive the severe injuries sustained. Two adult children of the patient are present and are requesting to be with the patient at this time. What is the best response by the nurse?

A)

I dont think you should see your loved one like this. Wouldnt you rather remember him the way he was?

B)

Our hospital doesnt allow more than one family member in with a patient. One of you can come in and one of you will have to wait in the waiting area.

C)

You may come in with your parent and I will have someone stay with you to explain what is happening.

D)

I have been through this many times and I promise you, it is a sight that you dont want to remember.

10.

The nurse is caring for the patient with chest tubes. Which observation by the nurse is a priority concern?

A)

250 mL/hr of blood in drainage collection system

B)

Pulse oximetry of 94%

C)

Blood pressure of 104/62

D)

30 mL/hr of urine output

11.

A patient is admitted to the emergency department after he was hit by a car. The car was going about 30 mph and was braking at the time of impact. The patient was struck just above the right knee, fell forward over the hood of the car, striking his anterior chest, and then slipped off the hood of the car and hit the pavement head first. Based on the mechanism of injury and transfer of force, what injuries does the nurse most expect? Select all that apply.

A)

Fracture of left femur and damage to left knee

B)

Fractures of thoracic and lumbar spine

C)

Fractured ribs and cardiac and lung contusion

D)

Bilateral radial and humerus fractures

E)

Closed head injury and cervical spine fracture

F)

Bilateral clavicle and scapular fractures

12.

The patient has received a gunshot wound. To help predict the amount of damage, what information does the nurse collect?

A)

Location of the shooting

B)

Information about the shooter

C)

Type of weapon and caliber of bullet

D)

Whether the injury involved a felony

13.

A patient was in a serious motor vehicle crash. At the scene, what is the highest priority of care?

A)

Extrication from the vehicle

B)

Cervical spine protection

C)

Establishing two large-bore intravenous lines

D)

Collecting information about the crash

14.

On initial admission of a trauma victim to the emergency department, the nurse completes a primary survey. The patient is awake and tachypneic, is using accessory muscles of respiration, has unequal chest expansion, and is very anxious. There are absent breath sounds on the right and cyanosis on 100% oxygen, and the trachea is deviated to the left. What action takes the highest priority during the primary survey?

A)

Jaw thrust maneuver

B)

Suctioning the oral pharynx

C)

Chest tube insertion

D)

Assisting ventilation with bag-mask device

15.

A patient has been admitted to the emergency department after being in a severe motor vehicle crash. The patient was a passenger and had a lap and seat belt in place. The patient is lethargic and moaning. Initial exposure and head-to-toe examination reveals scattered minor abrasions and contusions and bruising over the upper abdomen. The patient moans more when the abdomen is palpated, and the abdomen is rigid. Heart rate is 110, capillary refill is greater than 4 seconds, and blood pressure is 140/88 mm Hg. What is the nursing priority of care?

A)

Administer intravenous opioid for pain.

B)

Increase rate of intravenous crystalloid.

C)

Obtain CT of the abdomen.

D)

Prepare for immediate endotracheal intubation.

16.

As part of a major trauma, a patient has suffered a flail chest injury. What hallmark sign of flail chest does the nurse expect to find?

A)

Flail segment elevation during inhalation

B)

Evidence of rib fractures on chest radiograph

C)

Flail segment depression during inhalation

D)

Hypoxemia evident on arterial blood gases

17.

A patient is admitted to the CCU after experiencing blunt trauma to the chest. Among other injuries, the patient has a flail chest on the left and several extremity fractures. About 12 hours after admission, the patient is tachypneic and complaining of shortness of breath. Breath sounds are present bilaterally with scattered fine crackles. Chest radiograph shows an ill-defined, patchy, ground-glass area of density on the left. If the patient has a pulmonary contusion, what is the nursing priority?

A)

Monitor pulse oximetry and arterial blood gases closely.

B)

Place an oral endotracheal tube immediately.

C)

Increase the amounts of intravenous crystalloid administration.

D)

Obtain sputum culture and sensitivity and Gram stain.

18.

A patient has suffered severe blunt trauma to the abdomen with bruising, diffuse pain, guarding, and rigidity evident. Damage to which structure is most likely?

A)

Stomach

B)

Bladder

C)

Large intestine

D)

Liver

19.

As part of a multiple trauma injury, the patient has suffered a closed fracture of the radius. What nursing assessment finding indicates a significant complication warranting immediate treatment?

A)

Swelling and pain over the fracture

B)

Loss of pulses distal to the fracture

C)

Ecchymosis over the fracture

D)

Deformity of forearm

20.

A patient has experienced multiple fractures, including pelvic and long bone fractures. After 72 hours, the patient complains of tachypnea and dyspnea and is found to have cyanosis, tachycardia, confusion, and fever. Laboratory analysis reveals a normal complete blood count except for thrombocytopenia and progressive respiratory insufficiency. What is the nursing care priority?

A)

Administer oxygen and monitor pulse oximetry.

B)

Initiate low-molecular-weight heparin therapy.

C)

Obtain cultures of all body substances.

D)

Initiate fall and seizure precautions.

21.

During a motor vehicle accident, a patient sustained blunt trauma to the head and face, resulting in hairline skull fracture and a LeFort III maxillofacial fracture. The patient also has bruising across the chest and upper abdomen and multiple small superficial bleeding abrasions and lacerations. On admission to the emergency department, what is the nursing care priority?

A)

Apply direct pressure to bleeding areas.

B)

Assess neurologic status.

C)

Perform endotracheal intubation.

D)

Administer tetanus booster immunization.

22.

As part of a multiple trauma injury, a patient developed hemorrhagic hypovolemic shock, necessitating fluid resuscitation with massive amounts of intravenous crystalloid fluids and blood products as well as extensive surgical repair under general anesthesia. Twenty-four hours later, the patient develops hypoxia unresponsive to oxygen therapy and diffuse white, ground-glass infiltrates of the lung fields on a chest radiograph. Development of this complication has what effect on the patients recovery?

A)

Significantly greater chance of death

B)

No change in outcome expectations

C)

Outcome depends on treatment.

D)

Lower chance of death

Answer Key

1.

B

2.

A

3.

C

4.

B

5.

B, C, D

6.

B

7.

C

8.

D

9.

C

10.

A

11.

A, C, E

12.

C

13.

B

14.

C

15.

B

16.

C

17.

A

18.

D

19.

B

20.

A

21.

C

22.

A

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