Question 1

A patient is brought to the emergency department after being bitten and dragged by a large dog while jogging in the morning. When planning care for this patient, on which forces should the nurse focus as the reason for this patient's injuries? Select all that apply.

Accepted Answer

1. Stress is the force applied to deform the body, and strain is tissue damage that results from stress. The different types of stress include tensile, compression, and shearing. Being dragged by the dog causes stress.
2. The patient was not exposed to an electrical force.
3. The patient was bitten by a dog. The bite penetrated the patient's skin.
4. The dog's bite was caused by a mechanical force.
5. The patient was jogging when the dog attacked. The dog caused the patient to stop abruptly, or decelerate, which added to the injuries.

Question 2

The charge nurse delegates the completion of a secondary survey of a patient with traumatic injuries to a nurse being oriented to the emergency department. What should the charge nurse remind the new colleague to complete? Select all that apply.

Accepted Answer

1. The secondary survey includes completion of the patient's history.
2. The secondary survey includes a complete set of the patient's vital signs.
3. The secondary survey includes providing comfort to the patient and family.
4. The secondary survey includes completing a head-to-toe assessment.
5. Nasogastric tube insertion would have been completed during the primary survey, if required.

Question 3

A patient with massive injuries to the head and chest has died. The family is in the hallway waiting to see the patient. What can the nurse do to prepare the family to be with the patient at this time? Select all that apply.

Accepted Answer

1. The nurse should remove body fluids from the environment.
2. The nurse should make sure the patient's hand is out and secured.
3. The nurse should make sure the stretcher is in the low position so that chairs can be placed around it.
4. Turning on one dim light in the room calms the room.
5. The nurse should be present to answer questions and provide support.

Question 4

A patient with a penetrating abdominal wound is identified as having a Class IV hemorrhage. What should the nurse expect to assess? Select all that apply.

Accepted Answer

1. Heart rate greater than 140 is an indication of Class IV hemorrhage.
2. Tachypnea is an indication of Class IV hemorrhage.
3. Mean arterial pressure less than 60 is an indication of Class IV hemorrhage.
4. Delayed capillary refill is an indication of Class IV hemorrhage.
5. Mild decrease in urine output would be seen in a Class II hemorrhage.

Question 5

The nurse assists the health care professional with rapid sequence intubation of a patient with severe traumatic injuries. Which agents should the nurse have available for this procedure? Select all that apply.

Accepted Answer

1. Medications administered during rapid sequence intubation include repolarizing agents.
2. Medications administered during rapid sequence intubation include depolarizing agents.
3. Medications administered during rapid sequence intubation include anesthetizing agents.
4. Infection control agents are not administered during rapid sequence intubation.
5. Medications administered during rapid sequence intubation include pain management agents.

Question 6

A patient receives emergency care for maxillofacial injuries from a motor vehicle crash. What assessment finding should indicate to the nurse that the patient sustained laryngeal trauma? Select all that apply.

Accepted Answer

1. The patient with laryngeal trauma will demonstrate hoarse speech.
2. Painful swallowing is a manifestation of laryngeal trauma.
3. Hemoptysis is a manifestation of laryngeal trauma.
4. Epistaxis is not a manifestation of laryngeal trauma but would be present because of the maxillofacial trauma.
5. Periorbital edema is not a manifestation of laryngeal trauma but would be present because of the maxillofacial trauma.

Question 7

A patient is admitted with injuries sustained from a skiing accident. While completing the primary survey, the nurse suspects the patient has an injury to the spleen because of which findings? Select all that apply.

Accepted Answer

1. A rapid heart rate can indicate hemorrhage or hypovolemic shock, which is an assessment finding consistent with an injury to the spleen.
2. Kehr's sign is referred pain to the left shoulder. This is an assessment finding consistent with an injury to the spleen.
3. Upper left quadrant abdominal tenderness or pain is an assessment finding consistent with an injury to the spleen.
4. Hematuria is not an assessment finding consistent with an injury to the spleen.
5. Bruising or ecchymosis over the flank area is not an assessment finding consistent with an injury to the spleen.

Question 8

For which situation should the nurse plan to prepare a patient with abdominal trauma for surgery?

Accepted Answer

1. If additional bleeding requires more than 2 units of blood or becomes unstable, the patient with splenic injury will require surgical repair to stop the bleeding.
2. In a Grade III liver injury, conservative management outweighs the risks of surgery. If a Grade IV or V injury occurs in the liver, then surgical repair is called for immediately.
3. With a contusion to the kidney, bedrest and careful assessment of renal status is enough for the contusion to resolve with time.
4. The patient with a pelvic fracture is exhibiting signs of bladder rupture by the muscle rigidity. Immediate surgery is required to assess and repair the damage to internal organs.

Question 9

A patient with a C6 spinal cord injury who received several liters of intravenous fluid continues to have a blood pressure of 78/50 mm Hg. What should the nurse anticipate being prescribed for this patient?

Accepted Answer

1. The use of steroids is controversial and would not be prescribed to improve the patient's blood pressure.
2. Beta blockers will slow the heart and drop the blood pressure.
3. Treatment of hypotension presumes hypovolemia, and the patient is immediately provided with crystalloid fluids. If volume repletion does not restore an adequate blood pressure, vasopressors such as norepinephrine may be prescribed.
4. Packed red blood cells are not identified as treatment for the patient with a spinal cord injury experiencing hypotension.

Question 10

Which activities should the nurse plan to increase comfort for a patient who is intubated? Select all that apply.

Accepted Answer

1. Developing eye contact will give comfort and reassurance when the patient is unable to speak while intubated.
2. Sedation and not talking to the patient do not give support to the patient. Sedation may be needed, but explaining the reason and timing for such should be for the improved ventilatory effectiveness and not the nurse's convenience.
3. Pain medication needs to be given based on the patient's interpretation of its need. Restlessness is often a symptom of hypoxia, and further assessment needs to be done before just medicating the patient.
4. Developing a separate method of communication, such as blinking one's eyes or squeezing the nurse's hand, will give comfort and reassurance when the patient is unable to speak while intubated.
5. It is not the family's role to communicate or to meet the needs of the patient. It is a nursing obligation to identify and meet the needs of the patient.

Question 11

An unconscious patient is brought to the emergency department. During the primary survey, the patient begins to moan when the left arm is moved. How should the nurse document this finding using the AVPU scale?

Accepted Answer

1. An A would be assigned if the patient responds to verbal stimuli and is alert.
2. A P would be assigned if the patient does not respond to verbal stimuli but responds to painful stimuli. Moaning when the left arm is moved would mean that the unconscious patient would be assigned a P.
3. A U would be assigned if the patient is unresponsive and does not respond to any stimuli.
4. A V would be assigned if the patient responds to verbal stimuli.

Question 12

A patient with traumatic injuries to the abdomen expresses the fear of dying. What can the nurse do to provide comfort to the patient at this time? Select all that apply.

Accepted Answer

1. Using the en face position is comforting to a patient with traumatic injuries.
2. Using comfort talk is helpful to the patient with traumatic injuries.
3. Providing physical contact by holding the patient's hand provides comfort to the patient with traumatic injuries.
4. The use of pain medication is not identified as an intervention to provide comfort to the patient with traumatic injuries.
5. Leaving the patient alone is not identified as an intervention of comfort to the patient with traumatic injuries.

Question 13

A patient with traumatic injuries has a carotid pulse of 64 bpm. What should this finding indicate to the nurse?

Accepted Answer

1. There is not enough information to determine if the patient is or is not actively bleeding.
2. Having a carotid pulse does not indicate that the patient's injuries are not as severe as they seem.
3. The central pulses are palpated first. If the patient exhibits these pulses, then his systolic blood pressure is usually at least 60 to 80 mm Hg systolic.
4. The presence of carotid pulses does not provide parameters for the diastolic blood pressure.

Question 14

A patient sustained a thoracic injury from a motor vehicle crash. What finding suggests that the patient is developing cardiac tamponade? Select all that apply.

Accepted Answer

1. Hypotension is an assessment finding within Beck's triad indicating cardiac tamponade.
2. An increase in central venous pressure assessed as jugular vein distention is an assessment finding within Beck's triad indicating cardiac tamponade.
3. Heart sounds are muffled in cardiac tamponade because of the accumulation of fluid in the pericardial sac. This is an assessment finding within Beck's triad indicating cardiac tamponade.
4. In paradoxical pulse, blood pressure is at least 10 mm Hg higher on expiration than on inspiration. This is an assessment finding of cardiac tamponade.
5. In cardiac tamponade, the blood pressure is higher on expiration than inspiration.

Question 15

The nurse prepares to complete the secondary survey of a patient admitted with a traumatic chest injury. On what should the nurse focus when conducting this survey? Select all that apply.

Accepted Answer

1. This is a part of the secondary trauma survey.
2. This is a part of the secondary trauma survey.
3. This is a part of the secondary trauma survey.
4. This is a part of the secondary trauma survey.
5. This is a part of the primary trauma survey.

Question 16

The nurse assesses a patient with abdominal injuries sustained during a motor vehicle crash. Which finding indicates that the patient may have bleeding from the liver? Select all that apply.

Accepted Answer

1. Hematuria is associated with a bladder or kidney injury.
2. Left shoulder pain is associated with an injury to the spleen.
3. Liver injury is often manifested by absent bowel sounds.
4. A tender costovertebral angle is associated with an injury to the kidney.
5. Liver injury is often manifested by Cullen's sign or a bluish discoloration of the periumbilical skin.

Question 17

Under the F section of the assessment process, in addition to full vital signs, the family is considered as a part of the treatment process. Which approach to the family would be most appropriate for the nurse to use?

Accepted Answer

1. This is a bias, and it has been shown that having family at the bedside to support the patient will frequently give a better outcome.
2. Legally and ethically the family has the right to be with the patient under all circumstances, including trauma resuscitation. This topic is greatly debated, but the right is still present and often left to the physician to decide if the family should step out.
3. With or without the medical/health care background, the right is still present and is not a privilege to be awarded by staff.
4. Even if the circumstance is graphic for the family, the right is present and benefits will be gained by the patient. The focus of care is not the family's needs first but the patient's.

Question 18

What should the nurse do to convey comfort to a trauma patient? Select all that apply.

Accepted Answer

1. This will convey comfort to a trauma patient.
2. This will convey comfort to a trauma patient.
3. This will convey comfort to a trauma patient.
4. This will convey comfort to a trauma patient.
5. Giving extensive details will delay care and often confuses the patient in a traumatic situation and increases the patient's anxiety rather than reducing stress. A patient under stress can best comprehend and follow brief directions given in a comforting manner to allow the staff to do their job without having to over explain or rationalize why they are doing what they are doing during the "golden" hour that may mean the difference between life and death.

Question 19

The nurse plans interventions for a patient with traumatic injuries to prevent the onset of the lethal triad. What should the nurse include in this patient's plan of care Select all that apply.

Accepted Answer

1. Monitoring body temperature is critical in the prevention of deaths from the lethal triad.
2. Measuring intake and output is critical in the prevention of deaths from the lethal triad.
3. Evaluating recent laboratory data is critical in the prevention of deaths from the lethal triad.
4. Assessing arterial blood gas values is critical in the prevention of deaths from the lethal triad.
5. Measuring gastric pH is not critical in the prevention of deaths from the lethal triad.

Quiz 9: Care of the Patient Following Traumatic Injury