General Trauma

A nurse is providing education on injury prevention at a community health fair. Which statement by the nurse best reflects the correct philosophy of trauma management?

A. "Accidents are a part of life that we must learn to manage."

B. "Trauma events are preventable and should not be viewed as happenstance."

C. "Legislation is more effective than education in preventing injuries."

D. "Airbags are the most important component because they require personal intervention."

B. "Trauma events are preventable and should not be viewed as happenstance."

((Rationale: Nursing professionals should avoid using the word "accident" because trauma events are preventable and should be viewed as such rather than as “fate” or “happenstance"))

According to the Emergency Severity Index, how often must patients in the urgent category be reassessed?

every 30 minutes

how does fat embolism syndrome most commonly present after traumatic injury ?

changes in LOC within 24-48 hrs

What is the cardinal symptom of acute compartment syndrome?

severe pain out of proportion to injury

A trauma patient arrives at the Emergency Department (ED). Which action by the triage nurse represents the goal of rapid assessment?

A. Completing a full head-to-toe assessment within 15 minutes.

B. Initiating laboratory studies before the patient is assigned a bed.

C. Making a triage decision within 5 minutes of the patient's arrival.

C. Making a triage decision within 5 minutes of the patient's arrival.

Using the Emergency Severity Index (ESI), which patient would the nurse classify as Level 1?

A. A patient with a simple rib fracture and stable vital signs.

B. A patient requiring immediate, continuous nursing surveillance and resuscitation.

C. A patient who needs to be reassessed every 15 minutes for emergent needs.

D. A patient with an ankle sprain who requires an X-ray.

B. A patient requiring immediate, continuous nursing surveillance and resuscitation.

((Rationale: ESI assigns patients into five levels; Level 1 is the most urgent, and patients in the resuscitation category must receive continuous nursing surveillance))

A triage nurse is assessing a patient using the ESI system. The patient is stable but will likely require multiple diagnostic tests and resources. The nurse should assign this patient to which category?

A. Level 1 B. Level 2 C. Level 3 D. Level 5

C. Level 3

A patient is assigned to the "emergent" category during triage. What is the minimum frequency for nursing reassessment?

A. Every 5 minutes

B. Every 15 minutes

C. Every 30 minutes

D. Every 60 minutes

B. Every 15 minutes

A trauma patient arrives with uncontrolled external hemorrhage from a leg wound. According to the primary survey, what is the nurse's first priority?

A. Stabilize the cervical spine.

B. Assess the airway for patency.

C. Apply direct, firm pressure to the bleeding site.

D. Obtain a full set of vital signs.

C. Apply direct, firm pressure to the bleeding site.

During the primary survey (ABCDEFG), the "D" stands for Disability. Which assessment tool is most appropriate for this step?

A. Focused Assessment with Sonography for Trauma (FAST)

B. Glasgow Coma Scale (GCS)

C. SAMPLE history

D. Pain scale

B. Glasgow Coma Scale (GCS)

A patient fell against a glass tabletop and was admitted following a surgical repair of her

neck from the jaw to the cricothyroid membrane. Identify the priority nursing intervention

for this patient.

A. Assessing blood pressure for hypertension.

B. Checking the incision for signs of infection.

C. Monitoring the surgical site for external bleeding.

D. Listen for sounds of stridor.

D. Listen for sounds of stridor.

Signs of increasing ICP include what 3 things

slowing of the heart rate (bradycardia), increasing systolic BP, and widening pulse pressure.

A nurse is performing a primary survey on a trauma victim. Which action is included in the "A" (Airway and Alertness) step?

A. Checking for symmetrical chest rise.

B. Assessing the patient's response to painful stimuli. C. Auscultating for breath sounds.

D. Evaluating capillary refill.

B. Assessing the patient's response to painful stimuli.

((Rationale: Airway and Alertness (A) includes using the AVPU scale (Alert, Verbal, Pain, Unresponsive) to determine the patient's level of consciousness))

A person involved in an all-terrain vehicle crash

sustained an injury to the neck after riding into a

suspended cable. Which finding would suggest an

expanding hematoma?

A. Strained hoarse voice

B. Bloody sputum

C. Coughing

D. Coarse crackles

A. Strained hoarse voice

. A trauma patient is suspected of having a cervical spine injury. Which maneuver should the nurse use to open the airway?

A. Head-tilt/chin-lift

B. Jaw-thrust maneuver

C. Neck hyperextension

D. Side-lying position

B. Jaw-thrust maneuver

(Rationale: Maneuvers such as the jaw-thrust maneuver may be needed to open the airway while protecting the cervical spine from injury))

what is damage to lung tissue resulting in hemorrhage and edema; it may not be evident initially but develops post-trauma with signs like crackles and blood-tinged secretions

pulm contusion

When assessing "Breathing and Ventilation" (B) in the primary survey, which finding would require immediate intervention?

A. Pulse oximetry of 94% on room air.

B. Tracheal deviation and jugular venous distention (JVD).

C. Vesicular breath sounds in the lung bases.

D. Respiratory rate of 20 breaths/minute.

B. Tracheal deviation and jugular venous distention (JVD).

what type of pneumothorax air rapidly escapes from the lung into the pleural space, collapsing the lung and increasing thoracic pressure.

Increasing thoracic pressure decreases venous return resulting in a decrease in cardiac output.

tension

A patient presents with a foreign-body airway obstruction and is coughing forcefully. What is the nurse's best action?

A. Perform the Heimlich maneuver immediately.

B. Encourage the patient to continue coughing and breathing efforts.

C. Attempt a blind finger sweep to remove the object. D. Initiate rescue breathing.

B. Encourage the patient to continue coughing and breathing efforts.

((Rationale: If the patient can breathe and cough spontaneously, they should be encouraged to cough forcefully as long as good air exchange exists.))

To support circulation (C) in a trauma patient, which IV access is most appropriate?

A. One 22-gauge peripheral IV in the hand.

B. Two large-gauge IV lines for warmed isotonic crystalloids.

C. A single-lumen central venous catheter.

D. A 24-gauge butterfly needle.

B. Two large-gauge IV lines for warmed isotonic crystalloids.

A nurse suspects internal hemorrhage in a patient who shows no external bleeding. Which set of vital signs supports this suspicion?

A. BP 140/90, HR 60, RR 12

B. BP 120/80, HR 80, RR 16

C. BP 90/60, HR 118, RR 24

D. BP 110/70, HR 70, RR 14

C. BP 90/60, HR 118, RR 24

(Rationale: Signs of internal hemorrhage and shock include decreasing blood pressure, increasing heart rate (tachycardia), and increased respiratory rate)

what focal injuries) are bruises to the brain.

cerebral contusions

During the "Exposure and Environment" (E) phase of the primary survey, why is it critical to keep the patient warm?

A. To prevent the patient from shivering.

B. To reduce the risk of infection.

C. To prevent hypothermia-related complications during resuscitation.

D. To improve the accuracy of the pulse oximetry.

C. To prevent hypothermia-related complications during resuscitation.

(Rationale: You want to keep the patient warm with warming lights, warm fluids, and warm oxygen to prevent complications during trauma resuscitation.)

Which component of the history is addressed during the secondary survey using the "SAMPLE" mnemonic?

A. Signs of external hemorrhage.

B. Surgical history and allergies.

C. Symmetrical chest rise.

D. Spontaneity of respirations.

B. Surgical history and allergies.

(Rationale: SAMPLE includes Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events related to the injury))

A nurse is performing the "I" (Inspect Posterior Surfaces) portion of the secondary survey. What is the correct method for moving the patient?

A. Pivot the patient on their side using one nurse.

B. Log roll the patient while maintaining cervical spine protection.

C. Use a mechanical lift to visualize the back.

D. Ask the patient to sit up slowly.

B. Log roll the patient while maintaining cervical spine protection.

((Rationale: Inspecting the posterior surface involves log rolling the patient along with maintaining cervical spinal protection))

An older adult patient is admitted following a fall. Why is trauma management more challenging in this population?

A. They have a lower incidence of hospital admission.

B. They often present with atypical symptoms like weakness or fatigue.

C. They have a decreased risk of complications like pneumonia.

D. They always have adequate social and financial support.

B. They often present with atypical symptoms like weakness or fatigue.

(Rationale: Older adult patients may have an atypical presentation (e.g., weakness, fatigue, change in mental status), making emergencies more difficult to manage)

Which thoracic injury is a priority to assess during the primary survey because it is immediately life-threatening?

A. Simple pneumothorax

B. Pulmonary contusion

C. Tension pneumothorax

D. Rib fracture

C. Tension pneumothorax

(Rationale: Initial assessment includes life-threatening injuries like tension pneumothorax, flail chest, and cardiac tamponade.))

A patient with three rib fractures is breathing shallowly. Which complication is the nurse trying to prevent by encouraging deep breathing?

A. Cardiac tamponade

B. Subcutaneous emphysema

C. Atelectasis and pneumonia

D. Hemothorax

C. Atelectasis and pneumonia

(Rationale: Reluctance to breathe deeply due to pain results in diminished ventilation and atelectasis; older adults with three or more rib fractures have a fourfold increased incidence of pneumonia))

A tension pneumothorax can be quickly converted to a simple pneumothorax by inserting a _____at the _____, midclavicular line

14-gauge needle . second intercostal space

A patient presents with "paradoxical chest motion" after a motor vehicle crash. Which injury does the nurse suspect?

A. Tension pneumothorax

B. Flail chest

C. Pulmonary contusion

D. Cardiac contusion

B. Flail chest

(Rationale: Flail chest occurs when three or more adjacent ribs are fractured at two or more sites, causing the detached segment to move in a paradoxical manner (inward on inspiration, outward on expiration))

What is a key nursing intervention for a patient with flail chest?

A. Strictly limiting all fluid intake.

B. Encouraging the patient to hold their breath during movement.

C. Providing pain management to allow for lung expansion.

D. Applying a tight, restrictive chest binder.

C. Providing pain management to allow for lung expansion.

what are the 3 classic signs of symptoms associated with urethral injury

blood at the urinary meatus

inability to void

distended bladder

how long can permanent brain injury or death occur if the airway is completely obstructed

within 3- 5 minutes due to hypoxia

A nurse notes blood-tinged secretions and crackles in a patient 24 hours after blunt chest trauma. Which condition is likely developing?

A. Simple pneumothorax

B. Pulmonary contusion

C. Cardiac tamponade

D. Sternal fracture

B. Pulmonary contusion

What is the primary goal in managing a patient with an open pneumothorax (sucking chest wound)?

A. Inserting a nasogastric tube immediately.

B. Stopping the flow of air through the opening in the chest wall.

C. Performing a needle decompression at the 5th intercostal space.

D. Administering high-dose anticoagulants.

B. Stopping the flow of air through the opening in the chest wall.

A patient has a tension pneumothorax. What is the emergency procedure to vent the positive pressure?

A. Insertion of a large-bore needle at the second intercostal space, midclavicular line.

B. Immediate thoracotomy in the ED.

C. Placing the patient in a Trendelenburg position.

D. Manual chest compressions.

A. Insertion of a large-bore needle at the second intercostal space, midclavicular line.

A nurse palpates a "crackling sensation" under the skin of a patient's neck and chest. How should the nurse document this?

A. Petechiae

B. Ecchymosis

C. Subcutaneous emphysema

D. Paradoxical motion

C. Subcutaneous emphysema

Which heart chamber is most commonly injured in a cardiac contusion due to its position behind the sternum?

A. Left atrium

B. Right ventricle

C. Left ventricle

D. Right atrium

B. Right ventricle

A patient with a cardiac contusion is at high risk for which complication within the first 24 to 48 hours?

A. Pulmonary embolism

B. Arrhythmias

C. Hypoglycemia

D. Renal failure

B. Arrhythmias

Which solid organ is most frequently injured in penetrating abdominal trauma due to its size and anterior placement?

A. Spleen B. Kidney C. Liver D. Pancreas

C. Liver

A nurse hears bowel sounds above the diaphragm during an assessment. This finding is highly suggestive of which injury?

A. Liver laceration

B. Ruptured diaphragm

C. Splenic rupture

D. Paralytic ileus

B. Ruptured diaphragm

What is the "gold standard" indicator of a urinary system injury in a trauma patient?

A. Hypotension

B. Flank pain

C. Hematuria

D. Increased BUN

C. Hematuria

A patient presents with the classic triad of urethral injury: blood at the urinary meatus, inability to void, and a distended bladder. What should the nurse avoid?

A. Starting an IV.

B. Inserting a urinary catheter.

C. Administering oxygen.

D. Performing a GCS assessment.

B. Inserting a urinary catheter.

A nurse is monitoring a patient with renal trauma. Which finding would suggest rapid exsanguination?

A. Microscopic hematuria

B. Expanding flank hematoma and oliguria

C. Stable hemoglobin levels

D. Normal blood pressure

B. Expanding flank hematoma and oliguria

Following a femur fracture, a patient develops restlessness, confusion, and petechiae on the chest. What is the nurse's priority?

A. Assess for a wound infection.

B. Suspect fat embolism syndrome (FES).

C. Screen for alcohol withdrawal.

D. Prepare the patient for a cast change.

B. Suspect fat embolism syndrome (FES).

what is is characterized by systemic fat globules from fractures (often long bones) and presents with mental status changes and petechiae

Suspect fat embolism syndrome (FES).

What is the most important factor in the prevention of fat embolism syndrome?

A. Early administration of antibiotics.

B. Careful immobilization of the long bone fracture.

C. Keeping the patient in a supine position.

D. Aggressive fluid restriction.

B. Careful immobilization of the long bone fracture.

A trauma patient has dark, reddish-brown urine. The nurse knows this is a sign of myoglobin release, which can lead to:

A. Acute Kidney Injury (AKI)

B. Liver failure

C. Cardiac tamponade

D. Pneumothorax

A. Acute Kidney Injury (AKI)

what occurs when several ribs are broken in two places and no longer stable.

This results in paradoxical movement of the chest wall as the client inspires the chest wall sinks inward and on exhalation bulges outward) and can lead to respiratory distress rapidly.

flailed chest

A patient with a tibial fracture reports severe, deep, burning pain that is unrelieved by medication and out of proportion to the injury. What should the nurse assess for?

A. Fat embolism

B. Acute compartment syndrome

C. Deep vein thrombosis

D. Myocardial infarction

B. Acute compartment syndrome

When assessing the "5 Ps" for compartment syndrome, which finding is a late sign indicating prolonged ischemia?

A. Pain on passive stretch

B. Paresthesia

C. Paralysis

D. Pallor

C. Paralysis

How should the nurse position an extremity suspected of having acute compartment syndrome?

A. Elevated above the level of the heart.

B. Dependent (below the level of the heart).

C. At the level of the heart.

D. In a restrictive splint.

C. At the level of the heart.

What is the definitive surgical treatment for acute compartment syndrome?

A. Internal fixation of the fracture.

B. Fasciotomy.

C. Amputation.

D. Skin grafting.

B. Fasciotomy.

A patient in the ED is suspected of being a victim of a crime. How should the nurse handle the patient's clothing?

A. Cut through any blood stains to remove clothing quickly.

B. Place all clothing items together in one large plastic bag.

C. Place each piece of clothing in an individual paper bag.

D. Give the clothing to the family immediately

C. Place each piece of clothing in an individual paper bag.

To maintain the "chain of custody" for forensic evidence, what must the nurse do?

A. Leave the evidence on the counter for the police to find.

B. Document the transfer of custody, including the officer's name, date, and time.

C. Put the evidence in the hospital's general lost and found.

D. Only collect evidence if a doctor is present.

B. Document the transfer of custody, including the officer's name, date, and time.

A trauma patient has died and a medical examiner's autopsy is required. What is the nurse's responsibility regarding the body?

A. Remove all IV lines and tubes before the family arrives.

B. Wash the body thoroughly.

C. Leave all tubes and lines in place and cover the hands with paper bags.

D. Immediately move the body to the morgue.

C. Leave all tubes and lines in place and cover the hands with paper bags.

When documenting statements made by a trauma patient for legal purposes, how should the nurse record them?

A. Summarize the patient's main points.

B. Use the patient's own words surrounded by quotation marks.

C. Only document what the nurse thinks is relevant to the injury.

D. Avoid documenting anything the patient says.

B. Use the patient's own words surrounded by quotation marks.

A patient has a suspected blunt renal injury. Which diagnostic test is the standard for genitourinary imaging in a stable patient?

A. KUB X-ray

B. Contrast-enhanced CT scan

C. Renal biopsy

D. Intravenous pyelogram (IVP)

B. Contrast-enhanced CT scan

Which diagnostic procedure is used to rapidly detect intraperitoneal bleeding in a hemodynamically unstable patient?

A. Abdominal CT scan

B. Focused Assessment with Sonography for Trauma (FAST)

C. Diagnostic Peritoneal Lavage (DPL)

D. Exploratory Laparotomy

B. Focused Assessment with Sonography for Trauma (FAST)

In a Diagnostic Peritoneal Lavage (DPL), which finding is considered positive for injury?

A. RBC count of 50,000/mm³.

B. Absence of bile or feces.

C. WBC count greater than 500/mm³.

D. Clear return of the 1L of fluid.

C. WBC count greater than 500/mm³.

A nurse is caring for a patient after a nephrectomy due to trauma. What education is vital for the patient's long-term safety?

A. Avoid all physical activity for one year.

B. Wear medical identification indicating the nephrectomy.

C. Drink no more than 1 liter of fluid per day.

D. Stop taking all blood pressure medications.

B. Wear medical identification indicating the nephrectomy.

A trauma center’s designation level is a measure of

A. staff member’s commitment to trauma patient

care.

B. a trauma center’s operating room and bed

capacity.

C. clinical resources available to care for trauma

patients.

D. compliance with the Joint Commission trauma

standards

C. clinical resources available to care for trauma

patients.

Twelve hours after injury, which of the following is

the priority nursing intervention for a patient with a

cerebral contusion?

A. Deep vein thrombosis prophylaxis

B. Hyperventilation; keep CO2 24 mmHg

C. Frequent neurological assessment

D. Hypertonic saline administration

C. Frequent neurological assessment

A person involved in an all-terrain vehicle crash

sustained an injury to the neck after riding into a

suspended cable. Which finding would suggest an

expanding hematoma?

A. Strained hoarse voice

B. Bloody sputum

C. Coughing

D. Coarse crackles

A. Strained hoarse voice

In the patient with blunt chest trauma, what simple

nursing intervention can be best used to screen for

thoracic aorta injury?

A. Measure the pulse pressure

B. Bilateral upper extremity BP measurement

C. BP cuff inflation to elicit carpal spasm

D. SpO2 comparison of the right and left arm

B. Bilateral upper extremity BP measurement

((f a complete tear occurs,the patient will quickly die, usually at the scene of the accident. With a partial tear, blood flow can be impeded –usually to the left arm. When flow is impeded/disrupted, BP drops in the left arm.))

A patient involved in a head-on collision has an abdominal wall contusion at the level of the lap belt. Eight hours after injury which assessment finding would lead the nurse to believe that the patient suffered from a bowel tear.

A. Temp 102°F; WBC count 16,000/mm³; absent bowel sounds with diffuse abdominal tenderness

B. BP 98/70 mm Hg; HR 131/min; RUQ pain

C. Temp 100.2°F; WBC count 12,000/mm³; abd. tenderness around the contusion

D. BP 111/52 mm Hg; HR 128/min; markedly elevated serum lactate level

A. Temp 102°F; WBC count 16,000/mm³; absent bowel sounds with diffuse abdominal tenderness

While auscultating a trauma victim's chest for breath sounds you believe you hear muffle heart sounds. You assess that this

1. client needs a nasogastric tube immediately to prevent aspiration pneumonia.

2. Could be a diaphragmatic rupture and notify the physician immediately.
   

3. client is hemorrhaging and needs immediate transfusion.

4. Could be cardiac tamponade and needs a pericardial centesis.

1. Could be cardiac tamponade and needs a pericardial centesis.

Muffled heart sounds is part of Beck's triad indicating a possible? and You would hear bowel sounds in the chest if there were a ??.))

cardiac tamponade

tear in the diaphragm

The priority nursing intervention for a client with facial trauma is

• Administration of IV fluids at a rapid rate.

• Immobilization of the C spine.

• Application of a dressing to control facial bleeding.

• Clearing the airway of blood and debris.,

• Immobilization of the C spine.

The physiologic responses producing clinical findings specific to a tension pneumothorax are

• Rising intrathoracic pressure and decreased cardiac output.

• Decreasing intrathoracic pressure and increased cardiac output.

• Rising intrathoracic pressure and increased cardiac output.

• Decreasing intrathoracic pressure and decreased cardiac output.

• Rising intrathoracic pressure and decreased cardiac output.

A trauma client becomes restless and agitated with cyanosis around the mouth. He has diminished breath sounds bilaterally. The priority intervention for this client is to

• Administer pain medication.

• Insert 2 large-caliberIV's and infuse normal saline at a rapid rate.

• Apply high-flow oxygen using a non-rebreather mask.

• Apply high-flow oxygen using a non-rebreather mask.

A client sustained a crush injury to the chest and is diagnosed with a flail chest. On assessment, the nurse should expect to observe

• Cyanosis, air hunger, agitation, and tracheal deviation to the same side as the injury.

• Respiratory distress and an area of the chest wall bulge outward on expiration.

• Dyspnea, pain, and chest wall moves inward on expiration

• Respiratory distress and an area of the chest wall bulges outward on inspiration.

• Respiratory distress and an area of the chest wall bulge outward on expiration.

During a motor vehicle accident, a client sustained blunt trauma to the head and face, resulting in hairline skull fracture and a LeFort Ill maxillofacial fracture. The client has a Glasgow Coma Scale of 7 and 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?

Apply direct pressure to bleeding areas.

• Perform endotracheal intubation.

• Administer tetanus stat.

• Insert two large bore IVS

• Perform endotracheal intubation.

The nurse is caring for a client with increased intracranial pressure (IC) caused by a traumatic brain injury. Which of the following clinical manifestations would suggest that the client may be experiencing increased brain compression causing brain stem damage?

Hypothermia

Vasodilation in lower extremities

Increasing diastolic pressure

Hyperthermia

Hyperthermia

On initial admission of a trauma victim to the emergency department, the nurse completes a primary survey. The client 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?

chest tube insertion

Clinical manifestations of neurogenic shock include which of the following?

Select all that apply.

Bradycardia

Profuse bilateral sweating on one side

Tachycardia

Warm Skin

Venous pooling

brady, waem skin and venous pooling

A client with an acute brain injury is receiving IV mannitol, an osmotic diuretic. If this medication is effective, what does the nurse expect?

Increased cerebral perfusion pressure

Reduction of Glasgow Coma Scale values

Decrease cerebral perfusion pressure

Increased cerebral perfusion pressure

Battles sign is often indicative of

basilar fracture

Primary assessment of a motor vehicle crash (MVC) victim reveals: increasing respiratory distress, absent breath sounds over the upper third of the right lung, tachycardia, and probable fracture of the right humerus. The best action for the nurse to take next would be to

Obtain an electrocardiogram.

Inquire about medication allergies.

Prepare for insertion of a chest tube.

Prepare for insertion of a chest tube.

A client who was brought to the Emergency Department with a T-6 injury begins to experience dyspnea and shortness of breath. Considering the level of the client's injury, you'd assess the breathing difficulty is caused by

Severing of the nerves that activate the diaphragm.

Edema of the spinal cord above the level of injury.

Hemorrhage into the brain stem caused by trauma.

Movement of the parts of the fractured vertebrae.

Edema of the spinal cord above the level of injury.

(Rationale We are always concerned with high Tinjuries that the client may start to develop respiratory distress either due to wearing out from having to use abdominal muscles or from the edema occurring within the spinal cord to move upward which would impact even more muscles including the diaphragm.)

The second day after admission with a fractured pelvis, a client develops acute onset confusion. Which action should the nurse take first?

Take the blood pressure.

Assess client orientation.

Check pupil reaction to light.

Assess the oxygen saturation.

Assess the oxygen saturation.