Endocrine, Trauma, & MODS Quiz

Question 1

Patient with high index of suspicion for extensive trauma:

a.) Death in the compartment
b.) Mechanism of injury consistent with extensive deceleration, acceleration, or rotational injury such as high speed MVC or fall from above 20 feet
c.) Fracture of first & second rib
d.) All of the above

Answer 1

d.) All of the above

Question 2

Which of the following is one of the body’s responses to profound stress?

a.) Decreased polymorphonuclear leukocytes
b.) Decreased endogenous opioids
c.) Hyperglycemia
d.) Decreased aldosterone

Answer 2

c.) Hyperglycemia

Stress on the body also leads to:
* increased glucose (hyperglycemia)
* increased aldosterone (in response to intravscular volume)
* increased endogenous opioids (to help deal with pain)
*** increased WBCs **(to help fight infection)

Question 3

Which laboratory result is used to follow long-term compliance of Type 1 & Type II diabetics?

a.) Serum glucose
b.) Serum protein
c.) Home glucometer
d.) A1c - glycosolated hemoglobin

Answer 3

d.) A1c - glycosolated hemoglobin

Question 4

Which endocrine condition has the following signs and symptoms?
* develops rapidly
* diaphoresis
* mental confusion

a.) Diabetic ketoacidosis (DKA)
b.) Hypoglycemia
c.) Hyperosmolar hyperglycemic syndrome (HHS)
d.) Diabetes insipidus (DI)
e.) Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 4

b.) Hypoglycemia

Question 5

Which endocrine condition has the following signs & symptoms?
* insidious onset
* may have abdominal pain
* Kussmaul breathing
* volume depletion

a.) Diabetic ketoacidosis (DKA)
b.) Hypoglycemia
c.) Hyperosmolar hyperglycemic syndrome (HHS)
d.) Diabetes insipidus (DI)
e.) Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 5

a.) Diabetic ketoacidosis (DKA)

Question 6

Which endocrine condition has the following signs & symptoms?
* very high blood sugar
* may mimic signs of stroke
* dehydration
* slow / subtle onset

a.) Diabetic ketoacidosis (DKA)
b.) Hypoglycemia
c.) Hyperosmolar hyperglycemic syndrome (HHS)
d.) Diabetes insipidus (DI)
e.) Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 6

c.) Hyperosmolar hyperglycemic syndrome (HHS)

Question 7

Which endocrine condition has the following signs & symptoms?
* very high urine output with low specific gravity
* insufficient or hypofunciton of antidiuretic hormone (ADH)

a.) Diabetic ketoacidosis (DKA)
b.) Hypoglycemia
c.) Hyperosmolar hyperglycemic syndrome (HHS)
d.) Diabetes insipidus (DI)
e.) Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 7

d.) Diabetes insipidus

Question 8

Which endocrine condition has the following signs & symptoms?
* slow / subtle onset
* mental confusion
* dilutional hyponatremia
* excess antidiuretic hormone (↑ ADH)
* low serum osmolarity

a.) Diabetic ketoacidosis (DKA)
b.) Hypoglycemia
c.) Hyperglycemic hyperosmolar syndrome (HHS)
d.) Diabetes insipidus (DI)
e.) Syndrome of inappropriate antidiuretic hormone (SIADH)

Answer 8

e.) Syndrome of inappropriate antidiuretic hormone (SIADH)

Question 9

TRUE or FALSE: A patient arrives with multiple gunshot wounds to the abdomen. The surgeon will remain in the OR until all major & minor bleeding is controlled and all injuries are identified.

Answer 9

FALSE

• Damage control surgery is an option to avoid hypothermia, coagulopathies, & metabolic acidosis, stop the bleeding, resuscitate the patient, & return to the OR for definitive care

Question 10

Which statement about aortic injury is true?

a.) Greatest risk from shearing forces from rapid deceleration
b.) Vulnerable area is the proximal aorta where mobile arch meets fixed descending aorta at point where ligamentum arteriosum “tethers”
c.) Occurs with frontal or side impacts & falls from significant height
d.) All of the above

Answer 10

d.) All of the above

• Greatest risk is from shearing forces from rapid deceleration
• Vulnerable area is the proximal aorta where the mobile arch meets the fixed descending aorta at the point where the ligamentum arteriosum “tether”
• Occurs with frontal or side impacts & falls from significant heights

Question 11

Match the letter with the intervention & place in correct order.

A
B
C
D
E
F
G

1.) Farenheit - Control temperature / increasing ambient warmth
2.) Da neuro, obtain Glascow Coma Scale & repeat
3.) Airway maintenance & C-spine protection
4.) Circulation - control external hemorrhage, start IVs stat for instability
5.) Get vital signs & tubes in (NG, foley)
6.) Expose the entire patient - don’t miss an injury
7.) Breathing & ventilation - if inadequate, support with BVM / intubation

Answer 11

• A-3.) Airway maintenance & C-spine protection
• B-7.) Breathing & ventilation - if inadequate, support with BVM / intubation
• C-4.) Circulation - control external hemorrhage, start IVs stat for instability
• D-2.) Da neuro, obtain Glascow Coma Scale (GCS) & repeat
• E-6.) Expose the entire patient - don’t miss an injury
• F-1.) Farenheit - control temperature / increasing ambient warmth
• G-5.) Get vital signs & tubes (NG, foley, etc.)

Question 12

TRUE or FALSE: SIRS (Systemic Inflammatory Response Syndrome) is preseent when two or more of the following clinical manifestations are present:
* ↑ RR
* ↑ or ↓ WBC
* HR > 90
* ↑ or ↓ temperature

The manifestations are a deviation from baseline & not related to treatment such as chemotherapy.

Answer 12

TRUE

Question 13

Select all the statements that are true regarding MODS (Multiple Organ Dysfunction Syndrome).

a.) Kidneys are usually the first organs affected.
b.) Hypermetabolism lasts 14-21 days & leads to autocatabolism.
c.) Organs always fail in progressive order.
d.) In addition to ARF, ARDS, & DIC, MODS may also impact the GI & biliary systems signficantly.

Answer 13

b.) Hypermetabolism lasts 14-21 days & leads to autocatabolism.

d.) In addition to ARF, ARDS, & DIC, MODS may also impact the GI & biliary systems significantly.

GI Manifestations
* translocation fo GI bacteria through “leaky” gut
* hypoperfusion
* colinization

Hepatobiliary Manifestations
* altered metabolism
* hepatitis
* cholecystitis

Question 14

Which is the highest level of cervical spine cord injury that can occur so that the patient still has the ability to feed him or herself?

a.) C2
b.) C4
c.) C7
d.) T2

Answer 14

c.) C7

Question 15

Which of the following is the earliest & most reliable sign of compartment syndrome?

a.) Pallor
b.) Unrelenting pain
c.) Pulseless
d.) Paresthesias

Answer 15

b.) Unrelenting pain

Question 16

Which of the following conditions is a medical emergency in spinal cord injury that results from stimulation below the level of injury such as pain, distended bladder, or rectum?

a.) Autonomic dysreflexia
b.) Neurogenic shock
c.) Flaccid paralysis
d.) Spinal shock

Answer 16

a.) Autonomic dysreflexia

S/S of Autonomic Dysreflexia
* bradycardia (↓ HR)
* hypertension (↑ BP)
* facial flushing
* headache

Question 17

Which of the following is the standard measure for optimal care of a patient with a spinal cord injury?

a.) Methylprednisolone
b.) Fractures are always stabilized with four point device if expertise available
c.) Prevention of hypotension & search for associated injuries
d.) All of the above

Answer 17

c.) Prevention of hypotension & search for associated injuries

Question 18

The orthopedic nurse is aware that traumatic dislocations are treated as orthopedic emergencies due to the risk of diminished blood supply & subsequent tissue death. What is the tissue death due to anoxia & diminished blood supply called?

a.) Subluxation
b.) Avascular necrosis
c.) Nerve palsy
d.) Compartment syndrome

Answer 18

b.) Avascular necrosis