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TCRN Pre-test > Pre-test > Flashcards

Pre-test Flashcards

1
Q
  1. Systemic vascular resistance (afterload) is decreased in which type of shock?
    a. Hypovolemic
    b. Cardiogenic
    c. Obstructive
    d. Distributive
A

D - Afterload (systemic vascular resistance) is decreased in distributive shock due to vasodilation and maldistribution of blood. Pg. 79

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2
Q
  1. Pulse pressure (PP) is widened in which disorder?
    a. Early shock.
    b. Increased intracranial pressure.
    c. Cardiac tamponade.
    d. Aortic valve stenosis.
A

B - Pulse pressure is widened in increased intracranial pressure. Pulse pressure is narrow in early shock. Pg. 96

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3
Q
  1. A patient is diagnosed with a pelvic fracture and right tibial fracture after a motorcycle crash. Which classification of hypovolemic shock would most likely occur because of these injuries?
    a. Class I
    b. Class II
    C. Class III
    d. Class IV
A

D - Pelvic fractures cause massive blood loss resulting in severe shock. Pg. 78

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4
Q
  1. A chest tube was just inserted on a patient with a tension pneumothorax. Which assessment finding would best indicate the treatment plan has been successful?
    a. Patient reports a decrease in chest pain.
    b. Presence of blood in the chest drainage system.
    c. Improved hemodynamic status.
    d. Decreased patient anxiety and diaphoresis.
A

C- The treatment is effective if the patient’s vital signs (hemodynamics) improve. Pg. 134

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5
Q
  1. Abdominal compartment syndrome is a form of which type of shock?
    a. Hypovolemic
    b. Cardiogenic
    c. Distributive
    d. Obstructive
A

D - Abdominal compartment syndrome is compression or obstructive shock. Pg. 395

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6
Q
  1. A 20-year-old male was discharged home yesterday after a femur fracture from a fall. He returns today via EMS with dyspnea, tachypnea, and tachycardia. You notice a petechial rash over the axilla and peaked waves on the EKG, so you suspect which disorder?
    a. Sepsis
    b. Disseminated Intravascular Coagulation (DIC)
    c. Fat emboli
    d. Rhabdomyolysis
A

. C- The classic S/S of fat embolism is axillary petechial rash, along with sudden onset of restlessness and severe hypoxia. Pg. 391

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7
Q
  1. A hazardous vulnerability assessment is completed in which emergency management phase?
    a. Mitigation
    b. Preparedness
    c. Response
    d. Recovery
A

A - Disaster mitigation is completing a hazardous vulnerability assessment. Pg. 348

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8
Q
  1. Which is the best early indicator of shock in pediatric patients?
    a. Hypotension
    b. Tachypnea
    c. Decreased capillary refill.
    d. Tachycardia
A

D- Tachycardia and delayed capillary refill (not decreased) are early signs of poor tissue perfusion in the
pediatric patient. Pg. 237

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9
Q
  1. Which type of skull fracture has the highest risk for developing an intracranial infection?
    a. Temporal bone fracture
    b. Depressed skull fracture
    C. Basilar skull fracture
    d. Linear skull fracture
A

C- A complication of basilar skull fractures is infection so do not pack ears or nose. Pg. 115

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10
Q
  1. A teenager dives into a shallow pool and completely transects his spinal cord. In addition to poikilothermia, which combination of assessment findings is commonly seen in neurogenic shock?
    a. Hypotension and bradycardia.
    b. Hypotension and tachycardia.
    c. Hypertension and bradycardia.
    d. Hypertension and tachycardia.
A

A - The loss of sympathetic nervous system stimulation and unopposed parasympathetic results in bradycardia and hypotension. Pg. 172

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11
Q
  1. Advocating for bicycle lanes is an example of which phase of injury prevention?
    a. Primary
    b. Secondary
    c. Tertiary
    d. Quinary
A

A - Primary prevention is focused on preventing the occurrence of the injury. Pg. 409

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12
Q
  1. The nurse is assessing a multi-trauma patient. Which of the following symptoms is an EARLY sign of shock?
    a. Restlessness
    b. Hypotension
    c. Bradycardia
    d. Weak peripheral pulses
A

A - Restlessness, anxiety, tachycardia, and narrowed pulse pressure are seen in early shock. Pg. 74

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13
Q
  1. The trauma nurse who works with community resources to distribute bike helmets and car seats is implementing which phase of injury prevention?
    a. Primary
    b. Secondary
    c. Tertiary
    d. Quinary
A

B - Secondary prevention focuses on reducing the severity of the injury. Pg. 409

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14
Q
  1. A 64-year-old patient with a history of atrial fibrillation fell yesterday hitting her head. She did not lose
    a. Epidural
    b. Subdural
    c. Subarachnoid
    d. Intracerebral
A

B - Subdural bleeds result from tearing of the bridging veins resulting in a steady decline in LOC. Pg. 108

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15
Q
  1. A 21-year old male is broucht in by EMS afer a gunshot wound to the lef Tank while he was “running away From some dude.” He can move his right leg but is unable to move his left leg. He has also lost pain and temperature sensation on the right side. You suspect:
    a. Anterior cord syndrome
    b. Brown-Sequard syndrome
    c. Central cord syndrome
    d. Posterior cord syndrome
A

B - Brown-Sequard results in ipsilateral motor loss and contralateral loss of pain sensation. Pg. 175

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16
Q
  1. A function of collecting data elements for trauma registry includes the following, EXCEPT:
    a. Evaluating clinical care
    b. Developing injury prevention strategies
    c. Assisting in staff debriefing
    d. Verifying trauma center designation
A

C- The purpose of collecting data for trauma registry is to design prevention strategies and improve care.

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17
Q
  1. A 16-year-old male walks into the ED with a knife protruding from his abdomen. Your priority action is to:
    a. Remove the obiect and apply direct pressure.
    b. Stabilize the object.
    c. Initiate two large-bore IV’s.
    d. Ordering an MRI to see where the knife blade is.
A

B - Stabilize impaled objects to tamponade bleeding. Sheehy’s Pg. 394

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18
Q
  1. Which of the following statements in INCORRECT regarding trauma performance improvement (PI)?
    a. Trauma PI is multidisciplinary, and data driven.
    b. The PIPS plan pertains to the trauma center only, without feedback to referring facilities.
    c. Trauma PI fosters a culture of safety, transitioning from blame to opportunity.
    d. The key concepts are monitoring, evaluating, and improving performance.
A

B - Performance improvement is a system of multidisciplinary reviews with a feedback loop to identify areas for improvement and develop an action plan. Pg. 6

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19
Q
  1. Which symptom is considered the hallmark sign of compartment syndrome?
    a. Decreased distal pulses.
    b. Pulselessness
    c. Pain out of proportion to the injury.
    d. No pain with movement of the affected extremity.
A

C - Pain out of proportion to the injury is the classic sign of compartment syndrome. Keep the extremity in neutral position. Pg. 196

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20
Q
  1. A patient presents to the ED after accidently splashing lye in his eyes. Irrigation should continue until:
    a. The ocular pH reaches 7.4.
    b. Two liters of fluid has been instilled.
    c. The patient’s visual acuity is 20/20.
    d. Blepharospasms decrease.
A

A - Lye is an alkaline substance (pH 14) so irrigation should continue until the ocular pH reaches 7.4. Pg. 114

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21
Q
  1. The following mechanisms of injury require transportation to a trauma center, EXCEPT:
    A fall two to three times the height of the child
    b. Motorcycle crash
    c. A fall > 20 feet in an adult
    d. Ejection from an automobile
A
  1. B - Motorcycle crashes at > 20 mph meet criteria for transporting to a trauma center, not all motorcycle crashes. Pg. 27
22
Q
  1. Prior to calculating the total body surface area (TBS), the recommended starting point for fluid resuscitation in an eight-year-old child with significant burn is:
    a. 125 mL/hour
    b. 250 mL/hour
    c. 375 mL/hour
    d. 500 mL/hour
A

B - The recommended starting points for fluid resuscitation rates prior to burn calculation are 250 ml/hour for ages 6-13 years of age, 125 mL/hour for 5 years of age and younger, and 500 mL/hour for 14 years and older.
Pg. 221

23
Q
  1. Conditions or situations requiring a secured airway include the following, EXCEPT:
    a. Glasgow coma score (GCS) of 12 or less.
    b. Severe maxillofacial fractures.
    c. High risk of aspiration and the patient’s inability to protect the airway.
    d. Inhalation injury with stridor and carbonaceous sputum.
A

A - A Glasgow coma score (GCS) of 8 or less requires a secured airway. Pg. 31

24
Q
  1. A shift of the oxyhemoglobin dissociation curve to the right occurs in response to which of the following conditions?
    a. Hypothermia
    b. Carbon monoxide poisoning
    c. Methemoglobinemia
    d. Acidemia
A

D - Acidemia (decreased pH), increased carbon dioxide (hypercapnia), and hyperthermia shift the oxyhemoglobin curve to the right, so oxygen is released to the tissues. Pg. 58

25
Q
  1. The classic sign of this head injury is a transient loss of consciousness followed by a lucid period, and asecond loss of consciousness.
    a. Subdural hematoma
    b. Intracerebral hematoma
    c. Epidural hematoma
    d. Diffuse axonal injury
A

C- The classic sign of an epidural hematoma is loss of consciousness, lucid period, second loss of consciousness. Additional symptoms include ipsilateral pupil dilation and contralateral hemiparesis. Pg. 107

26
Q
  1. Which incomplete spinal cord syndrome is characterized by loss of motor and sensory function in the upper extremities that is greater than that of the lower extremities?
    a. Central cord
    b. Brown-Sequard
    C. Anterior cord
    d. posterior cord
A

Central cord syndrome most frequently oceurs due to hyperextension, in older adults. Pg. 175

27
Q
  1. Mortality is the highest with injuries to which zone in the neck?
    a. Zone I
    b. Zone II C.
    Zone III
    d. Zone IV
A

A - Mortality is the highest with injuries to zone I in the neck where major vessels and trachea are located.
Symptoms include dysphonia, dysphagia, and subcutaneous emphysema. Pg. 124

28
Q
  1. Lip laceration or fractured teeth are commonly associated with which maxillary fracture?
    a. Le Fort I
    b. Le Fort II
    c. Le Fort III
    d. Le Fort IV
A

A - Assessment findings seen in a transverse maxillary bone fracture (Le Fort) include lip laceration or fractured teeth and malocclusion. Pg. 111

29
Q
  1. Laboratory indicators of rhabdomyolysis
    include the following, EXCEPT:
    a. Increased creatine kinase (CK) levels
    b. Myoglobinuria C.
    Elevation of aspartate aminotransferase (AST) levels
    d. Hypokalemia
A

D - Laboratory indicators of rhabdomyolysis include and elevated CK, myoglobin, potassium, and AST. S/S:
include muscle pain and dark red urine. Pg. 396

30
Q
  1. Appropriate fluid resuscitation of the pediatrio patient in hemorrhagic shock includes:
    a. Packed red blood cells administered as a bolus of 20 mL./kg.
    b. Infusion of 10 mL/kg of isotonic crystalloid solution over 20 minutes.
    c. Rapid infusion of 20 mL/kg of warmed isotonie crystalloid solution over 5- 10 minutes.
    d. Blood product transfusion at a 1:1:2 ratio.
A

C - Interventions include rapid infusion of 20 mL/kg of warmed isotonic crystalloid solution (NS or LR) over
5-10 minutes with a three-way stopcock and a 20-mL syringe. Pg. 237

31
Q
  1. The normal range for fetal heart rate is between:
    a. 60-100 beats per minute
    b. 100-150 beats per minute
    c. 120-160 beats per minute
    d. 150-200 beats per minute
A

C- The normal fetal heart rate is 120-160 beats per minute and may be heard using a Doppler ultrasound by 10
weeks gestation. Pg. 297

32
Q
  1. These medications can prevent the increase in heart rate that is an expected response in patients with
    hypovolemia and/or shock states.
    a. Positive inotropes
    b. Vasopressors
    c. ACE inhibiters
    d. Beta-blockers
A

D - Beta blockers may mask tachycardia, an early sign of shock. Pg. 272

33
Q
  1. Which of the following is the antidote for cyanide toxicity?
    a. 100% oxygen
    b. Hydroxocobalamin
    c. 2-PAM
    d. Atropine
A

B- Hydroxocobalamin is the antidote for cyanido toxicity, turns urine red. Oxygen is the antidote for carbon monoxide toxicity. Atropine at 2-PAM are the antidotes for nerve agent exposure like Sarin gas and VX, and organophosphates. Pg. 219

34
Q
  1. The initial symptoms of acute radiation poisoning include:
    a. Nausea, vomiting, and diarrhea.
    b. Dyspnea and cherry red skin.
    c. Salivation and lacrimation.
    d. Cough, burning, and blisters.
A

A - Symptoms of acute radiation syndrome begin with nausea, vomiting, headache, and diarrhea. Radiation exposure may be from a “dirty bomb”. SLUDGE acronym is seen in nerve agent exposure. Pg. 359

35
Q
  1. In Simple Triage and Rapid Treatment (START) triage patients are sorted in a manner to allow the nurseto provide the most good to the greatest number of patients. The “walking wounded” are classified as:
    a. Black
    b. Red
    C. Yellow
    d. Green
A

D- The “walking wounded” are classified using the green triage tag color. Red is immediate, yellow is delayed, green is minor, and black is unlikely to survive. Pg. 366

36
Q
  1. Laboratory findings in disseminated intravascular coagulation (DIC) include:
    a. Elevated D-dimer and increased fibrinogen
    b. Elevated fibrin degradation products and decreased fibrinogen
    c. Prolonged PTT and increased platelet count
    d. Decreased platelet count and increased fibrinogen
A

. B - Laboratory finding in DIC include elevated fibrin degradation products and D-dimer, prolonged PT and PTT, and decreased platelet count and fibrinogen. Pg. 394

37
Q
  1. What is a normal ankle-brachial index?
    a. 1.2-1.6
    b. 0.9-1.2
    c. 0.4-0.9
    d. < 0.4
A

B - Normal ankle-brachial index (ABl) is 0.9-1.2 and is used to detect peripheral vascular injuries. 0.4-0.9

38
Q
  1. What is a normal shock index?
    a. 0.5-.07
    b. 0.7-0.9
    c. 0.9-1.2
    d. 1.2-1.6
A

A - Shock index is heart rate (HR) divided by systolic blood pressure (SP) Normal shock index is 0.5-0.7.
Higher the number, the poorer the outcome. EX: 80/120 = .67. Reference: https://www.resus.com.au/the-shock-
index/

39
Q
  1. Diagnostic criteria for acute respiratory distress syndrome (ARDS) includes:
    a. Hypoxemia resolved by higher levels of oxygen.
    b. Clinical evidence of left ventricular failure.
    c. Partial pressure of oxygen/fraction of inspired oxygen ratio of less than 200 mm Hg.
    d. High pulmonary artery occlusive pressure.
    d. High pulmonary artery occlusive pressure.
    Jovitato of loss than 200 mm rig.
A

C - P:F ratio of < 200 mm Hg is diagnostic for ARDS, along with normal PA pressures, and refractory hypoxemia. P:F ratios of 201-300 mm Hg is diagnostic for acute lung injury (ALI), ideal P:F ratio is > 400 mm
Hg. Pg. 392

40
Q
  1. Which of the following is a possible cause of hypercarbia (ETCO, > 45 mm Hg)?
    a. Increase in respiratory rate.
    b. Rapid rise in body temperature.
    c. Increase in tidal volume.
    d. Decrease in metabolic rate.
A

B - Possible causes of hypercarbia include a rapid rise in body temperature (suspect infection), increase in metabolic rate, and a decrease in respiratory rate (retaining COs). Pg. 68

41
Q
  1. In drug-assisted intubation, which induction agent is preferred in trauma because it does not affect hemodynamic stability?
    a. Propofol
    b. Midazolam
    c. Etomidate
    d. Fentanyl
A

C - Etomidate does not affect hemodynamic stability. Midazolam, Fentanyl, and Propofol decrease mean arterial pressure (MAP). Pg. 65

42
Q
  1. Which of the following physical findings may indicate globe rupture?
    a. Flashes of light and floaters in the visual field
    b. A teardrop-shaped pupil and vitreous humor leakage
    c. Halos around lights and tunnel vision
    d. Painless loss of vision and transient episodes of blindness
A

B- A teardrop-shaped pupil and vitreous humor leakage is indicative of globe rupture. Pg. 113

43
Q
  1. The treatment plan for hydrofluoric acid exposure includes which medication:
    a. Silvadene
    b. Polyethylene glycol (PEG) C.
    Calcium gluconate
    d. Sodium bicarbonate
A

C - Calcium gluconate is used for hydrofluoric acid (used for glass etching) burns since fluoride binds with calcium in the blood. Pg. 228

44
Q
  1. Treatment for rib fractures includes the following, EXCEPT:
    a. Early mobilization to enhance chest wall expansion.
    b. Lidocaine(xylocaine) patches to reduce pain.
    c. Intercostal nerve blocks to reduce pain.
    d. Rib binding to support the chest wall.
A

D - Binding ribs may push a jagged edge into the lungs causing a pneumothorax, so not recommended. Pg. 131

45
Q
  1. Application of a pelvic binder is performed in unstable pelvic fractures to:
    a. Reduce muscle spasms.
    b. Prevent fat embolism.
    c. Temporarily tamponade the bleeding.
    d. Prevent compartment syndrome.
A

C - Pelvic binder application will help attain stab zation and control hemorrhage by exerting external pressure. Pg. 156

46
Q
  1. Appropriate management of an amputated finger includes storing it in which of the following
    a. Distilled water
    b. Iodine gauze
    c. Saline-moistened gauze
    d. Ice water
A

C- Keep the amputated finger cool by wrapping it in saline-moistened sterile gauze, and then place it in a scaled plastic bag. Place that bag on top of a second bag of ice. Do not freeze the amputated part by putting it in the ice water. Pg. 203

47
Q
  1. A nonporous dressing is placed over an open chest wound to the right chest from a stab wound indicates the treatment is ineffective?
    a. Decreasing oxygen saturation and tracheal shift to the left side.
    b. Chest wall pain.
    c. Respiratory rate remains at 32 breaths/minute.
    d. Flat jugular veins
A

A - Decreased oxygen saturation and tracheal shift to the unaffected side indicates tension pneumothorax so remove the dressing and reevaluate the patient. Pg. 133

48
Q
  1. Hypotension in tension pneumothorax is the result of:
    a. Impaired venous return to the heart.
    b. Negative intrathoracie pressure.
    c. Vasodilation from distributive shock.
    d. Hemorrhage from the internal mammary artery.
A

A - Air enters the pleural space but cannot escape on expiration, increasing intrathoracie pressure. As pressure rises, venous return is impaired, cardiac output decreases, and hypotension occurs. Pg. 134

49
Q
  1. Which injury is NOT typically seen from lap belt only restraint in an MVC?
    a. Small bowel rupture
    b. Renal injury
    c. Stomach rupture
    d. Chance fracture
A

B - Lap belt only restraint may cause hollow organ (bowel and stomach) injury and/or a chance fractureof
TI2-L2. Pg. 145
forced to participate.

50
Q
  1. Following a mass casualty event, a critical incident stress debriefing (CISD) is offered for the hospital staff who were directly involved in the care of the patients. The primary goal of holding a CISM is:
    a. Collecting information to prepare a media statement.
    b. Mitigating the impact of traumatic events and restore adaptive functioning to those exposed.
    c. Identifying the staff who will require mental health counseling.
    d. Gaining information on the cause of the event to assist law enforcement.
A

B - CISD promotes communication and promotes resiliency. Those affected by the event are invited, but not forced to participate

TCRN Pre-test (1 decks)

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