TEST

Question 1

Why is a measure of serum lactate obtained in the initial assessment of the trauma patient?

a) to measure oxygenation and ventilation
b) to quantify the base deficit for the adequacy of cellular perfusion
c) to gauge end-organ perfusion and tissue hypoxia
d) to determine the underlying cause of shock

Answer 1

C. p 35

“Lactic acid is an excellent reflection of tissue perfusion and an endpoint measure of resuscitation…high levels of lactic acid are associated with hypo perfusion.”

A. does not measure O2, does not measure ventilation, but cellular respiration.
B. While LA measures perfusion (Pubmed) it does not quantify base deficit
C. correct answer
D. does not indicate cause of shock

Question 2

A trauma patient is restless and repeatedly asking “where am I?” vital signs upon arrival were BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and symptoms of which stage of shock?

A) compensated
B) Progressive
C) irreversible
D) decompensated

Answer 2

A. p.74

Signs of compensation
* rising diastolic BP
*narrowed pulse pressure PP was 40, now 20
* slightly tachy at 108
*increased RR at 28

B. same as decompensated - hypotensive, obtunded
C. irreversible– usually obtunded to comatose
D. same as progressive - hypotensive , obtunded ,

The patient is just not “sick” enough for the other shock stages based on presentation.

Question 3

An elderly patient with a history of anticoagulant use presents after a fall at home that day. she denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. Which is a most likely cause of her symptoms?

A) epidural hematoma
B) diffuse axonal injury
C) post-concussive syndrome
D) subdural hematoma

Answer 3

D. p.108.

however epidural hematoma on page 107 mentions “dizziness, nausea and headache”. SDH does not mention dizziness as a symptom.
Epidural happens (90%) from parietal or temporal bone injury lacerating artery an the patient has an injury to the frontal bone.

The totality of symptoms lean towards SDH.

Question 4

EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance?

A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests of water
D) Smell of alcohol on breath

Answer 4

D. P188 PART OF NEXUS CRITERIA

patient cannot be intoxicated to be cleared with imaging.

Question 5

Which of the following occurs during the third impact of a motor vehicle crash?

A) The driver of the vehicle collides with the steering
wheel
B) the vehicle collides with a tree
C) the aorta is torn at its attachment with the ligamentum arteriosum
D) the airbag deploys and strikes the front seat passenger

Answer 5

C P. 14 “The third impact occurs when internal structures collide within the body cavity…and/or are TORN loose and may…”

A. secondary impact
B. primary impact
C. organs collide or tear
D. secondary impact

Question 6

A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions?

A) initiate transfer to a trauma center
B) provide report to the operating room nurse
C) Obtained imaging studies
D) Place a gastric tube

Answer 6

A. p. 379 table 19-2

The table speaks to, “major abdominal vascular injury” and “unstable pelvic fracture requiring more than 6 units of PRBCs in 6 hours”.
While C & D are reasonable, facilitating transfer is a priority The question stem mentions the patient is in a rural ED and assumes it is not trauma capable hospital.
p. 380 “Directly after the primary survey , a reevaluation decision point emphasizes early consideration for patient transfer”.
This decision would occur before Primary G (N- naso/orogastric tubes) and before imaging, which would come after the primary survey just after G-p-pain.
p. 36 reevaluation “reevaluation begins with radiographs”

Question 7

Which of the following injuries is LEAST likely to be promptly identified?

A) spleen
B) lung
C) bowel
D) brain

Answer 7

C. p. 153 “the difficult diagnosis of small bowel injuries delays treatment”. Also, p. 147 “ Hollow viscus injuries are more difficult to identify…with diagnosis often being delayed”.

Question 8

Patients with a crush injury should be monitored for which of the following conditions?

A) Hypernatremia
B) Hypercalcemia
C) Dysrhthmias
D) polyuria

Answer 8

C p. 195

Question 9

What finding raises suspicion of complete spinal cord injury?

A) Weakness in the lower extremities
B) Priapism
C) voluntary anal sphincter tone
D) intact reflexes distal to the injury

Answer 9

B. p. 176 “priapism”.
“It is assumed that the mechanism of priapism in most patients with SCI is that abrupt loss of sympathetic input to the pelvic vasculature leads to increased parasympathetic input and uncontrolled arterial inflow directly into the penile sinusoidal spaces” Todd, N. Priapism in acute spinal cord injury. Spinal Cord 49, 1033–1035 (2011). https://doi.org/10.1038/sc.2011.57

Question 10

A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs?

A) Bradycardia and ipsilateral absences of motor function
B) Tachycardia and respiratory depression
C) Tachycardia and absent motor function below the level of injury
D) Bradycardia and absent motor function below the level of the injury

Answer 10

D. p.176 “Bradycardia” and “absent motor function below the level of the injury”.

Question 11

A 5-year old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention?

A) report your suspicion of the maltreatment in
accordance with local regulations
B) apply ice to the bruises and consult wound care
C) engage in therapeutic communication to determine the MOI
D) provide the family with injury prevention resourse

Answer 11

A. p. 244 “injuries in different stages of healing” indicates maltreatment,

Question 12

A patient with lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention?

A) elevating the extremity above the level of the heart
B) repositioning and apply ice
C) Elevating the extremity to the level of the heart
D) Preparing the patient for ultrasound

Answer 12

C. p. 202
“Avoid elevating the limb higher than the heart, as this can reduce circulation and tissue perfusion”. pp. 1

Question 13

A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention?

A) apply a sling and elevate the extremity to the level of
the heart.
B) apply a splint and ELEVATE ABOVE THE LEVEL OF THE HEART
C) Apply a sling and elevate the extremity above the level of the heart
D) apply a splint and elevate the extremity to the level of the heart

Answer 13

B. p 202

A. patient needs a splint, not sling
B. correct
C. patient needs a split, not sling
D. splint is needed, but needs to be above the level of the heart

Question 14

Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage?

A) ABC
B) MARCH
C) AVPU
D) VIPP

Answer 14

B. p. 29

Question 15

Which of the following is a late sign of increased intracranial pressure?
A. Cushing Response Widening pulse pressure Reflex bradycardia)
Decreased RR)
) Restlessness or drowsiness
B) Nausea and vomiting
C) Decreased respiratory effort**
D) amnesia and anxiety

Answer 15

C. p. 99 table 6-2

but cushing’s response is also listed ?
A. Widened PP, bradycardia also listed as late signs
B. listed as early signs
C. correct and listed as late
D. listed as early sign

Question 16

A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented, and has delayed cap refill. Which of the following interventions would be most appropriate for this
patient based on the disaster triage principle?

A) initiate two large caliber intravenous lines for Ringers
lactate solution administration
B) Administer Dilaudid for pain control and provide comfort care
C) Place the patient in an observation area for care within the next few hours
D) Contact the command center for the personnel to notify next of kin.

Answer 16

A. delayed cap refill indicated hypotension. hypotension is treated with fluids.

A.
B. May drop BP, P-pain relief comes after C-Circulation and the patient has S/SX of poor circulation (pale, disoriented, poor cap refill)
C. Does not make sense
D. Does not make sense

Question 17

A patient arrives with a large open chest wound after being assault ed with a machete, Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3 sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood pressure. Which of the
following is the MOST appropriate interventions?

A) needle decompression
B) tube thoracostomy
C) dressing removal
D)surgical repair

Answer 17

A. tension pneumo p. 134

A.
B. takes too long compared to needle decomp, but will be needed
C. will worsen the pneumo
D. takes too long

Question 18

A patient is found lying on the floor after falling 13 hours ago. Which of the following lab values is expected with a musculoskeletal complication associated with this presentation?
A) elevated creatine kinase
B) decreased potassium level
C) decreased WBC
D) elevated GFR

Answer 18

A.

p. 264 pp. 3 mention rhabdo, see Chap 10, p.198, pp. 4 “elevated CK”

Question 19

A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows:
BP 98/71
HR 125 beats/min
RR 26 breaths/min
SpO2 94% on high flow O2 via NRB mask
which of the following is the priority intervention for this patient?

A) Expedite transport to the CT scanner
B) prepare the patient for spinal radiographs
C) expedite transfer to the closest trauma center
D) notify the patients family

Answer 19

C. p. 379 table 19-2

Following the ABCD Primary Survey, the decision point for transfer would come before either A or B as they come under “reevaluation” p. 36.

Question 20

Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and crying with increased work of breathing and pale skin. which of the following interventions has the highest priority?

A) padding the upper back while stabilizing the cervical
spine
B) applying a tight-fitting NRB mask with an attached resevior
C) establishing intravenous access and administering a 20mL/kg bolus
D) preparing for drug assisted intubation

Answer 20

A. p. 29 -30 “During the entire initial assessment and identified required interventions, protection of the cervical spine is described in this section as essential”.

using ABCDE, the patient is awake, airway patent and he is breathing.
abnormalities–increased WOB and pale skin

B. the child is breathing and crying this is under “B”, “A’ - airway AND c-spine come prior to this intervention.
D. no need for intubation
C. pale skin could indicate shock OR hypoxia (combined with WOB)
more information is needed from vital signs but they are not available until the Secondary survey.

Given MOI CSI is assumed until ruled out. Intervention would be C-collar.

Question 21

Which of the following is a component of the trauma triad of death?

A. hypothermia, metabolic acidosis, coagulopathy

A) Acidosis
B) hyperthermia
C) hemorrhage
D) sepsis

Answer 21

A.
p. 35 hypothermia, hypotension, acidosis leading to coagulation issues

P.76 HYPOTHERMIA, ACIDOSIS, COAGULOPATHY FIG. 5-5**

A. correct
B. hypothermia is a cause, nit HYPER
C. hemorrhage is not a cause
D. Sepsis may cause the other conditions (hypotension, acidosis) BUT sepsis is not directly caused y trauma, per the question “trauma triad of death”.

Question 22

A 35-year old male presents with facial trauma after bring struck in the face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected?

A) oculomotor nerve palsy
B) globe rupture
C) uncal herniation
D) retinal detachment

Answer 22

B. p. 113 table 6-6

Question 23

Which of the following is true about the log roll maneuver?

A) it causes less spinal motion than the lift and slide
manuever
B) it is recommended for patients with unstable pelvic fractures
C) it can worsen cord damage from an unstable spinal injury
D) it does not increases the risk of life threatening hemorrhage from unstable injuries

Answer 23

C. p. 40

Question 24

EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar?

A) after a physical examination if the patient has no
radiologic abnormalities on a computed tomography scan
B) after physician evaluation if the patient has not neurologic abnormalities on exam
C) after palpation of the spine if the patient has no point tenderness the the vertebral column
D) after physical examination if the patient has no neck pain with movement

Answer 24

A. nexus criteria, c-spine cannot be removed if patient is under the influence of ETOH. p. 188

Question 25

Tearing of the bridging veins is most frequently associated with which brain injury?

A) epidural hematoma
B) subdural hematoma
C) diffuse axonal injury
D) intracerebral hematoma

Answer 25

B. P. 108

A. results form arterial tear
B. correct answer
C. results from shearing of axons at high speed
D. bridging veins are superficial and not in the cerebrum

Question 26

If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation?

A) potassium
B) magnesium
C) sodium
D) calcium

Answer 26

D. P. 81

Question 27

A trauma patient is en route to a rural ED. Radiology notifies the charge nurse that the CT scanner will be out of service for several of hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication?

A) Brief
B) loop
C) debrief
D) huddle

Answer 27

D. P. 6 HUDDLES SOLVE PROBLEMS PRE PATIENT ARRIVAL

A. is more planned and usually before a shift
B. ??
C. occurs after an event
D. correct

Question 28

The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient’s fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours?

A) 2280 mL
B) 3840 mL
C) 4560 mL
D) 7680 mL

Answer 28

A. 2280 ml

p. 225, Table 11-4

kg x 2ml x TBSA burned % (p.221)\

120 x 2 x (19%)= 4560 total 4560/2 = 2280 in first 8 hours.

(upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA.
120 kg x (2 mL) x (19% TBSA) = 4560 mL
4560 / 2 (half of fluids given in first 8 hours) = 2280 mL

1. Determine extent of PARTIAL THICKNESS and FULL_THICKNESS burns.
2. Table 17-3 says PARTIAL THICKNESS burns appear as , “…blisteres, moist and weeping with exudate, red, pink, blanche with pressure, edematous”.
3. only the arm burns are counted.

Question 29

Which of the following assessment findings differentiates a tension PTX from a simple PTX?

A) increased work of breathing
B) unilaterally diminished breath sounds
C) pleuritic chest pain
D) hypotension that worsens with inspiration

Answer 29

D.

A. found with both p.132
B. found with both
C. chest pain found with both– no mention of pleuritic in book. NIH Stat Pearls mentions pleuritic pain
D. Hypotension mentioned on p. 134, pp 1, pp. 2. No mention of hypotension worsening with inspiration, though it makes sense.

Assessment findings associated with tension pneumothorax include anxiety, severe restlessness, severe respiratory distress, and absent breath sounds on the injured side. Hypotension due to compression of the heart and great vessels is consistent with obstructive shock. Hypotension worsens with inspiration due to increased intrathoracic pressure. Late signs include distended neck veins, tracheal deviation, and cyanosis.

Question 30

Which of the following considerations is most important when caring for a geriatric trauma patient?

A) head to to exam
B) medical history
C) incontinence
D) falls

Answer 30

B. p. 272

“for the older adult patient, a pertinent medical history is crucial”.

While a head to toe exam is part of the Secondary survey, no special mention of importance is made in the TNCC manual leading me to believe B is the more correct answer.

Question 31

An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions?

A) call for a portable CXR stat
B) check to make sure the ventilator is plugged in
C) suction the ET tube
D) confirm ET tube placement

Answer 31

D. NOT Specifically ANSWERED

alluded to on p. 386

DOPE pneumonic. Given the patient was just moved, displacement is more likely.

Suctioning a displaced tube would not fix the problem
CXR takes too much time versus 5 pt. auscultation or verifying teeth/lip line measurement.
Checking to make sure the ventilator is plugged in– a quick glance would verify if the vent were on/working/not alarming.

Question 32

What factor contributes most the kinetic energy of a body in motion?

A) acceleration
B) mass
C) velocity ***
D) inertia

Answer 32

C. p. 11

“when mass is doubled, so is net energy. When velocity id doubled, energy is quadrupled”

KE= 1/2 mv2

Question 33

During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next?

A) open the airway with the head-tilt/chin lift maneuver
B) auscultate bilateral breath sounds to assess ventilatory status
C) assist respirations using a BVM
D) insert an oropharyngeal airway if there is no gag reflex ***

Answer 33

D.

A. is ruled out because of multi-system trauma. you must assume a CSI
B and C assess in assist ventilation, but the patient has an unaddressed airway issue

D. address the airway issue in the ABCD order

Question 34

Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of future disaster. Which phase of the disaster life cycle does this describe?

A) mitigation ***
B) preparedness
C) response
D) recovery

Answer 34

A. p. 348 mitigation incorporates lessons learned form previous events

preparedness involves hazard vulnerability analysis (HVA)

Question 35

Which pulse pressure description is an indication of early hypovolemic shock?

A) widened
B) narrowed ***
C) bounding
D) weak

Answer 35

B. (conflicting data in book).

p. 78 Table 5-2

Class I hypovolemic shock

“blood loss up to 750ml/ 15% volume Pulse pressure normal or Increased

seems to contradict page 74 which states,

“SBP usually within normal range, a rising DBP resulting in a NARROWED pulse pressure, which is a reflection of peripheral vasoconstriction”.

Question 36

The most reassuring finding for a male patient with hIp pain after a fall is which of the following?

A) a normal prostate exam
B) absence of abdominal distension
C) a normal fast exam
D) pelvic stability

Answer 36

D. only answer that makes sense

Question 37

A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following?

A) diagnostic peritoneal lavage ***
B) serial fast exams
C) abdominal and pelvic CT scans
D) serial abdominal assessments

Answer 37

A. p. 158 DPL used in patients who are, “…hemodynamically unstable..”

The FAST exam is done at the bedside to identify pathological fluid in the
abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic
peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage.
Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma.

Question 38

Which of the following is an expected finding in a patient with a thoracostomy connected to a chest drainage system?

A) output of 200 mL/hr
B) tubing clamp closed for transport
C) dependent loops in the tubing to promote drainage
D) fluctuations in the water serial chamber ***

Answer 38

D

A.

Question 39

Which of the following patients warrants referral to a burn center?

A) a 21- year old female with a partial thickness burn to
the right forearm
B) a 40-year old hypertensive male with a superficial burn to the back
C) a 52-year old diabetic male with partial thickness burn to the left lower leg ***
D) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax.

Answer 39

C

B and D are only superficial burns, A is partial thickness, but the patient is young with no specified health issues and the burn is not on the “hands, feet, genitalia, perineum, or major joints” p.222

C has “preexisting medical disorder that could complicate management , prolong recovery or affect mortality”. Diabetes would meet this criteria

Question 40

A patient has been in the ED for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and c/o leg pain. His wife reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. the patient is exhibiting signs of symptoms commonly associated with which of the following conditions?

A) acute lung injury
B) fat embolism
C) PTX
D) pulmonary contusion

Answer 40

B. p. 194

Question 41

Which is the effect of hypothermia on the oxyhemoglobin dissociation curve?

A) Hemoglobin does not readily release oxygen for use
by the tissues
B) The amount of oxygen available to the tissues increases
C) Tissue oxygenation (PaO2) increases
D) Hemoglobin molecule saturation (SaO2) decreases

Answer 41

A. causes leftward shift that causes an increased affinity for binding resulting in less o2 released to tissues.
p. 59

Question 42

A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars while performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions?

A) Fast exam
B) CT scan
C) straight cath for urine sample
D) ice and elevation of the scrotum

Answer 42

C. is the only contraindicated answer. patient may have urethral injury

Question 43

You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation?

A) 1000 mL/hr
B) 500 mL/hr ***
C) 250 mL/hr
D) 125 mL/hr

Answer 43

B. p. 221 “14 years or older: 500 ml/hr Lactated Ringers”.

Question 44

Which of the following is possible complication of positive-pressure ventilation?

A) worsening pneumothorax
B) worsening flail chest
C) reabsorption of pleural air
D) negative intrapleural pressure

Answer 44

A. p.133 clinical pearl

Question 45

Which of the following is NOT considered goal-directed therapy of cardiogenic shock?

A) controlled fluid boluses
B) antidysrhythmic administration
C) pericardiocentesis ***
D) cardiac cat

Answer 45

C. p. 79

while not specifically mentioned cardiac cath could treat MI, which can be a cause of cardiogenic shock. No mention of pericardiocentesis is made.

Pericardiocentesis can treat tamponade, which can cause shock, but that would be obstructive shock, not cardiogenic.

Question 46

What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation?

A) pulse oximetry and capnogaphy **
B) respiratory rate and capnography
C) pulse oximetry and respiratory rate
D) capnography and capnometry

Answer 46

A.

pulse ox measure oxygen and capnography measure ventilation

Question 47

Which of the following values indicates the need for alcohol withdrawal interventions?

A) CIWA-Ar of 36 ***
B) GCS 13
C) ETCo2 of 48 mm Hg
D) heart rate of 45 beats/min

Answer 47

A.
CIWA score of 27-67 indicates severe withdrawal per Merck manual

no other option makes sense

Question 48

An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, and dusky skin. the trauma team has administered medications for drug assisted intubation and attempted intubation but was unsuccessful. What is
the most appropriate immediate next step?

A) Ventilate with a BVM ***
B) Prepare for cricothyroidotomy
C) administer reversal medications
D) contact anesthesia for assistance

Answer 48

A.

Considering the ABCs, no other choice makes sense.

Question 49

The trauma nurse knows that placing a bariatric patients in a “ramped position”
provides better visualization during the insertion of which device?

A) Intraosseous line
B) orogastric tube
C) ET tube
D) urinary catheter

Answer 49

C) ET tube p. 285 fig. 14-3

Question 50

You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal high at the costal margin, and some dark bloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent
with which of the following?

A) placental abruption
B) preterm labor
C) uterine rupture
D) fetal demise

Answer 50

A. p. 296

Most likely answer while bloody show is consistent with preterm labor,

acle/decels, increased fundal height and the MVA are more indicative of a placentae abruption.

Fundal height at 32 weeks is 30-34 cm (Cleveland clinic)
The costal margin is about 36 cm making the fundal height high for 32 weeks.
There are more boxes checked under abruption than preterm.