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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 1 of 25

1.

What type of IV fluid should the trauma nurse use for burn resuscitation?

  • Lactated Ringers

  • 0.9% normal saline

  • 0.45% normal saline

  • 5% dextrose

Correct answer: Lactated Ringers

Lactated Ringers is the only IV fluid that should be used for burn resuscitation. Lactated Ringers best approximates intravascular solute contents and will have the best effect of available IV fluids. 

Other IV fluids, including 0.9% normal saline, 0.45% normal saline, and 5% dextrose should not be used during burn resuscitation.

2.

The nurse is assessing a patient's Glasgow Coma Score. Upon entering the patient's room, the patient spontaneously opens their eyes, but then closes them, only opening them again in response to verbal stimuli. 

What score should the nurse assign for the patient's eye-opening response?

  • 4

  • 5

  • 3

  • 2

Correct answer: 4

The patient's eye-opening response is scored on a scale of 4 to 1 and is scored based on the patient's best effort. Even though the patient may primarily only be opening their eyes to verbal stimuli, if they open their eyes spontaneously, they should be scored as a 4. 

A score of 5 is not possible when evaluating a patient's eye-opening response using the GCS.

3.

Which of the following is not a function of an incident command system?

  • Mitigating disasters

  • Overseeing incident-related financial considerations

  • Managing operations

  • Gathering information about the incident

Correct answer: Mitigating disasters

Mitigation of disasters occurs before an incident occurs and is designed to reduce the potential negative effects of disasters when they occur. Incident command systems are designed to oversee the response to an incident during the event, not mitigation before it occurs. 

Overseeing incident-related finances, managing operations, and gathering intelligence about the incident are all roles of incident command systems.

4.

An emergency room (ER) nurse asks the trauma nurse to administer a PRN morphine dose to one of their patients because they have to respond to an emergency. The ER nurse hands the trauma nurse a filled syringe that they have already drawn the morphine into. 

What action should the trauma nurse take?

  • Tell the other nurse to waste the medication, and that they will draw it up themselves and administer it to the patient

  • Refuse, and tell the nurse that they must give the medication to the patient

  • Give the patient the medication because it is an emergency

  • Ask the ER nurse to label the syringe before giving it to the trauma nurse for administration to the patient

Correct answer: Tell the other nurse to waste the medication, and that they will draw it up themselves and administer it to the patient

It is reasonable to ask another nurse to administer a medication while the patient's primary nurse responds to an emergency; however, the trauma nurse should not administer a syringe that is unlabeled and that they did not draw up themselves. 

Refusing to administer the medication is not correct, and giving the medication that has been drawn up is also incorrect. Asking the nurse to label the medication does not provide additional reassurance that the medication is the correct one.

The trauma nurse should draw up the medication themselves and administer it. This may require the medication already drawn up to be discarded.

5.

Which level(s) of trauma centers will not generally accept trauma transfers?

  • Level 3 and level 4 trauma centers

  • Level 4 trauma centers

  • Level 2, level 3 and level 4 trauma centers

  • All trauma centers will generally accept trauma transfers

Correct answer: Level 3 and level 4 trauma centers

Level 1 and level 2 trauma centers will accept all trauma transfers. In exceptional cases, a level 3 trauma center may accept trauma transfers, but will not do so generally. A level 4 trauma center will not normally accept trauma transfers.

6.

Which of the following findings should the nurse notify the physician of after a chest tube is placed?

  • 1600 mL of drainage collected immediately after insertion

  • 100mL/hr of drainage collected for 6 hours after insertion

  • Only 100 mL of drainage initially collected

  • Patient complains of a spike in pain after the chest tube is placed

Correct answer: 1600 mL of drainage collected immediately after insertion

Drainage of more than 1500 mL obtained upon insertion of a chest tube can indicate a continued bleed, and the physician should be notified of this finding. 

Drainage of 200 mL or more per hour over 4 or more hours may indicate a bleed. A low amount initially collected is not an ominous finding unless a large amount was expected. Increased pain after chest tube placement is an expected finding.

7.

A patient with a T4 spinal cord injury is learning how to transfer from a bed to a wheelchair. Which of the following instructions is most important?

  • Change positions slowly

  • Lock your knees

  • Position the wheelchair facing the bed

  • Always ask for help

Correct answer: Change positions slowly

Spinal cord injuries above T7 can lead to orthostatic hypotension, and patients who have this type of spinal cord injury should be instructed to change positions slowly to avoid dizziness or syncope. 

Locking the knees will not be possible for many patients with a T4 spinal cord injury. The wheelchair should be positioned perpendicular to the bed, not facing the bed. While the patient may need help initially, they should become able to transfer independently, without asking for help.

8.

A 42-year-old female presents after involvement in a motor vehicle accident with periorbital ecchymosis. Which of the following fractures is most likely to be present, given this finding?

  • Le Fort III

  • Le Fort I

  • Le Fort II

  • Mandibular fracture

Correct answer: Le Fort III

Le Fort fractures are facial fractures in which the midfacial skeletal structure partially or fully separates from the skull. A Le Fort III fracture is a transverse facial fracture that involves the orbits, causing periorbital ecchymosis, also called “raccoon eyes”. 

A Le Fort I, Le Fort II, or a mandibular fracture is not likely to cause periorbital ecchymosis.

9.

The trauma nurse is assessing a patient with periorbital swelling who has recently received a paralytic agent. The nurse needs to assess the patient's Glasgow Coma Scale (GCS) score. 

Which of the following approaches is correct?

  • Assess the GCS, but note the presence of periorbital swelling and recent use of a paralytic agent

  • Wait until the paralytic agent wears off to assess the GCS

  • Do not use the GCS to assess this patient

  • Use the GCS, but add 2 to the end score to compensate for interfering conditions

Correct answer: Assess the GCS, but note the presence of periorbital swelling and recent use of a paralytic agent

The Glasgow Coma Scale (GCS) is a valuable and widely used clinical tool that can provide invaluable information. Using the GCS as an assessment tool should not be avoided just because there are interfering factors; however, these interfering factors should be noted. 

The GCS should not be changed or adjusted because of the interfering conditions, and use of the GCS to assess a patient should not be delayed until medications wear off.

10.

A two-year-old, who is the youngest of five children and whose father is a wealthy CEO, presents to the emergency room with a burn injury with splatter marks on his bilateral forearm. The patient's father states that the patient was burned by spilling a cup of fresh, hot coffee that was sitting on a coffee table. 

Which of the following is the strongest indicator that this injury was not caused by abuse?

  • The description of the injury

  • The age of the patient

  • The birth order position of the patient

  • The socioeconomic background of the patient's father

Correct answer: The description of the injury

The description of the injury is consistent with the nurse's assessment and is a strong indicator that the injury occurred as described. 

The patient's age and birth order position does not make them more or less likely to be the victim of abuse. The socioeconomic background of the patient's father does not mean that the patient's family is more or less likely to be abusive than other people.

11.

The trauma nurse needs to be aware of the normal physiologic alterations that are expected during pregnancy when assessing a pregnant trauma patient. Which of the following is not a normal physiologic alteration in a patient who is 10 weeks pregnant?

  • Edema of the ankles

  • Breast tenderness

  • Headaches

  • Severe fatigue

Correct answer: Edema of the ankles

Edema of the ankles is a normal physiologic alteration expected during pregnancy during the third trimester (29-40 weeks gestation). 

A patient who is in their first trimester (1-12 weeks) may have breast tenderness, headaches, and severe fatigue, but will not be likely to have edema of the ankles.

12.

Which of the following is the most likely cause of blunt trauma in patients who are pregnant?

  • Motor vehicle accidents

  • Assaults

  • Falls

  • Workplace injuries

Correct answer: Motor vehicle accidents

Women who are pregnant most commonly experience blunt trauma from motor vehicle accidents. 

While pregnancy increases the risk of assault, the risk of motor vehicle accidents is still greater in this population. Falls are the third most common cause of blunt trauma in patients who are pregnant, while workplace injuries to pregnant women are uncommon.

13.

Which of the following would electroencephalography not provide information about for the medical team?

  • Intracranial pressure

  • Seizure activity

  • Depth of sedation

  • Cerebral perfusion

Correct answer: Intracranial pressure

Electroencephalography (EEG) measures a patient's brainwaves and provides information about neurological activity. Seizure activity will create changes in electrical activity that can be detected on an EEG. The depth of sedation will also affect electrical activity in the brain, making EEG helpful in determining how deep sedation is. 

Cerebral perfusion is not directly measured by EEG, but insufficiencies in cerebral perfusion do correlate with electrical activity in the brain. 

Intracranial pressure (ICP) does not correlate with electrical activity in the brain, and while increased ICP will cause electrical changes, an EEG is not used to assess ICP levels.

14.

What type of burn will commonly cause injuries that will not be appreciable during the initial physical assessment of the patient?

  • Electrical

  • Thermal

  • Chemical

  • Radiation

Correct answer: Electrical

Electrical energy often transverses the body between the point of contact with the area of high voltage and the grounding point nearest to the point of contact. Because electrical energy travels through the body, much of the burn will not be appreciable during initial physical assessment of the patient. 

Thermal burns and chemical burns typically affect the external surfaces and will be appreciable during a physical assessment. Some types of radiation burns, such as radiation burns sustained during cancer treatments, may be both internal and external, although these will often be more visible than electrical burns. The most common form of radiation burn, sunburns, are very noticeable during physical assessments.

15.

Which of the following exams is most useful for confirming the presence of a penile fracture?

  • MRI

  • Plain-film radiography

  • CT

  • The penis cannot be fractured

Correct answer: MRI

A penile fracture refers to the rupture of the tunica albuginea, typically due to bending of an erect penis during sexual activity. While the penis does not contain osseous structures, a rupture of the tunica albuginea is considered to be a fracture of the penis. 

MRI is the best form of imaging to assess for this condition.

16.

Which of the following will most assist the decontamination of a patient exposed to a dry chemical?

  • Taking their clothes off

  • Washing after taking their clothes off

  • Washing with their clothes still on

  • Brushing their clothes off vigorously

Correct answer: Taking their clothes off

Taking the patient's clothes off will remove most of the dry chemical. 

Washing after taking their clothes off will further reduce the patient's exposure, but not to the extent that taking their clothes off will. Washing with clothes still on is not recommended, as this can activate the dry chemical or cause it to seep through clothing or be otherwise displaced. Brushing the patient's clothes off vigorously could aerosolize the powder and cause further contamination.

17.

Traumatic injury to which organ will be treated operatively, even if the patient is hemodynamically stable?

  • Small bowel

  • Spleen

  • Liver

  • Pancreas

Correct answer: Small bowel

The decision to treat abdominal trauma operatively or not depends on if the patient is hemodynamically stable and if there is a risk of infection if the trauma is left unaddressed. Trauma to the small bowel can lead to perforation that could cause peritonitis, and will be treated surgically, even if the patient is hemodynamically stable. 

Trauma to the spleen, liver, and pancreas will only be treated surgically if the trauma causes hemodynamic instability.

18.

The trauma nurse is calculating the amount of fluid needed for a patient who has been severely burned. When calculating the percentage of the body area burned, what should the nurse consider to be a burn?

  • Only partial-thickness burns and full-thickness burns

  • Any reddened area

  • Superficial burns, partial-thickness burns, and full-thickness burns

  • Only full-thickness burns

Correct answer: Only partial-thickness burns and full-thickness burns

When calculating the total surface area burned, only areas with partial-thickness burns and full-thickness burns should be counted. 

Superficial burns and any other areas that are considered burns or irritation should not be counted.

19.

The trauma nurse is treating a patient who was saved from a house fire and brought to the emergency room with carbon monoxide poisoning. Which of the following considerations for this patient is correct?

  • The patient should be provided with high concentration oxygen

  • Carbon monoxide and oxygen have close to an equal affinity for hemoglobin

  • The patient needs continuous oximetry to monitor their progression

  • Carbon monoxide poisoning affects the lining of the lungs

Correct answer: The patient should be provided with high concentration oxygen

Carbon monoxide's half life is about four hours on room air and about one hour with 100% oxygen. Administering high concentration oxygen decreases carbon monoxide more quickly, improving the patient's oxygenation. 

Carbon monoxide has an affinity for hemoglobin that is about 200 times that of oxygen. Carbon monoxide that is bound to hemoglobin may be detected as oxygenated blood by pulse oximetry, making this method of monitoring less clinically useful. Carbon monoxide poisoning does not affect the lining of the lungs.

20.

The nurse is treating a patient with pain related to a spinal cord injury in the rehab setting. Which of the following is true about pain related to a spinal cord injury?

  • It can increase the risk of depression

  • It will never completely resolve

  • It is likely that it will be completely eliminated

  • Chronic pain only typically develops in the lower back

Correct answer: It can increase the risk of depression

Pain related to a spinal cord injury (SCI) is associated with an increased risk of depression if the pain becomes chronic. 

SCI associated pain may completely resolve, but is not likely to be completely eliminated. The prevalence of chronic pain with a spinal cord injury is 26 to 96%. Chronic SCI-related pain can often develop between the shoulders and is not limited to the lower back.

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