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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 10 of 25

181.

Which of the following laboratory values is most important to check in a patient who has suffered massive musculoskeletal trauma?

  • Potassium

  • Calcium

  • Magnesium

  • Phosphorus

Correct answer: Potassium

Massive musculoskeletal trauma can cause hyperkalemia as a large number of cells are damaged and release their contents into the blood stream. 

Calcium, magnesium, and phosphorus are not as essential to check as potassium for these patients.

182.

The trauma nurse is teaching a new nurse about extremity injuries. Which of the following descriptions by the new nurse correctly describes a strain?

  • A stretch or tear in a muscle or tendon

  • A stretch or tear in a ligament

  • An area of broken capillaries or venules beneath the skin

  • An injury in which tissue is torn away or separated

Correct answer: A stretch or tear in a muscle or tendon

A strain is a stretch or tear in a muscle or tendon that occurs due to traumatic injury. 

A sprain, not a strain, is a stretch or tear in a ligament. An area of broken capillaries or venules beneath the skin describes a contusion, while an injury in which tissue is torn away or separated describes an avulsion.

183.

The trauma nurse understands that which of the following is not a result of sympathetic nervous system stimulation?

  • Increased gastric secretions

  • Increased secretions of sweat glands

  • Increased respiratory rate

  • Decreased urine output

Correct answer: Increased gastric secretions

Stimulation of the sympathetic nervous system leads to a decrease (not increase) in secretions such as gastric secretions.

Stimulation of the sympathetic nervous system increases secretions of sweat glands, increases respiratory rate, and decreases urinary output.

184.

Which of the following is least likely to affect the ability to obtain an accurate oxygen saturation reading?

  • Severe tension pneumothorax

  • Methemoglobinemia

  • Carbon monoxide poisoning

  • Hypovolemic shock

Correct answer: Severe tension pneumothorax

A severe tension pneumothorax may cause severe hypoxia; however, it will not interfere with the ability to obtain an accurate oxygen saturation reading, even though the reading may be low.

Methemoglobinemia and carboxyhemoglobin can mimic oxyhemoglobin and lead to false high oxygen saturation readings. Hypovolemic shock can cause poor perfusion in the digits and other areas where oxygen saturation readings are typically acquired, making for inaccurate oxygen saturation readings.

185.

A 10-month-old infant has suffered a head injury during a fall from a changing table. Which of the following considerations is correct when assessing this patient using the Glasgow Coma Scale (GCS)?

  • The GCS can be used, but must be modified

  • The GCS should be used as normally; however, a normal score is a score of 13 or greater

  • The GCS cannot be used for this patient

  • Only eye-opening and best motor response can be used, and the score is ranked from 2-10 instead of 3-15 as it is in adults

Correct answer: The GCS can be used, but must be modified

As infants may not understand commands and are unable to provide verbal responses like an adult would, the GCS must be modified to adapt for these factors. 

A normal, adult GCS is not used; however, the modified GCS can still be used. While each category is modified, no category is eliminated, and the interpretation of the GCS score will be comparable to adults.

186.

A patient who has just been brought to the ER after being in a house fire has an elevated respiratory rate, shortness of breath, confusion, eye irritation, and elevated serum lactate after receiving 1 L of IV crystalloids. 

Which of the following interventions is most important to treat suspected cyanide poisoning?

  • Treat the patient with a hydroxocobalamin cyanide kit

  • Administer more IV fluids

  • Test the patient's cyanide level

  • Administer 100% O2 via a non-rebreather mask

Correct answer: Treat the patient with a hydroxocobalamin cyanide kit

The patient has hallmark signs of cyanide poisoning and should be treated using a hydroxocobalamin cyanide kit as the antidote for cyanide. 

Cyanide poisoning can occur during house fires, depending upon the material that is burning. There is a laboratory test for cyanide, but it normally has a turnaround time of over 24 hours, making it impractical to use for clinical decision-making. Cyanide antidote should be administered prophylactically without taking the time to obtain a laboratory result.

Administering more IV fluids will not help treat cyanide poisoning. Administering 100% O2 via a non-rebreather mask will help treat carbon monoxide poisoning but not cyanide poisoning.

187.

A 43-year-old female presents to the ER via EMS after a motor vehicle accident. Her radiograph shows a left femoral head fracture, and she has an area of open skin over her left thigh that appears to be a shallow abrasion. The femur is in two pieces and both pieces seem to be aligned. 

What type of fracture would this be?

  • Open fracture

  • Comminuted fracture

  • Incomplete fracture

  • Displaced fracture

Correct answer: Open fracture

A fracture that has non-intact skin above it is always considered an open fracture, even if the bone is still aligned, and it does not appear that the bone caused the opening in the skin. 

The bones are aligned, so this would not be considered a displaced fracture. A comminuted fracture is fragmented at the fracture site. In an incomplete fracture, the bone would still be in one piece.

188.

Which of the following burn injuries is most likely to be accompanied by concurrent injuries?

  • Being struck by lightening

  • Being splashed with acid

  • Being exposed to radiation while providing a cancer treatment

  • Having your arm ignited while by a campfire

Correct answer: Being struck by lightening

Lightening causes a shock wave that can cause concurrent, non-burn related injuries, in addition to electrical burns. 

Being splashed with acid, being exposed to radiation while providing a cancer treatment, or having your arm ignited while by a campfire are not likely to cause concurrent injuries by themselves.

189.

Which of the following factors is not an indicator that operative management is necessary for managing a splenic injury?

  • Age 51

  • Hemodynamic instability

  • Presence of other intra-abdominal injuries

  • Traumatic brain injury that limits patient participation in abdominal exams

Correct answer: Age 51

Operative management is typically necessary for managing a splenic injury for patients aged 55 or older. It is also necessary in patients with hemodynamic instability, patients who have other intra-abdominal injuries, and patients who have a TBI that limits participation in abdominal exams.

190.

Which of the following considerations is important for trauma nurses in rural areas?

  • Rural residents are 50% more likely to die of trauma than urban residents

  • Rural residents are 50% less likely to die of trauma than urban residents

  • Rural residents are about as likely to die of trauma as urban residents

  • Rural residents are more likely to refuse treatment for trauma than urban residents

Correct answer: Rural residents are 50% more likely to die of trauma than urban residents

Rural populations tend to be older than urban populations and typically take longer to get to facilities providing definitive care due to the lower population densities of rural areas. This results in a higher fatality rate from trauma. 

Rural residents are not less likely or equally likely to die of trauma than urban residents. Rural residents are also not significantly more likely to refuse treatment for traumatic injuries than urban residents are.

191.

A 44-year-old male who was partially trapped in a car that was on fire is brought to the trauma center with fourth-degree burns to his bilateral lower legs. Which of the following treatments will likely be necessary?

  • Amputation of the extremities

  • Only skin grafts on the burned areas

  • Both muscle and skin grafts over the burned areas

  • This injury is fatal; only comfort care measures are needed

Correct answer: Amputation of the extremities

Limbs that have a fourth-degree burn, which involves the muscle, bones, vasculature, and/or the nerves, will almost always require amputation due to the extent of the injury. 

Skin and/or muscle grafts will not be effective except in rare situations. While amputation may be necessary, it is not likely to be fatal if treated with amputation.

192.

Which of the following is not a late sign of elevated intracranial pressure (ICP)?

  • Amnesia

  • Non-reactive pupils

  • Reflex bradycardia

  • Flaccidity

Correct answer: Amnesia

Amnesia is an early sign of increased ICP. To demonstrate amnesia the patient must be at least somewhat responsive, which is only typically true with early increases in ICP.

Reflex bradycardia, non-reactive pupils, and flaccidity are all late signs of elevated ICP.

193.

The family member of a patient who has been shot in the head asks you how likely the patient is to survive. Which of the following is not associated with increased mortality after a penetrating head trauma?

  • Male sex

  • Hypotension

  • Self-inflicted injury

  • Low GCS score

Correct answer: Male sex

There are several factors that increase the probability of death following a penetrating head trauma, including hypotension, hypoxia, increased ICP, self-inflicted injury, and a low GCS score. The sex of the patient, however, is not a significant risk factor for increased mortality.

194.

Which of the following is the only digestive organ attached to the anterior abdominal wall?

  • Liver

  • Gallbladder 

  • Pancreas

  • Small bowel

Correct answer: Liver

The liver is attached to the abdominal wall and diaphragm by the falciform ligament and is the only digestive organ attached to the anterior abdominal wall. 

The gallbladder, pancreas, and small bowel are not attached to the anterior abdominal wall.

195.

A physician tells the trauma nurse to attach defibrillator pads to a patient so that the team can prepare to pace the patient externally if needed. Which of the following responses best exhibits high-quality closed loop communication?

  • "I will attach defibrillator pads and prepare to pace if needed."

  • "I will attach defibrillator pads to the patient so that the team can prepare to pace the patient externally if needed."

  • "I have heard and understood your instructions and will carry them out."

  • "Okay, I will prepare to attach the defibrillator pads."

Correct answer: "I will attach defibrillator pads and prepare to pace if needed."

Closed loop communication requires repeating back the concept that was communicated. This provides the team leader with the opportunity to be sure their instructions were understood. 

Closed loop communication should be as concise as possible and does not need to be a verbatim repetition of the instructions given. The nurse should acknowledge both the instructions to attach the defibrillator and the instructions to prepare to pace, even though the instruction to prepare to pace was less clear.

196.

At what point in the initial assessment and treatment of a trauma patient should the nurse anticipate initiating IV access?

  • During the "circulation" step of the primary survey

  • During the get "resuscitation adjuncts" step of the primary survey

  • During the "airway" step of the primary survey

  • During the secondary survey

Correct answer: During the "circulation" step of the primary survey

IV access should be established during the circulation step of the primary survey, as IV access is not typically needed to emergently treat airway or breathing, but is needed to address many emergency circulatory concerns. 

Establishing IV access should not be delayed until a later step of the trauma survey.

197.

A patient who has experienced a head trauma has an atlanto-occipital dislocation, a type of cervical fracture in which the atlas dislocates from the occipital bone. 

What consideration should guide the trauma nurse's care?

  • This type of fracture is often fatal

  • This type of fracture occurs more often in children

  • This type of fracture is likely caused by abuse

  • Carotid artery involvement is highly likely

Correct answer: This type of fracture is often fatal

An atlanto-occipital dislocation creates instability of the spine at the base of the skull, affecting the medulla and often resulting in death. 

This type of fracture is not more common in children, is not normally caused by abuse, and involvement of the carotid artery is not a significant factor.

198.

Which of the following is least likely to be a cause of compartment syndrome?

  • Administration of mannitol 

  • Bleeding disorders

  • Venomous bites

  • Eschar from burns

Correct answer: Administration of mannitol 

Administration of mannitol may decrease, not increase, intracompartmental pressures. 

Bleeding disorders and venomous bites are potential internal causes of compartment syndrome. Eschar from burns can cause external compression that increases the pressure on the compartments, increasing the risk of compartment syndrome.

199.

A 22-year-old male has a tibia fracture at the proximal epiphyseal plate after a skateboarding accident. Which of the following is a consideration for this type of fracture?

  • The risk of bone length alterations due to the healing pattern of this fracture is only a concern for prepubescent or adolescent patients.

  • There is a risk of bone length alterations due to the healing pattern of this fracture for this patient.

  • There is a significant risk of non-union due to the healing pattern of this fracture for this patient.

  • The risk of non-union due to the healing pattern of this fracture is only a concern for prepubescent or adolescent patients.

Correct answer: The risk of bone length alterations due to the healing pattern of this fracture is only a concern for prepubescent or adolescent patients.

The epiphyseal plate is also called the growth plate and is the site of growth in the bone. A fracture at this site while the bone is growing can lead the bone to stop lengthening prematurely or to continue to lengthen beyond its ideal length. Once growth has stopped, however, this risk is no longer a consideration.

There is not a significantly increased risk of non-union with this type of fracture, regardless of age.

200.

A patient who is hemorrhaging has bradycardia with pale and clammy skin. They are obtunded. Which of the following is true about the treatment of this patient's condition?

  • Interventions for this patient are likely to be ineffective

  • Initiating rapid transfusion protocols will reverse this patient's hypovolemic shock

  • This patient is developing obstructive shock and will probably die

  • This patient is in compensated shock and requires aggressive and immediate interventions

Correct answer: Interventions for this patient are likely to be ineffective

Bradycardia, pale and clammy skin, and being obtunded are all signs of irreversible shock, indicating ischemia and necrosis of tissues and cells throughout the body. Interventions in this stage of shock are likely to be ineffective. 

Initiating rapid transfusion protocols is the correct intervention for this patient, as the patient is in hypovolemic shock; however, these interventions are not likely to be effective. There are no indicators that this patient is developing obstructive shock, and these symptoms are consistent with irreversible, not compensated, shock.

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