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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 2 of 25

21.

Which of the following fluids is best for a patient who has increased intracranial pressure (ICP)?

  • 5% normal saline

  • 0.9% normal saline

  • 0.45% normal saline

  • 5% dextrose 

Correct answer: 5% normal saline

Hypertonic saline can draw fluid off of the brain and may avoid some of the negative effects of mannitol, such as hypotension. The brain, however, will adapt to permissive hypernatremia, and the efficacy of this treatment will be reduced after 48 hours. 

0.9% normal saline and 5% dextrose are isotonic solutions and 0.45% normal saline is hypotonic. These solutions will not decrease ICP.

22.

Which of the following will increase a patient's risk of developing compartment syndrome?

  • Venomous spider bite

  • Broken fifth digit of the foot

  • Kerlix dressing applied correctly to the left lower leg

  • Dehydration

Correct answer: Venomous spider bite

A venomous bite can lead to shifts in intracompartmental fluids that can cause compartment syndrome. 

A broken bone next to a compartment may increase the risk of compartment syndrome; however, the fifth digit of the foot is not within a compartment, making the risk of compartment syndrome with this type of injury low. 

A pressure dressing or a Kerlix dressing that is applied too tightly can cause external pressure that increases the risk of compartment syndrome; however, a correctly applied Kerlix dressing will not increase this risk. 

Dehydration does not significantly increase the risk of compartment syndrome.

23.

Which of the following best describes the zone of stasis in a burn injury?

  • This zone has impaired blood flow

  • This zone contains necrotic tissue

  • This zone is likely to heal rapidly

  • This zone will develop eschar

Correct answer: This zone has impaired blood flow

The zone of stasis in a burn is characterized by impaired blood flow, but can be recovered if adequate blood flow is restored. 

The zone of coagulation describes the zone that contains necrotic tissues and that develops eschar. The zone of hyperemia is damaged, but is likely to recover quickly.

24.

When assessing a patient for cervical spine injury using the Canadian C-Spine Rule, which of the following is not considered a dangerous mechanism of injury?

  • Experiencing a motor vehicle accident with a 45 mph impact

  • Falling down a flight of stairs

  • Hitting one's head while diving

  • Riding a bicycle in a bicycle vs. car collision

Correct answer: Experiencing a motor vehicle accident with a 45 mph impact

According to the Canadian C-Spine Rule, a tool commonly used to clear the cervical spine, dangerous injuries include falling down five or more stairs, axial load to the head (including diving injuries), and riding a bicycle that is struck by a car. 

A motor vehicle accident is considered a dangerous injury when there is a 100 kph (~60 mph) impact, rollover, or ejection.

25.

A group of agricultural workers is in a field that is accidentally crop-dusted with an organophosphate. Which of the following is the most important initial intervention for these individuals?

  • Evacuation

  • Disrobing

  • Decontamination

  • No interventions needed 

Correct answer: Evacuation

Organophosphates are nerve agents that can cause cholinergic toxicity. Intervention is certainly needed after potential exposure to organophosphates. Evacuation is the most important initial intervention, as decontamination and disrobing in the affected area will result in continued and potentially worsening exposure.

26.

The trauma nurse provides care to a patient who was rescued from a house fire and who smokes two packs of cigarettes a day. 

How will the patient's smoking history impact their carboxyhemoglobin levels?

  • The baseline carboxyhemoglobin may be higher, but will elevate at about the same rate as someone who doesn't smoke

  • A smoking history will not impact their carboxyhemoglobin level

  • The baseline carboxyhemoglobin will be the same as a non-smoker, but will elevate significantly faster than someone who doesn't smoke

  • The baseline carboxyhemoglobin may be higher and will elevate significantly faster than someone who doesn't smoke

Correct answer: The baseline carboxyhemoglobin may be higher, but will elevate at about the same rate as someone who doesn't smoke

A non-smoker's baseline carboxyhemoglobin level will be 0-3%, while a smoker's baseline carboxyhemoglobin level will be 0-15%. While the baseline carboxyhemoglobin may be different, smoking will not play a role in elevating someone's carboxyhemoglobin level more quickly. A smoker, however, may have a higher carboxyhemoglobin level than a non-smoker with a similar level of exposure due to starting with a higher baseline.

27.

Which of the four conditions, if called into the trauma center by EMS prior to their arrival, is associated with the highest risk of exsanguination?

  • Partial amputation

  • Complete amputation

  • Open fracture

  • Degloving injury

Correct answer: Partial amputation

Partial amputation carries the highest risk of bleeding of the four conditions given. In a complete amputation, the transected vasculature retracts and spasms. In a partial amputation, the vasculature continues to attempt to perfuse the organ without having the same degree of vasospasm, making a partial amputation a higher risk of bleeding than a complete amputation. 

An open fracture may or may not involve the vasculature, while amputations almost always do. A degloving injury, while serious, does not typically involve veins and arteries, reducing the risk of bleeding compared to the other conditions.

28.

A patient presents after being struck in the head with a baseball bat. Which of the following describes the injury that occurs when the brain contacts the skull at the site of the impact?

  • Coup injury

  • Contrecoup injury

  • Rotation injury

  • Skull deformation

Correct answer: Coup injury

A coup injury occurs when the brain contacts the skull at the site of an impact due to the skull accelerating faster than the brain. 

Contrecoup injuries occur when the brain contacts the skull on the site directly opposite of the impact as the brain accelerates away from the impact while the skull is decelerating. Rotation injury occurs when the brain twists along the axis of the spinal cord. Skull deformation may occur during blunt trauma to the head, but does not describe the injury in the question stem.

29.

An eight-month-old infant who has sustained a traumatic injury has a respiratory rate of 65 breaths per minute and a heart rate of 120 beats per minute. Which of the following interpretations of these vital signs is correct?

  • The patient's respiratory rate is elevated and the heart rate is normal

  • The patient's respiratory rate is normal and the heart rate is elevated

  • Both the patient's respiratory rate and heart rate are elevated

  • The patient's respiratory rate is normal and the heart rate is low

Correct answer: The patient's respiratory rate is elevated and the heart rate is normal

The normal respiratory rate for an infant is 30-53 breaths per minute and the normal heart rate for an awake infant is 100-205. This means that the patient's respiratory rate is elevated and the heart rate is normal.

30.

Which of the following interventions is most important for a patient who is suspected to have a tracheobronchial injury?

  • Obtain a surgical consult

  • Prepare to insert a chest tube

  • Institute comfort measures

  • Obtain an ABG

Correct answer: Obtain a surgical consult

Tracheobronchial injuries are often fatal, with most patients who have this type of injury dying at the scene. If a patient is suspected to have a tracheobronchial injury, they will require an immediate surgical consult, as surgical repair of the injury is typically warranted, and as this injury is often fatal, potentially deteriorating quickly. 

Inserting a chest tube will not help to treat a tracheobronchial injury and may worsen it. While tracheobronchial injury is often fatal, it can be treated with surgical measures, and thus, instituting comfort measures is not necessary. 

Obtaining an ABG is not incorrect, but will not provide diagnostic information needed to reveal if the patient has a tracheobronchial injury; a bronchoscopy is necessary for this.

31.

Which of the following is not correct when considering the use of partial pressure end tidal carbon dioxide (PETCO2) monitoring during CPR?

  • A waveform is only present during spontaneous breaths

  • Lower waveform plateaus will be present if spontaneous circulation is absent

  • PETCO2 can be used to assess the quality of CPR

  • PETCO2 can be used to assess for the return of spontaneous circulation

Correct answer: A waveform is only present during spontaneous breaths

A PETCO2 waveform is present during any monitored breath, whether it is spontaneous or ventilated. 

Lower waveform plateaus will be present if spontaneous circulation is absent because less CO2 is being returned to the lungs. PETCO2 can be used to assess for the return of spontaneous circulation, as end tidal CO2 will increase substantially when spontaneous circulation is restored. 

PETCO2 can be used to assess the quality of CPR, as low quality CPR will result in a lower or absent end tidal CO2.

32.

Which of the following is not a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) critical communication point during trauma treatment?

  • Execution

  • Brief

  • Huddle

  • Debrief

Correct answer: Execution

There are three important TeamSTEPPS critical communication points during trauma treatment. These include briefs, huddles, and debriefs. Briefs typically precede the clinical situation or event, but may occur at the beginning of treatment. Huddles include teamwork communication during an event or situation and are designed to change or modify the plan. Debriefs occur following the event or situation and help to optimize future performance.

33.

Which of the following best describes the main use of colorimetric capnography?

  • Determining the presence or absence of carbon dioxide

  • Monitoring the concentration of exhaled carbon dioxide of an intubated patient

  • Monitoring for return of spontaneous circulation (ROSC)

  • Quantifying dissolved carbon dioxide in blood

Correct answer: Determining the presence or absence of carbon dioxide

Colorimetric capnography uses a pH sensitive paper to determine the presence or absence of carbon dioxide and is primarily used to determine if an advanced airway is in the lungs or not.

In-line capnography can be used to quantify exhaled carbon dioxide levels in an intubated patient and monitor for ROSC. Quantifying dissolved carbon dioxide in blood is done through an ABG, not through capnography.

34.

What volume of fluid should be administered to a burn patient in the first 24 hours following the injury if the burn covers 50% of the patient's body surface area?

  • There is not enough data to calculate the volume needed

  • 8,800 mL

  • 9,500 mL

  • 5,000 mL

Correct answer: There is not enough data to calculate the volume needed

The calculation for the amount of fluid needed after a burn is weight (in kg), multiplied by 2, multiplied by % of total body surface area burned. The patient's weight is necessary to calculate this value and is not provided in the question, making it impossible to determine.

35.

Which of the following patients would benefit the most from use of cognitive behavior therapy to manage their pain?

  • A 43-year-old male who suffered a left lower limb traumatic amputation three days ago

  • A 31-year-old female who has ongoing pain due to severely increased intracranial pressure

  • A 91-year-old female who is being evaluated after a motor vehicle accident and has mild discomfort during assessment

  • A 54-year-old male who is temporarily deaf and blind after a blast injury and has painful burns

Correct answer: A 43-year-old male who suffered a left lower limb traumatic amputation three days ago

Cognitive behavior therapy (CBT) is a type of psychotherapy that focuses on the significance thinking has on influencing our feelings and actions. CBT can be a non-pharmacological pain management intervention that is ideal for chronic pain. A patient who has a recent history of traumatic amputation will likely have ongoing pain and will be a candidate for CBT after the acute treatment phase is over, which will be the case after three days. 

Severely increased intracranial pressure or inability to receive instructions due to blindness and deafness will inhibit the patient's ability to participate in CBT. A patient who only has mild discomfort and may not need ongoing pain management is not the ideal candidate for CBT.

36.

Which of the following medications is not used as a paralytic while performing a rapid sequence intubation?

  • Propofol

  • Succinylcholine

  • Rocuronium

  • Vecuronium

Correct answer: Propofol

Propofol is an induction agent, not a paralytic. While propofol may cause complete flaccidity at high doses, it is not considered a paralytic because it does not act on muscles. 

Succinylcholine, rocuronium, and vecuronium are all paralytic agents that can be used while performing a rapid sequence intubation.

37.

Which of the following statements is correct regarding gunshot wound victims?

  • Denser organs absorb more kinetic energy from gunshot wounds, accumulating more damage

  • Less dense organs absorb more kinetic energy from gunshot wounds, accumulating more damage

  • Denser organs absorb more static energy from gunshot wounds, accumulating more damage

  • Less dense organs absorb more static energy from gunshot wounds, accumulating more damage

Correct answer: Denser organs absorb more kinetic energy from gunshot wounds, accumulating more damage

Bullets cause damage by transferring kinetic energy, not static energy, to organs and tissues. Denser organs will absorb more energy as the bullet passes through them, accumulating more damage than less dense organs.

38.

A 34-year-old male is brought to the emergency room with subconjunctival hemorrhage after a motor vehicle accident. Which of the following is true about this injury?

  • It is likely to resolve without a lasting effect on vision

  • It is never associated with serious intraocular or orbital trauma

  • It is often associated with serious intraocular or orbital trauma

  • It is caused by eye disease, not by trauma

Correct answer: It is likely to resolve without a lasting effect on vision

Subconjunctival hemorrhage is bleeding within the conjunctiva. This may be caused by trauma, but the bleeding is normally reabsorbed within days to a few weeks and does not cause any lasting effects on vision. 

Subconjunctival hemorrhage can be associated with serious intraocular or orbital trauma, but this is uncommon.

39.

Of the following complications of renal injury, which one is least likely to develop within the first four weeks?

  • Hypertension

  • Infected urinoma

  • Hemorrhage

  • Arteriovenous fistula

Correct answer: Hypertension

Hypertension is a complication of renal injury but is unlikely to occur until at least four weeks after the injury. 

An infected urinoma, hemorrhage, and formation of an arteriovenous fistula are all complications of renal injury that are likely to occur within four weeks of the injury.

40.

Which of the following types of renal failure are trauma patients at the greatest risk for?

  • Prerenal failure

  • Intrarenal failure

  • Postrenal failure

  • Trauma patients are not at a risk of renal failure

Correct answer: Prerenal failure

Prerenal failure refers to a loss of normal kidney function that occurs due to injuries not directly affecting the kidneys. This can be any injury that decreases circulation to the kidneys, causing renal failure. 

Intrarenal failure is kidney failure caused by injury to the renal parenchyma. Postrenal failure is renal failure caused by damage to the drainage system, including the bladder, ureters, and urethra. Traumatic injury to these postrenal organs is only likely to lead to acute renal failure if the flow of urine is obstructed.

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