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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 3 of 25

41.

Which of the following mechanisms of injury would be least likely to suggest aortic disruption?

  • Restrained passenger in a motor vehicle accident involving a head-on collision 

  • A fall from 45 feet

  • Pedestrian struck by motor vehicle

  • Ejection from a motor vehicle accident

Correct answer: Restrained passenger in a motor vehicle accident involving a head-on collision 

A motor vehicle accident (MVA) involving a head-on collision is not likely to raise as high a degree of suspicion for aortic disruption as the other injuries listed. If the passengers were unrestrained or ejected from the vehicle, aortic disruption would be a reasonable suspicion.

Ejection from a motor vehicle accident, being struck by a motor vehicle as a pedestrian, or falling from more than 10 feet are all criteria that should increase the suspicion of aortic disruption.

42.

Which of the following data is used to set the tidal volume of a trauma patient who is being placed on a mechanical ventilator?

  • The patient's predicted body weight

  • The patient's actual body weight

  • The patient's age

  • The patient's PaO2

Correct answer: The patient's predicted body weight

Tidal volume (VT) is calculated using the patient's predicted body weight, not their actual body weight. In most situations, a VT of 6-8 mL/kg is used. 

The patient's age is not normally a significant factor when considering VT except for potentially in small, pediatric patients. The PaO2 may be used to help determine the FiO2 needed, but will not be used to determine VT.

43.

Which of the following is not considered one of the 6 Ps of compartment syndrome?

  • Potassium elevation

  • Poikilothermia

  • Paralysis

  • Pallor

Correct answer: Potassium elevation

Potassium elevation may occur as cells become ischemic and release their contents, however, this is not considered one of the clinical hallmarks of compartment syndrome. 

Poikilothermia is a late sign as distal regulation of the limb's temperature is affected. Paralysis is also a late sign once there is significant nerve involvement. Pallor is also one of the 6 Ps, along with pain, pulses, and parasthesia.

44.

A patient with blunt head trauma presents with rhinorrhea. Which of the following tests is the most reliable way to determine whether the drainage is cerebrospinal fluid (CSF)?

  • Test the drainage for beta-2 transferrin

  • Test the drainage for glucose

  • Test the drainage for a positive halo sign

  • Measure the patient's intracranial pressure (ICP)

Correct answer: Test the drainage for beta-2 transferrin

Beta-2 transferrin is specific to CSF and is considered the gold standard for determining whether drainage is CSF.

Testing for glucose is not the gold standard, but may be used as a quicker test. A halo sign is unreliable and not typically recommended. Measuring the ICP may be necessary but will not indicate whether the drainage is CSF.

45.

Which of the following is not a component of the Virchow triad?

  • Acidosis

  • Hypercoagulopathy

  • Stasis

  • Endothelial damage

Correct answer: Acidosis

The Virchow triad refers to a triad of conditions that increases the risk of venous thromboembolism (VTE) development. Hypercoagulopathy, stasis, and endothelial damage are these three components and are all likely in trauma patients, making them predisposed to VTEs. 

While acidosis may also be more likely to occur in trauma patients, it is not a component of the Virchow triad.

46.

Trauma care for a vertebral fracture will depend on the stability of the fracture. Which of the following vertebral fractures is most likely to be a stable fracture?

  • Anterior compression fracture

  • Burst fracture

  • Chance fracture

  • Fracture-dislocation

Correct answer: Anterior compression fracture

An anterior compression fracture, also called a wedge fracture, is typically a stable type of vertebral fracture in most circumstances.

A burst fracture, also called a comminuted fracture, is a fracture in which the bone fractures into more than two pieces and is often unstable. A Chance fracture, also called a seatbelt fracture, is a horizontal fracture of the vertebra which is normally unstable. This type of fracture is commonly associated with the use of a lap seatbelt without the shoulder restraint. A fracture-dislocation occurs when there is a vertebral fracture concomitantly with dislocation of the facet joints. This type of injury is highly unstable and often causes spinal cord injury.

47.

A student nurse asks the trauma nurse how cerebrospinal fluid (CSF) moves in the brain. Which of the following responses is best?

  • CSF flows in a single direction in the brain

  • CSF does not move in the brain

  • CSF circulates in the brain like blood does in the body

  • CSF moves back and forth between ventricles and other spaces randomly

Correct answer: CSF flows in a single direction in the brain

CSF is produced in the choroid plexus and flows through the intracranial spaces unidirectionally until it is reabsorbed. It is not static, does not circulate in a circular fashion like blood, and does not move randomly.

48.

Anosmia after an injury indicates potential damage to which of the cranial nerves?

  • CN I

  • CN VII

  • CN XI

  • CN XII

Correct answer: CN I

Anosmia, or the loss of ability to smell, indicates damage to CN I, or the olfactory nerve. 

CN VII, or the facial nerve, innervates the muscles controlling facial expression and the anterior two thirds of the tongue. CN XI, or the accessory nerve, innervates the sternocleidomastoid and trapezius muscles. CN XII, or the hypoglossal nerve, controls most motor functions of the tongue.

49.

Which of the following is incorrect about treating a patient with exposure to a biological agent during a terrorist attack?

  • The onset of symptoms will be rapid

  • Decontamination is unnecessary

  • The patient should be treated using antibiotics or vaccines

  • The first responders are likely to be nurses and physicians

Correct answer: The onset of symptoms will be rapid

The onset of symptoms after exposure to a biological agent will be delayed and may take days to weeks. 

Biological agents will affect patients over a wide geographical area. Decontamination is not necessary for these patients, as the initial exposure was likely several days ago. Antibiotics or vaccines are used to treat biological agents. The first responders are likely to be nurses and physicians because exposure is not recognized until symptoms develop.

50.

A patient who has a cervical spine injury, traumatic brain injury, and is unresponsive to painful stimuli is brought into the ER by EMS after a high speed motor vehicle accident (MVA). The patient is obviously pregnant; fetal heart sounds are normal, the uterus is midline, and there is no vaginal bleeding or discharge noted. 

Which of the following is important for the trauma nurse to assess for in this patient?

  • Cervical dilation and effacement

  • Pulmonary contusion

  • Abruptio placenta

  • Ruptured uterus

Correct answer: Cervical dilation and effacement

A traumatic injury can stimulate labor, and a patient who is unresponsive to pain may go into labor without exhibiting any obvious symptoms. Assessing cervical dilation and effacement allows the trauma nurse to determine if the patient is close to going into labor. 

There are no indications that pulmonary contusion is likely. Abruptio placenta and ruptured uterus are concerns for patients who are pregnant; however, the assessments already performed wound have provided indications if either of these were present.

51.

Which of the following head injury complications is likely to lead to the most rapid deterioration?

  • Epidural hematoma

  • Acute subdural hematoma

  • Chronic subdural hematoma

  • Cerebral contusion

Correct answer: Epidural hematoma

An epidural hematoma is caused by arterial bleeding. Arterial bleeding has more force because of the pressure applied by systole. This leads to a more rapid accumulation of blood and more rapid deterioration than other injuries. 

An acute subdural hematoma is a venous bleed. While an acute subdural hematoma can lead to a rapid deterioration in condition, this change will not typically be as rapid as an epidural hematoma. A chronic subdural hematoma will not tend to deteriorate rapidly. Cerebral contusion may cause hematomas, but will not by itself lead to rapid deterioration of a patient's condition.

52.

When a pregnant patient goes into cardiac arrest, what care should be provided to a viable fetus?

  • The fetus should be delivered by emergency cesarean section within 4 minutes of maternal arrest 

  • No special care should be provided to the fetus; efforts should be focused on resuscitating the mother

  • The fetus should be monitored during the cardiac arrest

  • The fetus should be delivered by emergency cesarean section if the mother is determined to be unlikely to survive the arrest or if resuscitation efforts have exceeded 15 minutes

Correct answer: The fetus should be delivered by emergency cesarean section within 4 minutes of maternal arrest 

When a pregnant patient goes into cardiac arrest, a viable fetus should be delivered by emergency cesarean section no later than 4 minutes of maternal arrest. This can improve maternal cardiac output by eliminating the effect of a gravid uterus on blood return to the heart while also rescuing the fetus. 

Fetal monitoring during cardiac arrest is not recommended. Fetal delivery by emergency cesarean section may improve both maternal and fetal survival, and is recommended within 4 minutes of maternal arrest.

53.

A patient with multiple fractures to the bilateral legs and pelvis will need stabilization of these fractures. Which of the following is a consideration when planning fracture stabilization?

  • The method of fracture stabilization will vary

  • Intramedullary devices will be used

  • External fixation will be needed

  • Most of these fractures will not need stabilization

Correct answer: The method of fracture stabilization will vary

There are many different ways to stabilize fractures, and the method of stabilization will vary based on the fracture's location and type. 

Without knowing more about the specific locations and type of fractures sustained by this patient, it will not be possible to determine if intramedullary devices or external fixation will be necessary, or if some fractures do not require stabilization.

54.

The trauma nurse is assessing a 67-year-old male who had a car vs. tree motor vehicle accident. The airbags did not deploy, and the patient impacted his chest on the steering wheel. Assessment reveals a positive Kehr's sign, and lung sounds that sound like bowel sounds on the left. 

What is the likely explanation for the nurse's findings?

  • Ruptured diaphragm

  • Ruptured spleen

  • Pulmonary contusion

  • Blunt cardiac injury

Correct answer: Ruptured diaphragm

The mechanism of injury, coupled with a positive Kehr's sign and bowel sounds in the left lung, indicate diaphragmatic rupture is likely. The left side of the diaphragm is more likely to rupture than the right, and bowel can herniate through the rupture into the thoracic cavity, causing bowel sounds where lung sounds are expected. 

Kehr's sign would be expected for splenic rupture, but bowel sounds in the thoracic cavity would not be. Pulmonary contusion and blunt cardiac injury do not explain these findings.

55.

Which of the following is the first step in the secondary trauma survey?

  • History

  • Get resuscitation adjuncts

  • Inspect posterior surfaces

  • Full set of vitals

Correct answer: History

The primary trauma survey is typically remembered using the mnemonic ABCDEFG. A Full set of vitals and Get resuscitation adjuncts are the last two steps of the primary survey. 

The mnemonic HIJ is often used for the secondary survey, with History being the first of these steps and Inspect posterior surfaces being the second.

56.

When a trauma nurse is taking a burn patient's history, which of the following is not a factor directly affecting burn depth?

  • The area over which the offending agent was spread

  • The duration of contact with the offending agent

  • The thickness of the epidermis and dermis

  • The blood supply to the area

Correct answer: The area over which the offending agent was spread

The area over which the offending agent was spread will affect the surface area burned but does not directly impact the depth of the burn. 

The duration of contact with the offending agent, the thickness of the epidermis and dermis, the blood supply to the area, and the temperature of the offending agent are the four factors that affect the depth of a burn.

57.

The trauma nurse is caring for a three-year-old female who was struck by a car. Which of the following considerations is important when assessing this patient?

  • Reduced body mass causes greater force to be distributed throughout the patient's body

  • Pediatric patients are more likely to suffer pedestrian injuries than other populations

  • The smaller size of the patient means that less force will be transferred to the patient

  • The transmission of force throughout the patient's body will typically result in injuries that are focused on a single organ 

Correct answer: Reduced body mass causes greater force to be distributed throughout the patient's body

Because the patient has a small body mass, the energy that is transferred during an injury will be greater due to the lower amount of mass that can absorb it. 

It is true that pediatric patients are more likely to suffer pedestrian injuries than other populations; however, this is not a relevant consideration during assessment of an injured patient. The smaller body size and closer proximity of organs results in injuries that are multisystemic.

58.

The trauma nurse is caring for a patient who may have a pulmonary contusion. When or how should the nurse expect that symptoms will occur?

  • Symptoms may take 4-6 hours to begin developing and can take up to 48 hours to fully develop

  • Symptoms will occur within 30 minutes of the injury

  • Symptoms may take 1-2 hours to begin developing and can take up to 12 hours to fully develop

  • Symptoms will be the worst immediately after the trauma and may improve from the time of the trauma onward

Correct answer: Symptoms may take 4-6 hours to begin developing and can take up to 48 hours to fully develop

Pulmonary contusion symptoms can develop slowly and will not typically manifest with any specific symptoms until several hours after the initial injury. Symptoms may take up to 24 to 48 hours to fully develop.

59.

A trauma nurse is in an emergency room when a visitor produces a firearm and begins randomly firing at personnel and patients. The trauma nurse is about 50 feet from the shooter, and the exit is in the opposite direction. 

Which of the following actions taken by the nurse is wisest?

  • Run toward the exit without helping any patients or staff

  • Hide from the shooter until the police arrive

  • Attempt to attack the shooter

  • Evacuate, taking time to help patients and staff as able

Correct answer: Run toward the exit without helping any patients or staff

During an active mass shooting, trauma nurses should ensure their protection prior to helping others. This goes against normal nursing instincts but is necessary: stopping to help others decreases the nurse's chance of survival significantly without significantly improving the odds that the people being helped will survive. The survival of the trauma nurse will enable them to provide care after the incident is over. 

During a mass shooting, running is ideal, followed by hiding, followed by fighting. 

60.

Which of the following is least likely to be the cause of a motor vehicle accident (MVA) where a geriatric patient was the driver?

  • Excessive speed

  • Intoxication

  • Merging into traffic

  • Night driving

Correct answer: Excessive speed

Geriatric populations are less likely to drive at excessive speed than other drivers. 

Geriatric populations will have greater effects from alcohol use than younger populations, sometimes creating effects of intoxication while below the legal limit. Geriatric populations are more likely to have accidents while merging due to decreased peripheral vision and reaction times. Geriatric populations are more likely to have night driving accidents due to decreased visual acuity.

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