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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 4 of 25

61.

Which of the following best describes tensile strength in the context of traumatic injuries?

  • The tension that a tissue can withstand

  • The ability of tissue to resume its original shape

  • The ability of tissue to resume its original size

  • The ability of tissue to resist squeezing forces or inward pressure

Correct answer: The tension that a tissue can withstand

Tensile strength describes the tension that a tissue can withstand and its ability to resist stretching forces. 

The ability of tissue to resume its original shape and size describes elasticity. The ability of tissue to resist squeezing forces or inward pressure describes compressive strength.

62.

Which of the following intracranial pressure (ICP) situations creates the greatest likelihood of a poor outcome in a patient with head trauma?

  • An ICP that is sustained at 25 mmHg

  • An ICP that is 20 mm Hg and is not responsive to treatment

  • An ICP that spikes to 35 mmHg, but quickly resolves with treatment

  • An ICP that is sustained lower than 10 mm Hg

Correct answer: An ICP that is sustained at 25 mmHg

An ICP that is sustained above 22 mmHg and is not responsive to treatment is correlated with poor clinical outcomes in patients who have suffered head trauma. An ICP that is sustained above 22 mmHg will have a worse effect than a temporary spike in ICP that responds well to treatment. 

A sustained low ICP is not a concern.

63.

A patient with a suspected spinal cord injury has a CT of the spine that finds no radiographic abnormalities. What type of spinal cord injury could this be?

  • A stretch-related injury

  • A cord contusion

  • An incomplete cord transection

  • No spinal cord injury

Correct answer: A stretch-related injury

Stretch-related spinal cord injuries occur when the spinal cord is stretched along its axis. Injuries caused by this mechanism of injury are often at the cellular level and may not appear on radiographic imaging. 

A cord contusion and an incomplete cord transection will normally be visible on a CT scan. This finding does not mean that there is no spinal cord injury.

64.

Which of the following is not a cause of hypothermia in burn patients?

  • Decreased core temperature due to blood loss

  • Rapid fluid resuscitation

  • Evaporation from fluids on the skin

  • Loss of the normal skin barrier

Correct answer: Decreased core temperature due to blood loss

Hypothermia may be caused during hemorrhage due to the extensive loss of blood volume; however, this is not normally a significant factor in burn patients. While fluid loss from burns may lead to dehydration, it is unlikely that blood volume loss will occur fast enough to affect the body's ability to regulate its core temperature. 

Rapid fluid resuscitation can lead to hypothermia if the fluids are not warmed. Evaporation from fluids seeping from the burn can cause hypothermia in the same way that sweat evaporation promotes cooling. Loss of the normal skin barrier does affect the body's ability to regulate its normal temperature.

65.

Which of the following is not true when administering mannitol?

  • The mechanism of beneficial action for mannitol is well understood

  • Mannitol must be filtered prior to administration

  • Mannitol should be given through a central line whenever possible

  • Mannitol can be harmful if it leaks through the blood-brain barrier

Correct answer: The mechanism of beneficial action for mannitol is well understood

Mannitol's mechanism of action is still not fully understood and is an area of medical debate. While the mechanism of action is still under research, it is known that mannitol has an osmotic effect that reduces intracranial pressure by pulling fluids from the brain into the bloodstream. 

Mannitol can create solid condensate that must be filtered prior to administration, either by using a filtered needle or an inline filter. Mannitol should be given through a central line whenever possible because it can cause tissue damage due to its osmotic effect if it infiltrates. Injuries that cause permeability of the blood-brain barrier can allow mannitol to leak into the cerebrospinal fluid (CSF), causing osmotic effects that draw fluid into the CSF and having a harmful effect.

66.

The trauma nurse is in an emergency room where there is an active shooter. The trauma nurse is hiding in a room when she hears footsteps approaching the door and shooting that is getting closer.

Which of the following actions by the trauma nurse is best?

  • Find anything in the room that be used as a weapon

  • Run out of the room and try to find an exit

  • Try to find a barrier to hide behind in the room

  • Yell out to the shooter and attempt to establish a dialogue

Correct answer: Find anything in the room that be used as a weapon

During a mass shooting, the three options in order of preference are run, hide, and fight. If the nurse is already hiding, running is likely to have not been an option initially. Running as the shooter approaches the nurse's hiding spot is not recommended, as the likelihood of being injured or killed is high at that point. Trying to hide inside the room the shooter is approaching is not likely to be effective, except in unusual circumstances. Dialogue with the shooter is unlikely to be effective, and nurse should not draw attention to herself. 

Fighting is the best option at this point, and the trauma nurse should arm themselves and attempt to fight with the shooter if they enter the room.

67.

A patient experiences a penetrating trauma when they are thrown against a broken metal beam during an explosion. What type of blast injury would this be?

  • Tertiary blast injury

  • Secondary blast injury

  • Quaternary blast injury

  • Quinary blast injury

Correct answer: Tertiary blast injury

There are five different types of blast injuries. Primary injuries are caused by the pressure wave the blast causes. Secondary injuries are caused by shrapnel from the explosive device or shrapnel created by the blast wave. Tertiary injuries are caused by the individuals involved being thrown by the blast wind or by structural collapses. Quaternary injuries are caused by other explosion-related injuries, such as thermal injuries, exposure to fumes, and other factors that occur during or immediately after the explosion. Quinary injuries are more long-term injuries associated with hazardous materials from the explosive, such as radioactive materials or infectious agents. 

Any injury caused by being thrown against an object is considered a tertiary blast injury. Blast injuries are classified based exclusively on their cause, not on the type of injury caused.

68.

Which of the following will decrease a patient's cerebral perfusion pressure?

  • Increased intracranial pressure

  • Increased mean arterial pressure

  • Increased systolic blood pressure

  • Increased atmospheric pressure

Correct answer: Increased intracranial pressure

Increased intracranial pressure (ICP) will cause a decrease in cerebral perfusion pressure (CPP) by countering mean arterial pressure (MAP). 

CPP is calculated by subtracting ICP from MAP. An increase in MAP will increase CPP. An increase in systolic blood pressure will increase MAP, resulting in increased CPP. 

Atmospheric pressure has no effect on ICP, as the cranial vault is a rigid container that is not affected by atmospheric pressure unless its integrity is disrupted.

69.

Which of the following spinal injuries will cause distributive shock?

  • Neurogenic shock

  • Spinal shock

  • Wedge fracture of C3

  • Contused vertebral disc

Correct answer: Neurogenic shock

Neurogenic shock causes a loss of vasomotor tone, leading to distributive shock. 

Spinal shock is a temporary condition that affects the spinal column and can disrupt sensory and motor function. A vertebral fracture or a disc contusion could lead to neurogenic shock in some cases, but this is unlikely.

70.

The trauma nurse is caring for a 24-year-old female who was involved in a motorcycle accident. The cyclist lost control during a turn, and the patient did not hit the ground hard but was primarily injured from sliding across the pavement. The patient was traveling at 55 mph when the accident occurred. 

Which of the following organs is least likely to be affected by this mechanism of injury?

  • Lungs

  • Liver

  • Pancreas

  • Spleen

Correct answer: Lungs

The mechanism of injury described involves primarily shear forces that would have been transferred internally. These forces are more likely to affect solid organs than air filled organs due to the decreased compliance of solid organs. The lungs are the only air-filled organ listed and would be less likely to be injured from shear force mechanisms than the liver, pancreas, or spleen.

71.

A patient who is 14 weeks pregnant is brought in by EMS for a 25-foot fall, but her pregnancy is not initially known by the trauma team. At what point in the trauma assessment would the assessment needed to discover her pregnancy be performed?

  • The end of the primary survey

  • The end of the secondary survey

  • The beginning of the primary survey

  • The beginning of the secondary survey

Correct answer: The end of the primary survey

During the normal course of a trauma assessment where a pregnancy is not visible due to an expanded uterus, pregnancy would be discovered during labs, which would include a urinalysis on a patient who could be pregnant. Having laboratory tests is part of the last step of the primary survey.

72.

The trauma nurse is caring for a patient 36 hours after a motor vehicle accident. The patient has multiple fractures, contusions, and a T8 spinal cord injury. The patient has a change in mental status and starts to develop dyspnea. The trauma nurse also notes a petechial rash on the patient's neck and axilla. 

Which of the following conditions should the nurse initially suspect?

  • Fat embolism

  • Deep vein thrombosis

  • Pulmonary embolism

  • Coagulopathy

Correct answer: Fat embolism

Fat embolism is indicated by hypoxemia that causes respiratory distress, neurological changes that can range from irritability to coma, and petechiae that are usually distributed over the chest, base of the neck, conjunctiva, mucous membranes, and axilla. 

Deep vein thrombosis would not normally cause petechia or respiratory distress. Pulmonary embolism causes respiratory distress, but does not normally cause petechiae. Coagulopathy may cause petechiae, but does not fit the other symptoms as well as fat embolism does.

73.

An RN is evaluating a patient's neurological status using the FOUR score. Which of the following is not a component of this score?

  • Verbal response

  • Motor response

  • Eye response

  • Respiration

Correct answer: Verbal response

Verbal response is an area of assessment in the Glasgow Coma Score, not the FOUR score. 

The areas of assessment used in the FOUR score are motor response, eye response, respiration, and brainstem response. Each area is scored from 4 to 0 with a maximum possible score of 16.

74.

Which of the following is not a benefit of restoring normal alignment to a fractured bone?

  • Decreases bleeding

  • Improves venous return

  • Improves lymphatic return

  • Reduces the release of marrow components into circulation

Correct answer: Decreases bleeding

Restoring normal alignment to a fractured bone does not significantly reduce bleeding at the fracture site. 

Restoring bone alignment will, however, improve both venous and lymphatic return and will reduce the release of marrow components into circulation.

75.

Which of the following interventions should the trauma nurse do first when assessing the airway of an alert patient?

  • Ask the patient "Do you know where you are?"

  • Inspect the airway for foreign objects

  • Listen for stridor

  • Palpate for subcutaneous emphysema

Correct answer: Ask the patient "Do you know where you are?"

The first priority during airway assessment is to ensure that the airway is open. The easiest way to do this is to ask the patient a question and see if they are able to open their mouth and verbalize. 

Once the nurse has assessed that the airway is open, further assessment such as inspection, palpation, and auscultation can be performed.

76.

An 18-year-old male presents to the emergency room after rolling a four-wheeler. The patient has single fractures of the 8th, 9th, and 10th ribs on the left. Which of the following is the greatest initial concern for this patient?

  • Hemorrhage

  • Tension pneumothorax

  • Flail chest

  • Cardiac tamponade

Correct answer: Hemorrhage

The location of this injury indicates possible damage to the spleen, a vascular organ that can be a source of hemorrhage.

A tension pneumothorax is possible if the fractured ribs have punctured the left lung, but this is less likely given the ribs that are injured. Flail chest would be a concern if there were rib fractures in more than one location. Cardiac involvement, such as cardiac tamponade, is unlikely as the injury site is beneath the cardiac region.

77.

A hospital reorders tourniquets to restock tourniquets that were used in treating multiple patients from a high-speed bus accident. What phase of the disaster life-cycle is this hospital in?

  • Recovery

  • Response

  • Mitigation

  • Preparedness

Correct answer: Recovery

There are four phases of the disaster life-cycle. The mitigation phase focuses on reducing the likelihood of disaster or reducing its potential impact. The preparedness phase shares some characteristics with the mitigation phase, but focuses on being prepared for a disaster when one occurs. The response phase is the actual process of responding to an existing or occurring disaster. Recovery refers to the post-disaster phase in which normal operations are resumed and the hospital returns to a pre-disaster state. 

While restocking a disaster supply may be thought of a preparedness by some, this is actually a preparation that was already made by the hospital. Recovery better describes this hospital's status in the disaster life-cycle as they are replenishing supplies that were used in a disaster to return to a pre-disaster status.

78.

A trauma nurse is caring for a patient with a gunshot wound in the left lower leg with injury to the fibula, the left lower abdomen with injury to the rectum and sigmoid colon, and the right cheek without any other facial or head involvement. The patient begins having pain in the left leg, muscle spasms in the left leg, fever, and full-body chills. 

Which of the following conditions should be suspected?

  • Osteomyelitis

  • Peritonitis

  • Deep vein thrombosis

  • Damage to the posterior tibial artery

Correct answer: Osteomyelitis

Localized pain and spasms with signs of infection are indicative of osteomyelitis, especially with foreign body damage to a bone. 

Peritonitis would not be likely to cause localized pain and spasms in the left leg. Deep vein thrombosis would not cause chills. Damage to the posterior tibial artery would cause symptoms of bleeding.

79.

A 23-year-old trauma patient is pregnant, and her fundus is at the level of her umbilicus. About how many weeks into the pregnancy is this patient?

  • 20 weeks

  • 26 weeks

  • 16 weeks

  • 36 weeks

Correct answer: 20 weeks

The length of a pregnancy can be determined with some accuracy by measuring the distance of the fundus from the pubic symphysis after 20 weeks and taking the number of centimeters as the number of weeks, but can also be approximated by measuring the distance of the fundus from the umbilicus. 

The fundus reaches the level of the umbilicus at 20 weeks.

80.

Which of the following injuries is least likely to require transfer to a burn center?

  • Burns to part of the abdomen

  • Partial thickness burns covering 15% of the body

  • Burns to the soles of the feet

  • Inhalation injury

Correct answer: Burns to part of the abdomen

Burns to the abdomen by themselves do not require transfer to a burn center unless they cover a large area, are deep, or are circumferential. 

Partial thickness burns covering more than 10% of the body, burns to the feet, and inhalation injuries will all require treatment at a burn center.

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