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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 5 of 25

81.

How will the trauma nurse assess for blunt trauma to the ileum during an initial clinical examination?

  • Signs of ileal trauma will not be evident initially

  • Using ascultation and percussion

  • Palpating to evaluate for a ridged abdomen

  • Assessing for associated spinal trauma

Correct answer: Signs of ileal trauma will not be evident initially

The ileum has a neutral pH and harbors few bacteria. This means that signs of peritonitis are unlikely to be evident upon initial examination. 

Using ascultation and percussion and palpating to evaluate if the abdomen is soft or firm will not indicate the presence of ileal trauma. Only imaging or potentially a peritoneal lavage can indicate ileal trauma, and these will not often be performed specifically to rule out ileal trauma. Ileal trauma is often associated with spinal trauma, however, the presence of spinal trauma does not necessarily indicate ileal trauma is present.

82.

A patient presents to the ER with a spiral facture of the left humerus. What type of force is most likely to cause this type of fracture?

  • Torsion

  • Tension

  • Combined loading

  • Bending

Correct answer: Torsion

Torsion forces are forces that are applied in a twisting motion of two ends around the longitude axis of the ends. This twisting force is the cause of a spiral fracture when the force is applied to a bone. 

Tension forces are the stretching of two ends away from each other and can lead to multiple types of fractures when the force is applied to bone. Combined loading refers to the application of multiple different forces simultaneously. Bending forces refers to the application of a force on an object that causes compression of one side and stretching of the other.

83.

The trauma nurse is caring for a 220-pound adult with burns covering both legs. How much fluid should this patient be given over the first 24 hours after his injury?

  • 7,200 mL

  • 14,400 mL

  • 9,200 mL

  • Not enough data given to determine

Correct answer: 7,200 mL

The calculation to determine the amount of fluid that should be provided in the 24 hours after a burn is calculated by multiplying the patient's weight in kilograms by the percent of their total body surface area that has been burned. For this patient, 220 lb is equal to 100 kg and, using the rule of nines, burns covering both legs is 36% of his total body surface area. The equation for this would be:

100 kg x 2 x 36 = 7,200 mL

84.

You are the trauma nurse treating a patient who has been successfully treated for hypovolemic shock. Nineteen units of packed red blood cells were used during the resuscitation of this patient. Which of the following laboratory values is most important to test at this point?

  • Calcium

  • Glucose

  • Magnesium

  • Chloride

Correct answer: Calcium

Red blood cells require the use of a citrate preservative when transported and stored. This preservative interacts with calcium to decrease serum calcium levels. After administering many units of blood, checking for hypocalcemia will be an important intervention. 

While the other laboratory levels are important, massive transfusion are not likely to significantly impact these levels.

85.

A patient with a recent traumatic brain injury has cycles of respirations that become increasingly shallow until there is a period of apnea followed by increasingly deep respirations that then begin to become shallow again. 

Which of the following would best describe this respiratory pattern?

  • Cheyne-Stokes breathing

  • Cluster breathing

  • Irregular breathing

  • Central neurogenic hyperventilation

Correct answer: Cheyne-Stokes breathing

Cheyne-Stokes breathing describes a breathing pattern that gradually alternates between periods of hyperpnea and apnea. 

Cluster breathing describes clusters of irregular breaths followed by apneic periods that are variable. Irregular breathing does not follow a specific pattern. Central neurogenic hyperventilation is a pattern of deep, rapid respirations that has a neurological origin.

86.

Which of the following is the most important specific consideration in the treatment of facial trauma?

  • Airway

  • Impaired self-image 

  • Infection

  • Malnutrition

Correct answer: Airway

Facial trauma can lead to compromise of a patient's airway and this is the most important consideration in facial trauma. 

Impaired self-image can occur with facial trauma due to the cosmetic implications or deformities it can cause; however, the airway is a more important consideration. Malnutrition can be caused by an inability to take nutrients orally, but airway compromise is a more important consideration. Infection is a consideration, but airway compromise is a more important consideration.

87.

Which of the following types of stress injuries is most likely to be experienced by a patient's family after the patient passes away from a trauma?

  • Grief injury

  • Trauma injury

  • Moral injury

  • Fatigue injury

Correct answer: Grief injury

Grief injury is caused by the loss of cherished people, things, or parts of one's self and is the type of stress injury that is normally caused by death. 

Fatigue injury describes a psychological stress injury cause by the accumulation of stress over time without sufficient rest and recovery. Trauma injury is caused by the experience of death, provoking terror, horror, or helplessness. Moral injury is caused by inner conflict due to behaviors or witnessing behaviors that violate moral values.

88.

A patient develops radiation sickness 36 hours after being exposed to an explosion at a nuclear power plant. What type of blast injury is this?

  • Quinary blast injury

  • Quaternary blast injury

  • Tertiary blast injury

  • Not a blast injury

Correct answer: Quinary 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. 

An explosion-related injury due to exposure to radiation is considered a quinary blast injury.

89.

The trauma nurse is preparing to administer a round of blood products to a patient who is pregnant and is hemorrhaging after the initial round of transfusion. Which of the following crossmatching considerations is correct if crossmatched products are available?

  • Blood should be crossmatched only against the maternal blood type

  • Blood should be crossmatched both against the maternal and fetal blood types

  • Only O-negative blood should be used because checking fetal blood type is not feasible

  • Fetal blood type is always the same as maternal blood type

Correct answer: Blood should be crossmatched only against the maternal blood type

Maternal blood and fetal blood do not significantly mix and maternally transfused blood does not carry a high risk of reacting with fetal blood. 

It is not necessary to crossmatch blood against fetal blood or to give O-negative blood to avoid fetal blood reactions. Fetal blood type is not always the same as maternal blood type.

90.

The trauma nurse is part of a hospital committee that is preparing a disaster response plan. Which of the following considerations is most important when providing advice in this area?

  • The types of disasters that should be prepared for will be unique, depending on the hospital's location

  • The types of disasters that should be prepared for will be unique, depending on the hospital's size

  • The types of disasters that should be prepared for will be unique, depending on the services the hospital offers

  • All hospitals should plan for every disaster equally, regardless of their unique factors

Correct answer: The types of disasters that should be prepared for will be unique, depending on the hospital's location

When planning for potential disasters, the most important consideration for determining the type of disasters that should be prepared for is a hospital's location. A hospital in Kansas, for example, will need to spend much less time and resources planning for volcanoes and tsunamis than a hospital in Hawaii would. 

The services that a hospital offers and the size of the hospital may influence how it plans to respond to potential disasters, but should not affect what potential disasters are considered to be likely to occur.

91.

Which of the following is the correct way for the trauma nurse to provide care to an amputated body part?

  • Wrap the part in gauze and place it in a dry bag, which is then placed on ice

  • Wrap the part in gauze and place it directly on ice

  • Immerse the part in milk

  • Always keep the part with the patient

Correct answer: Wrap the part in gauze and place it in a dry bag, which is then placed on ice

The part should never be immersed in fluid. While a tooth may be immersed in milk to maintain its viability, an amputated body part should never be. An amputated part should never be placed directly on ice. 

An amputated body part may need to be imaged or separated from the patient for other purposes. While the part may leave the patient, it should be clearly labeled with two patient identifiers.

92.

A patient stumbles into the emergency room with apparent head trauma and confusion. The patient is too confused to explain what happened to them. The trauma nurse knows that the most likely cause of this head trauma, based on only this data, is which of the following?

  • A fall

  • A motor vehicle accident

  • A physical assault

  • A sports injury

Correct answer: A fall

Without any other data to go on than the fact that the patient has sustained a head injury, the most likely cause of the patient's head injury can only be based on head injury statistics. 

Statistically, falls are the most common cause of head trauma, followed by motor vehicle accidents. Sports injuries and physical assault can also cause head injuries, but are statistically less likely.

93.

A patient involved in a motorcycle accident is brought to the emergency room with a dislocated elbow. Which of the following neurovascular structures is at risk for involvement with this injury?

  • The ulnar nerve

  • The radial nerve

  • The ulnar artery

  • The radial artery

Correct answer: The ulnar nerve

The ulnar nerve (also known as the "funny bone") is at a high risk for damage due to dislocation of the elbow or while attempting to reduce it. The brachial artery is another structure associated with risk during elbow dislocation. 

There may be some small risk considerations with the other choices, but the ulnar nerve and the brachial arteries are the two primary concerns. 

94.

You are treating a 19-year-old female who was assaulted, being struck in the center of the top of the head with a downward blow using a blunt object. Which of the following questions will help you to determine the intensity of the force that was applied during the assault?

  • "What object did he use?"

  • "How would you rate the pain this caused on a scale of one to ten?"

  • "Do you have a history of previous head injuries?"

  • "Were you struck from behind or in front?"

Correct answer: "What object did he use?"

The intensity of a force is the product of its mass and acceleration. Asking what type of object was used will help you to determine its mass and will also help you to understand the area over which the force was applied.

Asking the patient to rate their pain or about previous head injuries is important but will not provide information about the force used. Asking the patient if they were struck from behind or in front will not provide information about the force used, but may provide information about how the patient was able to defend themselves. Asking information about the trajectory of the blow will provide information about the intensity of the force, but the trajectory for this injury will not be different based on where the attacker was standing.

95.

You are caring for a patient who has a respiratory rate of 20 and an oxygen saturation of 99%. What additional data is needed to assess this patient's oxygenation?

  • ABG values

  • Chest X-ray results

  • Lung sounds

  • No additional data is needed

Correct answer: ABG values

While the patient's oxygen saturation is high, the PaO2 may still be low or the oxygen saturation may be a false high. To truly understand this patient's oxygenation, a PaO2 level from an ABG is needed. 

A chest X-ray and lung sounds may provide information about ventilation, but will not provide data on oxygenation.

96.

The trauma nurse understands that maintaining a patient's privacy is important because:

  • The nurse is both legally and ethically obligated to maintain patient privacy

  • The nurse is legally obligated to maintain patient privacy

  • The nurse is ethically obligated to maintain patient privacy

  • In the trauma setting, maintaining privacy is preferred, but not obligatory

Correct answer: The nurse is both legally and ethically obligated to maintain patient privacy

There is both a legal and an ethical obligation for a nurse to maintain a patient's privacy to the greatest extent possible. 

While there may be times in trauma treatment where the patient's immediate medical needs may outweigh some privacy considerations, it is important to maintain the patient's privacy as much as possible while weighing this obligation with other responsibilities to the patient.

97.

A patient with an obvious flail chest is being brought to the emergency room, and the trauma nurse is preparing for their arrival. The trauma nurse understands that which of the following is true?

  • The patient also likely has a pneumothorax or a pulmonary contusion

  • This can likely be managed without providing ventilatory support

  • The patient is likely to be male

  • The patient will need a chest tube

Correct answer: The patient also likely has a pneumothorax or a pulmonary contusion

Flail chest is rarely the only thoracic injury and is frequently accompanied by a pneumothorax or a pulmonary contusion caused by the same mechanism of injury. 

Flail chest normally (but not always) requires ventilatory support. Flail chest is significantly more common in men. The patient may need a chest tube if flail chest is accompanied by a pneumothorax; however, this will not definitely be the case.

98.

A nurse in a small, rural hospital is caring for a 32-year-old with a gunshot wound to the chest who has a massive hemothorax. The patient's blood type is O negative. 

Which of the following strategies is best for reducing strain on the limited blood bank resources of the small hospital?

  • Collect blood from the patient's hemothorax and transfuse the patient with it

  • Give more crystalloids than normal to conserve red blood cells

  • Give four units of fresh frozen plasma for each unit of packed red blood cells

  • Ask for hospital staff and other patients to volunteer to donate blood

Correct answer: Collect blood from the patient's hemothorax and transfuse the patient with it

Autotransfusion is the practice of transfusing a patient with their own blood and is a feasible option in treating a patient with a massive hemothorax. 

Give more crystalloids than normal to conserve red blood cells would not benefit the patient, as this will reduce the patient's oxygen-carrying capacity and can cause harm to the patient. 

One unit of fresh frozen plasma should be transfused for each unit of packed red blood cells during a massive transfusion. 

Asking for donors is not practical, given the time needed to process the blood and given that the patient can only receive blood from a small number of donors.

99.

Which of the following could hide Battle's sign during assessment?

  • C-collar

  • Bandage over the eyes

  • Face mask

  • Shirt

Correct answer: C-collar

Battle's sign indicates a basilar skull fracture and consists of ecchymosis directly behind and underneath the auricles. Battle's sign may be initially obscured by a cervical collar that covers the area behind and under the ears. This area would not be covered by a shirt, eye bandage, or face mask.

100.

When caring for a patient with hypothermia, the trauma nurse understands that this will affect the oxyhemoglobin dissociation curve how?

  • It will shift to the left

  • It will shift to the right

  • It will not affect it

  • More data is needed to determine its effect

Correct answer: It will shift to the left

Hypothermia is a factor that will result in a left shift of the oxyhemoglobin dissociation curve, meaning that oxygen will develop a high affinity for hemoglobin. This means that a higher oxygen saturation will be present, however, there will be less dissolved oxygen in the blood.

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