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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 6 of 25

101.

Uretal damage will be most quickly detected with which of the following injuries?

  • Injuries causing obstruction of a ureter

  • Injuries that sever a ureter

  • Blast injuries

  • Penetrating traumas

Correct answer: Injuries causing obstruction of a ureter

Uretal damage often goes undetected due to the lack of pain created by this type of injury. Uretal damage will, however, cause pain when an obstruction is created due to the buildup of pressure proximal to the obstruction. 

The severing of a ureter is typically not painful afterward, and blast injuries or penetrating traumas are not more likely to create ureteral injuries that will be more easily detected.

102.

A 22-year-old male is brought to the emergency room after a motor vehicle accident (MVA). He was wearing a lap belt, and the vehicle impacted head-on with another vehicle. The vehicle did not roll over, and the patient was able to self extricate after the injury. 

Which of the following vertebrae is most likely to be injured?

  • L1

  • S4

  • T2

  • C4

Correct answer: L1

Chance fractures, also known as seatbelt fractures, are flexion-distraction injuries. These injuries commonly occur in patients involved in MVAs who are restrained using a lap belt. The lap belt hold the pelvis and lower spine stationary while the upper spine flexes forward. The area most commonly affected is the upper lumbar or lower thoracic spine. 

L1 is the only vertebra in this region that is listed as an answer.

103.

A trauma nurse is assessing a patient who has been electrocuted. She notes a burn injury on the sole of a patient's foot where she assumes the current exited. 

How should this wound be documented?

  • Contact point

  • Burn site

  • Exit wound

  • Grounding site wound

Correct answer: Contact point

The direction of movement of electricity through the body does not significantly affect how the wound is formed, and it can be difficult to tell in which direction the current traveled. An electrocution contact point should be documented as a contact point, not as an exit wound or a grounding site. 

A burn site may be incorrect since the burn extends internally between contact points. A contact point is the correct way to document this injury.

104.

A patient presents to the emergency room after being struck in the head by a small tool at a construction site where he was not wearing a hard hat. There is no obvious injury, and the patient's only complaints are a headache and rhinorrhea. 

Which of the following interventions is most important?

  • Test the patient's nasal secretions

  • Administer acetaminophen 650mg PO for pain

  • Evaluate the patient using the NIH stoke scale

  • Instruct the patient to avoid light or stimuli for 48 hours

Correct answer: Test the patient's nasal secretions

Rhinorrhea after a head injury could indicate internal damage that is causing leakage of cerebrospinal fluid (CSF). The nasal secretions should be tested to ensure that they do not consist of CSF, indicating a more severe internal injury. 

Administering acetaminophen for pain or instructing the patient to avoid light and stimuli may be appropriate, but are not as important as evaluating for a CSF leak. Using the NIH stoke scale to evaluate this patient is not appropriate.

105.

Which of the following would the Caprini scale be used to determine?

  • The risk of venous thromboembolism development

  • The risk of bleeding

  • The degree of sedation

  • The likelihood of intraoperative cardiac arrest

Correct answer: The risk of venous thromboembolism development

The Caprini scale scores patients on a variety of risk factors for developing a venous thromboembolism (VTE) and indicates the level of VTE risk that an individual patient has. 

The Caprini scale is not used to assess the risk of bleeding, the risk of intraoperative cardiac arrest, or a patient's degree of sedation.

106.

When evaluating deaths that have occurred in the trauma center, which of the following is not a potential determination made from the evaluation?

  • Unexpected mortality with no opportunity for improvement

  • Expected mortality with no opportunity for improvement

  • Expected mortality with opportunity for improvement

  • Unexpected mortality with opportunity for improvement

Correct answer: Unexpected mortality with no opportunity for improvement

When evaluating care delivered to patients who died, the case should be evaluated for if the mortality was expected or unexpected. If the mortality was expected, it should be further evaluated for if there was opportunity for improvement in the care that was provided. 

If a mortality was unexpected, it is given that there will be room for improvement.

107.

The nurse is preparing to suction a patient who has recently experienced a severe traumatic brain injury (TBI). Which of the following techniques is correct when suctioning this patient?

  • Avoid passing the catheter more than twice per suctioning episode

  • Only suction for as long as the nurse can hold their breath

  • Do not suction for more than 15 seconds at a time

  • Pass the suction catheter until it contacts the carina, then withdraw 1 cm prior to suctioning

Correct answer: Avoid passing the catheter more than twice per suctioning episode

The catheter should not be passed more than twice per suctioning episode to avoid hypoxia or excessive stimulation of the airways. 

In patients with TBI, stimulation of the airway should be avoided, making a technique that involves the catheter contacting the carina inadvisable. Suctioning should only be performed for 10 seconds at a time, and the nurse should not suction for as long as they can hold their breath.

108.

A trauma nurse documents a medication by overriding the computer's prompt to scan the patient's bracelet. Which of the following best describes this action?

  • At-risk behavior

  • Error

  • Reckless behavior

  • Negligence

Correct answer: At-risk behavior

At-risk behaviors are behaviors that occur due to cumbersome processes. Providers engaging in at-risk behaviors are aware of the correct thing to do, but find workarounds due to the system in place being cumbersome. 

Errors occur when a provider makes a mistake. Reckless behavior occurs when a provider is aware of rules and guidelines and willfully ignores them. Negligence occurs when a provider fails to provide care that a reasonable person would say is their responsibility to provide.

109.

When the trauma nurse is assessing and monitoring a trauma patient's chest and abdomen, which of the following is correct?

  • Repeated thoracic assessment is important for determining missed or progressive injuries

  • Repeated thoracic assessment is redundant and provides inefficient care

  • Repeated thoracic assessment should focus on a different area of the thorax each time

  • Repeated thoracic assessment is only necessary in blunt trauma patients

Correct answer: Repeated thoracic assessment is important for determining missed or progressive injuries

Patients who have sustained thoracic trauma are likely to have injuries that may be initially overlooked or may progress over time. Repeated thoracic assessment is essential when providing care to patients who may have suffered a thorax injury. 

Repeated thoracic assessment is not redundant and is an essential part of trauma care. Thoracic assessment should be consistent to ensure that changes are recognized. Thoracic assessment is important for any trauma patients, not only in patients who have sustained blunt trauma.

110.

What portion of the spine is most likely to be injured in a trauma?

  • Cervical

  • Thoracic

  • Lumbar

  • Sacral

Correct answer: Cervical

Fifty-five percent of traumatic injuries to the spine affect the cervical spine. This is because there is less support for this portion of the spine in the neck and because the cervical spine is more exposed than other areas of the spine.

111.

A trauma nurse enters the room of an unconscious burn patient who has burns to 32% of their total body surface area after a house fire. A student nurse has given the patients three blankets to stay warm. 

Which response by the trauma nurse to the nursing student is best?

  • "Thank you for keeping this patient warm."

  • "We should remove these blankets to allow the burn to cool down as much as possible."

  • "These blankets may disrupt healing in the burn wound bed and should be removed."

  • "While one blanket would be okay, three blankets may overheat the patient."

Correct answer: "Thank you for keeping this patient warm."

Burn patients are at a higher risk of developing hypothermia and should be kept warm. 

While removal of the initial agent that caused the burn and cooling the burn are priorities immediately after the injury, a patient who has come the ER after a house fire will be well past this being a potential factor to consider. Providing blankets to the patient is unlikely to disrupt healing of the burn. Overheating the patient is less of a concern than underheating them would be.

112.

A patient is brought to the emergency room after surviving a helicopter accidence. The only injuries noted during the initial assessment are a skull deformity, clear drainage from the left ear, an unstable pelvis, an amputation of the left hand with bleeding that is fully controlled with a tourniquet, and a step-off deformity at T6. 

Which of the following should the trauma nurse be most concerned for when initially caring for this patient?

  • Exsanguination

  • Increased intracranial pressure

  • Airway obstruction

  • Pain

Correct answer: Exsanguination

An unstable pelvis is associated with a high risk of exsanguination. While there are several neurological complications that this patient may suffer, including increased intracranial pressure, the risk of exsanguination is more pressing and more likely to lead to death if untreated. 

There is nothing in the patient's initial assessment to indicate that airway obstruction is a potential concern. While pain management is certainly needed for this patient, providing life sustaining care is more important than managing the patient's pain.

113.

Trauma to which of the following organs is most likely to impact the pH of digestive enzymes in the small intestine?

  • Pancreas

  • Small intestine

  • Liver

  • Gallbladder

Correct answer: Pancreas

The pancreas is responsible for buffering acidic gastric fluids and maintaining the pH of digestive enzymes in the small intestine. 

The liver produces bile, which helps to breakdown fatty acids, but does not help to maintain the pH of digestive enzymes. The small intestine and gallbladder also do not play an important role in regulating the pH in the small intestine.

114.

Which of the following is least likely to be a complication of an infected open fracture?

  • Osteoporosis

  • Nonunion

  • Osteomyelitis

  • Delayed union

Correct answer: Osteoporosis

Osteoporosis is a disease process that occurs due to inappropriate bone remodeling. The development of osteoporosis is not thought to be related to infections that may occur with an open fracture. 

Infected open fractures may result in complications that include nonunion, osteomyelitis, and delayed union.

115.

A 24-year-old female has a spinal cord injury at T10 after a skiing accident and is unable to move or sense tactile stimuli distal to the injury; however, indications are that the spinal cord does not appear to be transected. Twenty-four hours after the initial injury, the patient's mother asks if the patient will ever be able to walk again. What response by the trauma nurse is the best option?

  • "It may take several days for us to know how severe the damage is."

  • "Her condition is going to be permanent."

  • "She will make a full recovery after undergoing surgery if the surgery goes well."

  • "Tell me more about how your daughter's injury makes you feel."

Correct answer: "It may take several days for us to know how severe the damage is."

This patient may be experiencing spinal shock, and it may take several days to determine the extent of her long-term injuries. 

Telling the family that the condition will be permanent is not necessarily correct; this is not known at this point. The patient may not make a full recovery, regardless of the need for or success of surgery. Asking the family about their feelings does not address their question.

116.

Which of the following statements made by a training nurse is true about the penumbra of a cerebral contusion?

  • "The penumbra may eventually heal."

  • "The penumbra will cause tissue ischemia and cell death."

  • "The penumbra can be salvaged if we administer clot-busting medication." 

  • "There is no penumbra caused by a cerebral contusion."

Correct answer: "The penumbra may eventually heal."

In the context of cranial injury, the penumbra refers to an area of impaired circulation in which the tissues may remain viable if circulation is restored. This most often refers to the area salvageable brain tissue during a brain attack, but is also relevant to a cerebral contusion. During a cerebral contusion, cerebral edema may impair circulation, causing ischemia and a penumbra. The penumbra may eventually heal, but part of all of the penumbra may also become ischemic. 

Clot-busting medication can salvage the penumbra if it is caused by an ischemic brain attack, but not when it is caused by the edema related to a cerebral contusion.

117.

When developing a plan of care for the rehab care of a trauma patient, which of the following considerations regarding the level of involvement by the patient is most correct?

  • The patient should be as involved as possible because the patient is ultimately responsible for the outcome

  • The patient should be as involved as possible because the patient understands the care they need better than the care team

  • Patient involvement should be minimal because patient care is better planned by healthcare experts

  • Patient involvement should be minimal because their involvement can cause unnecessary stress that is counterproductive

Correct answer: The patient should be as involved as possible because the patient is ultimately responsible for the outcome

Developing a plan of care for the rehab of a trauma patient should be a collaborative process so that the patient's unique needs and desired outcomes are considered in the plan and because the outcome of the care plan will ultimately depend on the patient's involvement and effort. 

While the patient should be as involved as possible, this is not because the patient is more of an expert in rehab care than the care team. While the patient likely does not understand trauma rehab as well as trained healthcare professionals, they do understand their unique needs and motivators better than the healthcare team, making them an essential part of the planning process. 

While involvement in the planning process may cause stress at the time of planning care, it will help reduce stress over the long-term by helping the patient form accurate expectations for their treatment process.

118.

A patient who has recently suffered a head injury is unable to open their eyelids. Which of the cranial nerves controls this movement?

  • CN III

  • CN VII

  • CN IV

  • CN VI

Correct answer: CN III

The third cranial nerve, the oculomotor nerve, controls the eyelids' ability to open. 

Cranial nerve VII, or the facial nerve, controls closure of the eyelids. Cranial nerve VI, or the abducens nerve, controls movement of the eyes laterally and outward, and cranial nerve IV, or the trochlear nerve, controls movement of the eyes downward and inward.

119.

You are the trauma nurse caring for an 87-year-old female who presents with her daughter, who is her primary caregiver. The daughter tells you that the patient had a fall. The patient presents with a large hematoma on the posterior left calf. She has multiple bruises that are in various stages of healing, and her arm is in a sling. The patient's daughter tells you that this is for a broken humerus that occurred during another fall three weeks ago. 

Which of the following is most important for this patient?

  • Interview the patient without the caregiver present

  • Get the patient a life alert alarm and a walker

  • Assess the patient for bleeding disorders

  • Assess the patient for leukemia

Correct answer: Interview the patient without the caregiver present

The patient has bruising in various stages of healing combined with injuries that would not be expected from a fall. The patient may be a victim of abuse and should be interviewed without the caregiver present. 

Getting the patient a life alert alarm and a walker would be a good intervention if the patient seemed to be having frequent falls, but abuse is more likely. The patient could be assessed for bleeding disorders or leukemia, but these conditions are less likely and do not fit the patient's presentation as well.

120.

Which of the following is not a type of hip dislocation that may occur during a trauma?

  • Medial dislocation

  • Anterior dislocation

  • Posterior dislocation

  • Central fracture dislocation

Correct answer: Medial dislocation

There are three types of hip fractures that may occur during a trauma. These include central fracture dislocation, where a fracture of the pelvis results in free movement of the femoral head; anterior dislocation, where the femoral head dislocates by moving forward; and posterior dislocation, where the femoral head dislocates by moving backward. 

There is no such thing as a medial hip dislocation.

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