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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 7 of 25

121.

A patient who fell from the roof of a two-story building has a spinal cord contusion. Which of the following statements by the patient indicates an understanding of his injury's prognosis?

  • "My recovery will depend on how bad the bruising of my spinal cord is."

  • "My spinal cord is temporarily stunned and will be working normally within a few days."

  • "This injury will never heal; I will have to deal with its effects for the rest of my life."

  • "This injury will be completely better after surgery."

Correct answer: "My recovery will depend on how bad the bruising of my spinal cord is."

A contusion of the spinal cord is essentially bruising of the spinal cord, with bleeding and edema of the neural substance. Intrinsic responses to bleeding include edema, compression, ischemia and, possibly, infarction. The recovery after a spinal cord contusion will depend on the extent of the contusion and the body's intrinsic response. 

A spinal cord that is stunned and will regain normal function within a few days describes a spinal cord concussion. A laceration of the spinal cord will result in permanent injury; however, a spinal cord contusion may or may not result in permanent injuries. Surgery may be performed in some situations; however, this would be more uncommon and would not have a guaranteed result.

122.

A patient comes into the trauma center with a penetrating trauma causing a ruptured globe of the left eye, but which does not affect any other parts of the body. There is no damage of any kind to the right eye caused by this trauma. 

Which of the following considerations is correct?

  • The left eye trauma may cause problems in the right eye weeks to years later

  • The left eye trauma may cause problems in the right eye days later

  • The right eye is not at any risk of developing problems related to the trauma

  • The patient will likely become blind

Correct answer: The left eye trauma may cause problems in the right eye weeks to years later

Sympathetic ophthalmia is a rare condition that can occur with injury to an eye affecting the uninjured eye. Sympathetic ophthalmia may take weeks, or even years, to occur and its pathology is not fully understood. 

The risk to the right eye is very low, but does exist. The patient may have an increased risk of blindness, but it is still unlikely that blindness will occur.

123.

An 18-year-old male comes to the ER after a fireball exploded in his face when he threw gas on a campfire. The patient seems to be unharmed except for a hoarse voice and some singed nasal hairs. The patient is not having any dyspnea or problems breathing. 

What intervention is best for this patient?

  • Intubation

  • Administering 100% O2 via non-rebreather

  • Monitor his airway for at least 1 hour

  • No important interventions are needed for this patient

Correct answer: Intubation

The patient's singed nasal hairs and hoarse voice indicate that there is heat damage to his airway. Burns to the airway may not initially cause distress, but can result in airway edema and tissue damage that make intubation difficult when it is needed. When an airway burn injury is identified, prophylactic intubation is recommended before the negative impact on the airway makes emergent intubation necessary and more difficult. 

High concentration O2 is needed in cases of carbon monoxide poisoning, which is unlikely to occur with a fireball-type of injury. Monitoring the airway and delaying intubation is not correct. Failing to intervene and discharging this patient would likely result in their death.

124.

Which of the following injuries is most likely to be the primary cause of acute respiratory distress syndrome (ARDS)?

  • ARDS is not primarily caused by any of these injuries

  • Penetrating trauma

  • Blunt trauma

  • Any type of thoracic trauma

Correct answer: ARDS is not primarily caused by any of these injuries

Acute respiratory distress syndrome (ARDS) may occur secondary to an insult or combination of injuries and is not primarily caused by insult or injuries. 

While penetrating traumas, blunt traumas, and thoracic traumas can all cause injuries that can lead to ARDS, none of these will be the primary cause of ARDS.

125.

Which of the following approaches by the trauma nurse is most likely to result in the best outcome during a trauma resuscitation?

  • Provide care as a team, but be proactive and take initiative during the resuscitation process

  • Focus on performing their own tasks without distracting or interfering in the tasks of others

  • Serve as the team leader and provide instructions to other members of the care team

  • Follow the instructions of the team leader, and only perform the interventions that are delegated by the team leader

Correct answer: Provide care as a team, but be proactive and take initiative during the resuscitation process

Trauma care should be provided by the trauma nurse as part of a team, but the trauma nurse should also use their own initiative during the resuscitation process. 

Focusing only on their own tasks and not helping others with theirs is not a team approach, but describes a more siloed approach that will not be in the patient's best interests. The physician, advanced practice nurse, or physician assistant will serve as team lead. The role of the trauma nurse is to support the team lead and provide nursing care for the patient. The trauma nurse should act proactively and should not wait for tasks to be delegated by the team leader.

126.

Which of the following is least likely to cause rhabdomyolysis?

  • Blunt cardiac injury

  • Being struck by lightning

  • Burns

  • Poisonous snake bite

Correct answer: Blunt cardiac injury

Blunt cardiac injury can cause breakdown of the cardiac muscle; however, rhabdomyolysis is caused by the rapid dissolution of skeletal muscle.

Lightening strikes, burns, and venomous snake bites can all lead to rapid muscle breakdown, causing rhabdomyolysis.

127.

In which of the following situations should the trauma nurse least suspect genitourinary injuries?

  • Ski injuries

  • Penetrating abdominal injuries

  • Bicycle accidents

  • Falls

Correct answer: Ski injuries

Genitourinary (GU) injuries are likely to be caused by acceleration-deceleration forces and blunt or piercing trauma in an area that can affect the GU system. Bicycle accidents or falls cause acceleration-deceleration injuries. Penetrating abdominal injuries can affect the GU system. 

Ski injuries, unless the skier directly impacts a stationary object that arrests their forward motion (a rare occurrence), will normally not be acceleration-deceleration injuries and are unlikely to have GU effects.

128.

A 56-year-old male is brought to the ER after being in a house fire during which part of the structure fell on his head and chest. He is breathing at a rate of four breaths per minute and has an O2 saturation of 99%. 

Which of the following interventions is best?

  • Assist ventilations using a bag-mask device

  • Administer O2 at 15L/min using a non-rebreather

  • Prepare for an emergency escharotomy

  • Prepare for an emergency thoracentesis

Correct answer: Assist ventilations using a bag-mask device

The patient is not breathing at a rate that is likely to sustain life and requires assistance with ventilations. The patient's O2 saturation is not likely to be clinically useful, as carbon monoxide levels can artificially increase O2 saturation readings. 

While high concentrations of oxygen should be administered, a non-rebreather will not help treat the patient's hypoventilation. There is no indication that an emergency escharotomy or an emergency thoracentesis is necessary based on the information provided.

129.

Which of the following are important components in the prehospital management of penetrating eye trauma?

  • Shielding the eye

  • Irrigating, then shielding the eye

  • Irrigating the eye

  • Irrigating the eye, then applying a pressure dressing

Correct answer: Shielding the eye

The only prehospital management intervention that is recommended for a penetrating eye trauma is shielding the eye. 

Prehospital irrigation of the eye is recommended for a chemical exposure or potentially a burn, but not for a penetrating trauma. A pressure dressing should not be applied to the eye in a prehospital environment.

130.

The mnemonic LACE is used to assess for soft tissue injuries. Which of the following is not a component of this mnemonic?

  • Coloration

  • Laceration

  • Avulsion

  • Ecchymosis

Correct answer: Coloration

The mnemonic LACE stands for:

  • Lacerations
  • Avulsions and abrasions
  • Contusions
  • Ecchymosis and edema

Coloration is not part of this mnemonic.

131.

You are the nurse assessing a patient who opens their eyes to verbal stimuli and localizes to pain. Their Glasgow Coma Scale score (GCS) is 12. From this, which of the following can you anticipate?

  • Confused conversation

  • Oriented conversation

  • Inappropriate words

  • Incomprehensible words

Correct answer: Confused conversation

According to the GCS, eye-opening to verbal stimuli is scored as a 3, with the highest possible score for that category being 4 and the lowest 1. Localization to pain is scored as a 5 for the motor response category with the highest score in that category being 6 and the lowest 1. With a GCS score of 12 and with 8 points coming from these two categories, the last category's score must be 4. Verbal response is scored between 5 and 1 with 4 being scored for confused conversation, making this the correct answer. 

Oriented conversation would be scored as a 5, inappropriate words would be scored as a 3, and incomprehensible words would be scored as a 2.

132.

Which of the following statements made by a student nurse indicates that they understand the concepts of compartment syndrome?

  • "Compartment syndrome can affect any body compartment."

  • "Compartment syndrome only affects the extremities."

  • "Compartment syndrome most commonly affects the upper legs or the upper arms."

  • "Open fractures will not cause compartment syndrome."

Correct answer: "Compartment syndrome can affect any body compartment."

There are 46 compartments in the body, 36 of which are found in the extremities. Compartment syndrome can occur in any compartment in the body and does not only affect the extremities. 

Compartment syndrome occurs most commonly in the lower legs and forearms, not in the upper legs and the upper arms. Open fracture may cause compartment syndrome in other intact compartments that surround the compartment affected by the open fracture.

133.

A patient with a subdural hematoma requires surgical removal of the space-occupying lesion. Which of the following considerations is most important?

  • Surgery should be performed as soon as possible

  • The subdural hematoma should be allowed time to tamponade and reduce the risk of bleeding

  • Surgery cannot be performed if the cerebral tissues have begun to herniate

  • The patient must be NPO for at least 4 hours prior to surgery to avoid complications

Correct answer: Surgery should be performed as soon as possible

Surgery to remove space-occupying lesion correlates with better outcomes for patients with subdural hematomas if it is performed as quickly as possible. Mortality is 30% for patients with subdural hematomas and elevated intracranial pressures (ICPs) when surgeries are performed within 4 hours, and 90% for those whose surgeries are performed after 4 hours. 

Brain herniation is an indication, not a contraindication, for surgery. Allowing the bleed to tamponade will increase ICP which leads to poor outcomes. While being NPO prior to surgery is ideal, the benefits of immediate surgery for this patient definitely outweigh the risks of not being NPO. Surgery should not be delayed.

134.

Which of the following is a common chronic issue that can potentially be a serious complication of musculoskeletal trauma?

  • Pain

  • Infection

  • Fat embolism syndrome

  • Bleeding

Correct answer: Pain

Chronic pain is a potentially serious complication of musculoskeletal trauma that can inhibit full recovery and lead to a decreased quality of life. 

Chronic infection in the form of chronic osteomyelitis can occur, but is not a common chronic issue associated with musculoskeletal trauma. Fat embolism syndrome and bleeding are not chronic issues and are not likely to occur in the post-acute stage of musculoskeletal trauma.

135.

A pregnant patient presents with signs of being assaulted. The trauma nurse realizes that which of the following is true for pregnant patients?

  • Assault by an intimate partner is more likely during pregnancy

  • Assault by an intimate partner is less likely during pregnancy

  • Assault in general is more likely during pregnancy

  • Assault is not more likely during pregnancy, but is more likely to cause harm if it does occur

Correct answer: Assault by an intimate partner is more likely during pregnancy

The CDC reports that one in three women is likely to suffer intimate partner violence (IPV) during her lifetime. Statistics show that IPV is more likely to occur during pregnancy, not less likely. While IPV is more likely, assault by others is not significantly more likely.

136.

How can the trauma nurse best assess occular motility in an unconscious patient?

  • Move the patient's head from side to side

  • Occular motility cannot be assessed while the patient is unconscious

  • Open the patient's eyes and see if the patient's eyes track movement

  • Shine a penlight in the patient's eyes and see how they respond

Correct answer: Move the patient's head from side to side

Moving the patient's head from side to side will result in eye movement that is contralateral to head movement; this is called the doll's eye maneuver or the vestibulo-ocular reflex. Through this technique, occular motility can be assessed while the patient is unconscious. 

Tracking movement requires conscious effort. Shining light in a patient's eyes provides information about pupillary response, but not about occular movement.

137.

Which of the following best describes transcalvarial herniation?

  • The brain is displaced through a defect in the skull

  • The brain shifts toward one side of the skull

  • The brain moves from one brain compartment to another

  • The brain descends through the foramen magnum, compressing the brainstem

Correct answer: The brain is displaced through a defect in the skull

A transcalvarial herniation describes a condition in which the brain is displaced through a defect in the skull such as a fracture or a craniotomy. 

A herniation in which the brain shifts toward one side of the skull is a subfalcine herniation. A herniation in which the brain moves from one brain compartment to another is called a transtentorial herniation. A herniation in which the brain descends through the foramen magnum, compressing the brainstem, is called a central herniation and is a type of transtentorial herniation.

138.

Blunt trauma to what area of the brain is most likely to result in blindness?

  • Occipital lobe

  • Wernicke's area

  • Temporal lobe

  • Broca's area

Correct answer: Occipital lobe

Processing of visual stimuli occurs in the occipital lobe, and blunt trauma to this area can result in visual impairment or blindness. 

Wernicke's area is responsible for the comprehension of speech and other auditory stimuli, while Broca's area is related to the production of speech. The temporal lobe is not associated with visual processing.

139.

A patient comes into the emergency room with multiple complex injuries, including an amputation of the lower left leg after a motor vehicle accident (MVA). The patient only speaks Swahili, and the hospital's translation resource is not able to immediately provide an interpreter who speaks Swahili. 

Which of the following actions by the trauma nurse is most appropriate to address this patient's immediate needs?

  • Ask the patient's family to translate

  • Organize a professional translator

  • See if the hospital has any staff that can translate

  • Attempt to communicate using drawings and gestures

Correct answer: Ask the patient's family to translate

Translation using a patient's family members should be avoided due to the risk that the family will not fully communicate the concepts between the patient and the provider. When a professional translator is not available, however, family members can be used to translate until professional translation services are available. 

Organizing a professional translator is important, but will take too long to address the patient's immediate needs. It would be impractical to see if the hospital has staff who can translate, and it is unlikely the hospital will have staff that speak a language that is uncommon in the United States. 

Attempting to communicate using drawings and gestures is not ideal if there is a family member who can translate.

140.

A trauma center receives news that there has been a mass shooting nearby, with at least 50 people injured. How should the trauma center plan to address patients' family members as trauma patients begin to arrive.

  • Have a dedicated team to manage and care for family members who come to the hospital

  • Allow family members back with patients according to the hospital's normal policy

  • Do not allow family members near the hospital until all injured patient have been treated

  • Take all family members' contact information and keep them updated via text

Correct answer: Have a dedicated team to manage and care for family members who come to the hospital

Nursing care involves treating both patients and their families. Hospitals have a responsibility to provide care to patients' families, but will need to change how this care is provided in a mass casualty incident. Having a dedicated team to manage and care for family members who come to the hospital allows the hospital to provide support to family members while keeping them out of the care area and preventing them from inhibiting care of the trauma patients. 

Family members should not be allowed to visit as normally. Family members should still be allowed near the hospital, but they may not be allowed to access patient care areas. Care and support for family members should be provided in person, not via text.

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