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Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 8 of 25

141.

The trauma nurse is performing an eye assessment of a patient whose legs and torso were crushed between two vehicles and who is unconscious. Which of the following is most important?

  • Inspect the eyes for foreign objects

  • Gently palpate the patient's closed eyes

  • An eye assessment does not need to be performed for this patient

  • Determine the patient's gross visual acuity

Correct answer: Inspect the eyes for foreign objects 

Even thought the patient does not have any likely injury to the eyes, there may be contact lenses in the patient's eyes that should be removed. 

Gently palpating the patient's eyes is not a good assessment technique. It will not be possible to assess the patient's gross visual acuity while they are unconscious.

142.

The trauma nurse understands that which of the following is not true when placing tourniquets?

  • If the tourniquet doesn't work it should be taken off and applied higher

  • They should be placed as close to the amputation site as possible

  • They should be placed over clothes

  • The time applied should be clearly marked on the tourniquet

Correct answer: If the tourniquet doesn't work, it should be taken off and applied higher

When a tourniquet fails to control bleeding, another tourniquet should be applied proximal to the first tourniquet. The first tourniquet should not be removed, as this can cause bleeding to restart. 

Tourniquets should be placed over clothes and should be placed as close to the amputation site as possible. The time applied should be clearly marked on the tourniquet to avoid leaving the tourniquet on for too long, causing ischemia to the limb.

143.

A patient presents to the emergency room with an eyelid laceration. Which of the following is most important for the trauma nurse to assess for?

  • Underlying injury

  • Amount of blood

  • Cranial nerve involvement

  • Foreign object in eye

Correct answer: Underlying injury

An eyelid laceration can indicate injury to the eye itself if the injury completely penetrated the eyelid or if the force of injury was transferred on the eyeball. 

The eyelid is not likely to bleed heavily, making the loss of blood less of a concern than with other injuries. Cranial nerves are unlikely to be affected by a mechanism of injury that only creates an eyeball laceration. The presence of a foreign object in eye is a concern and will be addressed with an assessment for underlying injury.

144.

The mnemonic LEMON is used for which of the following?

  • Assessing the difficulty of establishing an airway

  • Assessing for life-threatening complications of penetrating trauma

  • Assessing for signs of internal bleeding

  • Assessing the different types of skull fractures

Correct answer: Assessing the difficulty of establishing an airway

The LEMON mnemonic is used to evaluate the difficulty of establishing an airway prior to the procedure. LEMON stands for:

  • Look externally
  • Evaluate the 3-3-2 rule
  • Mallampati score
  • Obstruction/obesity
  • Neck mobility

145.

A 24-year-old female is brought to the ER with possible spinal cord injury at the L4-L5 level. The patient's family member tells you that she is concerned because another nurse told the patient that he needed to assess the patient's reflexes by squeezing the patient's clitoris, which he subsequently did. 

Which of the following responses to this family member's concern is best?

  • "It sounds like the nurse was performing a normal assessment of the spinal nerves, but I would like to learn more about why you are concerned."

  • "It sounds like this nurse was acting inappropriately. Would you like me to contact the police, so you can file assault charges?"

  • "This nurse may have been sexually assaulting your family member. Would you like to speak to the department's manager?"

  • "This was a normal assessment for your family member's injury. There is no cause for concern."

Correct answer: "It sounds like the nurse was performing a normal assessment of the spinal nerves, but I would like to learn more about why you are concerned."

Assessment of the bulbocavernous reflex is performed by squeezing the glans penis or clitoris and observing for contraction of the anal sphincter. This assessment technique is appropriate to use to assess for spinal nerve innervation of the S3, S4 spinal nerves, and is appropriate to use for this patient, given her suspected injury. According to the family, the nurse did explain the assessment to the patient before performing it, and it is reasonable to assume that the nurse's intentions were to perform a medically indicated assessment. 

The correct response is to reassure the family that this is a legitimate medical assessment that was indicated, but also to ensure that there is no other reason that they have concerns about this interaction that may indicate inappropriate behavior.

146.

Which of the following is most likely to cause a tracheoarterial fistula?

  • Medical care

  • Blast injury

  • Blunt trauma

  • Penetrating trauma

Correct answer: Medical care

Tracheoarterial fistulas are most commonly caused by over-inflated endotracheal tube cuffs that cause erosion of the tracheal mucosa through the wall of the tracheoinnominate artery. 

Penetrating trauma can lead to a tracheoarterial fistula, but this would only occur in very unusual situations due to the very specific location the penetrating trauma would have to occur. Blunt trauma and blast injuries are very unlikely to cause tracheoarterial fistulas. The only mechanism for this occurring would be a penetrating shrapnel injury caused by a blast. 

147.

Which of the following is least likely to be caused by crush syndrome?

  • Hypertension

  • Rhabdomyolysis

  • Increased compartment pressures

  • Third spacing of fluid

Correct answer: Hypertension

Crush syndrome occurs due to prolonged entrapment in a crush injury, such as a cave-in or a motor vehicle accident with severe encroachment into the passenger compartment. Crush syndrome is the result of a predictable series of sequela and results in third spacing of fluid, leading to increased compartment pressures and relative hypotension. The crush injury also leads to rhabdomyolysis, which is complicated by the other effects of crush syndrome.

148.

While a trauma patient is being transferred between two hospitals, who is responsible for the patient's care?

  • The physician at the sending facility

  • The physician at the receiving facility

  • The medical director of the transportation services

  • The physician at the sending facility and receiving facility both share responsibility for the patient

Correct answer: The physician at the sending facility

Legally, the physician at the sending facility remains responsible for the patient's care until the patient reaches the sending facility. 

In some situations, transport may divert to another hospital and responsibility may transfer to a physician at the facility that transport diverted to.

149.

Which of the following is not a possible sequela of traumatic brain injury (TBI) that a nurse should monitor for in a patient who has a recent TBI?

  • Basilar skull fracture

  • Intracerebral hemorrhage

  • Cerebral edema

  • Seizures

Correct answer: Basilar skull fracture

A basilar skull fracture may occur at the time that a TBI occurs, but is not a potential sequela of TBI.

Delayed traumatic intracerebral hemorrhage may occur up to 48 hours after the initial injury. Cerebral edema and seizures are also potential sequelae of TBIs.

150.

A patient who is developing compartment syndrome will begin to experience pain and parasthesia with what compartment pressure?

  • 20 mm Hg

  • 5 mm Hg

  • 15 mm Hg

  • 35 mm Hg

Correct answer: 20 mm Hg

Normal intracompartmental pressures are 10-12 mm Hg, and pain and parasthesia typically are experienced with intracompartmental pressures of 20-30 mm Hg. Compartment syndrome is an emergent condition and early recognition of this condition is needed to spare the affected limb.

151.

Which of the following situation is an example of human trafficking?

  • An undocumented immigrant works for $1/hr and their employer threatens to report them if they leave or cut back their hours

  • A woman engages in commercial sex work to pay for her basic needs, even though there are other job opportunities available to her

  • A child is sexually assaulted by an adult relative

  • A paid college intern's employer makes unwanted sexual advances

Correct answer: An undocumented immigrant works for $1/hr and their employer threatens to report them if they leave or cut back their hours

Human trafficking is coercing or forcing a person to perform sexual acts or labor for commercial gain. Threatening an undocumented worker that they will be reported if they do not work for almost nothing is an example of human trafficking. 

Engaging in commercial sex work of one's own volition is not human trafficking, as it lacks the element of coercion or force. Sexual assault of a child or of an employee does involve force, but lacks the element of commercial gain.

152.

Which of the following questions by the trauma nurse does not provide spiritually sensitive grief care?

  • "Can I provide you with a pamphlet on grieving?"

  • "Are there preferred rites or rituals you would like performed?"

  • "Is there a spiritual leader that I can contact?"

  • "Is there a support person who can be with you?"

Correct answer: "Can I provide you with a pamphlet on grieving?"

While providing a pamphlet on grieving is not inappropriate, it does not demonstrate a sensitivity to the patient's family's spiritual needs. 

Asking about preferred rites or rituals does relate to the patient and the patient's family's spiritual needs. Offering to contact a spiritual leader also demonstrates spiritually sensitive grief care. Offering to get a support person provides an opportunity for the family to request a spiritual support person without pressuring them to seek spiritual support.

153.

Which of the following themes of a public injury prevention campaign is most likely to improve motor vehicle accident outcomes?

  • Always wear your seatbelt while driving

  • Always go under the speed limit

  • Stop driving after you turn 80 years old

  • Try other methods of travel besides driving

Correct answer: Always wear your seatbelt while driving

Use of restraints while driving is highly correlated with improved outcomes for those who are involved in a motor vehicle accident (MVA) and is an easy behavioral change to make.

Going under the speed limit, while possibly improving the outcome of MVAs, is not likely to be adopted by a wide segment of the public. Encouraging older drivers to stop driving may also improve the outcome of MVAs, but is not practical and violates the concept of autonomy for those who can still drive safely. Encouraging people to try other methods of travel besides driving may reduce the incidence of MVAs, but is unlikely to improve the outcomes of MVAs that do occur.

154.

A 35-year-old male who has just been shot in the right chest stumbles into the emergency room triage area in obvious respiratory distress. An entry wound is noted, but no exit wound is visible. 

What intervention by the triage nurse is correct?

  • Cover the entry wound with a non-porous dressing, only taping three sides of the dressing

  • Cover the entry wound with a porous dressing

  • Leave the wound open

  • Cover the entry wound with a non-porous dressing, only taping one side of the dressing

Correct answer: Cover the entry wound with a non-porous dressing, only taping three sides of the dressing

A patient with the wound described likely has a pneumothorax and is at risk for a tension pneumothorax. If air is allowed to continue to enter the wound, the pneumothorax will become worse. The wound should be sealed so that no air can continue to enter the wound, but air within the wound must be allowed to escape. Applying a non-porous dressing that is taped on three sides will create a one-way valve that only allows air to flow out of the pleural space. 

Using a porus dressing, leaving the wound open, or only taping one side of the dressing are not correct interventions.

155.

Which of the following describes pulsus paradoxus?

  • A decrease in systolic blood pressure of more than 10 mm Hg during inspiration

  • A decrease in systolic blood pressure of more than 10 mm Hg during exhalation

  • A decrease in heart rate of more than 10 beats per minute during inspiration

  • A decrease in heart rate of more than 10 beats per minute during exhalation

Correct answer: A decrease in systolic blood pressure of more than 10 mm Hg during inspiration

Pulsus paradoxus describes a decrease in systolic blood pressure of more than 10 mm Hg during inspiration and is observed in cardiac tamponade and in other conditions that cause intrathoracic pressure swings.

156.

A 30-year-old male is brought to the emergency room with a gunshot wound that has penetrated the stomach. Which of the following is not an intervention that is expected for this patient?

  • Abdominal fasciotomy

  • Insertion of a nasogastric tube

  • Surgical repair

  • Prophylactic antibiotics

Correct answer: Abdominal fasciotomy

Penetrating trauma of the stomach is unlikely to produce abdominal compartment syndrome, making an abdominal fasciotomy likely to be unnecessary. Abdominal compartment syndrome is more common with blunt traumas, as penetrating trauma often provides an outlet for pressure that may build up within the abdominal compartment. 

Insertion of a nasogastric tube is necessary for gastric decompression, which is used to treat gastric traumas. Surgical repair is the standard of care for penetrating trauma of the stomach, and prophylactic antibiotics are necessary for preventing peritonitis.

157.

Which of the following actions by a team leader is not an example of effective leadership?

  • Addressing an important mistake made by a team member after the trauma is over

  • Providing clear goals and ensuring they are understood

  • Modeling the behaviors that the leader expects

  • Choosing how to allocate limited resources

Correct answer: Addressing an important mistake made by a team member after the trauma is over

Important mistakes should be addressed at the time they occur. Follow up may also be needed after the event is over, but the mistake should initially be addressed when it occurs.

Clear goals should be provided, and the leader should make sure they are understood. A good leader should be sure to model the behaviors that they expect from others. An important part of leadership is choosing how to allocate limited resources.

158.

Which of the following self-inflicted gunshot wounds to the head is most likely to affect a patient's ability to speak if the patient survives?

  • A gun fired against the side of the head above the ear

  • A gun fired straight back in the mouth

  • A gun fired straight up into the mouth

  • A gun fired against the side of the head under the ear

Correct answer: A gun fired against the side of the head above the ear

Wernicke's area is the area of the brain that is primarily responsible for speech and is located in the temporal lobe above the ear. 

A gun fired straight back in the mouth or under the ear is very likely to be fatal but will not affect Wernicke's area if the patient survives. A bullet fired straight up into the mouth will primarily affect the frontal lobe.

159.

Which of the following pelvic injuries is most likely to occur when a passenger exiting a vehicle has their leg struck by a passing vehicle? 

  • Vertical sheer

  • Anteroposterior compression

  • Lateral compression

  • Complex

Correct answer: Vertical sheer

Vertical sheer pelvic injuries are injuries to the pelvis that typically occur by application of a large amount of vertical force, especially when applied to one side of the pelvis. 

Anteroposterior compression occurs with forces that are directed from the anterior to the posterior of the pelvis. This injury pattern would be more likely if the patient was struck directly in the pelvis instead of the leg. Lateral compression occurs due to rotation of one side of the pelvis, and is less likely to occur with the mechanism of injury described. Complex pelvic injuries are not easily classified and tend to result from obliquely applied forces.

160.

The trauma nurse is providing care to a patient who is eight months pregnant and is bleeding profusely from a laceration to her right forearm. Which of the following considerations is correct while monitoring this patient's hemodynamic condition?

  • Vital signs will remain unchanged until profound collapse of maternal vital signs occurs

  • Vital signs will steadily deteriorate, but will deteriorate more slowly than they would in patients who are not pregnant

  • There is no difference in the hemodynamic response of a pregnant patient when compared to a nonpregnant woman

  • Vital signs will steadily deteriorate more quickly than they would in patients who are not pregnant

Correct answer: Vital signs will remain unchanged until profound collapse of maternal vital signs occurs

Pregnancy alters normal response to intravascular compromise from hemorrhage or shock. Patients who are pregnant will have vital signs that will remain unchanged until profound collapse of maternal vital signs occurs. 

Vital signs will not steadily deteriorate, either slowly or quickly; they will plateau, followed by a profound collapse.

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