×

Quiz Session - Attempts With Random Questions

BCEN TCRN Exam Questions

Page 9 of 25

161.

A 64-year-old male has suffered a devastating trauma and is unresponsive. The patient's family is in the ER, including his estranged wife, who has not been with him for seven years, and the patient's girlfriend who lives with him. The patient's wife states that she would like care withdrawn, while the patient's girlfriend states she would like everything possible to be done. The patient has not made a living will or a last will and testament, and you find out that the patient is very wealthy, with his wife positioned to inherit if he passes. 

Which of the following treatment decisions is best?

  • Consult the hospital ethics committee, providing care until the consult occurs

  • Withdraw treatment, because the wife is the next-of-kin and has decision-making rights

  • Provide treatment because the patient's girlfriend has the right to make decisions for him

  • Provide treatment under the principle that consent to treat is implied

Correct answer: Consult the hospital ethics committee, providing care until the consult occurs

Complex ethical dilemmas arise in nursing, where the legally correct choice may be not be ethically correct. In this specific situation, the patient's wife does have the legal ability to make healthcare decisions for the patient, but there is a significant conflict of interest that may be causing her to make decisions that are not in his best interests. In complex ethical situations, the hospital's ethics committee should be consulted as quickly as possible. 

Withdrawing care will have an irreversible result and is not in the patient's best interests, so care should be provided until the ethics committee can make a recommendation. A situation like this may require the hospital to seek legal orders overturning the established decision-making chain for the patient.

162.

The trauma nurse is preparing to help measure a patient's intra-abdominal pressure. Which of the following interventions should the nurse perform?

  • Insert an indwelling urinary catheter

  • Make the patient NPO

  • Complete a pre-operative checklist

  • Insert a nasogastric tube

Correct answer: Insert an indwelling urinary catheter

Intra-abdominal pressure can be measured at the bedside non-invasively by measuring the pressure the abdominal wall exerts on a partially full bladder. Inserting an indwelling urinary catheter is necessary to perform this measurement. 

Completing a pre-operative checklist or making the patient NPO would be necessary if interventions were being taken to relieve elevated intra-abdominal pressure. A nasogastric tube is not used to non-invasively measure intra-abdominal pressure.

163.

Which of the following laboratory values is least important to check after a patient has received multiple transfusions?

  • Magnesium

  • Potassium

  • Calcium

  • Hemoglobin and hematocrit

Correct answer: Magnesium

Magnesium levels are not particularly affected by transfusions.

Potassium is present in blood bank blood in higher concentrations and may cause hyperkalemia. Citrate is used as a preservative in blood bank red blood cells and interacts with calcium in the body to cause hypocalcemia. Hemoglobin and hematocrit are used to evaluate the amount of blood needed and whether sufficient blood has been transfused.

164.

The nurse and a nursing student are caring for a patient with acute kidney injury after being treated for hemorrhagic shock six days ago. The patient has produced minimal amounts of urine over the six days, but begins producing urine again on the nurses' shift and has a high level of output. 

Which of the statements by the nursing student is correct?

  • "The patient is still in renal failure."

  • "Now that the patient is out of renal failure, he is getting rid of all the fluids they gave in the ER."

  • "The patient's oliguria is a good sign."

  • "The patient may have diabetes insipidus."

Correct answer: "The patient is still in renal failure."

Acute renal injury typically includes three distinct phases: oliguric phase, diuretic phase, and recovery. This patient is transitioning from the oliguric phase to the diuretic phase, but is still in renal failure. 

Stating that the patient is out of renal failure is incorrect. The fact that the patient is transitioning from the oliguric phase to the diuretic phase is a good sign, but this would be described as polyuria or diuresis, not oliguria. High urine output can be a sign of diabetes insipidus, but this is not a good explanation for this patient, given his history.

165.

The trauma nurse is caring for a 53-year-old patient who jumped out of a third story window and landed on a trash can with her abdomen taking most of the impact. The patient is developing intra-abdominal hypertension. 

Which of the following is not a complication that the trauma nurse will need to monitor for?

  • Respiratory alkalosis

  • Increased intracranial pressure

  • Decreased cardiac output

  • Decreased blood flow to the kidneys

Correct answer: Respiratory alkalosis

Respiratory acidosis, not respiratory alkalosis, is caused by intra-abdominal hypertension (IAH) as the intra-abdominal pressure decreases the free movement of the diaphragm. 

Increased intracranial pressure can occur as intra-abdominal pressure affects cerebrospinal pressures in the spinal cord, changes which can be transmitted into the intracranial vault. Decreased cardiac output occurs as elevated intra-abdominal pressures affect venous return by compressing the inferior vena cava. Blood flow to the kidneys is affected by increased intra-abdominal pressures.

166.

Which of the following best describes the Kleihauer-Betke (KB) test?

  • A laboratory test examining the level of fetal hemoglobin in maternal blood

  • An ultrasonography technique that detects placental separation

  • A clinical test that indicates if labor is impending

  • An assessment technique that indicates fetal wellbeing in a mother who is hemorrhaging

Correct answer: A laboratory test examining the level of fetal hemoglobin in maternal blood

The KB is a laboratory test that is used to determine the level of fetal hemoglobin in maternal blood. This can indicate if placental maternal separation has occurred and confirms fetomaternal hemorrhage.

167.

Which of the following treatments is recommended for blunt traumatic injury to the gallbladder during a moderate speed motor vehicle accident?

  • Cholecystectomy

  • Cholecystostomy

  • Surgical repair of the gallbladder

  • Nonsurgical management

Correct answer: Cholecystectomy

The recommended treatment for traumatic gallbladder injuries is removal of the gallbladder. Nonsurgical management may be used in very specific situations, however, removal of the gallbladder is less likely to lead to complications. 

Cholecystostomy is creation of a stoma in the gallbladder, and is not normally used to treat traumatic injury. Surgical repair of the gallbladder is not routinely done, as removal of the gallbladder is less likely to cause complications.

168.

A four-year-old patient may have intraabdominal bleeding. Which of the following considerations is important when using a CT to evaluate this patient?

  • A CT scan at this age specifically increases the patient's risk of developing cancer later in life

  • A CT scan at this age has the same considerations it does for adult patients

  • CT scans cannot be used in patients of this age

  • The only age-specific concern is if the patient will be able to remain still for the scan

Correct answer: A CT scan at this age specifically increases the patient's risk of developing cancer later in life

Children age 0 to 5 years are susceptible to ionizing radiation, and radiation exposure via CT scanners correlates with an increased lifelong risk of leukemia and solid-tumor cancers. 

A CT scan for a four-year-old does not have the same considerations as an adult. Patients of this age can still receive CT scans; however, the age-specific risks and benefits must be considered. While the patient's ability to stay still is an age-specific concern, it is not the only age-specific concern.

169.

Which of the following statements made by a patient indicates that they understand the trauma nurse's teaching about whiplash injury?

  • "Whiplash describes injuries caused when the neck is bent backward too far."

  • "Whiplash describes injuries caused when the neck is bent forward too far."

  • "Whiplash describes injuries caused when the neck is bent too far, first backward then forward."

  • "Whiplash describes injuries caused when the neck is bent too far, first forward then backward."

Correct answer: "Whiplash describes injuries caused when the neck is bent backward too far."

Whiplash is a broad term describing injuries caused by hyperextension of the neck. Whiplash injuries cause intervertebral movement and stress and strain injuries to the neck ligaments and muscles. 

Injuries do not need to involve hyperflexion of the neck, either by itself or in combination with other injuries, to be classified as a whiplash injury. Whiplash injuries are, however, often accompanied by hyperflexion due to acceleration-deceleration forces.

170.

The trauma nurse is caring for a patient who experienced blunt head trauma from a fall down eight steps while inebriated. The patient has a PaO2 of 62 mmHg. The trauma nurse bases her treatment on the knowledge that which of the following is true?

  • A single episode of hypoxemia (PaO2 < 60 mmHg) can have negative effects for this patient

  • A single episode of hypoxemia (PaO2 < 50 mmHg) can have negative effects for this patient

  • A sustained episode of hypoxemia (PaO2 < 60 mmHg) can have negative effects for this patient

  • A sustained episode of hypoxemia (PaO2 < 50 mmHg) can have negative effects for this patient

Correct answer: A single episode of hypoxemia (PaO2 < 60 mmHg) can have negative effects for this patient

A single episode of hypoxemia is correlated with poor clinical outcomes for patients with head trauma. The PaO2 should be kept above 60 mmHg, and oxygen saturation should be maintained at least 95% or greater to avoid a hypoxic episode.

171.

Which of the following best describes a hyphema?

  • Blood accumulating in the anterior chamber of the eye

  • Blood accumulating in the posterior chamber of the eye

  • Blood accumulating behind the eye

  • Blood leaking from the eye

Correct answer: Blood accumulating in the anterior chamber of the eye

A hyphema refers to blood accumulating inside the anterior chamber of the eye and occurs with occular trauma. 

Bleeding behind the eye is called retrobulbar hematoma and is an occular emergency that can cause blindness.

172.

A trauma nurse is evaluating a patient who was stabbed just below the diaphragm during an assault. The knife was removed from the wound during the stabbing. Which of the following factors can best help the trauma nurse to determine the knife's angle of entry?

  • The gender of the assailant

  • The height of the assailant

  • The height of the patient

  • The number of knife wounds

Correct answer: The gender of the assailant

The gender of the assailant is a helpful factor in determining the angle of entry of the knife. Males tend to stab with upward force, while females tend to stab downward. While this is not a rule, it is statistically significant and can help determine a knife's trajectory during a stabbing. 

The height of the patient and their assailant will impact where the entry wound is, but not the angle of entry. The number of knife wounds does not predictably affect the angle of entry during a stabbing.

173.

When a patient has trauma to the spine, which spinal structure is least likely to tear?

  • Discs

  • Spinal cord

  • Nerve roots

  • Ligaments

Correct answer: Discs

Vertebral discs are unlikely to experience tearing-type injuries and more likely to herniate. 

The spinal cord, nerve roots, and ligaments of the spine are all more likely to experience tearing types of injuries when compared to other injury types.

174.

While assessing a trauma patient, the nurse notes that the patient is able to extend and flex their legs. At what level of innervation is this movement controlled?

  • L2-L4

  • L4-L5

  • C5-C7

  • S3-S4

Correct answer: L2-L4

L2-L4 is the area of the spine innervating muscle movements of the legs. 

L4-L5 is associated with innervation that allows the foot to be flexed and the toes to be extended. C5-C7 is associated with innervation that allows flexion and extension of the arms. S3-S4 is associated with innervation of the anal sphincter.

175.

A 22-year-old female who is 33 weeks pregnant is involved in a high-speed motor vehicle accident in which the airbags were deployed. Which of the following is a consideration for this patient?

  • The benefits of airbag deployment are greater than the risks for pregnant patients

  • Airbag deployment only has benefits for pregnant patients involved in a motor vehicle accident

  • Airbag deployment only creates risk for pregnant patients involved in a motor vehicle accident

  • The risks of airbag deployment are greater than the benefits for pregnant patients

Correct answer: The benefits of airbag deployment are greater than the risks for pregnant patients

In the later stages of pregnancy, airbag deployment causes an equally distributed force of approximately 125 miles per hour across the mother's entire torso. This increases the risk of fetal coup-contrecoup injury. The risk of injuries due to the crash, however, are greater to the fetus and the mother if airbags do not deploy, making the risks of non-deployment of the airbags greater than the risk of airbag deployment.

176.

A hospital receives a gunshot wound victim and learns that this is the first victim coming to the hospital from a terrorism-related mass shooting in which 62 people are believed to be injured.

What phase of the disaster life-cycle is the hospital in?

  • Response

  • Mitigation

  • Preparedness

  • Recovery

Correct answer: Response

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. 

As there is an occurring disaster, the hospital here is best described as being in the response phase.

177.

Which of the following factors has the greatest influence on how destructive a bullet wound will be to internal tissues?

  • Muzzle distance from the entry point

  • Velocity of the bullet

  • Yaw

  • Tumble

Correct answer: Muzzle distance from the entry point

Muzzle distance from the entry point affects muzzle blast injury but does not affect how destructive the bullet is. 

The velocity of the bullet affects how much kinetic energy the bullet transfers. The yaw of the bullet describes how much the nose of the bullet deviates from a straight line and affects kinetic energy transfer on impact. Tumbling refers to the forward rotation of the bullet along its center of mass, which can cause extensive damage.

178.

The nurse is assessing a patient who was the restrained passenger during a motor vehicle accident (MVA). Which of the following organs is least likely to be damaged from the impact of the patient's abdomen against the seatbelt?

  • Spleen

  • Stomach

  • Bladder

  • Uterus

Correct answer: Spleen

The impact of the abdomen against the seatbelt causes compression of the abdominal cavity that can rupture hollow organs. This mechanism of injury would be less likely to injure solid organs such as the spleen and more likely to injure hollow organs like the stomach, bladder, and uterus.

179.

Which of the following is not considered part of the trauma triad of death?

  • Hypotension

  • Hypothermia

  • Coagulopathy

  • Acidosis

Correct answer: Hypotension

The trauma triad of death is used to describe the interrelationship between hypothermia, coagulopathy, and acidosis. These three factors contribute to the development of each other and, together, are associated with poor clinical outcomes in trauma patients.

180.

Which of the following best describes a state of loss and the period of response to that loss?

  • Bereavement

  • Mourning

  • Grief

  • Stress reaction

Correct answer: Bereavement

The terms "bereavement," "mourning," and "grief" are often used interchangeably but have distinct meanings. Bereavement refers to a state of loss and the period of grief and mourning that follows the loss. 

Grief describes an individual's response to loss. Mourning describes an individual's expression of their grief and loss. A stress reaction is a component of grief that does not specifically relate to a loss but to any psychological stress.

×