SeaBirdScientific.com Trauma Nursing Practice Test 1. The hospital administrator has informed you to activate the incident command system. You immediately: A. B. C. D. Open and activate your disaster manual. Notify law enforcement. Call for Code Charley (Federal Standard) on the overhead page system. Self-administer prophylactic Diazepam 10 mg I.M. 2. Fracture of C-4, hypotension, pulse of 43 is distributive shock because: A. B. C. D. There is increased intrathoracic pressure. The patient has become septic. There is a loss of sympathetic tone. The patient hasn’t received bolus IV fluids. 3. When palpating for a central pulse on a 35 year old blunt chest trauma, a rate of 25 beats per minute is discovered. You will: A. B. C. D. Attach pacer pads to chest. Perform a 12-lead ECG. Establish two large caliber intravenous sites. Prepare for emergent intubation. 4. ICP: 22, MAP: 62, CPP: A. B. C. D. 71 84 32 Inadequate. 5. The most important feature of decontamination is: A. B. C. D. Using chemically-appropriate decontamination solutions. Establishment of IVs before airway. Appropriate tent assembly. Avoiding contamination of you and coworkers. 6. A closed crush injury, with an obvious fracture of the left mid-shaft tibia, pain of 8/10 has been medicated. What should not be done? A. B. C. D. Apply traction splint, provide non-pharmacologic comfort measures, such as ice, verbal reassurance. Provide non-pharmacologic comfort measures, such as ice, immobilizing splint, verbal reassurance. Reassess pain level. Provide on-going evaluation of distal neurovascular status. Ver 1.1 9-2-08 Copyright 2008, Todd J. Adelman 1 unresponsive pupil. equipment or tubing. Nasal cannula at 6 liters per minute Non-rebreather mask at 10 liters per minute Endotracheal tube Bag-mask device with 100% oxygen 11. 9. May require immediate surgical intervention. 12. D. In an assertive posture. Prepare for burr holes (trepanation) to reduce ICP. either in the patient. B. Occur during frontal trauma Are slow. his head was turned to side.SeaBirdScientific. hypotension and narrowing pulse pressure produces what type of shock? A. Glasgow Coma Score 13. C. left lateral.com 7. Are generally controlled with firm. Apply atropine drops in responsive eye to equalize pupils. A suspected laceration of the middle meningeal artery with significant bleeding: A. Ask the domestic partner what she wants. insist she immediately leave the treatment area. Hypovolemic Cardiogenic Obstructive Distributive Ver 1. Place head midline. Call security or law enforcement. insidious and subtle in character. Oxygen delivery will be by: A. C. The suspected perpetrator of domestic violence refuses to leave her domestic partner's bedside. Assess bilateral breath sounds. bubbling is noted in the water seal chamber. His spine was cleared by the practitioner. causing a spontaneous tension pneumothorax. D. B. There is an air leak. Place in Trendelenburg position. D. In a permissive posture. C. direct pressure. anticipate hyperosmolar diuretics. D. Muffled heart tones. When checking FOCA 3 hours after chest tube insertion.1 9-2-08 Copyright 2008. C. D. He has a dilated. politely ask her to leave. Due to emesis. C. at this time is: A. B. Your next assessment or intervention: A. A 32 year old cage fighter received a chop to his anterior throat. Your best response. A 38 year old male. Respiratory rate of 6 and shallow. sustained a baseball bat head injury. The chest tube has been inserted in the wrong side. Next: A. Adelman 2 . Emesis has stopped after administration of ondansetron. 8. D. 4 mg IV. B. Todd J. C. This is normal after chest tube insertion. B. B. 10. D. Test for distal neurovascular status. D. tachycardia and thready radial pulses needs: A. open fracture of the femur is noted. Adelman 3 . Basilar skull fracture. C. C. 18. A 66 year old male fell 8 feet from a ladder. C. This means: A. Clear c-spine. A concurrent neurological assessment before proceeding with any other interventions. She may have a small bowel obstruction. Apply traction splint. Apply compression dressing. a non-bleeding. B. 14. B. B. Your priority: A. C. such as Dopamine. Surgical consultation. Illicit drug usage. increasing hypertension in upper extremity blood pressure. 16. Pneumothorax. paraplegia. D. blanched feet. Neurological evaluation. A 48 year old female stab wound to left upper abdomen. decreased level of consciousness. D.com 13.1 9-2-08 Copyright 2008. C. B. rectal sphincter tone is absent. Start second large bore IV. Splenic rupture. Observe for paroxysmal tachycardia. She needs immediate urinary catheterization. D. 15. A direct blow to the eye. with facial trauma has an "eight-ball hemorrhage". B. This probably occurred from: A. with strong central pulses. has 2 large-caliber IVs. Assume it is not life-threatening. Your initial intervention will be: A. When checking an 87 year old female who sustained a ground level fall with a loss of consciousness. Bad luck. Penetrating eye trauma. Tearing abdominal pain. Arterial blood gas. An actively bleeding patient (left groin). Ruptured diaphragm. C. The physician notes the patient. B. There may be a spinal cord injury. During the Initial Assessment. Chest x-ray reveals the gastric tube is in her left chest. Vasoconstrictors. Todd J. 17. Most likely cause: A. Ver 1.SeaBirdScientific. D. Control of bleeding. increase IV fluid rate observe for improvement Administer 1 mg epinephrine 1:10. U/A. D. 24. An example of acceleration/deceleration injury is: A. C. B. tachypnea. 23. Autotransfusion. SpO2: 86% on 100% oxygen. D.com 19. D. IV fluids at TKO. B. PERRL. LeFort fractures almost always will: A.000 IV push. Adelman 4 . pulse of 72. Transfer to another facility. C. Have malocclusion. using sterile technique. Affect balance.1. Trendelenburg. Needle decompression. respirations: 14. A trauma patient's hemoglobin and hematocrit are 6. C. Bullet extraction. Your options: A. coagulation studies. Have massive hemorrhage.1 9-2-08 Copyright 2008. C. C. Coup/contrecoup Head-on collision Liver laceration Perforated small intestine Ver 1.SeaBirdScientific. B. Labs ordered to this point: CBC. During the LOAD phase the initial neuromuscular blocking agent of choice is: A. C. 21. A closed-head injury with a blood pressure of 86/42 (MAP: 57). A 17 year old male gunshot wound to the right chest has decreased breath sounds. D. non-rebreather mask. Todd J. Affect gait. B. B. B. AVPU: Responds to painful stimuli. 35% burns with singed eyebrows and soot in mouth requires RSI. Rapid sequence intubation and hyperventilate. chem panel. regular.2/19. Reverse Trendelenburg. Obtain stat serum lactate level Type and cross-match Prepare for surgery Prepare for rapid sequence intubation 20. D. Your next action will be: A. Succinylcholine Vecuronium Lidocaine Labetalol 22. dullness with percussion of right chest. D. You will anticipate: A. SeaBirdScientific. C. Require aggressive airway management. D. B. D. In general. Aspiration of gastric contents. MIVT: MVC. Lidocaine. unrestrained driver struck steering wheel. Insist CT be performed first. 30. Sellick maneuver is released after failed RSI intubation. Hyperkalemia. Lidocaine IV: 1-1. Todd J. Upon arrival. 26. the best irrigating solution for alkaline ocular burns is: A. metabolic acidosis increases. viscous to prevent throat irritation and gagging. D. 27. 29. Adelman 5 . A weak acidic solution Copious amounts of normal saline. The “L” in LOAD stands for: A. As base deficit increases. Require atropine and 2-PAM injections. B. B. B. D. SpO2: 88% via nasal cannula at 2 liters per minute.5 mg/kg before intubation to prevent ICP. C. C. Prepare to insert gastric tube and urinary catheter. The trauma surgeon has elected to perform diagnostic peritoneal lavage.1 9-2-08 Copyright 2008. Respiratory rate 14. B. A. A weak alkaline solution Lactated ringer's solution Ver 1. Your best intervention: A. C. Hypoxia from apnea. assuming neurological compromise. Prep patient from nipple line to knees. Labetolol IV: 20 mg to prevent hypertension. D. Reflex bradycardia. Nasal cannula at 6 liters per minute Non-rebreather mask at 10 liters per minute Endotracheal tube Bag-mask device with 100% oxygen 28. Decontaminated before entering transporting vehicles or hospitals. B. Any patient presenting with possible external contamination will be: A. C. D. True False Only with internal bleeding. The patient has two patent IVs and is currently hemodynamically stable. When a patient has a pH less than 7.com 25. 31.35. Vigilant care must be given to prevent: A. your oxygen delivery will be by: A. Initiate Propofol drip. such as a Mark I kit. D. C. C. Laryngoscopic assessment prior to RSI. Triaged as priority. B. Surgical stabilization will likely be required. CT is out of order. Adelman 6 . A patient with a clothesline-type neck injury has an expanding neck hematoma. Placing a sandbag on the chest The incorporation of a ventilator Surgical intervention Chest tube insertion 38. Posturing. D. Shaken baby syndrome 35. A community-based disaster. Diffuse axonal injury. C. Your next move: A. C. Brain herniation is a result of uncontrolled increases in ICP. An example of a focal brain injury is: A.SeaBirdScientific. Patient's last name. cool. Bandage absorption.com 32. 34. Stat transfer. 37. You will anticipate: A. because the airway may be compromised. An important consideration when utilizing air transport is: A. 68 year old stab wound to the left upper quadrant with peritoneal signs. C. B. An incident with fewer than ten casualties. B. Your intervention: A. An institutional-based disaster.1 9-2-08 Copyright 2008. C. Ver 1. 90/58. Direct pressure usually will provide control. DPL. Coup/contrecoup Cerebral contusion. 110. B. Todd J. C. D. Apply a tourniquet as definitive care. B. Significant signs: A. This is indicative of cervical fracture. B. Skin: Pale. Pyelogram. IV bolus. Inability to swallow. B. Lateral shift on CT. moist. 36. A patient with blunt chest trauma exhibits paradoxical chest movements with a shallow breathing rate of 45. A requirement for mandatory decontamination. D. D. C. D. Intractable headache. D. D. B. A mass casualty incident is an example of: A. IV bag size. C. Air-filled cavities and containers. 33. A traumatic infant death. has shortening and rotation of the right leg and blood at the urethral meatus. Prepare for emergency thoracotomy. Atropine.com 39. D. 42. 44. Ver 1. D. A failed endotracheal intubation. Insert an intraosseous needle in the proximal tibia. You can perform all. A Critical Incident Stress Management team would more likely be utilized after: A. 24 year old male gymnast with C-4 fracture. 240 mL. motorcycle collision. 41. Instill topical anesthetic eyedrops to control pain. Apply traction splint to right leg. B. Restrained by lap belt. Priority: A. IV bolus. Anticipate hollow organ injury. B. Weight is 24 kg. 43. Cap refill 5 seconds. Rapidly assess for life-threatening problems. Anticipate intra-abdominal bleeding. 0.1 9-2-08 Copyright 2008. Shield affected eye. intravenous access has been unobtainable. An employee being arrested for DUII. 45. The Primary Assessment is to: A. Mottled skin. except: A. You should: A. B. B. You should: A. 40. Prevent patient from coughing. Evaluate in a "Go or Stop" paradigm. B. shallow. A 25 year old female. Priapism is present. Avoid pressure on globe. respiratory rate: 28. Blood pressure: 80/42. C. Specially evaluate pediatric patients. C. Fluid resuscitation. except: A. then recheck cap refill. C. Perform a saphenous venous cutdown. involved in MVC. D. Check distal neurovascular function on right foot. Insert a central line through the internal jugular vein. D. For care of an open globe injury. Contusion across abdomen. An encounter with a psychiatric patient requiring restraints. In the above child. Insert an intraosseous needle in the sternum. B. C. Triage non-critical patients. D.SeaBirdScientific. pulse: 46. with accessory use. all are appropriate. C. C. IV bolus. Hold inserting a urethral catheter. Adelman 7 . B. then recheck cap refill. Support breathing. Avoid chronotropic or inotropic medications.5 mg IV. D. C. 480 mL. Todd J. 5 year old. D. B. 51. 3584 4096 2048 8192 mL mL mL mL 49. Serum potassium of 5. Incorporating the Parkland Formula. B. high replacement rate. She states he sat up too quickly. C. weight: 64 Kg. Crush requires large amounts of IV fluid and compartment syndrome needs decompression. Serum Troponin I of 0. A 64 year old female burn patient.com 46.0. Ruptured bridging veins. you will consider: A. Needle thoracentesis. 47. You will anticipate: A. 48. Besides further neurological evaluation. An 84 year old male sustained a ground level fall while dancing yesterday. Ver 1. C. B. Notifying Children's Protective Services. tracheal deviation. ECG shows sinus rhythm. by 1200. A 17 year old GSW to right chest has absent breath sounds. Urine output of 150 mL per hour. B. Compartment syndrome requires the extremity to be elevated. D. sustained 2nd and 3rd degree burns over 32 percent of her body at 0400. B. he presents as disoriented. D. She arrives in the emergency department at 0500. Cerebral anasarca. Breathing is 24/ minute. hypotension. C. Pericardiocentesis. how much volume should be infused? A. Crush syndrome may require fasciotomy. A 31 year old electrician sustained an electrical burn between his hands. Todd J. The difference between extremities with crush versus compartment syndrome is: A. Today.SeaBirdScientific. A stat transfer to pediatric care facility. What measurement indicates a needed adjustment? A. A 4 month old male is brought in by his mother. D. Delerium. using. Adelman 8 . jugular venous distension. Crush syndrome can produce hypokalemia. Cricothyrotomy. Dementia. hitting his head on the overhead cabinet. D. 50. D. This may indicate: A. in a lethargic state. Autotransfusion.03. C. D. His airway is patent.1 9-2-08 Copyright 2008. Removing mother from treatment area. SPO2: 98%. Cap refill is less than 2 seconds. C. To ask the mother if the child has ever been abused before. B. C. Core temperature of 96 degrees. Your assessment: A. This may be the mother's rate. D. HAZMAT is civilian. 53.1 9-2-08 Copyright 2008. Child's chin touches chest. Calculation of 1 percent of a patient's burn is equal to the nurse's palm. without fingers. your priority is to: A. C. B. As a licensed nurse. A physician's standing order for haloperidol and lorazepam. Decontamination was performed on-scene by EMS.com 52. a rate of 145. The most important consideration when working with a potentially violent patient is: A. Proper position is obtained when: A. C. the "Rule of Palms" implies: A. C. Rapport.SeaBirdScientific. was involved in an explosion. Assess for barotrauma. Administer 2 mg Atropine I. Calculation of 1 percent of a patient's burn is equal to the patient's own palm. C. HAZMAT involves chemicals. Todd J. A pad is placed under a child's shoulders to support his airway. without variability is obtained. The ears are in line with the shoulders. CBRNE does not require full PPE. Child's neck is hyperextended. This is a normal fetal heart rate. Cervical crepitus is not palpated. Notify Homeland Security. B. 54. Handheld ultrasound is not used on pregnancies beyond 16 weeks.M. Palms Medical Center theorized trauma nurses underestimate TBSA of burns and overestimate severity. without fingers. D. D. When calculating body surface area. When assessing fetal heart rate on a 30 week pregnant trauma patient. the other deliberate. Ver 1. B. This indicates impending fetal demise. 56. B. using handheld ultrasound. The difference between HAZMAT and CBRNE is: A. Order for restraints. Perform secondary decontamination before entry to your facility. D. B. CBRNE is military. One is usually unintentional. D. D. A 29 year old unconscious male. B. who was experimenting with chemicals. C. 57. 55. Adelman 9 . Safety. Calculation of 1 percent of a patient's burn is equal to the patient's own palm and fingers. C. Ver 1. Todd J. 60. Cautiously perform Volkmann's Maneuver and reassess. with facial injuries. D. Eye contact with the patient is critical.com 58. This is most likely: A. is intubated. C. you should: A. D. Fax complete documentation after patient has left your facility. Tongue trauma. it must be tilted when being pulled because: A. C. C. B. The head and neck must remain in a neutral position. A fully immobilized 62 year old head injury patient.1 9-2-08 Copyright 2008. B. The patient may have jewelry around the neck. Insert a nasogastric tube to facilitate more patent oral care. After an endotracheal intubation has been performed. Glasgow Coma Score of 6. An uninflated cuff.SeaBirdScientific. B. Tracheobroncheal disruption. As the trauma nurse. Allow family to touch and talk to the patient. When removing a full-face helmet. Adelman 10 . there is no epigastric gurgling auscultated and bilateral breath sounds are heard. D. Tension pneumothorax. 59. sedated and is ready for transfer to another facility. An audible gurgle can be heard from the patient's mouth. It may contain emesis.