TCRN Test Questions with 100% Correct Answers

Fluid resuscitation is administered to a traumatically injured patient. After resuscitation, the trauma nurse evaluates the patient's response to that resuscitation to determine whether additional fluids should be administered. Which of the following factors is most likely to impact this evaluation? Correct Answer Beta-blockers blunt changes in the pulse and blood pressure. This may both reduce changes associated with recognizing hypovolemia but it can also reduce changes associated with the response to treatment. Many times the blood pressure falls and the pulse rises with hypovolemia and the opposite happens after fluid resuscitation. When the patient is on beta-blockers, these changes may not occur. Although it is more difficult to assess for changes in skin color in dark-skinned individuals, skin changes are generally not used to evaluate the effectiveness of fluid resuscitation and further resuscitation would not be based on changes in skin color. The presence of lower extremity trauma does not influence evaluation of fluid resuscitation nor the need for additional fluids. A body mass index of 21 kg/m2 is within normal limits and is unlikely to affect resuscitation or the evaluation of resuscitation 50% polyethylene glycol will be used as part of the treatment for: Correct Answer 50% polyethylene glycol is known to increase the solubility of phenols in water and should be used as part of the decontamination process in patients exposed to phenols. It will have no therapeutic effect for patients with pancreatic trauma, carbon monoxide poisoning (treated with 100% oxygen) or acute respiratory distress syndrome (treated with appropriate ventilator management and prone positioning) A reagent strip that tests for glucose is used in the assessment of a traumatically injured patient. What injury is likely suspected? Correct Answer A basilar skull fracture may result in leakage of cerebrospinal fluid, which is rich in glucose. Reagent strips that test for glucose can be used to assist the diagnosis of basilar skull fracture by checking fluid coming from the nose or ears for glucose. A reagent strip that tests for glucose will not be therapeutic in assessing for a bladder rupture, diffuse axonal injury or a ruptured amniotic sac. When administering large volumes of blood products, the trauma nurse should monitor for which of the following findings which could indicate hypocalcemia? Correct Answer A classic finding associated with hypocalcemia is QT prolongation. ST elevation is more common with cardiac ischemia and not associated with hypocalcemia. Tall peaked T waves and flattening of the P wave are both associated with hyperkalemia, not hypocalcemia The trauma nurse knows that treatment for a patient with non-operative abdominal trauma has been effective if: Correct Answer A goal of treatment after abdominal trauma is a return of the base deficit to normal. This indicates adequate fluid resuscitation and is associated with positive outcomes. Although serum amylase levels should be monitored because elevations in these levels may indicate pancreatic or bowel trauma, changes in serum amylase levels are not associated with effective treatment, but rather associated with the injuries themselves. Intraabdominal pressures should be below 10 mm Hg. An intaabdominal pressure above 12 mm Hg indicates intraabominal hypertension, indicating a need for further. Hyperrresonance to percussion in the abdomen is an indication of hollow organ injury and is not a goal of treatment Which of the following statements, made by a patient being discharged home with the diagnosis of a hyphema, indicates FURTHER teaching is warranted? Correct Answer A hyphema is a collection of blood in the anterior chamber of the eye. An isolated hyphema may be treated at home but the patient should be encouraged to rest and avoid any activities which could increase intraocular pressure and cause further bleeding. Patients will be encouraged to keep their head elevated 30 to 45 degrees on pillows, to rest their eyes (avoid activities such as watching television or reading) and to watch for signs of new bleeding (which can include vagal stimulation in the form of nausea and vomiting.) Ibuprofen and other medications which can increase the risk of bleeding should be avoided. A Kleihauer-Betke test may be used to determine: Correct Answer A Kleihauer-Betke test is used to determine the presence of fetal blood in maternal circulation and is often positive in patients with placental abruption. The Kleihauer-Betke test is not useful in determining pain levels nor will it help determine the presence of pancreatic trauma. It is not associated with acute respiratory distress syndrome Adoption of a mass transfusion protocol should help reduce the incidence of: Correct Answer A mass transfusion protocol may prevent the onset of a systemic inflammatory response syndrome (SIRS). The onset of SIRS is related to tissue trauma and prolonged tissue hypoxia. Early, aggressive fluid and blood resuscitation may decrease tissue hypoxia. Fat emboli are the result of a large bone fracture and the incidence of these is not affected by MTP. Post-renal failure is caused by obstructions in the lower genitourinary tract and the incidence of this complication is not altered by MTP. Abdominal compartment syndrome is the result of excessive fluid in the peritoneum. While MTP is not directly associated with abdominal compartment syndrome, the fluids administered during activation of MTP could worsen rather than reduce the incidence of abdominal compartment syndrome Which of the following goals of care is most appropriate for a patient with a maxillary fracture? Correct Answer A maxillary fracture causes loss of bony structure to the mid-face which can cause loss of integrity of the airway. This can be exacerbated by bleeding and edema in the airway, further putting the ability to maintain the airway in jeopardy. When caring for patients with a maxillary fracture, maintenance of airway is always a high priority. Alterations in visual acuity associated with maxillary fractures likely occurred at the time of injury and treatment is unlikely to alter this outcome.