2022 new tcrn practice questions with answers solution all solved get an easy a by downloading this solution
a transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrh
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2022 NEW TCRN PRACTICE QUESTIONS WITH ANSWERS SOLUTION ALL SOLVED
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A transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrhage. The doppler
is positive for vasospasm. The trauma nurse would expect which of the following medications to be
prescribed? - A vasospasm is a known complication of subarachnoid hemorrhages. Calcium channel
blockers are used to prevent or reverse vasospasms and are frequently used in the treatment of a
subarachnoid hemorrhage. Metoprolol, Hydralazine and Lisinopril are not calcium channel blockers and
would not be effective to prevent and treat vasospasms caused by a subarachnoid hemorrhage
Which chamber of the heart is most likely to be affected in blunt cardiac injuries? - Given the anatomical
position of the heart in the chest, the right ventricle is most exposed to the anterior portion of the chest
wall and is most likely to be injured in a blunt cardiac injury. Patients with blunt cardiac injuries
frequently experience signs of right ventricular failure. Additional findings that are associated with blunt
cardiac injuries include hypotension, atrial fibrillation, unexplained sinus tachycardia, multiple PVCs, ST
segment changes and right bundle branch blocks. The left atrium, right atrium and left ventricle are less
likely to be injured in a blunt cardiac injury.
A widened mediastinum is noted on the chest x-ray of a traumatically injured hypotensive patient. The
trauma nurse would anticipate gathering which of the following pieces of equipment as the highest
priority in this scenario? - A widened mediastinum on chest x-ray, accompanied by hypotension, is
strongly indicative of an aortic injury. One of the most life-threatening complications of an aortic injury
is blood loss, which can be treated by giving blood products via a rapid transfuser. Although patient
assessment may be enhanced by inserting an arterial line, this is less of a priority than giving fluids
rapidly. A chest tube is placed in the pleural space rather than the mediastinum and is therefore not
indicated in this scenario. Similarly, there is nothing in this scenario that indicates a pericardiocentesis is
indicated so this is not a higher priority than preparing a rapid transfuser.
A properly applied pelvic binder sits across the: - A properly applied pelvic binder is applied across the
greater trochanters of the femur. This allows for optimal compression of the pelvis to control bleeding.
Applying it across the midshaft of the femur is too low and would provide no therapeutic benefit.
Applying it across the pelvic ring or the iliac crests is too high and could actually separate the pelvis
further, increasing bleeding and internal damage.
Treatment for an extraperitoneal bladder rupture will most likely include: - Bladder lacerations that are
located below the pelvic peritoneum are diagnosed as an extraperitoneal bladder rupture. If a laceration
is found along with pelvic peritoneum, it would then be classified as an intraperitoneal bladder rupture.
Management of an extraperitoneal bladder rupture involves urinary catheterization (urethral or
suprapubic) to facilitate urinary drainage from the bladder. Intraperitoneal bladder ruptures require
,surgical intervention for definitive closure. An isolated extraperitoneal bladder rupture does not require
emergent surgical repair or interventional radiology.
Hyperextension of the neck is known to cause: - Hyperextension of the neck (the head snapping
backwards commonly seen in "whiplash" injuries) causes compression and damage to the posterior
portion of the spinal cord. In anterior cord syndrome, the mechanism of injury is the opposite of
posterior cord syndrome (a hyperflexion injury where the neck hyperextends forward - chin to chest)
causing injury to the anterior portion of the spinal cord. A cauda equina syndrome causes injury to the
sacral nerve roots within the spinal canal and is caused by falling directly on the sacrum. Brown-Sequard
Syndrome caused by penetrating trauma to the lateral aspect of the spinal cord will cause a left to right
phenomenon instead of a top down phenomenon.
A patient has a Zone II penetrating neck injury with penetration through the platysma. The trauma nurse
knows that this patient is at increased risk of injury to: - The platysma is a muscle in the neck that gives
support and protection to the vital structures underneath it. Any time there is penetration through the
platysma, there is an increased risk of damage to the underlying structures in the neck. The neck is
divided into three zones. Zone I extends from the sternal notch and clavicle up to the cricothyroid
cartilage. Zone II extends from the cricothyroid cartilage upward to the angle of the mandible. Zone III
extends from the angle of the mandible to the base of the skull. Structures found in Zone I include the
subclavian artery, vertebral artery, lung apices, trachea, thyroid and esophagus. Zone II includes the
internal jugular vein, esophagus, larynx, vagus nerve, carotid artery and vertebral artery. Zone III
includes the salivary and parotid glands, cranial nerves IX-XII, vertebral artery, distal carotid artery, and
distal jugular vein.
A pregnant patient's fundal height is palpated 6 cm above the umbilicus. What is the estimated
gestational age of the fetus? - Fundal height is defined as the distance from the pubic bone to the top of
the uterus in centimeters. In general, the fundus reaches the umbilicus by 20 weeks. Every centimeter
past that point is measured as 1 week. If every one centimeter above the umbilicus equals one week,
then the patient is approximately 26 weeks gestation.
Appropriate care for an amputated body part includes: - When caring for an amputated body part, the
trauma nurse should clean the part removing any dirt and debris, wrapping the part in a slightly saline
moistened gauze, and then placing it in a sealed plastic bag. At this time, the part should be placed in a
second bag containing a mixture of ice and water. It is imperative that the part does not freeze or does
not come into contact with water (which is hypotonic to body tissue). Also ensure that the amputated
part is properly labeled with the patient information.
Decontamination with water is discouraged in patients exposed to powdered: - Dry chemicals that
should not be irrigated with water include dry lime, elemental metals (including sodium, potassium,
, magnesium lithium and phosphorus) and phenol. When exposed to water these substances will cause a
harmful exothermic or "heat producing" reaction burning the patient's skin. They may also release
possible hazardous byproducts into the air. Sulfuric acid, muriatic acid and cement can all be irrigated
with copious amounts of water (although a much of the dry chemical as possible should be brushed off
before irrigation with water is initiated)
Hypovolemic shock is most likely to be caused by: - Hypovolemic shock is caused by fluid loss (e.g.
bleeding or diarrhea) or third spacing of fluids. The inflammatory response caused by a burn leads to
capillary permeability resulting in the third spacing of fluids which results in hypovolemic shock. Cervical
spinal injuries contribute to neurogenic rather than hypovolemic shock. Although an epidural hematoma
causes blood loss, the epidural space is relatively small, so blood accumulation would not be enough to
result in hypovolemic shock. A tension pneumothorax would cause obstructive shock.
The best method for assessing capillary refill on a two-week old traumatically injured neonate is to
blanch the: - The circulatory system of the neonate is not well developed and perfusion to the fingers is
not complete, therefore using the tip of the finger is reserved for older children, adolescents and adults.
It is generally recommended to use the forehead, sole of the foot, the sternum or the palm of the hand
as opposed to the skin over the iliac crest or the tip of the child's tongue
Enteral feedings are initiated on a traumatically injured patient and several days later, the trauma nurse
notes a significant elevation in serum blood urea nitrogen (BUN) and creatinine. The trauma nurse
should suspect this may be caused by: - One of the effects of overfeeding the traumatically injured
patient is azotemia (elevated BUN and creatinine) and the dietician should be notified of azotemia if it is
noted so that an adjustment in calories may be made. Insufficient protein in the diet does not cause
azotemia. Although bleeding ulcers may cause elevations in blood urea nitrogen, they do not tend to
cause elevations in creatinine. Feeding a patient too quickly after trauma does not cause elevations in
BUN and creatinine
A trauma center refers a challenging case to an outside reviewer to validate their review of deficiencies
associated with the care of the traumatically injured patient. What type of performance review process
is this? - The first stage of performance improvement is a primary review. The goal at this level of review
is to be able to provide immediate feedback and resolution of any deficiencies in care provided. Events
that require further investigation will follow into the category of a secondary review and these reviews
are done in a step-by-step approach, usually by the trauma medical director or designee. Immediate
resolution and feedback can be possible at the end of secondary review, and the issue may be resolved.
If the issue is not resolved, it should be referred for a multidisciplinary committee review for further
analysis. This type of analysis would be classified as a tertiary review. If further escalation of review is
required this would be considered a quaternary review. A quaternary review is either performed by the
hospital quality committee, or it is sentfor an external peer review. This type of review is reserved for
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