A 5-year old child presents to the ED with bruises to the upper arms and buttocks in
various stages of healing and multiple small, clean, round burns to the back. There are
no abnormalities found based on the pediatric assessment triangle or primary survey.
Which of the following is the priority nursing
interventio
n?
Answer: A - ANSA) report your suspicion of the maltreatment in accordance with local
regulations *** B) apply ice to the bruises and consult wound care
C) engage in therapeutic communication to determine
the MOI D) provide the family with injury prevention
resourse
A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the
bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment
reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would
the nurse questions?
Answer: C - ANSA) Fast
exam B) CT scan
C) straight cath for urine
sample *** D) ice and
elevation of the scrotum
A 35-year old male presents with facial trauma after bring struck inthe face with a
baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is
suspected?
Answer: B - ANSA) oculomotor nerve
palsy B) globe rupture ***
C) uncal
herniation D)
retinal
detachment
A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her
hand due to pain. Which of the following is the most appropriate intervention?
Answer: B - ANSA) apply a sling and elevate the extremity to the level
of the heart. B) apply a splint and ELEVATE ABOVE THE LEVEL OF THE
HEART ***
C) Apply a sling and elevate the extremity above the level of
the heart D) apply a splint and elevate the extremity to the
level of the heart.
A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd,
pelvic, and bil
lower extremity pain Vitals signs are stable. The nurse can anticipate all of these
negative fast exam
except which of the following?
Answer: A
The FAST exam is done at the bedside to identify pathological fluid in the abdominal and
pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage
and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST
study does not rule out injury and may warrant a follow-up computed tomography scan.
Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage.
Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical
team to rapidly identify the presence of hemorrhage in patients who are hemodynamically
unstable after trauma. - ANSA) diagnostic peritoneal lavage ***
B) serial fast exams
C) abdominal and pelvic CT
scans D) serial abdominal
assessments
A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access
facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as
follows:
BP 98/71
HR 125
beats/min RR 26
breaths/min
SpO2 94% on high flow O2 via NRB mask
which of the following is the priority intervention for this patient?
Answer: C - ANSA) Expedite transport to the CT
scanner B) prepare the patient for spinal
radiographs
C) expedite transfer to the closest trauma
center *** D) notify the patients family
A passenger is brought to the emergency department of a rural hospital following a high-
speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey,
which of the following is the priority interventions?
Answer: A - ANSA) initiate transfer to a trauma
center ** B) provide report to the operating
room nurse
C) Obtained imaging
studies D) Place a
gastric tube
A patient arrives with a large open chest wound after being assault ed with a machete,
Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3
sides. He is now showing signs of anxiety, restlessness, severe respiratory distress,
cyanosis, and decreasing blood pressure.
Which of the following is the MOST appropriate interventions?
Answer: C - ANSA) needle
decompression B) tube thoracostomy
C) dressing
removal ** D)
surgical repair
A patient has been in the ED for several hours waiting to be admitted. He sustained multiple
rib fractures and a femur fracture after a fall. He has been awake, alert, and c/o leg pain. His
wife reported suddenly becoming anxious and confused. Upon reassessment, the patient is
restless, with respiratory distress and petechiae to his neck. the patient is exhibiting signs of
symptoms commonly associated with which of the following conditions?
Answer: B - ANSA) acute lung
injury B) fat embolism ***
C) PTX
D) pulmonary contusion
A patient is found lying on the floor after falling 13 hours ago. Which of the following lab
values is expected with a musculoskeletal complication associated with this
presentation?
Answer: A - ANSA) elevated creatine
kinase *** B) decreased potassium level
C) decreased
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