Critical Care Final – trauma TEST LATEST 2025
ACTUAL EXAM QUESTIONS AND DETAILED
CORRECT ANSWERS | ALREADY GRADED A+
A nurse is caring for a patient with blunt chest trauma after a motor vehicle
accident. The patient starts to complain of pain from the chest to the shoulder
and a sense of impending doom. Upon assessing the patient, the nurse notes that
the patient has diminished breath sounds on the left side, jugular vein distention,
and tracheal deviation to the right. The nurse anticipates:
- insertion of an indwelling urinary catheter.
- insertion of a chest tube.
- a chest radiograph.
- administration of pain medications. - ANSWERinsertion of a chest tube.
Your patient was a passenger in a motor vehicle crash yesterday and suffered an
open fracture of the femur. His condition was stable until an hour ago, when he
began to complain of shortness of breath. His heart rate is 104/minute,
respiratory rate is 30/minute, B/P is 90/60 mm Hg, and temperature is now 38.4°C.
You suspect that he:
-has a fat embolism.
-has developed metabolic acidosis.
- is developing systemic inflammatory response syndrome
- is experiencing early multisystem organ failure. - ANSWERFat Embolism
Rationale: These are classic signs and symptoms of a fat embolism. The history
of a long-bone fracture increases the suspicion of fat embolism.
Poor patient outcomes after a traumatic injury are associated with:
- chest tube placement for treatment of a hemothorax.
- immediate decompression of a tension pneumothorax.
- massive transfusions of blood products.
- peritoneal lavage to diagnose intraabdominal bleeding. - ANSWERmassive
transfusions of blood products.
Rationale: Research has shown that patients receiving massive blood
transfusions have poorer outcomes.
,This is a common cause of death after chest trauma because it frequently leads
to the development of acute respiratory distress syndrome (ARDS) or pneumonia.
Cardiac tamponade
Hypothermia
Neurogenic shock
Pulmonary contusion - ANSWERPulmonary contusion
Rationale: Pulmonary contusion increases the risk for development of ARDS or
pneumonia.
A trauma patient with a fractured forearm complains of extreme, throbbing pain at
the fracture site, and paresthesia in his wrist and hand. Upon further assessment
you note that his forearm is extremely edematous and you are now having
difficulty palpating a radial pulse. You emergently notify the physician because
you suspect:
Compartment Syndrome
Fat Emboli
Hypothermia
Rhabdomyolysis - ANSWERcompartment syndrome.
Rationale: These signs and symptoms are characteristic of compartment
syndrome.
The trauma patient presenting with left lower rib fractures develops left upper
quadrant tenderness, hypotension, and referred pain to the left shoulder. You
suspect:
bowel obstruction.
cardiac tamponade.
pulmonary contusion.
splenic injury. - ANSWERsplenic injury.
Rationale: Splenic injury occurs most often as a result of blunt trauma to the
abdomen. However, penetrating trauma to the left upper quadrant of the abdomen
or fracture of the anterior left lower ribs also contributes to splenic injuries. The
patient may present with left upper quadrant tenderness, peritoneal irritation,
and/or referred pain to the left shoulder (Kehr's sign). Hypotension or signs of
hypovolemic shock may also be noted.
A 55-year-old trauma patient who hit the steering wheel and has a pulmonary
contusion requires mechanical ventilation. Which of the following is NOT a
potential complication of this injury?
Flail chest
Hemothorax
Pericardial tamponade
Pneumonia - ANSWERFlail chest
,Rationale: A flail chest is commonly associated with rib fractures, which are not
present in this patient.
Spinal cord injury causes a loss of sympathetic output, resulting in distributive
shock with hypotension and bradycardia. Although blood pressure may respond
to fluid resuscitation, what other therapy may be required to compensate for loss
of sympathetic innervation?
Colloids
Glucocorticoids
Proton pump inhibitors
Vasopressors - ANSWERVasopressors
Rationale: Blood pressure may respond to IV fluids, but vasopressor therapy is
often required to compensate for the loss of sympathetic innervation and
resultant vasodilation.
A restrained patient's status after a motor vehicle crash includes dyspnea and
complaints of severe chest pain. Upon assessment you note that he does not
have any femoral pulses. Which of the following complications and related
diagnostic test should be considered?
Aortic dissection and aortogram
Cardiac tamponade and pericardiocentesis
Hemothorax and chest x-ray
Pulmonary contusion and chest x-ray - ANSWERAortic dissection and aortogram
Rationale: Signs of aortic disruption include weak femoral pulses, dysphagia,
dyspnea, hoarseness, and pain. A chest x-ray study may demonstrate a widened
mediastinum, tracheal deviation to the right, depressed left mainstem bronchus,
first and second rib fractures, and left hemothorax. The diagnosis is confirmed by
an aortogram.
The primary priority for the critical care nurse in regards to the trauma patient is:
Decrease the patient's risk for multisystem organ dysfunction.
Ensure adequate fluid resuscitation.
Increase the physiological reserve of the trauma patient.
Provide adequate oxygenation and ensure tissue perfusion. - ANSWERprovide
adequate oxygenation and ensure tissue perfusion.
Rationale: The priority is to maintain adequate oxygenation and tissue perfusion.
A 72-year-old patient fractured his pelvis in a motor vehicle accident 2 days ago.
He suddenly becomes anxious and short of breath. His respiratory rate is 34
breaths per minute, and he is complaining of midsternal chest pain. His oxygen
saturation drops to 75%. You suspect:
cardiac tamponade.
myocardial infarction.
pulmonary embolus.
Rationale: The patient's history and respiratory signs and symptoms indicate
pulmonary embolus.
Which condition is a common cause of death after chest trauma?
Cardiac tamponade
Flail chest
Hemothorax
Pulmonary contusion - ANSWERPulmonary contusion
Pulmonary contusion as a result of blunt chest trauma increases the risk for
development of pneumonia, acute lung injury, and/or ARDS. Cardiac tamponade
is life threatening if untreated, but it is not a common complication after blunt
chest trauma. Flail chest and hemothorax may result with blunt chest trauma, but
they are not common causes of death
Check ALL THAT APPLY
A 55-year-old trauma patient hit the steering wheel and has a cardiac contusion.
Which are potential complications of the injury? (Select all that apply.)
Flail chest
Dysrhythmias
Hypotension
Myocardial ischemia - ANSWERDysrhythmias
Hypotension
Myocardial ischemia
A flail chest is commonly associated with rib fractures, which are not present in
this patient. Cardiac contusions present with signs and symptoms of ineffective
heart functioning, including dysrhythmias, decreased cardiac output (i.e.,
hypotension), and myocardial ischemia that may progress to infarction.
Check ALL THAT APPLY
When obtaining report on a trauma patient, which question would be helpful in
determining potential injuries associated with the mechanism of injury? (Select
all that apply.)
Was the patient wearing a seat belt?
Where was the patient in the car?
Where are the family members?
Was fluid resuscitation initiated? - ANSWERWas the patient wearing a seat belt?
Where was the patient in the car?
When obtaining report on a trauma patient, several questions should be asked to
help determine potential complications associated with the mechanism of injury.
It is especially important to ask where the patient was sitting in the car and
whether he or she was wearing a seatbelt. Asking the distance of a fall assists
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