Trauma and burns practice questions

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NCLEX EXAM PREVIEW

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SESSION 23

15 terms KIMYE0NCHIPreview NCLEX 22 terms EmS Placement of an NG tube contraindicated during emergency care when the patient has a possible

• Inhalation injury
• Head or facial fracture
• Intra-abdominal bleed
• Cervical spine fracture
• Head or facial fracture

A pt is admitted with an open fracture of the tibia after a bicycle accident. During assessment of the patient, the nurse questions the patient

specifically about:

• Any previous injuries to the leg
• The status of tetanus immunization
• The use of antibiotics in the last month
• Whether the injury was exposed to dirt or gravel
• The status of tetanus immunization

The nurse suspects a fat embolism rather than a pulmonary embolism from a venous thrombosis in the patient with a fracture who develops

• Tachycardia and dyspnea
• A sudden onset of chest pain
• ECG changes and decreased PaO2
• Petechiae around the neck and upper chest
• Petechiae around the neck and upper chest

The other answers are PE symptoms, and D is the only different answer.50-60% of cases have D as a symptom.

An RN is working in the ED of a small local hospital when a client with multiple gunshot wounds arrives by ambulance. Which action by the RN is contraindicated in the handling of legal evidence?

• Initiate a chain of custody log
• Give clothing and wallet to the family
• Cut clothing along seams, avoiding bullet holes
• Place personal belongings in a labeled sealed paper

bag

• Give clothing and wallet to the family

When there's a possible crime involved, you don't want to release anything that could be evidence.An hour ago the HCP split the client's forearm cast due to severe arm pain, throbbing, and tingling. Which most important action should be taken by the nurse when the client's symptoms return?

• Administer an IV pain med
• Notify the health care provider immediately
• Cut the cast padding and spread the cast further
• Elevate the arm on pillows above heart level
• Notify the health care provider immediately

What's causing compartment syndrome? Continuing bleeding and giant hematoma inside probably.The nurse is caring for a client involved with an MVA who sustained an unstable pelvic fracture. Which HCP order should be the nurse's priority?

• Urinalysis and culture and sensitivity
• Blood alcohol level and toxicology screen
• Computed tomography (CT) scan of the pelvis
• Give 2 units of cross-matched whole blood
• Give 2 units of cross-matched whole blood

In reality you could be doing more than one thing at once, but in terms of answering questions on the NCLEX, ID the priority thing you have to do when answering questions.Cross-matching usually takes a while so you want to get that started.In really emergent cases though they may just give them O-negative if pressed on time.The RN assesses that the client has some finger swelling of a newly casted right arm fracture with no other abnormal findings. Which is the nurse's priority action?

• Notify the HCP immediately
• Split the cast to prevent constriction
• Elevate the casted arm on pillows
• Document the degree of finger swelling
• Elevate the casted arm on pillows

The client is admitted to the ED after a sports injury. The client verbalizes extreme shoulder pain, and the nurse sees that the client's right arm is shorter than the left. What should the nurse do initially? Select all that apply.

• Lift the right arm to support it with a pillow
• Apply a covered ice pack to the left shoulder
• Prepare the client for immediate surgical repair
• Check the pulses and sensation of the right arm
• Prepare to administer an analgesic as prescribed
• Inspect the left shoulder for swelling and bruising
• Check the pulses and sensation of the right arm
• Prepare to administer an analgesic as prescribed

They should tell you which shoulder is painful...this is kind of a bad question.Arm can be shorter because muscle tries to pull it up and length of one arm can be shorter than the other in result.

The client and his spouse were involved in a motorcycle accident in which the spouse was killed. The client, being treated for multiple rib fractures and a broken leg, asks the nurse which room his wife is in. Which response is appropriate?

• "Unfortunately your wife is not in the hospital at this

time"

• "I'm sorry, but your wife did not survive that motor

vehicle accident"

• "Let me get your family so that you can talk to them

about your wife"

• "The doctor will be talking to you to let you know

where she is located"

• "I'm sorry, but your wife did not survive that motor vehicle accident"

If time of death is already called/it's known the wife is in fact deceased, it's within your scope to tell the patient what happened. What's not in your scope if it's something that's not for sure (e.g. patient getting tested for leukemia. You have the test results back, and their husband starts asking what's wrong with their partner → the doctor has to talk about that with them).What about if someone asks if they're going to die? Their injuries are really bad and you know they might not make it? "Your injuries are very serious, but we're going to stay here with you. You won't be alone. We're doing everything we can to help you." A client is admitted to the ED following a fall from home and the HCP prescribes insertion of a Foley catheter. While preparing for the procedure, the nurse notes blood at the urinary meatus. The RN should take which action?

• Notify the HCP
• Use a small-sized catheter
• Administer pain medication before inserting the

catheter

• Use extra povidone-iodine solution in cleaning the

meatus

• Notify the HCP

Bleeding around the urinary meatus is not normal. Could be a kidney injury, torn ureter, etc. There is a trauma! You don't put a tube in for a trauma.The RN is one of several people who witnessed a vehicle hit a pedestrian at fairly low speed on a small street. The victim is dazed and tries to get up. The leg appears fractured. Which intervention should the nurse take?

• Try to reduce the fracture manually
• Assist the victim to get up and walk to the sidewalk
• Leave the victim for a few moments to call for an

ambulance

• Stay with the victim and encourage the person to

remain still

• Stay with the victim and encourage the person to remain still

You could assist with a reduction, but you won't be doing a manual reduction on a fracture.Whenever Jason sees a trauma case, he always thinks "distract and treat"!

• The RN is caring for a client being treated for fat

embolus after multiple fractures.Which data would the RN evaluate as the most favorable indication of resolution of the fat embolus?

• Clear mentation
• Minimal dyspnea
• Oxygen saturation of 85%
• Arterial oxygen level of 78mm Hg
• Clear mentation

The RN is inserting an NG tube in a child admitted with head trauma. The RN should explain to the parents that the NG tube will be used for what purpose?

• Administer medications
• Decompress the stomach
• Obtain gastric specimens for analysis
• Provide adequate nutrition
• Decompress the stomach

With head traumas, they usually end up puking. There is risk for aspiration in this case.Emptying out their stomach so they won't puke is good.If NG tube is warranted for a head trauma, the situation for the child is probably severe enough.They don't do an NG tube for feeding purposes so soon after a head trauma case.In other cases though they do introduce nutrition ASAP.A parent of a child with a moderate head injury asks the RN, "How will I know if my child is getting worse?" THe RN should tell the parent that the best indicator

of the child's brain function is:

• The VS

B. LOC

• Reaction of the pupils
• Motor strength

B. LOC

With toddlers, think about observing them: change in LOC can be playing in a

different way compared to their normal, not acting the way they usually are, etc.A client with a fracture develops compartment syndrome.Which of the following signs should alert the nurse to impending organ failure?

• Crackles
• Jaundice
• Generalized edema
• Dark, scanty urine
• Dark, scanty urine

If you have compartment syndrome you'll be thinking muscle damage. Could be rhabdo → dark urine. Urine output is also a good indicator that something is wrong.Unless it's HF then you use the weight.You would give them a ton of fluids to treat this patient.Which of the following should lead the RN to suspect that a client with a fracture of the right femur is developing a fat embolus?

• Acute respiratory distress syndrome
• Migraine-like headaches
• Numbness in the right leg
• Muscle spasms of the right thigh
• Acute respiratory distress syndrome

Where does the fat embolus usually go first? Lungs.A client's chest tube is connected to a drainage system with a water seal. The RN notes that the fluid in the water-seal chamber is fluctuating with each breath

the client takes. The fluctuation means that:

• There's an obstruction in the chest tube
• The client is developing subcutaneous emphysema
• The chest tube system is functioning properly
• There is a leak in the chest tube system
• The chest tube system is functioning properly