CEN Trauma Nursing 2 — Questions and Answers
Question 1: Which assessment finding indicates a class III hemorrhagic shock (estimated blood loss 1500–2000 mL)?
- Heart rate <100, BP normal, slightly anxious
- Heart rate 100–120, decreased pulse pressure, mildly anxious
- Heart rate 120–140, decreased BP, confused, decreased urine output (Correct answer)
- Heart rate >140, no palpable BP, unconscious
Correct answer: Heart rate 120–140, decreased BP, confused, decreased urine output
Class III shock presents with HR 120–140, decreased BP, confusion, and urine output <5–15 mL/hr from significant volume loss.
Question 2: A patient with a traumatic amputation of the right forearm has uncontrolled arterial bleeding. A tourniquet is applied. Which documentation is mandatory?
- Reason for tourniquet application
- Time of tourniquet application (Correct answer)
- Name of the person who applied it
- Patient's blood type
Correct answer: Time of tourniquet application
The time of tourniquet application must be documented because prolonged application beyond 2 hours increases the risk of limb loss.
Question 3: A patient with multiple rib fractures (ribs 4–8) on the right side splints their breathing and has SpO2 of 91%. What is the most effective initial pain management strategy to restore ventilation?
- IV morphine titrated to effect
- Thoracic epidural or regional nerve block (Correct answer)
- Oral oxycodone every 4 hours
- Fentanyl patch application
Correct answer: Thoracic epidural or regional nerve block
Thoracic epidural or intercostal nerve blocks provide superior pain control for rib fractures, allowing deep breathing and preventing atelectasis.
Question 4: A patient sustains an impalement injury to the right chest with the object still in place. What is the correct field management of the impaled object?
- Remove the object carefully and apply pressure
- Stabilize the object in place and do not remove it (Correct answer)
- Remove the object only if it is obstructing the airway
- Cut the object to a manageable length and stabilize
Correct answer: Stabilize the object in place and do not remove it
Impaled objects should never be removed in the field as they may be tamponading hemorrhage; stabilize and transport for OR removal.
Question 5: Which trauma patient is most likely to benefit from permissive hypotension strategy (target MAP 50 mmHg) during resuscitation?
- 68-year-old with TBI and abdominal bleeding
- 25-year-old with penetrating abdominal trauma, no TBI (Correct answer)
- Patient with suspected spinal cord injury
- Patient in septic shock
Correct answer: 25-year-old with penetrating abdominal trauma, no TBI
Permissive hypotension is used in penetrating trauma without TBI to prevent coagulopathy worsening while limiting crystalloid dilution.
Question 6: A patient in hemorrhagic shock receives a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets. What does this ratio represent?
- Standard maintenance fluid replacement
- Damage control resuscitation to prevent trauma-induced coagulopathy (Correct answer)
- Treatment for dilutional anemia only
- Prevention of transfusion-related lung injury
Correct answer: Damage control resuscitation to prevent trauma-induced coagulopathy
1:1:1 (PRBCs:FFP:platelets) is the damage control resuscitation strategy to replace all coagulation factors and prevent lethal trauma triad.
CEN Trauma Nursing 2
Which assessment finding indicates a class III hemorrhagic shock (estimated blood loss 1500–2000 mL)?