CHAPTER 33: TRAUMA {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 33: T RAUMA
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. A patient is admitted to the intensive care unit (ICU) for observation of
his grade II splenic laceration. Which sign s and symptoms suggest that the
patient has had a delayed rupture of his splenic capsule and is now in
hemorrhagic shock?
a. Blood pressure (BP), 110/70 mm Hg; HR, 120 beats/min; Hct, 42
mg/dL; UO, 40 mL/h; skin that is pink, warm, and dry, with
capillary refill of 3 seconds
b. BP, 90/70 mm Hg; HR, 140 beats/min; Hct, 21 mg/dL; UO, 10
mL/h; pale, cool, clamm y skin; confused
c. BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 35 mg/dL; UO, 30
mL/h; pale, cool, dry skin; alert and oriented
d. BP, 110/60 mm Hg; HR, 118 beats/min ; Hct, 38 mg/dL; UO, 60
mL/h; flushed, warm, diaphoretic skin; agitated and confused



ANS: B



The first set of vital signs is normal. Patients who are in hemorrhagic
shock are significantly tachycardic with a narrowed pulse pressure and
oliguric, and their skin is pale, cool, and clamm y. They also have a low
hematocrit and are confused. Hemodynamicall y stable patients may be
monitored in the critical care unit by means of serial hematocrit values
and vital signs. Progressive deterioration may indicate the n eed for
operative management.

, PTS: 1 DIF: Cognitive Level: Anal yzing REF: p. 768
OBJ: Nursing Process Step: Assessment TOP: Trauma
MSC: NC LEX: Physiologic Integrit y



2. A patient was thrown 30 feet from an open -top Jeep and straddled a row of
mailboxes before landing on the ground. The patient has an open pelvic
fracture. What characteristics of this injury are important for the nurse to
understand?
a. Aggressive fluid and blood replacement will probabl y be needed.
b. The patient will probabl y be able to walk as soon as the patient is
stable.
c. The patient will probabl y not need surgery to stabilize her fracture.
d. There is little likelihood of damage to the genitourinary or
gastrointestinal tracts.



ANS: A



The mortalit y rate for these injuries is high because, u nlike closed
pelvic fractures that bleed into the peritoneum, open pelvic fractures
result in external exsanguinations.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
794 OBJ: Nursing Process Step: Intervention TOP:
Trauma MSC: NC LEX: Physiologi c Integrit y



3. A patient with multisystem trauma has been in the intensive care unit
(ICU) for 6 days. The patient is still intubated and mechanicall y ventilated
and has a chest tube, urinary drainage catheter, nasogastric tube, and two
abdominal drains. The patient’s vital signs include blood pressure (BP),
92/66 mm Hg; heart rate (HR), 118 beats/min; temperature (T), 38.7° C;

, and central venous pressure (CVP), 5 mm Hg. What is the most likel y
cause of this hemodynamic picture?
a. Septic shock
b. Hemorrhagic shock
c. Cardiogenic shock
d. Neurogenic shock



ANS: A



The patient with multiple injuries is at risk for overwhelming
infections and sepsis. The source of sepsis in the trauma patient can be
invasive therapeutic and diagnostic catheters or wound contamination
with exogenous or endogenous bacteria. The source of the septic nidus
must be promptl y evaluated. Gram stain and cultures of blood, urine,
sputum, invasive catheters, and wounds are obtained.



PTS: 1 DIF: Cognitive Level: Anal yzing REF: p. 796
OBJ: Nursing Process Step: Diagnosis TOP: Trauma
MSC: NC LEX: Physiologic Integrit y



4. Older trauma patients have a higher mortalit y than younger trauma
patients. The nurse understands that this fact is probabl y related to what
physiologic change?
a. Deterioration of cerebr al and motor skills
b. Poor vision and hearing
c. Diminished pain perception
d. Limited physiologic reserve



ANS: D