A patient is brought to the emergency department of a rural hospital following a high-speed
motor vehicle collision. When significant abdominal and pelvic injuries are noted in the pri-
mary survey, what is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter - ANSWER A. Initiate transfer to a trauma center
An adult who fell from a second story roof is brought to the emergency department by pri-
vate vehicle. The patient is confused with unlabored respirations and has strong, palpable
radial pulses. There is an open wound in proximity to an obvious deformity of the left lower
extremity. What is the priority intervention?
A. Initiate cervical spine stabilization
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen.
D. Log roll the patient onto a spine board - ANSWER A. Initiate cervical spine stabilization
An adult patient who sustained a severe head trauma has been intubated and is being man-
ually ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has re-
ceived one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The
PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is
the most important intervention to manage the cerebral blood flow?
A. Decrease the rate of manual ventilation
1
,B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered - ANSWER A. Decrease the rate of manual
ventilation
An adult patient is brought to the emergency department following a vehicle "roll-over" with
prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh
and a weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial in-
tervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa) - ANSWER B. Ap-
plication of a pelvic binder
An adult arrives at the emergency department with superficial burns to the extremities fol-
lowing a house fire. The patient is reporting a headache with nausea and is drowsy and con-
fused. What is the most likely cause of these symptoms?
A. Capillary leak syndrome
B. Rhabdomyolysis
C. Carbon monoxide poisoning
D. Hypothermia - ANSWER C. Carbon monoxide poisoning
Using the American College of Surgeons Guidelines for Screening Patients with Suspected
Spine Injury, what assessment finding would prompt the nurse to prepare a patient for cervi-
cal spine imaging?
A. Alert with no neurologic deficits or neck pain
B. Multiple abrasions to the extremities
2
, C. Ecchymosis to the flank
D. Responds to verbal stimulation using AVPU - ANSWER D. Responds to verbal stimula-
tion using AVPU
A 5-month pregnant patient arrives in the emergency department stating she tripped and
fell, landing on her abdomen. Assessment reveals bruising to the abdomen, both arms, and
her neck. She states she does not take any medications and has not had any prenatal care.
The nurse suspects the findings are most likely related to which of the following?
A.Intentional violence
B.Pregnancy-related changes
C.Undiagnosed embolus
D.Iron deficiency - ANSWER A. Intentional violence
During the primary survey of an unconscious patient with multi-system trauma, the nurse
notes snoring respirations. Which priority nursing intervention should be performed next?
A.Open the airway with the head-tilt/chin-lift maneuver
B.Auscultate bilateral breath sounds
C.Assist respirations using a bag-mask device
D.Insert an oropharyngeal airway if there is no gag reflex - ANSWER D. Insert an oropha-
ryngeal airway if there is no gag reflex
An adult was thrown against a concrete wall during a factory explosion and sustained a fe-
mur fracture, liver laceration, and a small subdural hematoma. These injuries most likely oc-
curred during what level of blast trauma?
A.Primary
B.Secondary
C.Tertiary
D.Quaternary - ANSWER C.Tertiary
3
motor vehicle collision. When significant abdominal and pelvic injuries are noted in the pri-
mary survey, what is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter - ANSWER A. Initiate transfer to a trauma center
An adult who fell from a second story roof is brought to the emergency department by pri-
vate vehicle. The patient is confused with unlabored respirations and has strong, palpable
radial pulses. There is an open wound in proximity to an obvious deformity of the left lower
extremity. What is the priority intervention?
A. Initiate cervical spine stabilization
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen.
D. Log roll the patient onto a spine board - ANSWER A. Initiate cervical spine stabilization
An adult patient who sustained a severe head trauma has been intubated and is being man-
ually ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has re-
ceived one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The
PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is
the most important intervention to manage the cerebral blood flow?
A. Decrease the rate of manual ventilation
1
,B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered - ANSWER A. Decrease the rate of manual
ventilation
An adult patient is brought to the emergency department following a vehicle "roll-over" with
prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh
and a weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial in-
tervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa) - ANSWER B. Ap-
plication of a pelvic binder
An adult arrives at the emergency department with superficial burns to the extremities fol-
lowing a house fire. The patient is reporting a headache with nausea and is drowsy and con-
fused. What is the most likely cause of these symptoms?
A. Capillary leak syndrome
B. Rhabdomyolysis
C. Carbon monoxide poisoning
D. Hypothermia - ANSWER C. Carbon monoxide poisoning
Using the American College of Surgeons Guidelines for Screening Patients with Suspected
Spine Injury, what assessment finding would prompt the nurse to prepare a patient for cervi-
cal spine imaging?
A. Alert with no neurologic deficits or neck pain
B. Multiple abrasions to the extremities
2
, C. Ecchymosis to the flank
D. Responds to verbal stimulation using AVPU - ANSWER D. Responds to verbal stimula-
tion using AVPU
A 5-month pregnant patient arrives in the emergency department stating she tripped and
fell, landing on her abdomen. Assessment reveals bruising to the abdomen, both arms, and
her neck. She states she does not take any medications and has not had any prenatal care.
The nurse suspects the findings are most likely related to which of the following?
A.Intentional violence
B.Pregnancy-related changes
C.Undiagnosed embolus
D.Iron deficiency - ANSWER A. Intentional violence
During the primary survey of an unconscious patient with multi-system trauma, the nurse
notes snoring respirations. Which priority nursing intervention should be performed next?
A.Open the airway with the head-tilt/chin-lift maneuver
B.Auscultate bilateral breath sounds
C.Assist respirations using a bag-mask device
D.Insert an oropharyngeal airway if there is no gag reflex - ANSWER D. Insert an oropha-
ryngeal airway if there is no gag reflex
An adult was thrown against a concrete wall during a factory explosion and sustained a fe-
mur fracture, liver laceration, and a small subdural hematoma. These injuries most likely oc-
curred during what level of blast trauma?
A.Primary
B.Secondary
C.Tertiary
D.Quaternary - ANSWER C.Tertiary
3
