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
You are caring for a patient who was thrown from a bike and was not wearing a helmet.
While performing the head-to-toe assessment, you note clear drainage from the right ear.
Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam. - ANSWER C. Notify the physician
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.
1
,D. Log roll the patient onto a spine board - ANSWER A. Initiate cervical spine stabilization
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 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.
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.
2. Which of the following situations could cause functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of one's self-image
D. Destruction of the patient's car - ANSWER B. Amputation of a limb
2
,Rationale: Preparation and Ongoing Care\Psychosocial Aspects
Functional grief relates to the loss of body function or body parts such as amputation of a
limb, paralysis, or loss of sight.
3. What is the most important consideration during the initial assessment when caring for an
older adult who has sustained serious injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician - ANSWER B. Medical history including current
medications
4. You are caring for a patient who was thrown from a bike and was not wearing a helmet.
While performing the head-to-toe assessment, you note clear drainage from the right ear.
Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam. - ANSWER C. Notify the physician
5. When should the definitive calculation for intravenous fluid resuscitation rate be per-
formed for a patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment - ANSWER B. After removal of clothing
Rationale: Musculoskeletal and Wounds\Burns
3
, Some fluid will be given initially, but an accurate fluid total is based on percentage of total
body surface area which requires a good skin assessment and is calculated after clothing is
removed.
6. In a motor vehicle collision, which injury pathway is most likely to increase the patient's
morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover - ANSWER B. Ejection
8. A teenaged patient presents to the emergency department with left arm pain after a
ground level fall. The patient identifies as transgender and shares they are homeless. The ED
staff are concerned the patient is experiencing human trafficking. What is most consistent
with human trafficking?
A. The individual appears well nourished.
B. Those who are being trafficked rarely seek medical care.
C. It is infrequently associated with substance abuse.
D. Those experiencing human trafficking rarely self-disclose. - ANSWER D. Those experi-
encing human trafficking rarely self-disclose.
7. A patient with a lower extremity fracture complains of severe pain and tightness in his
calf, minimally relieved by pain medications. Which of the following is the priority nursing
intervention?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg - ANSWER C. Elevating the leg to the
level of the heart
Rationale: Musculoskeletal and Wounds\Musculoskeletal
4
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
You are caring for a patient who was thrown from a bike and was not wearing a helmet.
While performing the head-to-toe assessment, you note clear drainage from the right ear.
Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam. - ANSWER C. Notify the physician
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.
1
,D. Log roll the patient onto a spine board - ANSWER A. Initiate cervical spine stabilization
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 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.
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.
2. Which of the following situations could cause functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of one's self-image
D. Destruction of the patient's car - ANSWER B. Amputation of a limb
2
,Rationale: Preparation and Ongoing Care\Psychosocial Aspects
Functional grief relates to the loss of body function or body parts such as amputation of a
limb, paralysis, or loss of sight.
3. What is the most important consideration during the initial assessment when caring for an
older adult who has sustained serious injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician - ANSWER B. Medical history including current
medications
4. You are caring for a patient who was thrown from a bike and was not wearing a helmet.
While performing the head-to-toe assessment, you note clear drainage from the right ear.
Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam. - ANSWER C. Notify the physician
5. When should the definitive calculation for intravenous fluid resuscitation rate be per-
formed for a patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment - ANSWER B. After removal of clothing
Rationale: Musculoskeletal and Wounds\Burns
3
, Some fluid will be given initially, but an accurate fluid total is based on percentage of total
body surface area which requires a good skin assessment and is calculated after clothing is
removed.
6. In a motor vehicle collision, which injury pathway is most likely to increase the patient's
morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover - ANSWER B. Ejection
8. A teenaged patient presents to the emergency department with left arm pain after a
ground level fall. The patient identifies as transgender and shares they are homeless. The ED
staff are concerned the patient is experiencing human trafficking. What is most consistent
with human trafficking?
A. The individual appears well nourished.
B. Those who are being trafficked rarely seek medical care.
C. It is infrequently associated with substance abuse.
D. Those experiencing human trafficking rarely self-disclose. - ANSWER D. Those experi-
encing human trafficking rarely self-disclose.
7. A patient with a lower extremity fracture complains of severe pain and tightness in his
calf, minimally relieved by pain medications. Which of the following is the priority nursing
intervention?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg - ANSWER C. Elevating the leg to the
level of the heart
Rationale: Musculoskeletal and Wounds\Musculoskeletal
4
