NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
Detailed Cases Studies
Questions & Answers
Detailed explanations for answers
Things to know for exam success
1. A 58-year-old woman is brought to the emergency
department (ED)by emergency medical service (EMS) after
slipping on a patch of ice while walking to work and hitting
her head on the cement pavement. Bystanders
acknowledged that the patient was unconscious for
approximately 1 minute.On arrival, her vital signs are:
blood pressure (BP) 155/75 mm Hg, heart rate (HR) 89
beats per minute, respiratory rate (RR) 18 breaths per
minute, and pulse oxygenation 98% on room air. She has
a 5-cm laceration to the back of her head that is actively
bleeding. You ask the patient what happened but she
cannot remember. You inform her that she is in the
hospital as a result of a fall. Over the next 10 minutes she
asks you repeatedly what happened and where she is. You
do not find any focal neurologic deficits.As you bring the
patient to the CT scanner she vomits once. CT results
,NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
show a normal brain scan. Which of the following is the
most likely diagnosis?
a. Cerebral concussion
b. Diffuse axonal injury
c. Cerebral contusion
d. Posttraumatic epilepsy
e. Trauma-induced Alzheimer disease
Answer: The answer is a. The patient sustained a cerebral
concussion. This is caused by a head injury leading to a brief loss
of neurologic function. These individuals are often amnestic to the
event and frequently ask the same questions over and over again
(perseverations). Headache with or without vomiting is generally
present; however, there are no focal neurologic findings on
examination. Loss of consciousness result from impairment of the
reticular activating system. Patients show rapid Clinical improvement.
CT scan is normal.
Diffuse axonal injury (b) is caused by microscopic shearing of brain
nerve fibers. Patients typically present unconscious and remain in a
coma for a prolonged period of time. Although the CT scan does not
show a mass lesion, patients have over a 33% mortality rate. The
clinical features of a cerebral contusion (c) are similar to those of a
2
,NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
concussion except neurologic dysfunction is more profound and
prolonged and focal deficits may be present if contusions occur in the
sensorimotor area. These injuries occur when the brain impacts the
skull. The lesion is typically seen on CT scan.
Posttraumatic epilepsy (d) is associated with intracranial hematomas
and depressed skull fractures. The seizures generally occur within
the first week of the head injury. Some scientists believe that head
trauma predisposes to Alzheimer disease (e); however, this would
take years to develop.
2. You are notified by the EMS dispatcher that there is a multiple-car
collision on the local highway with many injuries. He states that there
are two people dead at the scene, one person is critically injured and
hypotensive, andbthree people have significant injuries, but with
stable vital signs. Which of the following is the leading cause of death
and disability in trauma victims?
a. Abdominal injury
b. Thoracic injury
c. Back injury
d. Cervical injury
e. Head injury
3
, NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
Answer: The answer is e. Trauma is the leading cause of death
between the ages of 1 and 44 years. Many of these injuries are
treatable mainly because the patients are young and otherwise
healthy. The primary role of the emergency physician is to assess,
resuscitate, and stabilize the trauma patient by priority. There are
three peak times for trauma deaths.The first, classified as immediate
death, is the period with the greatest number of fatalities. This occurs
within seconds to minutes of the injury and these patients generally
die at the scene. The cause is most commonly because of massive
head injury, followed by high cervical spine injury with spinal cord
disruption, cardiac and great vessel rupture, and airway obstruction.
The second peak period, classified as early death, occurs within
minutes to a few hours of injury. This is the period called the “golden
hour” where intervention is critical and significantly reduces the
morbidity and mortality rate in these patients. Death in these patient
is generally secondary to subdural and epidural hematomas. Other
causes of death in this group include ruptured spleen, lacerated liver,
hypovolemic shock, fracture of pelvis or multiple long bones,
hemopneumothorax, tension pneumothorax, cardiac tamponade, and
aortic dissection or rupture. The third peak period, classified as
delayed death, occurs days to weeks following the initial injury.
Death in these patients is usually a result of multisystem organ failure
and sepsis.
4
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
Detailed Cases Studies
Questions & Answers
Detailed explanations for answers
Things to know for exam success
1. A 58-year-old woman is brought to the emergency
department (ED)by emergency medical service (EMS) after
slipping on a patch of ice while walking to work and hitting
her head on the cement pavement. Bystanders
acknowledged that the patient was unconscious for
approximately 1 minute.On arrival, her vital signs are:
blood pressure (BP) 155/75 mm Hg, heart rate (HR) 89
beats per minute, respiratory rate (RR) 18 breaths per
minute, and pulse oxygenation 98% on room air. She has
a 5-cm laceration to the back of her head that is actively
bleeding. You ask the patient what happened but she
cannot remember. You inform her that she is in the
hospital as a result of a fall. Over the next 10 minutes she
asks you repeatedly what happened and where she is. You
do not find any focal neurologic deficits.As you bring the
patient to the CT scanner she vomits once. CT results
,NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
show a normal brain scan. Which of the following is the
most likely diagnosis?
a. Cerebral concussion
b. Diffuse axonal injury
c. Cerebral contusion
d. Posttraumatic epilepsy
e. Trauma-induced Alzheimer disease
Answer: The answer is a. The patient sustained a cerebral
concussion. This is caused by a head injury leading to a brief loss
of neurologic function. These individuals are often amnestic to the
event and frequently ask the same questions over and over again
(perseverations). Headache with or without vomiting is generally
present; however, there are no focal neurologic findings on
examination. Loss of consciousness result from impairment of the
reticular activating system. Patients show rapid Clinical improvement.
CT scan is normal.
Diffuse axonal injury (b) is caused by microscopic shearing of brain
nerve fibers. Patients typically present unconscious and remain in a
coma for a prolonged period of time. Although the CT scan does not
show a mass lesion, patients have over a 33% mortality rate. The
clinical features of a cerebral contusion (c) are similar to those of a
2
,NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
concussion except neurologic dysfunction is more profound and
prolonged and focal deficits may be present if contusions occur in the
sensorimotor area. These injuries occur when the brain impacts the
skull. The lesion is typically seen on CT scan.
Posttraumatic epilepsy (d) is associated with intracranial hematomas
and depressed skull fractures. The seizures generally occur within
the first week of the head injury. Some scientists believe that head
trauma predisposes to Alzheimer disease (e); however, this would
take years to develop.
2. You are notified by the EMS dispatcher that there is a multiple-car
collision on the local highway with many injuries. He states that there
are two people dead at the scene, one person is critically injured and
hypotensive, andbthree people have significant injuries, but with
stable vital signs. Which of the following is the leading cause of death
and disability in trauma victims?
a. Abdominal injury
b. Thoracic injury
c. Back injury
d. Cervical injury
e. Head injury
3
, NUR CRITICAL TRAUMA LATEST
UPDATED QUESTIONS & ANSWERS
100% A+ GRADED
Answer: The answer is e. Trauma is the leading cause of death
between the ages of 1 and 44 years. Many of these injuries are
treatable mainly because the patients are young and otherwise
healthy. The primary role of the emergency physician is to assess,
resuscitate, and stabilize the trauma patient by priority. There are
three peak times for trauma deaths.The first, classified as immediate
death, is the period with the greatest number of fatalities. This occurs
within seconds to minutes of the injury and these patients generally
die at the scene. The cause is most commonly because of massive
head injury, followed by high cervical spine injury with spinal cord
disruption, cardiac and great vessel rupture, and airway obstruction.
The second peak period, classified as early death, occurs within
minutes to a few hours of injury. This is the period called the “golden
hour” where intervention is critical and significantly reduces the
morbidity and mortality rate in these patients. Death in these patient
is generally secondary to subdural and epidural hematomas. Other
causes of death in this group include ruptured spleen, lacerated liver,
hypovolemic shock, fracture of pelvis or multiple long bones,
hemopneumothorax, tension pneumothorax, cardiac tamponade, and
aortic dissection or rupture. The third peak period, classified as
delayed death, occurs days to weeks following the initial injury.
Death in these patients is usually a result of multisystem organ failure
and sepsis.
4
