Chapter 19: Trauma and Surgical Management Chapter 19: Trauma and Surgical
Management
MULTIPLE CHOICE
1. Which of the following best defines the term traumatic injury?
a. All trauma patients can be successfully rehabilitated.
b. Traumatic injuries cause more deaths than heart disease and cancer.
c. Alcohol consumption, drug abuse, or other substance abuse contribute to traumatic events.
d. Trauma mainly affects the older adult population.
ANS: C Many patients who sustain traumatic injury are under the influence of alcohol, drugs, or other
substances. Rehabilitation potential depends on multiple factors including severity of injury, patient age,
and comorbidities. Heart disease and cancer claim more lives than trauma, but trauma claims lives of
predominantly young individuals.
2. When providing information on trauma prevention, it is important to realize that individuals age 35 to
54 years are most likely to experience which type of trauma incident?
a. High-speed motor vehicle crashes
b. Poisonings from prescription or illegal drugs
c. Violent or domestic traumatic altercations
d. Work-related falls
ANS: B People age 35 to 54 years are at greater risk of experiencing poisonings from prescription and/or
illegal drugs resulting in unintentional injury, followed by motor vehicle crashes (MVCs). MVCs and
homicide are the leading causes of death for individuals age 16 to 24 years, and falls are responsible for
traumatic injuries in the 65 years and older population. Domestic violence is not well defined as an age-
related trauma incident
Integrity 3. An 18-year-old unrestrained passenger who sustained multiple traumatic injuries from a
motor vehicle crash has a blood pressure of 80/60 mm Hg at the scene. This patient should be treated at
which level trauma center?
a. Level I
b. Level II
c. Level III
d. Level IV
ANS: A Because the patient is hypotensive and was unrestrained, the patient is at higher risk for more
severe injuries related to the mechanism of injury; thus, treatment should occur at a level I trauma center.
Patients with less severe injuries can be treated at lower level trauma centers.
, 4. Which of the following injuries would result in a greater likelihood of internal organ damage and risk
for infection?
a. A fall from a 6-foot ladder onto the grass
b. A shotgun wound to the abdomen
c. A knife wound to the right chest
d. A motor vehicle crash in which the driver hits the steering wheel
ANS: B The penetrating injury of the gunshot wound would cause the greatest amount of injury because
of the kinetic energy and dispersion pattern of the shotgun ammunition once it penetrated the body. A fall
would cause a compression injury from the blunt force of the fall. The knife wound would cause a
penetrating injury in which the magnitude of the injury would depend on damage to the vessels and lung.
Blunt chest trauma that may include a cardiac contusion is possible following an injury in which the
patient hits the steering column. DIF:
Integrity 5. A 24-year-old unrestrained driver who sustained multiple traumatic injuries from a motor
vehicle crash has a blood pressure of 80/60 mm Hg at the scene. The primary survey of this patient upon
arrival to the ED:
a. includes a cervical spine x-ray study to determine the presence of a fracture.
b. involves turning the patient from side to side to get a look at his back.
c. is done quickly in the first few minutes to get a baseline assessment and establish priorities.
d. is a methodical head-to-toe assessment identifying injuries and treatment priorities.
ANS: C The primary survey is a systematic rapid assessment of the patient’s airway with cervical spine
immobilization, breathing and ventilation, circulation with hemorrhage control, disability or neurological
status, and exposure/environmental considerations.
Integrity 6. The nurse has admitted a patient to the ED following a fall from a first-floor hotel balcony.
The patient is 22 years old and smells of alcohol. The patient begins to vomit in the ED. Which of the
following interventions is most appropriate?
a. Insert an oral airway to prevent aspiration and to protect the airway.
b. Offer the patient an emesis basin so that you can measure the amount of emesis.
c. Prepare to suction the oropharynx while maintaining cervical spine immobilization.
d. Send a specimen of the emesis to the laboratory for analysis of blood alcohol content.
ANS: C Stabilization of the cervical spine, preventing aspiration, and maintaining a patent airway are
essential elements of trauma management. An oral airway may increase the risk of aspiration related to
the emesis and offering an emesis basin would contradict spine precautions. Alcohol level is best
determined by serum analysis.
Management
MULTIPLE CHOICE
1. Which of the following best defines the term traumatic injury?
a. All trauma patients can be successfully rehabilitated.
b. Traumatic injuries cause more deaths than heart disease and cancer.
c. Alcohol consumption, drug abuse, or other substance abuse contribute to traumatic events.
d. Trauma mainly affects the older adult population.
ANS: C Many patients who sustain traumatic injury are under the influence of alcohol, drugs, or other
substances. Rehabilitation potential depends on multiple factors including severity of injury, patient age,
and comorbidities. Heart disease and cancer claim more lives than trauma, but trauma claims lives of
predominantly young individuals.
2. When providing information on trauma prevention, it is important to realize that individuals age 35 to
54 years are most likely to experience which type of trauma incident?
a. High-speed motor vehicle crashes
b. Poisonings from prescription or illegal drugs
c. Violent or domestic traumatic altercations
d. Work-related falls
ANS: B People age 35 to 54 years are at greater risk of experiencing poisonings from prescription and/or
illegal drugs resulting in unintentional injury, followed by motor vehicle crashes (MVCs). MVCs and
homicide are the leading causes of death for individuals age 16 to 24 years, and falls are responsible for
traumatic injuries in the 65 years and older population. Domestic violence is not well defined as an age-
related trauma incident
Integrity 3. An 18-year-old unrestrained passenger who sustained multiple traumatic injuries from a
motor vehicle crash has a blood pressure of 80/60 mm Hg at the scene. This patient should be treated at
which level trauma center?
a. Level I
b. Level II
c. Level III
d. Level IV
ANS: A Because the patient is hypotensive and was unrestrained, the patient is at higher risk for more
severe injuries related to the mechanism of injury; thus, treatment should occur at a level I trauma center.
Patients with less severe injuries can be treated at lower level trauma centers.
, 4. Which of the following injuries would result in a greater likelihood of internal organ damage and risk
for infection?
a. A fall from a 6-foot ladder onto the grass
b. A shotgun wound to the abdomen
c. A knife wound to the right chest
d. A motor vehicle crash in which the driver hits the steering wheel
ANS: B The penetrating injury of the gunshot wound would cause the greatest amount of injury because
of the kinetic energy and dispersion pattern of the shotgun ammunition once it penetrated the body. A fall
would cause a compression injury from the blunt force of the fall. The knife wound would cause a
penetrating injury in which the magnitude of the injury would depend on damage to the vessels and lung.
Blunt chest trauma that may include a cardiac contusion is possible following an injury in which the
patient hits the steering column. DIF:
Integrity 5. A 24-year-old unrestrained driver who sustained multiple traumatic injuries from a motor
vehicle crash has a blood pressure of 80/60 mm Hg at the scene. The primary survey of this patient upon
arrival to the ED:
a. includes a cervical spine x-ray study to determine the presence of a fracture.
b. involves turning the patient from side to side to get a look at his back.
c. is done quickly in the first few minutes to get a baseline assessment and establish priorities.
d. is a methodical head-to-toe assessment identifying injuries and treatment priorities.
ANS: C The primary survey is a systematic rapid assessment of the patient’s airway with cervical spine
immobilization, breathing and ventilation, circulation with hemorrhage control, disability or neurological
status, and exposure/environmental considerations.
Integrity 6. The nurse has admitted a patient to the ED following a fall from a first-floor hotel balcony.
The patient is 22 years old and smells of alcohol. The patient begins to vomit in the ED. Which of the
following interventions is most appropriate?
a. Insert an oral airway to prevent aspiration and to protect the airway.
b. Offer the patient an emesis basin so that you can measure the amount of emesis.
c. Prepare to suction the oropharynx while maintaining cervical spine immobilization.
d. Send a specimen of the emesis to the laboratory for analysis of blood alcohol content.
ANS: C Stabilization of the cervical spine, preventing aspiration, and maintaining a patent airway are
essential elements of trauma management. An oral airway may increase the risk of aspiration related to
the emesis and offering an emesis basin would contradict spine precautions. Alcohol level is best
determined by serum analysis.
