Critical Care Final Exam Practice Questions
and Answers with rationales
1. Poor patient outcomes after a traumatic injury are associated with:
A. chest tube placement for treatment of a hemothorax.
B. immediate decompression of a tension pneumothorax.
C. massive transfusions of blood products.
D. intraosseous cannulation for intravenous fluid administration.
,Ans:C
Rationale: Current evidence suggests that patients receiving massive blood
transfusionshave poorer outcomes. Although a chest tube may be necessary in the
treatment of trauma patients, it is not associated with poor patient outcomes.
Immediate decompression of a tension pneumothorax is also not associated with
poor patient outcomes. Intraosseous cannulation for intravenous fluid
administration has not been shown to have adverse patient outcomes.
2. Your patient was a passenger in a motor vehicle crash yesterday and suffered an
open fracture of the femur. His condition was stable until an hour ago, when he
began to complain of shortness of breath. His heart rate is 104 beats/min,
respiratory rate is 30 breaths/min, BP is 90/60 mm Hg, and temperature is now
38.4°
C. You suspect that he:
A. has a fat embolism.
B. has developed metabolic acidosis.
C. is developing systemic inflammatory response syndrome (SIRS).
D. is experiencing early multiple organ dysfunction syndrome (MODS).
ANS: A
Rationale: These are classic signs and symptoms of a fat embolism. The history of a
long-bone fracture adds to the evidence of a fat embolism. The patient may develop
metabolic acidosis associated with poor oxygenation from the fat emboli. SIRS
possibly progressing to MODS would also be a consequence of the fat emboli
,3. Which condition is a common cause of death after chest trauma?
A. Cardiac tamponade
B. Flail chest
C. Hemothorax
D. Pulmonary
contusionANS: D
Rationale: Pulmonary contusion as a result of blunt chest trauma increases the risk
for development of pneumonia, acute lung injury, and/or ARDS. Cardiac tamponade
is life threatening if untreated, but it is not a common complication after blunt chest
trauma.Flail chest and hemothorax may result with blunt chest trauma, but they are
not common causes of death.
4. A trauma patient with a fractured forearm complains of extreme, throbbing pain
at the fracture site and paresthesia in the fingers. Upon further assessment, you
note that
, the forearm is extremely edematous and you are now having difficulty palpating a radial
pulse. You notify the physician immediately because you suspect:
A. compartment syndrome.
B. fat emboli.
C. hypothermia.
D. rhabdomyolysis.
Ans: A
Rationale: These signs and symptoms are characteristic of late signs of
compartmentsyndrome. Fat emboli are associated with long-bone fractures and
typically manifestpulmonary symptoms. These signs and symptoms are
characteristic of compartmentsyndrome, not hypothermia. Rhabdomyolysis is
associated with a crush injury and compartment syndrome. A clinical sign that
may be noted by the nurse is dark tea- colored urine.
5.The trauma patient presenting with left lower rib fractures develops left upper
quadrant tenderness, hypotension, and referred pain to the left shoulder. You
suspect:
A. bowel obstruction.
B. cardiac tamponade.
C. pulmonary contusion.
D. splenic injury.
Ans: D
and Answers with rationales
1. Poor patient outcomes after a traumatic injury are associated with:
A. chest tube placement for treatment of a hemothorax.
B. immediate decompression of a tension pneumothorax.
C. massive transfusions of blood products.
D. intraosseous cannulation for intravenous fluid administration.
,Ans:C
Rationale: Current evidence suggests that patients receiving massive blood
transfusionshave poorer outcomes. Although a chest tube may be necessary in the
treatment of trauma patients, it is not associated with poor patient outcomes.
Immediate decompression of a tension pneumothorax is also not associated with
poor patient outcomes. Intraosseous cannulation for intravenous fluid
administration has not been shown to have adverse patient outcomes.
2. Your patient was a passenger in a motor vehicle crash yesterday and suffered an
open fracture of the femur. His condition was stable until an hour ago, when he
began to complain of shortness of breath. His heart rate is 104 beats/min,
respiratory rate is 30 breaths/min, BP is 90/60 mm Hg, and temperature is now
38.4°
C. You suspect that he:
A. has a fat embolism.
B. has developed metabolic acidosis.
C. is developing systemic inflammatory response syndrome (SIRS).
D. is experiencing early multiple organ dysfunction syndrome (MODS).
ANS: A
Rationale: These are classic signs and symptoms of a fat embolism. The history of a
long-bone fracture adds to the evidence of a fat embolism. The patient may develop
metabolic acidosis associated with poor oxygenation from the fat emboli. SIRS
possibly progressing to MODS would also be a consequence of the fat emboli
,3. Which condition is a common cause of death after chest trauma?
A. Cardiac tamponade
B. Flail chest
C. Hemothorax
D. Pulmonary
contusionANS: D
Rationale: Pulmonary contusion as a result of blunt chest trauma increases the risk
for development of pneumonia, acute lung injury, and/or ARDS. Cardiac tamponade
is life threatening if untreated, but it is not a common complication after blunt chest
trauma.Flail chest and hemothorax may result with blunt chest trauma, but they are
not common causes of death.
4. A trauma patient with a fractured forearm complains of extreme, throbbing pain
at the fracture site and paresthesia in the fingers. Upon further assessment, you
note that
, the forearm is extremely edematous and you are now having difficulty palpating a radial
pulse. You notify the physician immediately because you suspect:
A. compartment syndrome.
B. fat emboli.
C. hypothermia.
D. rhabdomyolysis.
Ans: A
Rationale: These signs and symptoms are characteristic of late signs of
compartmentsyndrome. Fat emboli are associated with long-bone fractures and
typically manifestpulmonary symptoms. These signs and symptoms are
characteristic of compartmentsyndrome, not hypothermia. Rhabdomyolysis is
associated with a crush injury and compartment syndrome. A clinical sign that
may be noted by the nurse is dark tea- colored urine.
5.The trauma patient presenting with left lower rib fractures develops left upper
quadrant tenderness, hypotension, and referred pain to the left shoulder. You
suspect:
A. bowel obstruction.
B. cardiac tamponade.
C. pulmonary contusion.
D. splenic injury.
Ans: D
