Chapter 25: Trauma

Chapter 25: Trauma

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. When opening the airway of an unresponsive trauma patient in the emergency department, which of the following considerations is correct?

ANS:  A

Airway assessment must incorporate cervical spine immobilization. The patient’s head should not be rotated, hyperflexed, or hyperextended to establish and maintain an airway. The cervical spine must be immobilized in all trauma patients until a cervical spinal cord injury has been definitively ruled out.

2. A strategy to minimize secondary brain injury in head-injured patients is

ANS:  D

Secondary injury can be caused by ischemia, hypercapnia, hypotension, cerebral edema, sustained hypertension, calcium toxicity, or metabolic derangements. Hypoxia or hypotension, the best known culprits for secondary injury, typically are the result of extracranial trauma. Extreme vasodilation of the cerebral vasculature occurs in an attempt to supply oxygen to the cerebral tissue. This increase in blood volume increases intracranial volume and raises intracranial pressure.

3. A patient has sustained an epidural hematoma after a 10-foot fall from a roof. Which of the following is true about epidural hematomas?

ANS:  A

Epidural hematoma (EDH) is a collection of blood between the inner table of the skull and the outermost layer of the dura. EDHs are most often associated with skull fractures and middle meningeal artery lacerations (two thirds of patients). A blow to the head that causes a linear skull fracture on the lateral surface of the head may tear the middle meningeal artery. As the artery bleeds, it pulls the dura away from the skull, creating a pouch that expands into the intracranial space.

4. The nursing care plan of a patient with a diffuse axonal injury (DAI) would involve which of the following considerations?

ANS:  C

The pathophysiology of DAI is related to the stretching and tearing of axons as a result of movement of the brain inside the cranium at the time of impact. The stretching and tearing of axons result in microscopic lesions throughout the brain, but especially deep within cerebral tissue and the base of the cerebrum. Disruption of axonal transmission of impulses results in loss of consciousness. Unless surrounding tissue areas are significantly injured, causing small hemorrhages, DAI may not be visible on computed tomography or magnetic resonance imaging. DAI can be classified as one of three grades based on the extent of lesions: mild, moderate, or severe. Severe DAI usually manifests as a prolonged, deep coma with periods of hypertension, hyperthermia, and excessive sweating. Treatment of DAI includes support of vital functions and maintenance of intracranial pressure within normal limits. The outcome after severe DAI is poor because of the extensive dysfunction of cerebral pathways.