588 sole ards pul embolism

Sole: Introduction to Critical Care Nursing, 5th Edition

Chapter 19: Trauma and Surgical Management

Test Bank

MULTIPLE CHOICE

1. Which of the following statements about traumatic injury is TRUE?

a. All trauma patients can be successfully rehabilitated.b. Traumatic injuries cause more deaths than heart disease and cancer.c. Injury is often associated with alcohol use, drug use, or both.d. Trauma mainly affects the older adult population.

ANS: CMany patients who sustain traumatic injury are under the influence of alcohol or drugs.

Incorrect:A: Not all patients can be successfully rehabilitated.B: Trauma is the fifth leading cause of death, claiming predominately young individuals.D: Trauma mainly affects young individuals.

DIF: Cognitive Level: Analysis REF: Page 651OBJ: Identify mechanisms of traumatic injury commonly seen in the critical care setting.TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

2. Which of the following personnel would be in charge of trauma resuscitation?

a. An emergency department (ED) physician trained in advanced cardiac life supportb. A nurse certified as completing the Trauma Nurse Core Coursec. The first physician to arrive in the ED when the patient arrivesd. A trauma surgeon

ANS: DThe trauma surgeon is ultimately responsible for the activities of the trauma team and acts as the team leader in establishing rapid assessment, resuscitation, stabilization, and intervention priorities.

Incorrect:A: The trauma surgeon is ultimately responsible for the activities of the trauma team and acts

as the team leader in establishing rapid assessment, resuscitation, stabilization, and intervention priorities.

B: The trauma surgeon is ultimately responsible for the activities of the trauma team and acts as the team leader in establishing rapid assessment, resuscitation, stabilization, and intervention priorities.

Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Test Bank

C: The trauma surgeon is ultimately responsible for the activities of the trauma team and acts as the team leader in establishing rapid assessment, resuscitation, stabilization, and intervention priorities.

DIF: Cognitive Level: Analysis REF: Page 653OBJ: Describe a systems approach to trauma care.TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. An 18-year-old patient who sustains 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 Ib. Level IIc. Level IIId. Level IV

ANS: ABecause the patient is hypotensive, the treatment should occur at a level I trauma center.

Incorrect:B: Because the patient is hypotensive, the treatment should occur at a level I trauma center.C: Because the patient is hypotensive, the treatment should occur at a level I trauma center.D: Because the patient is hypotensive, the treatment should occur at a level I trauma center.

DIF: Cognitive Level: Analysis REF: Page 652OBJ: Discuss prehospital care, emergency care, and resuscitation of the trauma patient.TOP: Nursing Process Step: Evaluation MSC: NCLEX: Safe, Effective Care Environment

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 grassb. A gunshot wound to the abdomen with a shotgunc. A knife wound to the left wristd. A motor vehicle accident in which the driver hits the steering wheel


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ANS: BThe penetrating injury of the gunshot wound may cause substantial damage throughout the abdomen and increase the risk for organ damage, hemorrhage, or infection.

Incorrect:A: A fall may result in blunt or other trauma but would likely cause less internal organ

damage than a penetrating gunshot wound.C: A knife wound to the wrist may not cause as much internal damage as a penetrating injury

to the abdomen.D: A steering wheel injury increases the risk for pulmonary and cardiac contusion.

DIF: Cognitive Level: Analysis REF: Page 657OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

5. An 18-year-old patient who sustains 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 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.d. is not needed if injuries are not visible on the patient.

ANS: CThe primary survey is a systematic survey of the patient’s airway with cervical spine immobilization, breathing and ventilation, circulation with hemorrhage control, disability or neurological status, and exposure/environmental considerations.

Incorrect:A: A cervical spine x-ray study is part of the secondary survey.B: Turning is part of the secondary survey.D: The primary survey is the most crucial assessment tool in trauma care.

DIF: Cognitive Level: Application REF: Page 658OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity


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Test Bank

6. You have just 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: CStabilization of the cervical spine and prevention of aspiration are priorities.

Incorrect:A: This is not a priority at this time.B: This is not a priority at this time.D: This is not a priority at this time.

DIF: Cognitive Level: Analysis REF: Page 662 | Table 19-3OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

7. Which of the following interventions would not be appropriate for a patient who is admitted with a suspected basilar skull fracture?

a. Insertion of a nasogastric tubeb. Insertion of a Foley catheterc. Endotracheal intubationd. Placement of an oral airway

ANS: ANasogastric tubes are often contraindicated in basilar skull fractures, because insertion can result in penetration of the meninges.

Incorrect:B: A Foley catheter will be needed to monitor fluid balance and renal function.C: Endotracheal intubation may be indicated.D: Placement of an oral airway may be indicated.

DIF: Cognitive Level: Analysis REF: Page 661OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity


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Test Bank

8. If the physician is having difficulty inserting an endotracheal tube into a trauma patient who needs to be mechanically ventilated, which of the following emergency procedures is indicated to ensure ventilation?

a. Cricothyrotomy procedureb. Insertion of oral or nasal airwayc. Needle thoracostomyd. Percutaneous tracheostomy

ANS: AA cricothyrotomy is the procedure for this type of emergency airway management.

Incorrect:B: This procedure is not indicated for this type of emergency airway management.C: This procedure is not indicated for this type of emergency airway management.D: This procedure is not indicated for this type of emergency airway management.

DIF: Cognitive Level: Analysis REF: Page 661OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

9. In the trauma patient, symptoms of decreased cardiac output are most commonly caused by:

a. cardiac contusion.b. cardiogenic shock.c. hypovolemia.d. pericardial tamponade.

ANS: CHypovolemia is commonly associated with traumatic injury resulting from acute blood loss.

Incorrect:A: A contusion may result in decreased cardiac output, but hypovolemia occurs more often.B: Cardiogenic shock is not usually associated with trauma.D: Pericardial tamponade would result in decreased cardiac output, but hypovolemia occurs

more often.

DIF: Cognitive Level: Synthesis REF: Page 661OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity


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Test Bank

10. A patient with multiple traumatic injuries receives fluid to maintain a systolic blood pressure at 90 mm Hg. Despite the administration of 3 L of crystalloids, his systolic blood pressure is in the 80s and is very labile. A focused assessment with sonography for trauma (FAST) test identifies peritoneal hemorrhage. What action is anticipated at this time?

a. Administration of colloids to maintain intravascular volumeb. Administration of a vasoactive drip, such as a dopamine dripc. Computed tomography scan of the abdomen to assess for a lacerated liverd. Emergent surgical intervention to determine the site of bleeding

ANS: DEmergency surgical exploration is appropriate to determine the etiology of the patient’s bleeding.

Incorrect:A: Emergency surgical exploration is appropriate to determine the etiology of the patient’s

bleeding. Crystalloids and blood products may be indicated.B: Emergency surgical exploration is appropriate to determine the etiology of the patient’s

bleeding. Crystalloids and blood products may be indicated, not dopamine.C: Emergency surgical exploration is appropriate to determine the etiology of the patient’s

bleeding. The FAST test has already indicated bleeding. Because the patient's condition is unstable, emergency surgery is warranted.

DIF: Cognitive Level: Synthesis REF: 69OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

11. A diagnostic peritoneal lavage is often performed in a trauma patient during the resuscitation phase to:

a. assess renal function.b. determine intraperitoneal bleeding.c. eliminate nitrogenous wastes.d. prevent acute peritonitis.

ANS: BDiagnostic peritoneal lavage assists in the determination as to whether the intraperitoneal space is the source of bleeding. The FAST test is another test that is commonly used.

Incorrect:A: Diagnostic peritoneal lavage may also be used to evaluate intraperitoneal bleeding.C: Diagnostic peritoneal lavage may also be used to evaluate intraperitoneal bleeding.D: Diagnostic peritoneal lavage may also be used to evaluate intraperitoneal bleeding.DIF: Cognitive Level: Comprehension.REF: Page 662


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Test Bank

OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

12. Metabolic acidosis and the need for fluid resuscitation can be assessed in the trauma patient by monitoring and trending which of the following tests?

a. Arterial oxygen saturationb. Hourly urine outputc. Jugular bulb oxygen saturationd. Serum lactate levels

ANS: DSerum lactate levels are useful in assessing acidosis and the need for aggressive fluid resuscitation.

Incorrect:A: Serum lactate levels are useful in assessing acidosis and the need for aggressive fluid

resuscitation.B: Serum lactate levels are useful in assessing acidosis and the need for aggressive fluid

resuscitation.C: Serum lactate levels are useful in assessing acidosis and the need for aggressive fluid

resuscitation.

DIF: Cognitive Level: Analysis REF: Page 675OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. You are caring for a patient who sustained rib fractures after hitting the steering wheel of his car. He is spontaneously breathing and receiving oxygen via a face mask. His oxygen saturation is 95%. During your assessment, the oxygen saturation drops to 80%. The patient's blood pressure has dropped from 128/76 mm Hg to 84/50 mm Hg. You do not auscultate any breath sounds on the left side of the chest. You notify the physician and anticipate:

a. administration of lactated Ringer's solution (1 L) wide open.b. chest x-ray study to determine the etiology of the symptoms.c. endotracheal intubation and mechanical ventilation.d. needle thoracostomy and chest tube insertion.

ANS: DThese are classic symptoms of a tension pneumothorax in a patient at high risk related to mechanism of injury. Emergent decompression is warranted.


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Test Bank

Incorrect:A: These are classic symptoms of a tension pneumothorax in a patient at high risk related to

mechanism of injury. Emergent decompression is warranted.B: These are classic symptoms of a tension pneumothorax in a patient at high risk related to

mechanism of injury. Emergent decompression is warranted.C: These are classic symptoms of a tension pneumothorax in a patient at high risk related to

mechanism of injury. Emergent decompression is warranted.

DIF: Cognitive Level: Analysis REF: Page 662 | Table 19-3OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. Which of the following patients have the greatest risk of developing acute respiratory distress syndrome (ARDS) after traumatic injury?

a. A patient who has a closed head injury with a decreased level of consciousnessb. A patient who has a fractured femur and is currently in tractionc. A patient who has received large volumes of fluid and/or blood replacementd. A patient who has underlying chronic obstructive pulmonary disease

ANS: CDuring states of hypoperfusion and acidosis, inflammation occurs and vessels become more permeable to fluid and molecules. With aggressive fluid resuscitation, this change in permeability allows the movement of fluid from the intravascular space into the interstitial spaces (third spacing). Hypovolemia thus occurs in the intravascular space, and patients require a larger volume of fluid replacement. This creates a vicious cycle: As more intravenous (IV) fluids are given to support systemic circulation, fluids continue to migrate into the interstitial space, causing excessive edema and predisposing the patient to additional complications such as abdominal compartment syndrome, ARDS, acute renal failure, and multiple organ dysfunction syndrome.

Incorrect:A: During states of hypoperfusion and acidosis, inflammation occurs and vessels become

more permeable to fluid and molecules. With aggressive fluid resuscitation, this change in permeability allows the movement of fluid from the intravascular space into the interstitial spaces (third spacing). Hypovolemia thus occurs in the intravascular space, and patients require a larger volume of fluid replacement. This creates a vicious cycle: As more IV fluids are given to support systemic circulation, fluids continue to migrate into the interstitial space, causing excessive edema and predisposing the patient to additional complications such as abdominal compartment syndrome, ARDS, acute renal failure, and multiple organ dysfunction syndrome.


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Test Bank

B: During states of hypoperfusion and acidosis, inflammation occurs and vessels become more permeable to fluid and molecules. With aggressive fluid resuscitation, this change in permeability allows the movement of fluid from the intravascular space into the interstitial spaces (third spacing). Hypovolemia thus occurs in the intravascular space, and patients require a larger volume of fluid replacement. This creates a vicious cycle: As more IV fluids are given to support systemic circulation, fluids continue to migrate into the interstitial space, causing excessive edema and predisposing the patient to additional complications such as abdominal compartment syndrome, ARDS, acute renal failure, and multiple organ dysfunction syndrome.

D: During states of hypoperfusion and acidosis, inflammation occurs and vessels become more permeable to fluid and molecules. With aggressive fluid resuscitation, this change in permeability allows the movement of fluid from the intravascular space into the interstitial spaces (third spacing). Hypovolemia thus occurs in the intravascular space, and patients require a larger volume of fluid replacement. This creates a vicious cycle: As more IV fluids are given to support systemic circulation, fluids continue to migrate into the interstitial space, causing excessive edema and predisposing the patient to additional complications such as abdominal compartment syndrome, ARDS, acute renal failure, and multiple organ dysfunction syndrome.

DIF: Cognitive Level: Analysis REF: Page 664OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

15. Patients with musculoskeletal injury are at increased risk for compartment syndrome. What is an initial symptom of a suspected compartment syndrome?

a. Absence of pulse in affected extremityb. Pallor in the affected areac. Paresthesia in the affected aread. Severe, throbbing pain in the affected area

ANS: DThrobbing pain disproportionate to the injury is one of the initial signs of compartment syndrome. The affected area is marked by redness, swelling, and pain.

Incorrect:A: Loss of pulses is a late sign. B: Pallor is not a sign of compartment syndrome.C: Paresthesia is a late sign.



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Test Bank

16. During the treatment and management of the trauma patient, maintaining oxygenation, treating infections, and nutritional support are strategies to prevent:

a. disseminated intravascular coagulation.b. multisystem organ failure.c. septic shock.d. wound infection.

ANS: BOxygenation, appropriate treatment of infections, and nutritional support are all vital to prevent progression into multisystem organ failure.

Incorrect:A: Oxygenation, appropriate treatment of infections, and nutritional support are not vital to

prevent disseminated intravascular coagulation.C: Oxygenation, appropriate treatment of infections, and nutritional support are not vital to

prevent septic shock.D: Oxygenation, appropriate treatment of infections, and nutritional support are not vital to

prevent wound infection.


17. Range-of-motion exercises, early ambulation, and heparin prophylaxis are interventions to prevent:

a. catheter sepsis.b. deep vein thrombosis.c. fat embolism.d. nosocomial pneumonia.

ANS: BDeep vein thrombosis is a risk of any traumatic injury. Range of motion, early ambulation, and heparinization all help prevent this condition from occurring.

Incorrect:A: Range of motion, early ambulation, and heparinization do not prevent this condition from

occurring.C: Range of motion, early ambulation, and heparinization do not prevent this condition from

occurring.D: Range of motion, early ambulation, and heparinization do not prevent this condition from

occurring.

DIF: Cognitive Level: Analysis REF: Page 672


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Test Bank

OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

18. Which of the following interventions is a strategy to prevent fat embolism syndrome?

a. Administer lipid-lowering statin medications.b. Intubate the patient early after the injury to provide mechanical ventilation.c. Provide prophylaxis with low-molecular-weight heparin.d. Stabilize extremity fractures early.

ANS: DStabilization of extremity fractures to minimize both bone movement and the release of fatty products from the bone marrow must be accomplished as early as possible.

Incorrect:A: Lipid-lowering medications do not provide preventive treatment.B: Intubation and mechanical ventilation are treatments for fat embolism syndrome; they do

not prevent it.C: Heparin is given to prevent deep vein thrombosis.


19. Which of the following injuries would cause the least neurological damage?

a. Basilar skull fractureb. Depressed skull fracturec. Scalp lacerationd. Spinal cord injury

ANS: CScalp lacerations may be associated with significant bleeding but are not usually associated with neurological damage unless associated with a skull fracture or other injury.

Incorrect:A: Basilar skull fractures increase the risk of neurological infections.B: Depressed skull fractures increase the risk of direct injury to the brain and infection.D: Spinal cord injury is often associated with severe and permanent neurological damage.

DIF: Cognitive Level: Analysis REF: Page 665OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity


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Test Bank

20. Treatment and/or prevention of rhabdomyolysis in at-risk patients includes aggressive fluid resuscitation to achieve urine output of:

a. 30 mL/hr.b. 50 mL/hr.c. 100 mL/hr.d. 300 mL/hr.

ANS: CTreatment of rhabdomyolysis consists of aggressive fluid resuscitation to flush the myoglobin from the renal tubules. A common protocol includes the titration of IV fluids to achieve a urine output of 100 to 200 mL/hr.

Incorrect:A: This output is too low.B: This output is too low.D: This output is too high.


MULTIPLE RESPONSE

1. Fluid resuscitation is an important component of managing the trauma patient. Which of the following statements are true regarding the care of a trauma patient (choose all that apply)?

a. 5% Dextrose is recommended for rapid crystalloid infusion.b. IV fluids may need to be warmed to prevent hypothermia.c. Massive transfusions should be avoided to improve patient outcomes.d. Only fully crossmatched blood products are administered.


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ANS: B, CLactated Ringer's and normal saline are the crystalloids of choice in trauma resuscitation. Because hypothermia is a concern, fluids should be warmed. Massive blood transfusions are associated with poor outcomes.

Incorrect:A: 5% Dextrose is not recommended for rapid crystalloid infusion. D: Group O negative blood may be administered in cases of exsanguination.

DIF: Cognitive Level: Analysis REF: Page 664OBJ: Describe assessment and management of common traumatic injuries.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

2. Trauma patients are at high risk for multiple complications not only due to the mechanism of injury, but also due to their long-term management. Which of the following statements apply to trauma patients (choose all that apply)?

a. Foley catheters are a source of infection.b. Patients often develop infection and sepsis secondary to central line catheters.c. Pneumonia is often an adverse outcome of mechanical ventilation.d. Severe facial trauma and nasotracheal intubation may result in sinusitis.

ANS: A, B, C, DAll statements are true.

DIF: Cognitive Level: Analysis REF: Page 676OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. During your assessment of a patient after a motor vehicle crash, which of the following assessments would increase your suspicion of a basilar skull fracture (choose all that apply)?

a. Battle’s signb. Mucus drainage from the nosec. Pink-tinged drainage from the ear; positive for glucosed. Raccoon eyes


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Test Bank

ANS: A, C, DBasilar skull fractures are located at the base of the cranium and potentially involve the five bones that form the skull base. The diagnosis is based on the presence of cerebrospinal fluid in the nose (rhinorrhea), in the ears (otorrhea), or in both; ecchymosis over the mastoid area (Battle’s sign); or hemotympanum (blood in the middle ear). Raccoon eyes, or periorbital ecchymoses, are present after a cribriform plate fracture.

Incorrect:B: Cerebrospinal fluid from the nose, not mucus, is a sign of a basilar skull fracture.


4. It is important to prevent hypothermia in the trauma patient because hypothermia is associated with which of the following (choose all that apply)?

a. ARDSb. Coagulopathiesc. Decreased cardiac outputd. Myocardial dysfunction

ANS: B, C, DProlonged hypothermia is associated with the development of myocardial dysfunction, coagulopathies, reduced perfusion, and dysrhythmias (bradycardia and atrial or ventricular fibrillation).

Incorrect:A: Prolonged hypothermia is associated with the development of myocardial dysfunction,

coagulopathies, reduced perfusion, and dysrhythmias (bradycardia and atrial or ventricular fibrillation). It is not associated with ARDS.


5. Which of the following patients would require greater amounts of fluid resuscitation to prevent renal failure associated with rhabdomyolysis (choose all that apply)?

a. Crush injury to right armb. Gunshot wound to the abdomenc. Lightning strike of the left arm and torsod. Pulmonary contusion and rib fractureANS: A, C


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Test Bank

Causes of rhabdomyolysis include crush injuries, compartment syndrome, burns, and injuries from being struck by lightning.

Incorrect:B: Causes of rhabdomyolysis do not include gunshot wounds to the abdomen.D: Causes of rhabdomyolysis do not include pulmonary contusion and rib fracture.


6. Place the following actions in order in the management of the postoperative surgical trauma patient who has been admitted to the critical care unit after surgery.

a. Assessment of airway, breathing, and circulation.b. Complete assessment of vital signs, rhythm, oxygen saturation, and neurological

status.c. Connect the patient to bedside monitor and ventilator.d. Reassess IV access, evaluate patency of IV lines, and adjust rate of fluid

administration as ordered.

ANS: A, B, C, DThe initial intervention upon admission to the critical care unit is a rapid assessment of airway, breathing, and circulation. The nurse quickly connects the patient to the bedside monitor and ventilator, and completes an assessment of vital signs, cardiac rhythm, pulse oximetry reading, level of consciousness, and pupil reactivity. Hypothermia is a concern postoperatively; thus the nurse keeps the patient covered while assessing the body for surgical incisions, dressings, other injuries, and location and function of drainage devices (e.g., chest tubes, Hemovac). It is important to inspect the posterior surface of the patient, so a quick turn to assess and remove soiled linens is completed early. The nurse reassesses IV access and evaluates the patency of IV catheters, because they may have become dislodged during transport. All IV infusions are traced from the IV fluid, to the infusion pump, and to the IV access in the patient. Calculation of medication dosages and rates is completed as part of the initial assessment. All drainage devices are emptied, such as Hemovacs and the urinary drainage bag, and the volume of output is recorded. If a chest tube is in place, the amount of existing drainage is marked on the external collection system. Admission laboratory studies are obtained.. Once the assessment and initial interventions are completed, the family is contacted to see the patient.


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DIF: Cognitive Level: Synthesis REF: Page 673OBJ: Explain the priorities of care for the postoperative surgical patient.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

7. Prevention of hypothermia is crucial in caring for trauma patients. Place the following actions in the appropriate order of preparation for the trauma patient.

a. Remove wet clothing.b. Cover the patient with an external warming device.c. Warm fluids and blood products before administration.d. Warm the ED or intensive care unit (ICU) room before the patient's arrival.

ANS: A, B, C, DBefore arrival to the ED or ICU, the receiving room needs to be warmed. The patient’s clothing is removed and he or she should be covered to prevent external loss of heat. An external warming device needs to be immediately available for warming the patient after arrival. Fluids that are administered should be warmed via active internal devices.

DIF: Cognitive Level: Synthesis REF: Page 667 | Table 19-5OBJ: Discuss prehospital care, emergency care, and resuscitation of the trauma patient.TOP: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

COMPLETION

1. Due to a shift from aerobic to anaerobic metabolism, trauma patients frequently develop____________________ acidosis as the result of hypovolemia and hypoxemia.

ANS: metabolic As a result of hypovolemia and hypoxemia, oxygen debt occurs, causing a shift from aerobic to anaerobic metabolism and resulting in excessive production of lactic acid, which develops into metabolic acidosis.


2. Potential complications of massive fluid resuscitation in a trauma patient include organ dysfunction. Acute renal failure is a potential risk with crush injuries due to the release of

____________________, which may damage the kidneys.


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ANS: myoglobinMyoglobin is released from the damaged muscles. When myoglobinuria is combined with hypovolemia, acute renal failure may occur.

DIF: Cognitive Level: Analysis REF: Page 672OBJ: Formulate a plan of care of the trauma patient, including prevention of complications.TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity


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588 sole ards pul embolism

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