BCEN Trauma and Injury Management 3 — Questions and Answers
Question 1: A patient with a stab wound to zone II of the neck is hemodynamically stable. The appropriate initial management is:
- Immediate surgical exploration
- Computed tomography angiography (CTA) of the neck (Correct answer)
- Blind digital exploration of the wound
- Observation only for 24 hours
Correct answer: Computed tomography angiography (CTA) of the neck
Hemodynamically stable patients with zone II neck injuries undergo CTA to evaluate vascular and aerodigestive structures before surgical decisions.
Question 2: Which intervention is CONTRAINDICATED in a patient with a suspected basilar skull fracture?
- Nasogastric tube insertion (Correct answer)
- Orotracheal intubation
- IV fluid resuscitation
- CT scan of the head
Correct answer: Nasogastric tube insertion
Nasogastric tube insertion is contraindicated in basilar skull fracture due to risk of intracranial placement through the cribriform plate.
Question 3: A burn patient has circumferential full-thickness burns to both lower extremities with absent distal pulses. The priority intervention is:
- Increase IV fluid rate immediately
- Perform escharotomy (Correct answer)
- Apply compression dressings
- Administer vasopressors
Correct answer: Perform escharotomy
Circumferential full-thickness burns cause compartment syndrome requiring escharotomy to restore distal perfusion.
Question 4: According to the Parkland formula, how much fluid should be given in the first 8 hours for a 70 kg patient with 40% TBSA burns?
- 2,800 mL
- 5,600 mL (Correct answer)
- 11,200 mL
- 8,400 mL
Correct answer: 5,600 mL
Parkland formula: 4 mL × kg × %TBSA = 4 × 70 × 40 = 11,200 mL total; half (5,600 mL) given in first 8 hours.
Question 5: A pedestrian struck by a vehicle presents with ecchymosis in a 'tire track' pattern across the abdomen and pelvis. The nurse anticipates injury to which organ most commonly?
- Liver
- Spleen
- Small bowel and mesentery (Correct answer)
- Bladder
Correct answer: Small bowel and mesentery
Crush injury from tire tracks most commonly injures the small bowel and mesentery due to compression against the spine.
Question 6: A patient presents with a gunshot wound to the abdomen, evisceration of bowel, and hemodynamic instability. The appropriate wound management prior to surgery is:
- Attempt to reduce the bowel back into the abdomen
- Cover with a moist saline dressing or bowel bag (Correct answer)
- Apply a dry sterile dressing with pressure
- Leave the wound open to air until OR is ready
Correct answer: Cover with a moist saline dressing or bowel bag
Eviscerated bowel should be covered with a moist saline dressing or bowel bag to prevent desiccation; never attempt to replace it.
Question 7: Which mechanism best explains why elderly trauma patients have higher mortality than younger patients with similar injury severity scores?
- Elderly patients refuse treatment more often
- Reduced physiologic reserve and higher rates of anticoagulant use (Correct answer)
- Emergency nurses triage elderly patients as lower priority
- Elderly patients have more pain sensitivity causing vasovagal responses
Correct answer: Reduced physiologic reserve and higher rates of anticoagulant use
Reduced physiologic reserve, comorbidities, and common anticoagulant use impair the elderly patient's ability to compensate for traumatic injury.
BCEN Trauma and Injury Management 3
A patient with a stab wound to zone II of the neck is hemodynamically stable.
The appropriate initial management is: