CEN Trauma Nursing 1 — Questions and Answers
Question 1: A trauma patient arrives after a high-speed MVC. During the primary survey, the nurse identifies absent breath sounds on the left and tracheal deviation to the right. What is the priority action?
- Order portable CXR
- Perform needle thoracostomy on the left side (Correct answer)
- Administer 2L normal saline IV
- Apply a non-rebreather mask
Correct answer: Perform needle thoracostomy on the left side
Absent breath sounds with tracheal deviation indicate tension pneumothorax requiring immediate needle decompression without waiting for imaging.
Question 2: During the primary survey (ABCDE), when is massive hemorrhage control addressed in the updated ATLS framework?
- After airway management (A)
- Before airway — as the first priority (<C>ABC) (Correct answer)
- During circulation assessment (C)
- After the secondary survey
Correct answer: Before airway — as the first priority (<C>ABC)
Updated ATLS guidelines add <C> (catastrophic hemorrhage control) before airway management in the primary survey.
Question 3: A patient with an open abdominal wound has loops of bowel eviscerated. Which nursing action is most appropriate?
- Push the bowel back into the abdominal cavity
- Cover with a dry sterile dressing
- Cover with a moist saline dressing and do not reinsert (Correct answer)
- Apply an occlusive plastic dressing tightly
Correct answer: Cover with a moist saline dressing and do not reinsert
Eviscerated abdominal contents should be covered with a moist, sterile saline dressing and never pushed back into the abdomen.
Question 4: A trauma patient has a GCS of 9 (E2V3M4). What does this GCS score indicate about the patient's airway?
- The airway is patent and self-maintained
- Definitive airway management should be considered (Correct answer)
- The patient requires only nasal airway adjunct
- GCS does not predict airway patency
Correct answer: Definitive airway management should be considered
A GCS ≤8 is a widely used threshold for considering definitive airway management due to inability to protect the airway.
Question 5: Which type of shock is most likely in a trauma patient with distended neck veins, muffled heart sounds, and hypotension without obvious external hemorrhage?
- Hemorrhagic shock
- Neurogenic shock
- Obstructive shock from cardiac tamponade (Correct answer)
- Distributive shock
Correct answer: Obstructive shock from cardiac tamponade
Beck's triad (hypotension, JVD, muffled heart sounds) in trauma indicates obstructive shock from pericardial tamponade.
Question 6: A patient with a suspected pelvic fracture has ongoing hemodynamic instability. Which intervention is priority to reduce pelvic volume and control hemorrhage?
- Application of a commercial pelvic binder or sheet wrap (Correct answer)
- Emergent surgical exploration
- Bilateral femur traction splints
- Aggressive IV fluid resuscitation with 4L NS
Correct answer: Application of a commercial pelvic binder or sheet wrap
A pelvic binder reduces pelvic volume and tamponades venous bleeding, serving as a temporizing measure until definitive care.
CEN Trauma Nursing 1
A trauma patient arrives after a high-speed MVC.
During the primary survey, the nurse identifies absent breath sounds on the left and tracheal deviation to the right.
What is the priority action?