CPEN Trauma Care 4 — Questions and Answers
Question 1: A 9-year-old with a traumatic brain injury (TBI) has a GCS of 7, HR 52, BP 160/90, and irregular respirations. This triad is known as:
- Beck's triad
- Cushing's triad (Correct answer)
- Virchow's triad
- Charcot's triad
Correct answer: Cushing's triad
Cushing's triad (hypertension, bradycardia, irregular respirations) indicates dangerously elevated intracranial pressure and impending herniation.
Question 2: Which blood product ratio is currently recommended for massive transfusion in pediatric trauma to simulate whole blood?
- 1:1:1 (PRBCs:FFP:Platelets) (Correct answer)
- 2:1:1
- 3:1:1
- 1:2:1
Correct answer: 1:1:1 (PRBCs:FFP:Platelets)
A 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets is recommended to address all components of coagulopathy in massive hemorrhage.
Question 3: A 5-year-old has a suspected spinal cord injury after diving into a shallow pool. In-line cervical stabilization is initiated. Which statement about pediatric cervical spine injury is TRUE?
- Cervical spine injuries are more common in children than adults
- Children are more vulnerable to upper cervical (C1-C3) injuries than adults (Correct answer)
- A normal X-ray rules out cervical spine injury in children
- Cervical collars eliminate all movement and are sufficient alone
Correct answer: Children are more vulnerable to upper cervical (C1-C3) injuries than adults
Due to a proportionally larger head, horizontal facet joints, and ligamentous laxity, children are more susceptible to upper cervical spine injuries (C1-C3).
Question 4: SCIWORA stands for spinal cord injury without radiographic abnormality. It is most common in which age group?
- Adolescents 13-17 years
- Adults over 18 years
- Young children under 8 years (Correct answer)
- Infants under 1 year
Correct answer: Young children under 8 years
SCIWORA is most common in young children due to the elasticity of their spinal ligaments and immature bone structures, allowing cord injury without bony damage.
Question 5: A 2-year-old presents with a spiral femur fracture, multiple bruises in various stages of healing, and a healing rib fracture. The PRIORITY action is:
- Apply a traction splint and discharge
- Initiate child protective services notification and a skeletal survey (Correct answer)
- Administer pain medication and reassess in 24 hours
- Obtain only a femur X-ray
Correct answer: Initiate child protective services notification and a skeletal survey
This injury pattern (spiral fracture, patterned bruising, healing fractures) is highly concerning for non-accidental trauma, requiring mandatory reporting and a full skeletal survey.
Question 6: A 7-year-old arrives unresponsive after a building collapse. He has no IV access. Which route should be used immediately for fluid and medication administration?
- Sublingual
- Intraosseous (IO) (Correct answer)
- Intramuscular
- Subcutaneous
Correct answer: Intraosseous (IO)
Intraosseous access provides rapid, reliable vascular access in pediatric emergencies when IV access cannot be quickly established.
Question 7: After stabilizing a pediatric trauma patient, the nurse notes urine output of 0.3 mL/kg/hr. This finding indicates:
- Adequate renal perfusion
- Inadequate perfusion and possible ongoing shock (Correct answer)
- Normal output for a child under stress
- Expected response to pain medications
Correct answer: Inadequate perfusion and possible ongoing shock
Acceptable urine output in children is 1 mL/kg/hr; output below 0.5 mL/kg/hr suggests inadequate renal perfusion and ongoing hypovolemia.
CPEN Trauma Care 4
A 9-year-old with a traumatic brain injury (TBI) has a GCS of 7, HR 52, BP 160/90, and irregular respirations.
This triad is known as: