TCRN TCRN Special Patient Populations 5 — Questions and Answers
Question 1: A morbidly obese trauma patient (BMI 48) requires endotracheal intubation. Which airway challenge is most likely compared to a non-obese patient?
- Smaller glottic opening requiring a smaller ETT
- Rapid oxygen desaturation due to reduced functional residual capacity (Correct answer)
- Hypersensitivity to sedative medications
- Lower risk of aspiration due to delayed gastric emptying
Correct answer: Rapid oxygen desaturation due to reduced functional residual capacity
Morbidly obese patients have significantly reduced FRC and increased oxygen consumption, leading to rapid desaturation during apneic periods even with pre-oxygenation.
Question 2: A trauma patient with a known history of alcohol use disorder (AUD) is admitted and becomes agitated with tremors and diaphoresis 24 hours later. What is the priority intervention?
- Restraints and haloperidol for agitation
- IV thiamine followed by benzodiazepine-based CIWA protocol (Correct answer)
- Naloxone administration
- CT head for intracranial pathology as first step
Correct answer: IV thiamine followed by benzodiazepine-based CIWA protocol
Alcohol withdrawal can be life-threatening; IV thiamine prevents Wernicke's encephalopathy and benzodiazepines (guided by CIWA scoring) are first-line treatment for withdrawal symptoms.
Question 3: A trauma patient with spinal cord injury at T6 complains of severe headache and has a BP of 220/115 mmHg. What condition should the nurse immediately suspect?
- Hypertensive emergency from pain
- Autonomic dysreflexia (Correct answer)
- Neurogenic shock converting to hypertension
- Cushing's reflex from intracranial hypertension
Correct answer: Autonomic dysreflexia
Autonomic dysreflexia (AD) is a sudden hypertensive crisis in patients with SCI at T6 or above triggered by noxious stimuli below the injury level, most commonly a full bladder.
Question 4: A trauma patient with sickle cell disease is admitted with long bone fractures. Which additional complication should the nurse monitor for that non-sickle cell patients do not face?
- Fat embolism syndrome exclusively
- Vaso-occlusive crisis triggered by hypoxia, dehydration, and stress (Correct answer)
- Hypercalcemia from bone breakdown
- Excessive blood transfusion requirements from hemolysis only
Correct answer: Vaso-occlusive crisis triggered by hypoxia, dehydration, and stress
Trauma-induced hypoxia, dehydration, acidosis, and physiologic stress can trigger vaso-occlusive crisis in sickle cell patients, adding significant morbidity beyond the primary injury.
Question 5: A trauma patient is brought in by EMS after a high-speed crash. The patient is combative with pinpoint pupils and bradycardia. What substance should the nurse suspect?
- Cocaine or methamphetamine intoxication
- Opioid toxidrome (Correct answer)
- Alcohol intoxication
- Benzodiazepine overdose
Correct answer: Opioid toxidrome
Pinpoint (miotic) pupils, CNS depression, and bradycardia are classic signs of opioid toxidrome; the combativeness may reflect hypoxic agitation or head injury co-occurring with opioid effects.
Question 6: A trauma patient with hemophilia A and a traumatic knee hemarthrosis is admitted. What is the priority pharmacological treatment before orthopedic intervention?
- Aspirin and NSAIDs for pain and inflammation
- Factor VIII concentrate replacement to target 50-100% activity (Correct answer)
- Fresh frozen plasma alone
- Desmopressin (DDAVP) in all cases
Correct answer: Factor VIII concentrate replacement to target 50-100% activity
Hemophilia A requires Factor VIII concentrate replacement; the target activity level for major joint bleeding is 50-100% to achieve hemostasis before any procedure.
Question 7: An intubated trauma patient with a C5 spinal cord injury is difficult to wean from mechanical ventilation. What is the primary physiological reason?
- Increased metabolic demand from spasticity
- Loss of diaphragm innervation and intercostal muscle function (Correct answer)
- Neurogenic pulmonary edema reducing lung compliance
- Autonomic dysreflexia causing bronchospasm
Correct answer: Loss of diaphragm innervation and intercostal muscle function
C5 injury spares partial diaphragm function (phrenic nerve C3-C5) but eliminates intercostal and abdominal muscle contribution to breathing, severely limiting respiratory reserve and weaning capacity.
TCRN TCRN Special Patient Populations 5
A morbidly obese trauma patient (BMI 48) requires endotracheal intubation.
Which airway challenge is most likely compared to a non-obese patient?