TNCC - Trauma Nurse Core Curriculum Musculoskeletal and Surface Trauma Questions and Answers 1 — Questions and Answers
Question 1: A patient with a casted right tibial fracture develops severe, deep pain that is unrelieved by opioids. The toes are cool to the touch and swollen, and the patient reports numbness. Which of the following is the priority nursing action?
- Elevate the affected limb on two pillows to reduce swelling.
- Apply a warm pack to the foot to improve circulation.
- Immediately notify the provider and prepare for cast removal. (Correct answer)
- Administer the next scheduled dose of anxiolytic medication.
Correct answer: Immediately notify the provider and prepare for cast removal.
The patient is exhibiting classic signs of acute compartment syndrome, a limb-threatening emergency caused by increased pressure within a fascial compartment. [2, 9, 15] Pain out of proportion to the injury is the earliest and most sensitive sign. [2, 15, 22] The priority is to relieve the external pressure immediately by notifying the provider for cast removal or bivalving, and preparing for a potential fasciotomy. Elevating the limb can worsen ischemia by decreasing arterial inflow. [25]
Question 2: What is the primary purpose of applying a pelvic binder to a patient with a suspected unstable pelvic fracture during the initial trauma assessment?
- To provide definitive anatomical reduction of the fracture.
- To decrease pelvic volume and provide tamponade for hemorrhage. (Correct answer)
- To prevent the development of a fat embolism.
- To ensure complete immobilization of the lumbar spine.
Correct answer: To decrease pelvic volume and provide tamponade for hemorrhage.
The primary purpose of a pelvic binder is to provide temporary stabilization by applying circumferential pressure. [30] This action reduces the volume of the pelvic ring, which limits potential space for bleeding and creates a tamponade effect on venous and bony sources of hemorrhage, thereby improving hemodynamic stability. [11, 14, 21] It is a temporary measure, not a definitive fracture reduction.
Question 3: A patient is brought to the emergency department after being extricated from a structural collapse where their legs were pinned for several hours. To mitigate the systemic effects of crush syndrome upon reperfusion, which intervention is a critical priority?
- Aggressive intravenous fluid resuscitation with an isotonic crystalloid. (Correct answer)
- Administration of a potent diuretic such as furosemide.
- Application of warming blankets to prevent hypothermia.
- Immediate administration of intravenous calcium gluconate.
Correct answer: Aggressive intravenous fluid resuscitation with an isotonic crystalloid.
Crush syndrome involves traumatic rhabdomyolysis, where myoglobin, potassium, and other toxins are released from damaged muscle cells into the circulation. [6, 23] This can lead to acute kidney injury and life-threatening hyperkalemia. [6] The highest priority is aggressive fluid resuscitation, ideally started before extrication, to increase renal perfusion, dilute toxins, and help prevent myoglobin deposition in the renal tubules. [6, 20, 26]
Question 4: A patient presents with a traumatic amputation of their left hand. A coworker has brought the amputated part. Which method is correct for preserving the part for potential replantation?
- Place the hand directly into a container of ice.
- Clean the hand with an antiseptic solution and keep it at room temperature.
- Submerge the hand in a container of sterile normal saline.
- Wrap the hand in saline-moistened gauze, place in a sealed bag, and put the bag on ice water. (Correct answer)
Correct answer: Wrap the hand in saline-moistened gauze, place in a sealed bag, and put the bag on ice water.
The proper method for preserving an amputated part is to wrap it in saline-moistened gauze, place it in a watertight bag, and then place that bag in a container with ice and water. [1, 17, 24, 28] This cools the tissue to slow metabolism and ischemia without causing direct freezing injury (frostbite), which would occur with direct contact with ice. [1, 17]
Question 5: The trauma nurse should maintain a high index of suspicion for fat embolism syndrome (FES) in a patient with which of the following injuries, especially 24-72 hours after the event?
- A severe closed head injury with loss of consciousness.
- A flail chest with multiple rib fractures.
- Bilateral femur fractures and a pelvic fracture. (Correct answer)
- A penetrating abdominal injury requiring laparotomy.
Correct answer: Bilateral femur fractures and a pelvic fracture.
Fat embolism syndrome (FES) is most commonly associated with fractures of the long bones (like the femur) and the pelvis. [5, 8, 13, 18] These bones contain large amounts of fatty marrow that can be released into the bloodstream upon fracture. The classic triad of respiratory distress, neurologic changes, and a petechial rash typically manifests 24 to 72 hours post-injury. [8, 13, 29]
Question 6: When providing initial care for a patient with an open tibial fracture, which nursing action is the priority after controlling life-threatening hemorrhage?
- Administering intravenous opioid analgesics for pain control.
- Performing a deep wound culture to guide antibiotic therapy.
- Thoroughly irrigating the wound with 3 liters of normal saline.
- Covering the wound with a sterile, saline-moistened dressing. (Correct answer)
Correct answer: Covering the wound with a sterile, saline-moistened dressing.
After controlling active hemorrhage, the immediate priority for an open fracture is to prevent further contamination. [3, 7] This is best accomplished by covering the exposed bone and soft tissue with a sterile dressing moistened with saline to prevent desiccation. [3, 16, 19] While antibiotics, analgesia, and eventual surgical irrigation are all crucial, covering the wound is the next step in the sequence to protect it from the environment. [7, 12, 19]
TNCC - Trauma Nurse Core Curriculum Musculoskeletal and Surface Trauma Questions and Answers 1
A patient with a casted right tibial fracture develops severe, deep pain that is unrelieved by opioids.
The toes are cool to the touch and swollen, and the patient reports numbness.
Which of the following is the priority nursing action?