TNCC - Trauma Nurse Core Curriculum Thoracic and Abdominal Trauma Questions and Answers 1 — Questions and Answers
Question 1: A patient with blunt chest trauma from a steering wheel impact is noted to have a segment of their right chest wall that retracts inward during inspiration and bulges outward during expiration. This physical finding is the most definitive sign of which injury?
- Tension pneumothorax
- Massive hemothorax
- Flail chest (Correct answer)
- Simple rib fractures
Correct answer: Flail chest
Flail chest is defined by fractures of three or more adjacent ribs in two or more places, creating a free-floating segment. This segment moves independently and opposite to the rest of the chest wall during respiration, a sign known as paradoxical motion, which is the hallmark clinical finding of the injury. [11, 12, 17, 18]
Question 2: A patient arrives after a penetrating wound to the central chest. The nurse assesses hypotension, distended jugular veins, and muffled heart sounds. These findings, known as Beck's Triad, are the classic signs of which life-threatening condition?
- Aortic dissection
- Pericardial (cardiac) tamponade (Correct answer)
- Tension pneumothorax
- Pulmonary contusion
Correct answer: Pericardial (cardiac) tamponade
Beck's Triad consists of hypotension, jugular venous distention, and muffled heart sounds. This triad is the classic presentation for acute pericardial (cardiac) tamponade, where fluid accumulation in the pericardial sac compresses the heart, impairing its ability to pump blood effectively. [3, 6, 7, 9]
Question 3: A patient involved in a motor vehicle collision reports left upper quadrant abdominal pain that radiates to the tip of the left shoulder. This finding, known as Kehr's sign, is highly suggestive of an injury to which organ?
- Liver
- Stomach
- Spleen (Correct answer)
- Pancreas
Correct answer: Spleen
Kehr's sign is referred pain to the left shoulder caused by irritation of the diaphragm from blood, most commonly associated with a splenic injury or rupture. The phrenic nerve, which innervates the diaphragm, shares nerve roots (C3-C5) with the supraclavicular nerves that supply the shoulder area. [1, 2, 10, 16]
Question 4: A trauma patient presents with absent breath sounds on the right, tracheal deviation to the left, severe respiratory distress, and hypotension. What is the immediate, life-saving intervention for this condition?
- Obtain a stat portable chest x-ray.
- Prepare for immediate chest tube insertion.
- Administer a 1-liter bolus of crystalloid fluid.
- Perform an immediate needle decompression. (Correct answer)
Correct answer: Perform an immediate needle decompression.
The patient's signs and symptoms are classic for a tension pneumothorax, a life-threatening emergency where air is trapped in the pleural space, causing mediastinal shift and cardiovascular collapse. The immediate intervention is to relieve the pressure by performing a needle decompression. This is a temporizing measure performed before the definitive treatment of a chest tube (tube thoracostomy). [13, 27, 29, 30]
Question 5: A patient arrives with an abdominal evisceration following a stab wound. What is the most appropriate initial management of the exposed abdominal contents?
- Gently attempt to push the bowel back into the abdominal cavity.
- Cover the exposed contents with a sterile, saline-moistened dressing. (Correct answer)
- Apply an occlusive dressing taped on all four sides.
- Irrigate the exposed bowel with povidone-iodine solution.
Correct answer: Cover the exposed contents with a sterile, saline-moistened dressing.
The standard of care for an abdominal evisceration is to cover the exposed organs with a sterile dressing moistened with sterile saline to prevent drying, heat loss, and further contamination. The bowel should not be forced back into the abdomen. [4, 5, 15, 23]
Question 6: During the secondary survey of a patient with blunt thoracoabdominal trauma, the nurse auscultates bowel sounds in the left lower chest. This finding is most indicative of which injury?
- Hemothorax
- Esophageal perforation
- Diaphragmatic rupture (Correct answer)
- Pulmonary contusion
Correct answer: Diaphragmatic rupture
A diaphragmatic rupture, most commonly occurring on the left side due to the liver's protective effect on the right, can allow abdominal contents (like the stomach or intestines) to herniate into the thoracic cavity. The presence of bowel sounds upon auscultation of the chest is a classic sign of this injury. [20, 22, 25, 26]
TNCC - Trauma Nurse Core Curriculum Thoracic and Abdominal Trauma Questions and Answers 1
A patient with blunt chest trauma from a steering wheel impact is noted to have a segment of their right chest wall that retracts inward during inspiration and bulges outward during expiration.
This physical finding is the most definitive sign of which injury?