TNCC Musculoskeletal Trauma 5

Question 1

Which urinalysis finding most strongly suggests myoglobinuria in a patient with extensive crush injury?

Accepted Answer

Dipstick positive for blood with no RBCs on microscopy

Answer

Myoglobin causes a false-positive blood result on urine dipstick without corresponding red blood cells on microscopy, distinguishing myoglobinuria from hematuria.

Question 2

A patient with a long bone fracture develops acute confusion, tachycardia, and fever 24 hours post-injury. Which condition should be highest on the differential?

Accepted Answer

Fat embolism syndrome

Answer

Fat embolism syndrome typically occurs 24–72 hours after long bone fractures and presents with the triad of respiratory failure, neurologic dysfunction (including confusion), and petechial rash.

Question 3

When splinting an acute fracture in the emergency setting, what is the primary purpose of padding the splint?

Accepted Answer

To prevent pressure injury and accommodate swelling

Answer

Padding in splints protects bony prominences from pressure injury and accommodates swelling without creating a constrictive cast that could cause compartment syndrome.

Question 4

A child presents after falling from a bicycle with a transverse fracture through the growth plate. Using the Salter-Harris classification, which type of growth plate fracture has the WORST prognosis for normal bone growth?

Accepted Answer

Type V (crush injury to the growth plate)

Answer

Salter-Harris Type V injuries involve axial compression crushing of the growth plate, destroying the germinal cells and carrying the worst prognosis for normal bone growth.

Question 5

A patient with an isolated tibial fracture develops signs of compartment syndrome with a measured compartment pressure of 32 mmHg. The patient's diastolic blood pressure is 64 mmHg. What is the delta pressure (ΔP) and clinical significance?

Accepted Answer

ΔP = 32 mmHg; fasciotomy is indicated because ΔP ≤ 30 mmHg

Answer

ΔP = diastolic BP − compartment pressure = 64 − 32 = 32 mmHg; a ΔP ≤ 30 mmHg is the threshold for emergent fasciotomy.

(TNCC) Trauma Nursing Core Course Certified Practice Test

(TNCC) Trauma Nursing Core Course Certified Practice Test

TNCC Musculoskeletal Trauma 5