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1) Three adults present at different times during a one-hour period
with a high fever, fatigue, and headache. All three patients have a rash
which started on their mouth, face, and arms with progression to the
chest and abdomen. They all visited the same grocery store within the
last week. What is the most appropriate intervention from triage for
these patients?
A.Move them to a decontamination area
B.Mask the patients and send them to the waiting room
C.Immediately initiate isolation precautions
D.Send them to the waiting room without a mask

2) A 35-year-old male presents with facial trauma after being struck in

the face with a baseball. A teardrop-shaped left pupil is noted on
exam. What type of injury is suspected?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment

3) A patient has been diagnosed with an incomplete spinal cord injury

at L1. Which finding would indicate sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area

4) While caring for a trauma patient in the emergency department,

what finding raises suspicion of a complete spinal cord injury?
A.Weakness in the lower extremities
B.Urinary incontinence
C.Sacral sparing
D.Spastic paralysis of the legs

5) Which blood pressure finding is associated with early or

compensated hypovolemic shock?
A.Rising systolic
B.Rising diastolic
C.Decreasing diastolic
D.Decreasing systolic
6) Which of the following is true about the log-roll maneuver?
A.It causes less spinal motion than the lift-and-slide maneuver
B.It is recommended for patients with unstable pelvic fractures
C.It should be avoided with a suspected spine injury prior to imaging
D.It decreases the risk of hemorrhage from unstable pelvic injuries

7) A patient has uncontrolled bleeding from a wound to his right

upper extremity. What is the priority intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding

8) An adult patient who sustained a severe head trauma has been

intubated and is being manually ventilated via a bag-mask device at a
rate of 18 breaths/minute. The patient has received one intravenous
fluid bolus of 500 mL of warmed isotonic crystalloid solution. The
PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is
142/70 mm Hg. What is the most important intervention to manage the
cerebral blood flow?
A.Decrease the rate of manual ventilation.
B.Initiate another fluid bolus.
C.Recheck endotracheal tube placement.
D.Increase the amount of oxygen delivered.

9) An older adult presents to the emergency department with

complaints of dizziness, headache, and nausea. The patient was
involved in a motor vehicle collision 10 days ago. There was no loss
of consciousness and a hematoma is noted to the forehead. The
patient is currently on anticoagulant therapy. What is most likely the
cause of their symptoms?
A.Intracerebral hemorrhage
B.Epidural hematoma
C.Diffuse axonal injury
D.Post-concussive syndrome
10) A patient with a lower extremity fracture complains of severe pain
and tightness in his calf, minimally relieved by pain medications.
Which of the following is the priority nursing intervention?
A.Elevating the leg above the level of the heart
B.Repositioning the leg and applying ice
C.Elevating the leg to the level of the heart
D.Preparing the patient for ultrasound of the leg

11) A patient involved in a high-speed rollover is complaining of

increased difficulty breathing. There is a small penetrating wound to
the sixth intercostal space in the left lateral chest. Which finding is
most consistent with an injury to the diaphragm?
A.Severe left-sided abdominal pain
B.Bowel sounds heard in the left lower chest
C.Pain radiating to the left shoulder.
D.Decreased breath sounds on the left side

12) A patient has been in the emergency department for several hours
waiting to be admitted. They sustained multiple rib fractures and a
femur fracture after a fall. The patient has been awake, alert, and
complaining of leg pain. Their spouse reported that the patient
suddenly became anxious and confused. Upon reassessment, the
patient is restless, with respiratory distress and petechiae to his neck.
The patient is exhibiting signs and symptoms most commonly
associated with which of the following conditions?
A.Acute lung injury
B.Fat embolism
C.Pneumothorax
D.Pulmonary contusion

13) Using the American College of Surgeons screening guidelines,

what assessment finding would prompt the nurse to prepare a patient
for cervical spine imaging?
A.Alert with no neurologic deficits
B.Multiple abrasions to the extremities
C.Ecchymosis to the flank
D.Responds to verbal stimulation
14) An adult was thrown against a concrete wall during a factory
explosion and sustained a femur fracture, liver laceration, and a small
subdural hematoma. These injuries most likely occurred during what
level of blast trauma?
A.Primary
B.Secondary
C.Tertiary
D.Quaternary

15) An adult patient was brought to the emergency department

following a motorcycle crash. On arrival, the patient is only
responsive to pain, has bleeding from the nose, and multiple
abrasions and contusions to the face. What is the priority
intervention?
A.Use a bulb syringe to suction out secretions from the mouth.
B.Insert a nasopharyngeal airway to maintain an open airway.
C.Use a jaw thrust to open the airway and look for signs of
obstruction.
D.Ask the patient to open their mouth to inspect the airway.

16) An adult pedestrian was struck on the right side by a sport utility
vehicle traveling at 40 mph. The patient is awake and alert and the
right leg is shortened. Following initial resuscitation with fluids, the
patient remains hypotensive. What would be the priority intervention?
A.Send blood for type and crossmatch
B.Apply a pelvic binder
C.Prepare the patient for surgery
D.Insert a urinary catheter

17) A severely injured patient has been intubated and is being

mechanically ventilated. The patient has received a balanced
resuscitation including multiple blood products. Under which
circumstance will it be harder for the hemoglobin to release oxygen to
the tissues?
A.Decreased pH
B.Elevated carbon dioxide level
C.Decreased body temperature
D.Increased metabolic demand
18) A patient is thrown against a car during a tornado and presents
with obvious bilateral femur fractures. The patient is pale, alert,
disoriented, and has delayed capillary refill. Which of the following
interventions would be most appropriate for this patient based on the
disaster triage principles?
A.Initiate two large-caliber intravenous lines for isotonic crystalloid
administration.
B.Administer intravenous medications for pain.
C.Place the patient in an observation area for care within the next few
hours.
D.Contact the command center for personnel to notify next of kin.

19) A patient arrives with a large open chest wound after being
assaulted with a machete. Prehospital providers placed a nonporous
dressing over the chest wound and taped it on three sides. The
patient is now showing signs of anxiety, restlessness, severe
respiratory distress, cyanosis, and decreasing blood pressure. Which
of the following is the MOST appropriate immediate intervention?
A.Needle decompression
B.Tube thoracostomy
C.Dressing removal
D.Surgical repair

20) A driver involved in a high-speed motor vehicle collision arrives in

the emergency department. The vehicle's air-bag failed to deploy. The
patient is drowsy but arousable and complaining of chest pain with
ecchymosis noted to the chest. The patient is tachycardic and
hypotensive with no evidence of uncontrolled bleeding. Cardiac
monitor shows premature ventricular contractions. Which of the
following is the most appropriate intervention for this patient?
A.Rapid fluid boluses
B.Tranexamic acid administration
C.Inotropic support
D.Hemostatic resuscitation
21) A patient is diagnosed with a T12 spinal cord injury following a 20-
foot fall. Which finding is consistent with spinal shock?
A.Bradycardia
B.Loss of reflexes
C.Widened pulse pressure
D.Warm skin
D.Widening pulse pressure

22) A patient with a traumatic brain injury has a mean arterial

pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure
(ICP) of 22 mm Hg (2.93 kPa). Which finding is most likely an
indication of the body's response to these findings?
A.Reflex hypotension
B.Increased respiratory effort
C.Reflex tachycardia
D.Widening pulse pressure

23) An unconscious patient arrives following a motor vehicle

collision. The patient is on a backboard with a cervical collar in place
and one intravenous line running. Respirations are shallow and there
is active brisk bleeding from a large leg wound. What is the priority
intervention for this patient?
A.Check for a patent airway
B.Control the bleeding
C.Start a second intravenous line
D.Ventilate with a bag-mask device

24) An obese trauma patient requires intubation. Assuming there are

no contraindications, which position will provide the best
visualization for insertion of the endotracheal tube?
A.Reverse Trendelenburg
B.Lying on side
C.Ramped
D.Supine
25) Your patient is a pedestrian struck by a car and thrown 35 feet.
They were unconscious at the scene but became responsive with
initial and subsequent Glasgow Coma Scale (GCS) scores of 13 (E-3,
V-4, M-6). The patient has bilateral subdural hematomas and is
awaiting transfer to the ICU. Your next assessment reveals a GCS of 9
(E-2, V-2, M-5). What is the priority nursing intervention?
A.Hold all pain medications
B.Notify the provider of the change
C.Repeat the GCS in 30 minutes
D.Place the patient in Trendelenburg position

26) Which of the following situations could cause functional grief?

A.Inability to live at home
B.Amputation of a limb
C.Loss of one's self-image
D.Destruction of the patient's car

27) A patient arrives following prolonged exposure of their left hand

to the cold. The patient is awake and alert and complains of a tingling
sensation to the fingers. Assessment reveals swelling and bright red
skin to the left hand and a 1-inch round clear blister to the dorsum of
that hand. Which of the following nursing interventions is most
appropriate for this patient?
A.Massage the injured areas to promote circulation
B.Drain and debride the blister on the hand
C.Immerse in water between 37.5oC and 39.5oC (99.5oF to 103.1oF).
D.Gently rewarm over 15 to 30 minutes

28) A nurse verbalizes guilt and remorse after caring for multiple
severely injured patients during a staffing crisis. The nurse expresses
anger stating that the patients did not receive quality care and begins
exhibiting aggression toward colleagues. This is most consistent with
which condition?
A.Compassion fatigue
B.Vicarious trauma
C.Secondary traumatic stress
D.Moral injury
29) What is the rationale for obtaining a serum lactate level during the
initial assessment of a trauma patient?
A.Measures oxygenation and ventilation
B.Assesses the degree of alkalosis and base deficit
C.Gauges end-organ perfusion and tissue hypoxia
D.Determines the underlying cause of shock

30) What is the most important consideration during the initial

assessment when caring for an older adult who has sustained serious
injuries?
A.They are likely to be fearful in the emergency department
B.Medical history including current medications
C.Availability of support systems after discharge
D.Accessibility to a primary care physician

31) Following a gun shot wound, pre-hospital providers report

diminished breath sounds bilaterally. Upon emergency department
arrival, the patient is unresponsive with shallow respirations and an
O2 sat of 88%. What is the priority intervention for this patient?
A.Administer 15 L oxygen via nonrebreather mask
B.Attach patient to a CO2 detector
C.Prepare for a definitive airway
D.Assist ventilation with a bag-mask device

32) Your patient was the unrestrained driver involved in a moderate

speed motor vehicle collision. Assessment reveals tenderness in the
upper right quadrant, crepitus in the lower right ribs, and ecchymosis
around the umbilicus. The nurse is concerned about injury to which
organ?
A.Transverse colon
B.Pancreas
C.Liver
D.Spleen

33) What position optimizes ventilation in the obese patient with a

lumbar fracture?
A.Reverse Trendelenburg
B.Supine
C.Prone
D.Fowler's
34) A 5-year-old child presents to the emergency department with
bruises to the upper arms and buttocks in various stages of healing
and multiple small, clean, round burns to the back. There are no
abnormalities found based on the pediatric assessment triangle or
primary survey. Which of the following is the priority nursing
intervention?
A.Report your suspicion of maltreatment in accordance with local
regulations
B.Apply ice to the bruises and provide wound care
C.Engage in therapeutic communication to determine the mechanism
of injury
D.Provide the family with injury prevention resources

35) A patient arrives with a large metal rod embedded in their left
thigh and no active bleeding. Which intervention is most appropriate
for this patient?
A.Remove the rod immediately to facilitate cleansing.
B.Apply a tourniquet to the leg above the metal rod.
C.Hold antibiotics until after the rod is removed.
D.Prepare the patient for surgery to remove the rod.

36) When should the definitive calculation for intravenous fluid

resuscitation rate be performed for a patient with burns?
A.As soon as the patient arrives
B.During the secondary survey
C.Should only be done at a burn center
D.During the primary survey

37) Which of the following is true about use of the focused

assessment sonography for trauma exam for a patient with abdominal
trauma?
A.It has a higher sensitivity than diagnostic peritoneal lavage for fluid
detection
B.It can be used in hypotensive patients too unstable for computed
tomography scan
C.It can detect as little as 30 mL of fluid in the abdominal cavity
D.It has high sensitivity in pediatric patients for identifying fluid in the
peritoneum
38) What is the priority intervention for a child who has been
diagnosed with an atlanto-occipital dislocation following a high-speed
motor vehicle collision?
A.Initiating a second large caliber intravenous line
B.Maintaining spinal motion restriction
C.Placing the patient on pulse oximetry
D.Turning the patient to remove the backboard

39) During the primary survey of an unconscious patient with multi-

system trauma, the nurse notes snoring respirations. Which priority
nursing intervention should be performed next?
A.Open the airway with the head-tilt/chin-lift maneuver
B.Auscultate bilateral breath sounds
C.Assist respirations using a bag-mask device
D.Insert an oropharyngeal airway if there is no gag reflex

40) A trauma patient is being held in the emergency department

because there are no available inpatient beds. The patient sustained a
femur fracture and required multiple blood products. The patient now
has blood oozing from abrasions, IV sites, the nose, and gums. What
condition is most consistent with these findings?
A.Rhabdomyolysis
B.Fat embolism
C.Disseminated intravascular coagulopathy
D.Multiple organ dysfunctions syndrome

41) A patient is brought to the emergency department following a

snowmobile crash with prolonged exposure time prior to transport.
The patient is confused. Vital signs are BP 96/54 mm Hg, HR 114
beats/minute, RR 24 breaths/minute, T 34.6oC (94.2oF) and an SpO2
of 90% on oxygen at 15L per non-rebreather mask. Other findings
include ETCO2 24, serum lactate of 6 mmol/L, and a pH of 6.8. Based
on these findings, what is the most appropriate intervention?
A.Initiate warming measures
B.Titrate oxygen to 6 L per nasal cannula
C.Bolus with 500 mL isotonic crystalloids
D.Vigorously massage the extremities
42) Which of the following is a late sign of increased intracranial
pressure?
A.Restlessness
B.Vomiting
C.Decreased respiratory effort
D.Narrowing pulse pressure

43) Based on fall mechanism, which patient warrants prehospital

transfer to a trauma center?
A.A 35-year-old lands on a wooden porch from an 8-foot ladder
B.A 2-year-old lands on grass from a second-story balcony
C.A 14-year-old forcefully pushed onto cement from standing
D.A 50-year-old lands on a carpeted floor after tripping

44) The trauma nurse is caring for an unrestrained driver who struck
their head on the windshield following a high-speed MVC. The patient
has been diagnosed with an anterior spinal cord injury at the level of
C6. Which assessment finding would be most concerning?
A.Distension of the bladder
B.Incontinence of stool
C.Increasing work of breathing
D.Inability to move the legs

45) While caring for a child who has been injured, what nursing
intervention is consistent with a family-center approach?
A.Identifying a single family member to speak with
B.Having the family make all the care decisions
C.Allowing family to participate in the care of the patient
D.Limiting dissemination of complex information

46) A trauma patient who is 30-weeks pregnant arrives at the

emergency department following a motor vehicle collision. Which
normal physiologic change should be considered when assessing
ventilatory status?
A.Increased functional reserve capacity
B.Increased oxygen consumption
C.Decreased minute ventilation
D.Slower desaturation rates with apnea
47) A patient is brought to the emergency department with chest pain
and shortness of breath following a high-speed motor vehicle
collision in which they were the unrestrained driver. There is crepitus
to the left chest with clear and equal breath sounds. The vital signs
are BP 80/40 mmHg, HR 140 beats/minute, and RR 40 breaths/minute.
Cardiac monitor shows sinus tachycardia with premature ventricular
contractions. These findings are most consistent with which type of
shock?
A.Cardiogenic
B.Neurogenic
C.Hypovolemic
D.Obstructive

48) A patient who sustained severe injuries was brought to the

emergency department following a high-speed motor vehicle
collision. Interventions for hypovolemic shock have been initiated.
What component of the trauma triad of death is most likely to have
begun at the time of injury?
A.Acidosis
B.Hypothermia
C.Hypocalcemia
D.Coagulopathy

49) An adult patient involved in a motor vehicle collision is brought to

the emergency department of a rural critical access facility. They
complain of neck pain, shortness of breath, and diffuse abdominal
pain. The Glasgow Coma Score is 15. Vital signs are: BP 98/71 mm
Hg, HR 125 beats/minute, RR 26 breaths/minute, and SpO2 94% on
high-flow oxygen via non-rebreather mask. Which of the following is
the priority intervention for this patient?
A.Expedite transport to the CT scanner
B.Prepare the patient for spinal radiographs
C.Expedite transfer to the closest trauma center
D.Notify the patient's family
50) A patient who weighs 120 kg is brought to the emergency
department after sustaining partial thickness burns to both upper
extremities and chest with a total body surface area burned of 27%.
How much intravenous fluid should be administered in the first 8
hours?
A.1620 mL
B.2160 mL
C.3240 mL
D.6480 mL

51) A patient with complete spinal cord injury who is in neurogenic

shock will demonstrate hypotension and which other clinical signs?
A. Bradycardia and ipsilateral a sense of motor function.
B. Tachycardia and respiratory depression.
C. Tachycardia and piokilothermia.
D. Bradycardia and absent motor function below the level of injury.

52) You are caring for a patient who was shot multiple times in the
chest and abdomen. The patient is unresponsive with snoring,
shallow respirations. Assessment reveals absent radial pulses, weak
and rapid carotid pulse, and cool, diaphoretic skin. Which
management strategy should the nurse anticipate?
A. Autotransfusion
B. Massive transfusion
C. Controlled fluid boluses
D. Inotropic medications

53) Which of the following characteristics is found in high performing

teams?
A. Interdisciplinary collaboration
B. Provide on-the-job training
C. Work individually
D. Minimal feedback to decrease confusion
54) An adult patient weighing 75 kg sustained partial and full
thickness burns to 32% of their body 2 hours prior to arrival.
Intravenous fluid resuscitation was calculated to be 400 mL/hr. The
urine output over the last hour was 15mL. What intervention should
the nurse anticipate?
A. Add blood products to the resuscitation
B. Increase isotonic crystalloid infusion rate
C. Administer an intravenous diuretic
D. Switch to a hypertonic saline solution

55) You are speaking with the family of a critically injured patient. The
spouse is crying loudly and the daughter is angry and yelling at staff.
Which of the following nursing interventions is most appropriate?
A. Have the family escorted out of the department
B. Ask if the family would like spiritual support
C. Allow only the spouse to see the patient
D. Do not include the family in decision-making at this time

56) An unresponsive trauma patient has an oropharyngeal airway in

place, shallow and labored respirations, and dusky skin. Medications
for drug-assisted intubation have been administered but intubation
was unsuccessful. What is the most appropriate next step?
A. Ventilate with a bag-mask device
B. Prepare for a cricothyroidotomy
C. Administer reversal medications
D. Contact anesthesia for assistance

57) A restrained driver involved in a motor vehicle collision is brought

to the emergency department with abdominal, pelvic, and bilateral
lower extremity pain. Vital signs are BP 114/78 mm Hg, HR 98
beats/minute, RR 22 breaths/minute. A FAST exam is negative for fluid
in the abdominal and peritoneal cavities. Which of the following
should the nurse anticipate?
A. Diagnostic peritoneal lavage
B. Angiography
C. Non-contrast abdominal CT scan
D. Serial abdominal assessments
58) Which of the following is true of cavitation?
A. Energy cause the tissues to accelerate and displace outward
B. Once a bullet passes, the tissues always return to its normal
location
C. Damage occurs only to internal organs and blood vessels
D. Hollow organs do not tolerate high-velocity cavitation

59) An adult patient involved in an assault presents with shortness of

breath, BP 88/50 mmHg, heart rate 130 beats/minute. The patient has
muffled heart sounds and is cyanotic. What is the priority
intervention?
A. Needle thoracostomy
B. Chest tube insertion
C. Pericardiocentesis
D. Tracheal intubation

60) A patient with a chest tube is being transported to the intensive

care unit and fluctuation is noted in the water seal chamber during
inspiration and expiration. What is the best action for the nurse to
take?
A. Clamp the chest tube
B. Return to the emergency department
C. Assist ventilation with bag-mask device
D. Continue to intensive care unit

61) In a motor vehicle collision, which injury pathway is most likely to

increase the patients morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover

62) Which of the following assessment findings differentiates a

tension pneumothorax from a simple pneumothorax?
A. Increased work of breathing
B. Unilaterally diminished breath sounds
C. Tachycardia
D. Hypotension
63) An 85 year old is brought to the emergency department by a family
member for fever and cough. There are multiple bruises in various
stages of healing on the upper extremities and the back. Based on
these findings what is the most appropriate initial question to
facilitate screening for abuse?
A. How did you get these bruises?
B. How long have you had these bruises?
C. Did someone hurt you?
D. Who takes care of you?

64) Caregivers carry a 2 year old into the emergency department who
fell out of a second story window. The patient is awake and crying
with increased work of breathing and pale skin. Which intervention
has the highest priority?
A. Stabilizing the cervical spine
B. Applying a nonrebreather mask
C. Establishing intravenous access
D. Preparing for drug-assisted intubation

65) A patient arrives at the emergency department following a motor

vehicle collision. Prehospital personnel report significant damage to
the vehicle. The patient is alert and agitated with a strong odor of
alcohol and appears intoxicated. After physician evaluation, under
what circumstances can an order to remove the rigid cervical collar
be anticipated?
A. No imaging abnormalities of the neck
B. No neurological abnormalities on examination
C. No point tenderness to cervical spine
D. Absence of neck pain with movement

66) What intravascular solution is most commonly used for patients

who have sustained burns?
A. Lactated ringer’s
B. Normal saline
C. D5/normal saline
D. Hypertonic saline
67) A patient arrives with a 3 inch laceration to their forearm from a
tree branch.
Which of the following methods will the nurse use to remove small
pieces of bark and debris from the wound?
A. Low pressure irrigation
B. High pressure irrigation
C. Scrubbing with normal saline
D. Scrubbing with tap water

68) An adult patient was a restrained passenger involved in a high

speed motor vehicle collision. The patient complained of generalized
abdominal and left leg pain. A FAST exam was negative for fluid in the
abdominal cavity. While awaiting inpatient bed placement, the patient
develops increased abdominal pain with rebound tenderness, fever,
and an elevated white blood cell count. These findings are most
consistent with an injury to which organ?
A. Spleen
B. Kidney
C. Small bowel
D. Liver

69) A patient involved in a fall from 25 feet has a traumatic brain

injury, three anterior rib fractures on the right, and a grade III liver
injury. The patient was intubated and placed on a ventilator with
PEEP. Chest tube was deferred at this time. Upon reassessment,
which finding is most concerning?
A. Severely diminished breath sounds on the right
B. Guarding in the right upper quadrant
C. Ecchymosis in the right upper quadrant
D. Crepitus to the right chest

70) A patient presents, after a 25 foot fall, with paradoxical chest wall
movement to the right lower chest and complaints of shortness of
breath. What is the priority intervention?
A. Surgical intervention
B. Chest tube insertion
C. Needle decompression
D. Airway and ventilation support
71) An adult presents to the emergency department after sustaining
severe facial injuries during an altercation. The patient is awake,
confused, and smells heavily of alcohol. Pulse oximetry is 94% on
room air. Immediate intubation should be anticipated based on which
clinical indicator? A. Confusion
B. Pulse oximetry reading
C. Severe facial injuries
D. Smell of alcohol on breath

72) An adult who fell from a second story roof is brought to the
emergency department by private vehicle. The patient is confused
with unlabored respirations and has strong, palpable radial pulses.
There is an open wound in proximity to an obvious deformity of the
left lower extremity. What is the priority intervention?
A. Initiate cervical spine stabilization
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen
D. Log roll the patient onto a spine board

73) A trauma patient is en route to a rural emergency department.

Radiology notifies the charge nurse that the computed tomography
(ct) scanner will be out of service for several hours. The team gathers
to plan accordingly. Which of the following terms best describes this
trauma team’s communication?
A. Brief
B. Closed loop
C. Debrief
D. Huddle

74) A seriously injured patient is noted to have weak, thready pulse

and cool, clammy skin. There is instability of the pelvis on palpating
and blood on the urinary meatus. A pelvic binder is appropriately
applied and balanced fluid resuscitation is being managed by the
team. What is most likely to be ordered next?
A. Insert a urinary catheter
B. Bolus with 2L isotonic crystalloid solution
C. Diagnostic peritoneal lavage
D. Insertion of a Supra public catheter
75) Patients with a crush injury should be monitored for which of the
following conditions?
A. Hypermatremia
B. Hypercalcemia
C. Dysrhythmias
D. Polyuria

76) Which commonly prescribed medication may worsen a

complication that is associated with massive transfusion?
A. Lisinopril
B. Metformin
C. Metoprolol
D. Diltiazem

77) A 36-year-old patient has a deformity of the left wrist after a fall.
The patient is reluctant to move their hand due to pain. Which of the
following is the most appropriate intervention?
A. Apply a sling and elevate the extremity to the level of the heart
B. Apply a splint and elevate the extremity above the level of the heart
C. Apply a sling and elevate the extremity above the level of the heart
D. Apply a splint and elevate the extremity to the level of the heart

78) A patient is brought to the emergency department of a rural

hospital following a high-speed motor vehicle collision. When
significant abdominal and pelvic injuries are noted in the primary
survey, what is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter

79) Following a review of recent drills and a real disaster event, a

hospital has identified deficiencies and is taking steps to minimize the
impact of a future disaster. Which phase of the disaster life cycle
does this describe?
A. Mitigation
B. Preparedness
C. Response
D. Recovery
80) A trauma patient is restless and repeatedly asking "Where am I?"
Vital signs upon arrival were BP 110/60 mm Hg, HR 96 beats/minute,
and RR 24 breaths/minute. Skin is cool and moist. Current vital signs
are BP 86/68 mm Hg, HR 118 beats/minute, and RR 28 breaths/minute.
The patient is demonstrating signs and symptoms of which stage of
shock?
A. Compensated
B. Refractory
C. Irreversible
D. Decompensated

81) When should the definitive calculation for intravenous fluid

resuscitation rate be performed for a patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment

82) An adult arrives at the emergency department with superficial

burns to the extremities following a house fire. The patient is
reporting a headache with nausea and is drowsy and confused. What
is the most likely cause of these symptoms?
A. Capillary leak syndrome
B. Rhabdomyolysis
C. Carbon monoxide poisoning
D. Hypothermia

83) An adult patient is brought to the emergency department following

a vehicle “roll-over” with prolonged extrication. Assessment reveals
swelling and bruising to the right proximal thigh and a weak pedal
pulse. Skin is pale, cool, and moist. What is the most appropriate
initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a traction splint to the affected extremity
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30–35 mm Hg (3.9–4.6 kPa)
84) A patient has received multiple transfusions of banked blood in
the past two hours. The patient has now developed muscle tremors
and short runs of ventricular tachycardia. Which of the following
medications does the nurse anticipate administering?
A. Hypertonic saline
B. Calcitonin
C. Insulin and glucose
D. Calcium gluconate

85) A 5-month pregnant patient arrives in the emergency department

stating she tripped and fell, landing on her abdomen. Assessment
reveals bruising to the abdomen, both arms, and her neck. She states
she does not take any medications and has not had any prenatal care.
The nurse suspects the findings are most likely related to which of
the following?
A. Intentional violence
B. Pregnancy-related changes
C. Undiagnosed embolus
D. Iron deficiency