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Nrsg 466:Trauma And Emergency Nursing Question Paper

Nrsg 466:Trauma And Emergency Nursing

Course:Nursing

Institution: Kenya Methodist University question papers

Exam Year:2013

KENYA METHODIST UNIVERSITY

END OF 1''ST ''TRIMESTER 2013 (EVENING) EXAMINATION
SCHOOL : MEDICINE & HEALTH SCIENCES
DEPARTMENT : NURSING
UNIT CODE : NRSG 466
UNIT TITLE : TRAUMA AND EMERGENCY NURSING
TIME : 3HOURS

INSTRUCTIONS: Answer ALL Questions

SECTION A (Multiple Choice Questions, choose the most appropriate

Response 20marks)

Question 1

In the management of life threatening injuries in emergency department. The first priority in the primary assessment is:

Drugs
Circulation
Breathing
Airway.

Question 2

Regarding the management of major trauma

Deaths follow a trimodial distribution
Cardiac tamponade is characterized by raised BP , low jugular various pressure (JVP) and muffled heart sounds
Assessment of uncomplicated limb fractures should occur during the primary survey.
Deterioration of the casualty during the primary survey should.

Question 3

What type of breath sounds will one hear on auscultation when a pneumothorax is present?

Low breath sounds
Diminished or absent breath sounds
Paradoxical breath sounds
Adventitious breath sounds.

Question 4

A diabetic patient has been admitted to the emergency ward with a serum glucose level of 824mg/dl (45.7mmols/l) and is unresponsive. The following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of:

Polyuria
Severe dehydration
Rapid deep respirations
Decreased serum potassium

Question 5

An emergency room nurse is caring for a child brought to the emergency room after the ingestion of approximately half a bottle of acetylsalicylic acid (aspirin). The nurse anticipates that the most likely initial treatment will be:

The administration of syrup of ipecac
The administration of sodium bicarbonate
The administration of vitamin K
Dialysis

Question 6

Incase of a flail chest, what rib fractures has the worst prognosis?

1st and 4th ribs
1st and 2nd ribs
3rd and 4th rib
All the above.

Question 7

Mr. Zeni in emergency room is being prepared to go for an emergency surgery. Before transportation to theatre, the nurse confirms that an informed consent is ready. The principle of nursing ethics promoted is:

Veracity
Non malfeasance
Confidentiality
Respect for autonomy.

Question 8

Which of the following actions should the nurse take to help prevent increased intra-cranial pressure in a patient following traumatic head injury?

Do not give anything by mouth
Keep the head of the bed elevated at 30 degrees
Suction frequently to keep the airway clear
Monitor patient for projectile vomiting.

Question 9

The following is true of a patient with severe hemorrhage.

Decreasing heart rate
Falling blood pressure
Increasing urine output
Capillary refill less.

Question 10

When performing CPR (Cardio-Pulmonary Rescuitate) the recommended ration for chest compressions to ventilation for two rescuers is:

15:2
30:2
15:5
5:2

Question 11

Direct pressure to a deep laceration on the clients lower leg has failed to stop the bleeding. As a nurse, one should:

Place a tourniquet proximal to the laceration
Elevate the leg above the level of the heart
Lower the laceration and apply and ice compress
Apply pressure to the femoral artery.

Question 12

Which of the following is not true about a severely injured pregnant patient secondary to road traffic accident? (RTA).

Giving 02 should only be done if the mother is hypotensive
Fetal distress may be the first sign of shock in the mother
Aggressive resuscitation of the mother provides the best change of salvaging the fetus.
The patient should be log-rolled and bolstered as degrees on her left side to alleviate pressure of the uterus on the vena cava.

Question 13

Which of the following is not a method of assess organ perfusion?

Urinary output
Skin color and temperature
Respiratory rate
Pulse rate and character

Question 14

To prevent increased intracranial pressure (ICP) in a patient with a head injury, what position should the head of the bed be in?

Flex the neck and elevate the head of bed to 30 degrees
Elevate the foot of the bed to 30 degrees
Extend the neck and elevate head of the bed to 45 degrees
Avoid neck flexion with the head of the bed elevated 30 degrees.

Question 15

In defibrillation, the pads are placed

Below the right clavicle at the sterna border
Below the left clavicle at the sternal edge
Over the cardiac apex, in the mid axillary line
A and C only.

Question 16

Myocardial infarction

Refers to permanent destruction of myocardial cells due to prolong imbalance between oxygen demand and supply.
Is characterized by sudden severe chest pain that is relieved by rest and medication
Laboratory tests reveal a depression of the creatininie kinase isoenzyme (CK-MB) within a few hours.
Both A and B.

Question 17

In the diagnosis of myocardial infarction which of the following creatinine kinase isoenzyme is heart specific?

Troponin
CK –MB
CK – BB
CK – MM

Question 18

With regards to Acid-Base balance, in response to low PH (acidosis), the kidneys

Secrete hydrogen ion (H+)
Conserve hydrogen ion (H+)
Secrete HCO-3 (Bicarbonate)
Secrete K+ (Potassium ion)

Question 19

In acid base balance, carbon dioxide is the largest contributer to:

Hydrogen ion (H+)
Bicarbonate (HCO-3)
Carboxyl group (COOH)
Carbon monoxide (CO)

Question 20

The most effective intervention in decreasing absorption an ingested poison is:

Hemodialysis
Milk dilution
Gastric larage
Activated charcoal.

SECTION B (Short Answer Questions 40marks)

Question 1
Describe THREE types of stressors that affect the patient`s basic coping mechanism in emergency nursing. (6marks)

Question 2
State the TWO common causes of trauma. (5marks)

Question 3
Describe THREE factors that contribute to tissue hypoxia in the trauma patient. (6marks)

Question 4

Differentiate between blunt thoracic trauma and penetrating thoracic injury.
(4marks)

Question 5

Mr Obot is brought to the emergency unit with carpo-pedal spasms. The attending doctor orders for serum calcium levels. The serum calcium is 1.8 mmol/L and a diagnosis of hypocalcemia made.
a) Describe hoe trousseaus sign is elicited by the emergency nurse. (2marks)
b) Describe how chrostek`s sign is elicited on assessment. (2marks)

Question 6
Describe the immediate management of a patient brought to the emergency room with history of food poisoning. (8marks)

Question 7

Describe the nursing care given to a burnt patient before arrival in the hospital.
(7marks)

SECTION C (Long Answer Questions 40marks)

Question 1

Mr. Zumba has been brought to Accident and Emergency with severe

hemartiage secondary assault. He has multiple cut wounds on his body.
a) Define hemorrhagic shock. (1mark)
b) Describe the systemic responses to acute blood loss. (5marks)
c) State 5 assessment findings expected that Mr. Zumba would have.
(5marks)
d) Discuss the specific management of Mr. Zumba while in emergency
department. (8marks)
e) List TWO other causes of haemorrhagic shock other than trauma.
(1mark)

Question 2

Burns that result to mass casualties are common in the emergency departments in Kenya today.
a) When is admission to hospital recommended? (4marks)
b) State THREE causes of burns. (3marks)
c) Master Kelly has been brought by his mum with 20% burns, he weighs

30 kgs.

Calculate the amount of fluids to be administered in the first 8hours.

(2marks)

Using the nursing process, discuss the collaborative care aid nursing management of, Master Kelly while in emergency room.

(12marks)

Nrsg 466:Trauma And Emergency Nursing Question Paper

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