',', \"""\11",

",,\1 \
".~~ "~,,,,
_

SCHOOL OF NURSING
COLLEGE OF HEALTH SCIENCES
UNIVERSITY OF GHANA
FIRST SEMESTER EXAMINATIONS, 2010/2011
NURS 111: TRAUMA AND EMERGENCY NURSING (2 CREDiTS)
TIM~: ALLOWED: TWO (2) HOURS
INSTRUCTIONS: ANSWER ALL QUESTIONS. S~~CTION A ON TIlE QUESTION
PAPER AND SECTION B IN THE ANSWER BOOKLET PROVIDIW

Section A: For questions 1-47, circle the cOl"rect answer.

I. Which of the following head injuries generally get worse in the first few hours after injury')
a. Brainstem contusion
b. Cerebral concussion
c. Cerebral contusion
d. Cerebral edema and intracranial hemorrhage

2. The injury which causes the brain to be damaged on the side opposite of the impact is called
... _ - - - -
a. concussion
b. contrecoup
c. contusion
d. coup

3. The trauma nurse knows that an injury which classically presents with unconsciousness
immediately after the accident followed by a lucid interval and then a decreasing kvel or
consciousness is most likely a(n )_ __
a. cerebral hemorrhage
b. concussion
c. epidural hematoma
d. subdural hematoma

--------------- ------------ ... _---- _.. __ .

EXAMINER: MRS CECILIA ElIASON

\
. " ...
.. ~
,
'< N (J M BE iC __________ _ ~~-

From of fractures with their descriptions

51. \
a. Bone fragment into each other

~~
52. bent
53. Open Line of fracture twist along shaft of bone
54. Oblique , d. Results from pulling effect of tendons iligament

~-
55. Impacted

~-
56. Greenstick

~-
57. Transverse Fracture fragment overrides other bone fragment

~-
58. Displaced Fracture with more than two fragment
---Si9.t;~,-n-;;ct;~-Y--I\::'i.-s;;-;:;;:;t;;;:;;~~;ts";t;:;~~~~---------··
at ----. -
I==::-~~==-~~s;:.-~:==;~=-==~:::..::.·~~:=~--·-··--···-·------
_ _60. Pathologic Line of fracture at right angle to longitudinal axis

Section B
Answer all the questions in the answer booklet provided
Ii
I. Akosua seven years old, mistakenly drank kerosene from a Tampico bottle and has been
rushed to the outpatient department.
a. List [<OUR signs and symptoms of irritant poison?
\ \ G~• '\ (( I\\) .
(2marks) :: .~ -
No L. ( ,U
b. How would you classify Akosua's poisoning?
_j -.; \ '- (
(2marks) . '.' ~ -::-:,'I'
c. Describe the first aid management you would give to Akosua and family.
(6marks)

2. Mr Obo, a carpenter in your neighborhood suddenly collapsed whilst working. What

would be your responsibility as a first aider at the site?
(I5marks)

3. Mr Addo, a 56 year-old man suffered heart attack on admission.

Describe the Basic Life Support intervention you would give. (15marks)

Total =40marks

EXAMINER: MRS CECILIA ELIASON

 ....
.i
i,()F;{ NUM BER _ _ _ _ _ _ _ _ _ _ __

4. During your assessment you determine that the patient exhibits confused speech, follows
-- simple commands and opens his eyes on his own. What Glasgow Coma Scale value would
you assign?
a. IS
b. 14
c. 12
d. 10

S. The tissue that is normally damaged in sprain is the ______

a. articular cartilage
b. ligament
c. muscle
d. tendon

6. The overstretching of a muscle that presents with pain is the _______

a. cramp
b. spasm
c. sprain
d. strain

7. Which is the preferred method to determine if respirations are present in an unconscious

patient?
a. Watching for the rise and fall of the chest
b. Listening for the sound of air flow at the mouth and nose
c. Feeling for the movement of air against your cheek
d. All of the above

8. The presence of blood or other fluids in the trachea causes an unusual breathing sound
known as ________
a. crowlIlg
b. gurgling
c. snoring
d. wheezing
9. An emergency or first aider who is breathing for a patient must continue to do so until

a. cardiac arrest is detected

b. patient starts to vomit
c. pupils are fixed and dilated
d. the responsibility is transferred to another trained responder

- - - - - - - _..._ - - - - -
EXAMINER: MRS CECILIA ELIASON
, I
.,
;'1)\;\ NIJMflEH _ _ __ SICNATlJl,E
.,
'10, If breathing ceases, the patient is in _ _ _ _ __
a, cardiac arrest
b, dyspnea
c. respiratory arrest
d. tachypnea

II. During mouth·to·mouth ventilation the patient receives air with .. ___ .~
a. 6% oxygen
b, 10% Oxygen
c. 15% Oxygen
d, 21 % oxygen

12, The best place to check for a pulse in a patient with a possible cardiac arrest is at the ______'
a, ankle
b, elbow
c, neck
d. wrist

13. To open the airway of an infant, use the head -tilt, chin -lift maneuver and apply
a. a slight extension
b, a slight flexion
c. an exaggerated extension
d. an exaggerated flexion

14, A victim is considered an infant if he / she is between

a. birth and 3months
b. birth and I year
c. bilth and 18months
d, birth and 2years

IS, The proper rate of cardiac compression for a child is _ _ _ _ __

a. 40 to 50 per minute
b. 60 to 70 per minute
c, 80 to 100 per minute
d. 100 to 120 per minute
16. Which part of the hand is used to perfoml CPR on an infant? The
a. heel of one hand
b. palm and fingers of only one hand
c. tips of all four fingers
d. tips of two fingers

EXAMINER: MRS CECILIA ELIASON

.J
SI(;NATURE
:',1I x NIIMBER

-17. Chest compressions for an infant are most appropriately perfomled _ _ __

a. at the stemal notch
b. at the xiphoid
c. with two fingers above xiphoid
d. with two finger below the breast line

18. [n ventilating an infant, the rescuer should provide _ _ _ _ _ _ _. _ _ _ _ _ ...____ _

a. a gentle breath, enough to cause the infant's chest to rise
b. a large oversized breath
c. a small puff, being careful not to expand the lungs
d. a full breath to totally expand the victim's lungs

19. During adult CPR the heel of the hand is placed over the compression point. Where are the
fingers?
a. Off the chest
b. Curled into a fist
c. Curled between the ribs
d. Pressing downward

20. What method is most useful in determining if an unconscious patient is breathing?

a. Check for cyanosis at the tips and nail beds
b. Check the blood pressure
c. Check the pulse and pupi Is
d. Look, listen and feel for signs of air and chest movement

21. Which pulse should you palpate to detemline circulation on a child?

a. Apical
b. Radial
c. Carotid
d. Brachial
22. Place a cardiac arrest victim _ _ _ _ _ _ _ _ __
a. in the prone position
b. on a hard surface
c. directly on the ambulance
d. with the head elevated
23. During CPR, the chest of an adult should be compressed _ _ _ _ __
a. [.5 to 2inch
b. 1.5 to 2.5 inch
c. I to 2 inch
d. 2 to 2.5 inch

EXAMINER: MRS CECILIA ELIASON

. . ~ .
24. Which of the following IS NOT a sign of fracture?
a. Periosteum
b. Swelling
c. Ecchymosis
d. Loss of function
•
25. A sprain is _ _ _ _ _ __
a. easily differentiated from a fracture
b. treated as a fracture in the field
c. always less serious than a fracture
d. usually not splinted, and the patient is not pem1itted to walk

26. Strains are _ _ _ _ _ _ _ _ __

a. tom tendons
b. tom ligaments
c. stretched ligaments
d. muscle fiber damaged by stretching

27. Which of the following should be treated LAST?

a. Airway obstruction
b. External bleeding from the femur
c. Closed fracture of the wrist
d. Hypotension

28. A greenstick fracture is a fracture that _ _ _ _ _ __

a. protrudes through the skin
b. splits the bone lengthwise
c. is incomplete
d. is most commonly seen in the elderly

29. Which finding most likely indicates a spinal cord injury?

a. Defom1ity
b. Pain
c. Paralysis
d. Unconsciousness
30. A dislocation _ _ _ _ _ _ __
a. is easily differentiated from a fracture in the field
b. cannot be splinted
c. should be immediately splinted as found
d. should be manipulated gently to diagnosed and then splinted

EXAMINER: MRS CECILIA ELIASON

,
, ';;lI:X NUMBER Sl(;NAT!iRE

'31. A patient with a head injury has clear or light pink fluid coming from the nose. This likely
indicates _ _ _ _ _ _ _ _ __
a. A skull fracture
b. Perforation of a sinus
c. Intracranial bleeding
d. Intracranial pressure

32. Which of the following is not evaluated in the Glasgow Coma Scale?
a. Spontaneous eye opening
b. Ability to obey commands
c. Ability to withdraw from painful stimuli
d. Blood pressure

33. Which type of shock is caused by a severe infection?

a. Anaphylaxtic
b.Metabolic
c. Septic
d. Neurogenic

34. After ensuring respirations and circulation in a patient with possible internal bleeding you
should
a. Administer liquids by mouth
b. Apply a bulky dressing
c. Elevate the feet
d.Place the patient in sitting position

35. Shock may be indicated by all of the following signs and symptoms EXCEPT____ _
a. Bounding pulse
b.Cold clammy skin
c. Restlessness
d. Shallow breathing

36. Which of the following is a closed wound?

a. Avulsion
b.hematoma
c.lncision
d. Laceration

EXAMINER: MRS CECILIA ELIASON

, , • ',Uf,X N1JMI3ER _ _ __

'37, Which of the following is NOT a symptom of poisoning?

a. C0J11a
b, Depression of the urinary system
c, Irritation of the skin
d, Shortness of breath and coughing

38, Which poisonous substance should not be eliminated by vomiting?

a, Aspirin
b, Caustic soda
c, Poisonous berries
d, Iron pills ingested by a 3 year old

39, Pinpoint pupils may be caused by _ _ _ _ _ _ _ _ __

a, Atropine-like drugs
b, Fright
c, Narcotic drugs
d, Painki ller

40, Who is most susceptible to heat stroke?

a, Females
b, Persons over 50
c, Persons under 40
d, Thin people

41, Which body part is LEAST likely to be affected by frostbite?

a, Buttocks
b. Ears
c, Finger
d, Toes

42, Frostbite is most likely to occur _ _ _ _ _ _ _ _ _ __

a, When the humidity is low
b, On a sunny 20° F day
c, When the wind is blowing at 30mph and the temperature is 20 F
d, When humidity is high
43, In a near-drowning victim, you should first _ _ _ _ _ _ _ __
a, Remove the patient from the water
b, Start pulmonary resuscitation
c, Start cardiac compressiom
d, Clear airway

EXAMINER: MRS CECILIA ELIASON

.-
"', <\-.X NIIMIlEP.---_._----

'44. Diabetic coma is caused by _________ . _ __

a. Cerebral swelling
b. Dehydration and increased acid in the blood
c. Kussmaul's respirations
d. Protein deficiency

45. A diabetic person has the following signs: rapid full pulse, cold clammy skin,
and convulsions. These signs may indicate _________
a. Diabetic coma
b. Diabetic shock
c. Insulin coma
d. Insulin shock

46. A patient who experiences tonic and clonic seizures probably has ____ ._ .. __ _
a. A brain tumor
b. Asthma
c. Epilepsy
d. Pancreatitis

47. Which seizure disorder begins at one location and may progress to a generalized seizure?
a. r ocal motor
b. Grand mal
c. hysterical
d. Petit mal

State whether the following statements (questions 48 to 50) are True or False

48. Both head and spine injuries may present without recognizable signs or symptoms.

49. lt is common [or the trauma nurse to observe either Battle's sign or bilateral periorbital
ecchymosis in the patient who has just sustained a basilar skull fracture.

50. The primary assessment is completed in the first few minutes while at the patient's side. Ir
done correctly, it never needs to be repeated or updated. ______

EXAMINER: MRS CECILIA ELIASON

_ ._--- _._---------