Pangasinan State University

Institute of Nursing

Bayambang Campus

Thoracic Emergency Trauma Questionnaires

1. A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and
hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment,
you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You
also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray shows
a pneumothorax. What type of pneumothorax is this known as?

A. Closed pneumothorax

B. Open pneumothorax

C. Tension pneumothorax 

D. Spontaneous pneumothorax
The answer is B. This description is of an open pneumothorax. An open pneumothorax happens
when there is an opening in the chest wall ( from a gun shot, stabbing etc.) that creates a passage
between the outside air and intrapleural space. This allows air to pass back and forth during
inspiration and expiration. The body will shunt air through the opening in the chest well instead
of the trachea (if the opening on the chest is large enough) which will create a "sucking" sound.

2. In regard to the patient in the question above, which of the following options below is a
nursing intervention you would provide to this patient?

A. Place the patient in supine position 

B. Place a non-occlusive dressing over the chest wound

C. Place a sterile occlusive dressing over the chest wound and tape it on three
sides

D. Prepare the patient for a thoracentesis

The answer is C. The nursing intervention would be to place a sterile occlusive dressing over the
wound and tape it on 3 sides (leaving one side NOT taped). This will allow exhaled air to leave
the opening but seal over the opening when inhaling (hence not letting pressure build in the
intrapleural space and prevent a tension pneumothorax).

3. Which statement is CORRECT about a tension pneumothorax?

A. This condition happens when an opening to the intrapleural space creates a two-way
valve which causes pressure to build up in the space leading to shifting of the
mediastinum.

B. A tension pneumothorax is a medical emergency and is treated with needle

decompression.

C. Tracheal deviation is an early sign of a tension pneumothorax 

D. An open pneumothorax is the only cause of a tension pneumothorax.

The answer is B. The only correct statement about a tension pneumothorax is option B. Option A
is wrong because this condition happens when an opening to the intrapleural space creates a
ONE-way (not two-way) valve which causes pressure to build up in the space leading to shifting
of the mediastinum. Option C is wrong because tracheal deviation is a LATE (not early) sign of a
tension pneumothorax. Option D is wrong because not only can an open pneumothorax cause a
tension pneumothorax but a closed or spontaneous pneumothorax can as well.

4. Which action should the nurse implement for the client with a hemothorax who has a right-
sided chest tube and there is excessive bubbling in the water-seal compartment?

A. Check the amount of wall suction being applied.

B. Assess the tubing for any blood clots.

C. Milk the tubing proximal to distal.

D. Encourage the client to cough forcefully.

The answer is A. Checking to see if someone has increased the suction rate is the simplest action
for the nurse to implement; if it is not on high, then the nurse must check to see if the problem is
with the client or the system.

5. When assessing a patient who has just arrived after an automobile accident, the emergency
department nurse notes tachycardia and absent breath sounds over the right lung. For which
intervention will the nurse prepare the patient?
 A. Emergency pericardiocentesis
B. Stabilization of the chest wall with tape
C. Administration of an inhaled bronchodilator
D. Insertion of a chest tube with a chest drainage system
The answer is D. The patient's history and absent breath sounds suggest a right-sided
pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. The
other therapies would be appropriate for an acute asthma attack, flail chest, or cardiac
tamponade, but the patient's clinical manifestations are not consistent with these problems.

6. Which intervention is appropriate for a patient with blunt chest trauma?

A. Assist with test tube insertion

B. Initiate rapid infusion of an isotonic crystalloid solution
C. Place patient in a semi-Fowler’s position
D. Prepare the patient for surgery

Answer: C.

Because patient with blunt chest trauma may have a pulmonary contusion, plan to place the
patient in the semi-Fowler’s position to promote lung re-expansion, suction the airway, perform
chest physiotherapy, possibly use continuous positive airway pressure (CPAP), and expect
intubation and mechanical ventilation. To prevent pulmonary overload (fluid in pleura), restrict
fluids when no evidence of hypovolemia exists. No information suggests that this patient has a
pneumothorax or hemothorax, which would require chest tube insertion or surgery

7. Hemoptysis is a finding in which injury?

A. Diaphragmatic injury
B. Pulmonary Contusion
C. Tension Pneumothorax
D. Esophageal Injury

Answer: B

Hemoptysis is a finding in pulmonary contusion, bronchial injuries, open pneumothorax, and

aortic disruptions. It is not associated with diaphragmatic injury, tension pneumothorax, or
esophageal injury.

8.Fracture of the first rib is associated with injury to which structure?

 A. Liver
B. Spleen
C. Heart
D. Trachea

Answer: D

Fractures of the first and second ribs are rare because the clavicles protect these ribs. Because
significant blunt force is needed to fracture these ribs, expect associated injuries to underlying
structures, such as the great vessels, brachial plexus clavicles, scapulae, trachea, and lungs. Left
lower rib fractures are associated with spleen and left kidney injuries. Right lower rib fractures
are associated with liver and right kidney injuries. Sternal fractures can cause heart or great
vessel injuries.

9. The focused assessment with sonography for trauma (FAST) examination if highly reliable for
detecting which injury?

A. Blunt cardiac injury

B. Hollow viscus injury
C. Retroperitoneal injury
D. Hemothorax

Answer: D

The focused assessment with sonography for trauma examination is highly reliable for detecting
pericardial effusion and hemothorax. It is a poor diagnostic tool for identifying hollow viscus or
retroperitoneal injury. It cannot identify the source of bleeding or the injuries that may cause
hemoperitoneum and is limited in detecting less than 250mL of peritoneal fluid. It cannot
identify blunt cardiac injury but can be used to detect cardiac tamponade.

10.Hypotension is a likely finding in which injury?

A. Laryngeal injury
B. Diaphragmatic injury
C. Tension pneumothorax
D. Pulmonary Contusion

Answer: C
In tension pneumothorax, the lung injury lets air enter the pleural space with inspiration but does
not let it escape. This air accumulation forces the thoracic contents away from the injured side
and causes a mediastinal shift towards the uninjured side, which results in hypotension. This
finding does not occur in diaphragmatic injury, laryngeal injury, or pulmonary contusion.
11. During the assessment of a patient's respiratory status, the nurse notes paradoxical lung
movements. This finding is consistent with what health problem?

A. Flail chest
B. Pleurisy
C. Pneumothorax
D. Pneumonia

Answer: A

Physiologic function of the chest wall is impaired as the flail segment is sucked inward during
inhalation and moves outward with exhalation. This is known as paradoxical movement. This
movement is not associated with pleurisy, pneumothorax, or pneumonia.

12. Prevention Strategies are?

A. Gun Safety Education
B. Sports Training & Protective Equipment
C. Seat Belt & Air Bag Use
D. All the Above

Answer: D
All the above is the answer because all of it are the prevention strategies.

13. Many deaths due to thoracic trauma are preventable? (TRUE OR FALSE)
Answer: True
The remainder can be treated successfully in the emergency department through the application
of fundamental principles of initial trauma management as well as through direct interventions
within the scope of practice of emergency physicians. These management principles are
especially important as thoracic trauma impacts directly on the heart and lungs, the two organs
most integral to the provision of oxygenation and perfusion.
14. Thoracic Trauma is the second leading cause of trauma deaths after head injury? (TRUE OR
FALSE)
Answer: True
Thoracic trauma is emerging as one of the major findings in the trauma settings and comprises
10%-15% of all trauma cases. It can be divided into different types depending upon the location
of the injury. The major locations include injury to the chest wall, lungs, esophagus, heart, and
major vessels. The initial management of these injuries is essential as these patients can develop
multiple complications, ultimately leading to death of the patients.
15. Thoracic Trauma causes about 10-20% of all trauma deaths? (TRUE OR FALSE)
Answer: True
This is evident by the fact that about 25% of the trauma-related deaths are due to thoracic trauma
16. Thoracic Trauma can alter a patient's mental status? (TRUE OR FALSE)
Answer: True
Chest trauma can lead to several serious and potentially life-threatening injuries. As a generality,
chest trauma patients present with chest pain and shortness of breath but can also present in
shock (altered mental status) or in traumatic arrest. Presenting vital signs tend to range from
slightly abnormal to floridly unstable. Thoracic injuries are identified by primary survey signs:
tachypnea, respiratory distress, hypoxia, tracheal deviation, breath sounds, percussion
abnormalities, and chest wall deformities.

17. What are the causes of penetrating chest trauma? (Select all that apply)
A. Knife
B. Gunshot
C. Falls
D. Impaled objects

Answer: A, B , D
Fall is one of the causes of blunt trauma. Knife, Gunshot an Impaled objects are the causes of
penetrating chest trauma

18. What are the diagnostic tests done with a blunt chest trauma?

A. Chest xray
B. Ct scan
C. EKG
D. All of the above
 Answer : D
The answer is D because all o the above is the diagnostic testing for blunt chest trauma

19. The mechanisms of injuries causing chest trauma are separated into two categories?
A. Blunt and Penetrating
B. Hemothorax and Pneumothorax
C. Cardiac Tamponade and Flail Chest
D. None of the above

Answer: A
The answer is A because the mechanisms of injuries causing chest trauma are separated into
Blunt and Penetrating.

20. A condition in which two or more ribs are fractured in two or more places or in association
with a fracture of the sternum so that a segment of the chest wall is effectively detached from the
rest of the thoracic cage?
A. Flail Chest
B. Sternal and rib fractures
C. Pulmonary contusion
D. None of the above

Answer: A
The answer is a because Flail Chest is a condition in which two or more ribs are fractured in two
or more places or in association with a fracture of the sternum so that a segment of the chest wall
is effectively detached from the rest of the thoracic cage.