TNCC final exam test 2024 open book updated
TNCC final exam test 2024 open book
Why is a measure of serum lactate obtained in the initial assessment of the trauma
patient?
Answer: c – a) to measure oxygenation and ventilation
b) to quantify the base deficit for the adequacy of cellular perfusion
c) *to gauge end-organ perfusion and tissue hypoxia **
d) to determine the underlying cause of shock
A trauma patient is restless and repeatedly asking “where am I?” vital signs upon arrival
were BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and
dry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient
is demonstrating signs and symptoms of which stage of shock?
Answer: A – A) compensated **
B) Progressive
C) irreversible
D) decompensated
An elderly patient with a history of anticoagulant use presents after a fall at home that
day. she denies any loss of consciousness. She has a hematoma to her forehead and
complains of headache, dizziness, and nausea. Which is a most likely cause of her
symptoms?
Answer: D – A) epidural hematoma
B) diffuse axonal injury
C) post-concussive syndrome
D) subdural hematoma ***
EMS brings a patient who fell riding his bicycle. Using the American College of
Surgeons screening guidelines, which assessment finding would prompt the nurse to
prepare the patient for radiologic spine clearance?
Answer: D – A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests of water
D) Smell of alcohol on breath ***
Which of the following occurs during the third impact of a motor vehicle crash?
Answer: C – A) The driver of the vehicle collides with the steering wheel
B) the vehicle collides with a tree
C) the aorta is torn at its attachment with the ligamentum arteriosum
D) the airbag deploys and strikes the front seat passenger ***
A passenger is brought to the emergency department of a rural hospital following a
high-speed MVC. When significant abdominal and pelvic injuries are noted in the
primary survey, which of the following is the priority interventions?
Answer: A – A) initiate transfer to a trauma center **
B) provide report to the operating room nurse
C) Obtained imaging studies
D) Place a gastric tube
Which of the following injuries is LEAST likely to be promptly identified?
Answer: C – A) spleen
B) lung
C) bowel ***
D) brain
Patients with a crush injury should be monitored for which of the following conditions?
Answer: C – A) Hypernatremia
B) Hypercalcemia
C) Dysrhthmias **
D) polyuria
What finding raises suspicion of complete spinal cord injury?
Answer: B – A) Weakness in the lower extremities
B) Priapism ***
C) voluntary anal sphincter tone
D) intact reflexes distal to the injury
A patient with a complete spinal cord injury in neurogenic shock will demonstrate
hypotension and which other clinical signs?
Answer: D – A) Bradycardia and ipsilateral absences of motor function
B) Tachycardia and respiratory depression
C) Tachycardia and absent motor function below the level of injury
D) Bradycardia and absent motor function below the level of the injury ***
A 5-year old child presents to the ED 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?
Answer: A – A) report your suspicion of the maltreatment in accordance with local
regulations ***
B) apply ice to the bruises and consult wound care
C) engage in therapeutic communication to determine the MOI
D) provide the family with injury prevention resourse
A patient with 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?
Answer: C – A) elevating the extremity above the level of the heart
B) repositioning and apply ice
C) Elevating the extremity to the level of the heart ***
D) Preparing the patient for ultrasound
A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to
move her hand due to pain. Which of the following is the most appropriate intervention?
Answer: B – A) apply a sling and elevate the extremity to the level of the heart.
B) apply a splint and ELEVATE 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. Which of the following is a late sign of increased intracranial pressure? Answer: C Cushing Response Widening pulse pressure Reflex bradycardia Decreased RR – A) Restlessness or drowsiness B) Nausea and vomiting C) Decreased respiratory effort
D) amnesia and anxiety
Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage?
Answer: B – A) ABC
B) MARCH***
C) AVPU
D) VIPP
A patient is thrown against a car during a tornado and presents with obvious bilateral
femoral fractures. The patient is pale, alert, disoriented, and has delayed cap refill.
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What are the greatest risk for transport?
Loss of airway
patency, displaced obstructive tubes lines or catheters, dislodge splinting devices,
need to replace or reinforce dressings, deterioration in patient status change in vital
signs or level of consciousness, injury to the patient and/or team members
According to newton’s law which of these two force is greater: size or force?
neither, equal and opposite reaction
What is the relationship between mass and velocity to kinetic energy?
Kinetic energy is equal to 1/2 the mass multiplied the square of its velocity
therefore when mass is doubled so is the net energy, however, when velocity is
doubled energy is quadrupled.
What is tension?
stretching force by pulling at opposite ends
What is compression?
Crushing by squeezing together
What is bending?
Loading about an axis. Bending causes
compression on the side the person is bending toward intention to the opposite side
What is shearing?
Damage by tearing or bending by
exerting faucet different parts in opposite directions at the same time.
What is torsion?
Torsion forces twist ends in
opposite directions.
What is combined loading?
any combination of
tension compression torsion bending and/or shear.
What are the four types of trauma related injury?
Blunt, penetrating, thermal, or blast.
What are the contributing factors to injuries related to blunt trauma?
the point of impact on the patient’s body, the type of surface that is hit,
the tissues ability to resist (bone versus soft tissue, air-filled versus solid organs),
and the trajectory of for
What are the seven patterns of pathway injuries related to motor vehicle accidents?
Up and over, down and under, lateral,
rotational, rear, roll over, and ejection.
Differentiate between the three impacts of motor vehicle impact sequence.
The first impact occurs when the vehicle collided with another
object. The second impact occurs after the initial impact when the occupant
continues to move in the original direction of travel until they collide with the interior
of the vehicle or meet resistance. The third impact occurs when internal structures
collide within the body cavity.
What are the three factors that contribute to the damage caused by penetrating
trauma’s?
The point of impact, the velocity and speed of impact, and the proximity to the object
What causes the primary effects of blast trauma?
The direct
blast effects. Types of injuries include last long, tympanic membrane rupture and
middle ear damage, abdominal hemorrhage and perforation, global rupture, mild
Trumatic brain injury.
What causes the secondary effects of blast traumas?
Projectiles
propelled by the explosion. Injuries include penetrating or blunt injuries
What causes the tertiary effects of blast traumas?
Results
from individuals being thrown by the blast wind. Injuries include hole or partial body
translocation from being thrown against a hard service: blunt or penetrating
trauma’s, fractures, traumatic amputations.
What causes quarternary effects of blast traumas?
All
explosion related injuries, illnesses, or diseases not due to the first three
mechanisms. Injuries include external and internal burns, crush injuries, closed and
open brain injuries, asthmatic or breathing problems from dust smoke or toxic fumes,
angina, or hyper glycemia and hypertension.
What causes quinary effects of blasts traumas?
Those
associated with exposure to hazardous materials from radioactive, biologic, or chemical
components of a blast. Injuries include a variety of health effects depending on agent
What are the three processes that transfer oxygen from the air to the lungs and blood stream?
Ventilation: the active mechanical movement of air into and out of the lungs; diffusion: the passive movement of gases from an area of higher concentration to an area of lower concentration; and perfusion: the movement of blood to and from the lungs as a delivery medium of oxygen to the
entire body
When would you use a nasopharyngeal airway (NPA) versus an oral pharyngeal airway(OPA)?
Nasopharyngeal airways is contraindicated in patients with
facial trauma or a suspected basilar skull fracture. Oral pharyngeal airways is used
in unresponsive patients unable to maintain their airway, without a gag reflex as a
temporary measure to facilitate ventilation with a bag mask device or spontaneous
ventilation until the patient can be intubated.
Describe the measurement of an NPA?
Measure from the tip
of the patient’s nose to the tip of the patients earlobe.
Measurement of OPA
Place the proximal end or flange of
the airway adjunct at the corner of the mouth to the tip of the mandibular angle
True or False: NPAs and OPAs are definitive airways?
false, need to consider a definitive airway
3 ways to confirm ETT placement?
Placement of a CO2 monitoring device, Assessing for equal chest rise and fall, and listening at
the epigastrium and four lung fields for equal breath sounds.
When capnography measurement reads greater than 45MMHG, the nurse
should consider increasing or decreasing the ventilation rate?
Increasing the ventilation rate. Doing so would allow the patient to
blow off retained CO2
When capnography measurement reads less than 35MMHG, the nurse should
consider increasing or decreasing the ventilation rate?
Decreasing the ventilation rate. By doing so, the nurse allows the patient to retain
CO2
What are the three stages of shock
Compensated, decompensated or progressive, and irreversible.
What are the signs of compensated shock?
Anxiety, confusion, restlessness, increased respiratory rate, narrowing pulse pressure were diastolic increases yet systolic remains unchanged, tachycardia with bounding pulses, and decreased urinary output
What are the signs and symptoms of decompensated shock?
Decreased level of consciousness, hypertension, narrow pulse pressure,
tachycardia with weak pulses, tachypnea, skin that is cool clammy and cyanotic,
base access outside the normal range, and serum lactate levels greater than two to
4MMOL/L.
What are the signs and symptoms of irreversible shock?
Obtunded stuporous or comatose state, marked hypertension and heart failure,
bradycardia with possible dysrhythmias, decreased and shallow respiratory rate,
pale cool and clammy skin, kidney liver and other organ failure, severe acidosis,
elevated lactic acid levels, worsening base access on ABGs, coagulopathies with
petechiae purpura or bleeding
What are the four types of shock?
ypovolemic,
Cardiogenic, Obstructive, & Distributive
What is the trauma triad of death?
hypothermia,
acidosis, coagulopathy
Describe the characteristics of obstructive shock
Obstructive shock is it mechanical problem that results from hypoperfusion of the
tissue due to an obstruction in either the vasculature or the heart resulting in
decreased cardiac output. Some causes include a tension pneumothorax, cardiac
tamponade, or venous air embolism on the right side of the heart during systole in
the pulmonary artery.Signs include anxiety, muffled heart sounds, JVD,
hypertension, chest pain, difficulty breathing, or pulses paradoxes.
Describe the characteristics of cardiogenic shock
Cardiogenic shock results from pump failure in the presence of adequate
intravascular volume. Lack of cardiac output and an organ perfusion occurs
secondary to a decrease in myocardial contractility and or valvular insufficiency. This
can happen with blunt cardiac trauma or an MI. Symptoms can include low blood
pressure increase heart rate and respiratory rate chest pain shortness of breath
dysrhythmias increase troponin and pale cool moist skin
Describe the characteristics of distributive shock
Distributive shock occurs as a result of Mel distribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm pink and dry skin with a cool core temperature.
Describe the characteristics of hypovolemic shock
Hypovolemia is caused by a decrease in the amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities especially long bones.
What is the recommended fluid bolus for a trauma?
500 ML’s of warmed isotonic crystalloid. Ongoing fluid boluses of 500 ML’s should be given judiciously with constant reassessments after administration.
What is the minimum permissive hypertension and a trauma patient?
A systolic of greater than or equal to 90 MMHG
What is the minimum permissive oxygenation level of a trauma patient?
Greater than or equal to 94%
What is Cullen’s sign and its significance?
Cullens sign
is periumbilical bruising and is indicative of intraperitoneal bleeding
Define Cushing’s triad
Bradycardia, progressive
hypertension (widening pulse pressure), and decreased respiratory effort
What are the early signs of increased Intracranial pressure
headache, vomiting, behavioral changes that begin with restlessness and may
progress to confusion, drowsiness, or impaired judgment
Late signs of increased ICP
dilated, non-reactive pupil(s); abnormal motor posturing (flexion, extension,
flaccidity); Cushing’s triad, Unresponsive to per verbal and painful stimuli,
bradycardia and decreased respiratory effort
What are the symptoms of a subdural hematoma?
Decreased LOC, nausea vomiting headache and ipsilateral pupillary changes
What is a trademark symptom of an epidural hematoma
Loss
of consciousness then awake and alert then loss of consciousness
Define the characteristics of neurogenic shock
Distributive shock with a T6 or higher injury results and vasodilation, bradycardia, flushed warm dry skin. Risk for temperature instability. Nursing interventions include maintaining warmth and spinal stabilization.
Define the charateristics of spinal shock
transient loss
of function can include loss of reflexes and muscle tone below the level of
industry with possible vascular response.
Describe the four types of spinal cord injury
Central cord injury results in greater weakness distally, anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown-Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome although rare is when the patient is unable to use sense vibration in proprioception
Describe one fat embolism syndrome is most likely to occur in its characteristics –
With longform fractures. Tachycardia, Thrombocytopenia,
and petechiae rash.
What is the Munro-Kellie doctrine?
Within the skull 80% his brain, 10% is blood, and 10% is CSF. Any increase of any of the products results in increased intracranial pressure.
What are the treatment goals for a TBI?
O2 saturation > or equal to 95%, systolic blood pressure > or equal to 100 MMHG, ICP < 15 MMHG, CPP > or equal to 60 MMHG, normal glycemia, hemoglobin > or equal to 7 g/DL, sodium 135-145, osmotic diuretics, anti-emetics, sedatives, anticonvulsants, head of bed at 30°, and neck at midline
What is the key to high performing trauma team?
effective communication
When obtaining a history for an injured patient, understanding the kinematic concepts
associated with the mechanism of injury and energy transfer can initially assist the
trauma provider in:
evaluating and anticipating the types of injuries that may be present
rationale: mechanism of injury and energy transfer can assist the provider in evaluating
and anticipating damage
The major preventable cause of death in the traume patients is
uncontrolled hemorrage
the across-the-room observation step in the initial assessment provides the opportunity
to
eprioritize circulation before airway or breathing
rationale: the across-the-room observation is done at the beginning of the primary
survey to rapidly assess the need to reprioritize circulation before airway or
breathing. This is done if uncontrolled external hemorrhage is identified.
Which of the following accurately describes ventilation prinicples associated with a bag-
mask device?
ventilate at a rate of 10-12 breaths/min or every 5-6 sec
Which of the following is the best measure of the adequacy of cellular perfusion
and helps to predict the outcome of resuscitation?
base deficit
rationale: base deficit serves as an endpoint measurement of the adequacy of cellular
perfusion and when used in conjunction with serum lactate helps predict the success
of resuciation
What is the safe pharmacological alternative to opioids for rib fracture pain management
in the anticoagulated patient?
intercostal nerve block
rationale: continuous intercostal nerve blocks use long-acting anesthetics and
can provide safe and effective pain management for the anticoagulated patient.
In a patient with severe traumatic brain injury, hypocapnia causes:
cerebral vasoconstriction
rationale: hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction,
especially in the cerebra; vasculature
A patient with a knife injury to the neck has an intact airway and is hemodynamically
stable. He complains of difficulty swallowing and speaking. Further assessment is
indicated next for which of the following?
damage to spinal cord
rationale: penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular neck structures. With an intact airway and hemodynamic
stability, the other common concurrent injury is to the spinal cord
What is the appropriate technique for palpating the pelvis for stability?
apply gentle pressure over the iliac downward and medially
rationale: to assess for pelvic instability, gentle pressure is applied over the iliac crests
downward and medially
a patient with a spinal cord injury at C5 is being cared for in the emergency department
while awaiting transport to a trauma center. which of the following represents the
highest priority for ongoing assessment and management?
maintain adequate respiratory status
rationale: spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function,
resulting in a paralyzed diaphragm and inability to breathe
Based on proper bleeding control techniques, what is the first step to stop the bleeding
of a penetrating injury to the lower extremity?
initiate direct pressure
rationale: the first step in controlling any bleeding is direct pressure. if that is not
adequate, the application of a tourniquet may be needed
treatment for frostbite includes:
administer tissue plasminogen activator
rationale: with frostbite, thrombus formation is a risk. tissue plasminogen or
nonsteroidal anti-inflammatory medication can be administered. The tissue
plasminogen activator has been effective in maintaining perfusion and decreasing the
need for amputation when administered within 24 hours of rewarming
A 30-week pregnant trauma patient’s vital signs include a blood pressure of 94/62 mm
Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The
emergency nurse interprets the patient’s hemodynamic findings as an indication of
which of the following?
normal vital signs in pregnancy
rationale: in pregnancy, the resting heart rate increases by 10 to 20 bpm and a small
decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance. Normal fetal rate is between 120 and 160
bpm
While performing an assessment on a 13-month old involved in a motor vehicle
collision, the nurse identifies which of the following findings from the patient as a
potential sign of mental status change?
cooperation with the assessment
rationale: an alert older infant or toddler will recognize his or her caregiver, be cautious
of strangers, and may not respond to commands, which is a normal response
What is the best position for maintaining an open airway in the bariatric
patient?
reverse trendelenburg
rationale: the reverse trendelenburg position will benefit both airway maintenance
and work of breathing in the bariatric patient.
The nurse is obtaining for a patient who presents following sexual assault. The history is
completed using which of the following techniques?
use direct quotes to record
information
rationale: history includes a detailed description of the incident that is objective, using
direct quotes
A trauma nurse cared for a child with devasting burns 2 weeks ago. She called in
sick for a couple of days and is now back working on the team. Which of the following
behaviors would indicate this nurse is coping well?
she is talking about taking the emergency nursing certification examination
rationale: this is an indication she is taking positive steps to advance her own practice, a
sign of resilience
Following a bomb explosion, fragmentation injuries from the bomb or objects in
the enviroment are examples of which phase of injury?
seconday
rationale: the secondary phase of a blast results from flying debris, projectiles, and
bomb fragments causing lacerations or penetrating injuries
A patient fell two weeks ago, striking his head. He came to the emergency department
with a persistent headache and nausea. He was diagnosed with a small subdural
hematoma and has been in the ED for 24 hours awaiting an inpatient bed. The night
shift nurse reports he has been anxious, restless, and shaky. he vomited twice during
the night. He tells the day shift nurse he couldn’t sleep because a young child kept
coming into his room. What is a likely cause for these signs and symptoms?
alcohol
withdrawal
rationale: alcohol withdrawal is a common delayed condition because symptoms are
difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea
or vomiting, psychomotor agitation, anxiety, insomnia, hallucinations, or seizures.
Why is a measure of serum lactate obtained in the initial assessment of the trauma patient?
to measure oxygenation and ventilation
A trauma patient is restless and repeatadly asking “where am I?” vital signs upon arrival were BP 100/60, HR 96, and RR 24. Her skin is cool and dry. Current vital signs BP 104/84, HR 108, RR 28. The patient is demonstrating signs and symptoms of what stage of shock?
compensated
An elderly patient with a history of anticoagulation use presents after a fall at gome that day. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is mostly likely the cause of her symptoms?
epidural hematom
EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance?
alert with no neurological deficits
Which of the following occurs during the third impact of a MVC?
the vehicle collides with a tree