TNCC WRITTEN EXAM 2024

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TNCC WRITTEN EXAM 2024

Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing score -100 Questions and Answers

-Format: Multiple-choice / Flashcard

Question 1: How would you assess a pt in hypovolemic shock?

Answer:

(Use Initial Assessment) and then:

Inspect:

• LOC
• Rate and quality of respirations
• External bleeding?
• Skin color and moisture
• Assess jugular veins and peripheral veins

Auscultate:

• BP
• Pulse pressure
• Breath sounds
• Heart sounds
• Bowel sounds

Percuss:

• Chest and abdomen

Palpate:

• Central pulse (carotid or femoral)
• Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
• Palpate peripheral pulses
• Palpate skin temp and moisture

Diagnostic Procedures:

• Xrays and other studies
• Labs

Planning and Implementation

• Oxygen

• IV's with warmed replacement fluids
• Control external bleeding with direct pressure
• Elevate LE's
• NGT
• Foley
• Monitor and pulse oximeter
• Monitor for development of coagulopathies
• Surgery?

Question 2: ICP is a reflection of what three volumes? What happens when one increases?

Answer:

• Brain

2. CSF

• Blood within the nonexpansible cranial vault

As volume of one increases, the volume of another decreases to maintain ICP within normal range.As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful.Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP.

Question 3: What are the late signs of breathing compromise?

Answer:

• Tracheal deviation
• JVD

Question 4: Why does herniation occur? What are the symptoms?

Answer:

Because of uncontrolled increases in ICP.S/E's

• Unilateral or bilateral pupillary dilation
• AsyDimmetric pupillary reactivity
• Abnormal motor posturing
• Other evidence of neurologic deterioration

Question 5: What are signs of ineffective circulation?

Answer:

• Tachycardia
• AMS
• Uncontrolled external bleeding
• Pale, cool, moist skin
• Distended or abnormally flattened external jugular veins
• Distant heart sounds

Question 6: What is a flail chest?

Answer:

A fracture of two or more sites on two or more adjacent ribs, or when rib fractures produce a free-floating sternum.Flail segments may not be clinically evident in the first several hours after injury b/c of muscle spasms that cause splinting. After positive pressure intiated, paradoxical chest wall movement ceases.

Question 7: Explain Pulmonary Response.

Answer:

Tachypnea happens for 2 reasons:

• Maintain acid-base balance

• Maintain increased supply of oxygen
• Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of

ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli.

Question 8: S/S of Esophageal Injury?

Answer:

-Subcutaneous emphysema -Peritoneal irritation -Pain radiating to the neck, chest, shoulders, or throughout the abdomen -Gross blood in gastric aspirate Question 9: What are you looking for when palpating the chest wall, clavicles and neck?

Answer:

• Tenderness
• Swelling
• subcutaneous emphysema
• step-off deformities

= These may indicate: esophageal, pleural, tracheal or bronchial injuries.

Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax.

Question 10: What are the S/S of Hemothorax?

Answer:

• Dyspnea, tachypnea
• Chest pain
• Signs of shock
• Decreased breath sounds on injured side
• Dullness to percussion on the injured side

Question 11: Explain Distributive Shock.

Answer:

Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region.Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock.Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities.

Question 12: S/S of Gastric Injury?

Answer:

-Abdominal Pain -Peritoneal irritation -Evisceration of stomach -Gross blood in gastric aspirate

Question 13: What are S/S with blunt cardiac injury?

Answer:

"Cardiac contusion" or "concussion." Common with MVC or falls from heights.

• ECG (sinus tach, PVC's, AV blocks)
• Chest pain
• Chest wall ecchymosis