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TNCC Exam 8th Edition Study Questions And
Answers – Best Scored!!
1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve Correct ans - Hemoglobin does not readily release oxygen for use by the tissues A shift to the left occurs in an environment of low metabolic demand (hypothermia, hypocapnia, alkalosis), increasing hemoglobin's affinity for oxygen.
2.EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the driver's side of the car. The patient is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? Correct ans - After a physical examination if the patient has no radiologic abnormalities on CT A CT is recommended for spinal clearance in an impaired patient.
3.The nurse is caring for a 120 kg male brought in after a warehouse fire and iscalculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total body surface area burned, how much IV fluid would be administered in the first 8 hours? Correct ans - 2280 mL Both upper arms = 8%, both lower arms = 6%, and both hands = 5%, yielding 19 * 2 * 120 = 4560 mL. Half of the total is equal to 2280 mL. Superficial burns are not included in the TBSA calculation for fluid resuscitation.
4.Which of the following is an expected finding in a patient with a tube thoracostomy connected to a chest drainage system Correct ans - Fluctuation in the water seal chamber Fluctuation in the water seal chamber
indicates the tube is placed correctly in the pleural space.
5.A 35-year-old male presents with facial trauma after being struck in the facewith a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? Correct ans - Globe rupture A teardrop-shaped pupil suggests a globe rupture.
6.A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? Correct ans - Bradycardia and absent motor function below the level of injury Patients with a complete spinal cord injury will have absent motor function below the level of the lesion. They become hypotensive and bradycardic due to loss of autonomic nervous system function.
7.Which of the following patients warrants referral to a burn center? Correct ans - A 52 - year-old diabetic male with a partial-thickness burn to
the left lower leg This patient has a 7% TBSA burn with a preexisting medical history that could complicate management, prolong recovery, or affect mortality.
8.You are caring for a patient who was involved in a motor vehicle crash and is32 weeks pregnant. Findings of your secondary survey include abdominal pain on palpation, fundal height at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cardiotocography. These findings are most consistent with which of the following? Correct ans - Placental abruption The findings of abdominal pain, elevated fundal height, dark bloody show, and fetal distress are most consistent with placental abruption.
9.A 20-year-old male presents to the ED complaining of severe lower abdominal pain after landing hard on the bicycle cross bars while performing an aerial BMX maneuver. Secondary assessment reveals lower abdominal
A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? Correct ans
- Diagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for hemodynamically unstable patients or if FAST and CT are not available.
An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? Correct ans - Subdural hematoma Subdural hematomas are characterized by nausea, vomiting, headache, changes in level of consciousness, ipsilateral dilated, nonreactive pupil, and unilateral weakness or hemiparesis. These typically occur after a fall or assault.
Tearing of the bridging veins is most frequently associated with which brain injury? Correct ans - Subdural hematoma Subdural hematomas are usually caused by tearing of the bridging veins and associated with direct injury to the underlying brain tissue.
.During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next? Correct ans - Insert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the tongue. Oropharyngeal airways can be used in patients without a gag reflex.
What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? Correct ans - Pulse oximetry and capnography Pulse oximetry measures the percentage of
hemoglobin saturated with oxygen. Capnography measures the amount of carbon dioxide exhaled. Carbon dioxide is the end-product of ventilation and a reflection of metabolism and pulmonary function.
Which of the following is NOT considered a benefit of debriefings? Correct ans - Identifying individuals who made mistakes during the traumatic event Debriefings are not used to single out individuals who made mistakes. Debriefings are used to provide an opportunity to review performance and identify areas for improvement with a sharing of individual responses.
Which of the following is NOT considered goal-directed therapy for cardiogenic shock? Correct ans - Pericardiocentesis A pericardial tamponade is a form of obstructive, not cardiogenic, shock.
A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority intervention? Correct ans - Initiate transfer to a trauma center Early consideration for transfer to a trauma center is essential to ensure optimal outcomes.
The most reassuring finding for a male patient with hip pain after a fall is which of the following? Correct ans - Pelvic stability Uncontrolled hemorrhage is the major cause of preventable death after injury. Unstable pelvic fractures increase the volume of the pelvic cavity and can be life- threatening due to blood loss.
EMS brings a patient from a motor vehicle crash. Vital signs are BP 90/49 mm Hg, heart rate 48 beats/minute, respiratory rate 12 breaths/minute, temperature 97.2°F (36.2° C). The patient exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the
will feel tight or tense upon palpation. The skin may also appear taut and shiny.
A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? Correct ans - Dressing removal This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing
Which of the following is a component of the trauma triad of death? Correct ans - Acidosis The three components of the trauma triad of death are acidosis, hypothermia and coagulopathy.
When is the tertiary survey completed for a trauma patient? Correct ans
- Within 24 hours of the trauma The tertiary survey consists of a complete examination performed following the primary and secondary surveys and within 24 hours after trauma to identify any injuries missed during the initial assessment.
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? Correct ans - Apply a splint and elevate the extremity above the level of the heart Splinting the injured extremity stabilizes the extremity and reduces further injury. Elevation above the level of the heart promotes venous return and may reduce swelling.
A trauma patient is restless and repeatedly asking "Where am I?" Vital signs
upon arrival were BP 110/60 mm Hg, HR 96 beats/minute and RR 24 breaths/minute. Her skin is cool and dry. Current vital signs are BP 104/ mm Hg , H R 108 be a t s/ minu te , a nd RR 28 brea ths / mi nute. T he p ati ent is demonstrating signs and symptoms of which stage of shock? Correct ans - Compensated Patients in compensated shock exhibit subtle changes in level of consciousness and vital signs including a narrowed pulse pressure.
Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? Correct ans - To gauge end-organ perfusion and tissue hypoxia The serum lactate is an indicator of end-organ tissue perfusion and tissue hypoxia.
A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the
There has been a mass casualty incident a block from the hospital. The hospital is receiving dozens of patients. A truck arrives with an unresponsive patient in the back with obvious chest and abdominal trauma. Agonal respirations do not improve with airway positioning. Using the START triage algorithm, you would triage tag this patient as which of the following? Correct ans - Black This patient is unlikely to survive given the severity of their injuries and is triaged as expectant. Resources should be reserved for individuals considered to be more salvageable.
A patient has been in the emergency department for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the patient is restless with respiratory distress and petechiae to his neck. The
patient is exhibiting signs and symptoms most commonly associated with which of the following conditions? Correct ans - Fat embolism Symptoms of fat embolism include decreased mental status, restlessness, agitation, respiratory distress, and a petechial rash to the head, neck, anterior thorax, conjunctivae, buccal mucous membranes, and axillae.
The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better visualization during the insertion of which device? Correct ans - Endotracheal tube The ramped position is described as elevation of the head with the external auditory canal parallel with the sternal notch to provide better visualization of pharyngeal landmarks. This position is useful during intubation.
The nurse is assessing a patient with a fractured forearm that was splinted three hours ago. Which symptom is of most concern as a late sign of an evolving complication? Correct ans - Weak radial pulse A weak radial pulse is evidence of an actual compromise in circulation.
Which of the following is true about the log-roll? Correct ans - It can worsen cord damage from an unstable spinal injury The log-roll maneuver has been shown to cause spinal motion that can worsen damage from an unstable spinal injury.
What factor contributes most to the kinetic energy of a body in motion? Correct ans - Velocity Kinetic energy is equal to one half the mass multiplied by the square of the velocity. Doubling the velocity quadruples its contribution to kinetic energy. Doubling the mass only doubles its contribution to kinetic energy.
An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted
A 56-year-old male patient involved in a motor vehicle crash is brought to the emergency department of a rural critical access facility. He complains of neck pain, shortness of breath, and diffuse abdominal pain. His Glasgow Coma Score is 15. His vital signs are as follows: BP 98/71 mm Hg, HR 125 be at s/ m i nute , RR 26 b rea ths / mi nu te , Sp O 2 94 % o n hig h- fl o w oxyg e n vi a non- rebreather mask. Which of the following is the priority intervention for this patient? Correct ans - Expedite transfer to the closest trauma center The American College of Surgeons recommends that patients with significant injuries be transported to a trauma center for definitive care. This patient's injuries might not be definitively diagnosed, but his symptoms and vital signs indicate the need for
Which of the following is most likely to contribute to inadequate oxygenation and ventilation? Correct ans - Advanced age Older patients are more likely to have pulmonary comorbidities and decreased pulmonary reserve.
Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? Correct ans - Hypotension that worsens with inspiration Hypotension that worsens with inspiration is associated with tension pneumothorax due to compression of the heart and great vessels (obstructive shock). The increased intrathoracic pressure with inspiration worsens the hypotension.
