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TNCC Exam 9th Edition Study Guide 2025 Q&A This study guide includes a comprehensive collection of questions and answers based on the TNCC 9th Edition, tailored for the 2025 exam. Covering essential trauma nursing concepts, assessment strategies, and clinical scenarios, this guide is ideal for students preparing for the TNCC exam. It supports both self-study and group review sessions aligned with the latest course objectives.
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1.Whateisetheeeffecteofehypothermiaeonetheeoxyhemoglobinedissociationecurvee- eCORRECTeANSWER- HemoglobinedoesenotereadilyereleaseeoxygeneforeuseebyetheetissueseAeshiftetoetheelefteoccurseineane environmenteofelowemetabolicedemande(hypothermia,ehypocapnia,ealkalosis),eincreasingehemogl obin'seaffinityeforeoxygen. EMSearrivesewithetheeintoxicatededrivereofeaecareinvolvedeineaemotorevehicleecrash.eEMSereportsesig nificantedamageetoetheedriver'sesideeofetheecar.eTheepatienteiseaskingetoehaveetheecervicalecollarere moved.eWheneiteiseappropriateetoeremoveetheecervicalecollar?e-eCORRECTeANSWER- AftereaephysicaleexaminationeifetheepatientehasenoeradiologiceabnormalitieseoneCTeAeCTeiserecomm endedeforespinaleclearanceeineaneimpairedepatient. Theenurseeisecaringeforeae 120 ekgemaleebroughteineaftereaewarehouseefireeandeisecalculatingetheepati ent'sefluideresuscitationeneeds.eHeehasepainfuleredeblisteringetoetheeentireesurfaceeofebotheupperee xtremitieseandesuperficialeburnsetoetheeanteriorechest. UsingetheemodifiedeLundeandeBrowderechartetoecalculateetheetotalebodyesurfaceeareaeburned,eh owemucheIVefluidewouldebeeadministeredeinetheefirste 8 ehours?e-eCORRECTeANSWER- 2280 emLeBotheupperearmse=e8%,ebothelowerearmse=e6%,eandebothehandse=e5%,eyieldinge 19 ee 2 ee 120 e=e 4560 emL.eHalfeofetheetotaleiseequaletoe 2280 emL.eSuperficialeburnseareenoteincludedeinetheeT BSAecalculationeforefluideresuscitation. Whicheofetheefollowingeiseaneexpectedefindingeineaepatientewitheaetubeethoracostomyeconnectedetoe aechestedrainageesysteme-eCORRECTeANSWER- FluctuationeinetheewateresealechambereFluctuationeinetheewateresealechambereindicatesetheetubeei seplacedecorrectlyeinetheepleuralespace. .Ae 35 - year- oldemaleepresentsewithefacialetraumaeafterebeingestruckeinetheefaceewitheaebaseball.eAeteardrop- shapedeleftepupileisenotedeoneexam.eWhatetypeeofeinjuryeisesuspected?e-eCORRECTeANSWER- GlobeeruptureeAeteardrop-shapedepupilesuggestseaeglobeerupture.
.Aepatientewitheaecompleteespinalecordeinjuryeineneurogeniceshockewilledemonstrateehypotensionea ndewhicheothereclinicalesigns?e-eCORRECTeANSWER- BradycardiaeandeabsentemotorefunctionebelowetheeleveleofeinjuryePatientsewitheaecompleteespinale cordeinjuryewillehaveeabsentemotorefunctionebelowetheeleveleofetheelesion.eTheyebecomeehypotensi veeandebradycardicedueetoelosseofeautonomicenervousesystemefunction. Whicheofetheefollowingepatientsewarrantsereferraletoeaeburnecenter?e-eCORRECTeANSWER-Ae 52 - year-oldediabeticemaleewitheaepartial- thicknesseburnetoetheeleftelowerelegeThisepatientehaseae7%eTBSAeburnewitheaepreexistingemedicalehi storyethatecouldecomplicateemanagement,eprolongerecovery,eoreaffectemortality.
Youeareetreatingeae 27 - year- oldemaleeinerespiratoryedistressewhoewaseinvolvedeineaehouseefire.eCalculatingetotalebodyesurfaceear eae(TBSA)eburnedeisedeferrededueetoetheeneedeforeemergenteintubation.eAtewhaterateeshouldeyouebe ginefluideresuscitation?e-eCORRECTeANSWER- 500 emL/hourePrioretoecalculatingeTBSA,ethiseisetheerecommendedestartingepointeforefluideresuscitati oneforepatientse 14 eyearseofeageeandeolder Ae 49 - year- olderestrainededrivereinvolvedeineaemotorevehicleecollisionepresentsetoetheetraumaecenterecomplaini ngeofeabdominal,epelvic,eandebilateralelowereextremityepain.eVitalesignseareestable.eTheenurseecanean ticipateealleofetheseeaftereaenegativeeFASTeexameEXCEPTewhicheofetheefollowing?e- eCORRECTeANSWER- DiagnosticeperitonealelavageeDiagnosticeperitonealelavageeiseindicatedeforehemodynamicallyeunsta bleepatientseoreifeFASTeandeCTeareenoteavailable.
Aneelderlyepatientewitheaehistoryeofeanticoagulanteuseepresentseaftereaefalleatehomeetoday.eSheedeniesea nyelosseofeconsciousness.eSheehaseaehematomaetoehereforeheadeandecomplainseofeheadache,edizzines s,eandenausea.eWhateisetheemostelikelyecauseeofeheresymptoms?e-eCORRECTeANSWER- SubduralehematomaeSubduralehematomaseareecharacterizedebyenausea,evomiting,eheadache,echange seineleveleofeconsciousness,eipsilateraledilated,enonreactiveepupil,eandeunilateraleweaknesseorehemipar esis.eTheseetypicallyeoccureaftereaefalleoreassault. Tearingeofetheebridgingeveinseisemostefrequentlyeassociatedewithewhichebraineinjury?e- eCORRECTeANSWER- SubduralehematomaeSubduralehematomaseareeusuallyecausedebyetearingeofetheebridgingeveinseande associatedewithedirecteinjuryetoetheeunderlyingebrainetissue. .Duringetheeprimaryesurveyeofeaneunconsciousepatientewithemulti- systemetrauma,etheenurseenotesesnoringerespirations.eWhatepriorityenursingeinterventioneshouldebee performedenext?e-eCORRECTeANSWER- InserteaneoropharyngealeairwayeifethereeisenoegagereflexeSnoringerespirationsemayeindicateeairwayeob structionefrometheetongue.eInserteaneairwayeadjunctetoealleviateeobstructionebyetheetongue.eOrophar yngealeairwaysecanebeeusedeinepatientsewithouteaegagereflex. Whatebedsideemonitoringeparameterseareeusedetoeassesseforeadequacyeofeoxygenationeandeeffectiv enesseofeventilation?e-eCORRECTeANSWER- PulseeoximetryeandecapnographyePulseeoximetryemeasuresetheepercentageeofehemoglobinesaturate dewitheoxygen.eCapnographyemeasuresetheeamounteofecarbonedioxideeexhaled.eCarbonedioxideeiseth eeend-producteofeventilationeandeaereflectioneofemetabolismeandepulmonaryefunction. WhicheofetheefollowingeiseNOTeconsideredeaebenefiteofedebriefings?e-eCORRECTeANSWER- IdentifyingeindividualsewhoemadeemistakeseduringetheetraumaticeeventeDebriefingseareenoteusedet oesingleeouteindividualsewhoemadeemistakes.eDebriefingseareeusedetoeprovideeaneopportunityetoere vieweperformanceeandeidentifyeareaseforeimprovementewitheaesharingeofeindividualeresponses. WhicheofetheefollowingeiseNOTeconsideredegoal-directedetherapyeforecardiogeniceshock?e- eCORRECTeANSWER- PericardiocentesiseAepericardialetamponadeeiseaeformeofeobstructive,enotecardiogenic,eshock.
EMSebringseaepatientefromeaemotorevehicleecrash.eVitalesignseareeBPe90/49emmeHg,ehearteratee 48 ebea ts/minute,erespiratoryeratee 12 ebreaths/minute,etemperaturee97.2°Fe(36.2°eC).eTheepatienteexhibitse urinaryeincontinenceeandepriapism.eTheseeassessmentefindingseareemosteconsistentewithewhicheofet heefollowingetypeseofespinalecordeinjury?e-eCORRECTeANSWER- CompleteeIncontinence,epriapism,eandehypotensionewithebradycardiaeareemanifestationseofeaecom pleteespinalecordeinjury. Whatephysiologicechangeeinetheeelderlyepopulationeincreasesetheeriskeofetraumaticeinjury?
eCORRECTeANSWER- DressingeremovaleThiseisetheefastesteeffectiveeinterventioneforethisedecompensatingepatient.eAenon porousedressingetapedeonethreeesideseisetemporaryeandehasevariableeeffectiveness.eIfesignseandesy mptomseofetensionepneumothoraxedevelopeafteretheeapplicationeofetheedressing Whicheofetheefollowingeiseaecomponenteofetheetraumaetriadeofedeath?e-eCORRECTeANSWER- AcidosiseTheethreeecomponentseofetheetraumaetriadeofedeatheareeacidosis,ehypothermiaeandeco agulopathy. Wheneisetheetertiaryesurveyecompletedeforeaetraumaepatient?e-eCORRECTeANSWER- eWithine 24 ehourseofetheetraumaeTheetertiaryesurveyeconsistseofeaecompleteeexamination
EMSebringseaepatientewhoefellewhileeridingehisebicycle.eUsingetheeAmericaneCollegeeofeSurgeonsesc reeningeguidelines,ewhicheassessmentefindingewouldepromptetheenurseetoeprepareetheepatienteforer adiologicespineeclearance?e-eCORRECTeANSWER- SmelleofealcoholeonebreatheSuspectedeintoxicationewarrantseradiologicespineeclearance. Ae 5 - year- oldechildepresentsetoetheeEDewithebruisesetoetheeupperearmseandebuttockseinevariousestageseofehea lingeandemultipleesmall,eclean,eroundeburnsetoetheeback.eThereeareenoeabnormalitiesefoundebasede onetheepediatriceassessmentetriangleeoreprimaryesurvey.eWhicheofetheefollowingeisetheepriorityenurs ingeintervention?e-eCORRECTeANSWER- eReporteyouresuspicioneofemaltreatmenteineaccordanceewithelocaleregulationseNurseseareemandat edereporterseinemostejurisdictions.eWithenoealterationseinetheeprimaryesurvey,ethiseisetheepriorityeint ervention. Aetoddlerewhoefelleoffeaetrampolineeisemakingeeyeecontactewithetheefamilyeandeiseconsolable.eThere eisenoeincreasedeworkeofebreathingeandetheeskinecoloreisepink.eThe
nurseeasksetheepatientetoeopenehisemouth,ebutetheepatientedoesenoterespondetoecommands.eTheen urseerecognizesethiseaseaneexpectedefindingedueetoewhicheofetheefollowingeconditions?e- eCORRECTeANSWER- DevelopmentalestageeAnealerteoreoldereinfanteoretoddlerewillerecognizeehiseoreherecaregiverebutebeec autiouseofestrangerseandemyenoterespondetoecommandseThiseisenormal. Thereehasebeeneaemassecasualtyeincidenteaeblockefrometheehospital.eTheehospitaleisereceivingedozen seofepatients.eAetruckearrivesewitheaneunresponsiveepatienteinetheebackewitheobviousechesteandeabdo minaletrauma.eAgonalerespirationsedoenoteimproveewitheairwayepositioning.eUsingetheeSTARTetriagee algorithm,eyouewouldetriageetagethisepatienteasewhicheofetheefollowing?e-eCORRECTeANSWER- BlackeThisepatienteiseunlikelyetoesurviveegivenetheeseverityeofetheireinjurieseandeisetriagedeaseexpectan t.eResourceseshouldebeereservedeforeindividualseconsideredetoebeemoreesalvageable. Aepatientehasebeeneinetheeemergencyedepartmenteforeseveralehoursewaitingetoebeeadmitted.eHeesu stainedemultipleeribefractureseandeaefemurefractureeaftereaefall.eHeehasebeeneawake,ealert,eandeco mplainingeofelegepain.eHisewifeereportedethateheesuddenlyebecameeanxiouseandeconfused.eUponer eassessment,etheepatienteiserestlessewitherespiratoryedistresseandepetechiaeetoehiseneck.eTheepati enteiseexhibitingesignseandesymptomsemostecommonlyeassociatedewithewhicheofetheefollowingecon ditions?e-eCORRECTeANSWER- FateembolismeSymptomseofefateembolismeincludeedecreasedementalestatus,erestlessness,eagitati on,erespiratoryedistress,eandeaepetechialerashetoetheehead,eneck,eanteriorethorax,econjunctivae,ebu ccalemucousemembranes,eandeaxillae. Theetraumaenurseeknowsethateplacingeaebariatricepatienteineae"rampedeposition"eprovidesebetterevisualiz ationeduringetheeinsertioneofewhichedevice?e-eCORRECTeANSWER- eEndotrachealetubeeTheerampedepositioneisedescribedeaseelevationeofetheeheadewithetheeexternaleaudito ryecanaleparallelewithetheesternalenotchetoeprovideebetterevisualizationeofepharyngealelandmarks.eThisep ositioneiseusefuleduringeintubation. Theenurseeiseassessingeaepatientewitheaefracturedeforearmethatewasesplintedethreeehourseago.eWhic hesymptomeiseofemosteconcerneaseaelateesigneofeaneevolvingecomplication?e-eCORRECTeANSWER- WeakeradialepulseeAeweakeradialepulseeiseevidenceeofeaneactualecompromiseeinecirculation.
foredrug- assistedeintubationeandeattemptedeintubationebutewaseunsuccessful.eWhateisetheemosteappropriatee immediateenextestep?e-eCORRECTeANSWER-Ventilateewitheaebag- emaskedeviceeAssisteventilationsewitheaebag- maskedeviceeuntileaedefinitiveeairwayeiseobtainedeisetheepriority. Whicheofetheefollowingeiseaelateesigneofeincreasedeintracranialepressure?e-eCORRECTeANSWER- DecreasederespiratoryeefforteOtherelateesignseofeincreasedeintracranialepressureeincludeedilate d,enonreactiveepupils,eunresponsiveness,eabnormalemotoreposturing,eandetheeCushingerespon se. WhicheofetheefollowingeinjurieseiseLEASTelikelyetoebeepromptlyeidentified?e-eCORRECTeANSWER- BoweleHolloweorganeinjuryesignseandesymptomsemayebeesubtleeandedelayedebuteareeassociatedew itheaehighemortalityerateeifenoteidentified. Ae 56 - year- oldemaleepatienteinvolvedeineaemotorevehicleecrasheisebroughtetoetheeemergencyedepartmenteofeaerur alecriticaleaccessefacility.eHeecomplainseofeneckepain,eshortnesseofebreath,eandediffuseeabdominalep ain.eHiseGlasgoweComaeScoreeise15.eHisevitalesignseareeasefollows:eBPe98/71emmeHg,eHRe 125 ebeats/ minute,eRRe 26 ebreaths/minute,eSpO2e94%eonehigh-floweoxygeneviaenon- rebreatheremask.eWhicheofetheefollowingeisetheepriorityeinterventioneforethisepatient?e- eCORRECTeANSWER- ExpediteetransferetoetheeclosestetraumaecentereTheeAmericaneCollegeeofeSurgeonserecommendseth atepatientsewithesignificanteinjuriesebeetransportedetoeaetraumaecentereforedefinitiveecare.eThisepatien t'seinjuriesemightenotebeedefinitivelyediagnosed,ebutehisesymptomseandevitalesignseindicateetheeneede for Whicheofetheefollowingeisemostelikelyetoecontributeetoeinadequateeoxygenationeandeventilation?e- eCORRECTeANSWER- AdvancedeageeOlderepatientseareemoreelikelyetoehaveepulmonaryecomorbiditieseandedecreasedepul monaryereserve. Whicheofetheefollowingeassessmentefindingsedifferentiateseaetensionepneumothoraxefromeaesimplee
pneumothorax?e-eCORRECTeANSWER- HypotensionethateworsensewitheinspirationeHypotensionethateworsensewitheinspirationeiseassociat edewithetensionepneumothoraxedueetoecompressioneofetheehearteandegreatevesselse(obstructiveesh ock).eTheeincreasedeintrathoracicepressureewitheinspirationeworsensetheehypotension.