Download TNCC Exam 9th Edition Study Guide 2025 Q&A and more Exams Nursing in PDF only on Docsity!
TNCC Exam 9th Edition Study Guide 2025 Q&A
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- DecreasedesubcutaneousefateDecreasedesubcutaneousefateandethinningeofetheeskineincreasesethee riskeofeinjuriesefromesoftetissueetraumaeandeincreasesetheeriskeofehypothermia Ifeaepatientehasereceivedemultipleetransfusionseofebankedebloodepreservedewithecitrate,ewhicheelect rolyteeisemostelikelyetoedropeanderequireesupplementation?e-eCORRECTeANSWER- CalciumeHypocalcemiaeiseaeconcernewithemassiveetransfusionebecauseecitrateeiseaddedetoebankede bloodetoepreventecoagulation.eCitrateechelatese(bindsewith)ecalcium,erenderingeiteinactive. Whicheofetheefollowingeiseaepossibleecomplicationeofepositive-pressureeventilation?e- eCORRECTeANSWER-WorseningepneumothoraxePositive- pressureeventilationecaneleadetoeincreasedeaireinetheechestecavityewithouteaerouteeofeescape,ewors eningeaepneumothoraxeandepossiblyeleadingetoeaetensionepneumothorax. Aneintubatedeandesedatedepatienteinetheeemergencyedepartmentehasemultipleeextremityeinjuriesewi thetheepotentialeforecausingecompartmentesyndrome.eWhateisetheemostereliableeindicationeofecomp artmentesyndromeeineaepatientewhoeiseunconscious?e-eCORRECTeANSWER- PressureePressureecanebeeassessedeinetheelimbebyepalpationeoredirectemeasurement.eTheecompart menteorelimbewillefeeletighteoretenseeuponepalpation.eTheeskinemayealsoeappearetauteandeshiny. Aepatientearrivesewitheaelargeeopenechestewoundeafterebeingeassaultedewitheaemachete.ePrehospita leproviderseplacedeaenonporousedressingeoveretheechestewoundeandetapedeiteonethreeesides.eHeeisen oweshowingesignseofeanxiety,erestlessness,esevereerespiratoryedistress,ecyanosiseandedecreasingeb loodepressure.eWhicheofetheefollowingeisetheeMOSTeappropriateeimmediateeintervention?e-
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.
