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TNCC final exam test 2022 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/ 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
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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. Which of the following interventions would be most appropriate for this patient based on the disaster triage principle? Answer: A A) initiate two large caliber intravenous lines for Ringers lactate solution administration *** B) Administer Dilaudid for pain control and provide comfort care C) Place the patient in an observation area for care within the next few hours D) Contact the command center for the personnel to notify next of kin. (^) A patient arrives with a large open chest wound after being assault ed with a machete, Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3 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 interventions? Answer: C A) needle decompression B) tube thoracostomy C) dressing removal ** D) surgical repair
(^) Which of the following is a component of the trauma triad of death? Answer: A hypothermia, metabolic acidosis, coagulopathy A) Acidosis ** B) hyperthermia C) hemorrhage D) sepsis (^) A 35-year old male presents with facial trauma after bring struck inthe face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? Answer: B A) oculomotor nerve palsy B) globe rupture *** C) uncal herniation D) retinal detachment Which of the following is true about the log roll maneuver? Answer: C A) it causes less spinal motion than the lift and slide manuever B) it is recommended for patients with unstable pelvic fractures C) it can worsen cord damage from an unstable spinal injury *** D) it does not increases the risk of life threatening hemorrhage from unstable injuries EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar? Answer: A A) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan
B) after physician evaluation if the patient has not neurologic abnormalities on exam C) after palpation of the spine if the patient has no point tenderness the the vertebral column D) after physical examination if the patient has not neck pain with movement Tearing of the bridging veins is most frequently associated with which brain injury? Answer: B A) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? Answer: D A) potassium B) magnesium C) sodium D) calcium *** A trauma patient is en route to a rural ED. Radiology notifies the charge nurse that the CT scanner will be out of service for several of hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication? Answer: D A) Brief B) loop C) debrief D) huddle *** The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating 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 BSA burned, how much IV fluids would be administered in the first 8 hours?
noted. Which of the following is the priority interventions? Answer: D A) call for a portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement What factor contributes most the kinetic energy of a body in motion? answer: C A) acceleration B) mass C) velocity *** D) inertia During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next? Answer: D A) open the airway with the head-tilt/chin lift maneuver B) auscultate bilateral breath sounds to assess ventilatory status C) assist respirations using a BVM D) insert an oropharyngeal airway if there is no gag reflex
Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of future disaster. Which phase of the disaster life cycle does this describe? Answer: A A) mitigation *** B) preparedness C) response D) recovery Which pulse pressure description is an indication of early hypovolemic shock? Answer: B
A) widened B) narrowed *** C) bounding D) weak The most reassuring finding for a male patient with hop pain after a fall is which of the following? Answer: D A) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability *** A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following? Answer: A The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage. Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma. A) diagnostic peritoneal lavage *** B) serial fast exams C) abdominal and pelvic CT scans D) serial abdominal assessments Which of the following is an expected finding in a patient with a thoracostomy connected to a chest drainage system?
A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? Answer: C A) Fast exam B) CT scan C) straight cath for urine sample *** D) ice and elevation of the scrotum You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? Answer: B A) 1000 mL/hr B) 500 mL/hr *** C) 250 mL/hr D) 125 mL/hr Which of the following is possible complication of positive- pressure ventilation? Answer: A A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure Which of the following is NOT considered goal-directed therapy of cardiogenic shock? Answer: C A) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis *** D) cardiac cath What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation?
Answer: A A) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry Which if the following values indicates the need for alcohol withdrawal interventions? Answer: A A) CIWA-Ar of 36 *** B) GCS 13 C) ETCo2 of 48 mm Hg D) heart rate of 45 beats/min An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, and dusky skin. the trauma team has administered medications for drug assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? Answer: A A) Ventilate with a BVM *** B) Prepare for cricothyroidotomy C) administer reversal medications D) contact anesthesia for assistance The trauma nurse knows that placing a bariatric patients in a "ramped position" provides better visualization during the insertion of which device? Answer: C A) Intraosseous line B) orogastric tube C) ET tube *** D) urinary catheter You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal high at the costal margin, and some dark bloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent with which of the following?
