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This resource provides questions and answers for the TNCC 9th edition final exam, covering core trauma nursing concepts. Topics include transport risks, Newton's laws, kinetic energy, and types of trauma injuries (blunt, penetrating, thermal, blast). It addresses motor vehicle accident impacts and blast trauma effects (primary, secondary, tertiary, quarternary, quinary). Airway management (nasopharyngeal, oral pharyngeal), ETT confirmation, capnography, shock stages (compensated, decompensated, irreversible), and shock types (hypovolemic, cardiogenic, obstructive, distributive) are also covered. The trauma triad of death, shock characteristics, fluid bolus recommendations, and permissive hypertension/oxygenation levels are discussed. Ideal for nursing students/professionals preparing for the TNCC exam or reinforcing trauma care knowledge, offering a concise review and clear answers.
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Whatvarevthevgreatestvrisksvforvtransport?v-vCORRECTvANSWER- Lossvofvairwayvpatency,vdisplacedvobstructivevtubesvlinesvorvcatheters,vdislodgevsplintingvdevices,vn eedvtovreplacevorvreinforcevdressings,vdeteriorationvinvpatientvstatusvchangevinvvitalvsignsvorvlevelvof vconsciousness,vinjuryvtovthevpatientvand/orvteamvmembers Accordingvtovnewtonsvlawvwhichvofvthesevtwovforcevisvgreater:vsizevorvforce?v-vCORRECTvANSWER- Neither.vForveachvforcevtherevisvanvequalvandvoppositevreaction. Whatvisvthevrelationshipvbetweenvmassvandvvelocityvtovkineticvenergy?v-vCORRECTvANSWER- Kineticvenergyvisvequalvtov1/2vthevmassvmultipliedvthevsquarevofvitsvvelocityvthereforevwhenvmassvisv doubledvsovisvthevnetvenergy,vhowever,vwhenvvelocityvisvdoubledvenergyvisvquadrupled. Whatvisvtension?v-vCORRECTvANSWER-stretchingvforcevbyvpullingvatvoppositevends Whatvisvcompression?v-vCORRECTvANSWER-Crushingvbyvsqueezingvtogether Whatvisvbending?v-vCORRECTvANSWER- Loadingvaboutvanvaxis.vBendingvcausesvcompressionvonvthevsidevthevpersonvisvbendingvtowardvintentionvto vthevoppositevside Whatvisvshearing?v-vCORRECTvANSWER- Damagevbyvtearingvorvbendingvbyvexertingvfaucetvdifferentvpartsvinvoppositevdirectionsvatvthevsamevt ime. Whatvisvtorsion?v-vCORRECTvANSWER-Torsionvforcesvtwistvendsvinvoppositevdirections. Whatvisvcombinedvloading?v-vCORRECTvANSWER- Anyvcombinationvofvtensionvcompressionvtorsionvbendingvand/orvshear. Whatvarevthevfourvtypesvofvtraumavrelatedvinjuries?v-vCORRECTvANSWER-
Blunt,vpenetrating,vthermal,vorvblast. Whatvarevcontributingvfactorsvtovinjuriesvrelatedvtovbluntvtraumas?v-vCORRECTvANSWER- Thevpointvofvimpactvonvthevpatient'svbody,vthevtypevofvsurfacevthatvisvhit,vthevtissuesvabilityvtovresis tv(bonevversusvsoftvtissue,vair-filledvversusvsolidvorgans),vandvthevtrajectoryvofvforce. Whatvarevthevsevenvpatternsvofvpathwayvinjuriesvrelatedvtovmotorvvehiclevaccidents?v- vCORRECTvANSWER-Upvandvover,vdownvandvunder,vlateral,vrotational,vrear,vrollvover,vandvejection.
Ventilation:vthevactivevmechanicalvmovementvofvairvintovandvoutvofvthevlungs;vdiffusion:vthevpassivev movementvofvgasesvfromvanvareavofvhighervconcentrationvtovanvareavofvlowervconcentration;vandvper fusion:vthevmovementvofvbloodvtovandvfromvthevlungsvasvavdeliveryvmediumvofvoxygenvtovtheventirevb ody. Whenvwouldvyouvusevavnasopharyngealvairwayvversusvanvoralvpharyngealvairway?v- vCORRECTvANSWER- Nasopharyngealvairwaysvisvcontraindicatedvinvpatientsvwithvfacialvtraumavorvavsuspectedvbasilarvsk ullvfracture.vOralvpharyngealvairwaysvisvusedvinvunresponsivevpatientsvunablevtovmaintainvtheirvairw ay,vwithoutvavgagvreflexvasvavtemporaryvmeasurevtovfacilitatevventilationvwithvavbagvmaskvdevicevorvs pontaneousvventilationvuntilvthevpatientvcanvbevintubated.
DescribevthevmeasurementvofvanvNPAv-vCORRECTvANSWER- Measurevfromvthevtipvofvthevpatient'svnosevtovthevtipvofvthevpatientsvearlobe. MeasurementvofvanvOPAv-vCORRECTvANSWER- Placevthevproximalvendvorvflangevofvthevairwayvadjunctvatvthevcornervofvthevmouthvtovthevtipvofvthevmandibul arvangle. Truevorvfalse:vNPAsvandvOPAsvarevdefinitivevairways.v-vCORRECTvANSWER- False.vWhenvplacingvonevofvthese?vOnevshouldvconsidervthevpotentialvneedvforvavdefinitivevairway. NamevthevthreevwaysvtovconfirmvETTvplacementv-vCORRECTvANSWER- PlacementvofvavCO2vmonitoringvdevice,vAssessingvforvequalvchestvrisevandvfall,vandvlisteningvatvthev epigastriumvandvfourvlungvfieldsvforvequalvbreathvsounds. Whenvcapnographyvmeasurementvreadsvgreatervthanv45MMHG,vthevnursevshouldvconsidervincre asingvorvdecreasingvthevventilationvrate?v-vCORRECTvANSWER- vIncreasingvthevventilationvrate.vDoingvsovwouldvallowvthevpatientvtovblowvoffvretainedvCO2. Whenvcapnographyvmeasurementvreadsvlessvthanv35MMHG,vthevnursevshouldvconsidervincreasingvorvdecr easingvthevventilationvrate?v-vCORRECTvANSWER- Decreasingvthevventilationvrate.vByvdoingvso,vthevnursevallowsvthevpatientvtovretainvCO2. Whatvarevthevthreevstagesvofvshockv-vCORRECTvANSWER- Compensated,vdecompensatedvorvprogressive,vandvirreversible. Whatvarevthevsignsvofvcompensatedvshock?v-vCORRECTvANSWER- Anxiety,vconfusion,vrestlessness,vincreasedvrespiratoryvrate,vnarrowingvpulsevpressurevwerevdiasto licvincreasesvyetvsystolicvremainsvunchanged,vtachycardiavwithvboundingvpulses,vandvdecreasedvur inaryvoutput Whatvarevthevsignsvandvsymptomsvofvdecompensatedvshock?v-vCORRECTvANSWER- vDecreasedvlevelvofvconsciousness,vhypertension,vnarrowvpulsevpressure,vtachycardiavwithvweakvp
Whatvisvthevtraumavtriadvofvdeath?v-vCORRECTvANSWER-hypothermia,vacidosis,vcoagulopathy Describevthevcharacteristicsvofvobstructivevshockv-vCORRECTvANSWER- Obstructivevshockvisvitvmechanicalvproblemvthatvresultsvfromvhypoperfusionvofvthevtissuevduevtovanv obstructionvinveithervthevvasculaturevorvthevheartvresultingvinvdecreasedvcardiacvoutput.vSomevcaus esvincludevavtensionvpneumothorax,vcardiacvtamponade,vorvvenousvairvembolismvonvthevrightvsidev ofvthevheartvduringvsystolevinvthevpulmonaryvartery.Signsvincludevanxiety,vmuffledvheartvsounds,vJV D,vhypertension,vchestvpain,vdifficultyvbreathing,vorvpulsesvparadoxes. Describevthevcharacteristicsvofvcardiogenicvshockv-vCORRECTvANSWER- Cardiogenicvshockvresultsvfromvpumpvfailurevinvthevpresencevofvadequatevintravascularvvolume.vLa ckvofvcardiacvoutputvandvanvorganvperfusionvoccursvsecondaryvtovavdecreasevinvmyocardialvcontrac tilityvandvorvvalvularvinsufficiency.vThisvcanvhappenvwithvbluntvcardiacvtraumavorvanvMI.vSymptomsvc anvincludevlowvbloodvpressurevincreasevheartvratevandvrespiratoryvratevchestvpainvshortnessvofvbrea thvdysrhythmiasvincreasevtroponinvandvpalevcoolvmoistvskin Describevthevcharacteristicsvofvdistributivevshock.v-vCORRECTvANSWER- DistributivevshockvoccursvasvavresultvofvMelvdistributionvofvanvadequatevcirculatingvbloodvvolumevwit hvthevlossvofvvascularvtonevorvincreasedvpermeability.vThisvcanvoccurvwithvspinalvcordvinjuries,vsepsi s,vorvanaphylaxis.vSymptomsvincludevlowvbloodvpressurevheartvratevrespiratoryvratevpreloadvandvaft erload,vspinalvtenderness,vdifficultyvbreathing,vwarmvpinkvandvdryvskinvwithvavcoolvcorevtemperature . Describevthevcharacteristicsvofvhypovolemicvshockv-vCORRECTvANSWER- Hypovolemiavisvcausedvbyvavdecreasevinvthevamountvofvcirculatingvvolumevusuallyvcausedvbyvmassi vevbleeding,vbutvalsovcanvbevfromvvomitingvandvdiarrhea.vCharacteristicsvincludevlowvbloodvpressur evandvpreload,vincreasevheartvratevrespiratoryvratevandvafterload,vwithvcontractilityvunchanged.vSign svincludevobviousvbleeding,vweakvperipheralvpulses,vpalevcoolvandvmoistvskin,vdistendedvabdomen, vpelvicvfracture,vorvbruisevswollenvandvdeformedvextremitiesvespeciallyvlongvbones. Whatvisvthevrecommendedvfluidvbolusvforvavtrauma?v-vCORRECTvANSWER- 500 vML'svofvwarmedvisotonicvcrystalloid.vOngoingvfluidvbolusesvofv 500 vML'svshouldvbevgivenvjudicio
uslyvwithvconstantvreassessmentsvaftervadministration. Whatvisvthevminimumvpermissivevhypertensionvandvavtraumavpatient?v-vCORRECTvANSWER- Avsystolicvofvgreatervthanvorvequalvtov 90 vMMHG Whatvisvthevminimumvpermissivevoxygenationvlevelvofvavtraumavpatient?v-vCORRECTvANSWER- Greatervthanvorvequalvtov94%
mevalthoughvrarevisvwhenvthevpatientvisvunablevtovusevsensevvibrationvinvproprioception Describevonevfatvembolismvsyndromevisvmostvlikelyvtovoccurvinvitsvcharacteristicsv- vCORRECTvANSWER- Withvlongformvfractures.vTachycardia,vThrombocytopenia,vandvpetechiaevrash. WhatvisvthevMunro-Kellievdoctrine?v-vCORRECTvANSWER- Withinvthevskullv80%vhisvbrain,v10%visvblood,vandv10%visvCSF.vAnyvincreasevofvanyvofvthevprodu ctsvresultsvinvincreasedvintracranialvpressure. WhatvarevthevtreatmentvgoalsvforvavTBI?v-vCORRECTvANSWER- O2vsaturationv>vorvequalvtov95%,vsystolicvbloodvpressurev>vorvequalvtov 100 vMMHG,vICPv<v 15 vMMHG,v CPP
vorvequalvtov 60 vMMHG,vnormalvglycemia,vhemoglobinv>vorvequalvtov 7 vg/DL,vsodium 135 - 145,vosmoticvdiuretics,vanti- emetics,vsedatives,vanticonvulsants,vheadvofvbedvatv30°,vandvneckvatvmidline