2024 Nurs Tncc Final Exam Questions With Correct Answers A+ Assured Success, Exams of Nursing

Download 2024 Nurs Tncc Final Exam Questions With Correct Answers A+ Assured Success and more Exams Nursing in PDF only on Docsity! 2024 Nurs Tncc Final Exam Questions With Correct Answers A+ Assured Success What roles are vital to a trauma team? -The patient -The team leader -Core team -Contigency and support services What are the characteristics of an effective team? - Clear roles and responsibilities - Shared mental model - Optimize resources - Strong team leadership - Engage in regular discipline of feedback - Strong sense of collective trust and confidence - Create mechanisms to cooperate and coordinate - Manage and optimize performance outcomes -Interdependent and adaptive What tools can be used to promote communication within a team structure? What are the benefits of each? - Brief: designed to form the team, designate team roles and responsibilities, establish climate and goals, and engage the team in short and long-term planning - Huddle: ideally convened prior to trauma patient's arrival; communicate critical issues and emerging events, anticipate outcomes and likely contingencies, assign resources, express concerns - Debrief: process improvement Define trauma Injury to living tissue caused by an extrinsic agent; creates stressors that exceed tissue or organ's ability to compensate Define epidemiology Study of factors that determine and influence the frequency and distribution of injury, disease, and other health-related events and their causes in a defined human population When is the potential for traumatic injury present? Whenever energy comes in contact with the human body Define kinematics The study of energy transfer as it applies to identifying actual or intentional injuries Define biomechanics The general study of forces and their effects Define mechanism of injury How external forces are transferred to the body, resulting in injury Define potential energy Stored energy; "at rest" Define kinetic energy Energy in motion Describe Newton's First Law of Motion A body at rest will remain at rest, and a body in motion will stay in motion unless acted upon by an outside force (energy) Describe Newton's Second Law of Motion (F)orce = (m)ass x (a)cceleration; It takes more force to move a heavy object Describe Newton's Third Law of Motion For every action, there is an equal and opposite reaction resulting from the transfer of energy Describe the Law of Conservation of Energy Energy can neither be created nor destroyed, but it can change form What are the five forms in which energy exist? - Mechanical: direct impact of an object - Thermal - Chemical Examples of blast trauma - Overpressure - Dynamic pressure What is overpressure? Sudden change in atmospheric pressure caused by blast; can cause crushing forces What is dynamic pressure? Directional, similar to a gust of wind. Can carry with it fragments and debris that are displaced by explosion. *Can carry fragment and debris at velocities exceeding those in high-velocity firearms Primary MOI in blast trauma Found in those closest to detonation; air filled organs most susceptible to rupture Secondary MOI in blast trauma Results from flying debris and bomb fragments; causes most casualties Tertiary MOI in blast trauma Results from individuals being thrown by the blast wind; high-energy transfer can result in major thoracic injuries or pelvic/femur fractures Quaternary MOI in blast trauma Result from heat, flame, gas, and smoke Quinary MOI in blast trauma Result from radioactive, biological, or chemical elements present in explosion Describe the usefulness of the Haddon Matrix in prevention and reduction of injury. Places emphasis on countermeasures instead of changing human behaviors Initial Assessment - Preparation and triage - Across the room observation to identify any uncontrolled external hemorrhage - Primary survey ~ A: Airway and Alertness with simultaneous cervical spinal stabilization ~ B: Breathing and Ventilation ~ C: Circulation and Control of hemorrhage ~ D: Disability (neurological status) ~ E: Exposure and Environmental control - Resuscitation adjuncts ~ F: Full set of vitals and Family presence ~ G: Get resuscitation adjuncts - L: Labs and obtain blood for type & xmatch - M: Monitor for continuous cardiac rhythm and rate assessment - N: Naso- or orogastric tube consideration - O: Oxygenation and ventilation analysis: pulse oximetry and end-tidal CO2 monitoring or capnography - P: Pain assessment and management - Re-evaluation (consideration of transfer) - Secondary survey with re-evaluation adjuncts ~ H: History and Head-to-toe assessment ~ I: Inspect posterior surfaces - Re-evaluation and post resuscitation care - Definitive care or transfer to an appropriate trauma center Why is there repeated emphasis on assessment for hemorrhage throughout the initial assessment? Uncontrolled hemorrhage is the major cause of preventable death after injury When is cervical spinal injury (CSI) suspected? In any patient with multi system trauma, until pt has GCS of 15 and has CSI has been ruled out by physician or radiography *Can be stabilized manually or with semi-rigid cervical collar Which tool can be used to rapidly assess the LOC during the A - Airway and Alertness step? Why is it important to determine alertness along with airway? What are the components of this tool? A - Alert V - Verbal stimuli; if verbal stimuli needed to respond, an airway adjunct may be needed to keep to keep tongue from obstructing airway P - Responds to pain; if pt responds only to pain, may need airway adjunct while determining need for intubation U - Unresponsive; announce loudly to team; get someone to check for pulse while you assess airway Uses LOC to determine need for airway Airway may be compromised with V,P, or U What to inspect for when checking airway: - Tongue obstructing airway - Loose or missing teeth - Foreign objects - Blood, vomitus, or secretions - Edema - Burns or evidence of inhalation injury What to auscultate for when assessing airway: Obstructive airway sounds (snoring, gurgling, stridor) What to palpate for when assessing airway: - Possible occlusive maxillofacial body deformity - SQ emphysema How do you check for proper placement of definitive airway (endotracheal intubation)? - Adequate rise and fall of chest - Absence of gurgling on auscultation over epigastrium - BBS present - Presence of CO2 verified by CO2 detector device or monitor Which method of opening airway is recommended for use in trauma? Jaw-thrust maneuver *Performed by two people when needing to stabilize cervical spine What conditions or situations require definitely secure airway? - Apnea - GCS score of 8 or less - Severe maxillofacial fractures - Evidence of inhalation injury (facial burns) - Laryngeal or tracheal injury or neck hematoma - High risk of aspiration and patients inability to protect airway - Compromised or ineffective ventilation - Anticipation of deterioration of neuro status that may result in inability to maintain or protect airway *Ventilate with bag-mask at 15 L until airway can be established Breathing and Ventilation: Assessment Inspect for: - Spontaneous breathing - O: Oxygenation and ventilation assessment ~ Pulse ox measures oxygen saturation of arterial blood or % of bound hgb - Pulse ox relies on adequate peripheral perfusion for accuracy - Not evidence of ventilation - Normal: >94% ~ ETCO2 monitoring (capnography) - Provides info on ventilation, perfusion, and metabolism of CO2 - Normal: 35-45 mmHg - P: Pain assessment and management ~ Provide comfort for pt ~ Avoid respiratory depression Part of the History in the Secondary Survey is a review of the prehospital report using the mnemonic MIST. What are the components of a MIST report? - M: MOI - I: Injuries sustained - S: SSx (in the field) - T: Treatment (in the field) Components of the SAMPLE pneumonic that highlights important aspects of patient history - S: Symptoms associated with the injury - A: Allergies and tetanus status - M: Meds currently used - P: Past medical hx (include hospitalizations and surgeries) - L: Last oral intake - E: Events and Environmental factors related to injury Head-to-toe Assessment: General Appearance - Position and posture - Guarding - Stiffness, rigidity, and flaccidity of extremities - Odors Head-to-toe Assessment: Head and Face - Soft tissue injuries - Lacerations, puncture wounds, abrasions, contusions, edema, ecchymoses, impaled objects - Palpate for areas of tenderness, step-offs, and crepitus - Bone deformities - Asymmetry of facial expression - Any exposed tissue or bone that may suggest disruption of CNS - Palpate for depressions, angulations, tenseness Head-to-toe Assessment: Eyes - Gross visual acuity; " how many fingers am I holding up" - Prescription glasses or contacts? ~ Remove contacts before edema begins - PERRL - Muscle function; ask pt to follow moving finger in six cardinal positions Head-to-toe Assessment: Ears - Unusual drainage - Test otorrhea for CSF ~ Halo sign and glucose testing ~ Don't pack ear with suspected CSF leak - Ecchymosis behind the ear - Ear avulsions or lacerations Head-to-toe Assessment: Nose - Unusual drainage - Test rhinorrhea for CSF ~ Do not pack or insert NG tube if CSF leak suspected - Note position of nasal septum Head-to-toe Assessment: Neck and Cervical Spine - Presume pts with maxillofacial or head trauma may also have unstable CSI until proven otherwise; IMMOBILIZE - Sign of penetrating or surface trauma - Position of trachea and appearance of jugular veins - Palpate for cervical tenderness or deformities, tracheal deviation, SQ emphysema and areas tenderness Head-to-toe Assessment: Chest - Spontaneous breathing - Resp rate, depth, and effort; use of accessory or abd muscles and any paradoxical chest movement - Lacerations, puncture wounds, abrasions, contusions, avulsions, ecchymoses, edema, impaled objects, scars that may indicate previous chest surgery - Expansion and excursion of chest - Pain with breathing - Lung sounds - Heart sounds for presence of murmurs, friction rubs, or muffled heart tones - SQ edema - Bony crepitus or deformities (step offs or areas of tenderness) to the clavicles, sternum, and ribs Head-to-toe Assessment: Abdomen/Flanks - Lacerations, puncture wounds, abrasions, contusions, avulsions, ecchymoses, edema, impaled objects, and scars indicating previous abdominal surgery - Evisceration - Distention - Bowel sounds - Palpate for rigidity, guarding, masses, tenderness Head-to-toe Assessment: Pelvis/Perineum - Lacerations, puncture wounds, abrasions, contusions, avulsions, ecchymoses, edema, impaled objects, and scars - Bone deformities or exposed bone - Blood at urethral meatus, vagina, rectum - Priapism - Pain and/or urge, but inability to void - Palpate for instability if pelvis by applying gentle pressure over iliac wings downward and medially or on symphysis pubis Discuss why the insertion of a urinary catheter is no longer part of primary survey? Due to risk of UTI; alternate methods should be considered prior to placement Head-to-toe Assessment: Extremities - Lacerations, puncture wounds, abrasions, contusions, avulsions, ecchymoses, edema, impaled objects, deformity, and any open wounds - Bleeding - Angulation, deformity, and open wounds with evidence of protruding bone fragments, edema - Correct placement of previously applied splints - Skin color - Presence of dialysis catheters, PICCs, or other signs of complex medical hx - Skin temp and moisture - Pulses ~ Always compare sides - Crepitus - Deformity and areas of tenderness - Sensation - Spontaneous movement of all extremities - Motor strength and ROM in all extremities - Test equality of strength in bilateral extremities - Failure to maintain or protect the airway - Failure to maintain oxygenation or ventilation - A specific anticipated clinical course What are two types of rescue airways and what is their major risk when used? Supraglottic and retroglottic airways Supraglottic airways do not provide protection against aspiration and is not recommended in patients who have recently eaten List, in order, the seven steps of verifying ETT placement 1. Attacth a CO2 detection device and begin assisted ventilations 2.Watch for symmetric rise and fall of chest AND AT THE SAME TIME, listen for presence of gurgling over epigastrium, which may indicate tube is in esophagus 3.Listen for presence of BBS at midaxillary and midclavicular lines 4.Secure ETT, note the number at the lip for positioning, and document 5.Prepare for mechanical ventilation 6. Note patient's color for improvement 7. Obtain CXR for verification Identify and explain the circumstances in which the pulse oximetry reading may be unreliable and why. - Poor peripheral perfusion caused by vasoconstriction, hypotension, or hypothermia - BP cuff inflated above sensor - CO poisoning - Methemoglobinemia - Severe dehydration In terms of the oxyhemoglobin-dissociation curve, what does a "shift to the right mean" and when does it occur? A shift to the right means hemoglobins affinity for oxygen has decreased, making it easier to release the bound oxygen to the tissues. This occurs in an environment of high metabolic demand (increased CO2, temperature, 2,3-diphosphoglycerate and decreased pH). In terms of the oxyhemoglobin-dissociation curve, what does a "shift to the left mean" and when does it occur? A shift to the left means hemoglobins affinity for oxygen has increased, making it harder to release the bound oxygen to the tissues. This occurs in an environment of low metabolic demand (decreased CO2, temperature, 2,3-diphosphoglycerate; increased pH; CO poisoning and methemoglobinemia) Differentiate between qualitative and quantitative end-tidal carbon dioxide. Quantitative provides a numeric value while qualitative informs on presence or absence of exhaled CO2 through color changing strips DOPE mnemonic to troubleshoot ventilator or capnography alarms - D: Displaced tube - O: Obstructed or linked tube - P: Pneumothorax - E: Equipment Failure Define hyperoxia and the pulse oximetry parameters used to monitor it. Hyperoxia refers to an excess supply of oxygen in the tissues. Better outcomes depend on prompt titration of oxygen as indicated by maintaining SpO2 between 94-98%. Discuss the steps of rapid sequence intubation. Seven P's of RSI - Preparation - Preoxygenation ~ Provide oxygen at highest concentration ~ To prepare pt to tolerate the period of apnea without desaturation - Pretreatment ~ L: Lidocaine ~ O: Opioids ~ A: Atropine ~ D: Defasciculating dose of neuromuscular blocking agents - Paralysis with induction ~ Give sedative prior ~ Depolarizing (succinylcholine) and nondepolarizing (rocuronium and vecuronium) agents used ~ Nondepolarizing agents have fewer side effects but are longer acting ~ Short-acting medications preferred - Protection and Positioning ~ Protect airway from aspiration ~ Assist ventilation with bag-mask device if SpO2 falls below normal limits ~ Maintain cervical spinal stabilization - Placement with Proof - Post intubation management Etiology and pathophysiology of hypovolemic shock Due to loss of circulating blood volume; from hemorrhage, vomiting, diarrhea, burns Decreased circulating volume results in decreased preload; ventricles stretch less with filling; Starling's law states less stretch = less force = diminished CO Etiology and pathophysiology of obstructive shock Due to obstruction in either vasculature or heart; from tension pneumothorax and cardiac tamponade; results in obstruction to atrial filling Etiology and pathophysiology of cardiogenic shock Due to pump failure in presence of adequate intravascular volume; from MI, dysrhythmias, or blunt cardiac trauma; results from loss of cardiac contractility and reduced CO Etiology and pathophysiology of distributive shock Due to maldistribution of an adequate circulating blood volume with loss of vascular tone or increased permeability; from anaphylactic, septic, or neurogenic shock Anaphylactic shock results from release of inflammatory mediators —> contracts bronchial smooth muscle and increases vascular permeability and vasodilation Septic shock results from systemic release of bacterial endotoxins —> increased vascular permeability and vasodilation Neurogenic shock that occurs with SCI results in the loss of SNS control of vascular tone; unopposed vagal activity may result in decreased CO through bradycardia Define components of CO - CO = SV x HR - Stroke volume is affected by preload (venous return) and afterload (peripheral vascular resistance) and contractility Compensated Shock