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TNCC Test Prep: Exam Questions and Answers for Trauma Assessment, Exams of Medicine

A collection of questions and answers from the tncc test prep 8th edition related to trauma assessment. Topics covered include identifying assessment findings for various injuries and conditions, understanding the effects of hypothermia and acidosis on the body, and recognizing components of the trauma triad. Students preparing for the tncc certification exam can use this document as a study resource.

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2023/2024

Available from 02/14/2024

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Download TNCC Test Prep: Exam Questions and Answers for Trauma Assessment and more Exams Medicine in PDF only on Docsity! Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers Expedite transfer to the closest trauma center - correct answer A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high- flow O2 via NRB mask. Which of the following is the priority intervention for this patient? a pertinent medical hx is crucial - correct answer Which of the following considerations is the most important when caring for a geriatric trauma pt? Mitigation - correct answer 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 a future disaster . Which phase of the disaster life cycle does this describe? Alcohol All tools and guidelines require the patient to be awake, alert, not under the influence of any substances, and without neurologic abnormalities - correct answer EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeons screening guidelines, Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? hemoglobin does not readily release O2 for use by the tissues - correct answer What is the effect of hypothermia on the oxyhemoglobin dissociation curve? acidosis - correct answer Which of the following is a component of the trauma triad of death? Complete - correct answer EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? flucuation in the water seal chamber - correct answer Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? insert an oropharyngeal airway if there is no gag reflex - correct answer During the primary survey of an unconscious pt with multi-system Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers straight cath for urine sample - correct answer A 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? placental abruption - correct answer You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? it can worsen cord damage from an unstable spinal injury - correct answer Which of the following is true about the log-roll? defusings - correct answer All of these are considered a critical communication point in trauma care EXCEPT which of the following? pulse oximetry and capnography - correct answer What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers padding the upper back while stabilizing the cervical spine - correct answer Caregivers carry in a 2 y/o into the ED who fell out of a second- story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? bowel - correct answer Which of the following injuries is LEAST likely to be promptly identified? Initiate transfer to a trauma center - correct answer A pt is brought to the ED of a rural hospital following a high-speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? bardycardia and absent motor function below the level of injury - correct answer A pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? apply splint and elevate above the level of the heart - correct answer a 37 y/o F has a deformity of the L wrist after a fall. She is reluctant to Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers move her hand due to pain. Which of the following is the most appropriate intervention? the aorta is torn at its attachment with the ligamentum arteriosum - correct answer which of the following occurs during the third impact of a motor vehicle crash? Report your suspicion of maltreatment in accordance with local regulations - correct answer a 5 y/o child presents to the ED with bruises to the upper arm and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority survey. Which of the following is the priority nursing intervention? to guage end-organ perfusion and tissue hypoxia - correct answer Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? elevating the extremity to the level of the heart - correct answer A pt with a lower extremity fracture complains of severe pain and tightness Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? calcium - correct answer if a pt has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? identifying individuals who made mistakes during the traumatic event - correct answer Which of the following is NOT considered a benefit of debriefings? 500 mL/hr - correct answer You are treating a 27 y/o M in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? advanced age - correct answer Which of the following is most likely to contribute to inadequate oxygenation and ventilation? Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers a 52 y/o diabetic male with a partial thickness burn to the left lower leg - correct answer Which of the following patients warrants referral to a burn center? dressing removal - correct answer A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three 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 immediate intervention? after a physical examination if the pt has no radiologic abnormalities on CT - correct answer 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 pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? MARCH - correct answer Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is kinematics? - correct answer A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body. What is Newton's First Law? - correct answer A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. What is the Law of Conservation of Energy? - correct answer Energy can neither be created nor destroyed. It is only changed from one form to another. What is Newton's Second Law? - correct answer Force equals mass multiplied by acceleration of deceleration. What is kinetic energy (KE)? - correct answer KE equals 1/2 the mass (M) multiplied by the velocity squared. What is the Mnemonic for the Initial Assessment? - correct answer A = Airway with simultaneous cervical spine protection B = Breathing Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What intervention should be done if a pt presents with effective circulation? - correct answer - Insert 2 large caliber IV's - Administer warmed isotonic crystalloid solution at an appropriate rate What are signs of ineffective circulation? - correct answer - Tachycardia - AMS - Uncontrolled external bleeding - Pale, cool, moist skin - Distended or abnormally flattened external jugular veins - Distant heart sounds What are the interventions for Effective/Ineffective Circulation? - correct answer - Control any uncontrolled external bleeding by: - Applying direct pressure over bleeding site - Elevating bleeding extremity - Applying pressure over arterial pressure points - Using tourniquet (last resort). - Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Use warmed solution - Use pressure bags to increase speed of IVF infusion - Use blood administration tubing for possible administration of blood - Use rapid infusion device based on protocol - Use NS 0.9% in same tubing as blood product - IV = surgical cut-down, central line, or both. - Blood sample to determine ABO and Rh group - IO in sternum, legs, arms or pelvis - Administer blood products - PASG (without interfering with fluid resuscitation) How do you assess Mnemonic "D"? - correct answer DISABILITY A = Alert V = Verbal P = Pain U = Unresponsive - GCS - PERRL? Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Determine presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils - Symptoms that help to locate area of injury in brain What are the interventions for Disability? - correct answer - If assessment indicates a decreased LOC, conduct further investigation during secondary focused assessments - If pt is not alert or verbal, continue to monitor for any compromise to ABC's - If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation. What is assessed and intervened for Expose/Environmental Controls? - correct answer - Remove clothing - Ensure appropriate decontamination if exposed to hazardous material - Keep pt warm - Keep clothing for evidence What is the first thing assessed under the Secondary Assessment? - correct answer FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Neurologic injury - Spinal Cord Injury - Intracranial Injury - Blunt trauma - Pain caused by rib fractures - Penetrating Trauma - Preexisting hx of respiratory diseases - Increased age What medications are used during intubation? - correct answer LOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents What are the Rapid Sequence Intubation Steps? - correct answer PREPARATION: - gather equipment, staffing, etc. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers PREOXYGENATION: - Use 100% O2 (prevent risk of aspiration). PRETREATMENT: - Decrease S/E's of intubation PARALYSIS WITH INDUCTION: - Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING: - Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration PLACEMENT WITH PROOF - Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt 30-60 seconds between attempts. - After intubation, inflate the cuff - Confirm tube placement w/exhaled CO2 detector. POSTINTUBATION MANAGEMENT: - Secure ET tube - Set ventilator settings - Obtain Chest x-ray - Continue to medicate Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Recheck VS and pulse oxtimetry What is a Combitube? - correct answer A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are only two sizes: small adult and larger adult. What is a Laryngeal Mask Airway? - correct answer Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area. ILMA, does not require laryngoscopy and visualization of the chords. What is Needle Cricothyrotomy - correct answer Percutaneous transtracheal ventilation. (temporary) Complications include: - inadequate ventilation causing hypoxia - hematoma formation - esophageal perforation Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain What are you looking for when percussing the chest? - correct answer Dullness: - hemothorax Hyperresonance - Pneumothorax What are you looking for when palpating the chest wall, clavicles and neck? - correct answer - Tenderness - Swelling - subcutaneous emphysema - step-off deformities = These may indicate: esophageal, pleural, tracheal or bronchial injuries. Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is the DOPE mnemonic? - correct answer D - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing Explain Hypovolemic Shock. - correct answer Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers Explain Cardiogenic Shock. - correct answer Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: - MI - Blunt cardiac injury - Mitral valve insufficiency - dysrhythmias - Cardiac Failure Explain Obstructive Shock. - correct answer Results from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Retention of water by kidneys - Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. Explain adrenal gland response. - correct answer When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Hepatic Response. - correct answer Liver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Pulmonary Response. - correct answer Tachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Irreversible Shock. - correct answer Shock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. How would you assess someone in hypovolemic shock? - correct answer (Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. What are the early signs and symptoms of increased ICP? - correct answer - Headache - N/V - Amnesia regarding events around the injury - Altered LOC - Restlessness, drowsiness, changes in speech, or loss of judgement What are the late observable signs of symptoms of increased ICP? - correct answer - Dilated, nonreactive pupil - Unresponsiveness to verbal or painful stimuli Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Abnormal motor posturing patterns - Widening pulse pressure - Increased systolic blood pressure - Changes in RR and pattern - Bradycardia What is Cushing's phenomenon or Cushing's Reflex? - correct answer Triad of progressive HTN, bradycardia and diminished respiratory effort. What are the two types of herniation that occurs with ICP? - correct answer 1. Uncal herniation 2. Central or transtentorial herniation Why does herniation occur? What are the symptoms? - correct answer Because of uncontrolled increases in ICP. S/E's - Unilateral or bilateral pupillary dilation - AsyDimmetric pupillary reactivity Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Abnormal motor posturing - Other evidence of neurologic deterioration Define uncal herniation. - correct answer The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define central or transtentorial herniation. - correct answer A downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Disruptions of the bony structures of the skull can result in what? - correct answer Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers accerleration/deceleration forces resulting in microscopic damage primarily to axons within the brain. S/S: - Immediate unconsciousness - mild DAI, coma = 6-24 hrs - severe DAI, coma = weeks/months or persistent vegetative state - Elevated ICP - Abnormal posturing - HTN - Hyperthermia - Excessive sweating because of autonomic dysfunction - Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits What is a cerebral contusion and its S/S? - correct answer A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S: Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Alteration in LOC - Behavior, motor or speech deficits - Abnormal motor posturing - Signs of increased ICP What is an epidural hematoma and its S/S? - correct answer Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly: - Compression of underlying brain - rapid increase in ICP - Decreased CBF - Secondary brain injury * Usually requires surgical intervention S/S: - Transient LOC - Lucid period lasting a few minutes to several hours - Rapid deterioration in neurologic status - Severe H/A - Sleepiness Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Dizziness - N/V - Hemiparesis or hemiplegia on opposite side of hematoma - Unilateral fixed and dilated pupil on same side of hematoma What is a subdural hematoma and its S/S? - correct answer A focal brain injury beneath the dura mater that results from acceleration/deceleration. Usually venous, and not necessarily from a fx. Formation may be acute or chronic. Acute pt's hematoma manifest 48 hrs post injury S/S: - Altered LOC or steady decline in LOC - S/S of increased ICP - Hemiparesis or hemiplegia on opposite side of hematoma - Unilateral fixed and dilated pupil on same side of hematoma Chronic pt's " " up to 2 wks post injury - H/A Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 What are signs of a serious eye injury? - correct answer - Visual disturbances - Pain - Redness and ecchymosis of the eye - Periorbital ecchymosis - Increased intraocular pressure What is hyphema and its S/S? - correct answer Accumulation of blood, mainly RBC's that disperse and layer within the anterior chamber. A severe hymphema obscures entire anterior chamber + will diminish visual acuity severely or completely. Injuries are graded on amount of blood in chamber (Grades I-IV). Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is LeFort II fracture and its S/S? - correct answer Pyramidal maxillary fx=middle facial area. Apex of fx transverses bridge of nose. Two lateral fx's of pyramid extend through the lacrimal bone of the face and ethmoid bone of skull into the median portion of both orbits. Base of the fx extends above level of the upper teeth into maxilla. CSF leak is possible. S/S: - Massive facial edema - Nasal swelling w/obvious fx of nasal bones - Malocclusion - CSF rhinorrhea What is LeFort III fracture and its S/S? - correct answer Complete craniofacial separation involving maxilla, zygoma and bones of cranial base. This fx is frequently associated w/leakage of CSF and fx mandible. S/S: - Massive facial edema - Mobility and depression of zygomatic bones - Ecchymosis Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Anesthesia of the cheek - Diplopia - Open bite or malocclusion - CSF rhinorrhea What are the mandibular fracture S/S? - correct answer - Malocclusion - Inability to open the mouth (trismus) - Pain, especially on movement - Facial asymmetry and a palpable step-off deformity - Edema or hematoma formation at the fracture site - Blood behind, ruptured, tympanic membrane - Anesthesia of the lower lip What are neck injury S/S? - correct answer - Dyspnea - Hemoptysis (coughing up blood) - Subcutaneous emphysema in neck, face, or suprasternal area - Decreased or absent breath sounds - Penetrating wounds or impaled objects Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Pulsatile or expanding hematoma - Loss of normal anatomic prominence of the laryngeal region - Bruits - Active external bleeding - Neurologic deficit, such as aphasia or hemiplegia - Cranial nerve deficits - Facial sensory or motor nerve deficits - Dysphonia (hoarseness) - Dysphagia (difficulty swallowing) How would you assess a patient with ocular, maxillofacial and neck trauma? - correct answer (Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Tenderness - Edema - Step-off de What are the nursing interventions for a pt with an ocular injury? - correct answer - Assess visual acuity & reassess - Elevate HOB to minimize intraocular pressure - Instruct pt not to bend forward, cough or perform Valsalva maneuver b/c these actions may raise intraocular pressure - Assist w/removal of foreign bodies as indicated; stabilize impaled objects - Apply cool packs to decrease pain + periorbital swelling - Admin medications - Instill prescribed topical anesthetic drops for pain - Instill NS drops or artificial tears to keep corneas moist. Cover eyelids w/sterile, moist saline dsg to prevent drying and ulceration - Antibiotics topically or systemically - Admin tetanus prophylactically - Use an eye patch to affected eye Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Patch or shield both eyes to reduce movement + photophobia in pt's w/retinal injuries - Patch, shield or cover w/cool pack - Do NOT patch injured eye of pt w/suspected open or ruptured globe or impaled object, patch unaffected eye. Use metal or plastic and do not put pressure on the globe. - Provide psychosocial support - Obtain an ophthalmology consultation - Provide d/c instructions: - Importance of protective eyewear - No driving w/eye patch on - Wear sunglasses to prevent tearing, aid photophobia - Prepare for admission, OR or transfer What are the nursing interventions for a patient with a maxillofacial or neck injury? - correct answer - Administer oxygen - For facial trauma, place pt in high-fowler's position if no spinal injury is present. - Insert OG or NGT. OGT should be used if basilar skull fx or severe midface fx's are suspected Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Monitor for progressive airway assessment - Prepare for intubation, PRN. - Cannulate 2 large IV's, initiate isotonic crystalloid IV solution - Control external bleeding w/direct pressure - Monitor for continued bleeding + expanding hematomas - Apply cold compresses to face to minimize edema - Assist w/repair of oral lac's, PRN - Admin antibiotics - Stabilize impaled objects - Admin analgesic meds With any eye injury, what should the evaluation and ongoing assessments be? - correct answer - Reassessing visual acuity at reasonable intervals - Reassessing pain, including response to nonpharmacologic + pharmacologic interventions - Monitoring appearance, position, movements of globe and pupillary responses - Monitoring airway patency, respiratory effort and ABG's Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Tachycardia - Hyerresonance (increased echo produced by percussion over the lung field) on the injured side - Decreased or absent breath sounds on the injured side - Chest pain - Open, sucking wound on inspiration (open pneumothorax) Define tension pneumothorax. - correct answer Life-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. What are the S/S of a tension pneumothorax? - correct answer - Severe respiratory distress - Markedly diminished or absent breath sounds on affected side Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - hypotension - Distended neck, head and upper extremity veins-may not be clinically appreciated if significant blood loss present - Tracheal deviation - shift toward uninjured side (LATE sign) - Cyanosis (LATE sign) Define Hemothorax. - correct answer Accumulation of blood in the pleural space. What are the S/S of Hemothorax? - correct answer - Dyspnea, tachypnea - Chest pain - Signs of shock - Decreased breath sounds on injured side - Dullness to percussion on the injured side What is a pulmonary contusion? - correct answer They occur as a result of direct impact, deceleration or high-velocity bullet wounds. It develops when blood leaks into lung parenchyma, causing edema + hemorrhage. This usually develops overtime and not immediately. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What are the S/S of pulmonary contusion? - correct answer - Dyspnea - Ineffective cough - Hemoptysis - Hypoxia - Chest pain - Chest wall contusion or abrasions What happens to a ruptured diaphragm? - correct answer Potentially life-threatening, results from forces that penetrate the body. Left hemidiaphragm is more susceptible to injury because the right side is protected by the liver. - Herniation of abdominal contents - Respiratory compromise b/c impaired lung capacity + displacement of normal tissue. - Mediastinal structures may shift to opposite side of injury What are S/S of a ruptured diaphragm? - correct answer (Anything below the nipple line and should be evaluated for potential diaphragmatic injury). Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Loud systolic murmur in parascapular region - Chest pain - Chest wall ecchymosis - Widened mediastinum on chest xray - Paraplegia How would you assess a pt with a thoracic injury? - correct answer (Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP What is the planning and implementation for thoracic injury? - correct answer p. 142 What is kinematics? - correct answer A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What are signs of ineffective breathing? - correct answer - AMS - Cyanosis, especially around the mouth - Asymmetric expansion of chest wall - Paradoxical movement of the chest wall during inspiration and expiration - Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing - Sucking chest wounds - Absent or diminished breath sounds - Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated - Anticipate definitive airway management to support ventilation. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - correct answer A tight-fitting nonrebreather mask at 12-15 lpm. What intervention should be done if a pt presents with effective circulation? - correct answer - Insert 2 large caliber IV's - Administer warmed isotonic crystalloid solution at an appropriate rate Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What are signs of ineffective circulation? - correct answer - Tachycardia - AMS - Uncontrolled external bleeding - Pale, cool, moist skin - Distended or abnormally flattened external jugular veins - Distant heart sounds What are the interventions for Effective/Ineffective Circulation? - correct answer - Control any uncontrolled external bleeding by: - Applying direct pressure over bleeding site - Elevating bleeding extremity - Applying pressure over arterial pressure points - Using tourniquet (last resort). - Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution - Use warmed solution - Use pressure bags to increase speed of IVF infusion - Use blood administration tubing for possible administration of blood Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Use rapid infusion device based on protocol - Use NS 0.9% in same tubing as blood product - IV = surgical cut-down, central line, or both. - Blood sample to determine ABO and Rh group - IO in sternum, legs, arms or pelvis - Administer blood products - PASG (without interfering with fluid resuscitation) How do you assess Mnemonic "D"? - correct answer DISABILITY A = Alert V = Verbal P = Pain U = Unresponsive - GCS - PERRL? - Determine presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils - Symptoms that help to locate area of injury in brain Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is assessed under the Mnemonic "I"? - correct answer INSPECT POSTERIOR SURFACES - While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks and posterior thighs. - Palpate vertebral column for deformity and areas of tenderness - Assess rectum for presence/absence of tone, presence of blood What she be done after the Secondary Assessment? - correct answer Reassess: - Primary survey, - VS - Pain - Any injuries What are factors that contribute to ineffective ventilation? - correct answer - AMS - LOC - Neurologic injury - Spinal Cord Injury Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Intracranial Injury - Blunt trauma - Pain caused by rib fractures - Penetrating Trauma - Preexisting hx of respiratory diseases - Increased age What medications are used during intubation? - correct answer LOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents What are the Rapid Sequence Intubation Steps? - correct answer PREPARATION: - gather equipment, staffing, etc. PREOXYGENATION: - Use 100% O2 (prevent risk of aspiration). Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers PRETREATMENT: - Decrease S/E's of intubation PARALYSIS WITH INDUCTION: - Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING: - Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration PLACEMENT WITH PROOF - Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate pt 30-60 seconds between attempts. - After intubation, inflate the cuff - Confirm tube placement w/exhaled CO2 detector. POSTINTUBATION MANAGEMENT: - Secure ET tube - Set ventilator settings - Obtain Chest x-ray - Continue to medicate - Recheck VS and pulse oxtimetry Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Esophageal detection device - Chest x-ray How do you inspect the chest for adequate ventilation? - correct answer Observe: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when auscultating lung sounds? - correct answer Absence of BS: - Pneumothorax - Hemothorax - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What are you looking for when percussing the chest? - correct answer Dullness: - hemothorax Hyperresonance - Pneumothorax What are you looking for when palpating the chest wall, clavicles and neck? - correct answer - Tenderness - Swelling - subcutaneous emphysema - step-off deformities = These may indicate: esophageal, pleural, tracheal or bronchial injuries. Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax. What is the DOPE mnemonic? - correct answer D - Displaced tube O - Obstruction: Check secretions or pt biting tube Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing Explain Hypovolemic Shock. - correct answer Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. Explain Cardiogenic Shock. - correct answer Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is renal response? - correct answer Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes: - Vasoconstriction of arterioles and some veins - Stimulation of sympathetic nervous system - Retention of water by kidneys - Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. Explain adrenal gland response. - correct answer When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers Explain Hepatic Response. - correct answer Liver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Pulmonary Response. - correct answer Tachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? ICP is a reflection of what three volumes? What happens when one increases? - correct answer 1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. What are the early signs and symptoms of increased ICP? - correct answer - Headache - N/V - Amnesia regarding events around the injury - Altered LOC - Restlessness, drowsiness, changes in speech, or loss of judgement What are the late observable signs of symptoms of increased ICP? - correct answer - Dilated, nonreactive pupil - Unresponsiveness to verbal or painful stimuli - Abnormal motor posturing patterns - Widening pulse pressure - Increased systolic blood pressure - Changes in RR and pattern - Bradycardia Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is Cushing's phenomenon or Cushing's Reflex? - correct answer Triad of progressive HTN, bradycardia and diminished respiratory effort. What are the two types of herniation that occurs with ICP? - correct answer 1. Uncal herniation 2. Central or transtentorial herniation Why does herniation occur? What are the symptoms? - correct answer Because of uncontrolled increases in ICP. S/E's - Unilateral or bilateral pupillary dilation - AsyDimmetric pupillary reactivity - Abnormal motor posturing - Other evidence of neurologic deterioration Define uncal herniation. - correct answer The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What are the signs and symptoms of postconcussive syndrome? - correct answer - Persistent H/A - Dizziness - Nausea - Memory impairment - Attention deficit - Irritability - Insomnia - Impaired judgement - Loss of libido - Anxiety - Depression What is diffuse axonal injury and its signs and symptoms? - correct answer (DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic damage primarily to axons within the brain. S/S: - Immediate unconsciousness Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers - mild DAI, coma = 6-24 hrs - severe DAI, coma = weeks/months or persistent vegetative state - Elevated ICP - Abnormal posturing - HTN - Hyperthermia - Excessive sweating because of autonomic dysfunction - Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits What is a cerebral contusion and its S/S? - correct answer A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S: - Alteration in LOC - Behavior, motor or speech deficits - Abnormal motor posturing - Signs of increased ICP Combine - of 4 TNCC test. TNCC test prepA, 8th Edition, TNCC Test prep 8th Edition, TNCC Written Exam, TNCC final exam test 2024 open book Questions And Answers What is an epidural hematoma and its S/S? - correct answer Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly: - Compression of underlying brain - rapid increase in ICP - Decreased CBF - Secondary brain injury * Usually requires surgical intervention S/S: - Transient LOC - Lucid period lasting a few minutes to several hours - Rapid deterioration in neurologic status - Severe H/A - Sleepiness - Dizziness - N/V - Hemiparesis or hemiplegia on opposite side of hematoma - Unilateral fixed and dilated pupil on same side of hematoma