TNCC 40 Practice Exam Questions with 100% Correct Answers, Exercises of Medicine

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TNCC 40 Practice Exam Questions

A patient arrives at the emergency department by private vehicle after sustaining an injury to the right lower extremity while using a saw. There is a large gaping wound to the right thigh area with significant bleeding. What is the priority intervention?

A. Elevate the extremity to the level of the heart B. Initiate direct pressure C. Apply a tourniquet D. Cover the open wound with sterile saline dressings - ✔ ✔ B. Initiate direct pressure Which of the following is considered a cornerstone of a high-performance trauma team?

A. Individual goals B. Use of TeamSTEPPS C. Identification of a single decision maker D. Effective communication - ✔ ✔ D. Effective communication

Rationale: Skilled communication, cooperation, and coordination are the cornerstones of high- performance and high-quality trauma care. While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a sign of possible altered mental status?

A. Sunken fontanel B. Crying, but consolable C. Spontaneous movement of arms and legs D. Cooperation with the assessment - ✔ ✔ D. Cooperation with the assessment

Rationale: The first step inn controlling any bleeding is application of direct pressure. A patient fell two weeks ago, striking their head. Today, the patient presented with a persistent headache and nausea and was diagnosed with a small subdural hematoma. The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports the patient has been anxious, restless, shaky, and vomited twice during the night. The patient states they couldn't sleep because a young child kept coming into the room. What is the most likely cause for these signs and symptoms?

A. Increased intracranial pressure B. Alcohol withdrawal C. Rhabdomyolysis D. Pulmonary embolus - ✔ ✔ B. Alcohol withdrawal

Rationale: Alcohol withdrawal is a common delayed condition because symptoms are difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures.

Rationale: Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function, resulting in a paralyzed diaphragm and inability to breathe. Maintenance of respiratory function is the highest priority. A trauma nurse cared for a child with devastating burns two weeks ago. The nurse called in sick for a couple of days and is now back working on the team. Which of the following would indicate this nurse is coping well?

A. They are talking about taking the emergency nursing certification exam B. They keep requesting to be assigned to the walk-in/ambulatory area C. They are impatient and snap at their coworkers D. They are thinking about transferring out of the emergency department - ✔ ✔ A. They are talking about taking the emergency nursing certification exam

Rationale: This is an indication the nurse is taking positive steps to advance their own practice, a sign of resilience. B indicates the nurse is still not ready to return to their previous level of engagement in their job. C shows signs of burnout, irritability and frustration. D shows decreased satisfaction with the job, a sign of burnout.

Rationale: Penetrating neck trauma may include concurrent injuries to the cervical spine and cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the cervical spine. A patient involved in a MVC has sustained a fracture to the second rib of the anterior left chest. Which concurrent injury is most commonly associated with this fracture?

A. Blunt cardiac injury B. Brachial plexus injury C. Pneumothorax D. Hemothorax - ✔ ✔ B. Brachial plexus injury

Rationale: First and second rib fractures are most commonly associated with great vessel, head and spinal cord, and brachial plexus injuries. A patient with a spinal cord injury at C5 is being cared for in the emergency department while awaiting transport to a trauma center. Which of the following represents the highest priority for ongoing assessment and management for this patient?

A. Maintain adequate respiratory status B. Administer balanced resuscitation fluid C. Perform serial assessments of neurologic function D. Maintain core temperature - ✔ ✔ A. Maintain adequate respiratory status Following a bomb explosion, fragmentation injuries from the bomb or objects in the environment are examples of which phase of injury?

A. Primary B. Secondary C. Tertiary D. Quaternary - ✔ ✔ B. Secondary

In a patient with severe traumatic brain injury, hypocapnia causes which condition?

A. Respiratory acidosis B. Metabolic acidosis C. Neurogenic shock D. Cerebral vasoconstriction - ✔ ✔ D. Cerebral vasoconstriction

Rationale: Hypocapnia, or low levels or carbon dioxide, will cause vasoconstriction, especially in the cerebral vasculature. A - hypercapnia from inadequate ventilation causes respiratory acidosis. B - metabolic acidosis results from tissue hypoperfusion and oxygen deficit. C - neurogenic shock is associated with spinal cord injuries and results in generalized vasodilation. The vital signs of a pregnant trauma patient at 30 weeks include a blood pressure of 94/62 mmHg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following?

A. Decompensated shock B. Normal vital signs in pregnancy C. Compensated shock D. Supine hypotension syndrome - ✔ ✔ B. Normal vital signs in pregnancy

Rationale: In pregnancy, the resting heart rate increases by 10 to 20 beats/minute. This is also a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance. Normal fetal heart rate is between 120 and 160 beats/minute. Rationale: The reverse Trendelenburg position will benefit both airway maintenance and work of breathing in the obese patient. What is the leading cause of preventable death for the trauma patient in the prehospital environment?

A. Airway compromise B. Ineffective ventilation C. Secondary head injury D. Uncontrolled external hemorrhage - ✔ ✔ D. Uncontrolled external hemorrhage

Rationale: Uncontrolled external hemorrhage is the leading cause of preventable death after injury in the prehospital environment; assessment to identify uncontrolled external hemorrhage is key to the initial assessment process, beginning with the general impression. What is the best measure of the adequacy of the cellular perfusion and can help to predict the outcome of resuscitation?

A. End-tidal carbon dioxide B. Hematocrit C. Base deficit D. Oxygen saturation - ✔ ✔ C. Base deficit Treatment for frostbite can include which of the following interventions?

A. Warm the affected part over 30 to 60 minutes B. Use gentle friction to improve circulation C. Administer tissue plasminogen activator D. Drainage of all large and small blisters - ✔ ✔ C. Administer tissue plasminogen activator

Rationale: With frostbite, thrombus formation is a risk. Tissue plasminogen activator, a thrombolytic medication, has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming. Rationale: To assess for pelvic instability, gentle pressure is applied over the iliac crests, downward and medially.

Rationale: Base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and, when used in conjunction with serum lactate, helps predict the success of the resuscitation. What is the best position for maintaining an open airway in the obese patient?

A. Prone B. Supine C. Reverse Trendelenburg D. Right lateral recumbent - ✔ ✔ C. Reverse Trendelenburg

Rationale: Mechanism of injury and energy transfer can assist the provider in anticipating and evaluating the types of injuries that may be present and their severity. What is the appropriate technique for palpating the pelvis for stability?

A. Apply gentle pressure over the iliac crests, downward and laterally B. Apply gentle pressure over the iliac crests, downward and medially C. Apply firm pressure over the iliac crests, downward and laterally D. Apply firm pressure over the iliac crests, downward and medially - ✔ ✔ B. Apply gentle pressure over the iliac crests, downward and medially

Rationale: The secondary phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries. An adult patient with a knife injury to the neck has an intact airway and is hemodynamically stable. They complain of difficulty swallowing and speaking. In the primary survey, further assessment is indicated next for which of the following conditions?

A. Damage to the cervical spine B. An expanding pneumothorax C. Laceration of the carotid artery D. Injury of the thyroid gland - ✔ ✔ A. Damage to the cervical spine Rationale: Therapeutic communication techniques such as active listening decrease unintentional distress during the interaction. What technique is most appropriate when obtaining a history from a patient who has experienced a sexual assault?

A. Sitting next to the patient B. Ensuring the patient answers all the questions C. Asking for information only related to the assault D. Applying active listening - ✔ ✔ D. Applying active listening Understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma care provider in which of the following?

A. Anticipating the types of injuries that may be present B. Deciding whether law enforcement should be notified C. Determining needed laboratory tests D. Predicting the need for a surgical procedure - ✔ ✔ A. Anticipating the types of injuries that may be present

Which of following accurately describes ventilation principles associated with use of bag-mask device for an adult?

A. Compress the bag-mask device at a rate of one breath every 6 seconds B. Delivers 100% oxygen C. Squeeze the bag-mask device completely for each breath D. Maintain the oxygen saturation levels between 92% and 94% - ✔ ✔ A. Compress the bag-mask device at a rate of one breath every 6 seconds

Rationale: If breathing is ineffective for an adult, assist ventilations by compressing the bag-mask device at a rate of one breath every 6 seconds.

Rationale: An alert older infant or toddler will recognize their caregiver, be cautious of strangers, and may not respond to commands or cooperate, which are normal. A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? a. Decompensated shock b. Normal vital signs in pregnancy c. Abruptio placentae d. Supine hypotension syndrome - ✔ ✔ b. Normal vital signs in pregnancy Rationale: In pregnancy, the resting heart rate increases by 10 to 20 beats/minute and a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance (p. 294). Normal fetal heart rate is between 120 and 160 beats/minute (p. 297). A patient fell two weeks ago, striking his head. He came to the emergency department with a persistent headache and nausea. He was diagnosed with a small subdural hematoma and has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports that he has been anxious, restless, and shaky. He vomited twice during the night. He tells the day shift nurse that he couldn't sleep because a young child kept coming into his room. What is a likely cause for these signs and symptoms? a. Increased intracranial pressure

b. Alcohol withdrawal c. Rhabdomyolysis d. Pulmonary embolus - ✔ ✔ b. Alcohol withdrawal Rationale: Alcohol withdrawal is a common delayed condition because symptoms are difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or vomiting, psychomotor agitation, anxiety, insomnia, hallucinations, or seizures (p. 397). A patient with a knife injury to the neck has an intact airway and is hemodynamically stable. He complains of difficulty swallowing and speaking. Further assessment is indicated next for which of the following conditions? a. Damage to the spinal cord b. An expanding pneumothorax c. Laceration of the carotid artery d. Injury to the thyroid gland - ✔ ✔ a. Damage to the spinal cord Rationale: Penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the spinal cord (pp. 124, 126). The general impression step in the initial assessment provides the opportunity to do which of the following?

A. Assess for uncontrolled internal hemorrhage B. Accurately triage the patient C. Reprioritize circulation before airway or breathing D. Activate the trauma team - ✔ ✔ C. Reprioritize circulation before airway or breathing

Rationale: The general impression is formed at the beginning of the primary survey to rapidly assess the need to reprioritize circulation before airway or breathing. This is done if uncontrolled external hemorrhage is identified. A patient with a spinal cord injury at C5 is being cared for in the emergency department while awaiting transport to a trauma center. Which of the following represents the highest priority for ongoing assessment and management?

a. Maintain adequate respiratory status b. Administer balanced resuscitation fluid c. Perform serial assessments of neurologic function d. Maintain core temperature - ✔ ✔ a. Maintain adequate respiratory status Rationale: Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function, resulting in a paralyzed diaphragm and inability to breathe (p. 173, 179). The nurse is obtaining a history for a patient who presents following sexual assault. This history is completed using which of the following techniques? a. Bring the family in to the interview room b. Use direct quotes to record information c. Obtain information specific to the assault, not what happened afterward d. Provide food and drink before creating a rapport - ✔ ✔ b. Supine Rationale: In the supine position, the chest and diaphragm can become obstructed due to excess abdominal mass, hindering effective ventilation. The reverse Trendelenburg position, not the supine position, will benefit both airway maintenance and work of breathing in the bariatric patient (p. 281, 285). Treatment for frostbite includes: a. Warm the affected part slowly over 30 to 60 minutes b. Use gentle friction to improve circulation c. Administer tissue plasminogen activator d. Leave blisters intact - ✔ ✔ c. Administer tissue plasminogen activator Rationale: With frostbite, thrombus formation is a risk. Tissue plasminogen activator or nonsteroidal antinflammatory medication can be administered (p. 215). Tissue plasminogen activator has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming (p. 215). Based on proper bleeding control techniques, what is the first step to stop the bleeding of a penetrating injury to the lower extremity? a. Elevate the extremity to the level of the heart b. Initiate direct pressure c. Apply a tourniquet

d. Cover the open wound with sterile saline dressings - ✔ ✔ b. Initiate direct pressure Rationale: The first step in controlling any bleeding is direct pressure. If that is not adequate, the application of a tourniquet may be needed (p. 201-204). Following a bomb explosion, fragmentation injuries from the bomb or objects in the environment are examples of which phase of injury? a. Primary b. Secondary c. Tertiary d. Quaternary - ✔ ✔ b. Secondary Rationale: The secondary phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries (p. 20). In a patient with severe traumatic brain injury, hypocapnia causes: a. Respiratory acidosis b. Metabolic acidosis c. Neurogenic shock d. Cerebral vasoconstriction - ✔ ✔ d. Cerebral vasoconstriction Rationale: Hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the cerebral vasculature (p. 98). A trauma nurse cared for a child with devastating burns two weeks ago. She called in sick for a couple of days and is now back working on the team. Which of the following behaviors would indicate this nurse is coping well? a. She is talking about taking the emergency nursing certification examination b. She keeps requesting to be assigned to the walk-in/ambulatory area c. She is impatient and snaps at coworkers d. She is thinking about transferring out of the emergency department - ✔ ✔ a. She is talking about taking the emergency nursing certification examination Rationale: This is an indication she is taking positive steps to advance her own practice, a sign of resilience (p. 338). The across-the-room observation step in the initial assessment provides the opportunity to: a. Assess for uncontrolled internal hemorrhage b. Accurately triage the patient c. Reprioritize circulation before airway or breathing

d. Activate the trauma team - ✔ ✔ c. Reprioritize circulation before airway or breathing. Rationale: The across-the-room observation is done at the beginning of the primary survey to rapidly assess the need to reprioritize circulation before airway or breathing. This is done if uncontrolled external hemorrhage is identified (p. 28). The major preventable cause of death in the trauma patient is: a. Airway compromise b. Ineffective ventilation c. Secondary head injury d. Uncontrolled hemorrhage - ✔ ✔ d. Uncontrolled hemorrhage Rationale: Uncontrolled hemorrhage is the major cause of preventable death after injury, so assessment to identify uncontrolled hemorrhage is key to the initial assessment process (p. 29). What is a safe pharmacological alternative to opioids for rib fracture pain management in the anticoagulated patient? a. Corticosteroids b. Intercostal nerve blocks c. Nonsteroidal anti-inflammatory drugs d. Epidural anesthetics - ✔ ✔ b. Intercostal nerve blocks Rationale: Continuous intercostal nerve blocks use long-acting anesthetics and can provide safe and effective pain management for the anticoagulated patient (pp. 271, 273). What is the appropriate technique for palpating the pelvis for stability? a. Apply gentle pressure over the iliac crests downward and laterally b. Apply gentle pressure over the iliac crests downward and medially c. Apply firm pressure over the iliac crests downward and laterally d. Apply firm pressure over the iliac crests downward and medially - ✔ ✔ b. Apply gentle pressure over the iliac crests downward and medially Rationale: To assess for pelvic instability, gentle pressure is applied over the iliac crests downward and medially (p. 149). What is the best position for maintaining an open airway in the bariatric patient? a. Prone b. Supine

c. Reverse Trendelenburg d. Right lateral recumbent - ✔ ✔ c. Reverse Trendelenburg Rationale: The reverse Trendelenburg position will benefit both airway maintenance and work of breathing in the bariatric patient (p. 285). What is the key to a high-performance trauma team? a. Individual goals b. Use of TeamSTEPPS c. Identification of a single decision maker d. Effective communication - ✔ ✔ d. Effective communication Rationale: Skilled communication, cooperation, and coordination are the cornerstones of high-performance teams and high-quality trauma care (p. 5). Which of the following accurately describes ventilation principles associated with a bag-mask device? a. Ventilate at a rate of 10 to 12 breaths/minute b. Deliver 100% oxygen c. Compress the bag-mask device completely d. Maintain the oxygen saturation level between 92% and 94% - ✔ ✔ a. Ventilate at a rate of 10 to 12 breaths/minute Rationale: If ventilation is ineffective, assist ventilations at 10 to 12 breaths/minute or one every 5 to 6 seconds (p. 32). Which of the following is the best measure of the adequacy of cellular perfusion and helps to predict the outcome of resuscitation? a. End-tidal carbon dioxide b. Hypoxia c. Base deficit d. Oxygen saturation - ✔ ✔ c. Base deficit Rationale: Base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and when used in conjunction with serum lactate helps predict the success of the resuscitation (p. 57). While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a potential sign of mental status changes? a. Sunken fontanel b. Crying, but consolable

c. Hyperglycemia d. Cooperation with the assessment - ✔ ✔ d. Cooperation with the assessment Rationale: An alert older infant or toddler will recognize his or her caregiver, be cautious of strangers, and may not respond to commands, which is a normal response (p. 235). When obtaining a history for an injured patient, understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma provider in: a. Evaluating and anticipating the types of injury that may be present b. Deciding whether law enforcement should be notified c. Determining needed laboratory tests d. Predicting the need for a surgical procedure - ✔ ✔ a. Evaluating and anticipating the types of injury that may be present Rationale: Mechanism of injury and energy transfer can assist the provider in evaluating and anticipating damage (p. 23).