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TNCC 9TH EDITION EXAM 50 MCQs QUESTIONS AND
ANSWERS GRADED A+
TNCC 9TH REAL EXAM ACTUAL VERIFIED EXAM TEST BANK
QUESTIONS AND ANSWERS EXPERT VERIFIED DETAILED
ANSWERS| ALREADY GRADED A
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 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 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 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 What is the leading cause of preventable death for the trauma patient in the prehospital environment? a. Airway compromise b. Ineffective ventilation
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. 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. increase intracranial pressure b. alcohol withdrawal c. rhabdomyolysis d. pulmonary embolus b. alcohol withdrawal Treatment for frostbite can include which of the following interventions? a. warm the affected part over 30-60 minutes b. use gentle friction to improve circulation c. administer tissue plasminogen activator d. leave all of the blisters intact c. administer tissue plasminogen activator 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 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 behaviors would indicate this nurse is coping well? a. They are talking about taking the emergency nursing certification examination. 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 examination. Which of the following accurately describes ventilation principles associated with use of a 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. 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. The vital signs of a pregnant trauma patient at 30 weeks 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. Compensated shock d. Supine hypotension syndrome b. Normal vital signs in pregnancy 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 An adult pt who sustained a severe head trauma has been intubated and is being manually ventilated via a bag-mask device at a rate of 18 breaths/minute. The pt has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. the PaCO2 is 30mmHg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mmHg. What is the most important intervention to manage the cerebral blood flow? Decrease the rate of manual ventilation An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The pt was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness and a hematoma is noted to the forehead. The pt is currently on anticoagulant therapy. What is most likely the cause of their symptoms?
Expedite transfer to the closest trauma center A patient who weighs 120 kg is brought to the emergency department after sustaining partial thickness burns to both upper extremities and chest with a total body surface area burned of 27 %
. How much intravenous fluid should be administered in the first 8 hours? 3240 mL A trauma patient is being held in the emergency department because there are no available inpatient beds. The patient sustained a femur fracture and required multiple blood products. The patient now has blood oozing from abrasions , IV sites , the nose , and gums. What condition is most consistent with these findings? Disseminated intravascular coagulopathy A patient is brought to the emergency department following a snowmobile crash with prolonged exposure time prior to transport. The patient is confused. Vital signs are BP 96/54 mm Hg , HR 114 beats / minute , RR 24 breaths / minute , T 34.60C ( 94.20F ) and an SpO2 of 90 % on oxygen at 15L per non - rebreather mask. Other findings include ETCO2 24 , scrum lactate of 6 mmol / L , and a pH of 6.8. Based on these findings what is the most appropriate intervention Initiate warming measures Which of the following is a late sign of increased intracranial pressure? Decreased respiratory effort Based on fall mechanism , which patient warrants prehospital transfer to a trauma center? A 2 - year - old lands on grass from a second - story balcony nurse is caring for an unrestrained The trauma nurse is caring for an unrestrained driver who struck their head on the windshield following a high - speed MVC. The patient has been diagnosed with an anterior spinal cord injury at the level of C6. Which assessment finding would be most concerning? Increasing work of breathing While caring for a child who has been injured , what nursing intervention consistent with a family center approach Allowing family to participate in the care of the patient A patient is brought to the emergency department with chest pain and shortness of breath following a high - speed motor vehicle collision in which they were the unrestrained driver There is crepitus to the left chest with clear and equal breath sounds. The vital signs are BP 80/ mmHg HR 140 beats / minute , and RR 40 breaths / minute. Cardiac monitor shows sinus tachycardia with premature ventricular contractions. These findings are most consistent with which type of shock Cardiogenic Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadiani , crepitus in the lower right ribs , and cechymosis around the umbilicus The nurse is concerned about injury to which organ Liver A 5 - year - old child presents to the emergency department with bruises to the upper arms 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 nursing intervention?
Report your suspicion of maltreatment in accordance with local regulations A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which intervention is most appropriate for this patent? Prepare the patient for surgery to remove the rod. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns? During the secondary survey Which of the following is true about use of the focused assessment sonography for trauma exam for a patient with abdominal trauma? It can be used in hypotensive patients too unstable for computed tomography scan What is the priority intervention for a child who has been diagnosed th an atlanto - occipital dislocation following a high - speed motor vehicle collision? Maintaining spinal motion restriction What position optimizes ventilation in the obese patient with a lumbar Fracture Reverse Trendelenburg During the primary survey of an unconscious patient with multi system trauma , the nurse notes snoring respirations Which priority nursing tervention should be performed next? Insert an oropharyngeal airway if there is no gag reflex The patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrani , crepitus in the lower rigini rius , and cechymosis around the umbilicus. The nurse is concerned about injury to which organ? Liver A patient arrives following prolonged exposure of their left hand to the cold The patient is awake and alert and complains of a tingling sensation to the fingers. Assessment reveals swelling and bright red skin to the left hand and a 1 - inch round clear blister to the dorsum of that hand. Which of the following nursing interventions is most appropriate for this patient? Gently rewarm over 15 to 30 minutes A nurse verbalizes guilt and remorse after caring for multiple severely injured patients during a staffing crisis. The nurse expresses anger stating that the patients did not receive quality care and begins exhibiting aggression toward colleagues. This is most consistent with which condition? Moral injury What is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient? Gauges end organ perfusion and tissue hypoxia What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries? Medical history including current medications
A driver involved in a high - speed motor vehicle collision arrives in the emergency department. The vehicle's air - bag failed to deploy. The patient is drowsy bui arousable and complaining of chest pain wit ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions Which of the following is the most appropriate intervention for this patient? Inotropic support Which of the following situations could cause functional grief? Amputation of a limb Using the American College of Surgeons screening guidelines what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? Alert with no neurologic deficits An adult was thrown against a concrete wall during a factory explosion and sustained a femur fracture , liver laceration , and a small subdural hematoma These injuries most likely occurred during what level of blast trauma? Tertiary An adult patient was brought to the emergency department following a motorcycle crash. On arrival , the patient is only responsive to pain , has bleeding from the nose , and multiple abrasions and contusions to the face. What is the priority intervention? Use a law thrust to open the air way and look for signs of obstruction An adult pedestrian was struck on the right side by a sport utility vehicle traveling at 40 mph. The patient is awake and alert and the right leg is shortened. Following initial resuscitation with fluids , the patient remains hypotensive. What would be the priority intervention? Apply a pelvic binder A patient has a closed fracture to the left lower leg. Which symptoms are consistent with compartment syndrome Pain, diminished pedal pulse, pressure Which of the following characteristics is found in high performing teams Interdisciplinary collaboration An unresponsive patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. Medication for drug-assisted intubation have been administered but intubation was unsuccessful. What is the most appropriate next step? Ventilate with a bag-mask device An adult arrives at the emergency department with superficial burns to the extremities following a house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is most likely cause of these symptoms? CO2 poisoning An adult patient was a restrained passenger involved in a high-speed motor vehicle collision. The patient complained of generalized abdominal and left leg pain. A FAST exam was negative for
fluid in the abdominal cavity. While awaiting inpatient bed placement, the patient develops increased abdominal pain w/rebound tenderness, fever and elevated WBC. These findings are most consistent w/ an injury to which organ? Small bowel A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention? Apple direct pressure to the wound A 36 year old patient has a deformity of left wrist after a fall. The patient is reluctant to move their hand due to pain. Which of the following is the most appropriate intervention? Apply a splint and elevate the extremity above the level of the heart A trauma patient is being resuscitated in the emergency department when the radiology staff notifies the charge nurse that the CT scanner will be out of service for several hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication? Huddle A seriously injured patient is noted to have a weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpating and blood at the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What would be the most appropriate next intervention for this patient? Insertion of a suprapubic catheter A teenaged patient presents to the ED w/ left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is the most consistent w/ human trafficking Those experiencing human trafficking rarely self disclose An older patient w/a history of anticoagulant use presents after a fall at home the previous day. They deny loss of consciousness. The patient has a hematoma to their forehead and complains of headache, dizziness, left arm weakness, and nausea. What is the most likely cause of these symptoms? Subdural hematoma Which of the following is an expected finding when assessing a patient with a tube thoracostomy connected to a chest drainage system Fluctuation in the water seal chamber What two noninvasive interventions are used to assess for the adequacy of oxygenation and effectiveness of ventilation Pulse oxide try and capnography A trauma patient involved in a fall from 25 ft has a TBI, three anterior rib fractures on the right side, a small pneumothorax on the right, and grade III liver injury. The patient was intubated and placed on a ventilator w/ PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning
An adult patient is being treated in the ED after falling 30 ft and landing on their head. The patient has been intubated and initial stabilization efforts are ongoing. The vital sign are BP 70/40, HR 44, and respirations are being assisted at 16. The patient skin is warm, dry, and normal color. These findings are most consistent w/ what type of shock? Neurogenic Which of the following is true regarding cavitation Energy causes the tissues to accelerate and displace outward Which of the following is true about the log roll maneuver It should be avoided with a suspected spine injury prior to imaging Version 2
- An adult patient who sustained a severe head trauma has been intubated and is being manually ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to manage the cerebral blood flow? A. Decrease the rate of manual ventilation B. Initiate another fluid bolus. C. Recheck endotracheal tube placement. D. Increase the amount of oxygen delivered. A. Decrease the rate of manual ventilation
- Which of the following situations could cause functional grief? A. Inability to live at home B. Amputation of a limb C. Loss of one's self-image D. Destruction of the patient's car Rationale: Preparation and Ongoing Care\Psychosocial Aspects Functional grief relates to the loss of body function or body parts such as amputation of a limb, paralysis, or loss of sight. B. Amputation of a limb
- What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries? A. They are likely to be fearful in the emergency department B. Medical history including current medications C. Availability of support systems after discharge D. Accessibility to a primary care physician
C.
A. Elevating the leg above the level of the heart B. Repositioning the leg and applying ice Elevating the leg to the level of the heart D. Preparing the patient for ultrasound of the leg Rationale: Musculoskeletal and Wounds\Musculoskeletal This patient is exhibiting signs of possible compartment syndrome which is a dangerous complication of fractured extremities. The pain is often out of proportion to the injury and might not respond to pain medications. Elevate the limb to the level of the heart to decrease dependent edema but not above the heart, which can cause increased venous congestion and pressure within the compartment. C. Elevating the leg to the level of the heart
- A teenaged patient presents to the emergency department with left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is most consistent with human trafficking? A. The individual appears well nourished. B. Those who are being trafficked rarely seek medical care. C. It is infrequently associated with substance abuse. D. Those experiencing human trafficking rarely self-disclose. D. Those experiencing human trafficking rarely self-disclose.
- An intubated trauma patient has just been transported back from CT scan. Upon arrival to their room in the emergency department, resistance is noted with bag-mask ventilations and auscultation reveals unequal breath sounds. What is the most appropriate initial intervention for this patient? A. Place the patient back on the ventilator. B. Extubated the patient. C. Reposition the endotracheal tube. D. Suction the endotracheal tube. C. Reposition the endotracheal tube.
D.
- Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? A. Increased work of breathing B. Unilaterally diminished breath sounds C. Tachycardia Hypotension D. Hypotension
- A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what is the priority intervention? A. Initiate transfer to a trauma center B. Attempt family notification C. Obtain additional imaging studies D. Place an indwelling urinary catheter A. Initiate transfer to a trauma center
- A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention? A. Initiate two intravenous access sites B. Place the patient on supplemental oxygen C. Apply direct pressure to the wound D. Use a tourniquet to control the bleeding C. Apply direct pressure to the wound
- A trauma patient involved in a fall from 25 feet has a traumatic brain injury, three anterior rib fractures on the right side, a small pneumothorax on the right, and a Grade III liver injury. The patient was intubated and placed on a ventilator with PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning? A. Severely diminished breath sounds on the right B. Guarding in the right upper quadrant C. Ecchymosis in the right upper quadrant
C. Reflex tachycardia D. Reflex hypotension Rationale: Head and Torso Trauma\Head Trauma This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8 kPa) which is associated with poor outcomes. When the CPP falls below normal levels, the central nervous system initiates the Cushing response in an attempt to increase mean arterial pressure and improve CPP. Cushing response assessment findings include widening pulse pressure, reflex bradycardia, and irregular, decreased respiratory effort. Widening pulse pressure
- An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The patient was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness and a hematoma is noted to the forehead. The patient is currently on anticoagulant therapy. What is most likely the cause of their symptoms? A. Intracerebral hemorrhage B. Epidural hematoma C. Diffuse axonal injury D. Post-concussive syndrome Rationale: Special Populations\Older Adult Post-concussive syndrome can occur days to weeks after injury or trauma. The other three conditions present as a more rapid decline, especially in patients who are on anticoagulants. Post-concussive syndrome
- An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The patient was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness and a hematoma is noted to the forehead. The patient is currently on anticoagulant therapy. What is most likely the cause of their symptoms? A. Intracerebral hemorrhage B. Epidural hematoma C. Diffuse axonal injury D. Post-concussive syndrome
Rationale: Special Populations\Older Adult Post-concussive syndrome can occur days to weeks after injury or trauma. The other three conditions present as a more rapid decline, especially in patients who are on anticoagulants. D. Post-concussive syndrome A patient presents, after a 25-foot fall, with paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention? A. Surgical intervention B. Chest tube insertion C. Needle decompression D. Airway and ventilation support D. Airway and ventilation support
- A trauma patient is being held in the emergency department because there are no available inpatient beds. The patient sustained a femur fracture and required multiple blood products. The patient now has blood oozing from abrasions, IV sites, the nose, and gums. What condition is most consistent with these findings? A. Rhabdomyolysis B. Fat embolism C. Disseminated intravascular coagulopathy D. Multiple organ dysfunctions syndrome C. Disseminated intravascular coagulopathy
- Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about injury to which organ? A. Transverse colon B. Pancreas C. Liver D. Spleen Rationale: Head and Torso Trauma\Abdominal and Pelvic Trauma
