TNCC 9th Edition FINAL TEST. 75 QUESTIONS AND ANSWERS. GRADED A+, Exams of Nursing, Exams of Nursing

Download TNCC 9th Edition FINAL TEST. 75 QUESTIONS AND ANSWERS. GRADED A+, Exams of Nursing and more Exams Nursing in PDF only on Docsity! TNCC 9th Edition FINAL TEST. 75 QUESTIONS AND ANSWERS. GRADED A+, Exams of Nursing 1. 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 2. 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. Use a tourniquet to control the bleeding. D. Apply direct pressure to the wound. 3. A patient involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small penetrating wound to the sixth intercostal space in the left lateral chest. Which finding is most consistent with an injury to the diaphragm? A. Severe left-sided abdominal pain B. Pain radiating to the left shoulder. C. Bowel sounds heard in the left lower chest. D. Decreased breath sounds on the left side 4. 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 with rebound tenderness, fever, and an elevated white blood cell count. These findings are most consistent with an injury to which organ? A. Spleen B. Small bowel C. Kidney D. Liver 5. A patient is thrown against a car during a tornado and presents with obvious bilateral femur fractures. The patient is pale, alert, disoriented, and has delayed capillary refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principles? 1 A. Initiate two large-caliber intravenous lines for isotonic crystalloid administration. B. Administer intravenous medications for pain. C. Place the patient in an observation area for care within the next few hours. D. Contact the command centre for personnel to notify next of kin. 6. A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? A. Oculomotor nerve palsy B. Globe rupture C. Retrobulbar hematoma D. Retinal detachment 7. 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. The patient 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? A. Needle decompression B. Tube thoracostomy C. Dressing removal D. Surgical repair 8. 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 but arousable and complaining of chest pain with 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? A. Rapid fluid boluses B. Tranexamic acid administration C. Haemostatic resuscitation D. Inotropic support 9. 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. Initiate another fluid bolus. B. Recheck endotracheal tube placement. C. Decrease the rate of manual ventilation. D. Increase the amount of oxygen delivered. 10.A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention? A. Elevating the leg above the level of the heart 2 C. Repeat the GCS in 30 minutes D. Place the patient in Trendelenburg position 22. 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? A. Massage the injured areas to promote circulation B. Drain and debride the blister on the hand C. Immerse in water between 37.5oC and 39.5oC (99.5oF to 103.1oF). D. Gently rewarm over 15 to 30 minutes 23. 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? A. Compassion fatigue B. Vicarious trauma C. Secondary traumatic stress D. Moral injury 24. What is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient? A. Measures oxygenation and ventilation B. Assesses the degree of alkalosis and base deficit C. Gauges end-organ perfusion and tissue hypoxia D. Determines the underlying cause of shock 25. Following a gun shot wound, pre-hospital providers report diminished breath sounds bilaterally. Upon emergency department arrival, the patient is unresponsive with shallow respirations and an O2 sat of 88%. What is the priority intervention for this patient? A. Administer 15 L oxygen via nonrebreather mask B. Attach patient to a CO2 detector C. Prepare for a definitive airway D. Assist ventilation with a bag-mask device 26. 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 27. 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 5 no abnormalities found based on the paediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention? A. Report your suspicion of maltreatment in accordance with local regulations B. Apply ice to the bruises and provide wound care C. Engage in therapeutic communication to determine the mechanism of injury D. Provide the family with injury prevention resources 28. A trauma patient who is 30-weeks pregnant arrives at the emergency department following a motor vehicle collision. Which normal physiologic change should be considered when assessing ventilatory status? A. Increased functional reserve capacity B. Increased oxygen consumption C. Decreased minute ventilation D. Slower desaturation rates with apnea 29. 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 80/40 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? A. Cardiogenic B. Neurogenic C. Hypovolemic D. Obstructive 30. A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which intervention is most appropriate for this patient? A. Remove the rod immediately to facilitate cleansing. B. Apply a tourniquet to the leg above the metal rod. C. Hold antibiotics until after the rod is removed. D. Prepare the patient for surgery to remove the rod. 31. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns? A. As soon as the patient arrives B. During the secondary survey C. Should only be done at a burn center D. During the primary survey 32. Which of the following is true about use of the focused assessment sonography for trauma exam for a patient with abdominal trauma? A. It has a higher sensitivity than diagnostic peritoneal lavage for fluid detection B. It can be used in hypotensive patients too unstable for computed tomography scan C. It can detect as little as 30 mL of fluid in the abdominal cavity 6 D. It has high sensitivity in paediatric patients for identifying fluid in the peritoneum 33. What is the priority intervention for a child who has been diagnosed with an atlanto-occipital dislocation following a high-speed motor vehicle collision? A. Maintaining spinal motion restriction B. Initiating a second large caliber intravenous line C. Placing the patient on pulse oximetry D. Turning the patient to remove the backboard 34. During the primary survey of an unconscious patient with multisystem trauma, the nurse notes snoring respirations. Which priority nursing intervention should be performed next? A. Open the airway with the head-tilt/chin-lift manoeuvre B. Auscultate bilateral breath sounds C. Assist respirations using a bag-mask device D. Insert an oropharyngeal airway if there is no gag reflex 35. 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 36. 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 34.6oC (94.2oF) and an SpO2 of 90% on oxygen at 15L per non-rebreather mask. Other findings include ETCO2 24, serum lactate of 6 mmol/L, and a pH of 6.8. Based on these findings, what is the most appropriate intervention? A. Initiate warming measures B. Titrate oxygen to 6 L per nasal cannula C. Bolus with 500 mL isotonic crystalloids D. Vigorously massage the extremities 37. Based on fall mechanism, which patient warrants prehospital transfer to a trauma center? A. A 35-year-old lands on a wooden porch from an 8-foot ladder B. A 2-year-old lands on grass from a second-story balcony C. A 14-year-old forcefully pushed onto cement from standing D. A 50-year-old lands on a carpeted floor after tripping 38. 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? A. Distension of the bladder 7 B. Increased respiratory effort C. Reflex tachycardia D. Widening pulse pressure 50. A patient with a chest tube is being transported to the intensive care unit and fluctuation is noted in the water seal chamber during inspiration and expiration. What is the best action for the nurse to take? A. Clamp the chest tube B. Return to the emergency department C. Assist ventilation with bag-mask device D. Continue to intensive care unit 51. In a motor vehicle collision, which injury pathway is most likely to increase the patients morbidity and mortality? A. Rotational B. Ejection C. Lateral D. Rollover 52. 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 D. Hypotension 53. An 85 year old is brought to the emergency department by a family member for fever and cough. There are multiple bruises in various stages of healing on the upper extremities and the back. Based on these findings what is the most appropriate initial question to facilitate screening for abuse? A. Who takes care of you? B. How did you get these bruises? C. How long have you had these bruises? D. Did someone hurt you? 54. Caregivers carry a 2 year old into the emergency department who fell out of a second story window. The patient is awake and crying with increased work of breathing and pale skin. Which intervention has the highest priority? A. Stabilizing the cervical spine B. Applying a nonrebreather mask C. Establishing intravenous access D. Preparing for drug-assisted intubation 55. A patient arrives at the emergency department following a motor vehicle collision. Prehospital personnel report significant damage to the vehicle. The patient is alert and agitated with a strong 10 odour of alcohol and appears intoxicated. After physician evaluation, under what circumstances can an order to remove the rigid cervical collar be anticipated? A. No neurological abnormalities on examination B. No point tenderness to cervical spine C. Absence of neck pain with movement D. No imaging abnormalities of the neck 56. What intravascular solution is most commonly used for patients who have sustained burns? A. Lactated ringer’s B. Normal saline C. D5/normal saline D. Hypertonic saline 57. A patient arrives with a 3 inch laceration to their forearm from a tree branch. Which of the following methods will the nurse use to remove small pieces of bark and debris from the wound? A. Low pressure irrigation B. High pressure irrigation C. Scrubbing with normal saline D. Scrubbing with tap water 58.Which blood pressure finding is associated with early or compensated hypovolemic shock? A. Rising systolic B. Rising diastolic C. Decreasing diastolic D. Decreasing systolic 59. A patient involved in a fall from 25 feet has a traumatic brain injury, three anterior rib fractures 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 D. Crepitus to the right chest 60. 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 61. An adult presents to the emergency department after sustaining severe facial injuries during an altercation. The patient is awake, confused, and smells heavily of alcohol. Pulse oximetry is 94% on room air. Immediate intubation should be anticipated based on which clinical indicator? 11 A. Confusion B. Pulse oximetry reading C. Severe facial injuries D. Smell of alcohol on breath 62. An adult who fell from a second story roof is brought to the emergency department by private vehicle. The patient is confused with unlaboured respirations and has strong, palpable radial pulses. There is an open wound in proximity to an obvious deformity of the left lower extremity. What is the priority intervention? A. Initiate cervical spine stabilization B. Apply a splint to the lower extremity C. Put the patient on portable oxygen D. Log roll the patient onto a spine board 63. A trauma patient is enroute to a rural emergency department Radiology notifies the charge nurse that the computed tomography (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 team’s communication? A. Brief B. Closed loop C. Debrief D. Huddle 64. A seriously injured patient is noted to have weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpating and blood on the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What is most likely to be ordered next? A. Insert a urinary catheter B. Bolus with 2L isotonic crystalloid solution C. Diagnostic peritoneal lavage D. Insertion of a Supra public catheter 65. A 36-year-old patient has a deformity of the 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? A. Apply a sling and elevate the extremity to the level of the heart B. Apply a splint and elevate the extremity above the level of the heart C. Apply a sling and elevate the extremity above the level of the heart D. Apply a splint and elevate the extremity to the level of the heart 66. 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 12