TNCC 9th Edition FINAL TEST. 84 QUESTIONS AND ANSWERS. GRADED A+, Exams of Nursing, Exams of Nursing

Download TNCC 9th Edition FINAL TEST. 84 QUESTIONS AND ANSWERS. GRADED A+, Exams of Nursing and more Exams Nursing in PDF only on Docsity! TNCC 9th Edition FINAL TEST. 84 QUESTIONS AND ANSWERS. GRADED A+, Exams of Nursing Some reviews from verified buyers: 1. 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. Establishing intravenous access. B. Preparing for drug-assisted intubation. C. Stabilizing the cervical spine. D. Applying a nonrebreather mask. 2. Which of the following is true about the log-roll maneuver? A. It causes less spinal motion than the lift-and-slide maneuver B. It is recommended for patients with unstable pelvic fractures. C. It should be avoided with a suspected spine injury prior to imaging D. It decreases the risk of hemorrhage from unstable pelvic injuries. 3. 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. 4. 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. Bowel sounds heard in the left lower chest. B. Severe left-sided abdominal pain C. Pain radiating to the left shoulder. D. Decreased breath sounds on the left side. 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? A. Administer intravenous medications for pain. B. Place the patient in an observation area for care within the next few hours. C. Contact the command center for personnel to notify next of kin. D. Initiate two large-caliber intravenous lines for isotonic crystalloid administration. 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 1 B. Apply a pelvic binder C. Prepare the patient for surgery D. Insert a urinary catheter 18.A severely injured patient has been intubated and is being mechanically ventilated. The patient has received a balanced resuscitation including multiple blood products. Under which circumstance will it be harder for the hemoglobin to release oxygen to the tissues? A. Decreased pH B. Elevated carbon dioxide level C. Decreased body temperature D. Increased metabolic demand 19.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. Post-concussive syndrome D. Diffuse axonal injury 20. A patient is diagnosed with a T12 spinal cord injury following a 20- foot fall. Which finding is consistent with spinal shock? A. Loss of reflexes B. Bradycardia C. Widened pulse pressure D. Warm skin 21. An unconscious patient arrives following a motor vehicle collision. The patient is on a backboard with a cervical collar in place and one intravenous line running. Respirations are shallow and there is active brisk bleeding from a large leg wound. What is the priority intervention for this patient? A. Check for a patent airway B. Control the bleeding C. Start a second intravenous line D. Ventilate with a bag-mask device 22. An obese trauma patient requires intubation. Assuming there are no contraindications, which position will provide the best visualization for insertion of the endotracheal tube? A. Reverse Trendelenburg B. Lying on side C. Ramped D. Supine 23. Your patient is a pedestrian struck by a car and thrown 35 feet. They were unconscious at the scene but became responsive with initial and subsequent Glasgow Coma Scale (GCS) scores of 13 4 (E-3, V-4, M-6). The patient has bilateral subdural hematomas and is awaiting transfer to the ICU. Your next assessment reveals a GCS of 9 (E-2, V-2, M-5). What is the priority nursing intervention? A. Hold all pain medications B. Notify the provider of the change C. Repeat the GCS in 30 minutes D. Place the patient in Trendelenburg position 24. 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 25. 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 26. 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 27. 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 28. 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 5 29. 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 30. What position optimizes ventilation in the obese patient with a lumbar fracture? A. Reverse Trendelenburg B. Supine C. Prone D. Fowler's 31. 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? 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 32. 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 33. 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 34. 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. 6 A. Expedite transport to the CT scanner B. Prepare the patient for spinal radiographs C. Expedite transfer to the closest trauma center D. Notify the patient's family 47. 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? A. 1620 mL B. 2160 mL C. 3240 mL D. 6480 mL 48.A patient with complete spinal cord injury who is in neurogenic shock will demonstrate hypotension and which other clinical signs? A. Bradycardia and ipsilateral a sense of motor function. B. Tachycardia and respiratory depression. C. Tachycardia and piokilothermia. D. Bradycardia and absent motor function below the level of injury. 49. You are caring for a patient who was shot multiple times in the chest and abdomen. The patient is unresponsive with snoring, shallow respirations. Assessment reveals absent radial pulses, weak and rapid carotid pulse, and cool, diaphoretic skin. Which management strategy should the nurse anticipate? A. Autotransfusion B. Massive transfusion C. Controlled fluid boluses D. Inotropic medications 50. Which of the following characteristics is found in high performing teams? A. Interdisciplinary collaboration B. Provide on-the-job training C. Work individually D. Minimal feedback to decrease confusion 51. An adult patient weighing 75 kg sustained partial and full thickness burns to 32% of their body 2 hours prior to arrival. Intravenous fluid resuscitation was calculated to be 400 mL/hr. The urine output over the last hour was 15mL. What intervention should the nurse anticipate? A. Add blood products to the resuscitation B. Increase isotonic crystalloid infusion rate C. Administer an intravenous diuretic D. Switch to a hypertonic saline solution 9 52. You are speaking with the family of a critically injured patient. The spouse is crying loudly and the daughter is angry and yelling at staff. Which of the following nursing interventions is most appropriate? A. Have the family escorted out of the department B. Ask if the family would like spiritual support C. Allow only the spouse to see the patient D. Do not include the family in decision-making at this time 53. An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. Medications for drug-assisted intubation have been administered but intubation was unsuccessful. What is the most appropriate next step? A. Ventilate with a bag-mask device B. Prepare for a cricothyroidotomy C. Administer reversal medications D. Contact anesthesia for assistance 54. Which of the following is true of cavitation? A. Energy cause the tissues to accelerate and displace outward B. Once a bullet passes, the tissues always return to its normal location C. Damage occurs only to internal organs and blood vessels D. Hollow organs do not tolerate high-velocity cavitation 55. An adult patient involved in an assault presents with shortness of breath, BP 88/50 mmHg, heart rate 130 beats/minute. The patient has muffled heart sounds and is cyanotic. What is the priority intervention? A. Needle thoracostomy B. Chest tube insertion C. Pericardiocentesis D. Tracheal intubation 56.A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most likely an indication of the body's response to these findings? A. Reflex hypotension B. Increased respiratory effort C. Reflex tachycardia D. Widening pulse pressure 57. 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 10 58. 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 59. 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 60. 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. How did you get these bruises? B. How long have you had these bruises? C. Did someone hurt you? D. Who takes care of you? 61.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 odor of alcohol and appears intoxicated. After physician evaluation, under what circumstances can an order to remove the rigid cervical collar be anticipated? A. No imaging abnormalities of the neck B. No neurological abnormalities on examination C. No point tenderness to cervical spine D. Absence of neck pain with movement 62. 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 63. 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 11 B. Attempt family notification C. Obtain additional imaging studies D. Place an indwelling urinary catheter 76. 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? A. Mitigation B. Preparedness C. Response D. Recovery 77. A trauma patient is restless and repeatedly asking "Where am I?" Vital signs upon arrival were BP 110/60 mm Hg, HR 96 beats/minute, and RR 24 breaths/minute. Skin is cool and moist. Current vital signs are BP 86/68 mm Hg, HR 118 beats/minute, and RR 28 breaths/minute. The patient is demonstrating signs and symptoms of which stage of shock? A. Compensated B. Refractory C. Irreversible D. Decompensated 78.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 the most likely cause of these symptoms? A. Capillary leak syndrome B. Rhabdomyolysis C. Carbon monoxide poisoning D. Hypothermia 79. An adult patient is brought to the emergency department following a vehicle “roll-over” with prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh and a weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial intervention? A. Application of a tourniquet to the affected extremity B. Application of a traction splint to the affected extremity C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour D. Oxygen to maintain the ETCO2 between 30–35 mm Hg (3.9–4.6 kPa) 80. A patient has received multiple transfusions of banked blood in the past two hours. The patient has now developed muscle tremors and short runs of ventricular tachycardia. Which of the following medications does the nurse anticipate administering? A. Hypertonic saline B. Calcitonin C. Insulin and glucose D. Calcium gluconate 14 81. A 5-month pregnant patient arrives in the emergency department stating she tripped and fell, landing on her abdomen. Assessment reveals bruising to the abdomen, both arms, and her neck. She states she does not take any medications and has not had any prenatal care. The nurse suspects the findings are most likely related to which of the following? A. Intentional violence B. Pregnancy-related changes C. Undiagnosed embolus D. Iron deficiency 82. Three adults present at different times during a one-hour period with a high fever, fatigue, and headache. All three patients have a rash which started on their mouth, face, and arms with progression to the chest and abdomen. They all visited the same grocery store within the last week. What is the most appropriate intervention from triage for these patients? A. Move them to a decontamination area B. Mask the patients and send them to the waiting room C. Immediately initiate isolation precautions D. Send them to the waiting room without a mask 83. A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate sacral sparing? A. Involuntary flexion of the great toe B. Priapism C. Voluntary anal sphincter tone D. Numbness to the perianal area 84. While caring for a trauma patient in the emergency department, what finding raises suspicion of a complete spinal cord injury? A. Weakness in the lower extremities B. Urinary incontinence C. Sacral sparing D. Spastic paralysis of the legs 15