Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
TNCC 9th Edition, Final Test Questions With All Correct Answers
Typology: Exams
1 / 22
You are caring for a patient who was thrown from a bike and was not wearing a helmet. While performing the head-to-toe assessment, you note clear drainage from the right ear. Which of the following is the most appropriate next step? A. Clean the ear with a cotton-tipped applicator. B. Pack the ear with gauze. C. Notify the physician D. Document and continue the exam. correct answer -C. Notify the physician 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 correct answer -A. Initiate transfer to a trauma center An adult who fell from a second story roof is brought to the emergency department by private vehicle. The patient is confused with unlabored 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 correct answer -A. Initiate cervical spine stabilization 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. correct answer -A. Decrease the rate of manual ventilation. 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 pelvic binder 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) correct answer -B. Application of a pelvic binder 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 correct answer - Using the American College of Surgeons Guidelines for Screening Patients with Suspected Spine Injury, what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? A. Alert with no neurologic deficits or neck pain B. Multiple abrasions to the extremities C. Ecchymosis to the flank
D. Responds to verbal stimulation using AVPU correct answer - 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 correct answer - During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing intervention should be performed next? A.Open the airway with the head-tilt/chin-lift maneuver B.Auscultate bilateral breath sounds C.Assist respirations using a bag-mask device D.Insert an oropharyngeal airway if there is no gag reflex correct answer - 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? A.Primary B.Secondary C.Tertiary D.Quaternary correct answer - A patient presents to the emergency department with a degloving injury involving the entire forearm. What should the nurse consider when planning care for a patient with this injury? A.Wound edges can be easily approximated for suturing. B.Surgical intervention will be needed C.Extent of tissue damage does not affect potential limb salvage D.Only soft tissue has been damaged correct answer -
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 correct answer - 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.Inotropic support D.Epinephrine administration correct answer - 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 correct answer - A trauma patient is being resuscitated in the emergency department when the radiology staff 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 correct answer - 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? A.Send blood for type and crossmatch B.Apply a pelvic binder C.Prepare the patient for surgery D.Insert a urinary catheter correct answer - 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. kPa). Which finding is most likely an indication of the body's response to these findings? A.Increased respiratory effort B.Reflex tachycardia C.Widening pulse pressure D.Reflex hypotension correct answer - While caring for a child who has been injured, what nursing intervention is consistent with a family-center approach? A.Identifying a single family member to speak with B.Having the family make all the care decisions C.Allowing family to participate in the care of the patient D.Limiting dissemination of complex information correct answer - 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 D.It has high sensitivity in pediatric patients for identifying fluid in the peritoneum correct answer - What technique is most effective 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.Using direct quotes to record information. correct answer - 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 correct answer - 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 correct answer - A restrained driver involved in a motor vehicle collision is brought to the emergency department with abdominal, pelvic, and bilateral lower extremity pain. Vital signs are BP 114/78 mm Hg, HR 98 beats/minute, RR 22 breaths/minute. A FAST exam is negative for fluid in the abdominal and peritoneal cavities. Which of the following should the nurse anticipate?
A.Diagnostic peritoneal lavage B.Angiography C.Operative management D.Serial abdominal assessments correct answer - 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 correct answer - A patient presents with chest pain and shortness of breath following a motor vehicle collision. An electrocardiogram shows sinus tachycardia and ischemic changes with an elevated troponin. The nurse should be highly suspicious for which injury? A.Cardiac tamponade B.Blunt cardiac injury C.Aortic disruption D.Pulmonary contusion correct answer - 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 correct answer - 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 correct answer - 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. correct answer - 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 correct answer - Which of the following is true regarding cavitation? A.Energy causes the tissues to accelerate and displace outward B.Once a bullet passes, the tissue always returns to its normal location C.Damage occurs only to internal organs and blood vessels D.Hollow organs do not tolerate high-velocity cavitation correct answer - 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 correct answer -
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.Kidney C.Small bowel D.Liver correct answer - 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 D.Crepitus to the right chest correct answer - 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 correct answer - What position optimizes ventilation in the obese patient with a lumbar fracture? A.Reverse Trendelenburg B.Supine C.Prone D.Fowler's correct answer -
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 correct answer -
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.
A. Initiate transfer to a trauma center B. Attempt family notification C. Obtain additional imaging studies D. Place an indwelling urinary catheter correct answer -A. Initiate transfer to a trauma center
assessment findings include widening pulse pressure, reflex bradycardia, and irregular, decreased respiratory effort. 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 correct answer -D. Airway and ventilation support
If the blood is not sufficiently warmed when transfused, it can produce hypothermia. In the oxyhemoglobin dissociation curve, a shift to the left increases the affinity of hemoglobin for oxygen making it harder to release for use by the tissues. Factors that can cause this shift include an elevated pH, decreased carbon dioxide, decreased temperature, and low metabolic demand. correct answer -C. Decreased body temperature A patient with a spinal cord injuryt 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 fluid resucscitation c. perform serial assessment of neurological function d. maintain core temperature correct answer -A. Maintain respiratory status- injuries at C3-C5 can cause loss of phrenic nerve function, resulting in a paralyzed diaphragm and inability to breathe. Maintenance of respiratory function is the highest priority. 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 correct answer -c. Reverse trendelenburg An adult patient sustained a knife injury to the neck. The airway is intact and the patient is hemodynamically stable. they complain of difficulty swallowing and speaking. What is the most likely cause of these symptoms. a. damage to the cervical spine b. an expanding pneumothorax c.laceration of the carotid artery d. injury to the thyroid gland correct answer -a. damage to the cervical spine-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. The general impression step in the initail 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 and breathing d. activate the trauma team correct answer -c. reprioritize circulation before airway and breathing the general impression is formed in the beginning of the primary survey to rapidly assess the need to reprioritize before airway or breathing. This is done id uncontolled external hemorrhage is identified. 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 indicate the nurse is coll. a. they are talking about taking the emergency nurse certification exam b. they keep requesting to be assigned to the walk-in ambulatory area c.they are impaiient and snap at thier coworkers. d. they are thinking about transferring out of the department correct answer -a. this is an indication that the nurse is taking positive steps ti advance thier own practice, a sign of resilience. 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. drainage of all large and small blisters correct answer -c. admin tpa- with frostbite thrombus formation is a risk. TPA has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming. 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 hemmorage correct answer -d. uncontrolled external hemmorage 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 signifigant bleeding, what is the priority intervention? a. elevate the etremeity to the level of the heart b. initate direct pressure c. apply a tourniquet d. cover the open wound with sterile saline dressings correct answer -b. initate direct pressure what is the appropriate technique for palpating the pelvis for stability? a. apply gentle pressure over the illiac 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 correct answer -b. apply GENTLE pressure, downward and medially 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 vitalsigns in pregnancy c. compensated shock d. supine hypotension syndrome correct answer -b. Normal vital signs in pregnancy resting hr increases 10-20 bpm small decrease in sbp and a larger decrease in dbp d/t decreased peripheral resistance. normal fetal heart rate is between 120-160 bpm. 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 b. quaternary correct answer -a. the primary phase-impact of the pressurization wave on body surfaces. Injuries include blast lung, tympanic
membrane rupture, abdominal hemmorrhage, globe rupture. and mild traumatic brain injury. b. the seconday phase results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries. c. tertiary phase-results from individuals being thrown by the blast and impacting walls, ground or any hard object. d. quartenary phase-results from any explosion-related illness or injury including hyperglycemia, hypertension, andina, asthma, COPD or sepsis. A patient involved in an 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 correct answer -b. first and second rib fractures are commonly associated with great vessel, head and spinal cord and brachial plexus injuries. a. blunt cardiac injury-sternal fractures; c. pneumothorax is most commonly associated with sternal fractures, multiple rib fractures, flail chest d. Hemothorax is most commonly associated with flail chest of multiple rib fractures 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 the need for lab tests d. predicting the need for a surgical procedure correct answer -a. anticipating the types of injuries that may be present mechanism of injury and energy transfer can assist the provider in anticipating the types of injuries that may be present and their severity
In a patient with severe traumatic brain injury, hypocapnia causes which condition? a. respiratory acidosis b. metabolic acidosis c. neurogenic shock d. cerebral vasoconstriction correct answer -***d. hypocapnia, cause vasoconstriction especially in the cerebral vasculature a. hypercapnia from inadequate ventilation causes respiratory acidosis, not hypocapnia b. metabolic acidosis results from tissue hypoperfusion and oxygen deficit, not hypocapnia c. neurogenic shock is associated with spinal cord injuries and results in generalized vasodilation. Hypocapnia causes vasoconstriction. Which of the following 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 six seconds b. delivers 100 % oxygen c. squeeze the bag completely for each breath d. maintain correct answer -a. compress the bag-mask at a rate of one breath every six seconds What is the best measure of the adequacy of cellular perfusion and can help predict the outcome of resuscitation? a. end tidal CO2 b. Hematocrit level c. Base deficit d. Oxygen saturation correct answer -c. 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 resuscitation. a. End tidal CO2-end product of ventilation and a reflection of metabolism and pulmonary fxn. What technique is most appropriate when obtaining a history? a. sitting next to the patient b. ensuring the patient answers all questions
c. asking for information only related to the assault d. applying active listening correct answer -d. applying active listening 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 correct answer -d. cooperation with the assessment 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? correct answer -B: 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 A: Signs of increased intracranial pressure include headache, nausea and vomiting, amnesia, behavioral changes, and altered level of consciousness.. C: Signs of rhabdomyolysis include muscle pain or weakness, dark red or brown urine, general weakness or malaise, and elevated creatinine kinase levels. D: Signs of pulmonary embolus include anxiety, pleuritic chest pain, dyspnea, hypoxemia, hemoptysis, cough, orthopnea, adventitious lung sounds, decreased lung sounds, jugular vein distension, or hypotension.