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TNCC 9th Edition TNP
just keep evaluating - vipp - What does the J stand for at the end of the secondary survery? vital signs, injuries/interventions, primary survey, pain - What does VIPP stand for? flank - During the head-to-toe, where would you find Grey-Turner's sign? umbilicus - During the head-to-toe, where would you find Cullen's sign? inspecting posterior - What is sometimes deferred at the end of the head-to-toe? AFTER head-to-toe, BEFORE J (VIPP) - Antibiotics, consults, head CT, imaging, law enforcement, mandatory reporting, psychosocial support, social services, splinting, tetanus, and wound care are all interventions that you do AFTER and before WHAT? Medical records, prehospital report, SAMPLE - What three items are obtained during the pertinent history assessment? Distraction, family presence, padding bony prominences, repositioning, splinting, verbal reassurance
- What are examples of nonpharmacologic measures? (must identify at least one during testing) all patients - For whom is capnography highly recommended?
EKG -
In step M of "Get Adjuncts", what else might be indicated besides cardiac monitor? blankets, room temp increase, warmed fluids, warming lights - In Step 16 of "Exposure and Environment", you must name at least one of these interventions: In Step 15 of "Exposure and Environment" - At what point PRIOR TO the head-to-toe is the patient inspected for obvious injuries? glucose - In Step 13 of "Disability", what is assessed if pt is altered?
- inspect AND palpate skin color, temp, moisture and 2. palpate a pulse - To assess circulation, you must do these two main tasks: intervene as appropriate and reassess - What do you do when alterations are identified in any of the steps in the primary survery?
- attach CO2 detector and assess for evidence of exhaled CO2; 2. observe for rise and fall of the chest w/ assisted ventilations; 3. auscultate over epigastrium for gurgling AND lungs for bilateral breath sounds - What three assessments must be done if the patient is intubated? Breath sounds, depth/pattern/rate, spontaneous breathing, subcutaneous emphysema, increased work of breathing, symmetrical chest rise and fall, tracheal deviation/JVD, open wounds/deformities, skin color - Four of these must be identified to assess breathing effectiveness: cardiac monitor - What can be applied in step 12 of "Circulation and Control of Hemorrhage" for which credit is given in the LMNOP section?
B.Initiate another fluid bolus. C.Recheck endotracheal tube placement. D.Increase the amount of oxygen delivered. 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 C.Elevating the leg to the level of the heart - 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 B.Repositioning the leg and applying ice C.Elevating the leg to the level of the heart D.Preparing the patient for ultrasound of the leg Bowel sounds heard in the left lower chest - 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.Bowel sounds heard in the left lower chest C.Pain radiating to the left shoulder. D.Decreased breath sounds on the left side
fat embolism - A patient has been in the emergency department for several hours waiting to be admitted. They sustained multiple rib fractures and a femur fracture after a fall. The patient has been awake, alert, and complaining of leg pain. Their spouse reported that the patient suddenly became anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions? A.Acute lung injury B.Fat embolism C.Pneumothorax D.Pulmonary contusion Immediately initiate isolation precautions - 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 Globe rupture - 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
C.Apply direct pressure to the wound - 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 B.Amputation of a limb - 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 A.Alert with no neurologic deficits - Using the American College of Surgeons screening guidelines, what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? A.Alert with no neurologic deficits B.Multiple abrasions to the extremities C.Ecchymosis to the flank D.Responds to verbal stimulation C.Tertiary - 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 C.Use a jaw thrust to open the airway and look for signs of obstruction. - 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? A.Use a bulb syringe to suction out secretions from the mouth. B.Insert a nasopharyngeal airway to maintain an open airway. C.Use a jaw thrust to open the airway and look for signs of obstruction. D.Ask the patient to open their mouth to inspect the airway. Apply a pelvic binder - 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 C.Decreased body temperature - 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
B.Loss of reflexes - A patient is diagnosed with a T12 spinal cord injury following a 20-foot fall. Which finding is consistent with spinal shock? A.Bradycardia B.Loss of reflexes C.Widened pulse pressure D.Warm skin D.Widening pulse pressure - A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 65 mm Hg (8. 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 B.Control the bleeding - 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 C.Ramped -
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 B.Notify the provider of the change - 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 (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 D.Gently rewarm over 15 to 30 minutes - 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 D.Moral injury - 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?
D.Assist ventilation with a bag-mask device C.Liver - 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 A.Report your suspicion of maltreatment in accordance with local regulations - 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 D.Prepare the patient for surgery to remove the rod. - 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. B.During the secondary surveyt -
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 B.It can be used in hypotensive patients too unstable for computed tomography scan - 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 B.Maintaining spinal motion restriction - 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.Initiating a second large caliber intravenous line B.Maintaining spinal motion restriction C.Placing the patient on pulse oximetry D.Turning the patient to remove the backboard A.Reverse Trendelenburg - What position optimizes ventilation in the obese patient with a lumbar fracture? A.Reverse Trendelenburg B.Supine C.Prone
C.Decreased respiratory effort - Which of the following is a late sign of increased intracranial pressure? A.Restlessness B.Vomiting C.Decreased respiratory effort D.Narrowing pulse pressure B.A 2-year-old lands on grass from a second-story balcony - 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 C.Increasing work of breathing - 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 B.Incontinence of stool C.Increasing work of breathing D.Inability to move the legs C.Allowing family to participate in the care of the patient - 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 A.Cardiogenic - 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 B.Increased oxygen consumption - 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 D.Coagulopathy - A patient who sustained severe injuries was brought to the emergency department following a high-speed motor vehicle collision. Interventions for hypovolemic shock have been initiated. What component of the trauma triad of death is most likely to have begun at the time of injury? A.Acidosis B.Hypothermia C.Hypocalcemia D.Coagulopathy
