TNCC 9th Edition TNP Latest 2023-2024 Exam: 75 Questions and Answers, Exams of Nursing

Download TNCC 9th Edition TNP Latest 2023-2024 Exam: 75 Questions and Answers and more Exams Nursing in PDF only on Docsity! TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY 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 communicati - ansA.Report your suspicion of maltreatment in accordance with local regulations 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 - ansGlobe rupture 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 - ansC.Inotropic support 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 - ansD.Moral injury 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY 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 37.5 - ansD.Gently rewarm over 15 to 30 minutes 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. - ansD.Prepare the patient for surgery to remove the rod. 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 - ansC.Dressing removal 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 - ansVoluntary anal sphincter tone 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 co - ansfat embolism TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY 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 - ansD.Widening pulse pressure 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 - ansC.Decreased body temperature 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 - ansC.Disseminated intravascular coagulopathy 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 - ansB.Increased oxygen consumption An adult patient involved in a motor vehicle collision is brought to the emergency department of a rural critical access facility. They complain of neck pain, shortness of breath, and diffuse abdominal pain. The Glasgow Coma Score is 15. Vital signs are: BP 98/71 mm Hg, HR 125 beats/minute, RR 26 breaths/minute, and SpO2 94% on high- TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient? A.Expedite transport to the CT scanner B.Prepare the pati - ansC.Expedite transfer to the closest trauma center 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 - ansC.Use a jaw thrust to open the airway and look for signs of obstruction. 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.Re - ansA.Decrease the rate of manual ventilation. 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 - ansApply a pelvic binder 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY D.Quaternary - ansC.Tertiary 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 - ansC.Ramped 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 - anspost-concussive syndrome 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 - ansB.Control the bleeding 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? - ansAFTER head-to-toe, BEFORE J (VIPP) At what point PRIOR TO the head-to-toe is the patient inspected for obvious injuries? - ansIn Step 15 of "Exposure and Environment" 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY To assess circulation, you must do these two main tasks: - ans1. inspect AND palpate skin color, temp, moisture and 2. palpate a pulse 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 - ansA.Alert with no neurologic deficits What are examples of nonpharmacologic measures? (must identify at least one during testing) - ansDistraction, family presence, padding bony prominences, repositioning, splinting, verbal reassurance What can be applied in step 12 of "Circulation and Control of Hemorrhage" for which credit is given in the LMNOP section? - anscardiac monitor What do you do when alterations are identified in any of the steps in the primary survery? - ansintervene as appropriate and reassess What does the J stand for at the end of the secondary survery? - ansjust keep evaluating - vipp What does VIPP stand for? - ansvital signs, injuries/interventions, primary survey, pain What is sometimes deferred at the end of the head-to-toe? - ansinspecting posterior 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 - ansB.Medical history including current medications 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY D.Turning the patient to remove the backboard - ansB.Maintaining spinal motion restriction What is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient? 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 communicati - ansA.Report your suspicion of maltreatment in accordance with local regulations 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 - ansGlobe rupture 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 - ansC.Inotropic support 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY D.Moral injury - ansD.Moral injury 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 37.5 - ansD.Gently rewarm over 15 to 30 minutes 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. - ansD.Prepare the patient for surgery to remove the rod. 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 - ansC.Dressing removal 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 - ansVoluntary anal sphincter tone 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY C.Elevating the leg to the level of the heart D.Preparing the patient for ultrasound of the leg - ansC.Elevating the leg to the level of the heart 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 - ansD.Widening pulse pressure 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 - ansC.Decreased body temperature 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 - ansC.Disseminated intravascular coagulopathy 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 - ansB.Increased oxygen consumption TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY An adult patient involved in a motor vehicle collision is brought to the emergency department of a rural critical access facility. They complain of neck pain, shortness of breath, and diffuse abdominal pain. The Glasgow Coma Score is 15. Vital signs are: BP 98/71 mm Hg, HR 125 beats/minute, RR 26 breaths/minute, and SpO2 94% on high- flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient? A.Expedite transport to the CT scanner B.Prepare the pati - ansC.Expedite transfer to the closest trauma center 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 - ansC.Use a jaw thrust to open the airway and look for signs of obstruction. 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.Re - ansA.Decrease the rate of manual ventilation. 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 - ansApply a pelvic binder 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? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY A.Primary B.Secondary C.Tertiary D.Quaternary - ansC.Tertiary 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 - ansC.Ramped 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 - anspost-concussive syndrome 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 - ansB.Control the bleeding 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? - ansAFTER head-to-toe, BEFORE J (VIPP) At what point PRIOR TO the head-to-toe is the patient inspected for obvious injuries? - ansIn Step 15 of "Exposure and Environment" TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY C. Immediately initiate isolation precautions - ansImmediately initiate isolation precautions To assess circulation, you must do these two main tasks: - ans1. inspect AND palpate skin color, temp, moisture and 2. palpate a pulse 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 - ansA.Alert with no neurologic deficits What are examples of nonpharmacologic measures? (must identify at least one during testing) - ansDistraction, family presence, padding bony prominences, repositioning, splinting, verbal reassurance What can be applied in step 12 of "Circulation and Control of Hemorrhage" for which credit is given in the LMNOP section? - anscardiac monitor What do you do when alterations are identified in any of the steps in the primary survery? - ansintervene as appropriate and reassess What does the J stand for at the end of the secondary survery? - ansjust keep evaluating - vipp What does VIPP stand for? - ansvital signs, injuries/interventions, primary survey, pain What is sometimes deferred at the end of the head-to-toe? - ansinspecting posterior 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 - ansB.Medical history including current medications What is the priority intervention for a child who has been diagnosed with an atlanto- occipital dislocation following a high-speed motor vehicle collision? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY 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 - ansB.Maintaining spinal motion restriction 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 - ansC.Gauges end-organ perfusion and tissue hypoxia What position optimizes ventilation in the obese patient with a lumbar fracture? A.Reverse Trendelenburg B.Supine C.Prone D.Fowler's - ansA.Reverse Trendelenburg What should you verbalize after completing all ETT assessments? - ansmoving patient from assisted ventilation to mechanical What three assessments must be done if the patient is intubated? - ans1. 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 items are obtained during the pertinent history assessment? - ansMedical records, prehospital report, SAMPLE When should 2 IV sites be established? - ansDuring "Circulation" assessment 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 - ansB.During the secondary surveyt TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY Which blood pressure finding is associated with early or compensated hypovolemic shock? A.Rising systolic B.Rising diastolic C.Decreasing diastolic D.Decreasing systolic - ansB. Rising diastolic Which of the following is a late sign of increased intracranial pressure? A.Restlessness B.Vomiting C.Decreased respiratory effort D.Narrowing pulse pressure - ansC.Decreased respiratory effort 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 - ansIt should be avoided with a suspected spine injury prior to imaging 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 - ansB.It can be used in hypotensive patients too unstable for computed tomography scan 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 - ansB.Amputation of a limb 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 TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY D.It decreases the risk of hemorrhage from unstable pelvic injuries - ansIt should be avoided with a suspected spine injury prior to imaging 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 - ansB.It can be used in hypotensive patients too unstable for computed tomography scan 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 - ansB.Amputation of a limb 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 - ansC.Allowing family to participate in the care of the patient 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 - ansurinary incontinence 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? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY A.Hold all pain medications B.Notify the provider of the change C.Repeat the GCS in 30 minutes D.Place the patie - ansB.Notify the provider of the change 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 - ansC.Liver - ansPrehospital shock index pg. 85 .. activation ...... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ansBaroreceptors: 1. A- airway and Alertness with simultaneous cervical spinal stabilization 2. B- breathing and Ventilation 3. circulation and control of hemorrhage 4. D - disability (neurologic status) 5. F - full set of vitals and Family presence 6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - ansABCDEFGHI 1. Apnea 2. GCS 8 or less 3. Maxillary fractures 4. Evidence of inhalation injury (facial burns) 5. Laryngeal or tracheal injury or neck hematoma 6. High risk of aspiration and patients inability to protect the airway TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY 7. Compromised or ineffective ventilation - ansFollowing conditions might require a definitive airway 1. bony fractures and possible rib fractures, which may impact ventilation 2. palpate for crepitus 3. subcutaneous emphysema which may be a sign for a pneumothorax 4. soft tissue injury - ansPalpate the chest for 1. Check the presence of adequate rise and fall of the chest with assisted ventilation 2. Absence of gurgling on auscultation over the epigastrium 3. Bilateral breath sounds present on auscultation 4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ansIf the pt has a definitive airway in what should you do? 1. Dyspnea 2. Tachycardia 3. Decreased or absent breath sounds on the injured side 4. CP - ansSimple Pneumo assessment: 1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - ansAuscultate the chest for: 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check - ansD Interventions 1. Hypotension 2. JVD 3. Muffled heart sounds - ansBecks Triad: 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway - ansIf breathing is absent.. 1. pain - hallmark sign, early sign 2. pressure - early sign 3. pallor, pules, paresthesia, paralysis - late sign - ansSix P's of compartment syndrome: 1. Preparation 2. Preoxygenation 3. Pretreatment TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY c. depth, pattern, and rate of respiration d. signs of difficulty breathing such as accessory muscle use e. skin color (normal, pale, flushed, cyanotic) f. contusions, abrasions, deformities (flail chest) g. open pneumothoraces (sucking chest wounds) h. JVD i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) - ansB can be caused by blunt trauma. air escapes from injured lung to pleural space and negative intrapleural pressure is lost causing partial or collapsed lung - ansSimple Pneumothorax can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place. Might hear "sucking" Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair. - ansOpen Pneumo: Capnography monitors numeric value, as well as continuous waveform, indicating real- time measurement and trending over time. - ansQuantitative: Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury to the diaphragm. Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred. - ansHemothorax: Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry - ansC Colorimetric CO2 detectors provide info about the presence or absence of CO2. A chemically treated indicator strip changes color revealing the presence or absence of exhaled CO2 - ansQualitative D displaced tube O obstructed or kinked TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY P pneumothorax E equipment failure , such as becoming detached from the equipment or loss of capnopgrahy - ansDOPE Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response) - ansD don't forget flanks!!! inspect of lacs, puncture wounds, contusions, auscultate then palpate: bowel sounds? any rigidity, guarding? begin with light palpation start to palpate with side that does not hurt maybe do a fast scan? - ansHead to toe assessment: Abdomen Exposure and Environmental Control Remove all clothes and assess for any obvious injuries and uncontrolled bleeding - ansE Flail chest - ansParadoxical chest wall movement from hemorrhage is leading cause. Hypovolemia is caused by decrease in the amount of circulating volume. Goal is to replace volume. - ansHypovolemic Shock Full set of vitals and family presence - ansF Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management - ansG H,I - ansSecondary Survery TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY History and Head to toe MIST - prehospital report MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them - ansH IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids - ansE Interventions: immobilize cervical spine, tenderness, tracheal deviation - ansHead to toe assessment: Neck and cervical spine in massive transfusion protocol... responsible for dissolving clots - ansTXA inspect for lacs, abrasions, asymmetry of facial expressions palate for depressions and tenderness look at ears for drainage - ansHead to toe assessment: Head and face inspect posterior surfaces blogroll with at least 3 people. maintain c spine take out backboard Rectal tone per MD - ansI inspect, auscultate, palpate any spontaneous breathing, rate, depth, and degree of effort, use of accessory muscles lacs, contusions, auscilate lung sounds and heart sounds - ansHead to toe assessment: Chest jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust procedure should be done by two providers. One provider can TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY 4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone to chk in the pt is pulseless while assessing if the cause of the problem is the airway. - ansAirway and AVPU: Vital signs Interventions Primary survey Pain - ansPost resuscitation care parameters that are continuously evaluated: A 5-year old child presents to the ED 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? Answer: A - ANSA) report your suspicion of the maltreatment in accordance with local regulations *** B) apply ice to the bruises and consult wound care C) engage in therapeutic communication to determine the MOI D) provide the family with injury prevention resourse A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? Answer: C - ANSA) Fast exam B) CT scan C) straight cath for urine sample *** D) ice and elevation of the scrotum A 35-year old male presents with facial trauma after bring struck inthe face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? Answer: B - ANSA) oculomotor nerve palsy B) globe rupture *** C) uncal herniation D) retinal detachment A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? Answer: B - ANSA) apply a sling and elevate the extremity to the level of the heart. TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY B) apply a splint and ELEVATE 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. A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following? Answer: A The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage. Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma. - ANSA) diagnostic peritoneal lavage *** B) serial fast exams C) abdominal and pelvic CT scans D) serial abdominal assessments A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows: BP 98/71 HR 125 beats/min RR 26 breaths/min SpO2 94% on high flow O2 via NRB mask which of the following is the priority intervention for this patient? Answer: C - ANSA) Expedite transport to the CT scanner B) prepare the patient for spinal radiographs C) expedite transfer to the closest trauma center *** D) notify the patients family A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY Answer: A - ANSA) initiate transfer to a trauma center ** B) provide report to the operating room nurse C) Obtained imaging studies D) Place a gastric tube A patient arrives with a large open chest wound after being assault ed with a machete, Prehospital providers placed a nonporous dressing over the chest wound and tapes it on 3 sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate interventions? Answer: C - ANSA) needle decompression B) tube thoracostomy C) dressing removal ** D) surgical repair A patient has been in the ED for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and c/o leg pain. His wife reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. the patient is exhibiting signs of symptoms commonly associated with which of the following conditions? Answer: B - ANSA) acute lung injury B) fat embolism *** C) PTX D) pulmonary contusion A patient is found lying on the floor after falling 13 hours ago. Which of the following lab values is expected with a musculoskeletal complication associated with this presentation? Answer: A - ANSA) elevated creatine kinase *** B) decreased potassium level C) decreased WBC D) elevated GFR A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented, and has delayed cap refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principle? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY B) auscultate bilateral breath sounds to assess ventilatory status C) assist respirations using a BVM D) insert an oropharyngeal airway if there is no gag reflex *** EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar? Answer: A - ANSA) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan *** B) after physician evaluation if the patient has not neurologic abnormalities on exam C) after palpation of the spine if the patient has no point tenderness the the vertebral column D) after physical examination if the patient has not neck pain with movement EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? Answer: D - ANSA) Alert with no neurologic deficits B) Multiple abrasions to the extremities C) Multiple requests of water D) Smell of alcohol on breath *** 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 future disaster. Which phase of the disaster life cycle does this describe? Answer: A - ANSA) mitigation *** B) preparedness C) response D) recovery If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? Answer: D - ANSA) potassium B) magnesium C) sodium D) calcium *** Patients with a crush injury should be monitored for which of the following conditions? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY Answer: C - ANSA) Hypernatremia B) Hypercalcemia C) Dysrhthmias ** D) polyuria Tearing of the bridging veins is most frequently associated with which brain injury? Answer: B - ANSA) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma The most reassuring finding for a male patient with hop pain after a fall is which of the following? Answer: D - ANSA) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability *** The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours? (upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA. 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 / 2 (half of fluids given in first 8 hours) = 2280 mL Answer: A - ANSA) 2280 mL *** B) 3840 mL C) 4560 mL D) 7680 mL The trauma nurse knows that placing a bariatric patients in a "ramped position" provides better visualization during the insertion of which device? Answer: C - ANSA) Intraosseous line B) orogastric tube C) ET tube *** TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY D) urinary catheter What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? Answer: A - ANSA) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry What factor contributes most the kinetic energy of a body in motion? answer: C - ANSA) acceleration B) mass C) velocity *** D) inertia What finding raises suspicion of complete spinal cord injury? Answer: B - ANSA) Weakness in the lower extremities B) Priapism *** C) voluntary anal sphincter tone D) intact reflexes distal to the injury Which if the following values indicates the need for alcohol withdrawal interventions? Answer: A - ANSA) CIWA-Ar of 36 *** B) GCS 13 C) ETCo2 of 48 mm Hg D) heart rate of 45 beats/min Which is the effect of hypothermia on the oxyhemoglobin dissociation curve? Answer: A - ANSA) Hemoglobin does not readily release oxygen for use by the tissues *** B) The amount of oxygen available to the tissues increases C) Tissue oxygenation (PaO2) increases D) Hemoglobin molecule saturation (SaO2) decreases Which of the following assessment findings differentiates a tension PTX from a simple PTX? answer: D TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY Answer: C - ANSA) The driver of the vehicle collides with the steering wheel B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger *** Which of the following patients warrants referral to a burn center? Answer: C - ANSA) a 21- year old female with a partial thickness burn to the right forearm B) a 40-year old hypertensive male with a superficial burn to the back C) a 52-year old diabetic male with partial thickness burn to the left lower leg *** D) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax. Which pulse pressure description is an indication of early hypovolemic shock? Answer: B - ANSA) widened B) narrowed *** C) bounding D) weak Why is a measure of serum lactate obtained in the initial assessment of the trauma patient? Answer: c - ANSa) to measure oxygenation and ventilation b) to quantify the base deficit for the adequacy of cellular perfusion c) *to gauge end-organ perfusion and tissue hypoxia ** d) to determine the underlying cause of shock You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal high at the costal margin, and some dark bloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent with which of the following? Answer: A - ANSA) placental abruption *** B) preterm labor C) uterine rupture D) fetal demise You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY Answer: B - ANSA) 1000 mL/hr B) 500 mL/hr *** C) 250 mL/hr D) 125 mL/hr A 5-year old child presents to the ED 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? Answer: A - ANSA) report your suspicion of the maltreatment in accordance with local regulations *** B) apply ice to the bruises and consult wound care C) engage in therapeutic communication to determine the MOI D) provide the family with injury prevention resourse A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? Answer: C - ANSA) Fast exam B) CT scan C) straight cath for urine sample *** D) ice and elevation of the scrotum A 35-year old male presents with facial trauma after bring struck inthe face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? Answer: B - ANSA) oculomotor nerve palsy B) globe rupture *** C) uncal herniation D) retinal detachment A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? Answer: B - ANSA) apply a sling and elevate the extremity to the level of the heart. B) apply a splint and ELEVATE 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. TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following? Answer: A The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage. Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma. - ANSA) diagnostic peritoneal lavage *** B) serial fast exams C) abdominal and pelvic CT scans D) serial abdominal assessments A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows: BP 98/71 HR 125 beats/min RR 26 breaths/min SpO2 94% on high flow O2 via NRB mask which of the following is the priority intervention for this patient? Answer: C - ANSA) Expedite transport to the CT scanner B) prepare the patient for spinal radiographs C) expedite transfer to the closest trauma center *** D) notify the patients family A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? Answer: A - ANSA) initiate transfer to a trauma center ** B) provide report to the operating room nurse TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY complains of headache, dizziness, and nausea. Which is a most likely cause of her symptoms? Answer: D - ANSA) epidural hematoma B) diffuse axonal injury C) post-concussive syndrome D) subdural hematoma *** An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions? Answer: D - ANSA) call for a portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, and dusky skin. the trauma team has administered medications for drug assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? Answer: A - ANSA) Ventilate with a BVM *** B) Prepare for cricothyroidotomy C) administer reversal medications D) contact anesthesia for assistance Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and crying with increased work of breathing and pale skin. which of the following interventions has the highest priority? Answer: A - ANSA) padding the upper back while stabilizing the cervical spine *** B) applying a tight-fitting NRB mask with an attached resevior C) establishing intravenous access and administering a 20mL/kg bolus D) preparing for drug assisted intubation During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next? Answer: D - ANSA) open the airway with the head-tilt/chin lift maneuver B) auscultate bilateral breath sounds to assess ventilatory status C) assist respirations using a BVM TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY D) insert an oropharyngeal airway if there is no gag reflex *** EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical color removed. when is it appropriate to remove the cervical collar? Answer: A - ANSA) after a physical examination if the patient has no radiologic abnormalities on a computed tomography scan *** B) after physician evaluation if the patient has not neurologic abnormalities on exam C) after palpation of the spine if the patient has no point tenderness the the vertebral column D) after physical examination if the patient has not neck pain with movement EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? Answer: D - ANSA) Alert with no neurologic deficits B) Multiple abrasions to the extremities C) Multiple requests of water D) Smell of alcohol on breath *** 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 future disaster. Which phase of the disaster life cycle does this describe? Answer: A - ANSA) mitigation *** B) preparedness C) response D) recovery If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? Answer: D - ANSA) potassium B) magnesium C) sodium D) calcium *** Patients with a crush injury should be monitored for which of the following conditions? Answer: C - ANSA) Hypernatremia B) Hypercalcemia TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY C) Dysrhthmias ** D) polyuria Tearing of the bridging veins is most frequently associated with which brain injury? Answer: B - ANSA) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma The most reassuring finding for a male patient with hop pain after a fall is which of the following? Answer: D - ANSA) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability *** The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours? (upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA. 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 / 2 (half of fluids given in first 8 hours) = 2280 mL Answer: A - ANSA) 2280 mL *** B) 3840 mL C) 4560 mL D) 7680 mL The trauma nurse knows that placing a bariatric patients in a "ramped position" provides better visualization during the insertion of which device? Answer: C - ANSA) Intraosseous line B) orogastric tube C) ET tube *** D) urinary catheter TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY C) Decreased respiratory effort** D) amnesia and anxiety Which of the following is an expected finding in a patient with a thoracostomy connected to a chest drainage system? Answer: D - ANSA) output of 200 mL/hr B) tubing clamp closed for transport C) dependent loops in the tubing to promote drainage D) fluctuations in the water serial chamber *** Which of the following is NOT considered goal-directed therapy of cardiogenic shock? Answer: C - ANSA) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis *** D) cardiac cath Which of the following is possible complication of positive-pressure ventilation? Answer: A - ANSA) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure Which of the following is true about the log roll maneuver? Answer: C - ANSA) it causes less spinal motion than the lift and slide manuever B) it is recommended for patients with unstable pelvic fractures C) it can worsen cord damage from an unstable spinal injury *** D) it does not increases the risk of life threatening hemorrhage from unstable injuries Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? Answer: B - ANSA) ABC B) MARCH*** C) AVPU D) VIPP Which of the following occurs during the third impact of a motor vehicle crash? Answer: C - ANSA) The driver of the vehicle collides with the steering wheel TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger *** Which of the following patients warrants referral to a burn center? Answer: C - ANSA) a 21- year old female with a partial thickness burn to the right forearm B) a 40-year old hypertensive male with a superficial burn to the back C) a 52-year old diabetic male with partial thickness burn to the left lower leg *** D) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax. Which pulse pressure description is an indication of early hypovolemic shock? Answer: B - ANSA) widened B) narrowed *** C) bounding D) weak Why is a measure of serum lactate obtained in the initial assessment of the trauma patient? Answer: c - ANSa) to measure oxygenation and ventilation b) to quantify the base deficit for the adequacy of cellular perfusion c) *to gauge end-organ perfusion and tissue hypoxia ** d) to determine the underlying cause of shock You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal high at the costal margin, and some dark bloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent with which of the following? Answer: A - ANSA) placental abruption *** B) preterm labor C) uterine rupture D) fetal demise You are treating a 27-year old male in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? Answer: B - ANSA) 1000 mL/hr TNCC 9TH EDITION TNP LATEST 2023-2024 EXAM WITH COMPLETE 75 QUESTIONS AND CORRECT ANSWERS- GRADED A+ PASS ANSWERED CORRECTLY B) 500 mL/hr *** C) 250 mL/hr D) 125 mL/hr