TNCC 9TH EDITION TRAUMA NURSING PROCESS - TNP -QUESTIONS AND ANSWERS LATEST VERSION 2024 V, Exams of Nursing

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TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

**A stands for ___ and ___. - ansalertness, airway **B stands for ___ and ___. - ansbreathing, ventilation **C stands for ___. - anscirculation **D stands for ___. - ansdisability E stands for ___. - ansexposure After all of the assessments, interventions, reassessments, etc. are done, what is the last thing to ask? - ans"Is there anything you would like to add at this time?" After how many breaths do you assess for the evidence of exhaled CO2? - ansAfter 5 to 6 breaths. After identifying potential interventions/diagnostics and completing your assessments and interventions, you should ask yourself what? - ans"What findings will you continue to reevaluate while the patient is in your care?" "Just keep re-evaluating" After the head-to-toe, the learner should summarize injuries identified throughout the scenario and ask themselves: - ans"What interventions or diagnostics can you anticipate for this patient?" Continue the TNP assuming the patient was intubated. 9-11 - ans9. If intubated, assess endotracheal tube placement

10. If intubated, assess ETT position and securement
11. If intubated, state the need to begin mechanical ventilation or continue assisted ventilation

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

Continue the TNP following assessments of circulation, neuro status, and removal of clothing to inspect for injury. 16-18 - ans16. Provide warmth

17. Obtain a full set of vital signs and weight in kilograms (if not determined earlier)
18. Facilitate family presence Continue the TNP following assessments of ETT. 12- 12, 13, and 15 are double-starred - ans12. Assess circulation 13**. Assess neurologic status using GCS
19. Assess pupils 15**. Remove all clothing AND inspect for obvious abnormalities or injuries Continue the TNP using the LMNOP mnemonic. 19-23 - ans19. L - trauma panel labs
20. M - monitor (Cardiac, consider EKG)
21. N - consider need for NG/OG
22. O - assess O2 and end-tidal capnography 23**. P - assess pain using appropriate pain scale Continue TNP after LMNOP (so after pain has been assessed). 24-26 - ans24. Non-pharmacological comfort measures
23. Consider analgesic med order
24. Obtain pertinent history Double-starred criteria include letters -. - ansA-E During the general impression in TNP, when alterations are identified, you must do what? Then what? - ansIntervene as appropriate and continuously reassess for efficacy

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

Following the completion of head-to-toe assessment in TNP, you must do what? 44 - ans44. Identify at least THREE interventions or diagnostics these may include the following: Antibiotics Consults Head CT for any alterations in mental status Imaging (other radiographs, CT, ultrasound, interventional radiology as indicated) Law enforcement Mandatory reporting Psychosocial support Social services Splinting Tetanus immunization Wound care For double-starred criteria, ___ and ___ must be completed prior to moving to the next step. - ansassessments, interventions Give at least 4 examples of things to inquire about when assessing breathing efficacy: - ans- Breath sounds

• Depth, pattern, and general rate of respirations
• Increased work of breathing
• Open wounds or deformities
• Skin color
• Spontaneous breathing
• Subcutaneous emphysema
• Symmetrical chest rise and fall

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

• Tracheal deviation or jugular venous distention Give at least 4 examples of things to inquire about when assessing the patency and protection of the airway: - ansAcceptable things to ask about during this step include assessments for:
• Bony deformity
• Burns
• Edema
• Fluids (blood, vomit, or secretions)
• Foreign objects
• Inhalation injury (burns, soot)
• Loose or missing teeth
• Sounds (snoring, gurgling, or stridor)
• Tongue obstruction
• Vocalization Head-to-Toe 27-43 - ans27. Inspect and palpate head for injuries

28. Inspect and palpate face for injuries
29. Inspect and palpate neck for injuries -- Demonstrate removal AND reapplication of cervical collar for assessment (if indicated).
    30. Inspect and palpate chest for injuries
30. Auscultate breath sounds
31. Auscultate heart sounds
32. Inspect the abdomen for injuries
33. Auscultate bowel sounds
34. Palpate all four quadrants of the abdomen for injuries
35. Inspect and palpate the flanks for injuries
36. Inspect the pelvis for injuries

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

38. Apply gentle pressure over iliac crests downward and medially
39. Apply gentle pressure on the symphysis pubis (if iliac crests are stable)
40. Inspect the perineum for injuries
41. Consider GU - urinary output
42. Inspect and palpate all four extremities for neurovascular status and injuries
43. Inspect and palpate posterior surfaces -- NOT if the patient has suspected spinal or pelvic injuries How do you assess ETT position? - ansby noting the number at the teeth or gums How do you first assess for pelvic instability? Then what do you do? - ansApply gentle pressure over iliac crests downward and medially. If iliac crests are stable, then apply gentle pressure on the symphysis pubis. Identify at least one of the following when obtaining pertinent history: - ans- Medical records/documents

• Prehospital report
• SAMPLE If a patient is intubated, you must state... - ansthe need to begin mechanical ventilation or continue assisted ventilation If alterations in oxygenation or EtCO2 are noted, interventions may include but are not limited to the following: - ans- Increase or decrease rate of assisted ventilation
• Wean oxygen (consider parameters other than oximetry due to hypothermia, vasoconstriction, and skin color's impact on pulse oximetry measurements) If intubated, you must assess which 2 things? - ans1. Assess ETT position by noting the number at the teeth or gums

2. Assess how the ETT is secured

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

If there are no contraindications, the patient may be turned to quickly assess the ___. This is deferred until after the head-to-toe and imaging if needed to evaluate spinal and pelvic stability. - ansposterior Just Keep Reevaluating. 45-48 - ans45. Reevaluate vital signs

46. Reevaluate all identified injuries and effectiveness of interventions
47. Reevaluate primary survey
48. Reevaluate pain L in LMNOP - ansLabs May include but not limited to the following: Blood gases Blood cross/type and screen Coagulation studies Complete blood count Lactate Metabolic panel Pregnancy Toxicology screen M in LMNOP - ansmonitor cardiac status and consider EKG

• also set BP to recycle as indicated O in LMNOP - ansoxygen and EtCO

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

P in LMNOP - ansassess pain T/F: Delay removal of transport device when possible. - ansFalse. If a transport device is in place, it may be removed as soon as possible. T/F: During the general impression, assessments and interventions identify life-threatening conditions, and you should prioritize the life-saving interventions. Order of step completion is not important. - ansFalse. Order of step completion is of critical importance. T/F: During the general impression, you can perform the assessment and interventions simultaneously when multiple team members are present. - ansTrue. T/F: Even if the patient is alert and can cooperate, you must demonstrate manual opening of the airway using the jaw-thrust maneuver. - ansFalse. When the patient is alert and can cooperate, it is acceptable to ask the patient to open their mouth to assess the airway. T/F: If the patient was deemed unresponsive in step 4, you do not need to assess level of alertness, avpu.

• ansTrue General impression is step 4, and if you already know the patient is unresponsive, they won't be alert or responsive. T/F: It is acceptable to have one IV or IO site on a patient with altered circulatory status. - ansFalse. You must have two sites of access. T/F: It is appropriate to consider transfer to a higher level of care before or during the A-E. - ansTrue. Consider this throughout. T/F: Preparation and triage in TNP includes the activation of the trauma team, role assignment, preparation of the trauma room, and donning PPE. - ansTrue

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

T/F: The GCS is documented as non-testable if there is a factor, such as sedation or paralytics, interfering with communication. - ansTrue. This is why you should determine neurological status prior to administering medication for intubation if possible. T/F: When newly identified life-threatening alterations are identified, intervene as appropriate and reassess. - ansTrue. Always intervene and reassess. The general impression in TNP is to... - ansAssess for obvious uncontrolled external hemorrhage or unresponsiveness/apnea and the need to reprioritize to C-ABC. Trauma room preparations might include: - ans- Bariatric equipment

• Difficult airway or IV equipment
• Fluid warmer
• Pediatric equipment What 2 elements must be identified when assessing circulation? - ans- Inspect AND palpate the skin for color, temperature, and moisture
• Palpate a pulse What 2 things must you do when opening the airway if c-spine injury is suspected? - ans1. You need to have a second person provide manual cervical spinal stabilization

2. You must demonstrate manual opening of the airway using the jaw-thrust maneuver What 3 things must be done if the patient is intubated? - ans- Attach a CO2 detector device. After 5 to 6 breaths, assesses for evidence of exhaled CO2. (EtCO2)

• Simultaneously observe for rise and fall of the chest with assisted ventilations
• Auscultate over the epigastrium for gurgling AND lungs for bilateral breath sounds

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

What are some interventions that may be appropriate when alterations in airway patency and protection are noted? - ans- Anticipate the need for intubation

• Insert an oral or nasopharyngeal airway
• Remove any loose teeth or foreign objects
• Suction the airway What are some interventions that may be appropriate when alterations in breathing efficacy are noted? - ans- Anticipate need for a chest tube
• Anticipate need for drug-assisted intubation
• Anticipate need for decompression of pneumothorax
• Anticipate need for oxygen
• Provide bag-mask ventilations What are some interventions that may be appropriate when alterations in circulation are noted? - ans- Anticipate goal-directed therapy for shock
• Apply a cardiac monitor - credit given in Step 20
• Apply a pelvic binder
• Apply a traction splint
• Assess patency of prehospital IV lines
• Compare central and peripheral pulses
• Consider sources of internal hemorrhage
• Control external hemorrhage
• Draw labs - credit given in Step 19
• Facilitate FAST and/or radiographs to identify source of internal hemorrhage
• Initiate chest compressions and advanced life support
• Obtain IV or IO access (two sites)
• Palpate central pulse if peripheral pulse is absent
• Tilt pregnant patient or manually displace the uterus

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

What are some interventions that may be appropriate when alterations in neurological status are noted with GCS? - ans- Anticipate the need for a head CT

• Anticipate the need for drug-assisted intubation
• Assess bedside glucose (*with altered mental status) What are some ways an ETT may be secured? - ansScrew clamp: Secures the ETT to the holder without blocking the tube Hook-and-loop strap system: Secures the ETT to the holder without blocking the tube Cloth tape: Knotted around the ETT and patient's neck Commercial ETT holders: Secure the ETT What are the 4 potential single-starred criteria? - ans- reassessment of primary survey interventions
• blood glucose if alterations in mental status noted in disability assessment
• pain assessment using appropriate pain scale
• inspection of posterior surfaces (unless CI) What are the double-starred criteria? (hint: A-E) - ans**Alertness and Airway **Breathing and Ventilation **Circulation **Disability **Exposure What do you ask yourself after re-evaluations are done? 49-50 - ans49. "What is the definitive care for this patient?"

50. Consider need for transfer to a trauma center or admission

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

What does it mean to have double-starred criteria? - ansIt means that this criteria MUST be done in order. What does it mean to have single-starred criteria? - ansThis means the criteria needs to be done, but the sequence is not critical. What happens following patient arrival but before a decision to intubate has been made? 4- may change based on C-ABC - ans4. Assess for obvious uncontrolled external hemorrhage or unresponsiveness/apnea and the need to reprioritize to C-ABC 5**. Assess level of consciousness using AVPU

6. Open the airway 7. Assess the patency and protection of the airway 8. Assess breathing effectiveness What happens prior to patient arrival? 1-3 - ans1. Activate trauma team
7. Prepare trauma room
8. Don PPE What interventions are potentially included in the general impression? - ans- pulse

• control of external hemorrhage
• initiation of chest compressions
• initiation of IV resuscitation What is a systematic process to guide your care of trauma patients? - anstrauma nursing process What is assessed in GCS? - ansBest eye opening (1-4) Best verbal response (1-5)

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

Best motor response (1-6) What is the first double-starred assessment? What step is it? - ansAlertness and AVPU are the first double-starred assessments. It is step 5**. What might need to be reprioritized during the general impression? Why? - ansYou may need to switch from ABCs to C-ABCs in the case of uncontrolled external hemorrhage. What might you ask yourself during preparation and triage? - ans"Is there any specific equipment that you would prepare?" What should be considered when applying ice to patients for comfort? - ansApplying ice to swollen areas may be appropriate but consider hypothermia risk for major trauma and very small pediatric patients. What should be considered when providing warmth? - ansWarmth may be appropriate, but consider burn risk. What should you ask yourself after completing all of your interventions and reassessments? - ansDoes this patient need to be transferred to another hospital, to surgery, or to critical care? What should you ask yourself when assessing for alertness, avpu? - ansIs the patient Alert, do they require a Verbal or Painful stimulus to respond, or are they Unresponsive? When alterations are identified during the assessment of airway patency and protection, you must ___ as appropriate and remember to ___. - ansintervene, reassess When assessing for alertness and airway, you must simultaneously ___________. - anscontinue cervical spinal stabilization When considering GU and how to monitor urinary output: - ans- Assess for contraindications for an indwelling urinary catheter

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

• External catheter
• Weighing diapers (pediatrics and adults) When is capnography highly recommended? When is capnography vital? - ansrecommended for all patients, vital for sedated or ventilated patients When you remove all clothing, you are also doing what? - ansyou're also inspecting for obvious abnormalities or injuries While donning PPE, you should consider 2 things: - ans1. potential safety threats to the team

2. need for decontamination Why might inspection of posterior surfaces be contraindicated? - ansMay be contraindicated by suspected spine or pelvic injury Why would you initiate IV resuscitation? - ansfor signs of significant blood loss with signs of very poor perfusion You must assess pain using an ___________. - ansappropriate pain scale You must identify at least one of the following non-pharmacological comfort measures: - ans- Distraction

• Family presence
• Places padding over bony prominences
• Repositioning
• Splinting
• Verbal reassurance You must provide warmth by identifying at least one of the following: - ans- Blankets

TNP -QUESTIONS AND ANSWERS LATEST VERSION

2024 VERIFIED RATIONALE GRADED A+

• Increase room temperature
• Warmed fluids
• Warming lights You should determine neurological status using GCS ___ (before / after) sedation and intubation. - ansbefore