TNCC 9th Real Exam: Actual Verified Exam Test Bank, Exams of Community Health

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TNCC 9

TH

REAL EXAM ACTUAL VERIFIED EXAM TEST

BANK | INCLUDES 3 TESTED VERSIONS OF THE EXAM

WITH 50 MULTIPLE CHOICE QUESTIONS AND ANSWERS

| ALREADY GRADED A

A patient involved in a MVC has sustained a fracture to the second rib of the anterior left chest. Which concurrent injury is most commonly associated with this fracture? a. Blunt cardiac injury b. Brachial plexus injury c. Pneumothorax d. Hemothorax b. Brachial plexus injury A patient arrives at the emergency department by private vehicle after sustaining an injury to the right lower extremity while using a saw. There is a large gaping wound to the right thigh area with significant bleeding. What is the priority intervention? a. Elevate the extremity to the level of the heart b. Initiate direct pressure c. Apply a tourniquet d. Cover the open wound with sterile saline dressings b. Initiate direct pressure What is the best position for maintaining an open airway in the obese patient? a. Prone b. Supine c. Reverse Trendelenburg d. Right lateral recumbent c. Reverse Trendelenburg Understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma care provider in which of the following? a. Anticipating the types of injuries that may be present b. Deciding whether law enforcement should be notified c. Determining needed laboratory tests d. Predicting the need for a surgical procedure a. Anticipating the types of injuries that may be present What is the leading cause of preventable death for the trauma patient in the prehospital environment? a. Airway compromise b. Ineffective ventilation

c. Secondary head injury d. Uncontrolled external hemorrhage d. Uncontrolled external hemorrhage A adult patient with a knife injury to the neck has an intact airway and is hemodynamically stable. They complain of difficulty swallowing and speaking. In the primary survey, further assessment is indicated next for which of the following conditions? a. Damage to the cervical spine b. An expanding pneumothorax c. Laceration of the carotid artery d. Injury to the thyroid gland a. Damage to the cervical spine What is the best measure of the adequacy of cellular perfusion and can help to predict the outcome of resuscitation? a. End-tidal carbon dioxide b. Hematocrit level c. Base deficit d. Oxygen saturation c. Base deficit Which of the following is considered a cornerstone of a high-performance trauma team? a. Individual goals b. Use of TeamSTEPPS c. Identification of a single decision maker d. Effective communication d. Effective communication The nurse is obtaining a history for a patient who presents following sexual assault. This history is completed using which of the following techniques? a. Bring the family in to the interview room. b. Use direct quotes to record information. c. Obtain information specific only to the assault. d. Provide food and drink to help create rapport. b. Use direct quotes to record information. In a patient with severe traumatic brain injury, hypocapnia causes which condition? a. Respiratory acidosis b. Metabolic acidosis c. Neurogenic shock d. Cerebral vasoconstriction d. Cerebral vasoconstriction

A trauma nurse cared for a child with devastating burns two weeks ago. The nurse called in sick for a couple of days and is now back working on the team. Which of the following behaviors would indicate this nurse is coping well? a. They are talking about taking the emergency nursing certification examination. b. They keep requesting to be assigned to the walk-in/ambulatory area c. They are impatient and snap at their coworkers. d. They are thinking about transferring out of the emergency department. a. They are talking about taking the emergency nursing certification examination. Which of the following accurately describes ventilation principles associated with use of a bag- mask device for an adult? a. Compress the bag-mask device at a rate of one breath every 6 seconds. b. Delivers 100% oxygen. c. Squeeze the bag-mask device completely for each breath. d. Maintain the oxygen saturation levels between 92% and 94%. a. Compress the bag-mask device at a rate of one breath every 6 seconds. The general impression step in the initial assessment provides the opportunity to do which of the following? a. Assess for uncontrolled internal hemorrhage b. Accurately triage the patient c. Reprioritize circulation before airway or breathing. d. Activate the trauma team c. Reprioritize circulation before airway or breathing. The vital signs of a pregnant trauma patient at 30 weeks include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? a. Decompensated shock b. Normal vital signs in pregnancy c. Compensated shock d. Supine hypotension syndrome b. Normal vital signs in pregnancy While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a sign of possible altered mental status? a. Sunken fontanel b. Crying, but consolable c. Spontaneous movement of arms and legs d. Cooperation with the assessment d. Cooperation with the assessment

An adult pt 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 pt has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. the PaCO2 is 30mmHg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mmHg. What is the most important intervention to manage the cerebral blood flow? Decrease the rate of manual ventilation An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The pt 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 pt is currently on anticoagulant therapy. What is most likely the cause of their symptoms? post-concussive syndrome A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medication. Which of the following is the priority nursing intervention? Elevating the leg to the LEVEL of the heart (compression/crush- level of the heart) (regular fracture- above the heart) A pt involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small penetrating wound to the 6th intercostal space in the left lateral chest. Which finding is most consistent with an injury to the diaphragm? Bowel sounds heard in the lower left chest A pt 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 pt has been awake, alert, and complaining of leg pain. Their spouse reported that the pt suddenly became anxious and confused. Upon reassessment, the pt is restless, with respiratory distress and petechiae to his neck. The pt is exhibiting signs and symptoms most commonly associated with which of the following conditions? Fat embolism 3 adult pts present at different times during a 1-hour period with a high fever, fatigue, and headache. All 3 pts 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 pts? Immediately initiate contact precautions 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. Witai type of injury is suspecied?

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? Increasing work of breathing While caring for a child who has been injured , what nursing intervention consistent with a family center approach Allowing family to participate in the care of the patient 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/ 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 Cardiogenic Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadiani , crepitus in the lower right ribs , and cechymosis around the umbilicus The nurse is concerned about injury to which organ Liver 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? Report your suspicion of maltreatment in accordance with local regulations A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which intervention is most appropriate for this patent? Prepare the patient for surgery to remove the rod. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns? During the secondary survey Which of the following is true about use of the focused assessment sonography for trauma exam for a patient with abdominal trauma? It can be used in hypotensive patients too unstable for computed tomography scan What is the priority intervention for a child who has been diagnosed th an atlanto - occipital dislocation following a high - speed motor vehicle collision?

Maintaining spinal motion restriction What position optimizes ventilation in the obese patient with a lumbar Fracture Reverse Trendelenburg During the primary survey of an unconscious patient with multi system trauma , the nurse notes snoring respirations Which priority nursing tervention should be performed next? Insert an oropharyngeal airway if there is no gag reflex The patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrani , crepitus in the lower rigini rius , and cechymosis around the umbilicus. The nurse is concerned about injury to which organ? Liver 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? Gently rewarm over 15 to 30 minutes 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? Moral injury What is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient? Gauges end organ perfusion and tissue hypoxia What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries? Medical history including current medications Following a gun shot wound , pre - hospital providers report diminished breath sounds bilaterally

. Upon emergency department arrival , the patient is unresponsive with shallow respirations and an 02 sai of 90 %. What is the priority intervention for this patient? Assist ventilation with a bag - mask device A patient is diagnosed with a T12 spinal cord injury following a 20 - foot fall. Which finding is consistent with spinal shock? Loss of reflexes

evidence of uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions Which of the following is the most appropriate intervention for this patient? Inotropic support Which of the following situations could cause functional grief? Amputation of a limb Using the American College of Surgeons screening guidelines what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? Alert with no neurologic deficits 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? Tertiary 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? Use a law thrust to open the air way and look for signs of obstruction 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? Apply a pelvic binder A patient has a closed fracture to the left lower leg. Which symptoms are consistent with compartment syndrome Pain, diminished pedal pulse, pressure Which of the following characteristics is found in high performing teams Interdisciplinary collaboration An unresponsive patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. Medication for drug-assisted intubation have been administered but intubation was unsuccessful. What is the most appropriate next step? Ventilate with a bag-mask device An adult arrives at the emergency department with superficial burns to the extremities following a house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is most likely cause of these symptoms? CO2 poisoning

An adult patient was a restrained passenger involved in a high-speed motor vehicle collision. The patient complained of generalized abdominal and left leg pain. A FAST exam was negative for fluid in the abdominal cavity. While awaiting inpatient bed placement, the patient develops increased abdominal pain w/rebound tenderness, fever and elevated WBC. These findings are most consistent w/ an injury to which organ? Small bowel A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention? Apple direct pressure to the wound A 36 year old patient has a deformity of left wrist after a fall. The patient is reluctant to move their hand due to pain. Which of the following is the most appropriate intervention? Apply a splint and elevate the extremity above the level of the heart A trauma patient is being resuscitated in the emergency department when the radiology staff notifies the charge nurse that the CT scanner will be out of service for several hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication? Huddle A seriously injured patient is noted to have a weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpating and blood at the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What would be the most appropriate next intervention for this patient? Insertion of a suprapubic catheter A teenaged patient presents to the ED w/ left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is the most consistent w/ human trafficking Those experiencing human trafficking rarely self disclose An older patient w/a history of anticoagulant use presents after a fall at home the previous day. They deny loss of consciousness. The patient has a hematoma to their forehead and complains of headache, dizziness, left arm weakness, and nausea. What is the most likely cause of these symptoms? Subdural hematoma Which of the following is an expected finding when assessing a patient with a tube thoracostomy connected to a chest drainage system Fluctuation in the water seal chamber

You are caring for a patient who was involved in a MTV crash and is 32 weeks pregnant. Findings of your secondary survey include abdominal pain w/rigidity on palpation, fundal height at the costal margin, and bloody vaginal discharge. Varying acceleration and decelerations are noted on cardiotocography. These findings are most consistent w/ which of the following? Placental abruption A patient present after a 25 ft fall, w/ paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention? Airway and ventilation support What intravascular solution is most commonly used for patients who have sustained burns? LR An adult patient is being treated in the ED after falling 30 ft and landing on their head. The patient has been intubated and initial stabilization efforts are ongoing. The vital sign are BP 70/40, HR 44, and respirations are being assisted at 16. The patient skin is warm, dry, and normal color. These findings are most consistent w/ what type of shock? Neurogenic Which of the following is true regarding cavitation Energy causes the tissues to accelerate and displace outward Which of the following is true about the log roll maneuver It should be avoided with a suspected spine injury prior to imaging

Version 2

1. An adult patient who sustained a severe head trauma has been intubated and is being manually ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to manage the cerebral blood flow? A. Decrease the rate of manual ventilation B. Initiate another fluid bolus. C. Recheck endotracheal tube placement. D. Increase the amount of oxygen delivered. A. Decrease the rate of manual ventilation
2. 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 Rationale: Preparation and Ongoing Care\Psychosocial Aspects Functional grief relates to the loss of body function or body parts such as amputation of a limb, paralysis, or loss of sight. B. Amputation of a limb
3. 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

C. Elevating the leg to the level of the heart D. Preparing the patient for ultrasound of the leg Rationale: Musculoskeletal and Wounds\Musculoskeletal This patient is exhibiting signs of possible compartment syndrome which is a dangerous complication of fractured extremities. The pain is often out of proportion to the injury and might not respond to pain medications. Elevate the limb to the level of the heart to decrease dependent edema but not above the heart, which can cause increased venous congestion and pressure within the compartment. C. Elevating the leg to the level of the heart

8. A teenaged patient presents to the emergency department with left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is most consistent with human trafficking? A. The individual appears well nourished. B. Those who are being trafficked rarely seek medical care. C. It is infrequently associated with substance abuse. D. Those experiencing human trafficking rarely self-disclose. D. Those experiencing human trafficking rarely self-disclose.
9. An intubated trauma patient has just been transported back from CT scan. Upon arrival to their room in the emergency department, resistance is noted with bag-mask ventilations and auscultation reveals unequal breath sounds. What is the most appropriate initial intervention for this patient? A. Place the patient back on the ventilator. B. Extubated the patient. C. Reposition the endotracheal tube. D. Suction the endotracheal tube. C. Reposition the endotracheal tube.
10. Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? A. Increased work of breathing B. Unilaterally diminished breath sounds C. Tachycardia

D. Hypotension D. Hypotension

11. A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what is the priority intervention? A. Initiate transfer to a trauma center B. Attempt family notification C. Obtain additional imaging studies D. Place an indwelling urinary catheter A. Initiate transfer to a trauma center
12. 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 C. Apply direct pressure to the wound
13. A trauma patient involved in a fall from 25 feet has a traumatic brain injury, three anterior rib fractures on the right side, a small pneumothorax on the right, and a Grade III liver injury. The patient was intubated and placed on a ventilator with PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning? A. Severely diminished breath sounds on the right B. Guarding in the right upper quadrant C. Ecchymosis in the right upper quadrant D. Crepitus to the right chest A. Severely diminished breath sounds on the right
14. 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. Increased respiratory effort B. Widening pulse pressure

D. Post-concussive syndrome A patient presents, after a 25-foot fall, with paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention? A. Surgical intervention B. Chest tube insertion C. Needle decompression D. Airway and ventilation support D. Airway and ventilation support

18. 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 C. Disseminated intravascular coagulopathy
19. 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 Rationale: Head and Torso Trauma\Abdominal and Pelvic Trauma Liver injuries are associated with right, lower rib fractures. They also can present with tenderness, guarding, or rigidity in the right upper quadrant, along with ecchymosis of the right upper quadrant or around the umbilicus, known as Cullen's sign. C. Liver
20. 1. 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 Rationale: Head and Torso Trauma\Head Trauma The globe of the eye consists of multiple layers. The sclera is the white outer layer, while the cornea covers the iris and pupil. When a full thickness injury occurs to the cornea, sclera, or both, the globe will rupture, causing the shape of the pupil to become irregular or teardrop- shaped. B. Globe rupture

21. An adult arrives at the emergency department with superficial burns to the extremities following a house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is the most likely cause of these symptoms? A. Capillary leak syndrome B. Rhabdomyolysis C. Carbon monoxide poisoning D. Hypothermia C. Carbon monoxide poisoning
22. An adult patient is being treated in the emergency department after falling 30 feet and landing on their head. The patient has been intubated and initial stabilization efforts are ongoing. The vital signs are BP 70/40 mm Hg, HR 44 beats/minute, and respirations are being assisted at 16 breath/minute. The patient's skin is warm, dry, and of a normal color. These findings are most consistent with what type of shock? A. Spinal B. Hypovolemic C. Obstructive D. Neurogenic D. Neurogenic
23. A patient with a chest tube is being transported to the intensive care unit and fluctuation is noted in the water seal chamber during inspiration and expiration. What is the best action for the nurse to take? A. Clamp the chest tube