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A collection of questions and answers related to the tncc (trauma nursing core course) final exam. It covers various aspects of trauma care, including assessment, management, and interventions for different types of injuries. Useful for students preparing for the tncc exam or those seeking to enhance their knowledge of trauma nursing.
Typology: Exams
1 / 98
A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? - ANSWER>>Expedite transfer to the closest trauma center
Which of the following considerations is the most important when caring for a geriatric trauma pt? - ANSWER>>a pertinent medical hx is crucial
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 a future disaster. Which phase of the disaster life cycle does this describe? - ANSWER>>Mitigation
EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? - ANSWER>>Alcohol
All tools and guidelines require the patient to be awake, alert, not under the influence of any substances, and without neurologic abnormalities
What is the effect of hypothermia on the oxyhemoglobin dissociation curve? - ANSWER>>hemoglobin does not readily release O2 for use by the tissues
Which of the following is a component of the trauma triad of death? - ANSWER>>acidosis
EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? - ANSWER>>Complete
Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? - ANSWER>>flucuation in the water seal chamber
During the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? - ANSWER>>insert an oropharyngeal airway if there is no gag reflex
A 35 y/o M 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? - ANSWER>>globe rupture
A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock? - ANSWER>>compensated
An unresponsive trauma pt has an oropharygeal airway in place, shallow and labored respirations, 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>>ventilate with a bag mask device
When is the tertiary survey completed fora trauma pt? - ANSWER>>within 24 hrs of trauma
An intubated and sedated pt in the ED has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? - ANSWER>>pressure
Which of the following is possible complication of positive-pressure ventilation? - ANSWER>>worsening pneumothorax
the most reassuring finding for a male pt with hip pain after a fall is which of the following? - ANSWER>>pelvic stability
Which of the following pulse pressures indicate early hypovolemic shock? - ANSWER>>narrowed
Patients with a crush injury should be monitored for which of the following conditions? - ANSWER>>dysrhythmias
Tearing of the bridging veins is most frequently associated with which brain injury? - ANSWER>>subdural hematoma
A 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? - ANSWER>>straight cath for urine sample
You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? - ANSWER>>placental abruption
Which of the following is true about the log-roll? - ANSWER>>it can worsen cord damage from an unstable spinal injury
All of these are considered a critical communication point in trauma care EXCEPT which of the following? - ANSWER>>defusings
What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? - ANSWER>>pulse oximetry and capnography
Caregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? - ANSWER>>padding the upper back while stabilizing the cervical spine
Which of the following injuries is LEAST likely to be promptly identified? - ANSWER>>bowel
A pt is brought to the ED of a rural hospital following a high-speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? - ANSWER>>Initiate transfer to a trauma center
A pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? - ANSWER>>bardycardia and absent motor function below the level of injury
a 37 y/o F has a deformity of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? - ANSWER>>apply splint and elevate above the level of the heart
which of the following occurs during the third impact of a motor vehicle crash? - ANSWER>>the aorta is torn at its attachment with the ligamentum arteriosum
a 5 y/o child presents to the ED with bruises to the upper arm 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 survey. Which of the following is the priority nursing intervention? - ANSWER>>Report your suspicion of maltreatment in accordance with local regulations
Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? - ANSWER>>to guage end-organ perfusion and tissue hypoxia
A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally by pain medications. Which of the following is the priority nursing intervention? - ANSWER>>elevating the extremity to the level of the heart
What factor contributes most to the kinetic energy of a body in motion? - ANSWER>>velocity
An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? - ANSWER>>subdural hematoma
a pt has been in the ED for several hrs waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the pt is restless with respiratory distress and petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of the following conditions? - ANSWER>>fat embolism
Which of the following is a late sign of increased intracranial pressure? - ANSWER>>Late signs of increased intracranial pressure include: dilated nonreactive pupils, unresponsive to verbal or painful stimuli, abnormal motor posturing, and Cushing response (widening pulse pressure, reflex bradycardia, decreased respiratory effort)
a 49 y/o restrained driver involved in a MVC presents to the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? - ANSWER>>serial FAST exams
Which of the following is NOT considered goal-directed therapy for cardiogenic shock? - ANSWER>>pericardiocentesis
The trauma nurse knows that placing a bariatric patient in a ramped position providers better visualization during the insertion of which device? - ANSWER>>endotracheal tube
which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? - ANSWER>>increased work of breathing
Assessment findings associated with tension pneumothorax include anxiety, severe restlessness, severe respiratory distress, and absent breath sounds on the injured side
if a pt has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? - ANSWER>>calcium
Which of the following is NOT considered a benefit of debriefings? - ANSWER>>identifying individuals who made mistakes during the traumatic event
You are treating a 27 y/o M in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? - ANSWER>>500 mL/hr
Which of the following is most likely to contribute to inadequate oxygenation and ventilation? - ANSWER>>advanced age
Which of the following patients warrants referral to a burn center? - ANSWER>>a 52 y/o diabetic male with a partial thickness burn to the left lower leg
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. he 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? - ANSWER>>dressing removal
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 pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? - ANSWER>>after a physical examination if the pt has no radiologic abnormalities on CT
Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? - ANSWER>>MARCH
A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body. - ANSWER>>What is kinematics?
A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. - ANSWER>>What is Newton's First Law?
Energy can neither be created nor destroyed. It is only changed from one form to another. - ANSWER>>What is the Law of Conservation of Energy?
Force equals mass multiplied by acceleration of deceleration. - ANSWER>>What is Newton's Second Law?
KE equals 1/2 the mass (M) multiplied by the velocity squared. - ANSWER>>What is kinetic energy (KE)?
A = Airway with simultaneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) - ANSWER>>What is the Mnemonic for the Initial Assessment?
F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). H = Hx and Head-to-toe assessment I = Inspect posterior surfaces - ANSWER>>What is the Mnemonic for the Secondary Assessment?
Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostal space at the anterior axillary line. - ANSWER>>Where do you listen to auscultate breath sounds?
A tight-fitting nonrebreather mask at 12-15 lpm. - ANSWER>>Upon initial assessment, what type of oxygen should be used for a pt breathing effectively?
DISABILITY A = Alert V = Verbal P = Pain U = Unresponsive
FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE
HISTORY / HEAD-TO-TOE ASSESSMENT
INSPECT POSTERIOR SURFACES
Reassess:
LOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents - ANSWER>>What medications are used during intubation?
PREPARATION:
A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are only two sizes: small adult and larger adult. - ANSWER>>What is a Combitube?
Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area.
ILMA, does not require laryngoscopy and visualization of the chords. - ANSWER>>What is a Laryngeal Mask Airway?
Percutaneous transtracheal ventilation. (temporary)
Complications include:
Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into trachea. This is indicated when other methods of airway management have failed and pt cannot be adequately ventilated and oxygenated.
Complications include:
Observe:
Absence of BS:
Dullness:
D - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing - ANSWER>>What is the DOPE mnemonic?
Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn).
Some causes:
Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle.
Some causes:
Results from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself.
Some causes:
Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region.
Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock.
Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. - ANSWER>>Explain Distributive Shock.
As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of baroreceptors. Arterioles constrict to increase TPR and BP. - ANSWER>>What is vascular response?
Renal ischemia activates release of renin.
Kidneys do not receive adequate blood supply, renin is release into circulation.
Renin causes angiotensinogen, normal plasma protein, to release angiotensin I.
Angiotensin-converting enzyme from the lungs converts into angiotensin II.
Angiotensin II causes:
*Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. - ANSWER>>What is renal response?
When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase.
Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion.
Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol.
Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar.
Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. - ANSWER>>Explain adrenal gland response.
Liver can store excess glucose as glycogen.
As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose.
In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. - ANSWER>>Explain Hepatic Response.
Tachypnea happens for 2 reasons:
Shock uncompensated or irreversible stages will cause compromises to most body systems.
(Use Initial Assessment) and then: Inspect:
Diagnostic Procedures:
As volume of one increases, the volume of another decreases to maintain ICP within normal range.
As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful.
Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. - ANSWER>>ICP is a reflection of what three volumes? What happens when one increases?
Triad of progressive HTN, bradycardia and diminished respiratory effort. - ANSWER>>What is Cushing's phenomenon or Cushing's Reflex?
Because of uncontrolled increases in ICP.
S/E's
The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes.
A downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. - ANSWER>>Define central or transtentorial herniation.
Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF.
CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess - ANSWER>>Disruptions of the bony structures of the skull can result in what?
GCS 13- 15 - ANSWER>>Define Minor Head Trauma.
Postresuscitative state with GCS 9-13. - ANSWER>>Define Moderate Head Trauma
Postresuscitative state with GCS score of 8 or less. - ANSWER>>Define Severe Head Trauma.
A temporary change in neurologic function that may occur as a result of minor head trauma. S/S:
(DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic damage primarily to axons within the brain. S/S:
A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S:
Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly:
A focal brain injury beneath the dura mater that results from acceleration/deceleration. Usually venous, and not necessarily from a fx. Formation may be acute or chronic.
Acute pt's hematoma manifest 48 hrs post injury S/S:
Chronic pt's " " up to 2 wks post injury
Occur deep within brain tissue, may be single or multiple and commonly associated with contusions (frontal & temporal lobes). They result in significant mass effect, leading to increased ICP and neurologic deterioration. S/S:
(Initial assessment) INSPECTION:
Accumulation of blood, mainly RBC's that disperse and layer within the anterior chamber. A severe hymphema obscures entire anterior chamber + will diminish visual acuity severely or completely. Injuries are graded on amount of blood in chamber (Grades I-IV). S/S:
Chemical injuries require immediate intervention if it is to be preserved. S/S:
Transverse maxillary fx that occurs above level of teeth and results in separation of teeth from rest of maxilla. S/S:
Pyramidal maxillary fx=middle facial area. Apex of fx transverses bridge of nose. Two lateral fx's of pyramid extend through the lacrimal bone of the face and ethmoid bone of skull into the median portion of both orbits. Base of the fx extends above level of the upper teeth into maxilla. CSF leak is possible. S/S:
Complete craniofacial separation involving maxilla, zygoma and bones of cranial base. This fx is frequently associated w/leakage of CSF and fx mandible. S/S:
(Initial assessment) HISTORY
blunt; MVC's. Penetrating; firarm injuries or stabbings - ANSWER>>What are the most common type of injury associated with chest trauma?