TNCC final exam test 2023-2024 open book Graded A+, Exams of Nursing

Download TNCC final exam test 2023-2024 open book Graded A+ and more Exams Nursing in PDF only on Docsity! 1 TNCCfinalexamtest2023openbook Whyisameasureofserumlactateobtainedintheinitialassessmentofthetraumapatient? Answer:ccorrectanswera)tomeasureoxygenationandventilation b) toquantifythebasedeficitfortheadequacyofcellularperfusion c) *togaugeend-organperfusionandtissuehypoxia** d) todeterminetheunderlyingcauseofshock Atraumapatientisrestlessandrepeatedlyasking"whereamI?"vitalsignsuponarrivalwereBP100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and symptoms of which stage of shock? Answer:AcorrectanswerA)compensated** B) Progressive C) irreversible D) decompensated Anelderlypatientwithahistoryofanticoagulantusepresentsafterafallathomethatday.shedenies anylossofconsciousness.Shehasahematomatoherforeheadandcomplainsofheadache,dizziness, and nausea. Which is a most likely cause of her symptoms? Answer:DcorrectanswerA)epiduralhematoma B) diffuseaxonalinjury C) post-concussivesyndrome 2 D) subduralhematoma*** EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons screening guidelines,whichassessmentfindingwouldpromptthenursetopreparethepatientforradiologicspine clearance? Answer:DcorrectanswerA)Alertwithnoneurologicdeficits B) Multipleabrasionstotheextremities C) Multiplerequestsofwater D) Smellofalcoholonbreath *** Whichofthefollowingoccursduringthethirdimpactofamotorvehiclecrash? Answer:CcorrectanswerA)Thedriverofthevehiclecollideswiththesteeringwheel B) thevehiclecollideswithatree C) theaortaistornatitsattachmentwiththeligamentumarteriosum D) theairbagdeploysandstrikesthefrontseatpassenger*** A passenger is brought to the emergency department of a rural hospital following a high-speed MVC. Whensignificantabdominalandpelvicinjuriesarenotedintheprimarysurvey,whichofthefollowingis the priority interventions? Answer:AcorrectanswerA)initiatetransfertoatraumacenter** B) providereporttotheoperatingroomnurse C) Obtainedimagingstudies D) Placeagastrictube 5 D) applyasplintandelevatetheextremitytotheleveloftheheart. Whichofthefollowingisalatesignofincreasedintracranialpressure? Answer:C Cushing Response Wideningpulsepressure Reflex bradycardia Decreased RRcorrectanswerA)Restlessnessordrowsiness B) Nauseaandvomiting C) Decreasedrespiratoryeffort** D) amnesiaandanxiety Whichofthefollowingmnemonicscanhelpthenurseprioritizecareforatraumapatientwithmassive uncontrolled hemorrhage? Answer:BcorrectanswerA)ABC B) MARCH*** C) AVPU D) VIPP Apatientisthrownagainstacarduringatornadoandpresentswithobviousbilateralfemoralfractures. 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? 6 Answer:AcorrectanswerA)initiatetwolargecaliberintravenouslinesforRingerslactatesolution administration *** B) AdministerDilaudidforpaincontrolandprovidecomfortcare C) Placethepatientinanobservationareaforcarewithinthenextfewhours D) Contactthecommandcenterforthepersonneltonotifynextofkin. A patient arrives with a large open chest wound after being assault ed with a machete, Prehospital providersplaced anonporous dressingoverthe chestwound andtapes iton3 sides. He is nowshowing signsofanxiety,restlessness,severerespiratorydistress,cyanosis,anddecreasingbloodpressure.Which of the following is the MOST appropriate interventions? Answer:CcorrectanswerA)needledecompression B) tubethoracostomy C) dressingremoval** D) surgicalrepair Apatientisfoundlyingonthefloorafterfalling13hoursago.Whichofthefollowinglabvaluesis expected with a musculoskeletal complication associated with this presentation? Answer:AcorrectanswerA)elevatedcreatinekinase*** B) decreasedpotassiumlevel C) decreasedWBC D) elevatedGFR A56-year-malepatientinvolvedinaMVCisbroughttotheEDofaruralcriticalaccessfacility.Hec/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows: BP 98/71 HR125 beats/min 7 RR26breaths/min SpO294%onhighflowO2viaNRBmask whichofthefollowingisthepriorityinterventionforthispatient? Answer:CcorrectanswerA)ExpeditetransporttotheCTscanner B) preparethepatientforspinalradiographs C) expeditetransfertotheclosesttraumacenter*** D) notifythepatientsfamily Caregiverscarrya2-yearoldintotheEDwhofelloutof2ndstorywindow.Thepatientisawakeand cryingwithincreased workof breathingandpale skin.whichofthe followinginterventions hasthe highest priority? Answer:AcorrectanswerA)paddingtheupperbackwhilestabilizingthecervicalspine*** B) applyingatight-fittingNRBmaskwithanattachedresevior C) establishingintravenousaccessandadministeringa20mL/kgbolus D) preparingfordrugassistedintubation Whichofthefollowingisacomponentofthetraumatriadofdeath? Answer:A hypothermia,metabolicacidosis,coagulopathycorrectanswerA)Acidosis** B) hyperthermia C) hemorrhage 10 (upperarm4+4/lowerarm3+3/hand2.5+2.5)=19%TBSA. 120kgx(2mL)x(19%TBSA)=4560mL 4560/2(halfoffluidsgiveninfirst8hours)=2280 mL Answer:AcorrectanswerA)2280mL*** B) 3840 mL C) 4560 mL D) 7680 mL WhichofthefollowingassessmentfindingsdifferentiatesatensionPTXfromasimplePTX? answer:D Assessmentfindingsassociatedwithtensionpneumothoraxincludeanxiety,severerestlessness,severe respiratorydistress,andabsentbreathsoundsontheinjuredside.Hypotensionduetocompressionof the heart and great vessels is consistent withobstructive shock. Hypotension worsens with inspiration duetoincreasedintrathoracicpressure.Latesignsincludedistendedneckveins,trachealdeviation,and cyanosis. correct answerA) increased work of breathing B) unilaterallydiminishedbreathsounds C) pleuriticchestpain D) hypotensionthatworsenswithinspiration*** Whichofthefollowingconsiderationsismostimportantwhencaringforageriatrictraumapatient? 11 Answer:BcorrectanswerA)headtotoexam B) medicalhistory** C) incontinence D) falls Anintubatedtraumapatientisbeingtransferredtoatertiarycarecenter.Aftermovingthepatienttothe stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions? Answer:DcorrectanswerA)callforaportableCXRstat B) chesttomakesuretheventilatorispluggedin C) suctiontheET tube D) confirmETtubeplacement Whatfactorcontributesmostthekineticenergyofabodyinmotion? answer:CcorrectanswerA)acceleration B) mass C) velocity*** D) inertia Duringtheprimarysurveyofanunconsciouspatientwithmulti-systemtrauma,thenursenotessnoring respirations. Which priority nursing interventions should be performed next? Answer:DcorrectanswerA)opentheairwaywiththehead-tilt/chinliftmaneuver B) auscultatebilateralbreathsoundstoassessventilatorystatus 12 C) assistrespirationsusingaBVM D) insertanoropharyngealairwayifthereisnogagreflex*** Followingareviewofrecentdrillsandarealdisasterevent,ahospitalhasidentifieddeficienciesandis takingstepstominimizethe impactof futuredisaster.Whichphaseofthe disaster lifecycle doesthis describe? Answer:AcorrectanswerA)mitigation*** B) preparedness C) response D) recovery Whichpulsepressuredescriptionisanindicationofearlyhypovolemicshock? Answer:BcorrectanswerA)widened B) narrowed*** C) bounding D) weak Themostreassuringfindingforamalepatientwithhoppainafterafalliswhichofthefollowing? Answer:DcorrectanswerA)anormalprostateexam B) absenceofabdominaldistension C) anormalfastexam D) pelvicstability*** 15 B) CTscan C) straightcathforurinesample*** D) iceandelevationofthescrotum Youaretreatinga27-yearoldmaleinrespiratorydistresswhowasinvolvedinahousefire.Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should you begin fluid resuscitation? Answer:BcorrectanswerA)1000mL/hr B) 500mL/hr*** C) 250mL/hr D) 125mL/hr Whichofthefollowingispossiblecomplicationofpositive-pressureventilation? Answer:AcorrectanswerA)worseningpneumothorax B) worseningflailchest C) reabsorptionofpleuralair D) negativeintrapleuralpressure WhichofthefollowingisNOTconsideredgoal-directedtherapyofcardiogenicshock? Answer:CcorrectanswerA)controlledfluidboluses B) antidysrhythmicadministration C) pericardiocentesis*** D) cardiaccath 16 Whatbedsidemonitoringparametersareusedtoassessforadequacyofoxygenationandeffectiveness of ventilation? Answer:AcorrectanswerA)pulseoximetryandcapnogaphy** B) respiratoryrateandcapnography C) pulseoximetryandrespiratoryrate D) capnographyandcapnometry Whichifthefollowingvaluesindicatestheneedforalcoholwithdrawalinterventions? Answer:AcorrectanswerA)CIWA-Arof36*** B) GCS 13 C) ETCo2of48mmHg D) heartrateof45beats/min Anunresponsivetraumapatienthasanoropharyngealairwayinplace,shallowandlaboredrespiratory, 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:AcorrectanswerA)VentilatewithaBVM*** B) Prepareforcricothyroidotomy C) administerreversalmedications D) contactanesthesiaforassistance Thetraumanurseknowsthatplacingabariatricpatientsina"rampedposition"providesbetter visualization during the insertion of which device? 17 Answer:CcorrectanswerA)Intraosseousline B) orogastrictube C) ETtube*** D) urinarycatheter You are caring for a patient who was involved in a MVA and is 32 weeks pregnant. Findings of your secondarysurveyincludeabdpainonpalpation,fundalhighatthecostalmargin,andsomedarkbloody show. Varying, accelerations and decelerations are noted on the cardiotocography. These findings are most consistent with which of the following? Answer:AcorrectanswerA)placentalabruption*** B) pretermlabor C) uterinerupture D) fetaldemise