TNCC final exam test Q & AS LATEST UPDATE 2022/2023 open book Graded A+, Exams of Nursing

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TNCCfinalexamtest2022openbook

Whyisameasureofserumlactateobtainedintheini

tialassessmentof the traumapatient?

Answer:c

a)tomeasureoxygenationandventilation

b) toquantifythebasedeficitfortheadequacyofcellular

perfusion

c)togaugeend-

organperfusionandtissuehypoxia*

d) todeterminetheunderlyingcauseofshock

A trauma patient is restless and repeatedly

asking "where am I?"vital signs upon arrival

were BP 100/60 mm Hg, HR 96 beats/min,and

RR 24breaths/min.Her skin iscooland dry.

Currentvitalsignsare BP 104/84mm Hg, HR 108,

RR 28 breaths/min. The patient

isdemonstratingsignsandsymptomsofwhichst

ageofshock?

Answer:A

**A) compensated****

B) Progressive

C)irreversible

2

D) decompensated

Anelderlypatientwithahistoryofanticoagulantuse

presentsaftera fall at home that day. she

denies any loss of consciousness. Shehas a

hematoma to her forehead and complains of

headache,dizziness, and nausea. Which is a

most likely cause of hersymptoms?

Answer:D

A) epiduralhematoma

B) diffuseaxonalinjury

C)post-concussivesyndrome

**D) subduralhematoma*****

EMSbringsapatientwhofellridinghisbicycle.Usingt

heAmericanCollegeofSurgeonsscreeningguideline

s,whichassessmentfindingwould prompt the

nurse to prepare the patient for radiologic

spineclearance?

Answer:D

A) Alertwithnoneurologicdeficits

B) Multipleabrasionstotheextremities

C)Multiplerequestsofwater

**D) Smellofalcoholonbreath*****

3

Which of the following occurs during the

third impact of a motorvehiclecrash?

4

Answer:C

A) Thedriverofthevehiclecollideswiththesteeringwhe

el

B) thevehiclecollideswithatree

C)theaortaistornatitsattachmentwiththeligamentumar

teriosum

D) theairbagdeploysandstrikesthefrontseatpassen

**ger*****

Apassengerisbroughttotheemergencydepartme

ntofaruralhospitalfollowingahigh-

speedMVC.Whensignificantabdominaland pelvic

injuries are noted in the primary survey, which

of thefollowingisthepriorityinterventions?

Answer:A

**A) initiatetransfertoatraumacenter****

B) providereporttotheoperatingroomnurse

C)Obtainedimagingstudies

D) Placeagastrictube

Which of the following is an expected finding in a

patient with athoracostomy

connectedtoachestdrainagesystem?

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Answer:D

A) outputof200mL/hr

B) tubingclampclosedfortransport

C)dependentloopsinthetubingtopromotedrainage

**D) fluctuationsinthewaterserialchamber*****

Which ofthefollowing patientswarrantsreferral

toa burncenter?

Answer:C

A) a21- year oldfemale withapartialthicknessburnto

therightforearm

B)a40-

yearoldhypertensivemalewithasuperficialburntothe

back

C)a52-

yearolddiabeticmalewithpartialthicknessburntothel

eftlowerleg

---

D) a35-year oldhyperlipidemicfemale

withsuperficial burnstothe anteriorthorax.

A patient has been in the ED for several hours

waiting to beadmitted. He sustained multiple rib

fractures and a femur fractureafter a fall. He has

been awake, alert, and c/o leg pain. His

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wifereported suddenly becoming anxious and

confused.

Uponreassessment,thepatientisrestless,withresp

iratorydistressandpetechiaetohisneck.thepatien

tisexhibitingsignsofsymptoms

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commonlyassociatedwithwhichofthefollowingcon

ditions?

Answer:B

A) acutelunginjury

**B) fatembolism*****

C)PTX

D) pulmonarycontusion

Whichistheeffectofhypothermiaontheoxyhemogl

obindissociationcurve?

Answer:A

A) Hemoglobindoesnotreadilyreleaseoxygenforuse

**bythetissues*****

B)Theamountofoxygenavailabletothetissuesincrease s

C)Tissueoxygenation(PaO2)increases

D) Hemoglobinmoleculesaturation(SaO2)decreases

A 20 - year old male presents to the ED c/o

severe lower abd

painafterlandinghardonthebicyclecrossbarswhic

hperforminganaerialBMXmaneuver.Secondaryas

sessmentrevealslowerabdtendernessandscrotal

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ecchymosis.Whichofthefollowingorderswouldth

enursequestions?

Answer:C

A) Fastexam

B) CTscan

**C)straightcathforurinesample*****

D) iceandelevationofthescrotum

Youaretreatinga27-

yearoldmaleinrespiratorydistresswhowasinvolve

d in a house fire. Calculating TBSA burned is

deferred d/t theneed for emergent intubation.

At what rate should you begin

fluidresuscitation?

Answer:B

A)1000mL/hr

**B)500mL/hr*****

C)250mL/hr

D) 125mL/hr

Whichofthefollowingispossiblecomplicationofposi

tive-pressureventilation?

Answer:A

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A) worseningpneumothorax

B) worseningflailchest

C)reabsorptionofpleuralair

D) negativeintrapleuralpressure

Whichof thefollowingisNOT consideredgoal-

directed therapyofcardiogenicshock?

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Answer:C

A) controlledfluidboluses

B) antidysrhythmicadministration

**C)pericardiocentesis*****

D) cardiac cath

Whatbedsidemonitoringparametersareusedtoas

sessforadequacyofoxygenationandeffectiveness

ofventilation?

Answer:A

**A) pulseoximetryandcapnogaphy****

B) respiratoryrateandcapnography

C)pulseoximetryandrespiratoryrate

D) capnographyandcapnometry

Which if the following values indicates

the need for

alcoholwithdrawalinterventions?

Answer:A

**A) CIWA-Arof36*****

B) GCS

C)ETCo2of48mmHg

D) heartrateof 45 beats/min

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Anunresponsivetraumapatienthasanoropharyng

ealairwayinplace, shallow and labored

respiratory, and dusky skin. the

traumateamhasadministeredmedicationsfordrug

assistedintubationandattemptedintubationbutw

asunsuccessful.Whatisthemostappropriateimme

diatenextstep?

Answer:A

**A) VentilatewithaBVM*****

B) Prepareforcricothyroidotomy

C)administerreversalmedications

D) contactanesthesiaforassistance

Thetraumanurseknowsthat placing

abariatricpatients

ina"rampedposition"providesbettervisualization

duringtheinsertionofwhichdevice?

Answer:C

A) Intraosseousline

B) orogastrictube

**C)ETtube*****

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D) urinarycatheter

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You are caring for a patient who was involved in

a MVA and is

32weekspregnant.Findingsofyoursecondarysurv

eyincludeabdpainonpalpation,fundalhighattheco

stalmargin,andsomedarkbloody show. Varying,

accelerations and decelerations are noted onthe

cardiotocography.Thesefindings

aremostconsistent withwhichofthefollowing?

Answer:A

**A) placentalabruption*****

B) pretermlabor

C) uterinerupture

D) fetaldemise

Apatientarriveswithalargeopenchestwoundafter

beingassaulted with a machete, Prehospital

providers placed a

nonporousdressingoverthechestwoundandtapes

iton3sides.Heisnowshowingsignsofanxiety,restl

essness,severerespiratorydistress,cyanosis,and

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decreasingbloodpressure.Whichofthefollowingis

theMOSTappropriateinterventions?

Answer:C

A) needledecompression

B) tubethoracostomy

**C)dressingremoval****

D) surgicalrepair

Apatientisfoundlyingonthefloorafterfalling13hou

rsago.Whichofthefollowinglabvaluesisexpectedw

ithamusculoskeletalcomplicationassociatedwitht

hispresentation?

Answer:A

**A) elevatedcreatinekinase*****

B) decreasedpotassiumlevel

C)decreasedWBC

D) elevatedGFR

A56-year-

malepatientinvolvedinaMVCisbroughttotheEDofar

ural critical access facility. He c/o neck pain, SOB,

and diffuse

abdpain.HisGCSis15.Hisvitalsareasfollows:

BP98/

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HR125beats/min

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RR26breaths/min

SpO294%onhighflowO2viaNRBmask

whichofthefollowingisthepriorityinterventionfort

hispatient?Answer:C

A) ExpeditetransporttotheCTscanner

B) preparethepatientforspinalradiographs

**C)expeditetransfertotheclosesttraumacenter*****

D) notifythepatientsfamily

Caregivers carry a 2-year old into the ED who

fell out of 2nd storywindow. The patient is

awake and crying with increased work

ofbreathingandpaleskin.whichofthefollowingint

erventionshasthehighestpriority?

Answer:A

A) paddingtheupperbackwhilestabilizingthecervical

**spine*****

B)applyingatight-

fittingNRBmaskwithanattachedresevior

C)establishingintravenousaccessandadministeringa

20mL/kgbolus

D) preparingfordrugassistedintubation

Whichof the followingisacomponentof the

traumatriadof death?

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Answer:A

hypothermia,metabolicacidosis,coagulopathy

**A) Acidosis****

B) hyperthermia

C)hemorrhage

D) sepsis

A 35-year oldmale

presentswithfacialtraumaafterbring

struckinthefacewith a baseball.a tear-

dropshapedleftpupilisnotedonexam.Whattypeofin

juryissuspected?

Answer:B

A) oculomotornervepalsy

**B) globerupture*****

C)uncalherniation

D) retinaldetachment

Whichofthe followingistrueabout the

logrollmaneuver?

Answer:C

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A) itcauseslessspinalmotionthantheliftandslidemanu

ever

B)it isrecommended for

patientswithunstablepelvicfractures

C)itcanworsencorddamagefromanunstablespinalinjury

---

D) itdoesnotincreasestheriskoflifethreateninghemor

rhagefromunstableinjuries

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EMS arrives

withtheintoxicateddriverofacarinvolvedin

aMVC.EMSreportssignificantdamagetothedriverss

ideofthecar.Thepatient is asking to have the

cervical color removed. when is

itappropriatetoremovethecervicalcollar?

Answer:A

A) afteraphysicalexaminationifthepatienthasnoradi

ologicabnormalitieson a

**computedtomographyscan*****

B) afterphysicianevaluationifthepatienthasnotneur

ologicabnormalitiesonexam

C)afterpalpationof the spineif the patienthas no

pointtendernessthe thevertebralcolumn

D) afterphysicalexaminationifthepatienthasnotneckp

ainwithmovementTearingofthebridgingveins is

most frequently associated withwhich brain

injury?

Answer:B

A) epiduralhematoma

**B) subduralhematoma*****

C)diffuseaxonalinjury

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D) intracerebralhematoma

If apatient

hasreceivedmultipletransfusionsofbankedbloodpr

eservedwithcitrate,whichelectrolyteismostlikelyt

odropandrequiresupplementation?

Answer:D

A) potassium

B) magnesium

C)sodium

**D) calcium*****

A trauma patient is en route to a rural ED.

Radiology notifies thecharge nurse that the CT

scanner will be out of service for several

ofhours. The team gathers to plan accordingly.

Which of the followingtermsbest describes

thistraumateamscommunication?

Answer:D

A) Brief

B) loop

C)debrief

**D) huddle*****

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The nurse is caring for a 120 kg male is brought

in after

awarehousefireandiscalculatingthepatient'sfluid

resuscitationneeds. He has painful red

blistering to the entire surface of bothupper

extremities and superficialburnsto

theanteriorchest. Usingthe modified Lund and

Browder chart to calculate the total

BSAburned,howmuchIVfluidswouldbeadminister

edinthefirst8

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hours?

(upperarm4+4/lowerarm3+3/hand2.5+2.5)=19%T

BSA.

120kgx(2mL)x(19%TBSA)=4560mL

4560/2(halfof

fluidsgiveninfirst8hours)=2280mLAnswer:

A

**A)2280mL*****

B) 3840mL

C)4560mL

D) 7680mL

Whichofthefollowingassessmentfindingsdifferent

iatesatensionPTXfromasimplePTX?

answer:D

Assessmentfindingsassociatedwithtensionpneu

mothoraxincludeanxiety,severerestlessness,sev

ererespiratorydistress,andabsent breath

sounds on the injured side. Hypotension due

tocompressionoftheheartandgreatvesselsiscons

istentwithobstructive shock.Hypotension

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worsenswith inspirationdue

toincreasedintrathoracicpressure.Latesignsinclu

dedistendedneckveins,trachealdeviation,andcya

nosis.

A) increasedworkofbreathing

B) unilaterallydiminishedbreathsounds

C)pleuriticchestpain

**D) hypotensionthatworsenswithinspiration*****

WhichofthefollowinginjuriesisLEASTlikelytobepro

mptlyidentified?

Answer:C

A) spleen

B) lung

**C)bowel*****

D) brain

Patientswithacrushinjuryshouldbemonitoredforw

hichofthefollowingconditions?

Answer:C

A) Hypernatremia

B) Hypercalcemia

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**C)Dysrhthmias****

D) polyuria

Whatfindingraisessuspicionofcompletespinalcordi

njury?

Answer:B

A) Weaknessinthelowerextremities

**B) Priapism*****

C)voluntaryanalsphinctertone

D) intactreflexesdistaltotheinjury

Apatientwithacompletespinalcordinjuryinneuroge

nicshockwilldemonstratehypotensionand

whichotherclinicalsigns?

Answer:D

A) Bradycardiaandipsilateralabsencesofmotorfunctio

n

B) Tachycardiaandrespiratorydepression

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C)Tachycardiaandabsentmotorfunctionbelowthelevelo

finjury

D) Bradycardiaandabsentmotorfunctionbelowtheleve

**loftheinjury*****

A5-yearoldchildpresentsto theEDwithbruises

tothe

upperarmsandbuttocksinvariousstagesofhealinga

ndmultiplesmall,clean,round burns to the back.

There are no abnormalities found based

onthepediatricassessmenttriangleor

primarysurvey.Whichofthefollowingisthepriorityn

ursingintervention?

Answer:A

A) reportyoursuspicionofthemaltreatmentin

**accordancewithlocalregulations*****

B) applyicetothebruisesandconsultwoundcare

C)engageintherapeuticcommunicationtodeterminethe

MOI

D) providethefamilywithinjurypreventionresourse

A patient with lower extremity fracture

complains of severe painand tightness in his

calf, minimally relieved by pain