TNCC Test Prep: 8th Edition Questions and Answers, Exams of Nursing

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A 56 y/o M involved in a MVC is brought to the ED. He complains of neck pain, SOB, and diffuse abdominal pain. His GCS is 15, VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which is the priority intervention for this patient? - ANSWERSExpedite transfer to the closest trauma center Which of the following considerations is the most important when caring for a geriatric trauma pt? - ANSWERSa 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? - ANSWERSMitigation EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? - ANSWERSsmell of alcohol on breath What is the effect of hypothermia on the oxyhemoglobin dissociation curve? - ANSWERShemoglobin does not readily release O2 for use by the tissues Which of the following is a component of the trauma triad of death? - ANSWERSacidosis 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? - ANSWERSComplete Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? - ANSWERSflucuation 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? - ANSWERSinsert 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? - ANSWERSglobe 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? - ANSWERScompensated 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? - ANSWERSventilate with a bag mask device When is the tertiary survey completed fora trauma pt? - ANSWERSwithin 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? - ANSWERSpressure Which of the following is possible complication of positive-pressure ventilation? - ANSWERSworsening pneumothorax the most reassuring finding for a male pt with hip pain after a fall is which of the following? - ANSWERSpelvic stability Which of the following pulse pressures indicate early hypovolemic shock? - ANSWERSnarrowed Patients with a crush injury should be monitored for which of the following conditions? - ANSWERSdysrhythmias Tearing of the bridging veins is most frequently associated with which brain injury? - ANSWERSsubdural 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? - ANSWERSstraight 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? - ANSWERSplacental abruption Which of the following is true about the log-roll? - ANSWERSit can worsen cord damage from an unstable spinal injury

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? - ANSWERSsubdural 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? - ANSWERSfat embolism Which of the following is a late sign of increased intracranial pressure? - ANSWERSdecreased respiratory effort (Early signs of increased intracranial pressure include headache, nausea, vomiting, amnesia, and behavioral changes (impaired judgment, restlessness, drowsiness). 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? a.Diagnostic peritoneal lavage b.Serial FAST exams c.Abdominal and pelvic CT scans d.Serial abdominal assessments - ANSWERSDiagnostic peritoneal lavage Which of the following is NOT considered goal-directed therapy for cardiogenic shock? - ANSWERSpericardiocentesis The trauma nurse knows that placing a bariatric patient in a ramped position providers better visualization during the insertion of which device? - ANSWERSendotracheal tube which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? - ANSWERShypotension that worsens w/ inspiration if a pt has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? - ANSWERScalcium (Hypocalcemia is a concern with massive transfusion because citrate is added to banked blood to prevent coagulation. Citrate chelates/binds with calcium, rendering it inactive.) Which of the following is NOT considered a benefit of debriefings? - ANSWERSidentifying 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? - ANSWERS500 mL/hr Which of the following is most likely to contribute to inadequate oxygenation and ventilation? - ANSWERSadvanced age Which of the following patients warrants referral to a burn center? - ANSWERSa 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? - ANSWERSdressing removal (This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing) 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? - ANSWERSafter 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? - ANSWERSMARCH (The MARCH mnemonic stands for massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. The MARCH mnemonic recognizes uncontrolled hemorrhage as the major cause of preventable death after injury.) A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented, and has delayed capillary refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principles? - ANSWERSInitiate two large-caliber IVs for LR administration What finding raises suspicion of a complete spinal cord injury? - ANSWERSPriapism A trauma patient is en route to a rural emergency department. Radiology notifies the charge nurse that the computerized tomography (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? - ANSWERShuddle? An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority intervention? - ANSWERSConfirm ETT placement