TNCC Trauma Nursing Core Course 18th Edition ENA Test Bank, Exams of Nursing

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1. Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? A. Principles of PHTLS B. The Golden Period C. The XABCDE assessment D. Critical thinking process - ansQuestion 1: D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient.
2. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? A. Superficial (first degree) B. Partial thickness (second degree) C. Full thickness (third degree) D. Subdermal (fourth degree) - ansQuestion 1: B Scald burns are the most common burns seen in the pediatric population ages 1 to 5 years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters are present or popped. It is also the most painful type of burn.
3. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? A. Immediately begin triaging patients. B. Treat the patient with the most visible blood loss. C. Determine the need for additional resources. D. Assess the scene and ensure it is safe. - ansQuestion 1: D Ensure safety for responders, bystanders, and patient(s). The first consideration when approaching any scene is the safety of all emergency responders. When EMS personnel become victims, they not only can no longer assist others, but also add to the number of patients.
4. You are called to the scene of an explosion and fire at a chemical plant where you find multiple casualties.Triage has begun. Your first patient is a 40-year-old man who was near the source of the explosion. He is unconscious and has extensive injuries. You note gurgling respirations. Why should you use the trauma jaw thrust maneuver first when dealing with a trauma patient?

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A. It's an easy technique that always works to open the airway.

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regular; ventilation rate 20 and slightly labored; SpO2 93% on room

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air. She is taking warfarin for a clotting issue. Which of the following should you suspect? A. Cerebral contusion B. Epidural hematoma C. Subarachnoid hemorrhage D. Subdural hematoma - ansQuestion 1: D The patient's age, use of a blood thinner, and the fact she fell recently point to a subdural hematoma.

1. Your partner is compressing the bleeding site of a male patient who was stabbed multiple times in the left chest. The bleeding seems to be controlled, yet the patient becomes combative. He is pale and is breathing rapidly, yet states that he "can't breathe" and feels that he is about to die. Your next step in patient management is to: A. start assisted ventilation. B. give high-flow oxygen. C. decompress the left chest. D. give a 250-mL fluid bolus. - ansQuestion 1: C After X come A and B. You can quickly auscultate the lungs (pneumothorax is almost certain with multiple stabs in the chest) and decompress the chest. Decompressing a tension pneumothorax is the quickest way to treat shock.
2. Your patient is experiencing severe pain after sustaining a femur fracture in a motorcycle crash. You have a 20 minute transport to the nearest trauma center. There are no other injuries noted on your primary and secondary assessments. Which of the following medications would be the best pain management choice? A. NSAIDs B. Acetaminophen C. Fentanyl D. Morphine - ansQuestion 1: C Fentanyl is often a first-line agent due to speed of onset, short duration of action, and minimal effect on hemodynamics. Fentanyl can beadministered IN, IM, IO, or IV. The IV route provides effects instantly whereasthe IN and IM route have an onset of <10 minutes. The duration of fentanyl is short at 30 minutes to an hour. This will provide enough time to ease pain during transport and let the traumacenter decide pain management upon arrival.
3. A trauma patient from the highway incident is holding her right arm, and you note a significant amount of blood steadily flowing from a long gash. This is an example of what type of hemorrhage? A. Capillary bleeding B. Venous bleeding C. Arterial bleeding D. Road rash - ansQuestion 2: B Venous bleeding typically results in a steady flow of dark red blood.

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A. "Oh yes, that's a great idea!" B. "Yes, but we have to immobilize him first" C. "Take a blood pressure first to see if he needs an IV." D. "No, keep the pressure and let's get out of here!" - ansQuestion 2: D This patient is likely in decompensated shock with internal bleeding, so rapid transport is the next priority. You should maintain pressure on the wound, because having massive external bleeding start up again is the last thing you want in this situation.

2. Upon examination, you find the patient responsive to your presence, although she is clearly confused. Motor response shows reduced pain response but normal flexion. What's her GCS score? A. 15 B. 12 C. 10 D. 8 - ansQuestion 2: B Eye opening: 4; verbal response: 4; motor response: 4 = 12
3. When using the XABCDE assessment, which of the following takes precedence over all other actions? A. Controlling severe bleeding from a limb or other compressible site B. Airway stabilization and assessing circulatory status C. Exposing the body to allow a thorough evaluation D. Ensuring adequate breathing - ansQuestion 2: A The "X" placed before "ABCDE" in the primary survey refers to the need to address exsanguinating hemorrhage immediately after establishing scene safety and before addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding, has the potential to lead to loss of total or near total blood volume in a relatively short period of time.
4. You are responding to a call to an MVC involving one patient. When you perform your primary survey, you find a patent airway, but abnormalities with breathing and circulation. You suspect hypovolemic shock, but cannot determine the source. What does this finding most likely indicate? A. Hemothorax B. Intra-abdominal bleed C. Blunt cardiac injury D. Diaphragmatic rupture - ansQuestion 2: B The most reliable indicator of an intraabdominal bleed is the presence of hypovolemic shock from an unexplained source.
5. You have determined that you are going to need to perform orotracheal intubation on a 50-year-old male motor vehicle crash (MVC) critically injured trauma patient due to prolonged transport time. What do you need to do first?

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A. Preoxygenate to maximize oxygen saturation. B. Place the patient in a "sniffing"position. C. Clear the mouth of any obstructions. D. Prepare the patient for immediate transport. - ansQuestion 2: A Before insertion of any invasive airway, the patient is preoxygenated with a high concentration of oxygen using a simple airway adjunct or manual airway procedure.

3. After exposing the patient, no other burn injuries were found, but blisters have started to form on the hand and the child is crying from pain. How should you manage the blisters? A. Lance the blisters to drain the fluidand relieve the pressure. B. Cover the injury with a dry, loose, sterile dressing, being sure to leave the blisters intact. C. Use a topical antibiotic ointment and firmly wrap the burn injury. D. Establish an IV for fluid resuscitation. - ansQuestion 3: B In the prehospital setting, blisters are generally best left alone during the relatively short transport time. Blisters that have already ruptured should be covered with a clean, dry dressing.
4. What does the GCS score indicate? A. Mild TBI B. Moderate TBI C. Severe TBI D. No TBI - ansQuestion 3: B A total GCS score of 13 to 15 likely indicates a mild TBI whereas a score of 9 to 12 is indicative of moderate TBI. A GCS score of 3 to 8 suggests severe TBI.
5. What is the best way to control the bleeding? A. Direct pressure B. Elevation of the arm above the heart C. Tourniquet D. Occlusive dressing - ansQuestion 3: A With venous bleeds, direct pressure isusually sufficient to stop the flow.
6. When securing a patient to a backboard, which body part should you secure first? A. Head B. Torso C. Legs D. Pelvis - ansQuestion 3: B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis.
7. Which of the following is the basis on which a patient's chance of survival is maximized?

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C. Obtain the patient's medical records and resuscitate to his normal blood pressure reading. D. Carefully administer IV fluids to raise the patient's systolic blood pressure to between 80 and 90 mm Hg. - ansQuestion 3: D Abdominal trauma represents one of the key situations in which a balanced resuscitation is indicated. Aggressive administration of IV fluid may elevate the patient's blood pressure to levels that will disrupt any clot that has formed and result in recurrence of bleeding that had ceased because of blood clotting and hypotension. Prehospital care practitioners must achieve a delicate balance: maintain a blood pressure that provides perfusion to vital organs without restoring blood pressure to elevated or even normal ranges, which may reinitiate bleeding sites in the abdomen or pelvis. In the absence of TBI, the target systolic blood pressure is 80 to 90 mm Hg (mean arterial pressure of 60 to 65 mmHg).

4. After 400 mL of lactated Ringer solution, you get a radial pulse and his level of consciousness improves. The monitor shows heart rate 110 beats/minute, blood pressure 85/60mm Hg, SpO2 95%, ventilation rate 25 breaths/minute. What should you do? A. Give an additional 500 mL of lactated Ringer solution. B. Stop fluids and give 2 g of TXA. C. Give TXA and 500 mL of normal saline. D. Give 2 mg of morphine for analgesia. - ansQuestion 4: B The patient does not need more fluids right now. Giving morphine in a shocked patient is a risky move and could lead to dangerous hypotension.
5. The patient is wearing long sleeves, and you are having trouble visualizing the wound. What should you do? A. Cut the cloth away from the site until the entire wound site is visible. B. Leave the clothing in place. Put gauze over the wound. C. Remove the patient's shirt. D. Cut through the slash on the sleeve, and use the material as a makeshift tourniquet. - Clothing can be quickly removed by cutting. You cannot treat what you cannot see.
6. What is one reason to use capnography as part of your patient reassessment? A. To get accurate readings for blood pressure B. To assure proper ET tube placement C. To measure arterial blood saturation D. To ensure proper placement for needle decompression - ansQuestion 4: B Capnography can monitor proper endotracheal tube placement. It doesn't read blood pressure, so it cannot beused to determine if a patient is hypotensive. Pulse oximetry, not capnography, measures arterial blood saturation. Capnography is not useful in needle decompression. ansQuestion 4:

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4. What type of padding should you provide for this patient? A. Use compressible padding under the shoulders and torso to prevent hyperflexion. B. Use firm padding between the back of the head and the backboard to prevent C. Do not use any padding. It can cause extension or flexion in the neck. D. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral position. - ansQuestion 4: B Because the patient is an adult, you should use firm padding between the back of the head and the backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion, and you would tip the backboard for a pregnant patient to prevent decreased venous return.
5. When you examine the patient's pupils, you notice the right one is dilated significantly and her motor response on the left is delayed. What does this suggest? A. Coup-countercoup injury B. Hyphema C. Hypoxia D. Uncal herniation - ansQuestion 4: D When the medial portion of the temporal lobe (uncus) is pushed toward the tentorium and puts pressure on the brain stem, herniation compresses CN III, the motor tract, and the reticular activating system on the same side, resulting in a dilated or blown pupil on the same side, motor weakness on the opposite side, and respiratory dysfunction, progressing to coma.
6. Which of the following is a goal of the Golden Period? A. Provide written documentation from field care to receiving hospital. B. Expedite the field care and transport of the patient. C. Use a team approach for optimal patient care. D. Use the XABCDE approach to patient assessment. - ansQuestion 4: B One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the time from injuryto arrival at the appropriate site fordefinitive care is critical to survival.
7. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient? A. Shorter tracheas in geriatric patients create the need for ventilation assistance. B. Laxity of the rib cage makes hyperventilation more likely. C. Geriatric patients have greatly limited physiologic reserve. D. Geriatric patients have a greater alveolar surface area of the lungs. - ansQuestion 4: C hyperextensio

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In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY ch. 5, p. 45 , which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. - ansHYPERVENTILATION ch. 7, p. 74 55% of spinal injuries occur to which part of spine? - anscervical ch. 13, p. 179 A rapid, thready pulse may indicate (a. ), and an irregular pulse may warn of potential (b. ). - ansa. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the resuscitation. An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation of hydrogen ions and metabolic acidosis. ch. 5, p. 46 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility (potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use)

• NOREPINEPHRINE increases heart rate, vascular tone through alpha- adrenergic receptor activation, and blood flow to skeletal muscle and triggers the release of glucose from energy stores.

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ch. 7, p. 77 Additional history includes the following (MIST mnemonic) prehospital report:

• ans- MOI
• Injuries sustained
• Signs and Symptoms (in the field)
• Treatment (in the field) ch. 5, p. 47 All open fractures are considered contaminated due to exposure to the environment and are at risk for infection. These sites of injury have poor wound healing with a risk of.... - ansOSTEOMYELITIS and SEPSIS ch. 14, p. 197 Anterior cord syndrome - ansloss of pain and temperature sensation with weakness, paresthesia, and urinary retention ch. 13, p. 182 AORTIC DISRUPTION - ansAssessment findings
• Fractures of sternum, first or second rib or scapula
• CARDIAC MURMURS
• BACK, CHEST PAIN
• UNEQUAL EXTREMITY PULSE STRENGTH or BLOOD PRESSURE (Significantly greater in upper extremities)
• HYPOTENSION
• TACHYCARDIA
• SKIN CHANGES: diaphoresis, pallor, cyanosis
• PHARAPLEGIA (due to disruption of spinal perfusion from aortic injury)
• Radiograph findings include- left hemothorax, right-sided tracheal deviation, widened mediastinum Interventions
• Prepare for surgery or angiography
• Consider massive transfusion protocol ch. 11, p. 146 Are the lumen contents of the small bowel considered sterile? What is the pH? - ansneutral pH, and sterile ch. 12, p. 164

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• If patient hemodyanmically unstable for CT, a single-infusion IVP can be performed at
• Positive urine dipstick for microscopic blood or leukocyte esterase
• Abnormal or elevated BUN and creatinine 90% of injuries are minor. Anticipate nephrology consultation in more severe injures; surgical repair is required within 12 hours to salvage an ischemic kidney ch. 12, p. 167 Assessment findings of a CHRONIC SUBDURAL HEMATOMA - ans- ALTERED or
• HEADACHE
• LOSS OF MEMORY or ALTERED REASONING
• MOTOR DEFICIT: CONTRALATERAL HEMIPARESIS, HEMIPLEGIA, OR
• APHASIA
• IPSILATERAL UNILATERAL FIXED and DILATED PUPIL
• INCONTINENCE
• SEIZURES Ch. 9, p. 114 Assessment findings of a DIFFUSE INJURY - ansInjuries that occur over a wide spread area, not always identifiable on CT because damage involves contusions or hearing and stretching of micro vascular, not a localized hematoma. These injuries commonly follow a direct blow to the head and are often sports-related. Patients can have varying degrees of symptoms that last minutes to hours. Assessment findings include:
• TRANSIENT LOC
• HEADACHE, DIZZINESS
• NAUSEA, VOMITING
• CONFUSION, DISORIENTATION
• MEMORY LOSS and CONCENTRATION DIFFICULTY
• IRRITABILITY and FATIGUE Ch. 9, p. 115 Assessment findings of a EPIDURAL HEMATOMA - ans- TRANSIENT LOC followed by
• HEADACHE, DIZZINESS
• NAUSEA, VOMITING
• CONTRALATERAL HEMIPARESIS
• HEMIPLEGIA bedside followed by complete study once patient STEADY DECLINE IN ABNORMAL MOTOR POSTURING OR lucid period lasting minutes to

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- ABNORMAL MOTOR POSTURING (FLEXION/EXTENSION)

Extension is associated with brainstem HERNIATION and poor outcomes

• IPSILATERAL UNILATERAL FIXED, DILATED PUPIL
• RAPID DETERIORATION IN NEURO STATUS Ch. 9, p. 114 Assessment findings of a HERNIATION SYNDROME - ans- ASYMMETRIC PUPILLARY REACTIVITY
• UNILATERAL or BILATERAL PUPILLARY DILATION
• ABNORMAL MOTOR POSTURING
• other evidence of neurologic deterioration (loss of normal, reflexes, paralysis, or change in LOC) Ch. 9, p. 115 Assessment findings of a INTRACEREBRAL HEMATOMA - ans- PROGRESSIVE,
• HEADACHE
• SIGNS OF INCREASING ICP
• PUPIL ABNORMALITIES
• CONTRALATERAL HEMIPARESIS
• HEMIPLEGIA
• ABNORMAL POSTURING Ch. 9, p. 114 Assessment findings of an ACUTE SUBDURAL HEMATOMA - ans- SEVERE HEADACHE
• CHANGES IN LOC
• IPSILATERAL DILATED or NONREACTIVE PUPIL
• CONTRALATERAL HEMIPARESIS Ch. 9, p. 114 Assessment findings of DIFFUSE AXONAL INJURY - ans- UNCONSCIOUSNESS Mild DAI lasts 6-24 hrs Severe DAI lasts weeks to months
• INCREASED ICP
• ABNORMAL POSTURING
• HTN (systolic BP between 140-160)
• HYPERTHERMIA (104-105 F)
• EXCESSIVE SWEATING

RAPID DECLINE IN

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Beck's Triad- HYPOTENSION, MUFFLED HEART SOUNDS, DISTENDED NECK

• CHEST PAIN
• TACHYCARDIA
• DYSPNEA
• CYANOSIS
• Pulsus paradoxus greater than 10 mm Hg Interventions
• Prepare for pericardial decompression
• 3 to 4 cm incision made just left of xiphoid process
• Needle percardiocentesis may also be used to relieve symptoms of cardiac tamponade but its only temporary solution ch. 11, p. 146 Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on tissue. The impact of cavitation is dependent on the characterists of the affected tissue. Additional considerations include:
• Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high- velocity cavitation relatively well compared to other tissues
• Solid organs such as the liver, have a greater propensity to shear or tear under the same forces
• If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 Central cord syndrome - ansloss of motor function in upper extremities that is greater than that of lower extremities. often sacral sparing. bladder function may be affected ch. 13, p. 182 Classifications of acute pain are based on the source and origin and include... - ansSOMATIC pain originates from skin and muscloskeletal structures VISCERAL PAIN originates from organs and may lead to referred pain ch. 8, p. 93 Components of CUS and its purpose - ansC: I am

VEINS

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Concerned U: I am Uncomfortable