TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSI, Exams of Nursing

Download TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSI and more Exams Nursing in PDF only on Docsity! TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ _________ 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 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ 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. 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 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - ABNORMAL PUPILLARY RESPONSE - ABNORMAL POSTURING Ch. 9, p. 115 Assessment findings for renal injuries include - ans- Turner sign (bruising by 11th and 12th ribs) - Hematuria - Frank tenderness, costovertebral angle tenderness, palpable flank mass - Structural damage or leakage of contrast on intravenous pyelogram (IVP) - If patient hemodyanmically unstable for CT, a single-infusion IVP can be performed at bedside followed by complete study once patient is stable - 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 STEADY DECLINE IN LOC - HEADACHE - LOSS OF MEMORY or ALTERED REASONING - MOTOR DEFICIT: CONTRALATERAL HEMIPARESIS, HEMIPLEGIA, OR ABNORMAL MOTOR POSTURING OR ATAXIA - APHASIA - IPSILATERAL UNILATERAL FIXED and DILATED PUPIL - INCONTINENCE TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - 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 lucid period lasting minutes to hours - HEADACHE, DIZZINESS - NAUSEA, VOMITING - CONTRALATERAL HEMIPARESIS - HEMIPLEGIA - ABNORMAL MOTOR POSTURING (FLEXION/EXTENSION) Extension is associated with brainstem HERNIATION and poor outcomes - IPSILATERAL UNILATERAL FIXED, DILATED PUPIL TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - 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, RAPID DECLINE IN LOC - 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 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - 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 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ 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 Concerned U: I am Uncomfortable S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Components of DESC and its purpose - ansD: Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7 Components of SBAR and its purpose - ansS: Situation B: Background A: Assessment TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 Compression may occur from the effects of chemical substances and can cause.. - ansEdema, restricting or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33-34 Compression strength refers to the tissue's ability to: - ansResist crush force - Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 Consider ABGs. A decreased level of consciousness may be an indicator of... - ansDecreased cerebral perfusion, hypoventilation, or acid-base imbalance. ch. 5, p. 46 Define biomechanics - ansThe general study of forces and their effects p. 25 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ Describe SEPTIC SHOCK - ansCaused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe the MOI associated with brain, cranial, and maxillofacial trauma - ansBLUNT injury - falls, MVCs, sports-related injuries, recreation PENETRATING injury - firearms or exploding objects or projectiles Ch. 9, p. 108 Describe the three E's of injury control - ansEngineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury Education: these can be community-based initiatives such as public service announcements for improved seatbelt use, education regarding risks of distracted driving, programs to commit to no texting while driving, and promotions for bicycle helmet giveaways with instructions for proper use p. 11 Disadvantages of auto-transfusion include: - ans- Risk of contamination - RBCs might become hemolyzed during hemorrhage TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - Coagulation factors, including platelets and cryoprecipitate may be destroyed, increasing d-dimer in collected blood ch. 7, p. 81 During primary survey... - ansLife-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 During the secondary survey in patient with thoracic or neck trauma, what questions do you want to ask? - ansIf patient is complaining of: - DYSPNEA - DYSPHAGIA - DYSPHONIA Was there a cardiac event prior to injury? If CPR is being performed, when was it started? - Important information in determining the indications for performing an emergency thoracotomy or when to consider withdrawal of support Ch. 11, p. 143 Early assessment findings of increased ICP include: - ans- HEADACHE - NAUSEA/VOMITING - AMNESIA TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS) - ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY) Ch. 9, p. 109 Early treatment for septic shock includes... - ansEarly administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. ch. 7, p. 75 Examples of referred pain include... - ans- radiating to left shoulder (Kehr sign) - referred to testicle may be indicative of duodenal injury - always begin palpation away from inital site of pain by assessing the painful area last ch. 12, p. 158 Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred Tertiary: Improvement of outcomes related to the traumatic injury p. 10 Explain definitive care on pancreatic trauma - ans- Non-op management including complete bowel rest, nutritional support, serial CT scanning with observation - Pseudocyst formations may be managed with percutaneous drainage - Pancreatic ductal injuries may need distal pancreatectomy TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ Ch. 10, p. 131-132 Explain how to assess circulation and control of hemorrhage in relation to thoracic trauma - ansAuscultation for: - MUFFLED HEART SOUNDS or MURMURS Palate for: - CENTRAL PULSES compare quality between left and right and lower and upper extremities - EXTERNAL JUGULAR VEIN DISTENTION - EXTREMITIES FOR MOTOR and SENSORY function Lower extremity paresis or paralysis may indicate an aortic injury Ch. 11, p. 142 Explain HYPHEMA - ansCollection of blood in anterior chamber of eye - classified as spontaneous or traumatic Assessment findings include: - PAIN, PHOTOPHOBIA - NOTICEABLE COLLECTION OF BLOOD IN EYE CHAMBER - BLURRY VISION due to blood in chamber - INCREASED IOP, NAUSEA, and SEVERE PAIN with grade 4 Treatment includes: - ELEVATING HOB 30 degrees TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - protecting eye with METAL SHIELD - TOPICAL OPHTHALMIC CYCLOPLEGICS and OPHTHALMIC STEROIDS, OPHTHALMIC BETA-BLOCKERS if IOP is ELEVATED - Avoid aspirin and NSAIDs as they increase risk of re-bleeding - Risk of re-bleeding greatest 3-5 days after injury Ch. 10, p. 131 Explain NEUROGENIC SHOCK and what are the assessment findings - ansOccurs with SC damage at T6 or higher, resulting in sympathetic regulation disruption of vagal tone leading to loss of vascular resistance and generalized vasodilation Assessment findings - BRADYCARDIA - HYPOTENSION - WARM, NORMAL COLOR SKIN - CORE TEMPERATURE INSTABILITY ch. 13, p. 181 Explain OBITAL FRACTURE - ans- NOT CONSIDERED OPHTHALMOLOGIC EMERGENCY unless there is IMPAIRED VISION or GLOBE RUPTURE - Usually result from DIRECT BLOW TO EYE - Complication of this type of fracture is ENTRAPMENT OF THE INFERIOR RECTUS or INFERIOR OBLIQUE MUSCLE Assessment findings include: - PERIORBIAL ECCHYMOSIS TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - DIPLOPIA WITH UPWARD GAZE - ENOPHTHALMOS - INFRAORBITAL NUMBNESS - DECREASED EOM Treatment includes: - ORAL ANTIBIOTICS - COOL COMPRESSES - CONSULT with possible surgical repair if pt continues to have DIPLOPIA or ENOPHTHALMOS 1-2 weeks after swelling has decreased - Discharge instructions include: advise pt to AVOID BLOWING NOSE, SNEEZING, and/or PERFORMING A VASALVA MANEUVER BEARING DOWN Ch. 10, p. 130-131 Explain oligoanalgesia - ansthe concept of undertreatment of pain ch. 8, p. 94 Explain pancreatic injuries - ans- Penetrating pancreatic injuries often sustain concurrent duodenal injuries - Less than 10% of those with a pancreatic injury will have a single-system injury - Suspicion for spinal fractures when the pancreas is crushed between anterior abdominal wall and spinal column ch. 12, p. 164 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - diminished respiratory effort Ch. 9, p. 107 Explain the LMNOP mnemonic - ansUsed to remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch) - Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm - Dysrhythmias (PVCs, a fib, or ST segment changes) may indicate blunt cardiac trauma - PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia N - Naso- or orogastric tube consideration: insertion provides stomach content evacuation and relief of gastric distention O - Oxygenation and ventilation assessment - Pulse ox may only be accurate if there is adequate peripheral perfusion - ETCO2 monitoring (capnography) provides instantaneous information about the ventilation, perfusion, and metabolism of carbon dioxide (35-45 is normal) ch. 5, p. 47 Explain the MARCH mnemonic - ansM: MASSIVE HEMORRHAGE A: AIRWAY TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41-42 Explain TRACHEOBRONCHIAL INJURY and what are the assessment findings and interventions - ansUsually caused by penetrating mechanisms, occurring in proximal trachea. Direct blows to neck or clothesline-type injuries common mechanisms for blunt trauma. Dx based on assessment findings and confirmed with BRONCHOSCOPY or CT. Assessment findings include: - DYSPNEA, TACHYPNEA - HOARSENESS - SUBCUTANEOUS EMPHYSEMA in neck, face, upper thorax - PNEUMOTHORAX, tension pneumothorax - HEMOPTYSIS - DECREASED OR ABSENT BREATH SOUNDS - SIGNS and SYMPTOMS of AIRWAY OBSTRUCTION Interventions include: - Attempts at ET placement may cause further damage, anesthesiology if available may reduce risk of intubation injury - Other approaches include flexible endoscopy, or smaller ET tube Ch. 11, p. 143 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ Explain what second impact syndrome is - ansRefers to a condition that occurs when patient suffers a mild second TBI before recovery from the first. Rare but usually fatal. The second impact causes LOSS OF AUTO REGULATION LEADING TO CEREBRAL EDEMA Ch. 9, p. 115 Explain what Tranexamic acid (TXA) is - ansA synthetic version of the amino acid lysine. It is an antifibrinolytic that inhibits activation of plasminogen, a substance responsible for dissolving clots. ch. 7, p. 81 Explain why antipyretics are not effective in treating hyperthermia in acute brain injury. - ansFever is result of a change in thermoregulatory set point. A cooling blanket or ice packs may be used. Avoid causing shivering, it increases cerebral metabolic rate and may cause ICP to rise Ch. 9, p. 118 External energy forces can be exerted on the body by the following forces - ans- Deceleration forces: include those applied in falls and collisions where injuries are caused by sudden stop of the body's motion - Acceleration forces: not as common as deceleration forces and result from a sudden and rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed) - Compression force is an external force applied at times of impact, explains include: + Stationary objects such as dashboards or steering wheels, that collide with or push up into a person + Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or heavy falling objects + Blast forces TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ ch. 14, p. 200-201 How should you wrap an amputated part? - ansWrap it in slightly saline-moistened sterile gauze, placed in sealed plastic bag THEN place in a second bag containing ice water ch. 14, p. 201 hyperEXTENSION - ansetiology/cause- backward thrust beyond anatomic capacity of vertebral column rest of injury- stretching or ligament tears, bony dislocations example- rear-end whiplash ch. 13, p. 179 hyperFLEXION - ansetiology/cause- forceful forward flexion with head striking an immovable object rest of injury- wedge fractures, facet dislocations, subluxation (due to ligament rupture), teardrop, odontoid or transverse process fractures example- head-on MVC with head hitting windshield, creating starburst effect ch. 13, p. 179 Hypothermia combined with ______ and ______ is a potentially lethal combination. - ansHYPOTENSION and ACIDOSIS TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ ch. 5, p. 46 If a penetrating wound is found below the 4th intercostal space, penetration into the _________ is suspected until proven otherwise. - ansABDOMINAL CAVITY Ch. 11, p. 140 If autoregulation fails and MAP is elevated, _______ can result. - ansEDEMA Ch. 9, p. 109 If breathing is absent: - ans- Open airway using jaw-thrust maneuver while maintaining manual cervical spinal stabilization - Insert and oral airway adjunct - Assist ventilations with bag-mask device - Prepare for definitive airway ch. 5, p. 44 If breathing is present: - ans1. Administer O2 at 15L/min via nonrebreather mask -- inability to maintain adequate oxygenation, causes hypoxemia resulting in anaerobic metabolism and acidosis -- Titrate oxygen delivery for stabilized trauma patients to avoid the detrimental physiologic effects of hyperoxia 2. Determine if ventilation is effective -- ETCO2 (end-tidal carbon dioxide) measurement between 35-45 shows effective ventilation. Level above 50 signifies depressed ventilation TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ -- SpO2 of 94% of higher is associated with effective ventilation ch. 5, p. 44 If injury causes the CPP to fall outside the range between ___________ mm Hg, the brain loses its ability to autoregulate and CBF becomes directly dependent on MAP for perfusion. - ans50 and 160 mm Hg Ch. 9, p. 108 If patient's airway is NOT patent: - ans1. Suction airway - Avoid stimulating gag reflex - Use rigid suction device if obstructed by blood, vomitus, or secretions - Remove any foreign bodies carefully with forceps 2. If suctioning does not relieve airway obstruction, tongue may be cause. Insert airway adjunct. - Use jaw-thrust maneuver to open airway while maintaining manual stabilization - A nasopharyngeal airway can be used in patients who are conscious or unconscious - An oropharyngeal airway can be used in patients without gag reflex 3. Consider a definitive airway (ET tube securely placed in trachea with cuff inflated) - The following conditions or situations require a definitively secured airway --apnea -- GCS score < 8 -- severe maxillofacial fractures -- evidence of inhalation injury/facial burns -- laryngeal or tracheal injury or neck hematoma -- high risk of aspiration and patient's inability to protect airway -- compromised or ineffective ventilation TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ p. 26 Leading cause of death for ages 1. over 65 2. 5 to 24 3. 25 to 64 - ans1. Falls 2. MVCs 3. poisoning p. 9 Maintain PaO2 between - ans100-200 mm Hg for ABGs ch. 6, p. 66 Mastoid process ecchymooses - ansBattles sign, indicates middle fossa fracture Ch. 9, p. 113 Newton's First Law of Motion - ansA body at rest will remain at rest, and a body in motion will stay in motion p. 26 Newton's Second Law of Motion - ansForce = Mass X Acceleration TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ p. 26 Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction p. 26 Non-invasive near-infrared spectroscopy is used to... - ansmeasure decreased tissue blood flow, useful to diagnose compartment syndrome ch. 14, p. 202 Once patient has airway in place, assess for proper placement by... - ans- Presence of adequate rise and fall of the chest with assisted ventilation - Absence of gurgling on auscultation over epigastrium - Bilateral breath sounds present on auscultation - CO2 detector device color change ch. 5, p. 43 One of the earliest responses to inadequately pefused tissue is... - ansTACHYPNEA ch. 7, p. 78 Output less than 0.5 mL/kg per hour for two consecutive hours indicates... - ansOLIGURIA ch. 7, p. 84 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ Oxyhemoglobin-dissociation curve indicates the correlation of tissue oxygneation (PaO2) as it saturates the hemoglobin molecule (SO2). P50 describes the oxygen pressure when the hemoglobin molecule is 50% saturated. Normal P50 is 26.7 mm Hg. A shift in the curve notes changes in the relationship: - ansShift to the RIGHT occurs in an environment of HIGH metabolic demand. Hemoglobin's affinity for oxygen decreases, making it easier to release the bound oxygen to the tissues. A shift to the right occurs in response to: - Increased carbon dioxide (hypercapnia) - Increased temp (hyperthermia) - Increased 2,3-diphosphoglycerate levels (a substance in blood that helps O2 move from hemoglobin to the tissues) - Decreased pH (acidemia) Shift to the LEFT occurs in an environment of LOW metabolic demand. Hemoglobin's affinity for oxygen increases, making it harder to release bound oxygen to the tissues. A shift to the right occurs in response to: - Decreased carbon dioxide (hypocapnia) - Decreased temp (hypothermia) - Decreased 2,3-diphosphoglycerate levels - Elevated pH (alkalosis) - Carbon monoxide and methemoglobinemia ch. 6, p. 65 Pain Theories include... - ansGATE CONTROL THEORY- proposes pain may be modulated by interneurons within spinal cord. Stimulation of the large A-beta cutaneous fibers was thought to close gate pain impulses from A-delta or C fibers. A-beta fibers carry impulses from touch, vibration, rubbing a painful area. Supports non-pharmacologic therapies for pain control such as ice, heat, massage. TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - ansGLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Musculoskeletal - ansIMPAIRED MUSCLE FUNCTION IMMOBILITY FATIGUE MUSCLE SPASM ch. 8, p. 97 Physiologic effects of pain by system: Respiratory - ansSPLINTING HYPOVENTILATION HYPERCARBIA RESPIRATORY ACIDOSIS INCREASED RISK OF ATELECTASIS & PNEUMONIA ch. 8, p. 97 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ POSTCONCUSSIVE SYNDROME assessment findings include: - ans- NAUSEA - DIZZINESS, PERSISTENT HEADACHE - MEMORY and JUDGEMENT IMPAIRMENT as well as ATTENTION DEFICITS - INSOMNIA and SLEEP DISTURBANCES - LOSS OF LIBIDO - ANXIETY, IRRITABILITY, DEPRESSION, EMOTIONAL LIABILITY - Noise and light over sensitivity - ATTENTION or CONCENTRATION PROBLEMS Ch. 9, p. 115-116 Prophylactic administration of what can reduce the risk of contrast-induced nephropathy when patients serum creatinine is above 1.2mg? - ansN-acetylcysteine along with hydration ch. 12, p. 170 PULMONARY CONTUSION - anscommonly occur from rapid deceleration or direct blunt impact such as MVCs or falls - it develops when capillary blood leaks into lung parenchyma with edema and inflammation, it may be localized or diffuse The subtle assessment findings associated with pulmonary contusions usually develop over time rather than immediately after injury. Assessment findings - DYSPNEA - INEFFECTIVE COUGH - INCREASED WORK OF BREATHING TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - HYPOXIA - CHEST PAIN - CHEST WALL CONTUSIONS or ABRASIONS Interventions - Maintain SpO2 between 94-98% - Minimize or use IV fluids judiciously - Prepare for possible intubation ch. 11, p. 146 Replacement with packed cells and saline without also transfusing with _______ and _______ further dilutes the patient's ability to clot blood. - ansPLATELETS and PLASMA ch. 7, p. 79 Resuscitation-associated coagulopathy is associated with the trauma triad of death. It includes... - ansHYPOTHERMIA impairs thrombin production and platelet function ACIDOSIS impairs thrombin production COAGULOPATHY results in depletion of clotting factors through hemodilution and impaired ability to produce clotting factors ch. 7, p. 78 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ E - Events and Environmental factors related to injury ch. 5, p. 48 Shear strength describes the tissue's ability to: - ansResist a force applied parallel to the tissue - Coup/contrecoup injury, such as a boxer being hit in the head, is an example of this p. 27 Signs of increased work of breathing, tachypnea, SOB, tachycardia, hypotension, and unilateral decrease in breath sounds on injuries side... - ansSignifies decreased cardiac output. Caused when air or blood accumulates in thoracic cavity causing increase in INTRAPLEURAL pressure on side of injury. If this pressure is allowed to expand without intervention, it can produce a MEDIASTINAL SHIFT which compresses heart and great vessels, resulting in a DECREASE in VENOUS RETURN (PRELOAD) and SUBSUQUENT DECREASE IN CARDIAC OUTPUT. Ch. 11, p. 141 Spinal cord neurons DO NOT regenerate; therefore, severe injury with cellular death may result in... - ans- temporary or permanent loss of function - flaccidity - loss of reflexes ch. 13, p. 181 SPINAL SHOCK - ansWhen spinal cord is injured, cascade of events takes place - Blood supply to cord can be disrupted - Axons are severed or damaged TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - Conduction of electrical activity of neurons and axons is compromised - All of the above result in loss of function which can last from several hours to several days - A transient hypotensive period and poor venous circulation may be seen - Disruption of thermal control centers results in sweating and lack of ability to regulation body temp - Transient loss of muscle tone (flaccidity) and complete or incomplete paralysis with reflex losses - Bowel and bladder dysfunction - Return of sacral reflexes, bladder tone, and presence of hyperreflexia indicates resolution of spinal shock - Presence of rectal tone and intact perineal sensation indicates sacral sparing ch. 13, p. 181 Stage I: Compensated Shock - ans- Anxiety, lethargy, confusion, restlessness from oxygen being shunted to brainstem - Systolic BP usually within normal range - Rising diastolic BP, results in narrowed pulse pressure, which is a reflection of peripheral constriction - A bounding and/or slightly tachycardic pulse - Increased RR - Decreased urine output ch. 7, p. 79 Stage II: Decompenstated or Progressive Shock - ans- LOC deteriorates patient becomes obtunded or unconscious as cell switch to anaerobic metabolism with increasing levels of lactic and pyruvic acids - Normal or slightly decreased systolic BP - Narrowing pulse pressure that continues until peripheral vascular vasoconstriction fails to provide cardiovascular support TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ - HR > 100 beats/min - Weak, thready pulses - Rapid, shallow respirations - Cool, clammy, cyanotic skin - Base excess not within normal range of -2 to +2 - Serum lactate levsl > 2 to 4 ch. 7, p. 79 Stage III: Irreversible Shock - ans- Obtunded, stuporous, comatose - Marked hypotension and HF - Bradycardia with possible dysrhythmias - Decreased and shallow RR - Pale, cool, clammy skin - Kidney, liver, and other organ failure - Severe acidosis, elevated lactic acid levels, and worsening base excess on ABGs - Coagulopathies with petechiae, purpura, or bleeding ch. 7, p. 79 Structural strengths of tissue are described in what three ways? - ans-Compression -Tensile -Shear p. 27 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ type and cross match M - monitor for continuous cardiac rhythm and rate assessment N - naso or orogastric tube consideration O - oxygenation and ventilation analysis: pulse oximetry and end-tidal carbon dioxide (ETCO2) monitoring and capnography P - pain assessment and management H: history and head-to-toe assessment I: inspect posterior surfaces ch. 5, p. 39 The assessment of circulation during the primary survey includes... - ansEarly evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient who has sustained blunt trauma. In those cases, an emergent abdominal or pelvic assessment may be preformed to include a focused assessment with sonography for trauma (FAST) examination or a radiograph of the pelvis. ch. 5, p. 44 The degree to which tissues resist destruction under circumstances of energy transfer depends on... - ansTheir proximity to the impact and their structural characteristics p. 27 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ The Haddon Matrix broadened the approach and placed emphasis on countermeasures, such were more effective than changing human behavior. Haddon describes three phases of the injury event: - ansPre- event, Event, Post-event For each phase of the event, countermeasures for prevention can be applied. They include: The host (human) The agent (motor vehicle) The physical environment (socioeconomic environment) ch. 4, p. 34 The increase of the diastolic blood pressure with a narrowing pulse pressure... - ansMay be one of the first CONCRETE measurements signaling that the patient's circulatory status is compromised. ch. 7, p. 76 The major assessment parameters that produce important information within seconds of a patient's arrival are... - ans1. Level of consciousness 2. Skin color 3. Pulse ch. 5, p. 44 The standard approach to treating hypotension in trauma patients has been to infuse large volumes of IV fluids. Recent studies now recommend a different approach and note that an elevated BP may dislodge the body's formation of clots and promote further bleeding. In addition, large volumes of fluid lead to... - ansDilutional coagulopathy which worsens metabolic acidosis and may cause hypothermia ch. 5, p. 45 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary blast injuries: found in those closest to the detonation, with enclosed space detonation resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel) are most susceptible to rupture with primary blast injuries. - Secondary injuries: include fragment injuries and generally cause the greatest volume of casualties. They include injuries such as puncture wounds, lacerations, and impaled objects. - Tertiary injuries: include impacts with larger objects propelled by the blast wind resulting in blunt trauma. These cause high energy transfer and can result in pelvic or femur fractures or major thoracic injuries such as aortic and great vessel rupture. - Quaternary injuries: result of heat, flame, gas, and smoke. These injuries include external burns and internal burns from inhaled hot gases. - Quinary injuries are those associated with exposure to hazardous materials from radioactive, biologic, or chemical components of a blast. ch. 4, p. 33 Trauma nurse should be attempting to maintain NORMOTHERMIA and NORMOCARBIA, which... - ansDecreases risk of.. HYPOTHERMIA ACIDOSIS COAGULOPATHY ch. 6, p. 65 Treatment for CORNEAL ABRASIONS include: - ans- TOPICAL OPHTHALMIC ANTIBIOTICS If causes by contact lenses, treat for Pseudomonas - CYCLOPLEGIC OPHTHALMIC AGENT to decrease spasms and pain - TOPICAL OPHTHALMIC NSAIDS such as ketorolac, diclofenac to reduce swelling TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ What are late signs of MEDIASTINAL SHIFT? - ansNECK VEIN DISTENTION from increased intrathroatic pressure and TRACHEAL DEVIATION Ch. 11, p. 141 What are odors you want to be sure to document? - ansAlcohol, gasoline, other chemicals ch. 5, p. 48 What are signs of worsening hypoxia with nerve injuries? - ansIncreased pain even when pulses remain present, often the first sign of increased compartment pressures ch. 14, p. 196 What are some assessment findings for patients who sustain a pancreatic injury? - ans- Serial serum amylase levels increasing over time may indicate but this does not constitute a definitive diagnosis - Serial abdominal exams are preformed in conjunction with serial serum amylase levels to appropriately confirm pancreatic injury - slight abdominal pain and tenderness becoming more significant within 48 hours of injury - epigastric pain radiating to back - abdominal pain tenderness on deep palpation - increasing or worsening abdominal wall muscle rigidity, spasm, or involuntary guarding ch. 12, p. 16 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ What are some circumstances that may lead to unreliable pulse ox readings? - ans- Poor peripheral perfusion - BP cuff inflated above sensor - CO poisoning (carboxyhemoglobin) - Methemoglobinemia - Severe dehydration Pulse ox provides evidence of SaO2 but not PaO2. The non-liner relationship between the two measurements is reflected in the oxyhemoglobin-dissociation curve. ch. 6, p. 65 What are the late signs that may indicate a tension pneumothorax? - ansJVD and tracheal deviation ch. 5, p. 43 What are the rules concerning standard imaging in relation to eye injury - ans- If wood or a vegetative foreign body is suspected, MRI most appropriate imaging method to use, however, it is minimally useful in acute setting - CT scans not helpful if vegetative foreign bodies are suspected - the GOLD STANDARD for evaluation of mid-face and orbit trauma is a CT scan - Plain films are used to assess foreign bodies and fractures of facial structures, excluding orbits Ch. 10, p. 133-134 What are the two priorities in treating patients with TBI? - ansFacilitating OXYGENATION and VENTILATION TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ Ch. 9, p. 120 What are two examples of obstructive shock that may result from trauma? - ansTENSION PNEUMOTHORAX and CARDIAC TAMPONADE ch. 7, p. 73 What can you assess to ensure the brainstem is intact? - ansEXTRAOCULAR EYE MOVEMENTS (EOMs) - tests functions of CNs III, IV, and VI In presence of facial fractures, the inability to perform EOMs may indicate a trapped nerve Ch. 9, p. 113 What can you do to easily see eyes that have abrasions? - ansStain them with fluorescein Ch. 10, 129 What diagnostic exam is helpful to inspect abdominal spaces for spillage and to examine loops of bowel? - ansLaparoscopy ch. 12, p. 164 What do you do with open wounds? - ansCover in saline-soaked dressings ch. 14, p. 201 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ ch. 12, p. 165 What lab studies are used to guide resuscitative efforts in shock? - ans- Platelet count, clotting studies - Serum lactate, anion gap, base deficit, and ABGs to assess acidosis - Toxicology screen to help assess mental status and differentiate from head injury - Calcium level when rapidly infusing large volumes of blood products ch. 7, p. 83 What should you avoid using with fingers, toes or other areas where vasoconstriction could cause impaired distal blood circulation? - ansLIDOCAINE with EPI ch. 14, p. 211 What symptoms usually indicate an INTRAOCULAR foreign body is present? - ans- IRREGULAR PUPIL - SHALLOW ANTERIOR CHAMBER - POSITIVE SEIDEL TEST Ch. 10, p. 132 When does the approach to trauma care typically begin? - ansWith notification that a trauma patient is arriving to ED ch. 5, p. 39 TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ When does the secondary survey (HI) begin? - ansAfter the completion of the primary survey (ABCDE), after the initiation of resuscitation efforts, once vital functions have been stabilized and after consideration for resuscitation adjuncts (FG). ch. 5, p. 47 When patient is receiving massive blood transfusions it is important to closely monitor which electrolytes? Why? - ansHigh K, Low C Potassium : released from cellular destruction of banked blood occurs naturally when blood ages Calcium : calcium citrate used in banked blood to prevent clotting, this citrate binds with free calcium reducing serum levels ch. 12, p. 158 When someone suffers a GSW, below what part of the body is considered an abdominal injury that requires an exploratory laparotomy? - ansBelow the nipple line ch. 12, p. 155 While in ED, alignment and protection of the cervical spine can be accomplished by which 2 ways? - ans- Manual stabilization - Immobilization ch. 5, p. 42 Why do partial amputations have more severe bleeding than complete amputations? - ansThe severed arteries retract with complete amputations TNCC TRAUMA NURSING CORE COURSE 7TH EDITION ENA PRACTICE QUESTION AND ANSWERS LATEST VERSION 2024 VERIFIED RATIONALE GRADED A+ ch. 14, p. 197 Why is CONTINUOUS ICP MONITORING important? - ansImportant for assessing brain injury and response of patient to treatment. It can provide early detection of secondary brain injury such as cerebral hypoxia, ischemia. The device reflects oxygen delivery to cerebral tissues and monitors temperature Ch. 9, p. 119