TNCC Written Exam, Exams of Nursing

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TNCC Written Exam

What is the best measure of the adequacy of cellular perfusion and helps predict the outcome of resuscitation? - Base deficit used in conjunction with serum lactate Will hypocapnia cause vasoconstriction or vasodilation, especially in the cerebral vasculature? - Vasoconstriction What results from tissue hypo perfusion and oxygen deficit? - Metabolic acidosis What type of shock results in generalized vasodilation? - Neurogenic shock Spinal cord injuries at C3-C5 causes loss of what nerves function, resulting in what? - Phrenic nerve; paralyzed diaphragm and inability to breath Extremity elevation AT the level of the heart is beneficial for what type of injury? - Compartment Syndrome What is a high risk of frostbite? - Thrombus formation What two medications can be administered to maintain perfusion after a frostbite injury along with rewarming? - Tissue plasminogen activator or non steroidal anti-inflammatory medication (NSAIDS) An rise in diastolic blood pressures is a sign of increasing what? - Peripheral resistance What position will benefit the airway and work of breathing for the bariatric patient? - Reverse Trendelenburg Which phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries? - Secondary Phase What phase of a blast results from any explosion-related illness or injury including hyperglycemia, hypertension, angina, asthma, COPD, or sepsis? - Quaternary Phase What phase of a blast results from individuals being thrown by the blast and impacting walls, ground, or any hard object? - Tertiary Phase

What phase of a blast results from impact of the over and under pressurization wave with body surfaces. Injuries include blast lung, tympanic membrane rupture, abdominal hemorrhage, globe rupture, and mild traumatic brain injury? - Primary Phase Signs of what include muscle pain or weakness, dark red or brown urine, general weakness or malaise, and elevated creatinine kinase levels? - Rhabdomyolosis Signs of what include anxiety, pleuritic chest pain, dyspnea, hypoxemia, hemoptysis, cough, orthopnea, adventitious lung sounds, decreased lung sounds, jugular vein distention, or hypotension? - Pulmonary Embolus Signs of what include headache, nausea and vomiting, amnesia, behavioral changes, altered level of consciousness? - Increased intracranial pressure Signs of what include asymmetric pupillary reactivity, unilateral dilation, widening pulse pressure, abnormal motor posturing, bradycardia, and decreased respiratory effort? - Late signs of increased ICP with Herniation Syndrome What is caused by the tear of the bridging veins or middle meningeal artery? - Subdural and Epidural Hematoma Affect concentration, memory, sleep, mode, and libido. Causes headaches, dizziness and nausea. - Postconcussive Syndrome/ Mild Traumatic Brain Injury Signs and symptoms similar to early signs of increased ICP but do not worsen. - Postconcussive Syndrome/ Mild Traumatic Brain Injury Cerebral Perfusion Pressure = ______-______ - MAP - ICP What is the range for CO2 to maximize perfusion? - 35- Does hypoventilation cause dilation or constriction? Increase or decrease ICP? - Dilation and increase in ICP due to high CO Hyperventilation cause dilation or constriction? - Constriction d/t low CO Pupils with pressure on cranial nerve - Fixed and dilated Pupils with opiates vs stimulants - small; large Pupils with anticholinergics such as atropine, ipratropium, and scopolamine -

large Sluggish reaction of pupils is an early sign of what? - Increasing ICP Glasgow Coma Score with Mild, Moderate, and Severe TBI - Mild = 13- Moderate = 9- Severe = 3- Goal value for ICP - < Goal value for Cerebral Perfusion Pressure (CPP) -

Le Fort Fracture - Fracture of the maxilla What decrease ICP by decreasing cellular edema? - Osmotic diuretics (such as 3% saline and mannitol) Becks Triad is a sign of what? And includes what three symptoms? - Cardiac Tamponade;

1. Hypotension
2. JVD
3. Muffled heart sounds What is pulsus paradoxus? And what is it a sign of? - Drop in blood pressure with inspiration, sign of cardiac tamponade Tachycarida, weak pulses, hypotension, cool periphery, delayed cap refill, anxiety and agitation are signs of what type of shock? Seen with what? - Obstructive Shock; Cardiac Tamponade Persistent blood loss following chest tube insertion is a sign of what? - Hemothorax Ipsilateral diminished breath sounds and chest movement is a sign of what? - Hemothorax Tearing chest/back pain, unequal blood pressure and pulses are a sign of what? Caused by a high mechanism of injury. - Thoracic Aortic Disruption Dysrhythmia, ischemic changes, and persistent unexplained tachycardia are signs of what? - Myocardial contusion from Blunt Cardiac Injury

Decreased/absent breath sounds ipsilaterally, JVD, hypotension, and tracheal deviation to the contralateral side (late sign) is seen with what? Can lead to what? - Tension Pneumothorax; PEA Hemoptysis, ineffective cough, crackles in affected lung, hypoxia/hypercapnia, and alveolar opacities are signs of what? - Pulmonary Contusion Paradoxical chest wall movement, bony crepitus, rib segment depressed with inhalation and elevated with exhalation are signs of what? - Flail Chest (caused by chest wall injury) Open wound on chest wall resulting in sucking sound, decreased breath sounds, chest movement, and hyper-resonance ipsilaterally, subcutaneous emphysema, and tachycardia are signs of what? - Open Pneumothorax Hear bowel sounds in chest and Kehr's sign seen with what? - Traumatic Diaphragmatic Tear Referred pain down the left shoulder; indicative of a ruptured spleen. - Kehr's Sign Diaphragmatic Tears are seen with what types of injuries? - Penetrating injuries between T4-T12, or rapid deceleration causing severe blunt trauma to the torso. Incision with blood clot, edges approximated with suture closer, and results in a fine scar. This is __________ Intention. - Primary Irregular large wound with blood clot, no closure, granulation tissue fills in the wound, results in large scar. This is ________ Intention. - Secondary Contaminated wound, granulation tissue, delayed closure with suture. This is _______ Intention. - Tertiary Soft, dry, red wound with intact skin that blanches with pressure. No blistering or sloughing. What degree burn? - First degree; superficial Moist wound, weeping, red or pink edematous skin that blanches with pressure, some blisters. What degree burn? - Second degree; superficial partial thickness Wet, waxy, red to pale skin that does not blanch, multiple sisters. What degree burn? - Second degree; deep partial thickness

Waxy white to leathery gray to charred skin that is dry and firm with absent hair, no blanching. What degree burn? - Third degree; full thickness Burn extends into the fascia and/or muscle. What degree burn? - Fourth degree; full thickness Zones of burn injury (3) - Zone of coagulation Zone of stasis Zone of hyperemia What syndrome occurs most often in burns greater than 20% BSA and lasts for approximately 6- hours? - Capillary Leak Syndrome Fluid replacement goals/calculation - 2mL/kg LR x TBSA% (give 1/2 over first 8 hours (minus transport time) and 1/2 over next 16 hours) Urine Output goals for fluid replacement therapy - 0.5 mL/kg (30-50mL/hr) Disaster Definition - A sudden calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic losses that exceed the community's or society's ability to cope using its own resources. Mitigation - A foundation to limit the potential impact of a disaster Triage colors and meanings: - Green - minor, walking wounded Yellow - delayed Red - immediate Black - expectant, deceased When should the decision to transfer be made? - When the patient's needs outweigh the capabilities of your facility Tertiary care facility, teaching hospital, comprehensive care from resuscitation or rehabilitation, research, injury prevention. - Level 1 Trauma Center Trauma rescucitation and definitive trauma care. Specialty and rehabilitation care may not be as comprehensive, may not conduct research. - Level 2 Trauma Center

Provides ATLS assessment, intervention, resuscitation and emergency surgery. Generally does not accept transfers. - Level 3 Trauma Center Provides ATLS assessment, intervention, and resuscitation. May be in a remote area, has 24 hour physician and NP coverage. - Level 4 Trauma Center Greatest risk to the patient during interfaculty transfer/transport? - Loss of airway and respiratory compromise What survey is a complete exam within 24 hours of arrival and identified injuries missed during primary assessment, reviews radiology studies, orders more studies, and assesses for hidden injuries? - Tertiary Survey Stages of shock -

1. Compensatory Shock 2. Decompensatory Shock (progressive, hypotensive) 3. Irreversible Shock Anxiety, confusion, restlessness, narrowing pulse pressure, tachycardia, bounding pulse, and decreasing urinary output are signs of what? - Compensated Shock Decreased level of consciousness, hypotension, narrowed pulse pressure, tachycardia with weak pulse, tachypnea, and cool, clammy, cyanotic skin are signs of what? - Decompensated/Progressive shock Obtunded/comatose, profound hypotension, bradycardia, dysrhythmias, slow shallow respirations, petechiae/purpura are signs of what? - Irreversible shock Benefits of the trauma nursing process - Systematic approach to the evaluation of each trauma patient. Identifies life-threatening conditions, determines priorities of care. Efficient production of ATP, which maintains cellular metabolic function, is seen with what type of metabolism? - Aerobic metabolism Inefficient production of ATP, byproduct is lactic acid, leads to metabolic acidosis, cellular dysfunction leads to cell death with what type of metabolism? - Anaerobic metabolism The cellular process in which oxygen is used to metabolize glucose. Energy is produced in an efficient manner with minimal waste products. - Aerobic metabolism The cellular process in which glucose is metabolized into energy without oxygen. Energy is produced in an inefficient manner with many waste products. -

Anaerobic metabolism What is included in the Trauma Triad of Death? - Coagulopathy Acidosis Hypothermia Pump failure, caused by blunt cardiac injury, dysrhythmias, or myocardial infarction is what type of shock? - Cardiogenic Shock What type of shock is caused by cardiac tamponade or tension pneumothorax? Ventricular failure is seen. - Obstructive Shock Reservoir depletion and hemorrhage cause which type of shock? - Hypovolemic Shock Vasodilation, anaphylaxis, sepsis, and spinal cord injuries cause which type of shock? - Distributive Shock Options for hemorrhage - Pressure at site, tourniquet, hemostatic dressings, Massive Transfusion Protocol, Tranexamic Acid (clotting promoter) Treatment for cariogenic shock - inotropic support, anti-dysrhythmic medications, treat myocardial infarction or other underlying cause Treatment for obstructive shock - pericardiocentesis, cardiac window, needle decompression, position pregnant patient on L side Treatment for distributive shock - Support ventilations, vasopressors, pain management, apply warming methods Treatment for hypovolemic shock - Tourniquet, 1:1:1 blood products, massive transfusion protocol, TXA, surgical repair Subdural hematoma is caused by tearing of the ______ veins and symptoms usually present within ____ hours of the accident. - Bridging; 72 Epidural hematoma is caused by an arterial or venous bleed? Sx are transient LOC followed by a lucid period. - Arterial Hyperventilation causes cerebral blood vessels to do what? - Constrict