TNCC Written Exam 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 1 | P a g e 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 2 | P a g e 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 5 | P a g e 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 6 | P a g e 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 6-12 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 7 | P a g e 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 - 10 | P a g e 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 11 | P a g e