Trauma Management: Principles and Practices, Exams of Nursing

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TNCC Written Exam 2024 Questions and Answers

What is the best measure of the adequacy of cellular perfusion and helps predict the outcome of resuscitation? correct answer Base deficit used in conjunction with serum lactate Will hypocapnia cause vasoconstriction or vasodilation, especially in the cerebral vasculature? correct answer Vasoconstriction What results from tissue hypo perfusion and oxygen deficit? correct answer Metabolic acidosis What type of shock results in generalized vasodilation? correct answer Neurogenic shock Spinal cord injuries at C3-C5 causes loss of what nerves function, resulting in what? correct answer Phrenic nerve; paralyzed diaphragm and inability to breath Extremity elevation AT the level of the heart is beneficial for what type of injury? correct answer Compartment Syndrome What is a high risk of frostbite? correct answer Thrombus formation What two medications can be administered to maintain perfusion after a frostbite injury along with rewarming? correct answer Tissue plasminogen activator or non steroidal anti-inflammatory medication (NSAIDS) An rise in diastolic blood pressures is a sign of increasing what? correct answer Peripheral resistance

What position will benefit the airway and work of breathing for the bariatric patient? correct answer Reverse Trendelenburg Which phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries? correct answer Secondary Phase What phase of a blast results from any explosion-related illness or injury including hyperglycemia, hypertension, angina, asthma, COPD, or sepsis? correct answer Quaternary Phase What phase of a blast results from individuals being thrown by the blast and impacting walls, ground, or any hard object? correct answer 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? correct answer Primary Phase Signs of what include muscle pain or weakness, dark red or brown urine, general weakness or malaise, and elevated creatinine kinase levels? correct answer 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? correct answer Pulmonary Embolus Signs of what include headache, nausea and vomiting, amnesia, behavioral changes, altered level of consciousness? correct answer Increased intracranial pressure Signs of what include asymmetric pupillary reactivity, unilateral dilation, widening pulse pressure, abnormal motor posturing, bradycardia, and decreased respiratory effort? correct answer Late signs of increased ICP with Herniation Syndrome

What is caused by the tear of the bridging veins or middle meningeal artery? correct answer Subdural and Epidural Hematoma Affect concentration, memory, sleep, mode, and libido. Causes headaches, dizziness and nausea. correct answer Postconcussive Syndrome/ Mild Traumatic Brain Injury Signs and symptoms similar to early signs of increased ICP but do not worsen. correct answer Postconcussive Syndrome/ Mild Traumatic Brain Injury Cerebral Perfusion Pressure = - correct answer MAP - ICP What is the range for CO2 to maximize perfusion? correct answer 35- Does hypoventilation cause dilation or constriction? Increase or decrease ICP? correct answer Dilation and increase in ICP due to high CO Hyperventilation cause dilation or constriction? correct answer Constriction d/t low CO Pupils with pressure on cranial nerve correct answer Fixed and dilated Pupils with opiates vs stimulants correct answer small; large Pupils with anticholinergics such as atropine, ipratropium, and scopolamine correct answer large Sluggish reaction of pupils is an early sign of what? correct answer Increasing ICP Glasgow Coma Score with Mild, Moderate, and Severe TBI correct answer Mild = 13-

Moderate = 9- Severe = 3- Goal value for ICP correct answer< Goal value for Cerebral Perfusion Pressure (CPP) correct answer> Le Fort Fracture correct answer Fracture of the maxilla What decrease ICP by decreasing cellular edema? correct answer Osmotic diuretics (such as 3% saline and mannitol) Becks Triad is a sign of what? And includes what three symptoms? correct answer Cardiac Tamponade;

1. Hypotension
2. JVD
3. Muffled heart sounds What is pulsus paradoxus? And what is it a sign of? correct answer 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? correct answer Obstructive Shock; Cardiac Tamponade Persistent blood loss following chest tube insertion is a sign of what? correct answer Hemothorax Ipsilateral diminished breath sounds and chest movement is a sign of what? correct answer Hemothorax

Tearing chest/back pain, unequal blood pressure and pulses are a sign of what? Caused by a high mechanism of injury. correct answer Thoracic Aortic Disruption Dysrhythmia, ischemic changes, and persistent unexplained tachycardia are signs of what? correct answer 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? correct answer Tension Pneumothorax; PEA Hemoptysis, ineffective cough, crackles in affected lung, hypoxia/hypercapnia, and alveolar opacities are signs of what? correct answer Pulmonary Contusion Paradoxical chest wall movement, bony crepitus, rib segment depressed with inhalation and elevated with exhalation are signs of what? correct answer 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? correct answer Open Pneumothorax Hear bowel sounds in chest and Kehr's sign seen with what? correct answer Traumatic Diaphragmatic Tear Referred pain down the left shoulder; indicative of a ruptured spleen. correct answer Kehr's Sign Diaphragmatic Tears are seen with what types of injuries? correct answer 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. correct answer Primary

Irregular large wound with blood clot, no closure, granulation tissue fills in the wound, results in large scar. This is Intention. correct answer Secondary Contaminated wound, granulation tissue, delayed closure with suture. This is Intention. correct answer Tertiary Soft, dry, red wound with intact skin that blanches with pressure. No blistering or sloughing. What degree burn? correct answer First degree; superficial Moist wound, weeping, red or pink edematous skin that blanches with pressure, some blisters. What degree burn? correct answer Second degree; superficial partial thickness Wet, waxy, red to pale skin that does not blanch, multiple sisters. What degree burn? correct answer 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? correct answer Third degree; full thickness Burn extends into the fascia and/or muscle. What degree burn? correct answer Fourth degree; full thickness Zones of burn injury (3) correct answer 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? correct answer Capillary Leak Syndrome

Fluid replacement goals/calculation correct answer 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 correct answer 0.5 mL/kg (30-50mL/hr) Disaster Definition correct answer 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 correct answer A foundation to limit the potential impact of a disaster Triage colors and meanings: correct answer Green - minor, walking wounded Yellow - delayed Red - immediate Black - expectant, deceased When should the decision to transfer be made? correct answer 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. correct answer Level 1 Trauma Center Trauma rescucitation and definitive trauma care. Specialty and rehabilitation care may not be as comprehensive, may not conduct research. correct answer Level 2 Trauma Center Provides ATLS assessment, intervention, resuscitation and emergency surgery. Generally does not accept transfers. correct answer Level 3 Trauma Center

Provides ATLS assessment, intervention, and resuscitation. May be in a remote area, has 24 hour physician and NP coverage. correct answer Level 4 Trauma Center Greatest risk to the patient during interfaculty transfer/transport? correct answer 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? correct answer Tertiary Survey Stages of shock correct answer 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? correct answer Compensated Shock Decreased level of consciousness, hypotension, narrowed pulse pressure, tachycardia with weak pulse, tachypnea, and cool, clammy, cyanotic skin are signs of what? correct answer Decompensated/Progressive shock Obtunded/comatose, profound hypotension, bradycardia, dysrhythmias, slow shallow respirations, petechiae/purpura are signs of what? correct answer Irreversible shock Benefits of the trauma nursing process correct answer 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? correct answer 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? correct answer Anaerobic metabolism The cellular process in which oxygen is used to metabolize glucose. Energy is produced in an efficient manner with minimal waste products. correct answer 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. correct answer Anaerobic metabolism What is included in the Trauma Triad of Death? correct answer Coagulopathy Acidosis Hypothermia Pump failure, caused by blunt cardiac injury, dysrhythmias, or myocardial infarction is what type of shock? correct answer Cardiogenic Shock What type of shock is caused by cardiac tamponade or tension pneumothorax? Ventricular failure is seen. correct answer Obstructive Shock Reservoir depletion and hemorrhage cause which type of shock? correct answer Hypovolemic Shock Vasodilation, anaphylaxis, sepsis, and spinal cord injuries cause which type of shock? correct answer Distributive Shock Options for hemorrhage correct answer Pressure at site, tourniquet, hemostatic dressings, Massive Transfusion Protocol, Tranexamic Acid (clotting promoter) Treatment for cariogenic shock correct answer inotropic support, anti-dysrhythmic medications, treat myocardial infarction or other underlying cause

Treatment for obstructive shock correct answer pericardiocentesis, cardiac window, needle decompression, position pregnant patient on L side Treatment for distributive shock correct answer Support ventilations, vasopressors, pain management, apply warming methods Treatment for hypovolemic shock correct answer 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. correct answer Bridging; 72 Epidural hematoma is caused by an arterial or venous bleed? Sx are transient LOC followed by a lucid period. correct answer Arterial Hyperventilation causes cerebral blood vessels to do what? correct answer Constrict