Trauma Nurse Core Course (TNCC) 9th Edition, Exams of Nursing

Download Trauma Nurse Core Course (TNCC) 9th Edition and more Exams Nursing in PDF only on Docsity! (Ad TNCC 9th Edition - Questions and Answers Graded A+ (SOLVED 2023-2024)  TNCC 9th Edition Exam 1. An adult patient who sustained a severe head trauma has been intubated and is being manually ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has receive one intravenous fluid bolus 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to manage the cerebral blood flow? A. Decrease the rate of manual ventilation.*** B. Initiate another fluid bolus. C. Recheck endotracheal tube placement. D. Increase the amount of oxygen delivered. 2. A patient with complete spinal cord injury who is in neurogenic shock will demonstrate hypotension and which other clinical signs? A. Bradycardia and ipsilateral a sense of motor function. B. Tachycardia and respiratory depression. C. Tachycardia and piokilothermia. D. Bradycardia and absent motor function below the level of injury.*** 3. You are caring for a patient who was shot multiple times in the chest and abdomen. The patient is unresponsive with snoring, shallow respirations. Assessment reveals absent radial pulses, weak and rapid carotid pulse, and cool, diaphoretic skin. Which management strategy should the nurse anticipate? A. Autotransfusion B. Massive transfusion C. Controlled fluid boluses*** D. Inotropic medications 4. Three adults present at different times during a one-hour with a high fever, fatigue, and headache. All three patients have a rash which started on their mouth, face, and arms with progression to the chest and abdomen. They all visited the same grocery store within the last week. What is the most appropriate intervention from triage for these patients? A. Move them to a decontamination area B. Mask the patients and send them to the waiting room C. Immediately initiate isolation precautions*** D. Send them to the waiting room without a mask 15. An adult patient involved in an assault presents with shortness of breath, BP 88/50 mmHg, heart rate 130 beats/minute. The patient has muffled heart sounds and is cyanotic. What is the priority intervention? A. Needle thoracostomy B. Chest tube insertion C. Pericardiocentesis*** D. Tracheal intubation 16. A patient with a chest tube is being transported to the intensive care unit and fluctuation is noted in the water seal chamber during inspiration and expiration. What is the best action for the nurse to take? A. Clamp the chest tube B. Return to the emergency department C. Assist ventilation with bag-mask device D. Continue to intensive care unit*** 17. A trauma patient who is 30-weeks pregnant arrives at the emergency department following a motor vehicle collision. Which normal physiologic change should be considered when assessing ventilatory status? A. Increased functional reserve capacity B. Increased oxygen consumption*** C. Decreased minute ventilation D. Slower desaturation rates with apnea 18. An older patient with a history of anticoagulant use presents after a fall at home the previous day. They deny loss of consciousness. The patient has a hematoma to their forehead and complains of headache, dizziness, left arm weakness, and nausea. What is the most likely cause of these symptoms? A. Epidural hematoma B. Diffuse axonal injury C. Post-concussive syndrome D. Subdural hematoma*** 19. In a motor vehicle collision, which injury pathway is most likely to increase the patients morbidity and mortality? A. Rotational B. Ejection*** C. Lateral D. Rollover 20. An unconscious patient arrives following a motor vehicle collision. The patient is on a backboard with a cervical collar in place and one intravenous line running. Respirations are shallow and there is active brisk bleeding from a large leg wound. What is the priority intervention for this patient? A. Check for a patent airway B. Control the bleeding*** C. Start a second intravenous line D. Ventilate with bag-mask device 21. The trauma nurse is caring for an unrestrained driver who struck their head on the windshield following a high-speed MVC. The patient has been diagnosed with an anterior spinal cord injury at the level of C6. Which finding is most concerning? A. Dissension of the bladder B. Incontinence of stool C. Increasing work of breathing*** D. Inability to move the legs 22. A nurse verbalized guilt and remorse after taking caring for multiple severely injured patients during a staffing crisis. The nurse expresses anger stating that the patients did not receive quality care and begins exhibiting aggression towards colleagues. This is most consistent with which condition? A. Compassion fatigue B. Vicarious trauma C. Secondary traumatic stress D. Moral injury*** 23. An 85 year old is brought to the emergency department by a family member for fever and cough. There are multiple bruises in various stages of healing on the upper extremities and the back. Based on these findings what is the most appropriate initial question to facilitate screening for abuse? A. How did you get these bruises? B. How long have you had these bruises? C. Did someone hurt you? D. Who takes care of you?*** 24. Based on fall mechanism, which patient warrants prehospital transfer to a trauma center? A. A 35 year old lands on a wooden porch from an 8 foot ladder B. A 2 year old lands on grass from a second story balcony*** C. A 14 year old forcefully pushed on concrete from standing D. A 50 year old lands on a carpeted floor after tripping 25. Caregivers carry a 2 year old into the emergency department who fell out of a second story window. The patient is awake and crying with increased work of breathing and pale skin. Which intervention has the highest priority? A. Stabilizing the cervical spine*** B. Applying a nonrebreather mask C. Establishing intravenous access D. Preparing for drug-assisted intubation 26. A patient arrives at the emergency department following a motor vehicle collision. Prehospital personnel report significant damage to the vehicle. The patient is alert and agitated with a strong odor of alcohol and appears intoxicated. After physician evaluation, under what circumstances can an order to remove the rigid cervical collar be anticipated? A. No imaging abnormalities of the neck*** B. No neurological abnormalities on examination C. No point tenderness to cervical spine D. Absence of neck pain with movement 27. Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? A. Increased work of breathing B. Unilaterally diminished breath sounds C. Tachycardia D. Hypotension*** 28. A patient arrives with a 3 inch laceration to their forearm from a tree branch. Which of the following methods will the nurse use to remove small pieces of bark and debris from the wound? A. Low pressure irrigation B. High pressure irrigation*** C. Scrubbing with normal saline D. Scrubbing with tap water 29. What position optimizes ventilation in the obese patient with a lumbar fracture? A. Reverse trendelenburg*** B. Supine C. Prone D. Fowler’s 30. Patients with a crush injury should be monitored for which of the following conditions? A. Hypermatremia B. Hypercalcemia C. Dysrhythmias*** D. Polyuria 31. Which of the following is true about the use of the focused assessment sonography for trauma exam for a patient with abdominal trauma? A. Is has a higher sensitivity than diagnostic peritoneal lavage for fluid detection B. It can be used in hypotensive patients too unstable for computed tomography scan*** C. It can detect as little as 30 mLof fluid in the abdominal cavity D. It has high sensitivity in pediatric patients for identifying fluid in the peritoneum A. Rapid fluid boluses*** B. Tranexamic acid administration C. Inotropic support D. Hemostat iv resuscitation 43. A 35 year old male presents with facial trauma after being struck in the face with a baseball. A tear dropped shaped left pupil is noted on exam. What type of injury is suspected? A. Oculomotor nerve palsy B. Globe rupture*** C. Retrobulbar hematoma D. Retinal detachment 44. A patient with lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention? A. Elevating the leg above the level of the heart B. Repositioning the leg and applying ice C. Elevating the leg to the level of the heart*** D. Preparing the payment for ultrasound of the leg 45. Your patient is a pedestrian stuck by a car and thrown 35 feet. They were unconscious at the scene but became responsive with subsequent Glasgow coma scale scores of 13 (E3, V4, M6). The patient has bilateral subdural hematomas and is awaiting transfer to the ICU. Your next assessment reveals a GCS of 8 (E2, V2, M5). What is the priority nursing intervention? A. Hold all pain medications B. Notify the provider of the change*** C. Repeat the GCS in 30 minutes D. Place the patient in trendelenburg position 46. A patient presents, after a 25 foot fall, with paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention? A. Surgical intervention B. Chest tube insertion C. Needle decompression D. Airway and ventilation support*** 47. A patient is brought to the emergency department with chest pain and shortness of breath following a high speed motor vehicle collision in which they were the unrestrained driver. There is crepitus to the left chest with clear and equal breath sounds. The vital signs are BP 80/40, HR 140 beats/minute, and RR 40 breaths/minute. Cardiac monitor shows sinus tachycardia with premature ventricular contractions. These findings are most consistent with which type of shock? A. Cardiogenic*** B. Neurogenic C. Hypovolemic D. Obstructive 48. A seriously injured patient is noted to have weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpating and blood on the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What is most likely to be ordered next? A. Insert a urinary catheter B. Bolus with 2L isotonic crystalloid solution C. Diagnostic peritoneal lavage D. Insertion of a Supra public catheter*** 49. Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about injury to which organ? A. Transverse colon B. Pancreas C. Liver*** D. Spleen 50. An adult patient was brought to the emergency department following a motorcycle crash. On arrival, the patient is only responsive to pain, has bleeding from the nose, and multiple abrasions and contusions to the face. What is the priority intervention? A. Use a bulb syringe to suction our secretions from the mouth B. Insert a nasopharyngeal airway to maintain an open airway C. Use a jaw thrust to open the airway and look for signs of obstruction*** D. Ask the patient to open their mouth to inspect the airway