TNCC 8th Edition Provider Course Exam

Which of the following is a late sign of increased intracranial pressure? a. Restlessness or drowsiness b. Nausea and vomiting c. Decreased respiratory effort d. Amnesia and anxiety

Decreased respiratory effort

What physiologic change in the elderly population increases the risk of traumatic injury? a. Decreased cough strength b. Increased cardiac output c. Decreased subcutaneous fat d. Increased glomerular filtration rate

Decreased subcutaneous fat

All of these are considered a critical communication point in trauma care EXCEPT which of the following? a. Briefs b. Defusings c. Huddles d. Debriefs

Defusings

A toddler who fell off a trampoline is making eye contact with the family and is consolable. There is no increased work of breathing and the skin color is pink. The nurse asks the patient to open his mouth but the patient does not respond to commands. The nurse recognizes this as an expected finding due to which of the following conditions? a. Developmental stage b. Hypoglycemia c. Child maltreatment d. Head injury

Developmental stage

A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are stable. The nurse can anticipate all of these after a negative FAST Exam EXCEPT which of the following? a. Diagnostic peritoneal lavage b. Serial FAST Exam c. Abdominal and pelvic CT scans d. Serial abdominal assessments

Diagnostic Peritoneal Lavage (DPL)

What is the effect of hypothermia on the oxyhemoglobin dissociation curve? a. Hemoglobin does not readily release oxygen for use by the tissues b. The amount of oxygen available to the tissues increases c. Tissue oxygenation (PaO2) increases d. Hemoglobin molecule saturation (SaO2) decreases

Hemoglobin does not readily release oxygen for use by the tissues

Which of the following is NOT considered a benefit of debriefings? a. Identifying individuals who made mistakes during the traumatic event b. Promoting improved communication and patient safety c. Providing an opportunity to review performance and reflect on areas of improvement d. Supporting the perceived psychological safety of team members

Identifying individuals who made mistakes during the traumatic event

A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority intervention? a. Initiate transfer to a trauma center b. Provide a report to the operating room nurse c. Obtain imaging studies d. Place a gastric tube

Initiate transfer to a trauma center

During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next? a. Open the airway with the head-tilt chin-lift maneuver b. Auscultate bilateral breath sounds to assess ventilatory status c. Assist respirations using a bag-mask device d. Insert an oropharyngeal airway if there is no gag reflex

Insert an oropharyngeal airway if there is no gag reflex

Which of the following is TRUE about the log-roll? a. It causes less spinal motion than the lift-and-slide maneuver b. It is recommended for patients with unstable pelvic fractures c. It can worsen cord damage from an unstable spinal injury d. It does not increase the risk of life-threatening hemorrhage from unstable injuries

It can worsen cord damage from an unstable spinal injury

Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? a. ABC b. MARCH c. AVPU d. VIPP

MARCH

Which of the following pulse pressures indicate early hypovolemic shock? a. Widened b. Narrowed c. Greater than 50 d. Increased

Narrowed

The most reassuring finding for a male patient with hip pain after a fall is which of the following? a. A normal prostate exam b. Absence of abdominal distention c. A normal FAST exam d. Pelvic stability

Pelvic Stability

Which of the following is NOT considered a goal-directed therapy for cardiogenic shock? a. Controlled fluid boluses b. Anti-dysrhythmic administration c. Pericardiocentesis d. Cardiac catheterization

Pericardiocentesis

You are caring for a patient who was involved in a motor vehicle crash and is 32 weeks pregnant. Findings of your secondary survey include abdominal pain on palpation, fundal height at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cardiotocography. These findings are most consistent with which of the following? a. Placental abruption b. Preterm labor c. Uterine rupture d. Fetal demise

Placental abruption

Which of the following assessment findings differentiate a tension pneumothorax from a simple pneumothorax? a. Increased work of breathing b. Unilateral diminished breath sounds c. Pleuritic chest pain d. Hypertension that worsens with inspiration

Pleuritic chest pain (p. 132)

An intubated and sedated patient in the emergency department has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? a. Pulselessness b. Pressure c. Paresthesia d. Pallor

Pressure

What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? a. Pulse oximetry and capnography b. Respiratory rate and capnography c. Pulse oximetry and respiratory rate d. Capnography and capnometry

Pulse oximetry and capnography

When is the tertiary survey completed for a trauma patient? a. Within 24 hours of the trauma b. On the day of discharge c. At follow-up after discharge d. 1 week after the trauma

Within 24 hours of the trauma

Which of the following is a possible complication of positive-pressure ventilation? a. Worsening pneumothorax b. Worsening flail chest c. Reabsorption of pleural air d. Negative intrapleural pressure

Worsening pneumothorax

Which of the following is most likely to contribute to inadequate oxygenation and ventilation? a. Advanced age b. Gastric reflux c. Hypertension d. Nausea and vomiting

Advanced age

A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? a. Oculomotor nerve palsy b. Globe rupture c. Uncal herniation d. Retinal detachment

Globe rupture

The nurse caring for a 120-kg male brought in after a warehouse fire is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest.. Using the modified Lund and Browder chart to calculate the total body surface area burned, how much IV fluid would be administered in the first 8 hours? a. 2280 mL b. 3840 mL c. 4560 mL d. 7680 mL

2280 mL Upper arm 4 + 4 / Lower arm 3 + 3 / Hand 2.5 + 2.5 = 19% TBSA 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 mL / 2 (half of fluids given in first 8 hours) = 2280 mL

You are treating a 27-year-old male in respiratory distress who was involved in a house fire. Calculating total body surface area (TBSA) burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? a. 1000 ml/hr b. 500 ml/hr c. 250 ml/hr d. 125 ml/hr

500 ml/hr

Which of the following patients warrants referral to a burn center? a. A 21-yr-old female with a partial-thickness burn to her right forearm b. A40-yr-old hypertensive male with a superficial burn to the back c. A 52-yr-old diabetic male with a partial-thickness burn to the left lower leg d. A 35-yr-old hyperlipidemic female with a superficial burn to the anterior thorax

A-52-yr-old diabetic male with a partial-thickness burn to the left lower leg

Which of the following is a component of the trauma triad of death? a. Acidosis b. Hyperthermia c. Hemorrhage d. Sepsis

Acidosis

EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the driver's side of the car. The patient is asking to have the cervical collar removed. When is it appropriate to remove the cervical collar? a. After a physical examination if the patient has no radiologic abnormalities on CT b. After physician evaluation if the patient has no neurologic abnormalities on exam c. After palpation of the spine if the patient has no point tenderness to the vertebral column d. After a physical examination if the patient has no neck pain with movement

After a physical examination if the patient has no radiologic abnormalities on CT

A 36-year-old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? a. Apply a sling and elevate the extremity to the level of the heart b. Apply a splint and elevate the extremity above the level of the heart c. Apply a sling and elevate the extremity above the level of the heart d. Apply a splint and elevate the extremity to the level of the heart

Apply a splint and elevate the extremity above the level of the heart

There has been a mass casualty incident a block from the hospital. The hospital is receiving dozens of patients. A truck arrives with an unresponsive patient in the back with obvious chest and abdominal trauma. Agonal respirations do not improve with airway positioning. Using the START triage algorithm, you would triage tag this patient as which of the following? a. Black b. Red c. Imminent d. Immediate

Black Simple Triage & Rapid Treatment (START)

Which of the following injuries is LEAST likely to be promptly identified? a. Spleen b. Lung c. Bowel d. Brain

Bowel

A patient with a complete spinal injury in neurogenic shock will demonstrate hypotension and which other clinical signs? a. Bradycardia and ipsilateral absence of motor function b. Tachycardia and respiratory depression c. Tachycardia and absent motor function below the level of injury d. Bradycardia and absent motor function below the level of injury

Bradycardia and absent motor function below the level of injury

If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? a. Potassium b. Magnesium c. Sodium d. Calcium

Calcium

A trauma patient is restless and repeatedly asking "Where am I?". Vital signs upon arrival were BP 110/60 mmHg, HR 96 beats/min and RR 24 breaths/min. Her skin is cool and dry. Current vital signs are BP 104/84 mmHg, HR 108 beats/min, and RR 28 breaths/min. The patient is demonstrating signs and symptoms of which stage of shock? a. Compensated b. Progressive c. Irreversible d. Decompensated

Compensated

EMS brings a patient from a motor vehicle crash. Vital signs are BP 90/49 mmHg, HR 48 beats/min, RR 12 breaths/min, temperature 97.2°F (36.2°C). The assessment findings are most consistent with which of the following types of spinal cord injury? a. Brown-Sequard b. Complete c. Anterior d. Incomplete

Complete

A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a non-porous dressing over the chest wound and taped it on three sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? a. Needle decompression b. Tube thoracostomy c. Dressing removal d. Surgical repair

Dressing removal Rationale : (p. 133) If signs and symptoms of a tension pneumothorax develop after the application of the dressing, remove the dressing and reevaluate the patient.

A patient with a 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 extremity above the level of the heart b. Repositioning and applying ice c. Elevating the extremity to the level of the heart d. Preparing the patient for ultrasound

Elevate the extremity to the level of the heart Rationale : (p 202) If compartment syndrome is suspected, elevate the limb to the level of the heart. Avoid elevating higher than the heart as this can reduce circulation and tissue perfusion. If compartment syndrome is not a risk, elevate the limb ABOVE the level of the heart to reduce pain and swelling

The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better visualization during the insertion of which device? a. Introsseous line b. Orogastric tube c. Endotracheal tube d. Urinary catheter

Endotracheal tube

A 56-year-old male patient involved in a motor vehicle crash is brought to the emergency department of a rural critical access facility. He complains of neck pain, shortness of breath, and diffuse abdominal pain. His Glasgow Coma Score is 15. His vital signs are as follows: BP 98/71 mmHg, HR 125 beats/minute, RR 26 breaths/minute, SpO2 94% on high flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient? a. Expedite transport to CT scanner b. Prepare the patient for spinal radiographs c. Expedite transfer to the closest trauma center d. Notify the patient's family

Expedite transfer to the closest trauma center

A patient has been in the emergency department for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions? a. Acute lung injury b. Fat embolism c. Pneumothorax d. Pulmonary contusion

Fat embolism

Which of the following is an expected finding in a patient with a tube thoracostomy connected to a chest drainage system? a. Output of 200 ml/hour b. Tubing clamp closed for transport c. Dependent loops in the tubing to promote drainage d. Fluctuation in the water seal chamber

Fluctuation in the water seal chamber

A 5-yr-old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention? a. Report your suspicion of maltreatment in accordance with local regulations b. Apply ice to the bruises and consult wound care c. Engage in therapeutic communication

Report your suspicion of maltreatment in accordance with local regulations

EMS brings a patient who fell while riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? a. Alert with no neurologic deficits b. Multiple abrasions to the extremities c. Multiple requests for water d. Smell of alcohol on breath

Smell of alcohol on breath

A 20-year-old presents to the ED complaining of severe lower abdominal pain after landing hard on the bicycle cross bars while performing an aerial BMX maneuver. Secondary assessment reveals lower abdominal tenderness and scrotal ecchymosis. Which of the following orders would the nurse question? a. FAST Exam b. CT scan c. Straight catheter for urine sample d. Ice and elevation of the scrotum

Straight catheter for urine sample.

An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? a. Epidural hematoma b. Diffuse axonal injury c. Post-concussive syndrome d. Subdural hematoma

Subdural hematoma

Tearing of the bridging veins is most frequently associated with which brain injury? a. Epidural hematoma b. Subdural hematoma c. Diffuse axonal injury d. Intracerebral hematoma

Subdural hematoma

Which of the following occurs during the third impact of a motor vehicle crash? a. The driver of the vehicle collides with the steering wheel b. The vehicle collides with a tree c. The aorta is torn at its attachment with the ligamentum arteriosum d. The airbag deploys and strikes the front seat passenger

The aorta is torn at its attachment with the ligamentum arteriosum

Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? a. To measure oxygenation and ventilation b. To quantify the base deficit for the adequacy of cellular perfusion c. To gauge end-organ perfusion and tissue hypoxia d. To determine the underlying cause of shock

To gauge end-organ perfusion and tissue hypoxia

What factor contributes most to the kinetic energy of a body in motion? a. Acceleration b. Mass c. Velocity d. Inertia

Velocity

An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? a. Ventilate with bag-mask device b. Prepare for cricothyroidotomy c. Administer reversal medications d. Contact anesthesia for assistance

Ventilate with a bag-mask device

The nurse is assessing a patient with a fractured forearm that was splinted three hours ago. Which symptom is of most concern as a late sign of an evolving complication? a. Pain with palpation b. Weak radial pulse c. Redness and swelling d. Numbness and tingling

Weak radial pulse