TNCC

The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the patients 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?

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?

500 mL/hour

Which of the following patients warrants referral to a burn center?

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

EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the drivers side of the car. The patient is asking to have the cervical collar removed. When is it appropriate to remove the cervical collar?

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

EMS brings a patient who fell while riding his bicycle. Using the American College of surgeons screening guidelines, which assessment findings would prompt the nurse to prepare the patient for radiologic spine clearance?

Alert with no neurologic deficits

A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs?

Bradycardia and absent motor function below the level of injury

An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority intervention?

Check to make sure the ventilator is plugged in

A trauma patient is restless and repeatedly asking "Where am I?" Vital signs upon arrival were B/P 110/60 mm Hg, HR 96 beats/minute and RR 24 breaths/minute. Her skin is cool and dry. Current vital signs are B/P 104/84 mm Hg, HR 108 beats/minute, and RR 28 breaths/minute. The patient is demonstrating signs and symptoms of which stage of shock?

Compensated

The trauma nurse knows that placing a bariatric patient is a "ramped position" provides better visualization during the insertion of which device?

ET tube

A patient is found lying on the floor after falling 13 hours ago. Which of the following laboratory values is expected with a musculoskeletal complication associated with this presentation?

Elevated creatinine kinase

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?

Elevating the extremity to the level of the heart

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 GCS is 15. His vital signs are as follows: BP 98/71, HR 125, RR26, SpO2 94% on high flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient?

Expedite transfer to the closest trauma center.

Which of the following is an expected finding in a patient with a tube thoracotomy connected to a chest drainage system?

Fluctuation in the water seal chamber

What is the effect of hypothermia on the oxyhemoglobin dissociation curve?

Hemoglobin does not readily release oxygen for use by the tissues

Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax?

Hypotension that worsens with inspiration

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?

Initiate transfer to a trauma center

A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented, and has delayed capillary refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principles?

Initiate two large caliber IV lines for LR solution administration

Which of the following is true about the log roll maneuver?

It can worsen cord damage from an unstable spinal injury

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 of the following interventions has the highest priority?

Padding the upper back while stabilizing the cervical spine

Which of the following is NOT considered goal-directed therapy for cardiogenic shock?

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 palpitation, 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?

Placental abruption

What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation?

Pulse oximetry and capnography

A 5 year old child presents to the ED with bruises to the upper arm 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?

Report your suspicion of maltreatment in accordance with local regulations

A 20 year old male 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?

Straight catheter for a urine sample

Tearing of the bridging veins is most frequently associated with which brain injury?

Subdural hematoma

Which of the following occurs during the third impact of a motor vehicle crash?

The aorta is torn at its attachment with the ligamentum arteriosum

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?

Ventilate with a bag mask device

Which of the following is a possible complication of positive-pressure ventilation?

Worsening pneumothorax

Which of the following is a component of the trauma triad of death?

acidosis

Which of the following injuries is LEAST likely to be promptly identified?

bowel

If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation?

calcium

A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous 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?

dressing removal

Patients with a crush injury should be monitored for which of the following conditions?

dysrhythmias

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 and confused. Upon reassessment, the patient is restless, with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions?

fat embolism

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

globe rupture

Which of the following considerations is most important when caring for a geriatric trauma patient?

medical history

Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster. Which phase of the disaster life cycle does this describe?

mitigation

Which of the following is a late sign of increased intracranial pressure?

nausea and vomiting

The most reassuring finding for a male patient with hip pain after a fall is which of the following?

pelvic stability

What finding raises suspicion of a complete spinal cord injury?

priapism

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?

serial FAST exams

A 36 year old female has a deformity of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the next appropriate intervention?

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

During the primary survey of an unconscious patient with multi system trauma, the nurse notes snoring respirations. Which priority nursing interventions should be performed next?

Insert an oropharyngeal airway if there is no gag reflex

A trauma patient is en route to a rural emergency department. Radiology notifies the charge nurse that the computed tomography (CT) scanner will be out of service for several hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma team's communication?

Loop

Which of the following mnemonics can help a nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage?

MARCH

Which pulse pressure description is an indication of early hypovolemic shock?

Narrowed

An elderly patient with a history of anticoagulant use presents after a fall at home that day. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms?

subdural hematoma

why is a measure of serum lactate obtained in the initial assessment of a trauma patient?

to gauge end organ perfusion and tissue hypoxia

What factor contributes most to the kinetic energy of a body in motion?

velocity