TNCC 9th edition

A patient who weighs 120 kg is brought to the emergency department after sustaining partial thickness burns to both upper extremities and chest with a total body surface area burned of 27 % . How much intravenous fluid should be administered in the first 8 hours ?

3240 mL

Based on fall mechanism , which patient warrants prehospital transfer to a trauma center ?

A 2 - year - old lands on grass from a second - story balcony nurse is caring for an unrestrained

A patient present after a 25 ft fall, w/ paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention?

Airway and ventilation support

Using the American College of Surgeons screening guidelines what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging ?

Alert with no neurologic deficits

While caring for a child who has been injured , what nursing intervention consistent with a family center approach

Allowing family to participate in the care of the patient

Which of the following situations could cause functional grief ?

Amputation of a limb

A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention?

Apple direct pressure to the wound

An adult pedestrian was struck on the right side by a sport utility vehicle traveling at 40 mph . The patient is awake and alert and the right leg is shortened . Following initial resuscitation with fluids , the patient remains hypotensive . What would be the priority intervention ?

Apply a pelvic binder

A 36 year old patient has a deformity of left wrist after a fall. The patient is reluctant to move their hand due to pain. Which of the following is the most appropriate intervention?

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

Following a gun shot wound , pre - hospital providers report diminished breath sounds bilaterally . Upon emergency department arrival , the patient is unresponsive with shallow respirations and an 02 sai of 90 % . What is the priority intervention for this patient ?

Assist ventilation with a bag - mask device

A pt involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small penetrating wound to the 6th intercostal space in the left lateral chest. Which finding is most consistent with an injury to the diaphragm?

Bowel sounds heard in the lower left chest

An adult arrives at the emergency department with superficial burns to the extremities following a house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is most likely cause of these symptoms?

CO2 poisoning

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 mmHg 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

Cardiogenic

A patient who sustained severe injuries was brought to the emergency department following a high - speed motor vehicle collision . Interventions for hypovolemic shock have been initiated . What component of the trauma triad of death is most likely to have begun at the time of injury ?

Coagulopathy

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 ?

Control the bleeding

An adult pt 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 pt has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. the PaCO2 is 30mmHg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mmHg. What is the most important intervention to manage the cerebral blood flow?

Decrease the rate of manual ventilation

A severely injured patient has been intubated and is being mechanically ventilated . The patient has received a balanced resuscitation including multiple blood producis . Under which circumstance will it be harder for the hemoglobin to release oxygen to the tissues ?

Decreased body temperature

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

Decreased respiratory effort

Which commonly prescribed medication may worsen a complication that is associated with massive transfusion

Diltiazem

A trauma patient is being held in the emergency department because there are no available inpatient beds . The patient sustained a femur fracture and required multiple blood products . The patient now has blood oozing from abrasions , IV sites , the nose , and gums . What condition is most consistent with these findings ?

Disseminated intravascular coagulopathy

A patient arrives with a large open chest wound after being assaulted with a machete . Prehospital providers placed nonporous dressing over the chest wound and taped it on three sides . The patient 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

When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns ?

During the secondary survey

Patient w/ a crush injury should be monitored for which of the following conditions

Dysthymias

A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medication. Which of the following is the priority nursing intervention?

Elevating the leg to the LEVEL of the heart (compression/crush- level of the heart) (regular fracture- above the heart)

Which of the following is true regarding cavitation

Energy causes the tissues to accelerate and displace outward

An adult patient involved in a motor vehicle collision is brought to the emergency department of a rural critical access facility . They complain of neck pain , shortness of breath , and diffuse abdominal pain . The Glasgow Coma Score is 15. Vital signs are : BP 98/71 mm Hg , HR 125 beats / minute , RR 26 breaths / minute , and 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

A pt has been in the emergency department for several hours waiting to be admitted. They sustained multiple rib fractures and a femur fracture after a fall. The pt has been awake, alert, and complaining of leg pain. Their spouse reported that the pt suddenly became anxious and confused. Upon reassessment, the pt is restless, with respiratory distress and petechiae to his neck. The pt is exhibiting signs and symptoms most commonly associated with which of the following conditions?

Fat embolism

Which of the following is an expected finding when assessing a patient with a tube thoracostomy connected to a chest drainage system

Fluctuation in the water seal chamber

What is the rationale for obtaining a serum lactate level during the initial assessment of a trauma patient ?

Gauges end organ perfusion and tissue hypoxia

A patient arrives following prolonged exposure of their left hand to the cold The patient is awake and alert and complains of a tingling sensation to the fingers . Assessment reveals swelling and bright red skin to the left hand and a 1 - inch round clear blister to the dorsum of that hand . Which of the following nursing interventions is most appropriate for this patient ?

Gently rewarm over 15 to 30 minutes

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. Witai type of injury is suspecied?

Globe rupture

A trauma patient is being resuscitated in the emergency department when the radiology staff notifies the charge nurse that the 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 teams communication?

Huddle

3 adult pts present at different times during a 1-hour period with a high fever, fatigue, and headache. All 3 pts 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 pts?

Immediately initiate contact precautions

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 ?

Increased oxygen consumption

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 assessment finding would be most concerning ?

Increasing work of breathing

A patient is thrown against a car during a tornado and presents with obvious bilateral femur fractures . The patient is paie , aleri , 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 intravenous lines for isotonic crystalloid administration .

A patient is brought to the emergency department following a snowmobile crash with prolonged exposure time prior to transport . The patient is confused . Vital signs are BP 96/54 mm Hg , HR 114 beats / minute , RR 24 breaths / minute , T 34.60C ( 94.20F ) and an SpO2 of 90 % on oxygen at 15L per non - rebreather mask . Other findings include ETCO2 24 , scrum lactate of 6 mmol / L , and a pH of 6.8 . Based on these findings what is the most appropriate intervention

Initiate warming measures

A driver involved in a high - speed motor vehicle collision arrives in the emergency department . The vehicle's air - bag failed to deploy . The patient is drowsy bui arousable and complaining of chest pain wit ecchymosis noted to the chest . The patient is tachycardic and hypotensive with no evidence of uncontrolled bleeding . Cardiac monitor shows premature ventricular contractions Which of the following is the most appropriate intervention for this patient?

Inotropic support

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

Insert an oropharyngeal airway if there is no gag reflex

A seriously injured patient is noted to have a weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpating and blood at the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What would be the most appropriate next intervention for this patient?

Insertion of a suprapubic catheter

Which of the following characteristics is found in high performing teams

Interdisciplinary collaboration

Which of the following is true about use of the focused assessment sonography for trauma exam for a patient with abdominal trauma ?

It can be used in hypotensive patients too unstable for computed tomography scan

Which of the following is true about the log roll maneuver

It should be avoided with a suspected spine injury prior to imaging

What intravascular solution is most commonly used for patients who have sustained burns?

LR

The patient was the unrestrained driver involved in a moderate speed motor vehicle collision . Assessment reveals tenderness in the upper right quadrani , crepitus in the lower rigini rius , and cechymosis around the umbilicus . The nurse is concerned about injury to which organ ?

Liver

Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision . Assessment reveals tenderness in the upper right quadiani , crepitus in the lower right ribs , and cechymosis around the umbilicus The nurse is concerned about injury to which organ

Liver

A patient is diagnosed with a T12 spinal cord injury following a 20 - foot fall . Which finding is consistent with spinal shock ?

Loss of reflexes

What is the priority intervention for a child who has been diagnosed th an atlanto - occipital dislocation following a high - speed motor vehicle collision ?

Maintaining spinal motion restriction

You are caring for a patient who was shot multiple times in the chest and abdomen. The patient is unresponsive w/snoring, shallow respirations. Assessment reveals absent radial pulses, weak and carotid pulse, and cool, diaphoretic skin. Which management strategy should the nurse anticipate?

Massive transfusion

What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries ?

Medical history including current medications

A nurse verbalizes guilt and remorse after 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 toward colleagues . This is most consistent with which condition ?

Moral injury

An adult patient is being treated in the ED after falling 30 ft and landing on their head. The patient has been intubated and initial stabilization efforts are ongoing. The vital sign are BP 70/40, HR 44, and respirations are being assisted at 16. The patient skin is warm, dry, and normal color. These findings are most consistent w/ what type of shock?

Neurogenic

Your patient is a pedestrian struck by a car and thrown 35 feet . They were unconscious at the scene but became responsive with initial and subsequeni Glasgow Coma Scale ( GCS ) scores of 13 ( E - 3 , V - 4 , M - 6 ) . The patient has bilateral subdural hematomas and is awaiting transfer to the ICU . Your next assessment reveals a GCS of 9 ( E - 2 , V - 2 , M - 5 What is the priority nursing intervention ?

Notify the provider of the change

A patient has a closed fracture to the left lower leg. Which symptoms are consistent with compartment syndrome

Pain, diminished pedal pulse, pressure

You are caring for a patient who was involved in a MTV crash and is 32 weeks pregnant. Findings of your secondary survey include abdominal pain w/rigidity on palpation, fundal height at the costal margin, and bloody vaginal discharge. Varying acceleration and decelerations are noted on cardiotocography. These findings are most consistent w/ which of the following?

Placental abruption

A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which intervention is most appropriate for this patent?

Prepare the patient for surgery to remove the rod.

What two noninvasive interventions are used to assess for the adequacy of oxygenation and effectiveness of ventilation

Pulse oxide try and capnography

An obese trauma patient requires intubation . Assuming there are no contraindications , which position will provide the best visualization for insertion of the endotracheal tube ?

Ramped

A 5 - year - old child presents to the emergency department 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 ?

Report your suspicion of maltreatment in accordance with local regulations

An intubated trauma patient has just been transported back from CT scan. Upon arrival to their room in the emergency department, resistance is noted with bag-mask ventilations and auscultation reveals unequal breath sounds. What is the most appropriate initial intervention for this patient?

Reposition the endotracheal tube

What position optimizes ventilation in the obese patient with a lumbar Fracture

Reverse Trendelenburg

Which blood pressure finding is associated with early or compensated hypovolemic shock?

Rising diastolic

A trauma patient involved in a fall from 25 ft has a TBI, three anterior rib fractures on the right side, a small pneumothorax on the right, and grade III liver injury. The patient was intubated and placed on a ventilator w/ PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning

Severely diminished breath sounds on the right

An adult patient was a restrained passenger involved in a high-speed motor vehicle collision. The patient complained of generalized abdominal and left leg pain. A FAST exam was negative for fluid in the abdominal cavity. While awaiting inpatient bed placement, the patient develops increased abdominal pain w/rebound tenderness, fever and elevated WBC. These findings are most consistent w/ an injury to which organ?

Small bowel

An older patient w/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?

Subdural hematoma

An adult was thrown against a concrete wall during a factory explosion and sustained a femur fracture , liver laceration , and a small subdural hematoma These injuries most likely occurred during what level of blast trauma ?

Tertiary

A teenaged patient presents to the ED w/ left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is the most consistent w/ human trafficking

Those experiencing human trafficking rarely self disclose

What assessment finding is consistent w/impending herniation syndrome?

Unilaterally fixed and dilated pupil

While caring for a trauma patient in the ED, what finding raises suspicion of a complete spinal cord injury?

Urinary incontinence

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 ?

Use a law thrust to open the air way and look for signs of obstruction

An unresponsive patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. Medication for drug-assisted intubation have been administered but intubation was unsuccessful. What is the most appropriate next step?

Ventilate with a bag-mask device

A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate sacral sparing

Voluntary anal sphincter tone

A patient with a traumatic brain injury has a mean arterial pressure ( MAP ) of 65 mm Hg ( 8.66 kPa ) and an intracranial pressure ( ICP ) of 22 mun Hg ( 2.93 kPa ) . Which finding is most likely an indication of the body's response to these findings ?

Widening pulse pressure

An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The pt was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness and a hematoma is noted to the forehead. The pt is currently on anticoagulant therapy. What is most likely the cause of their symptoms?

post-concussive syndrome