TNCC Practice Exam

A patient with a knife injury to the neck has an intact airway and is hemodynamically stable. He complains of difficulty swallowing and speaking. Further assessment is indicated next for which of the following conditions? a. Damage to the spinal cord b. An expanding pneumothorax c. Laceration of the carotid artery d. Injury to the thyroid gland

a. Damage to the spinal cord Rationale: Penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the spinal cord (pp. 124, 126).

When obtaining a history for an injured patient, understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma provider in: a. Evaluating and anticipating the types of injury that may be present b. Deciding whether law enforcement should be notified c. Determining needed laboratory tests d. Predicting the need for a surgical procedure

a. Evaluating and anticipating the types of injury that may be present Rationale: Mechanism of injury and energy transfer can assist the provider in evaluating and anticipating damage (p. 23).

A patient with a spinal cord injury at C5 is being cared for in the emergency department while awaiting transport to a trauma center. Which of the following represents the highest priority for ongoing assessment and management? a. Maintain adequate respiratory status b. Administer balanced resuscitation fluid c. Perform serial assessments of neurologic function d. Maintain core temperature

a. Maintain adequate respiratory status Rationale: Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function, resulting in a paralyzed diaphragm and inability to breathe (p. 173, 179).

A trauma nurse cared for a child with devastating burns two weeks ago. She called in sick for a couple of days and is now back working on the team. Which of the following behaviors would indicate this nurse is coping well? a. She is talking about taking the emergency nursing certification examination b. She keeps requesting to be assigned to the walk-in/ambulatory area c. She is impatient and snaps at coworkers d. She is thinking about transferring out of the emergency department

a. She is talking about taking the emergency nursing certification examination Rationale: This is an indication she is taking positive steps to advance her own practice, a sign of resilience (p. 338).

Which of the following accurately describes ventilation principles associated with a bag-mask device? a. Ventilate at a rate of 10 to 12 breaths/minute b. Deliver 100% oxygen c. Compress the bag-mask device completely d. Maintain the oxygen saturation level between 92% and 94%

a. Ventilate at a rate of 10 to 12 breaths/minute Rationale: If ventilation is ineffective, assist ventilations at 10 to 12 breaths/minute or one every 5 to 6 seconds (p. 32).

A patient fell two weeks ago, striking his head. He came to the emergency department with a persistent headache and nausea. He was diagnosed with a small subdural hematoma and has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports that he has been anxious, restless, and shaky. He vomited twice during the night. He tells the day shift nurse that he couldn't sleep because a young child kept coming into his room. What is a likely cause for these signs and symptoms? a. Increased intracranial pressure b. Alcohol withdrawal c. Rhabdomyolysis d. Pulmonary embolus

b. Alcohol withdrawal Rationale: Alcohol withdrawal is a common delayed condition because symptoms are difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or vomiting, psychomotor agitation, anxiety, insomnia, hallucinations, or seizures (p. 397).

What is the appropriate technique for palpating the pelvis for stability? a. Apply gentle pressure over the iliac crests downward and laterally b. Apply gentle pressure over the iliac crests downward and medially c. Apply firm pressure over the iliac crests downward and laterally d. Apply firm pressure over the iliac crests downward and medially

b. Apply gentle pressure over the iliac crests downward and medially Rationale: To assess for pelvic instability, gentle pressure is applied over the iliac crests downward and medially (p. 149).

Based on proper bleeding control techniques, what is the first step to stop the bleeding of a penetrating injury to the lower extremity? a. Elevate the extremity to the level of the heart b. Initiate direct pressure c. Apply a tourniquet d. Cover the open wound with sterile saline dressings

b. Initiate direct pressure Rationale: The first step in controlling any bleeding is direct pressure. If that is not adequate, the application of a tourniquet may be needed (p. 201-204).

What is a safe pharmacological alternative to opioids for rib fracture pain management in the anticoagulated patient? a. Corticosteroids b. Intercostal nerve blocks c. Nonsteroidal anti-inflammatory drugs d. Epidural anesthetics

b. Intercostal nerve blocks Rationale: Continuous intercostal nerve blocks use long-acting anesthetics and can provide safe and effective pain management for the anticoagulated patient (pp. 271, 273).

A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? a. Decompensated shock b. Normal vital signs in pregnancy c. Abruptio placentae d. Supine hypotension syndrome

b. Normal vital signs in pregnancy Rationale: In pregnancy, the resting heart rate increases by 10 to 20 beats/minute and a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance (p. 294). Normal fetal heart rate is between 120 and 160 beats/minute (p. 297).

Following a bomb explosion, fragmentation injuries from the bomb or objects in the environment are examples of which phase of injury? a. Primary b. Secondary c. Tertiary d. Quaternary

b. Secondary Rationale: The secondary phase of a blast results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries (p. 20).

The nurse is obtaining a history for a patient who presents following sexual assault. This history is completed using which of the following techniques? a. Bring the family in to the interview room b. Use direct quotes to record information c. Obtain information specific to the assault, not what happened afterward d. Provide food and drink before creating a rapport

b. Supine Rationale: In the supine position, the chest and diaphragm can become obstructed due to excess abdominal mass, hindering effective ventilation. The reverse Trendelenburg position, not the supine position, will benefit both airway maintenance and work of breathing in the bariatric patient (p. 281, 285).

Treatment for frostbite includes: a. Warm the affected part slowly over 30 to 60 minutes b. Use gentle friction to improve circulation c. Administer tissue plasminogen activator d. Leave blisters intact

c. Administer tissue plasminogen activator Rationale: With frostbite, thrombus formation is a risk. Tissue plasminogen activator or nonsteroidal antinflammatory medication can be administered (p. 215). Tissue plasminogen activator has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming (p. 215).

Which of the following is the best measure of the adequacy of cellular perfusion and helps to predict the outcome of resuscitation? a. End-tidal carbon dioxide b. Hypoxia c. Base deficit d. Oxygen saturation

c. Base deficit Rationale: Base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and when used in conjunction with serum lactate helps predict the success of the resuscitation (p. 57).

The across-the-room observation step in the initial assessment provides the opportunity to: a. Assess for uncontrolled internal hemorrhage b. Accurately triage the patient c. Reprioritize circulation before airway or breathing d. Activate the trauma team

c. Reprioritize circulation before airway or breathing. Rationale: The across-the-room observation is done at the beginning of the primary survey to rapidly assess the need to reprioritize circulation before airway or breathing. This is done if uncontrolled external hemorrhage is identified (p. 28).

What is the best position for maintaining an open airway in the bariatric patient? a. Prone b. Supine c. Reverse Trendelenburg d. Right lateral recumbent

c. Reverse Trendelenburg Rationale: The reverse Trendelenburg position will benefit both airway maintenance and work of breathing in the bariatric patient (p. 285).

In a patient with severe traumatic brain injury, hypocapnia causes: a. Respiratory acidosis b. Metabolic acidosis c. Neurogenic shock d. Cerebral vasoconstriction

d. Cerebral vasoconstriction Rationale: Hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the cerebral vasculature (p. 98).

While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a potential sign of mental status changes? a. Sunken fontanel b. Crying, but consolable c. Hyperglycemia d. Cooperation with the assessment

d. Cooperation with the assessment Rationale: An alert older infant or toddler will recognize his or her caregiver, be cautious of strangers, and may not respond to commands, which is a normal response (p. 235).

What is the key to a high-performance trauma team? a. Individual goals b. Use of TeamSTEPPS c. Identification of a single decision maker d. Effective communication

d. Effective communication Rationale: Skilled communication, cooperation, and coordination are the cornerstones of high-performance teams and high-quality trauma care (p. 5).

The major preventable cause of death in the trauma patient is: a. Airway compromise b. Ineffective ventilation c. Secondary head injury d. Uncontrolled hemorrhage

d. Uncontrolled hemorrhage Rationale: Uncontrolled hemorrhage is the major cause of preventable death after injury, so assessment to identify uncontrolled hemorrhage is key to the initial assessment process (p. 29).