TNCC Test prep 8th Edition

dressing removal (This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing)

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?

hemoglobin does not readily release O2 for use by the tissues

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

a pertinent medical hx is crucial

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

bowel (Hollow organ injury signs and symptoms may be subtle and delayed but are associated with a high mortality rate if not identified.)

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

identifying individuals who made mistakes during the traumatic event

Which of the following is NOT considered a benefit of debriefings?

pericardiocentesis

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

acidosis

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

decreased respiratory effort (Early signs of increased intracranial pressure include headache, nausea, vomiting, amnesia, and behavioral changes (impaired judgment, restlessness, drowsiness).

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

flucuation in the water seal chamber

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

advanced age

Which of the following is most likely to contribute to inadequate oxygenation and ventilation?

worsening pneumothorax

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

MARCH (The MARCH mnemonic stands for massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. The MARCH mnemonic recognizes uncontrolled hemorrhage as the major cause of preventable death after injury.)

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

a 52 y/o diabetic male with a partial thickness burn to the left lower leg

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

During Tension Pneumothorax

- will cause obstructive shock - If Chest Tube placement is not ready available, needs Needle Decompression with 14-gauge needle, longer is better over the 2nd Intercostal space, midclavicular line OR 5th intercostal space, anterior axillary line

huddle?

A trauma patient is en route to a rural emergency department. Radiology notifies the charge nurse that the computerized 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 teams communication?

padding the upper back while stabilizing the cervical spine

Caregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority?

velocity

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

it can worsen cord damage from an unstable spinal injury

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

S/S of Tension Pneumothorax

-Decrease/Absent breath sounds ipsilaterally -JVD -Hypotension -Hyper-resonance ipsilaterally -Tracheal Deviation (late sign) -Severe Respiratory distress, Anxiety, agitation -Can lead to PEA

For Open Pneumothorax treatments are

-Immediate treatment is 3-sided dressing -Definitive treatment is Chest Tube

globe rupture

A 35 y/o M 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?

Expedite transfer to the closest trauma center

A 56 y/o M involved in a MVC is brought to the ED. He complains of neck pain, SOB, and diffuse abdominal pain. His GCS is 15, VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which is the priority intervention for this patient?

Initiate two large-caliber IVs for LR administration

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?

fat embolism

a pt has been in the ED for several hrs 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 pt is restless with respiratory distress and petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of the following conditions?

calcium (Hypocalcemia is a concern with massive transfusion because citrate is added to banked blood to prevent coagulation. Citrate chelates/binds with calcium, rendering it inactive.)

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

defusings

All of these are considered a critical communication point in trauma care EXCEPT which of the following?

pressure

An intubated and sedated pt in the ED 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?

Confirm ETT placement

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?

Which of is TRUE about rib fractures?

Associated with significant geriatric morbidity and mortality.

insert an oropharyngeal airway if there is no gag reflex

During the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next?

after a physical examination if the pt has no radiologic abnormalities on CT

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

dysrhythmias

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

subdural hematoma

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

endotracheal tube

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

Priapism

What finding raises suspicion of a complete spinal cord injury?

to guage end-organ perfusion and tissue hypoxia

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

placental abruption

You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following?

500 mL/hr

You are treating a 27 y/o M in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation?

apply splint and elevate above the level of the heart

a 37 y/o F 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 most appropriate intervention?

pelvic stability

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

hypotension that worsens w/ inspiration

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

the aorta is torn at its attachment with the ligamentum arteriosum

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

Initiate transfer to a trauma center

A pt is brought to the ED of a rural hospital following a high-speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions?

bardycardia and absent motor function below the level of injury

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

narrowed

Which of the following pulse pressures indicate early hypovolemic shock?

pulse oximetry and capnography

What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation?

within 24 hrs of trauma

When is the tertiary survey completed fora trauma pt?

serial FAST exams

a 49 y/o restrained driver involved in a MVC presents to the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following?

Report your suspicion of maltreatment in accordance with local regulations

a 5 y/o 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 survey. Which of the following is the priority nursing intervention?

subdural hematoma

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 to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms?

ventilate with a bag mask device

An unresponsive trauma pt has an oropharygeal 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?

straight cath for urine sample

A 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question?

Complete

EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury?

smell of alcohol on breath

EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance?

Hemothorax: Blood in the pleural space. Assessment Finding

-Persistent Blood lost following chest tube insertion -Hemorrhagic shock: pallor, tachycardia, hypotension, cool peripheries -External thoracic injury -Decrease Breath sounds and decrease chest movement - dullness ipsilaterally -Anxiety/ Agitation.

elevating the extremity to the level of the heart

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

compensated

A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock?

Mitigation

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?

2280 ml (Both upper arms = 8%, both lower arms = 6%, and both hands = 5%, yielding 19 * 2 * 120 = 4560 mL. Half of the total is equal to 2280 mL. Superficial burns are not included in the TBSA calculation for fluid resuscitation.)

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?