TNCC 9TH EDITION EXAM TEST BANK COMPLETE 130
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH RATIONALES|ALREADY
GRADED A+
Question 1
An adult patient 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 patient has received one intravenous fluid bolus of 500 mL of warmed
isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse
oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to
manage the cerebral blood flow?
A. Decrease the rate of manual ventilation
B. Initiate another fluid bolus
C. Recheck endotracheal tube placement
D. Increase the amount of oxygen delivered
Correct answer: A. Decrease the rate of manual ventilation
Rationale: PaCO2 of 30 mm Hg indicates hyperventilation, which causes cerebral
vasoconstriction and reduces cerebral blood flow. Decreasing the ventilation rate
will normalize PaCO2 to 35-40 mm Hg, optimizing cerebral perfusion.
Question 2
An older adult presents to the emergency department with complaints of
dizziness, headache, and nausea. The patient 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 patient is currently on anticoagulant therapy. What is
most likely the cause of their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
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,C. Diffuse axonal injury
D. Post-concussive syndrome
Correct answer: D. Post-concussive syndrome
Rationale: Symptoms delayed by 10 days after minor head injury, without rapid
neurological decline, are characteristic of post-concussive syndrome.
Anticoagulation increases bleeding risk, but the timeline fits post-concussive
syndrome better than acute intracranial hemorrhage.
Question 3
A patient 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?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg
Correct answer: C. Elevating the leg to the level of the heart
Rationale: Symptoms suggest compartment syndrome. Elevating to the level of
the heart reduces dependent edema without causing venous congestion, which
would increase compartment pressure. Elevation above the heart is
contraindicated.
Question 4
A patient 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?
A. Absent breath sounds on the left
B. Bowel sounds heard in the lower left chest
C. Subcutaneous emphysema
D. Tracheal deviation to the right
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,Correct answer: B. Bowel sounds heard in the lower left chest
Rationale: Diaphragmatic rupture allows abdominal contents (stomach, bowel) to
herniate into the chest cavity, producing bowel sounds on auscultation of the
chest.
Question 5
A patient 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 patient has been awake, alert, and complaining of leg pain. Their spouse
reported that the patient 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?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Disseminated intravascular coagulopathy
D. Acute respiratory distress syndrome
Correct answer: B. Fat embolism syndrome
Rationale: Classic triad of fat embolism syndrome: respiratory distress, neurologic
changes (confusion, anxiety), and petechial rash (often neck, upper chest, axillae).
Typically occurs 24-72 hours after long bone or pelvic fractures.
Question 6
Three adult patients present at different times during a 1-hour period with a high
fever, fatigue, and headache. All 3 patients 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 patients?
A. Immediately initiate airborne precautions
B. Immediately initiate contact precautions
C. Immediately initiate droplet precautions
D. Immediately initiate standard precautions only
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, Correct answer: B. Immediately initiate contact precautions
Rationale: The rash distribution (mouth, face, arms spreading to trunk) with
fever, fatigue, headache, and common exposure raises concern for a contagious
illness (e.g., measles, meningococcemia). Contact precautions are appropriate
pending diagnosis.
Question 7
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. Retrobulbar hematoma
D. Retinal detachment
Correct answer: B. Globe rupture
Rationale: Teardrop-shaped pupil is pathognomonic for open globe rupture due
to prolapse of intraocular contents through a defect in the cornea or sclera.
Question 8
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?
A. Increased functional reserve capacity
B. Increased oxygen consumption
C. Decreased minute ventilation
D. Slower desaturation rates with apnea
Correct answer: B. Increased oxygen consumption
Rationale: Pregnancy increases metabolic demand and oxygen consumption by
~20%. Pregnant patients desaturate faster during hypoventilation or apnea due to
decreased functional residual capacity and increased O2 consumption.
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QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) WITH RATIONALES|ALREADY
GRADED A+
Question 1
An adult patient 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 patient has received one intravenous fluid bolus of 500 mL of warmed
isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse
oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to
manage the cerebral blood flow?
A. Decrease the rate of manual ventilation
B. Initiate another fluid bolus
C. Recheck endotracheal tube placement
D. Increase the amount of oxygen delivered
Correct answer: A. Decrease the rate of manual ventilation
Rationale: PaCO2 of 30 mm Hg indicates hyperventilation, which causes cerebral
vasoconstriction and reduces cerebral blood flow. Decreasing the ventilation rate
will normalize PaCO2 to 35-40 mm Hg, optimizing cerebral perfusion.
Question 2
An older adult presents to the emergency department with complaints of
dizziness, headache, and nausea. The patient 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 patient is currently on anticoagulant therapy. What is
most likely the cause of their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
1|Page
,C. Diffuse axonal injury
D. Post-concussive syndrome
Correct answer: D. Post-concussive syndrome
Rationale: Symptoms delayed by 10 days after minor head injury, without rapid
neurological decline, are characteristic of post-concussive syndrome.
Anticoagulation increases bleeding risk, but the timeline fits post-concussive
syndrome better than acute intracranial hemorrhage.
Question 3
A patient 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?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg
Correct answer: C. Elevating the leg to the level of the heart
Rationale: Symptoms suggest compartment syndrome. Elevating to the level of
the heart reduces dependent edema without causing venous congestion, which
would increase compartment pressure. Elevation above the heart is
contraindicated.
Question 4
A patient 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?
A. Absent breath sounds on the left
B. Bowel sounds heard in the lower left chest
C. Subcutaneous emphysema
D. Tracheal deviation to the right
2|Page
,Correct answer: B. Bowel sounds heard in the lower left chest
Rationale: Diaphragmatic rupture allows abdominal contents (stomach, bowel) to
herniate into the chest cavity, producing bowel sounds on auscultation of the
chest.
Question 5
A patient 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 patient has been awake, alert, and complaining of leg pain. Their spouse
reported that the patient 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?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Disseminated intravascular coagulopathy
D. Acute respiratory distress syndrome
Correct answer: B. Fat embolism syndrome
Rationale: Classic triad of fat embolism syndrome: respiratory distress, neurologic
changes (confusion, anxiety), and petechial rash (often neck, upper chest, axillae).
Typically occurs 24-72 hours after long bone or pelvic fractures.
Question 6
Three adult patients present at different times during a 1-hour period with a high
fever, fatigue, and headache. All 3 patients 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 patients?
A. Immediately initiate airborne precautions
B. Immediately initiate contact precautions
C. Immediately initiate droplet precautions
D. Immediately initiate standard precautions only
3|Page
, Correct answer: B. Immediately initiate contact precautions
Rationale: The rash distribution (mouth, face, arms spreading to trunk) with
fever, fatigue, headache, and common exposure raises concern for a contagious
illness (e.g., measles, meningococcemia). Contact precautions are appropriate
pending diagnosis.
Question 7
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. Retrobulbar hematoma
D. Retinal detachment
Correct answer: B. Globe rupture
Rationale: Teardrop-shaped pupil is pathognomonic for open globe rupture due
to prolapse of intraocular contents through a defect in the cornea or sclera.
Question 8
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?
A. Increased functional reserve capacity
B. Increased oxygen consumption
C. Decreased minute ventilation
D. Slower desaturation rates with apnea
Correct answer: B. Increased oxygen consumption
Rationale: Pregnancy increases metabolic demand and oxygen consumption by
~20%. Pregnant patients desaturate faster during hypoventilation or apnea due to
decreased functional residual capacity and increased O2 consumption.
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