TNCC Exam 8th edition study
1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve -
ansHemoglobin does not readily release oxygen for use by the tissues A shift to the left
occurs in an environment of low metabolic demand (hypothermia, hypocapnia, alkalosis),
increasing hemoglobin's affinity for oxygen.
EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS
reports significant damage to the driver's side of the car. The patient is asking to have the
cervical collar removed. When it is appropriate to remove the cervical collar? - ansAfter a
physical examination if the patient has no radiologic abnormalities on CT A CT is
recommended for spinal clearance in an impaired patient.
The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the
patient's 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? - ans2280 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.
Which of the following is an expected finding in a patient with a tube thoracostomy
connected to a chest drainage system - ansFluctuation in the water seal chamber Fluctuation
in the water seal chamber indicates the tube is placed correctly in the pleural space.
.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? - ansGlobe
rupture A teardrop-shaped pupil suggests a globe rupture.
.A patient with a complete spinal cord injury in neurogenic shock will demonstrate
hypotension and which other clinical signs? - ansBradycardia and absent motor function
below the level of injury Patients with a complete spinal cord injury will have absent motor
function below the level of the lesion. They become hypotensive and bradycardic due to loss
of autonomic nervous system function.
Which of the following patients warrants referral to a burn center? - ansA 52-year-old
diabetic male with a partial-thickness burn to the left lower leg This patient has a 7% TBSA
burn with a preexisting medical history that could complicate management, prolong recovery,
or affect mortality.
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 palpation, 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? - ansPlacental abruption The findings of abdominal pain, elevated fundal
height, dark bloody show, and fetal distress are most consistent with placental abruption.
, 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? - ansStraight catheter for urine sample Insertion
of a urinary catheter is contraindicated if urethral transection is suspected. Signs and
symptoms of urethral injury include blood at the meatus, perineal ecchymosis, scrotal
ecchymosis, and a high-riding or non-palpable prostate.
Which of the following occurs during the third impact of a motor vehicle crash? - ansThe
aorta is torn at its attachment with the ligamentum arteriosum This occurs during the third
impact.
All of these are considered a critical communication point in trauma care EXCEPT which of
the following? - ansDefusings A defusing is part of critical incident stress management but is
not considered a critical communication point in trauma care.
Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage? - ansMARCH 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.
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? - ans500 mL/hour Prior to
calculating TBSA, this is the recommended starting point for fluid resuscitation for patients
14 years of age and older
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? - ansDiagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for
hemodynamically unstable patients or if FAST and CT are not available.
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? -
ansSubdural hematoma Subdural hematomas are characterized by nausea, vomiting,
headache, changes in level of consciousness, ipsilateral dilated, nonreactive pupil, and
unilateral weakness or hemiparesis. These typically occur after a fall or assault.
Tearing of the bridging veins is most frequently associated with which brain injury? -
ansSubdural hematoma Subdural hematomas are usually caused by tearing of the bridging
veins and associated with direct injury to the underlying brain tissue.
.During the primary survey of an unconscious patient with multi-system trauma, the nurse
notes snoring respirations. What priority nursing intervention should be performed next? -
ansInsert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate
airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the
tongue. Oropharyngeal airways can be used in patients without a gag reflex.
1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve -
ansHemoglobin does not readily release oxygen for use by the tissues A shift to the left
occurs in an environment of low metabolic demand (hypothermia, hypocapnia, alkalosis),
increasing hemoglobin's affinity for oxygen.
EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS
reports significant damage to the driver's side of the car. The patient is asking to have the
cervical collar removed. When it is appropriate to remove the cervical collar? - ansAfter a
physical examination if the patient has no radiologic abnormalities on CT A CT is
recommended for spinal clearance in an impaired patient.
The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the
patient's 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? - ans2280 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.
Which of the following is an expected finding in a patient with a tube thoracostomy
connected to a chest drainage system - ansFluctuation in the water seal chamber Fluctuation
in the water seal chamber indicates the tube is placed correctly in the pleural space.
.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? - ansGlobe
rupture A teardrop-shaped pupil suggests a globe rupture.
.A patient with a complete spinal cord injury in neurogenic shock will demonstrate
hypotension and which other clinical signs? - ansBradycardia and absent motor function
below the level of injury Patients with a complete spinal cord injury will have absent motor
function below the level of the lesion. They become hypotensive and bradycardic due to loss
of autonomic nervous system function.
Which of the following patients warrants referral to a burn center? - ansA 52-year-old
diabetic male with a partial-thickness burn to the left lower leg This patient has a 7% TBSA
burn with a preexisting medical history that could complicate management, prolong recovery,
or affect mortality.
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 palpation, 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? - ansPlacental abruption The findings of abdominal pain, elevated fundal
height, dark bloody show, and fetal distress are most consistent with placental abruption.
, 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? - ansStraight catheter for urine sample Insertion
of a urinary catheter is contraindicated if urethral transection is suspected. Signs and
symptoms of urethral injury include blood at the meatus, perineal ecchymosis, scrotal
ecchymosis, and a high-riding or non-palpable prostate.
Which of the following occurs during the third impact of a motor vehicle crash? - ansThe
aorta is torn at its attachment with the ligamentum arteriosum This occurs during the third
impact.
All of these are considered a critical communication point in trauma care EXCEPT which of
the following? - ansDefusings A defusing is part of critical incident stress management but is
not considered a critical communication point in trauma care.
Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage? - ansMARCH 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.
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? - ans500 mL/hour Prior to
calculating TBSA, this is the recommended starting point for fluid resuscitation for patients
14 years of age and older
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? - ansDiagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for
hemodynamically unstable patients or if FAST and CT are not available.
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? -
ansSubdural hematoma Subdural hematomas are characterized by nausea, vomiting,
headache, changes in level of consciousness, ipsilateral dilated, nonreactive pupil, and
unilateral weakness or hemiparesis. These typically occur after a fall or assault.
Tearing of the bridging veins is most frequently associated with which brain injury? -
ansSubdural hematoma Subdural hematomas are usually caused by tearing of the bridging
veins and associated with direct injury to the underlying brain tissue.
.During the primary survey of an unconscious patient with multi-system trauma, the nurse
notes snoring respirations. What priority nursing intervention should be performed next? -
ansInsert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate
airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the
tongue. Oropharyngeal airways can be used in patients without a gag reflex.
