TNCC 9TH EDITION TNP QUESTION AND
ANSWER.
—What does the J stand for at the end of the secondary survery? - CORRECT
ANSWER-just keep evaluating - vipp
—What does VIPP stand for? - CORRECT ANSWER-vital signs,
injuries/interventions, primary survey, pain
—During the head-to-toe, where would you find Grey-Turner's sign? - CORRECT
ANSWER-flank
—During the head-to-toe, where would you find Cullen's sign? - CORRECT ANSWER-
umbilicus
-What is sometimes deferred at the end of the head-to-toe? - CORRECT ANSWER-
inspecting posterior
-Antibiotics, consults, head CT, imaging, law enforcement, mandatory reporting,
psychosocial support, social services, splinting, tetanus, and wound care are all
interventions that you do AFTER and before WHAT? - CORRECT ANSWER-AFTER
head-to-toe, BEFORE J (VIPP)
-What three items are obtained during the pertinent history assessment? -
CORRECT ANSWER-Medical records, prehospital report, SAMPLE
-What are examples of nonpharmacologic measures? (must identify at least one
during testing) - CORRECT ANSWER-Distraction, family presence, padding bony
prominences, repositioning, splinting, verbal reassurance
-For whom is capnography highly recommended? - CORRECT ANSWER-all patients
-In step M of "Get Adjuncts", what else might be indicated besides cardiac monitor? -
CORRECT ANSWER-EKG
-In Step 16 of "Exposure and Environment", you must name at least one of these
interventions: - CORRECT ANSWER-blankets, room temp increase, warmed fluids,
warming lights
-To assess circulation, you must do these two main tasks: - CORRECT ANSWER-1.
inspect AND palpate skin color, temp, moisture and 2. palpate a pulse
,-What do you do when alterations are identified in any of the steps in the primary
survery? - CORRECT ANSWER-intervene as appropriate and reassess
-What three assessments must be done if the patient is intubated? - CORRECT
ANSWER-1. attach CO2 detector and assess for evidence of exhaled CO2; 2. observe
for rise and fall of the chest w/ assisted ventilations; 3. auscultate over epigastrium
for gurgling AND lungs for bilateral breath sounds
-Four of these must be identified to assess breathing effectiveness: - CORRECT
ANSWER-Breath sounds, depth/pattern/rate, spontaneous breathing, subcutaneous
emphysema, increased work of breathing, symmetrical chest rise and fall, tracheal
deviation/JVD, open wounds/deformities, skin color
-What can be applied in step 12 of "Circulation and Control of Hemorrhage" for
which credit is given in the LMNOP section? - CORRECT ANSWER-cardiac monitor
-When should 2 IV sites be established? - CORRECT ANSWER-During "Circulation"
assessment
-If the patient is intubated and you've already assessed ETT placement, what else
needs to be done with the ETT? (step 10) - CORRECT ANSWER-assess ETT position
by noting the number at teeth/gums AND secure ETT
-What should you verbalize after completing all ETT assessments? - CORRECT
ANSWER-moving patient from assisted ventilation to mechanical
-During which part of the primary survey would you anticipate the need for a chest
tube, intubation, decompression of pneumothorax, oxygen, or BVMs? - CORRECT
ANSWER-"Breathing and Ventilation"
-Four of these must be identified to assess patency and protection of the airway: -
CORRECT ANSWER-bony deformity, loose teeth, edema, inhalation injury, sounds,
tongue obstruction, burns, fluids, foreign objects, vocalization
-During which part of the primary survey would there be anticipation for intubation,
insertion of OPA/NPA, removal of any loose teeth or foreign objects, or suctioning? -
CORRECT ANSWER-Assessing patency and protection of the airway, Step 7 of
"Alertness and Airway with Simultaneous Cervical Spinal Stabilization"
If c-spine stabilization is necessary, what need should be stated? - CORRECT
ANSWER-the need for a second person to provide manual c-spine stabilization
*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? - CORRECT ANSWER-A.Decrease the rate of manual ventilation.
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
C.Diffuse axonal injury
D.Post-concussive syndrome - CORRECT ANSWER-post-concussive syndrome
A patient with a lower extremity fracture complains of severe pain and tightness in
his calf, minimally relieved by pain medications. 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
A patient involved in a high-speed rollover is complaining of increased difficulty
breathing. There is a small penetrating wound to the sixth intercostal space in the
left lateral chest. Which finding is most consistent with an injury to the diaphragm? -
CORRECT ANSWER-Bowel sounds heard in the left lower chest
A ruptured diaphragm is a potentially life-threatening injury. The patient will most
likely have decreased breath sounds on the affected side along with pain, which may
radiate to the left shoulder. However, these signs do not specifically implicate an
injury to the diaphragm. Auscultation of bowel sounds in the chest indicates that
abdominal contents have herniated up into the chest through a defect in the
diaphragm.
*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. Acute lung injury
B. Fat embolism
ANSWER.
—What does the J stand for at the end of the secondary survery? - CORRECT
ANSWER-just keep evaluating - vipp
—What does VIPP stand for? - CORRECT ANSWER-vital signs,
injuries/interventions, primary survey, pain
—During the head-to-toe, where would you find Grey-Turner's sign? - CORRECT
ANSWER-flank
—During the head-to-toe, where would you find Cullen's sign? - CORRECT ANSWER-
umbilicus
-What is sometimes deferred at the end of the head-to-toe? - CORRECT ANSWER-
inspecting posterior
-Antibiotics, consults, head CT, imaging, law enforcement, mandatory reporting,
psychosocial support, social services, splinting, tetanus, and wound care are all
interventions that you do AFTER and before WHAT? - CORRECT ANSWER-AFTER
head-to-toe, BEFORE J (VIPP)
-What three items are obtained during the pertinent history assessment? -
CORRECT ANSWER-Medical records, prehospital report, SAMPLE
-What are examples of nonpharmacologic measures? (must identify at least one
during testing) - CORRECT ANSWER-Distraction, family presence, padding bony
prominences, repositioning, splinting, verbal reassurance
-For whom is capnography highly recommended? - CORRECT ANSWER-all patients
-In step M of "Get Adjuncts", what else might be indicated besides cardiac monitor? -
CORRECT ANSWER-EKG
-In Step 16 of "Exposure and Environment", you must name at least one of these
interventions: - CORRECT ANSWER-blankets, room temp increase, warmed fluids,
warming lights
-To assess circulation, you must do these two main tasks: - CORRECT ANSWER-1.
inspect AND palpate skin color, temp, moisture and 2. palpate a pulse
,-What do you do when alterations are identified in any of the steps in the primary
survery? - CORRECT ANSWER-intervene as appropriate and reassess
-What three assessments must be done if the patient is intubated? - CORRECT
ANSWER-1. attach CO2 detector and assess for evidence of exhaled CO2; 2. observe
for rise and fall of the chest w/ assisted ventilations; 3. auscultate over epigastrium
for gurgling AND lungs for bilateral breath sounds
-Four of these must be identified to assess breathing effectiveness: - CORRECT
ANSWER-Breath sounds, depth/pattern/rate, spontaneous breathing, subcutaneous
emphysema, increased work of breathing, symmetrical chest rise and fall, tracheal
deviation/JVD, open wounds/deformities, skin color
-What can be applied in step 12 of "Circulation and Control of Hemorrhage" for
which credit is given in the LMNOP section? - CORRECT ANSWER-cardiac monitor
-When should 2 IV sites be established? - CORRECT ANSWER-During "Circulation"
assessment
-If the patient is intubated and you've already assessed ETT placement, what else
needs to be done with the ETT? (step 10) - CORRECT ANSWER-assess ETT position
by noting the number at teeth/gums AND secure ETT
-What should you verbalize after completing all ETT assessments? - CORRECT
ANSWER-moving patient from assisted ventilation to mechanical
-During which part of the primary survey would you anticipate the need for a chest
tube, intubation, decompression of pneumothorax, oxygen, or BVMs? - CORRECT
ANSWER-"Breathing and Ventilation"
-Four of these must be identified to assess patency and protection of the airway: -
CORRECT ANSWER-bony deformity, loose teeth, edema, inhalation injury, sounds,
tongue obstruction, burns, fluids, foreign objects, vocalization
-During which part of the primary survey would there be anticipation for intubation,
insertion of OPA/NPA, removal of any loose teeth or foreign objects, or suctioning? -
CORRECT ANSWER-Assessing patency and protection of the airway, Step 7 of
"Alertness and Airway with Simultaneous Cervical Spinal Stabilization"
If c-spine stabilization is necessary, what need should be stated? - CORRECT
ANSWER-the need for a second person to provide manual c-spine stabilization
*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? - CORRECT ANSWER-A.Decrease the rate of manual ventilation.
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
C.Diffuse axonal injury
D.Post-concussive syndrome - CORRECT ANSWER-post-concussive syndrome
A patient with a lower extremity fracture complains of severe pain and tightness in
his calf, minimally relieved by pain medications. 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
A patient involved in a high-speed rollover is complaining of increased difficulty
breathing. There is a small penetrating wound to the sixth intercostal space in the
left lateral chest. Which finding is most consistent with an injury to the diaphragm? -
CORRECT ANSWER-Bowel sounds heard in the left lower chest
A ruptured diaphragm is a potentially life-threatening injury. The patient will most
likely have decreased breath sounds on the affected side along with pain, which may
radiate to the left shoulder. However, these signs do not specifically implicate an
injury to the diaphragm. Auscultation of bowel sounds in the chest indicates that
abdominal contents have herniated up into the chest through a defect in the
diaphragm.
*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. Acute lung injury
B. Fat embolism
