TNCC ENA 9th Edition Pre Test
1. A patient arrives at the emergency department by private vehicle after sustaining
an injury to the right lower extremity while using a saw. There is a large gaping
wound to the right thigh area with significant bleeding. What is the priority
intervention?
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 - ------------ANS: B. Initiate
direct pressure
Rationale: The first step inn controlling any bleeding is application of direct pressure.
2. A patient fell two weeks ago, striking their head. Today, the patient presented with
a persistent headache and nausea and was diagnosed with a small subdural
hematoma. The patient has been in the ED for 24 hours awaiting an inpatient bed.
The night shift nurse reports the patient has been anxious, restless, shaky, and
vomited twice during the night. The patient states they couldn't sleep because a
young child kept coming into the room. What is the most likely cause for these signs
and symptoms?
A. Increased intracranial pressure
B. Alcohol withdrawal
C. Rhabdomyolysis
D. Pulmonary embolus - ------------ANS: 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, transient
hallucinations, or seizures.
,3. A patient involved in a MVC has sustained a fracture to the second rib of the
anterior left chest. Which concurrent injury is most commonly associated with this
fracture?
A. Blunt cardiac injury
B. Brachial plexus injury
C. Pneumothorax
D. Hemothorax - ------------ANS: B. Brachial plexus injury
Rationale: First and second rib fractures are most commonly associated with great
vessel, head and spinal cord, and brachial plexus injuries.
4. 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 for this
patient?
A. Maintain adequate respiratory status
B. Administer balanced resuscitation fluid
C. Perform serial assessments of neurologic function
D. Maintain core temperature - ------------ANS: 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. Maintenance of
respiratory function is the highest priority.
, 5. A trauma nurse cared for a child with devastating burns two weeks ago. The nurse
called in sick for a couple of days and is now back working on the team. Which of the
following would indicate this nurse is coping well?
A. They are talking about taking the emergency nursing certification exam
B. They keep requesting to be assigned to the walk-in/ambulatory area
C. They are impatient and snap at their coworkers
D. They are thinking about transferring out of the emergency department -
------------ANS: A. They are talking about taking the emergency nursing certification
exam
Rationale: This is an indication the nurse is taking positive steps to advance their
own practice, a sign of resilience. B indicates the nurse is still not ready to return to
their previous level of engagement in their job. C shows signs of burnout, irritability
and frustration. D shows decreased satisfaction with the job, a sign of burnout.
6. An adult patient with a knife injury to the neck has an intact airway and is
hemodynamically stable. They complain of difficulty swallowing and speaking. In the
primary survey, further assessment is indicated next for which of the following
conditions?
A. Damage to the cervical spine
B. An expanding pneumothorax
C. Laceration of the carotid artery
D. Injury of the thyroid gland - ------------ANS: A. Damage to the cervical spine
Rationale: Penetrating neck trauma may include concurrent injuries to the cervical
spine and cord, airway, or vascular neck structures. With an intact airway and
hemodynamic stability, the other common concurrent injury is to the cervical spine.
1. A patient arrives at the emergency department by private vehicle after sustaining
an injury to the right lower extremity while using a saw. There is a large gaping
wound to the right thigh area with significant bleeding. What is the priority
intervention?
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 - ------------ANS: B. Initiate
direct pressure
Rationale: The first step inn controlling any bleeding is application of direct pressure.
2. A patient fell two weeks ago, striking their head. Today, the patient presented with
a persistent headache and nausea and was diagnosed with a small subdural
hematoma. The patient has been in the ED for 24 hours awaiting an inpatient bed.
The night shift nurse reports the patient has been anxious, restless, shaky, and
vomited twice during the night. The patient states they couldn't sleep because a
young child kept coming into the room. What is the most likely cause for these signs
and symptoms?
A. Increased intracranial pressure
B. Alcohol withdrawal
C. Rhabdomyolysis
D. Pulmonary embolus - ------------ANS: 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, transient
hallucinations, or seizures.
,3. A patient involved in a MVC has sustained a fracture to the second rib of the
anterior left chest. Which concurrent injury is most commonly associated with this
fracture?
A. Blunt cardiac injury
B. Brachial plexus injury
C. Pneumothorax
D. Hemothorax - ------------ANS: B. Brachial plexus injury
Rationale: First and second rib fractures are most commonly associated with great
vessel, head and spinal cord, and brachial plexus injuries.
4. 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 for this
patient?
A. Maintain adequate respiratory status
B. Administer balanced resuscitation fluid
C. Perform serial assessments of neurologic function
D. Maintain core temperature - ------------ANS: 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. Maintenance of
respiratory function is the highest priority.
, 5. A trauma nurse cared for a child with devastating burns two weeks ago. The nurse
called in sick for a couple of days and is now back working on the team. Which of the
following would indicate this nurse is coping well?
A. They are talking about taking the emergency nursing certification exam
B. They keep requesting to be assigned to the walk-in/ambulatory area
C. They are impatient and snap at their coworkers
D. They are thinking about transferring out of the emergency department -
------------ANS: A. They are talking about taking the emergency nursing certification
exam
Rationale: This is an indication the nurse is taking positive steps to advance their
own practice, a sign of resilience. B indicates the nurse is still not ready to return to
their previous level of engagement in their job. C shows signs of burnout, irritability
and frustration. D shows decreased satisfaction with the job, a sign of burnout.
6. An adult patient with a knife injury to the neck has an intact airway and is
hemodynamically stable. They complain of difficulty swallowing and speaking. In the
primary survey, further assessment is indicated next for which of the following
conditions?
A. Damage to the cervical spine
B. An expanding pneumothorax
C. Laceration of the carotid artery
D. Injury of the thyroid gland - ------------ANS: A. Damage to the cervical spine
Rationale: Penetrating neck trauma may include concurrent injuries to the cervical
spine and cord, airway, or vascular neck structures. With an intact airway and
hemodynamic stability, the other common concurrent injury is to the cervical spine.
