TNCC 9th EDITION FINAL
TEST WITH 100%
ACCURATE ANSWERS AND
RATIONALE.
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
2. Which of the following situations could cause functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of one's self-image
D. Destruction of the patient's car - Correct Answer-B. Amputation of a limb
Rationale: Preparation and Ongoing Care\Psychosocial Aspects
Functional grief relates to the loss of body function or body parts such as amputation of a limb,
paralysis, or loss of sight.
3. What is the most important consideration during the initial assessment when caring for an older
adult who has sustained serious injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician - Correct Answer-B. Medical history including current
medications
4. You are caring for a patient who was thrown from a bike and was not wearing a helmet. While
performing the head-to-toe assessment, you note clear drainage from the right ear. Which of the
following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
, D. Document and continue the exam. - Correct Answer-C. Notify the physician
5. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a
patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment - Correct Answer-B. After removal of clothing
Rationale: Musculoskeletal and Wounds\Burns
Some fluid will be given initially, but an accurate fluid total is based on percentage of total body
surface area which requires a good skin assessment and is calculated after clothing is removed.
6. In a motor vehicle collision, which injury pathway is most likely to increase the patient's morbidity
and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover - Correct Answer-B. Ejection
7. 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
Rationale: Musculoskeletal and Wounds\Musculoskeletal
This patient is exhibiting signs of possible compartment syndrome which is a dangerous complication
of fractured extremities. The pain is often out of proportion to the injury and might not respond to
pain medications. Elevate the limb to the level of the heart to decrease dependent edema but not
above the heart, which can cause increased venous congestion and pressure within the
compartment.
8. A teenaged patient presents to the emergency department with left arm pain after a ground level
fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned
the patient is experiencing human trafficking. What is most consistent with human trafficking?
A. The individual appears well nourished.
B. Those who are being trafficked rarely seek medical care.
C. It is infrequently associated with substance abuse.
D. Those experiencing human trafficking rarely self-disclose. - Correct Answer-D. Those experiencing
human trafficking rarely self-disclose.
9. An intubated trauma patient has just been transported back from CT scan. Upon arrival to their
room in the emergency department, resistance is noted with bag-mask ventilations and auscultation
reveals unequal breath sounds. What is the most appropriate initial intervention for this patient?
A. Place the patient back on the ventilator.
TEST WITH 100%
ACCURATE ANSWERS AND
RATIONALE.
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
2. Which of the following situations could cause functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of one's self-image
D. Destruction of the patient's car - Correct Answer-B. Amputation of a limb
Rationale: Preparation and Ongoing Care\Psychosocial Aspects
Functional grief relates to the loss of body function or body parts such as amputation of a limb,
paralysis, or loss of sight.
3. What is the most important consideration during the initial assessment when caring for an older
adult who has sustained serious injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician - Correct Answer-B. Medical history including current
medications
4. You are caring for a patient who was thrown from a bike and was not wearing a helmet. While
performing the head-to-toe assessment, you note clear drainage from the right ear. Which of the
following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
, D. Document and continue the exam. - Correct Answer-C. Notify the physician
5. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a
patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment - Correct Answer-B. After removal of clothing
Rationale: Musculoskeletal and Wounds\Burns
Some fluid will be given initially, but an accurate fluid total is based on percentage of total body
surface area which requires a good skin assessment and is calculated after clothing is removed.
6. In a motor vehicle collision, which injury pathway is most likely to increase the patient's morbidity
and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover - Correct Answer-B. Ejection
7. 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
Rationale: Musculoskeletal and Wounds\Musculoskeletal
This patient is exhibiting signs of possible compartment syndrome which is a dangerous complication
of fractured extremities. The pain is often out of proportion to the injury and might not respond to
pain medications. Elevate the limb to the level of the heart to decrease dependent edema but not
above the heart, which can cause increased venous congestion and pressure within the
compartment.
8. A teenaged patient presents to the emergency department with left arm pain after a ground level
fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned
the patient is experiencing human trafficking. What is most consistent with human trafficking?
A. The individual appears well nourished.
B. Those who are being trafficked rarely seek medical care.
C. It is infrequently associated with substance abuse.
D. Those experiencing human trafficking rarely self-disclose. - Correct Answer-D. Those experiencing
human trafficking rarely self-disclose.
9. An intubated trauma patient has just been transported back from CT scan. Upon arrival to their
room in the emergency department, resistance is noted with bag-mask ventilations and auscultation
reveals unequal breath sounds. What is the most appropriate initial intervention for this patient?
A. Place the patient back on the ventilator.
