TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
A a 22 yr old was struck by a vehicle while crossing the street, sustaining
multiple fx she is alert and answering qestions and crying what is the best
method for initial pain assessment for this pt - ANSself report scale
A a pt sustrained a penetrating injury of his upper leg. the pre hospital
personnel states a large amount of blood loss before hemostasiswas
achieved. he presents to the ER responding to painful stimuli with moaning.
he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated
A an unrestrained driver was involved in a frontal collision without airbag
deployment. he is hypotensive and tachycardic with shallow respirations,
distended JVD and muffled heart tones the nurse prepare for what -
ANSpericardiocentesis
A during assessment of an extremety with suspected pulses are - ANScan be
normal
A for a ptwho has undergone recent bariatric surgery, flouroscopy is
recommended to place - ANSNG tube
A identification of vulnerabilities is an example of what phase of disaster
management - ANSmitigation
A in mass casualty "doing the greatest good for the greatest number of
people refers to a situation where - ANSthere may be more patients than
resources
A in neurogenic shock, alterations in vital signs include hypotension and
which other abnormal VS - ANSbradycardia
A In the primary survey AVPU is performed to determine if the patient can: -
ANSProtect their aiway
A prego trauma pt develops tachy, hypotension, a rigide board like uterus,
and dark, red vaginal bleeding. she reports constant back pain which is
increasing. the most likely cause of s/s is - ANSplacental abruption
A several groups of people are at higher risk for maltreatment including
children, elderly, prego, and ... - ANSpt's with disability
A the nurse is preparing to cleanse an extensive abrasion contaminated with
dirt and gravel. which of the following intervention is indicated - ANSus
copious amounts of NS
A The systemic inflammatory response is a normal part of the body's
response to shock from traumatic injury. what best describes this response -
ANSit is activated by tissue hypoxia and sends neutrophils to injury site
A what is an early assessment finding to increased ICP in pt with a brain
injury - ANSvomiting
,TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
A when providing care for the pedicatric pt with burns the post resuscitation
care, how are fluids delivered - ANSparkland formula with maintainence
fluidss
A which of hte following nursing interventions would be best for traumitc
- ANSHOB 30 degrees
A which of the following structures would be hte most affected by teh
concept of caviation - ANSLiver
A which of the following values is within the acceptable limits for trauma pt -
ANSend tidal CO2 of 40
B a pt father arrives in teh ER and needs to be told his son was severely
injured in a MVC and is in surgery, the father si agitated, yelling, and smells
of alcohol. in planning to talk with the father the trauma nurse will -
ANSdeliver information regarding the son;s care in a calm voice
B a pt involved in an MVC develops asymmetric pupillary reactivity,
bilateral pupillary dilation and abnormal motor posturing. what does the
nurse suspect as the most likely cause - ANSherniation syndrome
B a pt with injury to the middle meningeal artery is at risk for which of the
following - ANSepidural hematoma
B an occlusive dressing has been applied to a pt with a penetrating injury to
the chest. upon assessment the nurse notes that the patient is in respiratory
distress nad has absnet breath sounds on hte affected side. what is the
priroruty intervention - ANSremove the dressing to the wound
B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he
denies any pain and numbness and tinlging. according to NEXUS critera
which factors indicate need for radiological - ANSsuspected alcohol abuse
B pt to ER after being pinned to brick retaining wall. knwoing crushing
injuries can result to significant damage to muslces the priority asessment
for trauma nruse is for - ANSmyoglobinemia nd renal failure
B the most common cause of shock in the trauma pt is - ANSloss of circ
volume
B the unrestrained fron seat passenger in a MVC develops echymosis around
umbillicus. this assessment finding is most commonly associated with: -
ANSbleeding in the peritoneal cavity
B thinning skin and diminished autonomic response in older adult can have
what effect on primary assessment - ANScompromised thermoregulation
,TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
B when assessing a pt following a MVC the nurses asks how fsat the car was
going - ANSwhen volocity is doubled speed is quadroupled
B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin
B which of hte following significant assessment findigns is frequently found
in a patient with complete cransiofacial separation involving the maxilla,
zygoma, orbits, and bones of the cranial base. - ANSdiplopia
B which of the following hemodynamic support strategies is the prioririty
intervention for a pt with traumatic pulmonary contusion - ANSjudicios use
of IV fluids
Bduring the primary survery which of the following has the greatest priority
- ANScervical spine injury
C 32 wk pregnant lady arrives in er after trapped in a car that flipped. the
initial assessment reveals s/s of shock, vaginal bleeding, a palpable
asymmetrical uterus, and slowing fetal heart tones what is the most likely
cause - ANSuterine rupture
C a college student presents to the er stating afterarriving at a party , she
awoke in a dorm rom. she didnt recognize with no memory of the previous
evening the trauma nurse prepare for what exam. - ANSsexual assult
C an adult pt involved in a brush fire arrives to the er. upon initial
assessment in the er the most concerning finding is - ANShoarse voice and
repeatedly decides to clear throat.
C an older adult pt fell in the bathtub 3 days ago. now she is exihibiting
decreasd LOC and difficulty with speaking and walking. which of the
following injuries is most effective
- ANSsubdural hematoma
C effective pain management in hte pt iwth rib fxwill promote what -
ANScough with ability to clear secretions
C properly restrained 6 wk old kid was involved in a MVC. after the
assessment and stabilization the pt becomes more difficult to rouse.
responding with a weak cry to painful stimuli. the pupils remain brisk and
reactive. the anterior fontanel is soft and flat. what is the most likely cause
and pririty interventions - ANShypoglycemia
C What are the primary benefits of a team approach to trauma care - ANSit
provides a systemic approach to care and organizes care
C what organ might be injured in left lower rib fx - ANSspleen
, TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
C which of the following would be priority intervention for a pt with multiple
rib fractures and chest wall instability follwoing a mvc collision - ANSassist
with endotracheal intubation
C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic
fx
Cthe term worried well when refering to disaster preparedness planning
refers to: - ANSindividuals hwo think they have been affected by the event
but are asymptomatic
Cthe trauma nurse would prepare for a definitive airwya for which of the
following condition. - ANSGCS of 8 or ls
D An unrestrained driver is brought into the emergency department
following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is
the potential injury - ANSLumbar fx
D elevated comaprtment pressure can be the result of - ANShemorrhage from
within the muscle
D pt with amputation of an index finger with a knife. amputaiton is brought
in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic
bag. the next step amputation care is - ANSplace the bag on ice
D restrained driver is involved in a severe head on MVC and presnts with a
seatbelt mark along the neck and upper chest area. bilateral decreased
breath sounds, hemoptysis and diffuse sub q emphysemato the neck and
upper chest area - ANStracheobronchial injury
D which of the following diagnostic intervention is most appropriate for the
unstable pt with a suspectedinternal hemorrhage - ANSfocused
assessment with sonography for trauma
D which physiological change in airway of an odler adult pt places the pt at
risk for difficult intubation - ANScervical arthritisA a 22 yr old was struck by a
vehicle while crossing the street, sustaining multiple fx she is alert and
answering qestions and crying what is the best method for initial pain
assessment for this pt - ANSself report scale
A a pt sustrained a penetrating injury of his upper leg. the pre hospital
personnel states a large amount of blood loss before hemostasiswas
achieved. he presents to the ER responding to painful stimuli with moaning.
he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated
A an unrestrained driver was involved in a frontal collision without airbag
deployment. he is hypotensive and tachycardic with shallow respirations,
distended JVD and muffled heart tones the nurse prepare for what -
ANSpericardiocentesis
A a 22 yr old was struck by a vehicle while crossing the street, sustaining
multiple fx she is alert and answering qestions and crying what is the best
method for initial pain assessment for this pt - ANSself report scale
A a pt sustrained a penetrating injury of his upper leg. the pre hospital
personnel states a large amount of blood loss before hemostasiswas
achieved. he presents to the ER responding to painful stimuli with moaning.
he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated
A an unrestrained driver was involved in a frontal collision without airbag
deployment. he is hypotensive and tachycardic with shallow respirations,
distended JVD and muffled heart tones the nurse prepare for what -
ANSpericardiocentesis
A during assessment of an extremety with suspected pulses are - ANScan be
normal
A for a ptwho has undergone recent bariatric surgery, flouroscopy is
recommended to place - ANSNG tube
A identification of vulnerabilities is an example of what phase of disaster
management - ANSmitigation
A in mass casualty "doing the greatest good for the greatest number of
people refers to a situation where - ANSthere may be more patients than
resources
A in neurogenic shock, alterations in vital signs include hypotension and
which other abnormal VS - ANSbradycardia
A In the primary survey AVPU is performed to determine if the patient can: -
ANSProtect their aiway
A prego trauma pt develops tachy, hypotension, a rigide board like uterus,
and dark, red vaginal bleeding. she reports constant back pain which is
increasing. the most likely cause of s/s is - ANSplacental abruption
A several groups of people are at higher risk for maltreatment including
children, elderly, prego, and ... - ANSpt's with disability
A the nurse is preparing to cleanse an extensive abrasion contaminated with
dirt and gravel. which of the following intervention is indicated - ANSus
copious amounts of NS
A The systemic inflammatory response is a normal part of the body's
response to shock from traumatic injury. what best describes this response -
ANSit is activated by tissue hypoxia and sends neutrophils to injury site
A what is an early assessment finding to increased ICP in pt with a brain
injury - ANSvomiting
,TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
A when providing care for the pedicatric pt with burns the post resuscitation
care, how are fluids delivered - ANSparkland formula with maintainence
fluidss
A which of hte following nursing interventions would be best for traumitc
- ANSHOB 30 degrees
A which of the following structures would be hte most affected by teh
concept of caviation - ANSLiver
A which of the following values is within the acceptable limits for trauma pt -
ANSend tidal CO2 of 40
B a pt father arrives in teh ER and needs to be told his son was severely
injured in a MVC and is in surgery, the father si agitated, yelling, and smells
of alcohol. in planning to talk with the father the trauma nurse will -
ANSdeliver information regarding the son;s care in a calm voice
B a pt involved in an MVC develops asymmetric pupillary reactivity,
bilateral pupillary dilation and abnormal motor posturing. what does the
nurse suspect as the most likely cause - ANSherniation syndrome
B a pt with injury to the middle meningeal artery is at risk for which of the
following - ANSepidural hematoma
B an occlusive dressing has been applied to a pt with a penetrating injury to
the chest. upon assessment the nurse notes that the patient is in respiratory
distress nad has absnet breath sounds on hte affected side. what is the
priroruty intervention - ANSremove the dressing to the wound
B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he
denies any pain and numbness and tinlging. according to NEXUS critera
which factors indicate need for radiological - ANSsuspected alcohol abuse
B pt to ER after being pinned to brick retaining wall. knwoing crushing
injuries can result to significant damage to muslces the priority asessment
for trauma nruse is for - ANSmyoglobinemia nd renal failure
B the most common cause of shock in the trauma pt is - ANSloss of circ
volume
B the unrestrained fron seat passenger in a MVC develops echymosis around
umbillicus. this assessment finding is most commonly associated with: -
ANSbleeding in the peritoneal cavity
B thinning skin and diminished autonomic response in older adult can have
what effect on primary assessment - ANScompromised thermoregulation
,TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
B when assessing a pt following a MVC the nurses asks how fsat the car was
going - ANSwhen volocity is doubled speed is quadroupled
B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin
B which of hte following significant assessment findigns is frequently found
in a patient with complete cransiofacial separation involving the maxilla,
zygoma, orbits, and bones of the cranial base. - ANSdiplopia
B which of the following hemodynamic support strategies is the prioririty
intervention for a pt with traumatic pulmonary contusion - ANSjudicios use
of IV fluids
Bduring the primary survery which of the following has the greatest priority
- ANScervical spine injury
C 32 wk pregnant lady arrives in er after trapped in a car that flipped. the
initial assessment reveals s/s of shock, vaginal bleeding, a palpable
asymmetrical uterus, and slowing fetal heart tones what is the most likely
cause - ANSuterine rupture
C a college student presents to the er stating afterarriving at a party , she
awoke in a dorm rom. she didnt recognize with no memory of the previous
evening the trauma nurse prepare for what exam. - ANSsexual assult
C an adult pt involved in a brush fire arrives to the er. upon initial
assessment in the er the most concerning finding is - ANShoarse voice and
repeatedly decides to clear throat.
C an older adult pt fell in the bathtub 3 days ago. now she is exihibiting
decreasd LOC and difficulty with speaking and walking. which of the
following injuries is most effective
- ANSsubdural hematoma
C effective pain management in hte pt iwth rib fxwill promote what -
ANScough with ability to clear secretions
C properly restrained 6 wk old kid was involved in a MVC. after the
assessment and stabilization the pt becomes more difficult to rouse.
responding with a weak cry to painful stimuli. the pupils remain brisk and
reactive. the anterior fontanel is soft and flat. what is the most likely cause
and pririty interventions - ANShypoglycemia
C What are the primary benefits of a team approach to trauma care - ANSit
provides a systemic approach to care and organizes care
C what organ might be injured in left lower rib fx - ANSspleen
, TNCC FINAL EXAM 7 LATEST VERSIONS |100% COMPLETE PASS
C which of the following would be priority intervention for a pt with multiple
rib fractures and chest wall instability follwoing a mvc collision - ANSassist
with endotracheal intubation
C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic
fx
Cthe term worried well when refering to disaster preparedness planning
refers to: - ANSindividuals hwo think they have been affected by the event
but are asymptomatic
Cthe trauma nurse would prepare for a definitive airwya for which of the
following condition. - ANSGCS of 8 or ls
D An unrestrained driver is brought into the emergency department
following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is
the potential injury - ANSLumbar fx
D elevated comaprtment pressure can be the result of - ANShemorrhage from
within the muscle
D pt with amputation of an index finger with a knife. amputaiton is brought
in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic
bag. the next step amputation care is - ANSplace the bag on ice
D restrained driver is involved in a severe head on MVC and presnts with a
seatbelt mark along the neck and upper chest area. bilateral decreased
breath sounds, hemoptysis and diffuse sub q emphysemato the neck and
upper chest area - ANStracheobronchial injury
D which of the following diagnostic intervention is most appropriate for the
unstable pt with a suspectedinternal hemorrhage - ANSfocused
assessment with sonography for trauma
D which physiological change in airway of an odler adult pt places the pt at
risk for difficult intubation - ANScervical arthritisA a 22 yr old was struck by a
vehicle while crossing the street, sustaining multiple fx she is alert and
answering qestions and crying what is the best method for initial pain
assessment for this pt - ANSself report scale
A a pt sustrained a penetrating injury of his upper leg. the pre hospital
personnel states a large amount of blood loss before hemostasiswas
achieved. he presents to the ER responding to painful stimuli with moaning.
he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated
A an unrestrained driver was involved in a frontal collision without airbag
deployment. he is hypotensive and tachycardic with shallow respirations,
distended JVD and muffled heart tones the nurse prepare for what -
ANSpericardiocentesis
