TNCC 9th Edition TNP latest 2024-2025
What is the key to a high performing trauma team? - anseffective communication
rationale: skilled communication, cooperation, and coordination are the cornerstones of high-performance
teams and high-quality trauma care
When obtaining a history for an injured patient, understanding the kinematic concepts associated with the
mechanism of injury and energy transfer can initially assist the trauma provider in: - ansevaluating and
anticipating the types of injuries that may be present
rationale: mechanism of injury and energy transfer can assist the provider in evaluating and anticipating
damage
the major preventable cause of death in the trauma patient is: - ansuncontrolled hemorrhage
rationale: uncontrolled hemorrhage is the major cause of preventable death after injury, so assessment to
identify uncontrolled hemorrhage is key to the initial assessment process
the across-the-room observation step in the initial assessment provides the opportunity to - ansreprioritize
circulation before airway or breathing
rationale: the across-the-room observation is done at the beginning of the primary survey to rapidly
assess the need to reprioritize circulation before airway or breathing. This is done if uncontrolled external
hemorrhage is identified.
Which of the following accurately describes ventilation prinicples associated with a bag-mask device? -
ansventilate at a rate of 10-12 breaths/minute
rationale: if ventilation is ineffective, assist ventilation at 10-12 breaths/minute or one every 5-6 seconds
Which of the following is the best measure of the adequacy of cellular perfusion and helps to predict the
outcome of resuscitation? - ansbase deficit
rationale: base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and
when used in conjunction with serum lactate helps predict the success of resuciation
What is the safe pharmacological alternative to opioids for rib fracture pain management in the
anticoagulated patient? - ansintercostal nerve blocks
rationale: continuous intercostal nerve blocks use long-acting anesthetics and can provide safe and
effective pain management for the anticoagulated patient.
In a patient with severe traumatic brain injury, hypocapnia causes: - anscerebral vasoconstriction
rationale: hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the
cerebra; vasculature
A patient with a knife injury to the neck has an intact airway and is hemodynamically stable. He complains
of difficulty swallowing and speaking. Further assessment is indicated next for which of the following? -
ansdamage to spinal cord
rationale: penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular
neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is
to the spinal cord
,TNCC 9th Edition TNP latest 2024-2025
What is the appropriate technique for palpating the pelvis for stability? - ansapply gentle pressure over
the iliac downward and medially
rationale: to assess for pelvic instability, gentle pressure is applied over the iliac crests downward and
medially
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? - ansmaintain 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
Based on proper bleeding control techniques, what is the first step to stop the bleeding of a penetrating
injury to the lower extremity? - ansinitiate direct pressure
rationale: the first step in controlling any bleeding is direct pressure. if that is not adequate, the application
of a tourniquet may be needed
treatment for frostbite includes: - ansadminister tissue plasminogen activator
rationale: with frostbite, thrombus formation is a risk. tissue plasminogen or nonsteroidal anti-inflammatory
medication can be administered. The tissue plasminogen activator has been effective in maintaining
perfusion and decreasing the need for amputation when administered within 24 hours of rewarming
A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg and a heart
rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the
patient's hemodynamic findings as an indication of which of the following? - ansnormal vital signs in
pregnancy
rationale: in pregnancy, the resting heart rate increases by 10 to 20 bpm and a small decrease in systolic
blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral
resistance. Normal fetal rate is between 120 and 160 bpm
While performing an assessment on a 13-month old involved in a motor vehicle collision, the nurse
identifies which of the following findings from the patient as a potential sign of mental status change? -
anscooperation with the assessment
rationale: an alert older infant or toddler will recognize his or her caregiver, be cautious of strangers, and
may not respond to commands, which is a normal response
What is the best position for maintaining an open airway in the bariatric patient? - ansreverse
trendelenburg
rationale: the reverse trendelenburg position will benefit both airway maintenance and work of breathing
in the bariatric patient.
The nurse is obtaining for a patient who presents following sexual assault. The history is completed using
which of the following techniques? - ansuse direct quotes to record information
rationale: history includes a detailed description of the incident that is objective, using direct quotes
A trauma nurse cared for a child with devasting burns 2 weeks ago. She called in sick for a couple of
days and is now back working on the team. Which of the following behaviors would indicate this nurse is
coping well? - ansshe is talking about taking the emergency nursing certification examination
,TNCC 9th Edition TNP latest 2024-2025
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?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment - ANSGlobe rupture
A 5-year-old child presents to the emergency department with bruises to the upper arms and buttocks in
various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities
found based on the pediatric assessment triangle or primary survey. Which of the following is the priority
nursing intervention?
A.Report your suspicion of maltreatment in accordance with local regulations
B.Apply ice to the bruises and provide wound care
C.Engage in therapeutic communicati - ANSA.Report your suspicion of maltreatment in accordance with
local regulations
A driver involved in a high-speed motor vehicle collision arrives in the emergency department. The
vehicle's air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain with
ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of
uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. Which of the following
is the most appropriate intervention for this patient?
A.Rapid fluid boluses
B.Tranexamic acid - ANSC.Inotropic support
A nurse verbalizes guilt and remorse after caring for multiple severely injured patients during a staffing
crisis. The nurse expresses anger stating that the patients did not receive quality care and begins
exhibiting aggression toward colleagues. This is most consistent with which condition?
A.Compassion fatigue
B.Vicarious trauma
C.Secondary traumatic stress
D.Moral injury - ANSD.Moral injury
A patient arrives following prolonged exposure of their left hand to the cold. The patient is awake and alert
and complains of a tingling sensation to the fingers. Assessment reveals swelling and bright red skin to
the left hand and a 1-inch round clear blister to the dorsum of that hand. Which of the following nursing
interventions is most appropriate for this patient?
A.Massage the injured areas to promote circulation
B.Drain and debride the blister on the hand
C.Immerse in water between 37.5 - ANSD.Gently rewarm over 15 to 30 minutes
A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which
intervention is most appropriate for this patient?
A.Remove the rod immediately to facilitate cleansing.
B.Apply a tourniquet to the leg above the metal rod.
C.Hold antibiotics until after the rod is removed.
D.Prepare the patient for surgery to remove the rod. - ANSD.Prepare the patient for surgery to remove
the rod.
A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital
providers placed a nonporous dressing over the chest wound and taped it on three sides. The patient is
, TNCC 9th Edition TNP latest 2024-2025
now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood
pressure. Which of the following is the MOST appropriate immediate intervention?
A.Needle decompression
B.Tube thoracostomy
C.Dressing removal
D.Surgical repair - ANSC.Dressing removal
A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate
sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area - ANSVoluntary anal sphincter tone
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 co - ANSfat
embolism
A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority
intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding - ANSC.Apply direct pressure to the wound
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?
A.Severe left-sided abdominal pain
B.Bowel sounds heard in the left lower chest
C.Pain radiating to the left shoulder.
D.Decreased breath sounds on the left side - ANSBowel sounds heard in the left lower chest
A patient is brought to the emergency department following a snowmobile crash with prolonged exposure
time prior to transport. The patient is confused. Vital signs are BP 96/54 mm Hg, HR 114 beats/minute,
RR 24 breaths/minute, T 34.6oC (94.2oF) and an SpO2 of 90% on oxygen at 15L per non-rebreather
mask. Other findings include ETCO2 24, serum lactate of 6 mmol/L, and a pH of 6.8. Based on these
findings, what is the most appropriate intervention?
A.Initiate warming measures
B.Titrate oxygen to - ANSA.Initiate warming measures
A patient is brought to the emergency department with chest pain and shortness of breath following a
high-speed motor vehicle collision in which they were the unrestrained driver. There is crepitus to the left
chest with clear and equal breath sounds. The vital signs are BP 80/40 mmHg, HR 140 beats/minute, and
RR 40 breaths/minute. Cardiac monitor shows sinus tachycardia with premature ventricular contractions.
These findings are most consistent with which type of shock?
A.Cardiogenic
What is the key to a high performing trauma team? - anseffective communication
rationale: skilled communication, cooperation, and coordination are the cornerstones of high-performance
teams and high-quality trauma care
When obtaining a history for an injured patient, understanding the kinematic concepts associated with the
mechanism of injury and energy transfer can initially assist the trauma provider in: - ansevaluating and
anticipating the types of injuries that may be present
rationale: mechanism of injury and energy transfer can assist the provider in evaluating and anticipating
damage
the major preventable cause of death in the trauma patient is: - ansuncontrolled hemorrhage
rationale: uncontrolled hemorrhage is the major cause of preventable death after injury, so assessment to
identify uncontrolled hemorrhage is key to the initial assessment process
the across-the-room observation step in the initial assessment provides the opportunity to - ansreprioritize
circulation before airway or breathing
rationale: the across-the-room observation is done at the beginning of the primary survey to rapidly
assess the need to reprioritize circulation before airway or breathing. This is done if uncontrolled external
hemorrhage is identified.
Which of the following accurately describes ventilation prinicples associated with a bag-mask device? -
ansventilate at a rate of 10-12 breaths/minute
rationale: if ventilation is ineffective, assist ventilation at 10-12 breaths/minute or one every 5-6 seconds
Which of the following is the best measure of the adequacy of cellular perfusion and helps to predict the
outcome of resuscitation? - ansbase deficit
rationale: base deficit serves as an endpoint measurement of the adequacy of cellular perfusion and
when used in conjunction with serum lactate helps predict the success of resuciation
What is the safe pharmacological alternative to opioids for rib fracture pain management in the
anticoagulated patient? - ansintercostal nerve blocks
rationale: continuous intercostal nerve blocks use long-acting anesthetics and can provide safe and
effective pain management for the anticoagulated patient.
In a patient with severe traumatic brain injury, hypocapnia causes: - anscerebral vasoconstriction
rationale: hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the
cerebra; vasculature
A patient with a knife injury to the neck has an intact airway and is hemodynamically stable. He complains
of difficulty swallowing and speaking. Further assessment is indicated next for which of the following? -
ansdamage to spinal cord
rationale: penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular
neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is
to the spinal cord
,TNCC 9th Edition TNP latest 2024-2025
What is the appropriate technique for palpating the pelvis for stability? - ansapply gentle pressure over
the iliac downward and medially
rationale: to assess for pelvic instability, gentle pressure is applied over the iliac crests downward and
medially
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? - ansmaintain 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
Based on proper bleeding control techniques, what is the first step to stop the bleeding of a penetrating
injury to the lower extremity? - ansinitiate direct pressure
rationale: the first step in controlling any bleeding is direct pressure. if that is not adequate, the application
of a tourniquet may be needed
treatment for frostbite includes: - ansadminister tissue plasminogen activator
rationale: with frostbite, thrombus formation is a risk. tissue plasminogen or nonsteroidal anti-inflammatory
medication can be administered. The tissue plasminogen activator has been effective in maintaining
perfusion and decreasing the need for amputation when administered within 24 hours of rewarming
A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg and a heart
rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the
patient's hemodynamic findings as an indication of which of the following? - ansnormal vital signs in
pregnancy
rationale: in pregnancy, the resting heart rate increases by 10 to 20 bpm and a small decrease in systolic
blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral
resistance. Normal fetal rate is between 120 and 160 bpm
While performing an assessment on a 13-month old involved in a motor vehicle collision, the nurse
identifies which of the following findings from the patient as a potential sign of mental status change? -
anscooperation with the assessment
rationale: an alert older infant or toddler will recognize his or her caregiver, be cautious of strangers, and
may not respond to commands, which is a normal response
What is the best position for maintaining an open airway in the bariatric patient? - ansreverse
trendelenburg
rationale: the reverse trendelenburg position will benefit both airway maintenance and work of breathing
in the bariatric patient.
The nurse is obtaining for a patient who presents following sexual assault. The history is completed using
which of the following techniques? - ansuse direct quotes to record information
rationale: history includes a detailed description of the incident that is objective, using direct quotes
A trauma nurse cared for a child with devasting burns 2 weeks ago. She called in sick for a couple of
days and is now back working on the team. Which of the following behaviors would indicate this nurse is
coping well? - ansshe is talking about taking the emergency nursing certification examination
,TNCC 9th Edition TNP latest 2024-2025
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?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment - ANSGlobe rupture
A 5-year-old child presents to the emergency department with bruises to the upper arms and buttocks in
various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities
found based on the pediatric assessment triangle or primary survey. Which of the following is the priority
nursing intervention?
A.Report your suspicion of maltreatment in accordance with local regulations
B.Apply ice to the bruises and provide wound care
C.Engage in therapeutic communicati - ANSA.Report your suspicion of maltreatment in accordance with
local regulations
A driver involved in a high-speed motor vehicle collision arrives in the emergency department. The
vehicle's air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain with
ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of
uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. Which of the following
is the most appropriate intervention for this patient?
A.Rapid fluid boluses
B.Tranexamic acid - ANSC.Inotropic support
A nurse verbalizes guilt and remorse after caring for multiple severely injured patients during a staffing
crisis. The nurse expresses anger stating that the patients did not receive quality care and begins
exhibiting aggression toward colleagues. This is most consistent with which condition?
A.Compassion fatigue
B.Vicarious trauma
C.Secondary traumatic stress
D.Moral injury - ANSD.Moral injury
A patient arrives following prolonged exposure of their left hand to the cold. The patient is awake and alert
and complains of a tingling sensation to the fingers. Assessment reveals swelling and bright red skin to
the left hand and a 1-inch round clear blister to the dorsum of that hand. Which of the following nursing
interventions is most appropriate for this patient?
A.Massage the injured areas to promote circulation
B.Drain and debride the blister on the hand
C.Immerse in water between 37.5 - ANSD.Gently rewarm over 15 to 30 minutes
A patient arrives with a large metal rod embedded in their left thigh and no active bleeding. Which
intervention is most appropriate for this patient?
A.Remove the rod immediately to facilitate cleansing.
B.Apply a tourniquet to the leg above the metal rod.
C.Hold antibiotics until after the rod is removed.
D.Prepare the patient for surgery to remove the rod. - ANSD.Prepare the patient for surgery to remove
the rod.
A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital
providers placed a nonporous dressing over the chest wound and taped it on three sides. The patient is
, TNCC 9th Edition TNP latest 2024-2025
now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis, and decreasing blood
pressure. Which of the following is the MOST appropriate immediate intervention?
A.Needle decompression
B.Tube thoracostomy
C.Dressing removal
D.Surgical repair - ANSC.Dressing removal
A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate
sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area - ANSVoluntary anal sphincter tone
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 co - ANSfat
embolism
A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority
intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding - ANSC.Apply direct pressure to the wound
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?
A.Severe left-sided abdominal pain
B.Bowel sounds heard in the left lower chest
C.Pain radiating to the left shoulder.
D.Decreased breath sounds on the left side - ANSBowel sounds heard in the left lower chest
A patient is brought to the emergency department following a snowmobile crash with prolonged exposure
time prior to transport. The patient is confused. Vital signs are BP 96/54 mm Hg, HR 114 beats/minute,
RR 24 breaths/minute, T 34.6oC (94.2oF) and an SpO2 of 90% on oxygen at 15L per non-rebreather
mask. Other findings include ETCO2 24, serum lactate of 6 mmol/L, and a pH of 6.8. Based on these
findings, what is the most appropriate intervention?
A.Initiate warming measures
B.Titrate oxygen to - ANSA.Initiate warming measures
A patient is brought to the emergency department with chest pain and shortness of breath following a
high-speed motor vehicle collision in which they were the unrestrained driver. There is crepitus to the left
chest with clear and equal breath sounds. The vital signs are BP 80/40 mmHg, HR 140 beats/minute, and
RR 40 breaths/minute. Cardiac monitor shows sinus tachycardia with premature ventricular contractions.
These findings are most consistent with which type of shock?
A.Cardiogenic
