TNCC TEST PREP, TNCC NOTES FOR
WRITTEN EXAM, TNCC 8TH EDITION
QUESTIONS AND ANSWERS
it can worsen cord damage from an unstable spinal injury - Answer-Which of the
following is true about the log-roll?
defusings - Answer-All of these are considered a critical communication point in trauma
care EXCEPT which of the following?
pulse oximetry and capnography - Answer-What bedside monitoring parameters are
used to assess for adequacy of O2 and effectiveness of ventilation?
padding the upper back while stabilizing the cervical spine - Answer-Caregivers carry in
a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying
with increased work of breathing and pale skin. Which of the following interventions has
the highest priority?
bowel - Answer-Which of the following injuries is LEAST likely to be promptly identified?
Initiate transfer to a trauma center - Answer-A pt is brought to the ED of a rural hospital
following a high-speed MVC. When significant abd and pelvic injuries are noted in the
primary survey, which of the following is the priority interventions?
bardycardia and absent motor function below the level of injury - Answer-A pt with a
complete spinal cord injury in neurogenic shock will demonstrate hypotension and which
other clinical signs?
apply splint and elevate above the level of the heart - Answer-a 37 y/o F has a deformity
of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the
following is the most appropriate intervention?
the aorta is torn at its attachment with the ligamentum arteriosum - Answer-which of the
following occurs during the third impact of a motor vehicle crash?
Report your suspicion of maltreatment in accordance with local regulations - Answer-a 5
y/o child presents to the ED with bruises to the upper arm and buttocks in various
stages of healing and multiple small, clean, round burns to the back. There are no
abnormalities found based on the paediatric assessment triangle or primary survey.
,Which of the following is the priority survey. Which of the following is the priority nursing
intervention?
to gauge end-organ perfusion and tissue hypoxia - Answer-Why is a measure of serum
lactate obtained in the initial assessment of a trauma patient?
elevating the extremity to the level of the heart - Answer-A pt with a lower extremity
fracture complains of severe pain and tightness in his calf, minimally by pain
medications. Which of the following is the priority nursing intervention?
velocity - Answer-What factor contributes most to the kinetic energy of a body in
motion?
subdural hematoma - Answer-An elderly patient with a history of anticoagulant use
presents after a fall at home today. She denies any loss of consciousness. She has a
hematoma to her forehead and complains of headache, dizziness, and nausea. What is
the most likely cause of her symptoms?
fat embolism - Answer-a pt has been in the ED for several hrs waiting to be admitted.
He sustained multiple rib fractures and a femur fracture after a fall. He has been awake,
alert, and complaining of leg pain. His wife reported that he suddenly became anxious
and confused. Upon reassessment, the pt is restless with respiratory distress and
petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of
the following conditions?
nausea and vomiting - Answer-Which of the following is a late sign of increased
intracranial pressure?
serial FAST exams - Answer-a 49 y/o restrained driver involved in a MVC presents to
the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are
stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT
which of the following?
pericardiocentesis - Answer-Which of the following is NOT considered goal-directed
therapy for cardiogenic shock?
endotracheal tube - Answer-The trauma nurse knows that placing a bariatric patient in a
ramped position providers better visualization during the insertion of which device?
increased work of breathing? - Answer-which of the following assessment findings
differentiates a tension pneumothorax from a simple pneumothorax?
calcium - Answer-if a pt has received multiple transfusions of banked blood preserved
with citrate, which electrolyte is most likely to drop and require supplementation?
,identifying individuals who made mistakes during the traumatic event - Answer-Which of
the following is NOT considered a benefit of debriefings?
500 mL/hr - Answer-You are treating a 27 y/o M in respiratory distress who was
involved in a house fire. Calculating TBSA burned is deferred due to the need for
emergent intubation. At what rate should you begin fluid resuscitation?
advanced age - Answer-Which of the following is most likely to contribute to inadequate
oxygenation and ventilation?
a 52 y/o diabetic male with a partial thickness burn to the left lower leg - Answer-Which
of the following patients warrants referral to a burn center?
dressing removal - Answer-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. he is now showing signs of anxiety,
restlessness, severe respiratory distress, cyanosis and decreasing blood pressure.
Which of the following is the MOST appropriate immediate intervention?
after a physical examination if the pt has no radiologic abnormalities on CT - Answer-
EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports
significant damage to the drivers side of the car. The pt is asking to have the cervical
collar removed. When it is appropriate to remove the cervical collar?
MARCH - Answer-Which of the following mnemonics can help the nurse prioritize care
for a trauma patient with massive uncontrolled hemorrhage?
What is kinematics? - Answer-A branch of mechanics (energy transfer) that refers to
motion and does not consider the concepts of force and mass of the object or body.
What is Newton's First Law? - Answer-A body at rest will remain at rest. A body in
motion will remain in motion until acted on by an outside force.
What is the Law of Conservation of Energy? - Answer-Energy can neither be created
nor destroyed. It is only changed from one form to another.
What is Newton's Second Law? - Answer-Force equals mass multiplied by acceleration
of deceleration.
What is kinetic energy (KE)? - Answer-KE equals 1/2 the mass (M) multiplied by the
velocity squared.
What is the Mnemonic for the Initial Assessment? - Answer-A = Airway with
simultaneous cervical spine protection
B = Breathing
C = Circulation
, D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment? - Answer-F = Full set of
VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric
tube)/Family presence
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and
nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds? - Answer-Auscultate the lungs
bilaterally at the second intercostal space midclavicular line and at the fifth intercostal
space at the anterior axillary line.
What are the late signs of breathing compromise? - Answer-- Tracheal deviation
- JVD
What are signs of ineffective breathing? - Answer-- AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated
- Anticipate definitive airway management to support ventilation.
Upon initial assessment, what type of oxygen should be used for a pt breathing
effectively? - Answer-A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? - Answer--
Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? - Answer-- Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
What are the interventions for Effective/Ineffective Circulation? - Answer-- Control any
uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
WRITTEN EXAM, TNCC 8TH EDITION
QUESTIONS AND ANSWERS
it can worsen cord damage from an unstable spinal injury - Answer-Which of the
following is true about the log-roll?
defusings - Answer-All of these are considered a critical communication point in trauma
care EXCEPT which of the following?
pulse oximetry and capnography - Answer-What bedside monitoring parameters are
used to assess for adequacy of O2 and effectiveness of ventilation?
padding the upper back while stabilizing the cervical spine - Answer-Caregivers carry in
a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying
with increased work of breathing and pale skin. Which of the following interventions has
the highest priority?
bowel - Answer-Which of the following injuries is LEAST likely to be promptly identified?
Initiate transfer to a trauma center - Answer-A pt is brought to the ED of a rural hospital
following a high-speed MVC. When significant abd and pelvic injuries are noted in the
primary survey, which of the following is the priority interventions?
bardycardia and absent motor function below the level of injury - Answer-A pt with a
complete spinal cord injury in neurogenic shock will demonstrate hypotension and which
other clinical signs?
apply splint and elevate above the level of the heart - Answer-a 37 y/o F has a deformity
of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the
following is the most appropriate intervention?
the aorta is torn at its attachment with the ligamentum arteriosum - Answer-which of the
following occurs during the third impact of a motor vehicle crash?
Report your suspicion of maltreatment in accordance with local regulations - Answer-a 5
y/o child presents to the ED with bruises to the upper arm and buttocks in various
stages of healing and multiple small, clean, round burns to the back. There are no
abnormalities found based on the paediatric assessment triangle or primary survey.
,Which of the following is the priority survey. Which of the following is the priority nursing
intervention?
to gauge end-organ perfusion and tissue hypoxia - Answer-Why is a measure of serum
lactate obtained in the initial assessment of a trauma patient?
elevating the extremity to the level of the heart - Answer-A pt with a lower extremity
fracture complains of severe pain and tightness in his calf, minimally by pain
medications. Which of the following is the priority nursing intervention?
velocity - Answer-What factor contributes most to the kinetic energy of a body in
motion?
subdural hematoma - Answer-An elderly patient with a history of anticoagulant use
presents after a fall at home today. She denies any loss of consciousness. She has a
hematoma to her forehead and complains of headache, dizziness, and nausea. What is
the most likely cause of her symptoms?
fat embolism - Answer-a pt has been in the ED for several hrs waiting to be admitted.
He sustained multiple rib fractures and a femur fracture after a fall. He has been awake,
alert, and complaining of leg pain. His wife reported that he suddenly became anxious
and confused. Upon reassessment, the pt is restless with respiratory distress and
petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of
the following conditions?
nausea and vomiting - Answer-Which of the following is a late sign of increased
intracranial pressure?
serial FAST exams - Answer-a 49 y/o restrained driver involved in a MVC presents to
the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are
stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT
which of the following?
pericardiocentesis - Answer-Which of the following is NOT considered goal-directed
therapy for cardiogenic shock?
endotracheal tube - Answer-The trauma nurse knows that placing a bariatric patient in a
ramped position providers better visualization during the insertion of which device?
increased work of breathing? - Answer-which of the following assessment findings
differentiates a tension pneumothorax from a simple pneumothorax?
calcium - Answer-if a pt has received multiple transfusions of banked blood preserved
with citrate, which electrolyte is most likely to drop and require supplementation?
,identifying individuals who made mistakes during the traumatic event - Answer-Which of
the following is NOT considered a benefit of debriefings?
500 mL/hr - Answer-You are treating a 27 y/o M in respiratory distress who was
involved in a house fire. Calculating TBSA burned is deferred due to the need for
emergent intubation. At what rate should you begin fluid resuscitation?
advanced age - Answer-Which of the following is most likely to contribute to inadequate
oxygenation and ventilation?
a 52 y/o diabetic male with a partial thickness burn to the left lower leg - Answer-Which
of the following patients warrants referral to a burn center?
dressing removal - Answer-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. he is now showing signs of anxiety,
restlessness, severe respiratory distress, cyanosis and decreasing blood pressure.
Which of the following is the MOST appropriate immediate intervention?
after a physical examination if the pt has no radiologic abnormalities on CT - Answer-
EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports
significant damage to the drivers side of the car. The pt is asking to have the cervical
collar removed. When it is appropriate to remove the cervical collar?
MARCH - Answer-Which of the following mnemonics can help the nurse prioritize care
for a trauma patient with massive uncontrolled hemorrhage?
What is kinematics? - Answer-A branch of mechanics (energy transfer) that refers to
motion and does not consider the concepts of force and mass of the object or body.
What is Newton's First Law? - Answer-A body at rest will remain at rest. A body in
motion will remain in motion until acted on by an outside force.
What is the Law of Conservation of Energy? - Answer-Energy can neither be created
nor destroyed. It is only changed from one form to another.
What is Newton's Second Law? - Answer-Force equals mass multiplied by acceleration
of deceleration.
What is kinetic energy (KE)? - Answer-KE equals 1/2 the mass (M) multiplied by the
velocity squared.
What is the Mnemonic for the Initial Assessment? - Answer-A = Airway with
simultaneous cervical spine protection
B = Breathing
C = Circulation
, D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment? - Answer-F = Full set of
VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric
tube)/Family presence
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and
nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds? - Answer-Auscultate the lungs
bilaterally at the second intercostal space midclavicular line and at the fifth intercostal
space at the anterior axillary line.
What are the late signs of breathing compromise? - Answer-- Tracheal deviation
- JVD
What are signs of ineffective breathing? - Answer-- AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated
- Anticipate definitive airway management to support ventilation.
Upon initial assessment, what type of oxygen should be used for a pt breathing
effectively? - Answer-A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? - Answer--
Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? - Answer-- Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
What are the interventions for Effective/Ineffective Circulation? - Answer-- Control any
uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
