TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
3. When securing a patient to a backboard, which body part should you secure first?
A. Head
B. Torso
C. Legs
D. Pelvis - ansQuestion 3: B
When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis.
3. Which of the following is the basis on which a patient's chance of survival is maximized?
A. Preferences
B. Phases
C. Principles
D. Transport - ansQuestion 3: C
The science of medicine provides the principles of medical care. Simply stated, principles define the
duties required of the prehospital care practitioner in optimizing patient survival and outcome.
3. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still
confused, and you still have no radial pulse. Your next move is to:
A. give 1-L fluid bolus.
B. give one 250-mL fluid bolus, and then stop.
C. give fluid until you get a radial pulse.
D. administer TXA. - ansQuestion 3: C
Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your
target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids.
3. Why might it be more difficult to deal with an airway obstruction in a child?
A. Children have longer tracheas.
B. Children have larger heads and tongues so there is a greater potential for airway obstruction.
C. Children have smaller heads, so there is less room to clear the obstruction.
D. A child's epiglottis is smaller and stiffer than an adult's. - ansQuestion 3: B
Children have larger heads and tongues as compared to an adult so there is a greater potential for airway
obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric
patient to maintain a patent airway.
3. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze-release-
release" timing technique. As you watch for the rise and fall of the chest, you check end-tidal CO2
(ETCO2) monitoring aiming to maintain what level?
A. Between 40 and 45 mm Hg
B. Between 30 and 35 mm Hg
C. Between 35 and 40 mm Hg
D. The level is irrelevant because capnography is inaccurate in pediatric patients. - ansQuestion 3: C
The proper level to maintain is between 35 and 40 mm Hg.
3. You are transporting a 37-year-old male patient with a suspected intraabdominal bleed. His blood
pressure is 70/50 mm Hg (MAP 57), and his skin is pale and diaphoretic. How will you manage fluid
resuscitation for this patient?
A. Aggressively administer IV fluids to compensate for internal blood loss.
B. Do not administer IV fluids to patients with intra-abdominal bleeding.
C. Obtain the patient's medical records and resuscitate to his normal blood pressure reading.
,TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
D. Carefully administer IV fluids to raise the patient's systolic blood pressure to between 80 and 90 mm
Hg. - ansQuestion 3: D
Abdominal trauma represents one of the key situations in which a balanced resuscitation is indicated.
Aggressive administration of IV fluid may elevate the patient's blood pressure to levels that will disrupt
any clot that has formed and result in recurrence of bleeding that had ceased because of blood clotting
and hypotension. Prehospital care practitioners must achieve a delicate balance: maintain a blood
pressure that provides perfusion to vital organs without restoring blood pressure to elevated or even
normal ranges, which may reinitiate bleeding sites in the abdomen or pelvis. In the absence of TBI, the
target systolic blood pressure is 80 to 90 mm Hg (mean arterial pressure of 60 to 65 mmHg).
4. After 400 mL of lactated Ringer solution, you get a radial pulse and his level of consciousness improves.
The monitor shows heart rate 110 beats/minute, blood pressure 85/60mm Hg, SpO2 95%, ventilation rate
25 breaths/minute. What should you do?
A. Give an additional 500 mL of lactated Ringer solution.
B. Stop fluids and give 2 g of TXA.
C. Give TXA and 500 mL of normal saline.
D. Give 2 mg of morphine for analgesia. - ansQuestion 4: B
The patient does not need more fluids right now. Giving morphine in a shocked patient is a risky move and
could lead to dangerous hypotension.
4. The patient is wearing long sleeves, and you are having trouble visualizing the wound. What should you
do?
A. Cut the cloth away from the site until the entire wound site is visible.
B. Leave the clothing in place. Put gauze over the wound.
C. Remove the patient's shirt.
D. Cut through the slash on the sleeve, and use the material as a makeshift tourniquet. - ansQuestion 4: A
Clothing can be quickly removed by cutting. You cannot treat what you cannot see.
4. What is one reason to use capnography as part of your patient reassessment?
A. To get accurate readings for blood pressure
B. To assure proper ET tube placement
C. To measure arterial blood saturation
D. To ensure proper placement for needle decompression - ansQuestion 4: B
Capnography can monitor proper endotracheal tube placement. It doesn't read blood pressure, so it
cannot beused to determine if a patient is hypotensive. Pulse oximetry, not capnography, measures
arterial blood saturation. Capnography is not useful in needle decompression.
4. What type of padding should you provide for this patient?
A. Use compressible padding under the shoulders and torso to prevent hyperflexion.
B. Use firm padding between the back of the head and the backboard to prevent hyperextension.
C. Do not use any padding. It can cause extension or flexion in the neck.
D. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral
position. - ansQuestion 4: B
Because the patient is an adult, you should use firm padding between the back of the head and the
backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion,
and you would tip the backboard for a pregnant patient to prevent decreased venous return.
4. When you examine the patient's pupils, you notice the right one is dilated significantly and her motor
response on the left is delayed. What does this suggest?
A. Coup-countercoup injury
B. Hyphema
C. Hypoxia
,TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
D. Uncal herniation - ansQuestion 4: D
When the medial portion of the temporal lobe (uncus) is pushed toward the tentorium and puts pressure on
the brain stem, herniation compresses CN III, the motor tract, and the reticular activating system on the
same side, resulting in a dilated or blown pupil on the same side, motor weakness on the opposite side,
and respiratory dysfunction, progressing to coma.
4. Which of the following is a goal of the Golden Period?
A. Provide written documentation from field care to receiving hospital.
B. Expedite the field care and transport of the patient.
C. Use a team approach for optimal patient care.
D. Use the XABCDE approach to patient assessment. - ansQuestion 4: B
One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time
onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the
time from injuryto arrival at the appropriate site fordefinitive care is critical to survival.
4. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient?
A. Shorter tracheas in geriatric patients create the need for ventilation assistance.
B. Laxity of the rib cage makes hyperventilation more likely.
C. Geriatric patients have greatly limited physiologic reserve.
D. Geriatric patients have a greater alveolar surface area of the lungs. - ansQuestion 4: C
Early mechanical ventilation via bag mask device or advanced airway measures should be considered in
geriatric trauma patients because of their greatly limited physiologic reserve.
5. Which of the following signs would be most concerning at this point?
A. A drop in systolic blood pressure to 88 mm Hg
B. SpO₂ of 93%
C. A field GCS motor score of 4
D. Hemiplegia on the left side - ansQuestion 5: A
A systolic blood pressure of less than 90 mm Hg indicates secondary brain injury. Her SpO2 is > 90%, and
a motor score of 4 is not as concerning.
5. While attempting to lay the patient supine for spinal motion restriction she becomes increasingly
distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to
move distally and increases the difficulty of breathing as the patient lies back. What should you do?
A. Tip the backboard to a left lateral position.
B. Raise the back of the stretcher.
C. Let her sit up in a position of comfort.
D. Administer morphine. - ansQuestion 5: B
Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of
the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues.
5. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral
clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful?
A. No, he should stop talking and breathe.
B. Yes, he should see a cardiologist once in the local hospital.
C. Yes, he will need platelets and a heart surgeon ASAP.
D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ansQuestion 5: C
Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent
platelet transfusion.
, TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
6. According to the Monro-Kellie doctrine, what happens to the brain when it is still in a compensated
state after a TBI?
A. CSF, ICP, heart rate, and blood pressure are still within normal range.
B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases.
C. CSF and blood volume decrease, while heart rate and blood pressure are still within normál range.
D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases. - ansQuestion 6: C
In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still
within normal range.
_________ therapy is now suggested for fluid resuscitation to replace patient losses, including administering
PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY
ch. 5, p. 45
__________, which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic
pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. -
ansHYPERVENTILATION
ch. 7, p. 74
55% of spinal injuries occur to which part of spine? - anscervical
ch. 13, p. 179
A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). -
ansa. HYPOVOLEMIA
b. CARDIAC DYSFUNCTION
ch. 5, p. 45
ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint
measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the
resuscitation.
An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation
of hydrogen ions and metabolic acidosis.
ch. 5, p. 46
Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO
catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE
cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility
(potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral
vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use)
- NOREPINEPHRINE increases heart rate, vascular tone through alpha-adrenergic receptor activation, and
blood flow to skeletal muscle and triggers the release of glucose from energy stores.
ch. 7, p. 77
Additional history includes the following (MIST mnemonic) prehospital report: - ans- MOI
- Injuries sustained
- Signs and Symptoms (in the field)
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
3. When securing a patient to a backboard, which body part should you secure first?
A. Head
B. Torso
C. Legs
D. Pelvis - ansQuestion 3: B
When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis.
3. Which of the following is the basis on which a patient's chance of survival is maximized?
A. Preferences
B. Phases
C. Principles
D. Transport - ansQuestion 3: C
The science of medicine provides the principles of medical care. Simply stated, principles define the
duties required of the prehospital care practitioner in optimizing patient survival and outcome.
3. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still
confused, and you still have no radial pulse. Your next move is to:
A. give 1-L fluid bolus.
B. give one 250-mL fluid bolus, and then stop.
C. give fluid until you get a radial pulse.
D. administer TXA. - ansQuestion 3: C
Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your
target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids.
3. Why might it be more difficult to deal with an airway obstruction in a child?
A. Children have longer tracheas.
B. Children have larger heads and tongues so there is a greater potential for airway obstruction.
C. Children have smaller heads, so there is less room to clear the obstruction.
D. A child's epiglottis is smaller and stiffer than an adult's. - ansQuestion 3: B
Children have larger heads and tongues as compared to an adult so there is a greater potential for airway
obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric
patient to maintain a patent airway.
3. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze-release-
release" timing technique. As you watch for the rise and fall of the chest, you check end-tidal CO2
(ETCO2) monitoring aiming to maintain what level?
A. Between 40 and 45 mm Hg
B. Between 30 and 35 mm Hg
C. Between 35 and 40 mm Hg
D. The level is irrelevant because capnography is inaccurate in pediatric patients. - ansQuestion 3: C
The proper level to maintain is between 35 and 40 mm Hg.
3. You are transporting a 37-year-old male patient with a suspected intraabdominal bleed. His blood
pressure is 70/50 mm Hg (MAP 57), and his skin is pale and diaphoretic. How will you manage fluid
resuscitation for this patient?
A. Aggressively administer IV fluids to compensate for internal blood loss.
B. Do not administer IV fluids to patients with intra-abdominal bleeding.
C. Obtain the patient's medical records and resuscitate to his normal blood pressure reading.
,TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
D. Carefully administer IV fluids to raise the patient's systolic blood pressure to between 80 and 90 mm
Hg. - ansQuestion 3: D
Abdominal trauma represents one of the key situations in which a balanced resuscitation is indicated.
Aggressive administration of IV fluid may elevate the patient's blood pressure to levels that will disrupt
any clot that has formed and result in recurrence of bleeding that had ceased because of blood clotting
and hypotension. Prehospital care practitioners must achieve a delicate balance: maintain a blood
pressure that provides perfusion to vital organs without restoring blood pressure to elevated or even
normal ranges, which may reinitiate bleeding sites in the abdomen or pelvis. In the absence of TBI, the
target systolic blood pressure is 80 to 90 mm Hg (mean arterial pressure of 60 to 65 mmHg).
4. After 400 mL of lactated Ringer solution, you get a radial pulse and his level of consciousness improves.
The monitor shows heart rate 110 beats/minute, blood pressure 85/60mm Hg, SpO2 95%, ventilation rate
25 breaths/minute. What should you do?
A. Give an additional 500 mL of lactated Ringer solution.
B. Stop fluids and give 2 g of TXA.
C. Give TXA and 500 mL of normal saline.
D. Give 2 mg of morphine for analgesia. - ansQuestion 4: B
The patient does not need more fluids right now. Giving morphine in a shocked patient is a risky move and
could lead to dangerous hypotension.
4. The patient is wearing long sleeves, and you are having trouble visualizing the wound. What should you
do?
A. Cut the cloth away from the site until the entire wound site is visible.
B. Leave the clothing in place. Put gauze over the wound.
C. Remove the patient's shirt.
D. Cut through the slash on the sleeve, and use the material as a makeshift tourniquet. - ansQuestion 4: A
Clothing can be quickly removed by cutting. You cannot treat what you cannot see.
4. What is one reason to use capnography as part of your patient reassessment?
A. To get accurate readings for blood pressure
B. To assure proper ET tube placement
C. To measure arterial blood saturation
D. To ensure proper placement for needle decompression - ansQuestion 4: B
Capnography can monitor proper endotracheal tube placement. It doesn't read blood pressure, so it
cannot beused to determine if a patient is hypotensive. Pulse oximetry, not capnography, measures
arterial blood saturation. Capnography is not useful in needle decompression.
4. What type of padding should you provide for this patient?
A. Use compressible padding under the shoulders and torso to prevent hyperflexion.
B. Use firm padding between the back of the head and the backboard to prevent hyperextension.
C. Do not use any padding. It can cause extension or flexion in the neck.
D. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral
position. - ansQuestion 4: B
Because the patient is an adult, you should use firm padding between the back of the head and the
backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion,
and you would tip the backboard for a pregnant patient to prevent decreased venous return.
4. When you examine the patient's pupils, you notice the right one is dilated significantly and her motor
response on the left is delayed. What does this suggest?
A. Coup-countercoup injury
B. Hyphema
C. Hypoxia
,TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
D. Uncal herniation - ansQuestion 4: D
When the medial portion of the temporal lobe (uncus) is pushed toward the tentorium and puts pressure on
the brain stem, herniation compresses CN III, the motor tract, and the reticular activating system on the
same side, resulting in a dilated or blown pupil on the same side, motor weakness on the opposite side,
and respiratory dysfunction, progressing to coma.
4. Which of the following is a goal of the Golden Period?
A. Provide written documentation from field care to receiving hospital.
B. Expedite the field care and transport of the patient.
C. Use a team approach for optimal patient care.
D. Use the XABCDE approach to patient assessment. - ansQuestion 4: B
One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time
onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the
time from injuryto arrival at the appropriate site fordefinitive care is critical to survival.
4. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient?
A. Shorter tracheas in geriatric patients create the need for ventilation assistance.
B. Laxity of the rib cage makes hyperventilation more likely.
C. Geriatric patients have greatly limited physiologic reserve.
D. Geriatric patients have a greater alveolar surface area of the lungs. - ansQuestion 4: C
Early mechanical ventilation via bag mask device or advanced airway measures should be considered in
geriatric trauma patients because of their greatly limited physiologic reserve.
5. Which of the following signs would be most concerning at this point?
A. A drop in systolic blood pressure to 88 mm Hg
B. SpO₂ of 93%
C. A field GCS motor score of 4
D. Hemiplegia on the left side - ansQuestion 5: A
A systolic blood pressure of less than 90 mm Hg indicates secondary brain injury. Her SpO2 is > 90%, and
a motor score of 4 is not as concerning.
5. While attempting to lay the patient supine for spinal motion restriction she becomes increasingly
distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to
move distally and increases the difficulty of breathing as the patient lies back. What should you do?
A. Tip the backboard to a left lateral position.
B. Raise the back of the stretcher.
C. Let her sit up in a position of comfort.
D. Administer morphine. - ansQuestion 5: B
Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of
the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues.
5. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral
clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful?
A. No, he should stop talking and breathe.
B. Yes, he should see a cardiologist once in the local hospital.
C. Yes, he will need platelets and a heart surgeon ASAP.
D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ansQuestion 5: C
Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent
platelet transfusion.
, TNCC TRAUMA NURSING CORE
COURSE 12TH EDITION ENA TEST
BANK VERIFIED PASS
6. According to the Monro-Kellie doctrine, what happens to the brain when it is still in a compensated
state after a TBI?
A. CSF, ICP, heart rate, and blood pressure are still within normal range.
B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases.
C. CSF and blood volume decrease, while heart rate and blood pressure are still within normál range.
D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases. - ansQuestion 6: C
In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still
within normal range.
_________ therapy is now suggested for fluid resuscitation to replace patient losses, including administering
PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY
ch. 5, p. 45
__________, which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic
pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. -
ansHYPERVENTILATION
ch. 7, p. 74
55% of spinal injuries occur to which part of spine? - anscervical
ch. 13, p. 179
A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). -
ansa. HYPOVOLEMIA
b. CARDIAC DYSFUNCTION
ch. 5, p. 45
ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint
measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the
resuscitation.
An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation
of hydrogen ions and metabolic acidosis.
ch. 5, p. 46
Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO
catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE
cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility
(potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral
vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use)
- NOREPINEPHRINE increases heart rate, vascular tone through alpha-adrenergic receptor activation, and
blood flow to skeletal muscle and triggers the release of glucose from energy stores.
ch. 7, p. 77
Additional history includes the following (MIST mnemonic) prehospital report: - ans- MOI
- Injuries sustained
- Signs and Symptoms (in the field)
