TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
What causes the secondary effects of blast traumas? - ANSProjectiles propelled by the explosion. Injuries
include penetrating or blunt injuries or I penetration.
What causes the tertiary effects of blast traumas? - ANSResults from individuals being thrown by the
blast wind. Injuries include hole or partial body translocation from being thrown against a hard service:
blunt or penetrating trauma's, fractures, traumatic amputations.
What is a trademark symptom of an epidural hematoma - ANSLoss of consciousness then awake and
alert then loss of consciousness
What is bending? - ANSLoading about an axis. Bending causes compression on the side the person is
bending toward intention to the opposite side
What is combined loading? - ANSAny combination of tension compression torsion bending and/or shear.
What is compression? - ANSCrushing by squeezing together
What is Cullen's sign and its significance? - ANSCullens sign is periumbilical bruising and is indicative of
intraperitoneal bleeding
What is shearing? - ANSDamage by tearing or bending by exerting faucet different parts in opposite
directions at the same time.
What is tension? - ANSstretching force by pulling at opposite ends
What is the minimum permissive hypertension and a trauma patient? - ANSA systolic of greater than or
equal to 90 MMHG
What is the minimum permissive oxygenation level of a trauma patient? - ANSGreater than or equal to
94%
What is the Munro-Kellie doctrine? - ANSWithin the skull 80% his brain, 10% is blood, and 10% is CSF.
Any increase of any of the products results in increased intracranial pressure.
What is the recommended fluid bolus for a trauma? - ANS500 ML's of warmed isotonic crystalloid.
Ongoing fluid boluses of 500 ML's should be given judiciously with constant reassessments after
administration.
What is the relationship between mass and velocity to kinetic energy? - ANSKinetic energy is equal to 1/2
the mass multiplied the square of its velocity therefore when mass is doubled so is the net energy,
however, when velocity is doubled energy is quadrupled.
What is the trauma triad of death? - ANShypothermia, acidosis, coagulopathy
What is torsion? - ANSTorsion forces twist ends in opposite directions.
When capnography measurement reads greater than 45MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - ANSIncreasing the ventilation rate. Doing so would allow the patient to
blow off retained CO2.
,TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
When capnography measurement reads less than 35MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - ANSDecreasing the ventilation rate. By doing so, the nurse allows the
patient to retain CO2.
When would you use a nasopharyngeal airway versus an oral pharyngeal airway? - ANSNasopharyngeal
airways is contraindicated in patients with facial trauma or a suspected basilar skull fracture. Oral
pharyngeal airways is used in unresponsive patients unable to maintain their airway, without a gag reflex
as a temporary measure to facilitate ventilation with a bag mask device or spontaneous ventilation until
the patient can be intubated. According to newtons law which of these two force is greater: size or force?
- ANSNeither. For each force there is an equal and opposite reaction.
Define Cushing's triad - ANSBradycardia, progressive hypertension (widening pulse pressure), and
decreased respiratory effort
Define the characteristics of neurogenic shock - ANSDistributive shock with a T6 or higher injury results
and vasodilation, bradycardia, flushed warm dry skin. Risk for temperature instability. Nursing
interventions include maintaining warmth and spinal stabilization.
Define the characteristics of spinal shock - ANSTransient loss of function can include loss of reflexes and
muscle tone below the level of industry with possible vascular response.
Describe one fat embolism syndrome is most likely to occur in its characteristics - ANSWith longform
fractures. Tachycardia, Thrombocytopenia, and petechiae rash.
Describe the characteristics of cardiogenic shock - ANSCardiogenic shock results from pump failure in
the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs
secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with
blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and
respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin
Describe the characteristics of distributive shock. - ANSDistributive shock occurs as a result of Mel
distribution of an adequate circulating blood volume with the loss of vascular tone or increased
permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood
pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm
pink and dry skin with a cool core temperature.
Describe the characteristics of hypovolemic shock - ANSHypovolemia is caused by a decrease in the
amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and
diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and
afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool
and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities
especially long bones.
Describe the characteristics of obstructive shock - ANSObstructive shock is it mechanical problem that
results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart
resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac tamponade,
or venous air embolism on the right side of the heart during systole in the pulmonary artery.Signs include
anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes.
Describe the four types of spinal cord injury - ANSCentral cord injury results in greater weakness distally,
anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown-
Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome
although rare is when the patient is unable to use sense vibration in proprioception
,TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
Describe the measurement of an NPA - ANSMeasure from the tip of the patient's nose to the tip of the
patients earlobe.
Differentiate between the three impacts of motor vehicle impact sequence. - ANSThe first impact occurs
when the vehicle collided with another object. The second impact occurs after the initial impact when the
occupant continues to move in the original direction of travel until they collide with the interior of the
vehicle or meet resistance. The third impact occurs when internal structures collide within the body cavity.
Measurement of an OPA - ANSPlace the proximal end or flange of the airway adjunct at the corner of the
mouth to the tip of the mandibular angle.
Name the three ways to confirm ETT placement - ANSPlacement of a CO2 monitoring device, Assessing
for equal chest rise and fall, and listening at the epigastrium and four lung fields for equal breath sounds.
True or false: NPAs and OPAs are definitive airways. - ANSFalse. When placing one of these? One
should consider the potential need for a definitive airway.
What are contributing factors to injuries related to blunt traumas? - ANSThe point of impact on the
patient's body, the type of surface that is hit, the tissues ability to resist (bone versus soft tissue, air-filled
versus solid organs), and the trajectory of force.
What are the early signs of increased Intracranial pressure - ANSheadache, vomiting, behavioral changes
that begin with restlessness and may progress to confusion, drowsiness, or impaired judgment
What are the four types of shock? - ANSHypovolemic, Cardiogenic, Obstructive, & Distributive
What are the four types of trauma related injuries? - ANSBlunt, penetrating, thermal, or blast.
What are the greatest risks for transport? - ANSLoss of airway patency, displaced obstructive tubes lines
or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration in patient
status change in vital signs or level of consciousness, injury to the patient and/or team members
What are the late signs of Increased intracranial pressure - ANSdilated, non-reactive pupil(s); abnormal
motor posturing (flexion, extension, flaccidity); Cushing's triad, Unresponsive to per verbal and painful
stimuli, bradycardia and decreased respiratory effort
What are the seven patterns of pathway injuries related to motor vehicle accidents? - ANSUp and over,
down and under, lateral, rotational, rear, roll over, and ejection.
What are the signs and symptoms of decompensated shock? - ANSDecreased level of consciousness,
hypertension, narrow pulse pressure, tachycardia with weak pulses, tachypnea, skin that is cool clammy
and cyanotic, base access outside the normal range, and serum lactate levels greater than two to
4MMOL/L.
What are the signs and symptoms of irreversible shock? - ANSObtunded stuporous or comatose state,
marked hypertension and heart failure, bradycardia with possible dysrhythmias, decreased and shallow
respiratory rate, pale cool and clammy skin, kidney liver and other organ failure, severe acidosis, elevated
lactic acid levels, worsening base access on ABGs, coagulopathies with petechiae purpura or bleeding.
What are the signs of compensated shock? - ANSAnxiety, confusion, restlessness, increased respiratory
rate, narrowing pulse pressure were diastolic increases yet systolic remains unchanged, tachycardia with
bounding pulses, and decreased urinary output
, TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
What are the symptoms of a subdural hematoma? - ANSDecreased LOC, nausea vomiting headache and
ipsilateral pupillary changes
What are the three factors that contribute to the damage caused by penetrating trauma's? - ANSThe point
of impact, the velocity and speed of impact, and the proximity to the object.
What are the three processes that transfer oxygen from the air to the lungs and blood stream -
ANSVentilation: the active mechanical movement of air into and out of the lungs; diffusion: the passive
movement of gases from an area of higher concentration to an area of lower concentration; and
perfusion: the movement of blood to and from the lungs as a delivery medium of oxygen to the entire
body.
What are the three stages of shock - ANSCompensated, decompensated or progressive, and irreversible.
What are the treatment goals for a TBI? - ANSO2 saturation > or equal to 95%, systolic blood pressure >
or equal to 100 MMHG, ICP < 15 MMHG, CPP > or equal to 60 MMHG, normal glycemia, hemoglobin >
or equal to 7 g/DL, sodium 135-145, osmotic diuretics, anti-emetics, sedatives, anticonvulsants, head of
bed at 30°, and neck at midline
What causes quarternary effects of blast traumas? - ANSAll explosion related injuries, illnesses, or
diseases not due to the first three mechanisms. Injuries include external and internal burns, crush injuries,
closed and open brain injuries, asthmatic or breathing problems from dust smoke or toxic fumes, angina,
or hyper glycemia and hypertension.
What causes quinary effects of blasts traumas? - ANSThose associated with exposure to hazardous
materials from radioactive, biologic, or chemical components of a blast. Injuries include a variety of health
effects depending on agent.
What causes the primary effects of blast traumas? - ANSThe direct blast effects. Types of injuries include
last long, tympanic membrane rupture and middle ear damage, abdominal hemorrhage and perforation,
global rupture, mild Trumatic brain injury.
What causes the secondary effects of blast traumas? - ANSProjectiles propelled by the explosion. Injuries
include penetrating or blunt injuries or I penetration.
What causes the tertiary effects of blast traumas? - ANSResults from individuals being thrown by the
blast wind. Injuries include hole or partial body translocation from being thrown against a hard service:
blunt or penetrating trauma's, fractures, traumatic amputations.
What is a trademark symptom of an epidural hematoma - ANSLoss of consciousness then awake and
alert then loss of consciousness
What is bending? - ANSLoading about an axis. Bending causes compression on the side the person is
bending toward intention to the opposite side
What is combined loading? - ANSAny combination of tension compression torsion bending and/or shear.
What is compression? - ANSCrushing by squeezing together
What is Cullen's sign and its significance? - ANSCullens sign is periumbilical bruising and is indicative of
intraperitoneal bleeding
What is shearing? - ANSDamage by tearing or bending by exerting faucet different parts in opposite
directions at the same time.
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
What causes the secondary effects of blast traumas? - ANSProjectiles propelled by the explosion. Injuries
include penetrating or blunt injuries or I penetration.
What causes the tertiary effects of blast traumas? - ANSResults from individuals being thrown by the
blast wind. Injuries include hole or partial body translocation from being thrown against a hard service:
blunt or penetrating trauma's, fractures, traumatic amputations.
What is a trademark symptom of an epidural hematoma - ANSLoss of consciousness then awake and
alert then loss of consciousness
What is bending? - ANSLoading about an axis. Bending causes compression on the side the person is
bending toward intention to the opposite side
What is combined loading? - ANSAny combination of tension compression torsion bending and/or shear.
What is compression? - ANSCrushing by squeezing together
What is Cullen's sign and its significance? - ANSCullens sign is periumbilical bruising and is indicative of
intraperitoneal bleeding
What is shearing? - ANSDamage by tearing or bending by exerting faucet different parts in opposite
directions at the same time.
What is tension? - ANSstretching force by pulling at opposite ends
What is the minimum permissive hypertension and a trauma patient? - ANSA systolic of greater than or
equal to 90 MMHG
What is the minimum permissive oxygenation level of a trauma patient? - ANSGreater than or equal to
94%
What is the Munro-Kellie doctrine? - ANSWithin the skull 80% his brain, 10% is blood, and 10% is CSF.
Any increase of any of the products results in increased intracranial pressure.
What is the recommended fluid bolus for a trauma? - ANS500 ML's of warmed isotonic crystalloid.
Ongoing fluid boluses of 500 ML's should be given judiciously with constant reassessments after
administration.
What is the relationship between mass and velocity to kinetic energy? - ANSKinetic energy is equal to 1/2
the mass multiplied the square of its velocity therefore when mass is doubled so is the net energy,
however, when velocity is doubled energy is quadrupled.
What is the trauma triad of death? - ANShypothermia, acidosis, coagulopathy
What is torsion? - ANSTorsion forces twist ends in opposite directions.
When capnography measurement reads greater than 45MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - ANSIncreasing the ventilation rate. Doing so would allow the patient to
blow off retained CO2.
,TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
When capnography measurement reads less than 35MMHG, the nurse should consider increasing or
decreasing the ventilation rate? - ANSDecreasing the ventilation rate. By doing so, the nurse allows the
patient to retain CO2.
When would you use a nasopharyngeal airway versus an oral pharyngeal airway? - ANSNasopharyngeal
airways is contraindicated in patients with facial trauma or a suspected basilar skull fracture. Oral
pharyngeal airways is used in unresponsive patients unable to maintain their airway, without a gag reflex
as a temporary measure to facilitate ventilation with a bag mask device or spontaneous ventilation until
the patient can be intubated. According to newtons law which of these two force is greater: size or force?
- ANSNeither. For each force there is an equal and opposite reaction.
Define Cushing's triad - ANSBradycardia, progressive hypertension (widening pulse pressure), and
decreased respiratory effort
Define the characteristics of neurogenic shock - ANSDistributive shock with a T6 or higher injury results
and vasodilation, bradycardia, flushed warm dry skin. Risk for temperature instability. Nursing
interventions include maintaining warmth and spinal stabilization.
Define the characteristics of spinal shock - ANSTransient loss of function can include loss of reflexes and
muscle tone below the level of industry with possible vascular response.
Describe one fat embolism syndrome is most likely to occur in its characteristics - ANSWith longform
fractures. Tachycardia, Thrombocytopenia, and petechiae rash.
Describe the characteristics of cardiogenic shock - ANSCardiogenic shock results from pump failure in
the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs
secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with
blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and
respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin
Describe the characteristics of distributive shock. - ANSDistributive shock occurs as a result of Mel
distribution of an adequate circulating blood volume with the loss of vascular tone or increased
permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood
pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm
pink and dry skin with a cool core temperature.
Describe the characteristics of hypovolemic shock - ANSHypovolemia is caused by a decrease in the
amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and
diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and
afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool
and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities
especially long bones.
Describe the characteristics of obstructive shock - ANSObstructive shock is it mechanical problem that
results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart
resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac tamponade,
or venous air embolism on the right side of the heart during systole in the pulmonary artery.Signs include
anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes.
Describe the four types of spinal cord injury - ANSCentral cord injury results in greater weakness distally,
anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown-
Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome
although rare is when the patient is unable to use sense vibration in proprioception
,TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
Describe the measurement of an NPA - ANSMeasure from the tip of the patient's nose to the tip of the
patients earlobe.
Differentiate between the three impacts of motor vehicle impact sequence. - ANSThe first impact occurs
when the vehicle collided with another object. The second impact occurs after the initial impact when the
occupant continues to move in the original direction of travel until they collide with the interior of the
vehicle or meet resistance. The third impact occurs when internal structures collide within the body cavity.
Measurement of an OPA - ANSPlace the proximal end or flange of the airway adjunct at the corner of the
mouth to the tip of the mandibular angle.
Name the three ways to confirm ETT placement - ANSPlacement of a CO2 monitoring device, Assessing
for equal chest rise and fall, and listening at the epigastrium and four lung fields for equal breath sounds.
True or false: NPAs and OPAs are definitive airways. - ANSFalse. When placing one of these? One
should consider the potential need for a definitive airway.
What are contributing factors to injuries related to blunt traumas? - ANSThe point of impact on the
patient's body, the type of surface that is hit, the tissues ability to resist (bone versus soft tissue, air-filled
versus solid organs), and the trajectory of force.
What are the early signs of increased Intracranial pressure - ANSheadache, vomiting, behavioral changes
that begin with restlessness and may progress to confusion, drowsiness, or impaired judgment
What are the four types of shock? - ANSHypovolemic, Cardiogenic, Obstructive, & Distributive
What are the four types of trauma related injuries? - ANSBlunt, penetrating, thermal, or blast.
What are the greatest risks for transport? - ANSLoss of airway patency, displaced obstructive tubes lines
or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration in patient
status change in vital signs or level of consciousness, injury to the patient and/or team members
What are the late signs of Increased intracranial pressure - ANSdilated, non-reactive pupil(s); abnormal
motor posturing (flexion, extension, flaccidity); Cushing's triad, Unresponsive to per verbal and painful
stimuli, bradycardia and decreased respiratory effort
What are the seven patterns of pathway injuries related to motor vehicle accidents? - ANSUp and over,
down and under, lateral, rotational, rear, roll over, and ejection.
What are the signs and symptoms of decompensated shock? - ANSDecreased level of consciousness,
hypertension, narrow pulse pressure, tachycardia with weak pulses, tachypnea, skin that is cool clammy
and cyanotic, base access outside the normal range, and serum lactate levels greater than two to
4MMOL/L.
What are the signs and symptoms of irreversible shock? - ANSObtunded stuporous or comatose state,
marked hypertension and heart failure, bradycardia with possible dysrhythmias, decreased and shallow
respiratory rate, pale cool and clammy skin, kidney liver and other organ failure, severe acidosis, elevated
lactic acid levels, worsening base access on ABGs, coagulopathies with petechiae purpura or bleeding.
What are the signs of compensated shock? - ANSAnxiety, confusion, restlessness, increased respiratory
rate, narrowing pulse pressure were diastolic increases yet systolic remains unchanged, tachycardia with
bounding pulses, and decreased urinary output
, TNCC 8TH EDITION EXAM 10 LATEST VERSIONS (VERSION A & B) COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+VERIFIED
What are the symptoms of a subdural hematoma? - ANSDecreased LOC, nausea vomiting headache and
ipsilateral pupillary changes
What are the three factors that contribute to the damage caused by penetrating trauma's? - ANSThe point
of impact, the velocity and speed of impact, and the proximity to the object.
What are the three processes that transfer oxygen from the air to the lungs and blood stream -
ANSVentilation: the active mechanical movement of air into and out of the lungs; diffusion: the passive
movement of gases from an area of higher concentration to an area of lower concentration; and
perfusion: the movement of blood to and from the lungs as a delivery medium of oxygen to the entire
body.
What are the three stages of shock - ANSCompensated, decompensated or progressive, and irreversible.
What are the treatment goals for a TBI? - ANSO2 saturation > or equal to 95%, systolic blood pressure >
or equal to 100 MMHG, ICP < 15 MMHG, CPP > or equal to 60 MMHG, normal glycemia, hemoglobin >
or equal to 7 g/DL, sodium 135-145, osmotic diuretics, anti-emetics, sedatives, anticonvulsants, head of
bed at 30°, and neck at midline
What causes quarternary effects of blast traumas? - ANSAll explosion related injuries, illnesses, or
diseases not due to the first three mechanisms. Injuries include external and internal burns, crush injuries,
closed and open brain injuries, asthmatic or breathing problems from dust smoke or toxic fumes, angina,
or hyper glycemia and hypertension.
What causes quinary effects of blasts traumas? - ANSThose associated with exposure to hazardous
materials from radioactive, biologic, or chemical components of a blast. Injuries include a variety of health
effects depending on agent.
What causes the primary effects of blast traumas? - ANSThe direct blast effects. Types of injuries include
last long, tympanic membrane rupture and middle ear damage, abdominal hemorrhage and perforation,
global rupture, mild Trumatic brain injury.
What causes the secondary effects of blast traumas? - ANSProjectiles propelled by the explosion. Injuries
include penetrating or blunt injuries or I penetration.
What causes the tertiary effects of blast traumas? - ANSResults from individuals being thrown by the
blast wind. Injuries include hole or partial body translocation from being thrown against a hard service:
blunt or penetrating trauma's, fractures, traumatic amputations.
What is a trademark symptom of an epidural hematoma - ANSLoss of consciousness then awake and
alert then loss of consciousness
What is bending? - ANSLoading about an axis. Bending causes compression on the side the person is
bending toward intention to the opposite side
What is combined loading? - ANSAny combination of tension compression torsion bending and/or shear.
What is compression? - ANSCrushing by squeezing together
What is Cullen's sign and its significance? - ANSCullens sign is periumbilical bruising and is indicative of
intraperitoneal bleeding
What is shearing? - ANSDamage by tearing or bending by exerting faucet different parts in opposite
directions at the same time.
