TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
With venous bleeds, direct pressure isusually sufficient to stop the flow.
Widening pulse pressure
Why is CONTINUOUS ICP MONITORING important? - ansImportant for assessing
brain injury and response of patient to treatment. It can provide early detection of
secondary brain injury such as cerebral hypoxia, ischemia.
Why do partial amputations have more severe bleeding than complete amputations? -
ansThe severed arteries retract with complete amputations
While in ED, alignment and protection of the cervical spine can be accomplished by
which 2 ways? - ans- Manual stabilization
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.
When someone suffers a GSW, below what part of the body is considered an
abdominal injury that requires an exploratory laparotomy? - ansBelow the nipple line
When patient is receiving massive blood transfusions it is important to closely monitor
which electrolytes? Why? - ansHigh K, Low C
When immobilizing a patient, you should secure the torso first, then the head, the legs,
and the pelvis.
When does the secondary survey (HI) begin? - ansAfter the completion of the primary
survey (ABCDE), after the initiation of resuscitation efforts, once vital functions have
been stabilized and after consideration for resuscitation adjuncts (FG).
When does the approach to trauma care typically begin? - ansWith notification that a
trauma patient is arriving to ED
When does operative management occur? - ansNon- serial abdominal exams
What symptoms usually indicate an INTRAOCULAR foreign body is present? - ans-
IRREGULAR PUPIL
What should you avoid using with fingers, toes or other areas where vasoconstriction
could cause impaired distal blood circulation? - ansLIDOCAINE with EPI
What lab studies are used to guide resuscitative efforts in shock? - ans- Platelet count,
clotting studies
What is used to diagnosis renal injuries? What are the cons? How are rectal injuries
often managed? - ansSigmoidoscopy
What is the standard of care in the hemodynamically STABLE patient who sustained
blunt liver injury? - ansNon-operative management
What is the most major cause of preventable death after injury? - ansUncontrolled
hemorrhage
What is the most common cause of thoracic trauma? - ansMVC's
What is the difference between penetrating and perforating in regards to ocular injuries?
- ansPenetrating - having ENTRANCE WOUND, an INTRAOCULAR FOREIGN BODY
when they are present
,TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
What is one unique post-operative risk following a splenectomy? Explain. -
ansPNEUMOCOCCAL SEPSIS
What does 'safe practice' mean? - ansMeans taking into consideration the protection of
the team, including:
What does 'safe care' mean? - ansMeans assuring the patient is getting to the right
hospital in the right amount of time for the right care.
What does non-operative management include?
What do you do with open wounds? - ansCover in saline-soaked dressings
What diagnostic exam is helpful to inspect abdominal spaces for spillage and to
examine loops of bowel? - ansLaparoscopy
What can you do to easily see eyes that have abrasions? - ansStain them with
fluorescein
What can you assess to ensure the brainstem is intact? - ansEXTRAOCULAR EYE
MOVEMENTS (EOMs) - tests functions of CNs III, IV, and VI
What are two examples of obstructive shock that may result from trauma? -
ansTENSION PNEUMOTHORAX and CARDIAC TAMPONADE
What are the two priorities in treating patients with TBI? - ansFacilitating
OXYGENATION and VENTILATION
What are the rules concerning standard imaging in relation to eye injury - ans- If wood
or a vegetative foreign body is suspected, MRI most appropriate imaging method to
use, however, it is minimally useful in acute setting
What are the late signs that may indicate a tension pneumothorax? - ansJVD and
tracheal deviation
What are some circumstances that may lead to unreliable pulse ox readings? - ans-
Poor peripheral perfusion
What are some assessment findings for patients who sustain a pancreatic injury? - ans-
Serial serum amylase levels increasing over time may indicate but this does not
constitute a definitive diagnosis
What are signs of worsening hypoxia with nerve injuries? - ansIncreased pain even
when pulses remain present, often the first sign of increased compartment pressures
What are odors you want to be sure to document? - ansAlcohol, gasoline, other
chemicals
What are late signs of MEDIASTINAL SHIFT? - ansNECK VEIN DISTENTION from
increased intrathroatic pressure and TRACHEAL DEVIATION
What are complications related to crush injuries? - ansCompartment syndrome,
hyperkalemia, rhabdomyolysis
What are causes of peritoneal membrane irritation? - ans- presence of blood
Was there a cardiac event prior to injury?
VISCERAL PAIN originates from organs and may lead to referred pain
Venous bleeding typically results in a steady flow of dark red blood.
V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from
obstructing airway
,TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
Use the jaw-thrust maneuver to open airway and assess for obstruction when the
patient is... - ansUnable to open the mouth, responds only to pain, or is unresponsive.
Use the DOPE mnemonic to troubleshoot ventilator or capnography alarms - ansD -
Displaced tube
URINARY RETENTION
Up to 25% of the general population have UNEQUAL PUPILS, called ANISOCORIA;
this is benign and caused by... - ans- TRAUMA
Unstable fractures- 2 or more fractures of pelvic ring that have outward rotational
displacement
U: I am Uncomfortable
U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct
someone to check if the patient has a pulse while assessing if the cause of the problem
is the airway. Consider reprioritizing the assessment priority to <C>ABC
Types of injuries include - ans- Blunt trauma
type and cross match
True or false: ALL eye injuries, even the most minor, require a visual acuity
examination. - ansTRUE
Treatment includes:
Treatment includes:
Treatment includes:
Treatment include:
Treatment for CORNEAL ABRASIONS include: - ans- TOPICAL OPHTHALMIC
ANTIBIOTICS
Treatment - aggressive fluid resuscitation to flush out myoglobin to prevent renal failure
(>100 mL/hr until resolved is goal)
Trauma nurse should be attempting to maintain NORMOTHERMIA and
NORMOCARBIA, which... - ansDecreases risk of..
To help achieve the PHTLS goals, you will apply your critical thinking skills in the field.
Critical thinking in medicine is a process in which the healthcare practitioner assesses
the situation, the patient, and the resources available and uses the information to decide
on and provide the best care for the patient.
This patient is likely in decompensated shock with internal bleeding, so rapid transport
is the next priority. You should maintain pressure on the wound, because having
massive external bleeding start up again is the last thing you want in this situation.
The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary
blast injuries: found in those closest to the detonation, with enclosed space detonation
resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs,
stomach, and bowel) are most susceptible to rupture with primary blast injuries.
The supraglottic airway's greatest advantage is that it can be inserted independent of
the patient's position, which may be especially important in trauma patients with high
suspicion of cervical injury.
, TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
The subtle assessment findings associated with pulmonary contusions usually develop
over time rather than immediately after injury.
The standard approach to treating hypotension in trauma patients has been to infuse
large volumes of IV fluids. Recent studies now recommend a different approach and
note that an elevated BP may dislodge the body's formation of clots and promote further
bleeding. In addition, large volumes of fluid lead to... - ansDilutional coagulopathy which
worsens metabolic acidosis and may cause hypothermia
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.
The proper level to maintain is between 35 and 40 mm Hg.
The physical environment (socioeconomic environment)
The patient's age, use of a blood thinner, and the fact she fell recently point to a
subdural hematoma.
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.
The most reliable indicator of an intraabdominal bleed is the presence of hypovolemic
shock from an unexplained source.
The major assessment parameters that produce important information within seconds of
a patient's arrival are... - ans1. Level of consciousness
The increase of the diastolic blood pressure with a narrowing pulse pressure... - ansMay
be one of the first CONCRETE measurements signaling that the patient's circulatory
status is compromised.
The host (human)
The Haddon Matrix broadened the approach and placed emphasis on
countermeasures, such were more effective than changing human behavior. Haddon
describes three phases of the injury event: - ansPre-event, Event, Post-event
The device reflects oxygen delivery to cerebral tissues and monitors temperature
The degree to which tissues resist destruction under circumstances of energy transfer
depends on... - ansTheir proximity to the impact and their structural characteristics
The assessment of circulation during the primary survey includes... - ansEarly
evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient
who has sustained blunt trauma.
The A-I mnemonic helps the trauma nurse rapidly assess for and intervene in life-
threatening injuries and identify all injuries in a systematic manner. - ansA: airway and
alertness with simultaneous cervical spinal stabilization
The agent (motor vehicle)
The "X" placed before "ABCDE" in the primary survey refers to the need to address
exsanguinating hemorrhage immediately after establishing scene safety and before
addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding,
has the potential to lead to loss of total or near total blood volume in a relatively short
period of time.
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
With venous bleeds, direct pressure isusually sufficient to stop the flow.
Widening pulse pressure
Why is CONTINUOUS ICP MONITORING important? - ansImportant for assessing
brain injury and response of patient to treatment. It can provide early detection of
secondary brain injury such as cerebral hypoxia, ischemia.
Why do partial amputations have more severe bleeding than complete amputations? -
ansThe severed arteries retract with complete amputations
While in ED, alignment and protection of the cervical spine can be accomplished by
which 2 ways? - ans- Manual stabilization
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.
When someone suffers a GSW, below what part of the body is considered an
abdominal injury that requires an exploratory laparotomy? - ansBelow the nipple line
When patient is receiving massive blood transfusions it is important to closely monitor
which electrolytes? Why? - ansHigh K, Low C
When immobilizing a patient, you should secure the torso first, then the head, the legs,
and the pelvis.
When does the secondary survey (HI) begin? - ansAfter the completion of the primary
survey (ABCDE), after the initiation of resuscitation efforts, once vital functions have
been stabilized and after consideration for resuscitation adjuncts (FG).
When does the approach to trauma care typically begin? - ansWith notification that a
trauma patient is arriving to ED
When does operative management occur? - ansNon- serial abdominal exams
What symptoms usually indicate an INTRAOCULAR foreign body is present? - ans-
IRREGULAR PUPIL
What should you avoid using with fingers, toes or other areas where vasoconstriction
could cause impaired distal blood circulation? - ansLIDOCAINE with EPI
What lab studies are used to guide resuscitative efforts in shock? - ans- Platelet count,
clotting studies
What is used to diagnosis renal injuries? What are the cons? How are rectal injuries
often managed? - ansSigmoidoscopy
What is the standard of care in the hemodynamically STABLE patient who sustained
blunt liver injury? - ansNon-operative management
What is the most major cause of preventable death after injury? - ansUncontrolled
hemorrhage
What is the most common cause of thoracic trauma? - ansMVC's
What is the difference between penetrating and perforating in regards to ocular injuries?
- ansPenetrating - having ENTRANCE WOUND, an INTRAOCULAR FOREIGN BODY
when they are present
,TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
What is one unique post-operative risk following a splenectomy? Explain. -
ansPNEUMOCOCCAL SEPSIS
What does 'safe practice' mean? - ansMeans taking into consideration the protection of
the team, including:
What does 'safe care' mean? - ansMeans assuring the patient is getting to the right
hospital in the right amount of time for the right care.
What does non-operative management include?
What do you do with open wounds? - ansCover in saline-soaked dressings
What diagnostic exam is helpful to inspect abdominal spaces for spillage and to
examine loops of bowel? - ansLaparoscopy
What can you do to easily see eyes that have abrasions? - ansStain them with
fluorescein
What can you assess to ensure the brainstem is intact? - ansEXTRAOCULAR EYE
MOVEMENTS (EOMs) - tests functions of CNs III, IV, and VI
What are two examples of obstructive shock that may result from trauma? -
ansTENSION PNEUMOTHORAX and CARDIAC TAMPONADE
What are the two priorities in treating patients with TBI? - ansFacilitating
OXYGENATION and VENTILATION
What are the rules concerning standard imaging in relation to eye injury - ans- If wood
or a vegetative foreign body is suspected, MRI most appropriate imaging method to
use, however, it is minimally useful in acute setting
What are the late signs that may indicate a tension pneumothorax? - ansJVD and
tracheal deviation
What are some circumstances that may lead to unreliable pulse ox readings? - ans-
Poor peripheral perfusion
What are some assessment findings for patients who sustain a pancreatic injury? - ans-
Serial serum amylase levels increasing over time may indicate but this does not
constitute a definitive diagnosis
What are signs of worsening hypoxia with nerve injuries? - ansIncreased pain even
when pulses remain present, often the first sign of increased compartment pressures
What are odors you want to be sure to document? - ansAlcohol, gasoline, other
chemicals
What are late signs of MEDIASTINAL SHIFT? - ansNECK VEIN DISTENTION from
increased intrathroatic pressure and TRACHEAL DEVIATION
What are complications related to crush injuries? - ansCompartment syndrome,
hyperkalemia, rhabdomyolysis
What are causes of peritoneal membrane irritation? - ans- presence of blood
Was there a cardiac event prior to injury?
VISCERAL PAIN originates from organs and may lead to referred pain
Venous bleeding typically results in a steady flow of dark red blood.
V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from
obstructing airway
,TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
Use the jaw-thrust maneuver to open airway and assess for obstruction when the
patient is... - ansUnable to open the mouth, responds only to pain, or is unresponsive.
Use the DOPE mnemonic to troubleshoot ventilator or capnography alarms - ansD -
Displaced tube
URINARY RETENTION
Up to 25% of the general population have UNEQUAL PUPILS, called ANISOCORIA;
this is benign and caused by... - ans- TRAUMA
Unstable fractures- 2 or more fractures of pelvic ring that have outward rotational
displacement
U: I am Uncomfortable
U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct
someone to check if the patient has a pulse while assessing if the cause of the problem
is the airway. Consider reprioritizing the assessment priority to <C>ABC
Types of injuries include - ans- Blunt trauma
type and cross match
True or false: ALL eye injuries, even the most minor, require a visual acuity
examination. - ansTRUE
Treatment includes:
Treatment includes:
Treatment includes:
Treatment include:
Treatment for CORNEAL ABRASIONS include: - ans- TOPICAL OPHTHALMIC
ANTIBIOTICS
Treatment - aggressive fluid resuscitation to flush out myoglobin to prevent renal failure
(>100 mL/hr until resolved is goal)
Trauma nurse should be attempting to maintain NORMOTHERMIA and
NORMOCARBIA, which... - ansDecreases risk of..
To help achieve the PHTLS goals, you will apply your critical thinking skills in the field.
Critical thinking in medicine is a process in which the healthcare practitioner assesses
the situation, the patient, and the resources available and uses the information to decide
on and provide the best care for the patient.
This patient is likely in decompensated shock with internal bleeding, so rapid transport
is the next priority. You should maintain pressure on the wound, because having
massive external bleeding start up again is the last thing you want in this situation.
The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary
blast injuries: found in those closest to the detonation, with enclosed space detonation
resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs,
stomach, and bowel) are most susceptible to rupture with primary blast injuries.
The supraglottic airway's greatest advantage is that it can be inserted independent of
the patient's position, which may be especially important in trauma patients with high
suspicion of cervical injury.
, TNCC TRAUMA NURSING CORE
COURSE 19TH EDITION ENA TEST
BANK VERIFIED PASS
The subtle assessment findings associated with pulmonary contusions usually develop
over time rather than immediately after injury.
The standard approach to treating hypotension in trauma patients has been to infuse
large volumes of IV fluids. Recent studies now recommend a different approach and
note that an elevated BP may dislodge the body's formation of clots and promote further
bleeding. In addition, large volumes of fluid lead to... - ansDilutional coagulopathy which
worsens metabolic acidosis and may cause hypothermia
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.
The proper level to maintain is between 35 and 40 mm Hg.
The physical environment (socioeconomic environment)
The patient's age, use of a blood thinner, and the fact she fell recently point to a
subdural hematoma.
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.
The most reliable indicator of an intraabdominal bleed is the presence of hypovolemic
shock from an unexplained source.
The major assessment parameters that produce important information within seconds of
a patient's arrival are... - ans1. Level of consciousness
The increase of the diastolic blood pressure with a narrowing pulse pressure... - ansMay
be one of the first CONCRETE measurements signaling that the patient's circulatory
status is compromised.
The host (human)
The Haddon Matrix broadened the approach and placed emphasis on
countermeasures, such were more effective than changing human behavior. Haddon
describes three phases of the injury event: - ansPre-event, Event, Post-event
The device reflects oxygen delivery to cerebral tissues and monitors temperature
The degree to which tissues resist destruction under circumstances of energy transfer
depends on... - ansTheir proximity to the impact and their structural characteristics
The assessment of circulation during the primary survey includes... - ansEarly
evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient
who has sustained blunt trauma.
The A-I mnemonic helps the trauma nurse rapidly assess for and intervene in life-
threatening injuries and identify all injuries in a systematic manner. - ansA: airway and
alertness with simultaneous cervical spinal stabilization
The agent (motor vehicle)
The "X" placed before "ABCDE" in the primary survey refers to the need to address
exsanguinating hemorrhage immediately after establishing scene safety and before
addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding,
has the potential to lead to loss of total or near total blood volume in a relatively short
period of time.
