TNCC 9TH EDITION FINAL EXAM
1. An adult patient who sustained a severe head trauma has been
intubated and is being manually ventilated via a bag-mask device at a
rate of 18 breaths/minute. The patient has received one intravenous
fluid bolus of 500 mL of warmed isotonic crystalloid solution. The
PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is
142/70 mm Hg. What is the most important intervention to manage the
cerebral blood flow?
A. Decrease the rate of manual ventilation
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.: A. Decrease the rate of
manual ventilation
Rationale: the patient’s PaCO2 of 30 mmHg indicates hyperventilation,
which can lead to cerebral vasoconstriction and reduced cerebral blood
flow. In severe head trauma, maintaining adequate cerebral perfusion is
crucial to prevent secondary brain injury. While a mild degree of
hyperventilation might be used temporarily to reduce intracranial pressure,
prolonged and excessive hyperventilation can compromise cerebral blood
flow and oxygen delivery. Therefore, decreasing the ventilation rate helps
to normalize PaCO2 and optimize cerebral blood flow.
2. Which of the following situations could cause functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of one's self-image
D. Destruction of the patient's car: B. Amputation of a limb
Rationale: Preparation and Ongoing Care\Psychosocial Aspects
,Functional grief relates to the loss of body function or body parts such as
amputation of a limb, paralysis, or loss of sight.
3. What is the most important consideration during the initial
assessment when caring for an older adult who has sustained serious
injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician: B. Medical history including
current medications
4. An older adult presents to the emergency department with
complaints of dizziness, headache, and nausea. The patient was
involved in a motor vehicle collision 10 days ago. There was no loss
of consciousness and a hematoma is noted to the forehead. The
patient is currently on anticoagulant therapy. What is most likely the
cause of their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
C. Diffuse axonal injury
D. Post-concussive syndrome: D. Post-concussive syndrome
Rationale: Special Populations\Older Adult
Post-concussive syndrome can occur days to weeks after injury or trauma.
The other three conditions present as a more rapid decline, especially in
patients who are on anticoagulants.
5. A severely injured patient has been intubated and is being
mechanically ventilated. The patient has received a balanced
resuscitation including multiple blood products. Under which
,circumstance will it be harder for the hemoglobin to release oxygen to
the tissues?
A. Decreased pH
B. Elevated carbon dioxide level
C. Decreased body temperature
D. Increased metabolic demand: C. Decreased body temperature
Rationale: Primary Assessment\Airway and Ventilation
If the blood is not sufficiently warmed when transfused, it can produce
hypothermia. In the oxyhemoglobin dissociation curve, a shift to the left
increases the affinity of hemoglobin for oxygen making it harder to release
for use by the tissues. Factors that can cause this shift include an elevated
pH, decreased carbon dioxide, decreased temperature, and low metabolic
demand.
6. You are caring for a patient who was thrown from a bike and was
not wearing a helmet. While performing the head-to-toe assessment,
you note clear drainage from the right ear. Which of the following is
the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam.: C. Notify the physician
7. When should the definitive calculation for intravenous fluid
resuscitation rate be performed for a patient with burns?
A. As soon as the patient arrives
, B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment: B. After removal of clothing
Rationale: Musculoskeletal and Wounds\Burns Some fluid will be given
initially, but an accurate fluid total is based on percentage of total body
surface area which requires a good skin assessment and is calculated after
clothing is removed.
8. In a motor vehicle collision, which injury pathway is most likely to
increase the patient's morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover: B. Ejection
9. A patient with a lower extremity fracture complains of severe pain
and tightness in his calf, minimally relieved by pain medications.
Which of the following is the priority nursing intervention?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg: C. Elevating the leg
to the level of the heart
Rationale: Musculoskeletal and Wounds\Musculoskeletal
This patient is exhibiting signs of possible compartment syndrome which is
a dangerous complication of fractured extremities. The pain is often out of
proportion to the injury and might not respond to pain medications. Elevate
the limb to the level of the heart to decrease dependent edema but not
1. An adult patient who sustained a severe head trauma has been
intubated and is being manually ventilated via a bag-mask device at a
rate of 18 breaths/minute. The patient has received one intravenous
fluid bolus of 500 mL of warmed isotonic crystalloid solution. The
PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 92%. BP is
142/70 mm Hg. What is the most important intervention to manage the
cerebral blood flow?
A. Decrease the rate of manual ventilation
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.: A. Decrease the rate of
manual ventilation
Rationale: the patient’s PaCO2 of 30 mmHg indicates hyperventilation,
which can lead to cerebral vasoconstriction and reduced cerebral blood
flow. In severe head trauma, maintaining adequate cerebral perfusion is
crucial to prevent secondary brain injury. While a mild degree of
hyperventilation might be used temporarily to reduce intracranial pressure,
prolonged and excessive hyperventilation can compromise cerebral blood
flow and oxygen delivery. Therefore, decreasing the ventilation rate helps
to normalize PaCO2 and optimize cerebral blood flow.
2. Which of the following situations could cause functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of one's self-image
D. Destruction of the patient's car: B. Amputation of a limb
Rationale: Preparation and Ongoing Care\Psychosocial Aspects
,Functional grief relates to the loss of body function or body parts such as
amputation of a limb, paralysis, or loss of sight.
3. What is the most important consideration during the initial
assessment when caring for an older adult who has sustained serious
injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician: B. Medical history including
current medications
4. An older adult presents to the emergency department with
complaints of dizziness, headache, and nausea. The patient was
involved in a motor vehicle collision 10 days ago. There was no loss
of consciousness and a hematoma is noted to the forehead. The
patient is currently on anticoagulant therapy. What is most likely the
cause of their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
C. Diffuse axonal injury
D. Post-concussive syndrome: D. Post-concussive syndrome
Rationale: Special Populations\Older Adult
Post-concussive syndrome can occur days to weeks after injury or trauma.
The other three conditions present as a more rapid decline, especially in
patients who are on anticoagulants.
5. A severely injured patient has been intubated and is being
mechanically ventilated. The patient has received a balanced
resuscitation including multiple blood products. Under which
,circumstance will it be harder for the hemoglobin to release oxygen to
the tissues?
A. Decreased pH
B. Elevated carbon dioxide level
C. Decreased body temperature
D. Increased metabolic demand: C. Decreased body temperature
Rationale: Primary Assessment\Airway and Ventilation
If the blood is not sufficiently warmed when transfused, it can produce
hypothermia. In the oxyhemoglobin dissociation curve, a shift to the left
increases the affinity of hemoglobin for oxygen making it harder to release
for use by the tissues. Factors that can cause this shift include an elevated
pH, decreased carbon dioxide, decreased temperature, and low metabolic
demand.
6. You are caring for a patient who was thrown from a bike and was
not wearing a helmet. While performing the head-to-toe assessment,
you note clear drainage from the right ear. Which of the following is
the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam.: C. Notify the physician
7. When should the definitive calculation for intravenous fluid
resuscitation rate be performed for a patient with burns?
A. As soon as the patient arrives
, B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment: B. After removal of clothing
Rationale: Musculoskeletal and Wounds\Burns Some fluid will be given
initially, but an accurate fluid total is based on percentage of total body
surface area which requires a good skin assessment and is calculated after
clothing is removed.
8. In a motor vehicle collision, which injury pathway is most likely to
increase the patient's morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover: B. Ejection
9. A patient with a lower extremity fracture complains of severe pain
and tightness in his calf, minimally relieved by pain medications.
Which of the following is the priority nursing intervention?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg: C. Elevating the leg
to the level of the heart
Rationale: Musculoskeletal and Wounds\Musculoskeletal
This patient is exhibiting signs of possible compartment syndrome which is
a dangerous complication of fractured extremities. The pain is often out of
proportion to the injury and might not respond to pain medications. Elevate
the limb to the level of the heart to decrease dependent edema but not
