TNCC 9TH EDITION EXAM READINESS VALIDATION: THE
ULTIMATE COMPREHENSIVE TRAUMA NURSING
ASSESSMENT WITH EVERY FREQUENTLY TESTED
QUESTION, EXPERT-RATIONALE BREAKDOWNS, 100%
VERIFIED CORRECT ANSWERS, AND PROVEN STRATEGIES
TO GUARANTEE YOUR FIRST-TRY PASS FOR EMERGENCY
NURSES
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 mmHg (4.0 kPa), and the pulse
oximetry is 92%. Blood pressure is 142/70 mmHg. What is the most important
intervention to manage the cerebral blood flow?
CORRECT ANS: Decrease the rate of manual ventilation
Expert Rationale
In a patient with severe head trauma, the goal of ventilation is to maintain
normocarbia, with a PaCO2 typically between 35 and 45 mmHg. The patient's
PaCO2 is 30 mmHg, which indicates hyperventilation and hypocarbia.
Hyperventilation causes cerebral vasoconstriction, which reduces cerebral blood
flow and can worsen cerebral ischemia. While brief periods of hyperventilation
may be used to temporize impending herniation, prophylactic hyperventilation is
not recommended because it can compromise cerebral perfusion. The manual
ventilation rate of 18 breaths per minute is too high for this patient and is driving
the PaCO2 down. Therefore, the most important intervention is to decrease the
rate of manual ventilation to allow the PaCO2 to rise toward the normal range,
thereby improving cerebral blood flow. The other parameters, including blood
pressure and oxygen saturation, are acceptable, and the fluid bolus has already
been given. Decreasing the ventilation rate is the priority intervention.
,DIF: Cognitive Level: Apply (Application)
TOP: Neurological Trauma
MSC: NCLEX: Physiological Integrity
A patient has been in the emergency department for several hours waiting to be
admitted. They sustained multiple rib fractures and a femur fracture after a fall.
The patient has been awake, alert, and complaining of leg pain. Their spouse
reported that the patient suddenly became anxious and confused. Upon
reassessment, the patient is restless, with respiratory distress and petechiae to
his neck. The patient is exhibiting signs and symptoms most commonly
associated with which of the following conditions?
CORRECT ANS: Fat embolism
Expert Rationale
Fat embolism syndrome is a serious complication that can occur after long bone
fractures, particularly femur fractures, and pelvic fractures. It typically develops
12 to 72 hours after the injury. The classic triad of fat embolism syndrome
includes respiratory distress, neurological changes such as confusion and
anxiety, and a petechial rash, often seen on the neck, chest, axillae, and
conjunctiva. The patient in this scenario has multiple risk factors, including a
femur fracture, and is exhibiting all three components of the classic triad. The
sudden onset of anxiety, confusion, restlessness, respiratory distress, and
petechiae to the neck is highly consistent with fat embolism syndrome. Other
conditions such as pulmonary embolism, compartment syndrome, or delirium
could be considered, but the presence of petechiae with neurological and
respiratory symptoms after a long bone fracture strongly points to fat embolism.
DIF: Cognitive Level: Apply (Application)
TOP: Musculoskeletal Trauma
MSC: NCLEX: Physiological Integrity
Three adult patients present at different times during a 1-hour period with a high
fever, fatigue, and headache. All 3 patients have a rash which started on their
mouth, face, and arms with progression to the chest and abdomen. They all
visited the same grocery store within the last week. What is the most appropriate
intervention from triage for these patients?
CORRECT ANS: Immediately initiate contact precautions
,Expert Rationale
The presentation of three patients within a short time frame with fever, fatigue,
headache, and a rash that started on the mouth, face, and arms and progressed
to the chest and abdomen, all with a common exposure at a grocery store, is
highly suspicious for a communicable disease outbreak. The rash description is
consistent with a viral exanthem, and the clustering of cases with a shared
exposure raises concern for a disease such as measles, rubella, or another highly
contagious infectious disease. The most appropriate intervention from triage is to
immediately initiate contact precautions, which in this case should also include
airborne precautions if measles is suspected, to prevent further transmission to
other patients, visitors, and staff. Isolation should be initiated promptly, and the
local health department should be notified. Contact precautions are the minimum
immediate action, and in many cases airborne precautions would also be
warranted. Therefore, immediately initiating contact precautions is the correct
answer.
DIF: Cognitive Level: Apply (Application)
TOP: Infectious Disease and Emergency Preparedness
MSC: NCLEX: Safe and Effective Care Environment
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?
CORRECT ANS: Post-concussive syndrome
Expert Rationale
Post-concussive syndrome is a constellation of symptoms that can occur after a
mild traumatic brain injury, even without loss of consciousness. Symptoms
include headache, dizziness, nausea, fatigue, difficulty concentrating, and mood
changes. They can persist for days to weeks after the initial injury. In this patient,
the history of a motor vehicle collision 10 days ago with a forehead hematoma
and no loss of consciousness, along with current symptoms of dizziness,
headache, and nausea, is consistent with post-concussive syndrome. However,
the fact that the patient is on anticoagulant therapy raises concern for a delayed
intracranial hemorrhage, such as a chronic subdural hematoma, which can
present with similar symptoms. While post-concussive syndrome is the most
likely cause based on the typical presentation, the anticoagulant use is a critical
risk factor that must be considered. In a clinical setting, imaging would be
, warranted to rule out intracranial hemorrhage. Based on the information
provided, post-concussive syndrome is the most likely cause of the symptoms.
DIF: Cognitive Level: Apply (Application)
TOP: Neurological Trauma
MSC: NCLEX: Physiological Integrity
A patient with a lower extremity fracture complains of severe pain and tightness
in his calf, minimally relieved by pain medication. Which of the following is the
priority nursing intervention?
CORRECT ANS: Elevating the leg to the LEVEL of the heart
Expert Rationale
The patient's symptoms of severe pain and tightness in the calf that is minimally
relieved by pain medication are highly concerning for acute compartment
syndrome. Compartment syndrome occurs when increased pressure within a
muscle compartment compromises circulation and nerve function. The priority
nursing intervention is to elevate the affected extremity to the level of the heart,
not above it. Elevating above the level of the heart can reduce arterial perfusion
pressure and worsen ischemia. The limb should be kept at heart level to maintain
perfusion while reducing venous congestion. Compartment syndrome is a
surgical emergency, and the nurse should also notify the physician immediately,
assess neurovascular status, remove any constrictive dressings or casts, and
prepare for possible fasciotomy. However, among the options provided, elevating
the leg to the level of the heart is the correct intervention for a suspected
compression or crush injury. For a regular fracture without suspected
compartment syndrome, elevation above the heart may be appropriate to reduce
edema, but in this case, the symptoms suggest compartment syndrome, so
elevation should be at heart level.
DIF: Cognitive Level: Apply (Application)
TOP: Musculoskeletal Trauma
MSC: NCLEX: Physiological Integrity
A 35-year-old male presents with facial trauma after being struck in the face with
a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is
suspected?
CORRECT ANS: Globe rupture
ULTIMATE COMPREHENSIVE TRAUMA NURSING
ASSESSMENT WITH EVERY FREQUENTLY TESTED
QUESTION, EXPERT-RATIONALE BREAKDOWNS, 100%
VERIFIED CORRECT ANSWERS, AND PROVEN STRATEGIES
TO GUARANTEE YOUR FIRST-TRY PASS FOR EMERGENCY
NURSES
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 mmHg (4.0 kPa), and the pulse
oximetry is 92%. Blood pressure is 142/70 mmHg. What is the most important
intervention to manage the cerebral blood flow?
CORRECT ANS: Decrease the rate of manual ventilation
Expert Rationale
In a patient with severe head trauma, the goal of ventilation is to maintain
normocarbia, with a PaCO2 typically between 35 and 45 mmHg. The patient's
PaCO2 is 30 mmHg, which indicates hyperventilation and hypocarbia.
Hyperventilation causes cerebral vasoconstriction, which reduces cerebral blood
flow and can worsen cerebral ischemia. While brief periods of hyperventilation
may be used to temporize impending herniation, prophylactic hyperventilation is
not recommended because it can compromise cerebral perfusion. The manual
ventilation rate of 18 breaths per minute is too high for this patient and is driving
the PaCO2 down. Therefore, the most important intervention is to decrease the
rate of manual ventilation to allow the PaCO2 to rise toward the normal range,
thereby improving cerebral blood flow. The other parameters, including blood
pressure and oxygen saturation, are acceptable, and the fluid bolus has already
been given. Decreasing the ventilation rate is the priority intervention.
,DIF: Cognitive Level: Apply (Application)
TOP: Neurological Trauma
MSC: NCLEX: Physiological Integrity
A patient has been in the emergency department for several hours waiting to be
admitted. They sustained multiple rib fractures and a femur fracture after a fall.
The patient has been awake, alert, and complaining of leg pain. Their spouse
reported that the patient suddenly became anxious and confused. Upon
reassessment, the patient is restless, with respiratory distress and petechiae to
his neck. The patient is exhibiting signs and symptoms most commonly
associated with which of the following conditions?
CORRECT ANS: Fat embolism
Expert Rationale
Fat embolism syndrome is a serious complication that can occur after long bone
fractures, particularly femur fractures, and pelvic fractures. It typically develops
12 to 72 hours after the injury. The classic triad of fat embolism syndrome
includes respiratory distress, neurological changes such as confusion and
anxiety, and a petechial rash, often seen on the neck, chest, axillae, and
conjunctiva. The patient in this scenario has multiple risk factors, including a
femur fracture, and is exhibiting all three components of the classic triad. The
sudden onset of anxiety, confusion, restlessness, respiratory distress, and
petechiae to the neck is highly consistent with fat embolism syndrome. Other
conditions such as pulmonary embolism, compartment syndrome, or delirium
could be considered, but the presence of petechiae with neurological and
respiratory symptoms after a long bone fracture strongly points to fat embolism.
DIF: Cognitive Level: Apply (Application)
TOP: Musculoskeletal Trauma
MSC: NCLEX: Physiological Integrity
Three adult patients present at different times during a 1-hour period with a high
fever, fatigue, and headache. All 3 patients have a rash which started on their
mouth, face, and arms with progression to the chest and abdomen. They all
visited the same grocery store within the last week. What is the most appropriate
intervention from triage for these patients?
CORRECT ANS: Immediately initiate contact precautions
,Expert Rationale
The presentation of three patients within a short time frame with fever, fatigue,
headache, and a rash that started on the mouth, face, and arms and progressed
to the chest and abdomen, all with a common exposure at a grocery store, is
highly suspicious for a communicable disease outbreak. The rash description is
consistent with a viral exanthem, and the clustering of cases with a shared
exposure raises concern for a disease such as measles, rubella, or another highly
contagious infectious disease. The most appropriate intervention from triage is to
immediately initiate contact precautions, which in this case should also include
airborne precautions if measles is suspected, to prevent further transmission to
other patients, visitors, and staff. Isolation should be initiated promptly, and the
local health department should be notified. Contact precautions are the minimum
immediate action, and in many cases airborne precautions would also be
warranted. Therefore, immediately initiating contact precautions is the correct
answer.
DIF: Cognitive Level: Apply (Application)
TOP: Infectious Disease and Emergency Preparedness
MSC: NCLEX: Safe and Effective Care Environment
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?
CORRECT ANS: Post-concussive syndrome
Expert Rationale
Post-concussive syndrome is a constellation of symptoms that can occur after a
mild traumatic brain injury, even without loss of consciousness. Symptoms
include headache, dizziness, nausea, fatigue, difficulty concentrating, and mood
changes. They can persist for days to weeks after the initial injury. In this patient,
the history of a motor vehicle collision 10 days ago with a forehead hematoma
and no loss of consciousness, along with current symptoms of dizziness,
headache, and nausea, is consistent with post-concussive syndrome. However,
the fact that the patient is on anticoagulant therapy raises concern for a delayed
intracranial hemorrhage, such as a chronic subdural hematoma, which can
present with similar symptoms. While post-concussive syndrome is the most
likely cause based on the typical presentation, the anticoagulant use is a critical
risk factor that must be considered. In a clinical setting, imaging would be
, warranted to rule out intracranial hemorrhage. Based on the information
provided, post-concussive syndrome is the most likely cause of the symptoms.
DIF: Cognitive Level: Apply (Application)
TOP: Neurological Trauma
MSC: NCLEX: Physiological Integrity
A patient with a lower extremity fracture complains of severe pain and tightness
in his calf, minimally relieved by pain medication. Which of the following is the
priority nursing intervention?
CORRECT ANS: Elevating the leg to the LEVEL of the heart
Expert Rationale
The patient's symptoms of severe pain and tightness in the calf that is minimally
relieved by pain medication are highly concerning for acute compartment
syndrome. Compartment syndrome occurs when increased pressure within a
muscle compartment compromises circulation and nerve function. The priority
nursing intervention is to elevate the affected extremity to the level of the heart,
not above it. Elevating above the level of the heart can reduce arterial perfusion
pressure and worsen ischemia. The limb should be kept at heart level to maintain
perfusion while reducing venous congestion. Compartment syndrome is a
surgical emergency, and the nurse should also notify the physician immediately,
assess neurovascular status, remove any constrictive dressings or casts, and
prepare for possible fasciotomy. However, among the options provided, elevating
the leg to the level of the heart is the correct intervention for a suspected
compression or crush injury. For a regular fracture without suspected
compartment syndrome, elevation above the heart may be appropriate to reduce
edema, but in this case, the symptoms suggest compartment syndrome, so
elevation should be at heart level.
DIF: Cognitive Level: Apply (Application)
TOP: Musculoskeletal Trauma
MSC: NCLEX: Physiological Integrity
A 35-year-old male presents with facial trauma after being struck in the face with
a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is
suspected?
CORRECT ANS: Globe rupture
