TNCC ENA 9th Edition Pre Test
A patient arrives at the emergency department by private vehicle after sustaining an injury to
the right lower extremity while using a saw. There is a large gaping wound to the right thigh
area with significant bleeding. What is the priority intervention?
A. Elevate the extremity to the level of the heart
B. Initiate direct pressure
C. Apply a tourniquet
D. Cover the open wound with sterile saline dressings - correct answer-B. Initiate direct
pressure
Rationale: The first step inn controlling any bleeding is application of direct pressure.
A patient fell two weeks ago, striking their head. Today, the patient presented with a
persistent headache and nausea and was diagnosed with a small subdural hematoma. The
patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse
reports the patient has been anxious, restless, shaky, and vomited twice during the night.
The patient states they couldn't sleep because a young child kept coming into the room.
What is the most likely cause for these signs and symptoms?
A. Increased intracranial pressure
B. Alcohol withdrawal
C. Rhabdomyolysis
D. Pulmonary embolus - correct answer-B. Alcohol withdrawal
Rationale: Alcohol withdrawal is a common delayed condition because symptoms are
difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or
vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures.
A patient involved in a MVC has sustained a fracture to the second rib of the anterior left
chest. Which concurrent injury is most commonly associated with this fracture?
A. Blunt cardiac injury
B. Brachial plexus injury
C. Pneumothorax
D. Hemothorax - correct answer-B. Brachial plexus injury
Rationale: First and second rib fractures are most commonly associated with great vessel,
head and spinal cord, and brachial plexus injuries.
A patient with a spinal cord injury at C5 is being cared for in the emergency department
while awaiting transport to a trauma center. Which of the following represents the highest
priority for ongoing assessment and management for this patient?
A. Maintain adequate respiratory status
B. Administer balanced resuscitation fluid
, C. Perform serial assessments of neurologic function
D. Maintain core temperature - correct answer-A. Maintain adequate respiratory status
Rationale: Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function,
resulting in a paralyzed diaphragm and inability to breathe. Maintenance of respiratory
function is the highest priority.
A trauma nurse cared for a child with devastating burns two weeks ago. The nurse called in
sick for a couple of days and is now back working on the team. Which of the following would
indicate this nurse is coping well?
A. They are talking about taking the emergency nursing certification exam
B. They keep requesting to be assigned to the walk-in/ambulatory area
C. They are impatient and snap at their coworkers
D. They are thinking about transferring out of the emergency department - correct answer-A.
They are talking about taking the emergency nursing certification exam
Rationale: This is an indication the nurse is taking positive steps to advance their own
practice, a sign of resilience. B indicates the nurse is still not ready to return to their previous
level of engagement in their job. C shows signs of burnout, irritability and frustration. D
shows decreased satisfaction with the job, a sign of burnout.
An adult patient with a knife injury to the neck has an intact airway and is hemodynamically
stable. They complain of difficulty swallowing and speaking. In the primary survey, further
assessment is indicated next for which of the following conditions?
A. Damage to the cervical spine
B. An expanding pneumothorax
C. Laceration of the carotid artery
D. Injury of the thyroid gland - correct answer-A. Damage to the cervical spine
Rationale: Penetrating neck trauma may include concurrent injuries to the cervical spine and
cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability,
the other common concurrent injury is to the cervical spine.
Following a bomb explosion, fragmentation injuries from the bomb or objects in the
environment are examples of which phase of injury?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary - correct answer-B. Secondary
Rationale: The secondary phase of a blast results from flying debris, projectiles, and bomb
fragments causing lacerations or penetrating injuries.
In a patient with severe traumatic brain injury, hypocapnia causes which condition?
A patient arrives at the emergency department by private vehicle after sustaining an injury to
the right lower extremity while using a saw. There is a large gaping wound to the right thigh
area with significant bleeding. What is the priority intervention?
A. Elevate the extremity to the level of the heart
B. Initiate direct pressure
C. Apply a tourniquet
D. Cover the open wound with sterile saline dressings - correct answer-B. Initiate direct
pressure
Rationale: The first step inn controlling any bleeding is application of direct pressure.
A patient fell two weeks ago, striking their head. Today, the patient presented with a
persistent headache and nausea and was diagnosed with a small subdural hematoma. The
patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse
reports the patient has been anxious, restless, shaky, and vomited twice during the night.
The patient states they couldn't sleep because a young child kept coming into the room.
What is the most likely cause for these signs and symptoms?
A. Increased intracranial pressure
B. Alcohol withdrawal
C. Rhabdomyolysis
D. Pulmonary embolus - correct answer-B. Alcohol withdrawal
Rationale: Alcohol withdrawal is a common delayed condition because symptoms are
difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or
vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures.
A patient involved in a MVC has sustained a fracture to the second rib of the anterior left
chest. Which concurrent injury is most commonly associated with this fracture?
A. Blunt cardiac injury
B. Brachial plexus injury
C. Pneumothorax
D. Hemothorax - correct answer-B. Brachial plexus injury
Rationale: First and second rib fractures are most commonly associated with great vessel,
head and spinal cord, and brachial plexus injuries.
A patient with a spinal cord injury at C5 is being cared for in the emergency department
while awaiting transport to a trauma center. Which of the following represents the highest
priority for ongoing assessment and management for this patient?
A. Maintain adequate respiratory status
B. Administer balanced resuscitation fluid
, C. Perform serial assessments of neurologic function
D. Maintain core temperature - correct answer-A. Maintain adequate respiratory status
Rationale: Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function,
resulting in a paralyzed diaphragm and inability to breathe. Maintenance of respiratory
function is the highest priority.
A trauma nurse cared for a child with devastating burns two weeks ago. The nurse called in
sick for a couple of days and is now back working on the team. Which of the following would
indicate this nurse is coping well?
A. They are talking about taking the emergency nursing certification exam
B. They keep requesting to be assigned to the walk-in/ambulatory area
C. They are impatient and snap at their coworkers
D. They are thinking about transferring out of the emergency department - correct answer-A.
They are talking about taking the emergency nursing certification exam
Rationale: This is an indication the nurse is taking positive steps to advance their own
practice, a sign of resilience. B indicates the nurse is still not ready to return to their previous
level of engagement in their job. C shows signs of burnout, irritability and frustration. D
shows decreased satisfaction with the job, a sign of burnout.
An adult patient with a knife injury to the neck has an intact airway and is hemodynamically
stable. They complain of difficulty swallowing and speaking. In the primary survey, further
assessment is indicated next for which of the following conditions?
A. Damage to the cervical spine
B. An expanding pneumothorax
C. Laceration of the carotid artery
D. Injury of the thyroid gland - correct answer-A. Damage to the cervical spine
Rationale: Penetrating neck trauma may include concurrent injuries to the cervical spine and
cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability,
the other common concurrent injury is to the cervical spine.
Following a bomb explosion, fragmentation injuries from the bomb or objects in the
environment are examples of which phase of injury?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary - correct answer-B. Secondary
Rationale: The secondary phase of a blast results from flying debris, projectiles, and bomb
fragments causing lacerations or penetrating injuries.
In a patient with severe traumatic brain injury, hypocapnia causes which condition?
