TNCC 9TH EDITION EXAMS TESTS PAPER QUESTIONS AND
ANSWERS FIRM A+
—
✔✔*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.
✔✔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 - ✔✔post-concussive syndrome
✔✔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
✔✔A patient involved in a high-speed rollover is complaining of increased difficulty
breathing. There is a small penetrating wound to the sixth intercostal space in the left
lateral chest. Which finding is most consistent with an injury to the diaphragm? -
✔✔Bowel sounds heard in the left lower chest
A ruptured diaphragm is a potentially life-threatening injury. The patient will most likely
have decreased breath sounds on the affected side along with pain, which may radiate
to the left shoulder. However, these signs do not specifically implicate an injury to the
diaphragm. Auscultation of bowel sounds in the chest indicates that abdominal contents
have herniated up into the chest through a defect in the diaphragm.
✔✔*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?
A. Acute lung injury
B. Fat embolism
C. Pneumothorax
D. Pulmonary contusion - ✔✔B. Fat embolism
✔✔*Three adults present at different times during a one-hour period with a high fever,
fatigue, and headache. All three 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?
A. Move them to a decontamination area
B. Mask the patients and send them to the waiting room
C. Immediately initiate isolation precautions
D. Send them to the waiting room without a mask - ✔✔C. Immediately initiate isolation
precautions
The fact that multiple people with different demographics are appearing with similar
signs and symptoms would alert the nurse to a possible biological exposure. These
patients should be placed in isolation to prevent possible spread until further
determination can be made.
✔✔*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?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment - ✔✔B.Globe rupture
✔✔*A patient has been diagnosed with an incomplete spinal cord injury at L1. Which
finding would indicate sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area - ✔✔C.Voluntary anal sphincter tone
, ✔✔While caring for a trauma patient in the emergency department, what finding raises
suspicion of a complete spinal cord injury?
A.Weakness in the lower extremities
B.Urinary incontinence
C.Sacral sparing
D.Spastic paralysis of the legs - ✔✔urinary incontinence
✔✔*Which blood pressure finding is associated with early or compensated hypovolemic
shock? - ✔✔B. Rising diastolic
In the compensated stage of shock, the diastolic blood pressure rises causing a
narrowed pulse pressure in a attempt to compensate for compromised circulation.
Systolic blood pressure is usually within a normal range.
✔✔Which of the following is true about the log-roll maneuver? - ✔✔It should be avoided
with a suspected spine injury prior to imaging
✔✔*A patient has uncontrolled bleeding from a wound to his right upper extremity. What
is the priority intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding - ✔✔C.Apply direct pressure to the wound
✔✔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
✔✔???*Using the American College of Surgeons screening guidelines, what
assessment finding would prompt the nurse to prepare a patient for cervical spine
imaging?
A.Alert with no neurologic deficits or neck pain
B.Multiple abrasions to the extremities
C.Ecchymosis to the flank
D.Responds to verbal stimulation using AVPU - ✔✔A.Alert with no neurologic deficits
D.Responds to verbal stimulation using AVPU
Clinical decision tools are available to assess the patient's need for cervical spine
imaging following suspected spinal cord trauma: The Canadian C-Spine Rule, the
ANSWERS FIRM A+
—
✔✔*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.
✔✔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 - ✔✔post-concussive syndrome
✔✔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
✔✔A patient involved in a high-speed rollover is complaining of increased difficulty
breathing. There is a small penetrating wound to the sixth intercostal space in the left
lateral chest. Which finding is most consistent with an injury to the diaphragm? -
✔✔Bowel sounds heard in the left lower chest
A ruptured diaphragm is a potentially life-threatening injury. The patient will most likely
have decreased breath sounds on the affected side along with pain, which may radiate
to the left shoulder. However, these signs do not specifically implicate an injury to the
diaphragm. Auscultation of bowel sounds in the chest indicates that abdominal contents
have herniated up into the chest through a defect in the diaphragm.
✔✔*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?
A. Acute lung injury
B. Fat embolism
C. Pneumothorax
D. Pulmonary contusion - ✔✔B. Fat embolism
✔✔*Three adults present at different times during a one-hour period with a high fever,
fatigue, and headache. All three 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?
A. Move them to a decontamination area
B. Mask the patients and send them to the waiting room
C. Immediately initiate isolation precautions
D. Send them to the waiting room without a mask - ✔✔C. Immediately initiate isolation
precautions
The fact that multiple people with different demographics are appearing with similar
signs and symptoms would alert the nurse to a possible biological exposure. These
patients should be placed in isolation to prevent possible spread until further
determination can be made.
✔✔*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?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment - ✔✔B.Globe rupture
✔✔*A patient has been diagnosed with an incomplete spinal cord injury at L1. Which
finding would indicate sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area - ✔✔C.Voluntary anal sphincter tone
, ✔✔While caring for a trauma patient in the emergency department, what finding raises
suspicion of a complete spinal cord injury?
A.Weakness in the lower extremities
B.Urinary incontinence
C.Sacral sparing
D.Spastic paralysis of the legs - ✔✔urinary incontinence
✔✔*Which blood pressure finding is associated with early or compensated hypovolemic
shock? - ✔✔B. Rising diastolic
In the compensated stage of shock, the diastolic blood pressure rises causing a
narrowed pulse pressure in a attempt to compensate for compromised circulation.
Systolic blood pressure is usually within a normal range.
✔✔Which of the following is true about the log-roll maneuver? - ✔✔It should be avoided
with a suspected spine injury prior to imaging
✔✔*A patient has uncontrolled bleeding from a wound to his right upper extremity. What
is the priority intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding - ✔✔C.Apply direct pressure to the wound
✔✔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
✔✔???*Using the American College of Surgeons screening guidelines, what
assessment finding would prompt the nurse to prepare a patient for cervical spine
imaging?
A.Alert with no neurologic deficits or neck pain
B.Multiple abrasions to the extremities
C.Ecchymosis to the flank
D.Responds to verbal stimulation using AVPU - ✔✔A.Alert with no neurologic deficits
D.Responds to verbal stimulation using AVPU
Clinical decision tools are available to assess the patient's need for cervical spine
imaging following suspected spinal cord trauma: The Canadian C-Spine Rule, the
