TNCC EXAM COMPLETE QUESTION AND ANSWERS.
1. Preparation and Triage
2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
3. Reevaluation (consideration of transfer)
4. Secondary Survey (HI) with reevaluation adjuncts
5. Reevaluation and post resuscitation care
6. Definitive care of transfer to an appropriate trauma nurse Initial AssessmentANSWERS
1. A- airway and Alertness with simultaneous cervical spinal stabilization
2. B- breathing and Ventilation
3. circulation and control of hemorrhage
4. D - disability (neurologic status)
5. F - full set of vitals and Family presence
6. G - Get resuscitation adjuncts
L- Lab results (arterial gases, blood type and crossmatch)
M- monitor for continuous cardiac rhythm and rate assessment
N- naso or orogastric tube consideration
O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02)
monitoring and capnopgraphy
H- History and head to toe assessment
I- Inspect posterior surfaces ABCDEFGHIANSWERS Before the arrival of the pt
When should PPE be placed:ANSWERS Pt is at hospital in the right amount of
time, right care, right trauma facility, right resourcesSafe Care:ANSWERS
Uncontrolled Hemorrhage Major cause of preventable death:ANSWERS
reorganize care to C-ABC If uncontrolled hemorrhage ..ANSWERS Used at the
beginning of the initial assessment
1. A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear.
2. V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to
respond, an airway adjunct may be needed to keep the tongue from obstructing the airway.
3. P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his
or her airway adjunct may need to be placed while further assessment is made to determine the
need for intubation.
4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone
to chk in the pt is pulseless while assessing if the cause of the problem is the airway. Airway
and AVPU:ANSWERS ask pt to pen his or her mouth While assessing airway the
patient is alert and responds to verbal stimuli you should..ANSWERS jaw thrust
maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust
procedure should be done by two providers. One provider can maintain c-spine and the other can
perform the jaw thrust maneuver. While assessing airway pt is unable to open mouth,
responds only to pain, or is unresponsive you should..ANSWERS 1. The tongue
obstructing the airway
2. loose or missing teeth
3. foreign objects
4. blood, vomit, or secretions'
5. edema
, 6. burns or evidence of inhalation injury
Auscultiate or listen for:
1. Obstructive airway sounds such as snoring or gurgling
2. Possible occlusive maxillofacial bony deformity
3. Subcutaneous emphysema Inspect the mouth for:ANSWERS 1. Check the presence
of adequate rise and fall of the chest with assisted ventilation
2. Absence of gurgling on auscultation over the epigastrium
3. Bilateral breath sounds present on auscultation
4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor If the pt has a
definitive airway in what should you do?ANSWERS 1. Suction the airway
2, Use care to avoid stimulating the gag reflex
3. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device
If foreign body is noted, remove it carefully with forceps or another appropriate method If
Airway is not patentANSWERS 1. Apnea
2. GCS 8 or less
3. Maxillary fractures
4. Evidence of inhalation injury (facial burns)
5. Laryngeal or tracheal injury or neck hematoma
6. High risk of aspiration and patients inability to protect the airway
7. Compromised or ineffective ventilation Following conditions might require a definitive
airwayANSWERS Breathing: To assess breathing expose the chest:
1. Inspect for
a. spontaneous breathing
b. symmetrical rise and fall
c. depth, pattern, and rate of respiration
d. signs of difficulty breathing such as accessory muscle use
e. skin color (normal, pale, flushed, cyanotic)
f. contusions, abrasions, deformities (flail chest)
g. open pneumothoraces (sucking chest wounds)
h. JVD
i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) BANSWERS
tracheal deviation and jvd Late signs of tension pneumo:ANSWERS 1. equal
breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth
intercostal space at the axillary line Auscultate the chest for:ANSWERS 1. bony
fractures and possible rib fractures, which may impact ventilation
2. palpate for crepitus
3. subcutaneous emphysema which may be a sign for a pneumothorax
4. soft tissue injury Palpate the chest forANSWERS 1. open the airway, use jaw
thrust
2. insert an oral airway
3. assist ventilations with a bag mask
4. prepare for definitive airway If breathing is absent..ANSWERS trauma its
need early supplemental oxygen, start with 15 mL O2 and titrate oxygen delivery. Oxygen on
trauma patientsANSWERS Circulation and Control of Hemorrhage
1. Preparation and Triage
2. Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
3. Reevaluation (consideration of transfer)
4. Secondary Survey (HI) with reevaluation adjuncts
5. Reevaluation and post resuscitation care
6. Definitive care of transfer to an appropriate trauma nurse Initial AssessmentANSWERS
1. A- airway and Alertness with simultaneous cervical spinal stabilization
2. B- breathing and Ventilation
3. circulation and control of hemorrhage
4. D - disability (neurologic status)
5. F - full set of vitals and Family presence
6. G - Get resuscitation adjuncts
L- Lab results (arterial gases, blood type and crossmatch)
M- monitor for continuous cardiac rhythm and rate assessment
N- naso or orogastric tube consideration
O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02)
monitoring and capnopgraphy
H- History and head to toe assessment
I- Inspect posterior surfaces ABCDEFGHIANSWERS Before the arrival of the pt
When should PPE be placed:ANSWERS Pt is at hospital in the right amount of
time, right care, right trauma facility, right resourcesSafe Care:ANSWERS
Uncontrolled Hemorrhage Major cause of preventable death:ANSWERS
reorganize care to C-ABC If uncontrolled hemorrhage ..ANSWERS Used at the
beginning of the initial assessment
1. A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear.
2. V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to
respond, an airway adjunct may be needed to keep the tongue from obstructing the airway.
3. P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his
or her airway adjunct may need to be placed while further assessment is made to determine the
need for intubation.
4. U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone
to chk in the pt is pulseless while assessing if the cause of the problem is the airway. Airway
and AVPU:ANSWERS ask pt to pen his or her mouth While assessing airway the
patient is alert and responds to verbal stimuli you should..ANSWERS jaw thrust
maneuver to open airway and assess for obstruction. If pt has a suspected csi, the jaw thrust
procedure should be done by two providers. One provider can maintain c-spine and the other can
perform the jaw thrust maneuver. While assessing airway pt is unable to open mouth,
responds only to pain, or is unresponsive you should..ANSWERS 1. The tongue
obstructing the airway
2. loose or missing teeth
3. foreign objects
4. blood, vomit, or secretions'
5. edema
, 6. burns or evidence of inhalation injury
Auscultiate or listen for:
1. Obstructive airway sounds such as snoring or gurgling
2. Possible occlusive maxillofacial bony deformity
3. Subcutaneous emphysema Inspect the mouth for:ANSWERS 1. Check the presence
of adequate rise and fall of the chest with assisted ventilation
2. Absence of gurgling on auscultation over the epigastrium
3. Bilateral breath sounds present on auscultation
4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor If the pt has a
definitive airway in what should you do?ANSWERS 1. Suction the airway
2, Use care to avoid stimulating the gag reflex
3. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device
If foreign body is noted, remove it carefully with forceps or another appropriate method If
Airway is not patentANSWERS 1. Apnea
2. GCS 8 or less
3. Maxillary fractures
4. Evidence of inhalation injury (facial burns)
5. Laryngeal or tracheal injury or neck hematoma
6. High risk of aspiration and patients inability to protect the airway
7. Compromised or ineffective ventilation Following conditions might require a definitive
airwayANSWERS Breathing: To assess breathing expose the chest:
1. Inspect for
a. spontaneous breathing
b. symmetrical rise and fall
c. depth, pattern, and rate of respiration
d. signs of difficulty breathing such as accessory muscle use
e. skin color (normal, pale, flushed, cyanotic)
f. contusions, abrasions, deformities (flail chest)
g. open pneumothoraces (sucking chest wounds)
h. JVD
i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum) BANSWERS
tracheal deviation and jvd Late signs of tension pneumo:ANSWERS 1. equal
breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth
intercostal space at the axillary line Auscultate the chest for:ANSWERS 1. bony
fractures and possible rib fractures, which may impact ventilation
2. palpate for crepitus
3. subcutaneous emphysema which may be a sign for a pneumothorax
4. soft tissue injury Palpate the chest forANSWERS 1. open the airway, use jaw
thrust
2. insert an oral airway
3. assist ventilations with a bag mask
4. prepare for definitive airway If breathing is absent..ANSWERS trauma its
need early supplemental oxygen, start with 15 mL O2 and titrate oxygen delivery. Oxygen on
trauma patientsANSWERS Circulation and Control of Hemorrhage
