TNCC 9th Edition Questions and Answers (2024 edition)

just keep evaluating - vipp - What does the J stand for at the end of the secondary survery? vital signs, injuries/interventions, primary survey, pain - What does VIPP stand for? flank - During the head-to-toe, where would you find Grey-Turner's sign? umbilicus - During the head-to-toe, where would you find Cullen's sign? inspecting posterior - What is sometimes deferred at the end of the head-to-toe? AFTER head-to-toe, BEFORE J (VIPP) - Antibiotics, consults, head CT, imaging, law enforcement, mandatory reporting, psychosocial support, social services, splinting, tetanus, and wound care are all interventions that you do AFTER and before WHAT? Medical records, prehospital report, SAMPLE - What three items are obtained during the pertinent history assessment? Distraction, family presence, padding bony prominences, repositioning, splinting, verbal reassurance - What are examples of nonpharmacologic measures? (must identify at least one during testing) all patients - For whom is capnography highly recommended? EKG - In step M of "Get Adjuncts", what else might be indicated besides cardiac monitor? blankets, room temp increase, warmed fluids, warming lights - In Step 16 of "Exposure and Environment", you must name at least one of these interventions: In Step 15 of "Exposure and Environment" - At what point PRIOR TO the head-to-toe is the patient inspected for obvious injuries? glucose - In Step 13 of "Disability", what is assessed if pt is altered? 1. inspect AND palpate skin color, temp, moisture and 2. palpate a pulse - To assess circulation, you must do these two main tasks: intervene as appropriate and reassess - What do you do when alterations are identified in any of the steps in the primary survery? 1. attach CO2 detector and assess for evidence of exhaled CO2; 2. observe for rise and fall of the chest w/ assisted ventilations; 3. auscultate over epigastrium for gurgling AND lungs for bilateral breath sounds - What three assessments must be done if the patient is intubated? Breath sounds, depth/pattern/rate, spontaneous breathing, subcutaneous emphysema, increased work of breathing, symmetrical chest rise and fall, tracheal deviation/JVD, open wounds/deformities, skin color - Four of these must be identified to assess breathing effectiveness: cardiac monitor - What can be applied in step 12 of "Circulation and Control of Hemorrhage" for which credit is given in the LMNOP section? During "Circulation" assessment - When should 2 IV sites be established? assess ETT position by noting the number at teeth/gums AND secure ETT - If the patient is intubated and you've already assessed ETT placement, what else needs to be done with the ETT? (step 10) moving patient from assisted ventilation to mechanical - What should you verbalize after completing all ETT assessments? "Breathing and Ventilation" - During which part of the primary survey would you anticipate the need for a chest tube, intubation, decompression of pneumothorax, oxygen, or BVMs? bony deformity, loose teeth, edema, inhalation injury, sounds, tongue obstruction, burns, fluids, foreign objects, vocalization - Four of these must be identified to assess patency and protection of the airway: Assessing patency and protection of the airway, Step 7 of "Alertness and Airway with Simultaneous Cervical Spinal Stabilization" - During which part of the primary survey would there be anticipation for intubation, insertion of OPA/NPA, removal of any loose teeth or foreign objects, or suctioning? the need for a second person to provide manual c-spine stabilization - If c-spine stabilization is necessary, what need should be stated? A.Decrease the rate of manual ventilation. - 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. post-concussive syndrome - 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 C.Elevating the leg to the level of the heart - 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 Bowel sounds heard in the left lower chest - 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? A.Severe left-sided abdominal pain B.Bowel sounds heard in the left lower chest C.Pain radiating to the left shoulder. D.Decreased breath sounds on the left side fat embolism - 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 Immediately initiate isolation precautions - 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 Globe rupture - 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 Voluntary anal sphincter tone - 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 urinary incontinence - While caring for a trauma patient in the emergency department, what finding raises suspicion of a complete spinal cord injury?