TNCC Practice Exam with Rationale

TNCC Practice Exam with Rationale Questions And Answers A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? - normal vital signs in pregnancy rationale: in pregnancy, the resting heart rate increases by 10 to 20 bpm and a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure due to a decrease in peripheral resistance. Normal fetal rate is between 120 and 160 bpm A patient fell two weeks ago, striking his head. He came to the emergency department with a persistent headache and nausea. He was diagnosed with a small subdural hematoma and has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports he has been anxious, restless, and shaky. he vomited twice during the night. He tells the day shift nurse he couldn't sleep because a young child kept coming into his room. What is a likely cause for these signs and symptoms? - 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, hallucinations, or seizures. A patient with a knife injury to the neck has an intact airway and is hemodynamically stable. He complains of difficulty swallowing and speaking. Further assessment is indicated next for which of the following? - damage to spinal cord rationale: penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the spinal cord 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? - 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 A trauma nurse cared for a child with devasting burns 2 weeks ago. She called in sick for a couple of days and is now back working on the team. Which of the following behaviors would indicate this nurse is coping well? - she is talking about taking the emergency nursing certification examination rationale: this is an indication she is taking positive steps to advance her own practice, a sign of resilience Based on proper bleeding control techniques, what is the first step to stop the bleeding of a penetrating injury to the lower extremity? - initiate direct pressure