TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct pressure, elevate
bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component
therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis
corrected and coagulopathy prevented.
Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic)
Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to decrease swelling, oral
analgesics, Ophthalmic f/u in 24 hours.
(Do NOT patch - increases infection)
Corneal Foreign Body - ansRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia
Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery
Cycloplegic agent - ansCycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Because of the
paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects.
D (Primary Survey) - ansDisability (Neurologic Status)
Disability Assessment - ansAssess GCS on arrival and repeat per policy.
Assess pupils for equality, shape and reactivity (PERRL)
Disability interventions - ansEvaluate for need for CT. Assume AMS to be the result of CNS injury until proven otherwise.
Consider ABGs - AMS may be indicator of decreased cerebral perfusion, hypoventilation or acid-base imbalance.
Consider bedside glucose.
,TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
Distributive Shock - ansOccurs as a result of maldistribution of an adequate circulating volume with a loss of vascular tone or
increased permeability.
Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia o r reduction of the mean systemic volume and
venous return to the heart or drop in preload, resulting in distributive shock.
Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth muscle and increases
vascular permeability and vasodilation.
Septic Shock: systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation
Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which produces venous and arterial vasodilation.
With the loss of sympathetic nervous system input in spinal cord injury, unopposed vagal activity may result in decreased car diac
output through bradycardia.
TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in some cases (neurogenic)
Atropine to counteract bradycardia.
E (Primary Survey) - ansExposure and Environmental Control
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note
any obvious injuries.
Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured pati ent.
Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmer s, radiant warming lights.
F (Primary Survey) - ansFull Set of VS & Family Presence
G (Primary Survey) - ansGet Resuscitation Adjuncts:
(LMNOP)
L: Labs
M: Monitor cardiac rate and rhythm
N: Naso or orogastric tube consideration
O: Oxygenation - SpO2 and/or etCO2 monitor
P: Pain assessment and management
GCS - ansGCS
EYES
1: Does not open eyes
2: Opens eyes in response to pain
3: Opens eyes in response to voice
4: Opens eyes spontaneously
VERBAL
1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally
MOTOR
1. Makes no movements
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to painful stimuli
5. Localizes painful stimuli
6. Obeys commands
,TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
H (Secondary Survey) - ansHistory
Prehospital Report (MIST)
M: MOI
I: Injuries sustained
S: Signs and symptoms in the field
T: Treatment in field
Patient History (SAMPLE):
S: Symptoms
A: Allergies and tetanus status
M: Medications
P: Past medical history
L: Last oral intake
E: Events and Environmental factors related to injury.
H: Head and Face
Head to Toe Assessment (secondary survey) - ansSOFT TISSUE:
Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects.
Palpate: areas of tenderness, step -offs, crepitus
BONY DEFORMITIES:
Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter
Palpate: depressions, angulations, tenderness
Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure.
Hematoma - bleeding contained within the capsule
Laceration - the capsule is disrupted
Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9-12 rib FXs, elevated LFT
Graded I-VI, I = minor trauma
Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams.
Findings of contrast extravasation may be embolized by IR.
For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to
the evacuation of large amounts of blood resulting in hypovolemia.
Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume.
In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea.
Burn trauma can result in hypovolemic shock from d amage to the cell membranes leading to plasma and protein leakage. of body
water, results in inadequate perfusion.
Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac outpu t.
Initial Assessment - ans1. Preparation and Triage
2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
, TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
7. Definitive Care or Transport
Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL.
Findings: compromised visual acuity, misshapen pupils, pain
Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit concomitant eye movement,
globe closure ASAP, systemic and ophthalmic ABX, analgesics.
Postop infection, retinal detachment and vision loss are common complications.
lid injury - ans
Liver - ansLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule with blood vessels, lymphatics and
nerves. Filters 1.7L of blood per minute.
The liver filters out toxins, takes the nutrients and returns the blood to the heart via the hepatic veins.
Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue.
Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert ammonia to urea, secrete
electrolytes, lipids, lecithin, cholesterol and bile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary for
clotting).
Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart.
Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction to atrial filling, decreased
preload and decreased cardiac output.
Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload, strokes volume and cardiac output and
ultimately end organ perfusion.
P (AVPU) - ansPainful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening injuries such as
pneumothorax or pelvic fracture with uncontrolled internal hemorrhage. Can also confirm placement of ET tubes, chest tubes and
gastric tubes.
Consider need for transfer.
shock - ansInadequate tissue perfusion.
Spleen - ansEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the stomach. Minimal elasticity and
flexibility - most frequent injured organ in blunt trauma.
Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a reserve of blood. It recycles iron. I t
removes antibody-coated bacteria. Supplies lymphocytes to stimulate an immune response to blood borne microorganisms. Stores
200-300ml of blood and leads to hemodynamic instability quickly if damaged.
Splenic Injuries - ansIn blunt trauma the spleen may lacerate from increased abdominal p ressure.
Graded I-V, I = minor trauma
Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal contour, tenderness, guarding, rigidity, pain
left shoulder when supine.
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma.
Contrast blush or extravasation - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing
bleeding.
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - ansControl and treat external bleeding: apply direct pressure, elevate
bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component
therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis
corrected and coagulopathy prevented.
Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume
Obstructive - obstruction in either the vasculature or heart
Cardiogenic - pump failure in the presence of adequate intravascular volume
Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic)
Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein.
Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation
Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to decrease swelling, oral
analgesics, Ophthalmic f/u in 24 hours.
(Do NOT patch - increases infection)
Corneal Foreign Body - ansRoutinely metal, plastic or wood.
Findings: photophobia, pain, injected conjunctiva (redness), lid swelling
Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia
Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp.
Findings: similar to abrasion, pain out of proportion to findings, decreased vision
Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery
Cycloplegic agent - ansCycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Because of the
paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects.
D (Primary Survey) - ansDisability (Neurologic Status)
Disability Assessment - ansAssess GCS on arrival and repeat per policy.
Assess pupils for equality, shape and reactivity (PERRL)
Disability interventions - ansEvaluate for need for CT. Assume AMS to be the result of CNS injury until proven otherwise.
Consider ABGs - AMS may be indicator of decreased cerebral perfusion, hypoventilation or acid-base imbalance.
Consider bedside glucose.
,TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
Distributive Shock - ansOccurs as a result of maldistribution of an adequate circulating volume with a loss of vascular tone or
increased permeability.
Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia o r reduction of the mean systemic volume and
venous return to the heart or drop in preload, resulting in distributive shock.
Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth muscle and increases
vascular permeability and vasodilation.
Septic Shock: systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation
Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which produces venous and arterial vasodilation.
With the loss of sympathetic nervous system input in spinal cord injury, unopposed vagal activity may result in decreased car diac
output through bradycardia.
TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in some cases (neurogenic)
Atropine to counteract bradycardia.
E (Primary Survey) - ansExposure and Environmental Control
Exposure and Environmental Control - ansCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note
any obvious injuries.
Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured pati ent.
Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmer s, radiant warming lights.
F (Primary Survey) - ansFull Set of VS & Family Presence
G (Primary Survey) - ansGet Resuscitation Adjuncts:
(LMNOP)
L: Labs
M: Monitor cardiac rate and rhythm
N: Naso or orogastric tube consideration
O: Oxygenation - SpO2 and/or etCO2 monitor
P: Pain assessment and management
GCS - ansGCS
EYES
1: Does not open eyes
2: Opens eyes in response to pain
3: Opens eyes in response to voice
4: Opens eyes spontaneously
VERBAL
1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally
MOTOR
1. Makes no movements
2. Extension to painful stimuli (decerebrate)
3. Abnormal flexion to painful stimuli (decorticate)
4. Withdrawal to painful stimuli
5. Localizes painful stimuli
6. Obeys commands
,TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
H (Secondary Survey) - ansHistory
Prehospital Report (MIST)
M: MOI
I: Injuries sustained
S: Signs and symptoms in the field
T: Treatment in field
Patient History (SAMPLE):
S: Symptoms
A: Allergies and tetanus status
M: Medications
P: Past medical history
L: Last oral intake
E: Events and Environmental factors related to injury.
H: Head and Face
Head to Toe Assessment (secondary survey) - ansSOFT TISSUE:
Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects.
Palpate: areas of tenderness, step -offs, crepitus
BONY DEFORMITIES:
Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter
Palpate: depressions, angulations, tenderness
Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure.
Hematoma - bleeding contained within the capsule
Laceration - the capsule is disrupted
Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9-12 rib FXs, elevated LFT
Graded I-VI, I = minor trauma
Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams.
Findings of contrast extravasation may be embolized by IR.
For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to
the evacuation of large amounts of blood resulting in hypovolemia.
Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume.
In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea.
Burn trauma can result in hypovolemic shock from d amage to the cell membranes leading to plasma and protein leakage. of body
water, results in inadequate perfusion.
Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac outpu t.
Initial Assessment - ans1. Preparation and Triage
2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
, TNCC TEST 2024-2025 ACTUAL FINAL EXAM TEST BANK
300 QUESTIONS AND CORRET DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+|100% COMPLETE pass
7. Definitive Care or Transport
Intraocular Foreign Body - ans*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL.
Findings: compromised visual acuity, misshapen pupils, pain
Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit concomitant eye movement,
globe closure ASAP, systemic and ophthalmic ABX, analgesics.
Postop infection, retinal detachment and vision loss are common complications.
lid injury - ans
Liver - ansLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule with blood vessels, lymphatics and
nerves. Filters 1.7L of blood per minute.
The liver filters out toxins, takes the nutrients and returns the blood to the heart via the hepatic veins.
Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue.
Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert ammonia to urea, secrete
electrolytes, lipids, lecithin, cholesterol and bile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary for
clotting).
Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart.
Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction to atrial filling, decreased
preload and decreased cardiac output.
Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload, strokes volume and cardiac output and
ultimately end organ perfusion.
P (AVPU) - ansPainful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
Reevaluation - ansPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening injuries such as
pneumothorax or pelvic fracture with uncontrolled internal hemorrhage. Can also confirm placement of ET tubes, chest tubes and
gastric tubes.
Consider need for transfer.
shock - ansInadequate tissue perfusion.
Spleen - ansEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the stomach. Minimal elasticity and
flexibility - most frequent injured organ in blunt trauma.
Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a reserve of blood. It recycles iron. I t
removes antibody-coated bacteria. Supplies lymphocytes to stimulate an immune response to blood borne microorganisms. Stores
200-300ml of blood and leads to hemodynamic instability quickly if damaged.
Splenic Injuries - ansIn blunt trauma the spleen may lacerate from increased abdominal p ressure.
Graded I-V, I = minor trauma
Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal contour, tenderness, guarding, rigidity, pain
left shoulder when supine.
CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma.
Contrast blush or extravasation - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing
bleeding.
