TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
1. Which of the following requires you to develop a plan of action, initiate the plan,
reassess the plan as care for the patient moves forward, and adjust the plan as the
patient's condition or circumstances change?
A. Principles of PHTLS
B. The Golden Period
C. The XABCDE assessment
D. Critical thinking process - ansQuestion 1: D
To help achieve the PHTLS goals, you will apply your critical thinking skills in the
field. Critical thinking in medicine is a process in which the healthcare practitioner
assesses the situation, the patient, and the resources available and uses the
information to decide on and provide the best care for the patient.
1. You and your partner are responding to a call for a 2-year-old patient with a burn
injury to the hand. He has a visible burn to the left hand, ending at the level above the
wrist, red color, and wet in appearance. What type of burn do you suspect the patient
has sustained?
A. Superficial (first degree)
B. Partial thickness (second degree)
C. Full thickness (third degree)
D. Subdermal (fourth degree) - ansQuestion 1: B
Scald burns are the most common burns seen in the pediatric population ages 1 to 5
years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters
are present or popped. It is also the most painful type of burn.
1. You are called to the scene of a possible mass casualty motor vehicle collision on
the highway. Once you arrive on scene, what is your first priority?
A. Immediately begin triaging patients.
B. Treat the patient with the most visible blood loss.
C. Determine the need for additional resources.
D. Assess the scene and ensure it is safe. - ansQuestion 1: D
Ensure safety for responders, bystanders, and patient(s). The first consideration when
approaching any scene is the safety of all emergency responders. When EMS personnel
become victims, they not only can no longer assist others, but also add to the number
of patients.
1. You are called to the scene of an explosion and fire at a chemical plant where you
find multiple casualties.Triage has begun. Your first patient is a 40-year-old man who
was near the source of the explosion. He is unconscious and has extensive injuries. You
note gurgling respirations. Why should you use the trauma jaw thrust maneuver first
when dealing with a trauma patient?
A. It's an easy technique that always works to open the airway.
B. It allows you to open the airway with little or no movement of the head and cervical
spine.
,TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
C. Other techniques and interventions don't work as well.
D. It can relieve a variety of anatomic airway obstructions in patients who are
breathing spontaneously. - ansQuestion 1: B
Manual maneuvers like the trauma jaw thrust or chin lift are always the first airway
maneuver you should make when treating a trauma patient. In patients with suspected
head, neck, orfacial trauma, the cervical spine is maintained in a neutral in-line
position.The trauma jaw thrust maneuver allows you to open the airway with little or
no movement of the head and cervical spine.
1. You are responding to a call for 25-year-old, fit and healthy female who fell off a
mountain bike. Upon arrival, you find the patient walking around. She is alert but
complaining of pain in her clavicle and on her right side when she inhales. You notice
that her helmet is split in two. What is the first thing you need to do?
A. Complete a review of the ABCs.
B. Check motor and sensory function.
C. Perform manual in-line stabilization.
D. Place her on a backboard. - ansQuestion 1: C
Because there's a possibility of spinal injury, you should bring the patient's head into a
neutral in-line position.
1. You have been performing ongoing management on a 35-year-old female patient who
sustained thoracic trauma when a car hit her as she crossed the street. Originally,
your electronic monitoring devices all produce results consistent with your patient's
clinical condition. However, en route the trauma center, the monitors start to differ
from your patient's current clinical condition each time you reassess. How should you
handle this situation?
A. Treat the patient's condition, not the monitor results.
B. Continue to reassess the patient and record the results for the trauma center.
C. Treat your patient based on the test results.
D. Stop testing and wait until you arrive at the trauma center for them to perform an
assessment. - ansQuestion 1: A
If there are inconsistent data from electronic monitoring devices, reassess to be sure
the monitor matches the patient's current clinical condition. However, it is most
important to treat the patient, not the monitor, so use other signs and symptoms of
potential patient deterioration.
1. You're called out to an assisted living facility for a 72-year-old woman complaining
of a severe headache and experiencing increased confusion. Staff reports she fell out
of her wheelchair earlier in the week but didn't appear to be hurt; however, she's
become increasingly disoriented over the last day or so. Vital signs show: BP 110/90;
heartrate 118 and irregularly regular; ventilation rate 20 and slightly labored;
SpO2 93% on room air. She is taking warfarin for a clotting issue. Which of the following
should you suspect?
A. Cerebral contusion
B. Epidural hematoma
C. Subarachnoid hemorrhage
,TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
D. Subdural hematoma - ansQuestion 1: D
The patient's age, use of a blood thinner, and the fact she fell recently point to a
subdural hematoma.
1. Your partner is compressing the bleeding site of a male patient who was stabbed
multiple times in the left chest. The bleeding seems to be controlled, yet the patient
becomes combative. He is pale and is breathing rapidly, yet states that he "can't
breathe" and feels that he is about to die. Your next step in patient management is to:
A. start assisted ventilation.
B. give high-flow oxygen.
C. decompress the left chest.
D. give a 250-mL fluid bolus. - ansQuestion 1: C
After X come A and B. You can quickly auscultate the lungs (pneumothorax is almost
certain with multiple stabs in the chest) and decompress the chest. Decompressing a
tension pneumothorax is the quickest way to treat shock.
1. Your patient is experiencing severe pain after sustaining a femur fracture in a
motorcycle crash. You have a 20 minute transport to the nearest trauma center. There
are no other injuries noted on your primary and secondary assessments. Which of the
following medications would be the best pain management choice?
A. NSAIDs
B. Acetaminophen
C. Fentanyl
D. Morphine - ansQuestion 1: C
Fentanyl is often a first-line agent due to speed of onset, short duration of action, and
minimal effect on hemodynamics. Fentanyl can beadministered IN, IM, IO, or IV. The IV
route provides effects instantly whereasthe IN and IM route have an onset of <10
minutes. The duration of fentanyl is short at 30 minutes to an hour. This will provide
enough time to ease pain during transport and let the traumacenter decide pain
management upon arrival.
2. A trauma patient from the highway incident is holding her right arm, and you note a
significant amount of blood steadily flowing from a long gash. This is an example of
what type of hemorrhage?
A. Capillary bleeding
B. Venous bleeding
C. Arterial bleeding
D. Road rash - ansQuestion 2: B
Venous bleeding typically results in a steady flow of dark red blood.
2. During primary survey, you find the following:
. LOC: alert and oriented; speaking in full sentences
. GCS: 15
. Airway: good air entry to bases
. Breathing: bilateral
. Circulation: skin warm, flushed, dry
, TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
. Pulse rate: 112 bpm, strong andregular
. BP: 90/42 mm Hg
. Pain: Patient complains of severe pain at clavicle site and pain on inspiration at site
of possible fractured ribs. No other injuries detected. What is your next step?
A. Apply a cervical collar and in-line immobilization device.
B. Treat for hypovolemic shock.
C. Apply an arm sling for the clavicle injury.
D. Administer pain medication. - ansQuestion 2: A
Although the patient's GCS is normal, she does have a distracting injury, and the state
of her helmet indicates possible spinal compression/flexion, so you should immobilize
the patient.
2. The patient becomes apneic. You suspect he has a cervical injury. Which type of
airway should you use?
A. Supraglottic airway
B. Blind nasotracheal intubation
C. Oropharyngeal airway
D. Surgical airway - ansQuestion 2: A
The supraglottic airway's greatest advantage is that it can be inserted independent
of the patient's position, which may be especially important in trauma patients with
high suspicion of cervical injury.
2. The patient's care giver is a babysitter who reports the child was crawling on the
counter and placed his hand in a pot of water that was boiling on the stove. She is
applying ice to the burn and the child is shivering. What is your next step?
A. Administer analgesia for pain.
B. Cover the patient with a blanket to stop the shivering.
C. Start IV for fluid resuscitation.
D. Stop the burning process and remove the ice pack. - ansQuestion 2: D
A common error that results in damage to the zone of stasis is the application of ice by
a bystander or prehospital care practitioner. When ice is applied to a burn, the
patient will experience some reduction in pain; however, the pain relief will be at the
expense of additional tissue destruction.
2. The patient's respiration improves markedly, but he remains confused. He has an
absent radial pulse, and his carotid pulse is fast and thready. Your partner asks if he
can let the compression go to put in an IV. How should you respond?
A. "Oh yes, that's a great idea!"
B. "Yes, but we have to immobilize him first"
C. "Take a blood pressure first to see if he needs an IV."
D. "No, keep the pressure and let's get out of here!" - ansQuestion 2: D
This patient is likely in decompensated shock with internal bleeding, so rapid
transport is the next priority. You should maintain pressure on the wound, because
having massive external bleeding start up again is the last thing you want in this
situation.
Edition ENA Test Bank |Graded A+ pass
1. Which of the following requires you to develop a plan of action, initiate the plan,
reassess the plan as care for the patient moves forward, and adjust the plan as the
patient's condition or circumstances change?
A. Principles of PHTLS
B. The Golden Period
C. The XABCDE assessment
D. Critical thinking process - ansQuestion 1: D
To help achieve the PHTLS goals, you will apply your critical thinking skills in the
field. Critical thinking in medicine is a process in which the healthcare practitioner
assesses the situation, the patient, and the resources available and uses the
information to decide on and provide the best care for the patient.
1. You and your partner are responding to a call for a 2-year-old patient with a burn
injury to the hand. He has a visible burn to the left hand, ending at the level above the
wrist, red color, and wet in appearance. What type of burn do you suspect the patient
has sustained?
A. Superficial (first degree)
B. Partial thickness (second degree)
C. Full thickness (third degree)
D. Subdermal (fourth degree) - ansQuestion 1: B
Scald burns are the most common burns seen in the pediatric population ages 1 to 5
years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters
are present or popped. It is also the most painful type of burn.
1. You are called to the scene of a possible mass casualty motor vehicle collision on
the highway. Once you arrive on scene, what is your first priority?
A. Immediately begin triaging patients.
B. Treat the patient with the most visible blood loss.
C. Determine the need for additional resources.
D. Assess the scene and ensure it is safe. - ansQuestion 1: D
Ensure safety for responders, bystanders, and patient(s). The first consideration when
approaching any scene is the safety of all emergency responders. When EMS personnel
become victims, they not only can no longer assist others, but also add to the number
of patients.
1. You are called to the scene of an explosion and fire at a chemical plant where you
find multiple casualties.Triage has begun. Your first patient is a 40-year-old man who
was near the source of the explosion. He is unconscious and has extensive injuries. You
note gurgling respirations. Why should you use the trauma jaw thrust maneuver first
when dealing with a trauma patient?
A. It's an easy technique that always works to open the airway.
B. It allows you to open the airway with little or no movement of the head and cervical
spine.
,TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
C. Other techniques and interventions don't work as well.
D. It can relieve a variety of anatomic airway obstructions in patients who are
breathing spontaneously. - ansQuestion 1: B
Manual maneuvers like the trauma jaw thrust or chin lift are always the first airway
maneuver you should make when treating a trauma patient. In patients with suspected
head, neck, orfacial trauma, the cervical spine is maintained in a neutral in-line
position.The trauma jaw thrust maneuver allows you to open the airway with little or
no movement of the head and cervical spine.
1. You are responding to a call for 25-year-old, fit and healthy female who fell off a
mountain bike. Upon arrival, you find the patient walking around. She is alert but
complaining of pain in her clavicle and on her right side when she inhales. You notice
that her helmet is split in two. What is the first thing you need to do?
A. Complete a review of the ABCs.
B. Check motor and sensory function.
C. Perform manual in-line stabilization.
D. Place her on a backboard. - ansQuestion 1: C
Because there's a possibility of spinal injury, you should bring the patient's head into a
neutral in-line position.
1. You have been performing ongoing management on a 35-year-old female patient who
sustained thoracic trauma when a car hit her as she crossed the street. Originally,
your electronic monitoring devices all produce results consistent with your patient's
clinical condition. However, en route the trauma center, the monitors start to differ
from your patient's current clinical condition each time you reassess. How should you
handle this situation?
A. Treat the patient's condition, not the monitor results.
B. Continue to reassess the patient and record the results for the trauma center.
C. Treat your patient based on the test results.
D. Stop testing and wait until you arrive at the trauma center for them to perform an
assessment. - ansQuestion 1: A
If there are inconsistent data from electronic monitoring devices, reassess to be sure
the monitor matches the patient's current clinical condition. However, it is most
important to treat the patient, not the monitor, so use other signs and symptoms of
potential patient deterioration.
1. You're called out to an assisted living facility for a 72-year-old woman complaining
of a severe headache and experiencing increased confusion. Staff reports she fell out
of her wheelchair earlier in the week but didn't appear to be hurt; however, she's
become increasingly disoriented over the last day or so. Vital signs show: BP 110/90;
heartrate 118 and irregularly regular; ventilation rate 20 and slightly labored;
SpO2 93% on room air. She is taking warfarin for a clotting issue. Which of the following
should you suspect?
A. Cerebral contusion
B. Epidural hematoma
C. Subarachnoid hemorrhage
,TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
D. Subdural hematoma - ansQuestion 1: D
The patient's age, use of a blood thinner, and the fact she fell recently point to a
subdural hematoma.
1. Your partner is compressing the bleeding site of a male patient who was stabbed
multiple times in the left chest. The bleeding seems to be controlled, yet the patient
becomes combative. He is pale and is breathing rapidly, yet states that he "can't
breathe" and feels that he is about to die. Your next step in patient management is to:
A. start assisted ventilation.
B. give high-flow oxygen.
C. decompress the left chest.
D. give a 250-mL fluid bolus. - ansQuestion 1: C
After X come A and B. You can quickly auscultate the lungs (pneumothorax is almost
certain with multiple stabs in the chest) and decompress the chest. Decompressing a
tension pneumothorax is the quickest way to treat shock.
1. Your patient is experiencing severe pain after sustaining a femur fracture in a
motorcycle crash. You have a 20 minute transport to the nearest trauma center. There
are no other injuries noted on your primary and secondary assessments. Which of the
following medications would be the best pain management choice?
A. NSAIDs
B. Acetaminophen
C. Fentanyl
D. Morphine - ansQuestion 1: C
Fentanyl is often a first-line agent due to speed of onset, short duration of action, and
minimal effect on hemodynamics. Fentanyl can beadministered IN, IM, IO, or IV. The IV
route provides effects instantly whereasthe IN and IM route have an onset of <10
minutes. The duration of fentanyl is short at 30 minutes to an hour. This will provide
enough time to ease pain during transport and let the traumacenter decide pain
management upon arrival.
2. A trauma patient from the highway incident is holding her right arm, and you note a
significant amount of blood steadily flowing from a long gash. This is an example of
what type of hemorrhage?
A. Capillary bleeding
B. Venous bleeding
C. Arterial bleeding
D. Road rash - ansQuestion 2: B
Venous bleeding typically results in a steady flow of dark red blood.
2. During primary survey, you find the following:
. LOC: alert and oriented; speaking in full sentences
. GCS: 15
. Airway: good air entry to bases
. Breathing: bilateral
. Circulation: skin warm, flushed, dry
, TNCC Trauma Nursing Core Course 15th
Edition ENA Test Bank |Graded A+ pass
. Pulse rate: 112 bpm, strong andregular
. BP: 90/42 mm Hg
. Pain: Patient complains of severe pain at clavicle site and pain on inspiration at site
of possible fractured ribs. No other injuries detected. What is your next step?
A. Apply a cervical collar and in-line immobilization device.
B. Treat for hypovolemic shock.
C. Apply an arm sling for the clavicle injury.
D. Administer pain medication. - ansQuestion 2: A
Although the patient's GCS is normal, she does have a distracting injury, and the state
of her helmet indicates possible spinal compression/flexion, so you should immobilize
the patient.
2. The patient becomes apneic. You suspect he has a cervical injury. Which type of
airway should you use?
A. Supraglottic airway
B. Blind nasotracheal intubation
C. Oropharyngeal airway
D. Surgical airway - ansQuestion 2: A
The supraglottic airway's greatest advantage is that it can be inserted independent
of the patient's position, which may be especially important in trauma patients with
high suspicion of cervical injury.
2. The patient's care giver is a babysitter who reports the child was crawling on the
counter and placed his hand in a pot of water that was boiling on the stove. She is
applying ice to the burn and the child is shivering. What is your next step?
A. Administer analgesia for pain.
B. Cover the patient with a blanket to stop the shivering.
C. Start IV for fluid resuscitation.
D. Stop the burning process and remove the ice pack. - ansQuestion 2: D
A common error that results in damage to the zone of stasis is the application of ice by
a bystander or prehospital care practitioner. When ice is applied to a burn, the
patient will experience some reduction in pain; however, the pain relief will be at the
expense of additional tissue destruction.
2. The patient's respiration improves markedly, but he remains confused. He has an
absent radial pulse, and his carotid pulse is fast and thready. Your partner asks if he
can let the compression go to put in an IV. How should you respond?
A. "Oh yes, that's a great idea!"
B. "Yes, but we have to immobilize him first"
C. "Take a blood pressure first to see if he needs an IV."
D. "No, keep the pressure and let's get out of here!" - ansQuestion 2: D
This patient is likely in decompensated shock with internal bleeding, so rapid
transport is the next priority. You should maintain pressure on the wound, because
having massive external bleeding start up again is the last thing you want in this
situation.
