TNCC Final Exam 350 Practice Questions with detailed and Correct Answers and Rationale

1. During which part of the primary survey would you anticipate the need for a chest tube, intubation, decompression of pneumothorax, oxygen, or BVMs? A) "Breathing and Ventilation" B) "Circulation and Control of Hemorrhage" C) "Disability" D) "Exposure and Environment" Answer: A Rationale: These interventions specifically address problems with ventilation and oxygenation, which are evaluated in the “Breathing and Ventilation” step. During this phase, you assess the patient’s ability to move air effectively and ensure adequate oxygen delivery. If breathing is compromised, interventions such as chest tube placement for pneumothorax or providing supplemental oxygen become critical. By promptly correcting ventilation issues, you reduce the risk of severe hypoxia and potential secondary complications. 2. What three assessments must be done if the patient is intubated? A) Check tube placement, assess breath sounds, and monitor oxygen saturation B) Attach CO2 detector and assess for evidence of exhaled CO2; observe for rise and fall of the chest with assisted ventilations; auscultate over epigastrium for gurgling AND lungs for bilateral breath sounds C) Check cuff pressure, verify tube position, and assess respiratory rate D) Monitor end-tidal CO2, check breath sounds, and assess work of breathing Answer: B Rationale: Proper confirmation of endotracheal tube placement requires checking for exhaled CO2, visible chest rise, and bilateral breath sounds. Using a CO2 detector ensures that the tube is in the trachea rather than in the esophagus. Auscultation of both lungs and over the epigastrium rules out gastric placement and confirms air entry into both lung fields. These immediate steps prevent inadequate ventilation and reduce the risk of complications associated with a misplaced tube. 3. To assess circulation, you must do these two main tasks: A) Check pulse rate and blood pressure B) Inspect AND palpate skin color, temp, moisture and palpate a pulse C) Assess capillary refill and check pulses D) Monitor heart rate and check skin condition Answer: B Rationale: Evaluating circulation involves quickly checking for the presence and quality of pulses, along with skin assessment (color, temperature, and moisture). This combined approach provides information about perfusion and possible hypovolemia or shock states. By palpating a pulse and inspecting the skin, you can gauge circulatory adequacy and tissue perfusion status. Early identification of compromised circulation allows for prompt interventions such as fluid resuscitation or hemorrhage control. 4. Using the American College of Surgeons screening guidelines, what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging? A) Responds to verbal stimulation B) Multiple abrasions to the extremities C) Ecchymosis to the flank D) Alert with no neurologic deficits Answer: D Rationale: Even patients who are alert and have no obvious neurological deficits may still have an unstable cervical spine injury. The American College of Surgeons guidelines are conservative, advising imaging for patients with certain high-risk mechanisms or who meet specific criteria, regardless of immediate clinical presentation. Symptoms may be subtle or develop later, so imaging ensures that no cervical spine injury is missed. This precautionary measure helps prevent further harm from potential spinal instability. 5. A driver involved in a high-speed motor vehicle collision arrives in the emergency department. The vehicle’s air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain with ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. These findings are most appropriate intervention for this patient? A) Rapid fluid boluses B) Tranexamic acid administration C) Inotropic support D) Hemostatic resuscitation Answer: A Rationale: Hypotension and tachycardia in a trauma patient often suggest hypovolemia, even without obvious external bleeding. Rapid fluid boluses can help restore intravascular volume and improve perfusion if there is internal bleeding or other fluid loss. Given the chest trauma, there could be significant occult blood loss in the thorax or abdomen, and stabilizing blood pressure is paramount. Addressing potential hypovolemia early can prevent progression to more severe shock states. 6. 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) Recheck endotracheal tube placement B) Initiate another fluid bolus C) Decrease the rate of manual ventilation D) Increase the amount of oxygen delivered Answer: C Rationale: A PaCO2 of 30 mm Hg indicates the patient is being hyperventilated, which can cause cerebral vasoconstriction and reduce cerebral blood flow. In severe head injury, maintaining near-normal PaCO2 helps ensure optimal cerebral perfusion. Overventilation can lead to ischemia of brain tissue by constricting cerebral vessels. By reducing the ventilation rate, you help restore a more physiologic CO2 level and improve cerebral perfusion. 7. A patient is brought to the emergency department following a snowmobile crash with prolonged exposure time prior to transport. The patient is confused. Vital signs are BP 96/54 mm Hg, HR 114 beats/minute, RR 24 breaths/minute, T 34.6°C (94.2°F) and an SpO2 of 90% on oxygen at 15L per non-rebreather mask. Other findings include ETCO2 24, serum lactate of 6 mmol/L, and a pH of 6.8. Based on these findings, what is the most appropriate intervention? A) Initiate warming measures B) Titrate oxygen to 6 L per nasal cannula C) Bolus with 500 mL isotonic crystalloids D) Vigorously massage the extremities Answer: A Rationale: A core temperature of 34.6°C indicates hypothermia, and the low pH suggests severe acidosis likely exacerbated by cold-induced poor perfusion. Initiating active warming measures is crucial to improve enzymatic function, circulation, and reduce further lactate production. Hypothermia also impairs coagulation and can worsen metabolic acidosis. Correcting the temperature can help stabilize hemodynamics and improve the patient’s overall metabolic status. 8. What is true about use of the focused assessment sonography for trauma exam for a patient with abdominal trauma? A) It has a higher sensitivity than diagnostic peritoneal lavage for fluid detection B) It can be used in hypotensive patients too unstable for computed tomography scan C) It can detect as little as 30 mL of fluid in the abdominal cavity D) It has high sensitivity in pediatric patients for identifying fluid in the peritoneum Answer: B Rationale: A FAST (Focused Assessment with Sonography for Trauma) exam quickly detects free fluid in the peritoneal or pericardial spaces, making it especially useful when the patient is too unstable for transport to CT. Its noninvasive nature and bedside availability allow rapid identification of possible intra-abdominal bleeding. Though not as sensitive as CT for small fluid volumes, it is a practical choice in emergent situations. Early detection of fluid can guide immediate interventions to control hemorrhage. 9. What intravascular solution is most commonly used for patients who have sustained burns? A) Hypertonic saline B) Normal saline C) D5/normal saline D) Lactated Ringer’s Answer: D Rationale: Lactated Ringer’s is preferred in burn resuscitation because its electrolyte composition closely resembles that of normal extracellular fluid. The lactate it contains is metabolized to bicarbonate, which can help buffer metabolic acidosis often seen in burn patients. This fluid also helps maintain adequate perfusion without significantly altering serum osmolality. Ensuring appropriate fluid replacement is critical to stabilize circulation and support organ function in burn patients. 10. A patient arrives with a 3-inch laceration to their forearm from a tree branch. Which of the following methods will the nurse use to remove small pieces of bark and debris from the wound? A) Low pressure irrigation B) Scrubbing with normal saline C) High pressure irrigation D) Scrubbing with tap water Answer: C Rationale: High-pressure irrigation (5–8 psi) is more effective than low-pressure irrigation or scrubbing for removing contaminants. It reduces the bacterial load, decreases infection risk, and ensures deeper debris is flushed out of the wound. Scrubbing can damage viable tissue and increase discomfort, whereas high-pressure irrigation preserves tissue integrity. Thorough cleaning is essential before closing or dressing the wound to promote optimal healing. 11. A patient involved in a fall from 25 feet has a traumatic brain injury, three anterior rib fractures on the right, and a grade III liver injury. The patient was intubated and placed on a ventilator with PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning? A) Severely diminished breath sounds on the right B) Guarding in the right upper quadrant C) Ecchymosis in the right upper quadrant D) Crepitus to the right chest Answer: A