TNCC 9TH EDITION MAIN CORE EXAMINATION
QUESTIONS AND ANSWERS FIRM A+
✔✔PRIMARY ASSESSMENT/SHOCK - ✔✔Diltiazem is a calcium channel blocker and
in combination with the citrate used as a preservative in blood products, put the patient
at a higher risk for significant hypocalcemia and cardiac dysrhythmias.
✔✔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 piles of debris from the
wound?
A. Low pressure irrigation
B. High pressure irrigation
C. Scrubbing with normal saline
D. Scrubbing with tap water - ✔✔B. High pressure irrigation
High-pressure irrigation is the best method to remove smaller contaminants and
bacteria from a wound. Low pressure can be used for larger contaminants.
✔✔PRIMARY ASSESSMENT/SHOCK - ✔✔This patient has signs of hypovolemic
shock from a probable closed femur fracture. The patient needs fluid resuscitation while
maintaining a minimum urine output of 0.5 mL/kg/hour which is a good indicator or
adequate fluid resuscitation and end organ perfusion
✔✔HEAD AND TORSO TRAUMA/THORACIC AND NECK TRAUMA - ✔✔Positive
pressure ventilation in a patient with even a small pneumothorax can increase the risk
of worsening the pneumothorax, or possibly developing a tension pneumothorax.
Increasing respiratory distress along with severely diminished of absent breath sounds
on the affected side would be noted.
✔✔HEAD AND TORSO TRAUMA/HEAD TRAUMA - ✔✔Diffuse axonal injury (DAI) is
widespread microscopic damage, primarily to the axons. DAI results from diffuse
shearing, tearing, or compressive stresses from a rational or acceleration/deceleration
mechanism of injury. Deeper brain structures, the brain stem, and the reticular
activating system are most at risk for injury. Assessment findings can include
unconsciousness, abnormal motor posturing, signs of increased ICP, hyperthermia, and
excessive sweating.
✔✔HEAD AND TORSO TRAUMA/THORACIC AND NECK TRAUMA - ✔✔Assessment
findings associate with tension pneumothorax include anxiety, severe restlessness,
severe respiratory distress, absent breath sounds on the injured side, and hypotension
due to compression of the heart and great vessels.
✔✔Following a bomb explosion, fragmentation injuries from the bomb or objects in the
environment are examples of which phase of injury?
, A. Primary
B. Secondary
C. Tertiary
D. Quaternary - ✔✔B. Secondary
The primary phase of a blast results from impact of the pressurization wave on body
surfaces. injuries include blast lung, tympanic membrane rupture, abdominal
hemorrhage, globe rupture, and mild traumatic brain injury.
The secondary phase of a blast results from flying debris, projectiles, and bomb
fragments causing lacerations or penetrating injuries.
The tertiary phase of a blast results from individuals being thrown b the blast and
impacting walls, ground, or any hard object
The quaternary phase of blast results from any explosion-related illness or injury
including hyperglycemia, hypertension, angina, asthma, CPOD, or sepsis.
✔✔Treatment for frostbite can include which of the following interventions?
A. Warm the affected part over 30 to 60 minutes
B. Use gentle friction to improve circulation
C. Administer tissue plasminogen activator
D. Drainage of all large and small blisters - ✔✔C. Administer tissue plasminogen
activator
With frostbite, thrombus formation is a risk. Tissue plasminogen activator, a thrombolytic
medication, has been effective in maintaining perfusion and decreasing the need for
amputation when administered within 24 hours of rewarming.
✔✔A patient arrives at the emergency department by private vehicle after sustaining an
injury to the right lower extremity while using a saw. There is a large gaping wound to
the right thigh area with significant bleeding. What is the priority intervention?
A. Elevate the extremity to the level of the heart
B. Initiate direct pressure
C. Apply a tourniquet
D. Cover the ope wound with sterile saline dressings - ✔✔B. Initiate direct pressure
The first step in controlling any bleeding is application of direct pressure.
✔✔A patient involved in a MVC has sustained a fracture to the second rib of the anterior
left chest. Which concurrent injury is most commonly associated with this fracture?
A. Blunt Cardiac Injury
B. Brachial plexus injury
C. Pneumothorax
QUESTIONS AND ANSWERS FIRM A+
✔✔PRIMARY ASSESSMENT/SHOCK - ✔✔Diltiazem is a calcium channel blocker and
in combination with the citrate used as a preservative in blood products, put the patient
at a higher risk for significant hypocalcemia and cardiac dysrhythmias.
✔✔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 piles of debris from the
wound?
A. Low pressure irrigation
B. High pressure irrigation
C. Scrubbing with normal saline
D. Scrubbing with tap water - ✔✔B. High pressure irrigation
High-pressure irrigation is the best method to remove smaller contaminants and
bacteria from a wound. Low pressure can be used for larger contaminants.
✔✔PRIMARY ASSESSMENT/SHOCK - ✔✔This patient has signs of hypovolemic
shock from a probable closed femur fracture. The patient needs fluid resuscitation while
maintaining a minimum urine output of 0.5 mL/kg/hour which is a good indicator or
adequate fluid resuscitation and end organ perfusion
✔✔HEAD AND TORSO TRAUMA/THORACIC AND NECK TRAUMA - ✔✔Positive
pressure ventilation in a patient with even a small pneumothorax can increase the risk
of worsening the pneumothorax, or possibly developing a tension pneumothorax.
Increasing respiratory distress along with severely diminished of absent breath sounds
on the affected side would be noted.
✔✔HEAD AND TORSO TRAUMA/HEAD TRAUMA - ✔✔Diffuse axonal injury (DAI) is
widespread microscopic damage, primarily to the axons. DAI results from diffuse
shearing, tearing, or compressive stresses from a rational or acceleration/deceleration
mechanism of injury. Deeper brain structures, the brain stem, and the reticular
activating system are most at risk for injury. Assessment findings can include
unconsciousness, abnormal motor posturing, signs of increased ICP, hyperthermia, and
excessive sweating.
✔✔HEAD AND TORSO TRAUMA/THORACIC AND NECK TRAUMA - ✔✔Assessment
findings associate with tension pneumothorax include anxiety, severe restlessness,
severe respiratory distress, absent breath sounds on the injured side, and hypotension
due to compression of the heart and great vessels.
✔✔Following a bomb explosion, fragmentation injuries from the bomb or objects in the
environment are examples of which phase of injury?
, A. Primary
B. Secondary
C. Tertiary
D. Quaternary - ✔✔B. Secondary
The primary phase of a blast results from impact of the pressurization wave on body
surfaces. injuries include blast lung, tympanic membrane rupture, abdominal
hemorrhage, globe rupture, and mild traumatic brain injury.
The secondary phase of a blast results from flying debris, projectiles, and bomb
fragments causing lacerations or penetrating injuries.
The tertiary phase of a blast results from individuals being thrown b the blast and
impacting walls, ground, or any hard object
The quaternary phase of blast results from any explosion-related illness or injury
including hyperglycemia, hypertension, angina, asthma, CPOD, or sepsis.
✔✔Treatment for frostbite can include which of the following interventions?
A. Warm the affected part over 30 to 60 minutes
B. Use gentle friction to improve circulation
C. Administer tissue plasminogen activator
D. Drainage of all large and small blisters - ✔✔C. Administer tissue plasminogen
activator
With frostbite, thrombus formation is a risk. Tissue plasminogen activator, a thrombolytic
medication, has been effective in maintaining perfusion and decreasing the need for
amputation when administered within 24 hours of rewarming.
✔✔A patient arrives at the emergency department by private vehicle after sustaining an
injury to the right lower extremity while using a saw. There is a large gaping wound to
the right thigh area with significant bleeding. What is the priority intervention?
A. Elevate the extremity to the level of the heart
B. Initiate direct pressure
C. Apply a tourniquet
D. Cover the ope wound with sterile saline dressings - ✔✔B. Initiate direct pressure
The first step in controlling any bleeding is application of direct pressure.
✔✔A patient involved in a MVC has sustained a fracture to the second rib of the anterior
left chest. Which concurrent injury is most commonly associated with this fracture?
A. Blunt Cardiac Injury
B. Brachial plexus injury
C. Pneumothorax
