TNCC 9TH EDITION STUDY EXAMS GUIDE QUESTIONS AND
ANSWERS FIRM A+
✔✔An unconscious patient arrives following a motor vehicle collision. The patient is on
a backboard with a cervical collar in place and one intravenous line running.
Respirations are shallow and there is active brisk bleeding from a large leg wound.
What is the priority intervention for this patient?
A.Check for a patent airway
B.Control the bleeding
C.Start a second intravenous line
D.Ventilate with a bag-mask device - ✔✔B.Control the bleeding
✔✔*An obese trauma patient requires intubation. Assuming there are no
contraindications, which position will provide the best visualization for insertion of the
endotracheal tube?
A.Reverse Trendelenburg
B.Lying on side
C.Ramped
D.Supine - ✔✔C.Ramped
✔✔*Your patient is a pedestrian struck by a car and thrown 35 feet. They were
unconscious at the scene but became responsive with initial and subsequent Glasgow
Coma Scale (GCS) scores of 13 (E-3, V-4, M-6). The patient has bilateral subdural
hematomas and is awaiting transfer to the ICU. Your next assessment reveals a GCS of
9 (E-2, V-2, M-5). What is the priority nursing intervention?
A. Hold all pain medication
B. Notify the provider of the change
C. Repeat the GCS in 30 minutes
D. Place the patient in Trendelenburg position - ✔✔B.Notify the provider of the change
✔✔A patient arrives following prolonged exposure of their left hand to the cold. The
patient is awake and alert and complains of a tingling sensation to the fingers.
Assessment reveals swelling and bright red skin to the left hand and a 1-inch round
clear blister to the dorsum of that hand. Which of the following nursing interventions is
most appropriate for this patient?
A.Massage the injured areas to promote circulation
B.Drain and debride the blister on the hand
C.Immerse in water between 37.5 - ✔✔D.Gently rewarm over 15 to 30 minutes
✔✔*A nurse verbalizes guilt and remorse after caring for multiple severely injured
patients during a staffing crisis. The nurse expresses anger stating that the patients did
,not receive quality care and begins exhibiting aggression toward colleagues. This is
most consistent with which condition? - ✔✔D.Moral injury
✔✔What is the rationale for obtaining a serum lactate level during the initial assessment
of a trauma patient?
A.Measures oxygenation and ventilation
B.Assesses the degree of alkalosis and base deficit
C.Gauges end-organ perfusion and tissue hypoxia
D.Determines the underlying cause of shock - ✔✔C.Gauges end-organ perfusion and
tissue hypoxia
✔✔*What is the most important consideration during the initial assessment when caring
for an older adult who has sustained serious injuries?
A.They are likely to be fearful in the emergency department
B.Medical history including current medications
C.Availability of support systems after discharge
D.Accessibility to a primary care physician - ✔✔B.Medical history including current
medications
✔✔Following a gun shot wound, pre-hospital providers report diminished breath sounds
bilaterally. Upon emergency department arrival, the patient is unresponsive with shallow
respirations and an O2 sat of 88%. What is the priority intervention for this patient?
A.Administer 15 L oxygen via nonrebreather mask
B.Attach patient to a CO2 detector
C.Prepare for a definitive airway
D.Assist ventilation with a bag-mask device - ✔✔D.Assist ventilation with a bag-mask
device
✔✔Your patient was the unrestrained driver involved in a moderate speed motor vehicle
collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the
lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about
injury to which organ?
A.Transverse colon
B.Pancreas
C.Liver
D.Spleen - ✔✔C.Liver
✔✔*A 5-year-old child presents to the emergency department with bruises to the upper
arms and buttocks in various stages of healing and multiple small, clean, round burns to
the back. There are no abnormalities found based on the pediatric assessment triangle
, or primary survey. Which of the following is the priority nursing intervention? -
✔✔A.Report your suspicion of maltreatment in accordance with local regulations
✔✔A patient arrives with a large metal rod embedded in their left thigh and no active
bleeding. Which intervention is most appropriate for this patient?
A.Remove the rod immediately to facilitate cleansing.
B.Apply a tourniquet to the leg above the metal rod.
C.Hold antibiotics until after the rod is removed.
D.Prepare the patient for surgery to remove the rod. - ✔✔D.Prepare the patient for
surgery to remove the rod.
✔✔When should the definitive calculation for intravenous fluid resuscitation rate be
performed for a patient with burns?
A.As soon as the patient arrives
B.During the secondary survey
C.Should only be done at a burn center
D.During the primary survey - ✔✔B.During the secondary survey
✔✔Which of the following 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 -
✔✔B.It can be used in hypotensive patients too unstable for computed tomography
scan
✔✔What is the priority intervention for a child who has been diagnosed with an atlanto-
occipital dislocation following a high-speed motor vehicle collision?
A.Initiating a second large caliber intravenous line
B.Maintaining spinal motion restriction
C.Placing the patient on pulse oximetry
D.Turning the patient to remove the backboard - ✔✔B.Maintaining spinal motion
restriction
✔✔What position optimizes ventilation in the obese patient with a lumbar fracture?
A.Reverse Trendelenburg
B.Supine
C.Prone
D.Fowler's - ✔✔A.Reverse Trendelenburg
ANSWERS FIRM A+
✔✔An unconscious patient arrives following a motor vehicle collision. The patient is on
a backboard with a cervical collar in place and one intravenous line running.
Respirations are shallow and there is active brisk bleeding from a large leg wound.
What is the priority intervention for this patient?
A.Check for a patent airway
B.Control the bleeding
C.Start a second intravenous line
D.Ventilate with a bag-mask device - ✔✔B.Control the bleeding
✔✔*An obese trauma patient requires intubation. Assuming there are no
contraindications, which position will provide the best visualization for insertion of the
endotracheal tube?
A.Reverse Trendelenburg
B.Lying on side
C.Ramped
D.Supine - ✔✔C.Ramped
✔✔*Your patient is a pedestrian struck by a car and thrown 35 feet. They were
unconscious at the scene but became responsive with initial and subsequent Glasgow
Coma Scale (GCS) scores of 13 (E-3, V-4, M-6). The patient has bilateral subdural
hematomas and is awaiting transfer to the ICU. Your next assessment reveals a GCS of
9 (E-2, V-2, M-5). What is the priority nursing intervention?
A. Hold all pain medication
B. Notify the provider of the change
C. Repeat the GCS in 30 minutes
D. Place the patient in Trendelenburg position - ✔✔B.Notify the provider of the change
✔✔A patient arrives following prolonged exposure of their left hand to the cold. The
patient is awake and alert and complains of a tingling sensation to the fingers.
Assessment reveals swelling and bright red skin to the left hand and a 1-inch round
clear blister to the dorsum of that hand. Which of the following nursing interventions is
most appropriate for this patient?
A.Massage the injured areas to promote circulation
B.Drain and debride the blister on the hand
C.Immerse in water between 37.5 - ✔✔D.Gently rewarm over 15 to 30 minutes
✔✔*A nurse verbalizes guilt and remorse after caring for multiple severely injured
patients during a staffing crisis. The nurse expresses anger stating that the patients did
,not receive quality care and begins exhibiting aggression toward colleagues. This is
most consistent with which condition? - ✔✔D.Moral injury
✔✔What is the rationale for obtaining a serum lactate level during the initial assessment
of a trauma patient?
A.Measures oxygenation and ventilation
B.Assesses the degree of alkalosis and base deficit
C.Gauges end-organ perfusion and tissue hypoxia
D.Determines the underlying cause of shock - ✔✔C.Gauges end-organ perfusion and
tissue hypoxia
✔✔*What is the most important consideration during the initial assessment when caring
for an older adult who has sustained serious injuries?
A.They are likely to be fearful in the emergency department
B.Medical history including current medications
C.Availability of support systems after discharge
D.Accessibility to a primary care physician - ✔✔B.Medical history including current
medications
✔✔Following a gun shot wound, pre-hospital providers report diminished breath sounds
bilaterally. Upon emergency department arrival, the patient is unresponsive with shallow
respirations and an O2 sat of 88%. What is the priority intervention for this patient?
A.Administer 15 L oxygen via nonrebreather mask
B.Attach patient to a CO2 detector
C.Prepare for a definitive airway
D.Assist ventilation with a bag-mask device - ✔✔D.Assist ventilation with a bag-mask
device
✔✔Your patient was the unrestrained driver involved in a moderate speed motor vehicle
collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the
lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about
injury to which organ?
A.Transverse colon
B.Pancreas
C.Liver
D.Spleen - ✔✔C.Liver
✔✔*A 5-year-old child presents to the emergency department with bruises to the upper
arms and buttocks in various stages of healing and multiple small, clean, round burns to
the back. There are no abnormalities found based on the pediatric assessment triangle
, or primary survey. Which of the following is the priority nursing intervention? -
✔✔A.Report your suspicion of maltreatment in accordance with local regulations
✔✔A patient arrives with a large metal rod embedded in their left thigh and no active
bleeding. Which intervention is most appropriate for this patient?
A.Remove the rod immediately to facilitate cleansing.
B.Apply a tourniquet to the leg above the metal rod.
C.Hold antibiotics until after the rod is removed.
D.Prepare the patient for surgery to remove the rod. - ✔✔D.Prepare the patient for
surgery to remove the rod.
✔✔When should the definitive calculation for intravenous fluid resuscitation rate be
performed for a patient with burns?
A.As soon as the patient arrives
B.During the secondary survey
C.Should only be done at a burn center
D.During the primary survey - ✔✔B.During the secondary survey
✔✔Which of the following 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 -
✔✔B.It can be used in hypotensive patients too unstable for computed tomography
scan
✔✔What is the priority intervention for a child who has been diagnosed with an atlanto-
occipital dislocation following a high-speed motor vehicle collision?
A.Initiating a second large caliber intravenous line
B.Maintaining spinal motion restriction
C.Placing the patient on pulse oximetry
D.Turning the patient to remove the backboard - ✔✔B.Maintaining spinal motion
restriction
✔✔What position optimizes ventilation in the obese patient with a lumbar fracture?
A.Reverse Trendelenburg
B.Supine
C.Prone
D.Fowler's - ✔✔A.Reverse Trendelenburg
