TNCC Notes for Written Exam| All
correct Answers
What is kinematics?
A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts
of force and mass of the object or body.
What is Newton's First Law?
A body at rest will remain at rest. A body in motion will remain in motion until acted on by an
outside force.
What is the Law of Conservation of Energy?
Energy can neither be created nor destroyed. It is only changed from one form to another.
What is Newton's Second Law?
Force equals mass multiplied by acceleration of deceleration.
What is kinetic energy (KE)?
KE equals 1/2 the mass (M) multiplied by the velocity squared.
What is the Mnemonic for the Initial Assessment?
A = Airway with simultaneous cervical spine protection
B = Breathing
C = Circulation
D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment?
F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric
tube)/Family presence
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and
nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
,I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds?
Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth
intercostal space at the anterior axillary line.
What are the late signs of breathing compromise?
- Tracheal deviation
- JVD
What are signs of ineffective breathing?
- AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated
- Anticipate definitive airway management to support ventilation.
Upon initial assessment, what type of oxygen should be used for a pt breathing effectively?
A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation?
- Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation?
- Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
, What are the interventions for Effective/Ineffective Circulation?
- Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of blood
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)
How do you assess Mnemonic "D"?
DISABILITY
A = Alert
V = Verbal
P = Pain
U = Unresponsive
- GCS
- PERRL?
- Determine presence of lateralizing signs including:
- Unilateral deterioration in motor movements or unequal pupils
- Symptoms that help to locate area of injury in brain
What are the interventions for Disability?
- If assessment indicates a decreased LOC, conduct further investigation during secondary
focused assessments
- If pt is not alert or verbal, continue to monitor for any compromise to ABC's
- If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation.
What is assessed and intervened for Expose/Environmental Controls?
- Remove clothing- Ensure appropriate decontamination if exposed to hazardous material
- Keep pt warm
- Keep clothing for evidence
correct Answers
What is kinematics?
A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts
of force and mass of the object or body.
What is Newton's First Law?
A body at rest will remain at rest. A body in motion will remain in motion until acted on by an
outside force.
What is the Law of Conservation of Energy?
Energy can neither be created nor destroyed. It is only changed from one form to another.
What is Newton's Second Law?
Force equals mass multiplied by acceleration of deceleration.
What is kinetic energy (KE)?
KE equals 1/2 the mass (M) multiplied by the velocity squared.
What is the Mnemonic for the Initial Assessment?
A = Airway with simultaneous cervical spine protection
B = Breathing
C = Circulation
D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment?
F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric
tube)/Family presence
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and
nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
,I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds?
Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth
intercostal space at the anterior axillary line.
What are the late signs of breathing compromise?
- Tracheal deviation
- JVD
What are signs of ineffective breathing?
- AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated
- Anticipate definitive airway management to support ventilation.
Upon initial assessment, what type of oxygen should be used for a pt breathing effectively?
A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation?
- Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation?
- Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
, What are the interventions for Effective/Ineffective Circulation?
- Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of blood
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)
How do you assess Mnemonic "D"?
DISABILITY
A = Alert
V = Verbal
P = Pain
U = Unresponsive
- GCS
- PERRL?
- Determine presence of lateralizing signs including:
- Unilateral deterioration in motor movements or unequal pupils
- Symptoms that help to locate area of injury in brain
What are the interventions for Disability?
- If assessment indicates a decreased LOC, conduct further investigation during secondary
focused assessments
- If pt is not alert or verbal, continue to monitor for any compromise to ABC's
- If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation.
What is assessed and intervened for Expose/Environmental Controls?
- Remove clothing- Ensure appropriate decontamination if exposed to hazardous material
- Keep pt warm
- Keep clothing for evidence
