TNCC Exam( 8th edition) study Guide Completely Solved!!

What physiologic change in the elderly population increases the risk of traumatic injury? - ANSWER Decreased subcutaneous fat Decreased subcutaneous fat and thinning of the skin increases the risk of injuries from soft tissue trauma and increases the risk of hypothermia If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? - ANSWER Calcium Hypocalcemia is a concern with massive transfusion because citrate is added to banked blood to prevent coagulation. Citrate chelates (binds with) calcium, rendering it inactive. Which of the following is a possible complication of positive-pressure ventilation? - ANSWER Worsening pneumothorax Positive-pressure ventilation can lead to increased air in the chest cavity without a route of escape, worsening a pneumothorax and possibly leading to a tension pneumothorax. An intubated and sedated patient in the emergency department has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? - ANSWER Pressure Pressure can be assessed in the limb by palpation or direct measurement. The compartment or limb will feel tight or tense upon palpation. The skin may also appear taut and shiny. A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. He is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? - ANSWER Dressing removal This is the fastest effective intervention for this decompensating patient. A nonporous dressing taped on three sides is temporary and has variable effectiveness. If signs and symptoms of tension pneumothorax develop after the application of the dressing Which of the following is a component of the trauma triad of death? - ANSWER Acidosis The three components of the trauma triad of death are acidosis, hypothermia and coagulopathy. When is the tertiary survey completed for a trauma patient? - ANSWER Within 24 hours of the trauma The tertiary survey consists of a complete examination performed following the primary and secondary surveys and within 24 hours after trauma to identify any injuries missed during the initial assessment. A 36-year-old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? - ANSWER Apply a splint and elevate the extremity above the level of the heart Splinting the injured extremity stabilizes the extremity and reduces further injury. Elevation above the level of the heart promotes venous return and may reduce swelling. A trauma patient is restless and repeatedly asking "Where am I?" Vital signs upon arrival were BP 110/60 mm Hg, HR 96 beats/minute and RR 24 breaths/minute. Her skin is cool and dry. Current vital signs are BP 104/84 mm Hg, HR 108 beats/minute, and RR 28 breaths/minute. The patient is demonstrating signs and symptoms of which stage of shock? - ANSWER Compensated Patients in compensated shock exhibit subtle changes in level of consciousness and vital signs including a narrowed pulse pressure. Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? - ANSWER To gauge end-organ perfusion and tissue hypoxia The serum lactate is an indicator of end-organ tissue perfusion and tissue hypoxia. A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention? - ANSWER Elevating the extremity to the level of the heart Elevating the extremity higher than the heart can reduce circulation and tissue perfusion if compartment syndrome is suspected. Which of the following pulse pressures indicate early hypovolemic shock? - ANSWER Narrowed A rising diastolic blood pressure, reflecting peripheral vasoconstriction, results in a narrowed pulse pressure. EMS brings a patient who fell while riding his bicycle. Using the American College of Surgeons screening guidelines, which assessment finding would prompt the nurse to prepare the patient for radiologic spine clearance? - ANSWER Smell of alcohol on breath Suspected intoxication warrants radiologic spine clearance. A 5-year-old child presents to the ED 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? - ANSWER Report your suspicion of maltreatment in accordance with local regulations Nurses are mandated reporters in most jurisdictions. With no alterations in the primary survey, this is the priority intervention. A toddler who fell off a trampoline is making eye contact with the family and is consolable. There is no increased work of breathing and the skin color is pink. The nurse asks the patient to open his mouth, but the patient does not respond to commands. The nurse recognizes this as an expected finding due to which of the following conditions? - ANSWER Developmental stage An alert or older infant or toddler will recognize his or her caregiver but be cautious of strangers and my not respond to commands This is normal. There has been a mass casualty incident a block from the hospital. The hospital is receiving dozens of patients. A truck arrives with an unresponsive patient in the back with obvious chest and abdominal trauma. Agonal respirations do not improve with airway positioning. Using the START triage algorithm, you would triage tag this patient as which of the following? - ANSWER Black This patient is unlikely to survive given the severity of their injuries and is triaged as expectant. Resources should be reserved for individuals considered to be more salvageable. A patient has been in the emergency department for several hours waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the patient is restless with respiratory distress and petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated with which of the following conditions? - ANSWER Fat embolism Symptoms of fat embolism include decreased mental status, restlessness, agitation, respiratory distress, and a petechial rash to the head, neck, anterior thorax, conjunctivae, buccal mucous membranes, and axillae. The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better visualization during the insertion of which device? - ANSWER Endotracheal tube The ramped position is described as elevation of the head with the external auditory canal parallel with the sternal notch to provide better visualization of pharyngeal landmarks. This position is useful during intubation. The nurse is assessing a patient with a fractured forearm that was splinted three hours ago. Which symptom is of most concern as a late sign of an evolving complication? - ANSWER Weak radial pulse A weak radial pulse is evidence of an actual compromise in circulation. Which of the following is true about the log-roll? - ANSWER It can worsen cord damage from an unstable spinal injury The log-roll maneuver has been shown to cause spinal motion that can worsen damage from an unstable spinal injury. What factor contributes most to the kinetic energy of a body in motion? - ANSWER Velocity Kinetic energy is equal to one half the mass multiplied by the square of the velocity. Doubling the velocity quadruples its contribution to kinetic energy. Doubling the mass only doubles its contribution to kinetic energy. An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? - ANSWER Ventilate with a bag-mask device Assist ventilations with a bag-mask device until a definitive airway is obtained is the priority. Which of the following is a late sign of increased intracranial pressure? - ANSWER Decreased respiratory effort Other late signs of increased intracranial pressure include dilated, nonreactive pupils, unresponsiveness, abnormal motor posturing, and the Cushing response. Which of the following injuries is LEAST likely to be promptly identified? - ANSWER Bowel Hollow organ injury signs and symptoms may be subtle and delayed but are associated with a high mortality rate if not identified. A 56-year-old male patient involved in a motor vehicle crash is brought to the emergency department of a rural critical access facility. He complains of neck pain, shortness of breath, and diffuse abdominal pain. His Glasgow Coma Score is 15. His vital signs are as follows: BP 98/71 mm Hg, HR 125 beats/minute, RR 26 breaths/minute, SpO2 94% on high-flow oxygen via non-rebreather mask. Which of the following is the priority intervention for this patient? - ANSWER Expedite transfer to the closest trauma center The American College of Surgeons recommends that patients with significant injuries be transported to a trauma center for definitive care. This patient's injuries might not be definitively diagnosed, but his symptoms and vital signs indicate the need for Which of the following is most likely to contribute to inadequate oxygenation and ventilation? - ANSWER Advanced age Older patients are more likely to have pulmonary comorbidities and decreased pulmonary reserve. Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? - ANSWER Hypotension that worsens with inspiration Hypotension that worsens with inspiration is associated with tension pneumothorax due to compression of the heart and great vessels (obstructive shock). The increased intrathoracic pressure with inspiration worsens the hypotension.