TNCC 9th edition
An adult pt 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 pt has received one intravenous fluid bolus of 500
mL of warmed isotonic crystalloid solution. the PaCO2 is 30mmHg (4.0 kPa), and the pulse oximetry is
92%. BP is 142/70 mmHg. What is the most important intervention to manage the cerebral blood flow?
Decrease the rate of manual ventilation
An older adult presents to the emergency department with complaints of dizziness, headache, and
nausea. The pt was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness
and a hematoma is noted to the forehead. The pt is currently on anticoagulant therapy. What is most
likely the cause of their symptoms?
post-concussive syndrome
A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally
relieved by pain medication. Which of the following is the priority nursing intervention?
Elevating the leg to the LEVEL of the heart
(compression/crush- level of the heart)
(regular fracture- above the heart)
A pt involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small
penetrating wound to the 6th intercostal space in the left lateral chest. Which finding is most consistent
with an injury to the diaphragm?
Bowel sounds heard in the lower left chest
A pt has been in the emergency department for several hours waiting to be admitted. They sustained
multiple rib fractures and a femur fracture after a fall. The pt has been awake, alert, and complaining of
leg pain. Their spouse reported that the pt suddenly became anxious and confused. Upon reassessment,
the pt is restless, with respiratory distress and petechiae to his neck. The pt is exhibiting signs and
symptoms most commonly associated with which of the following conditions?
Fat embolism
3 adult pts present at different times during a 1-hour period with a high fever, fatigue, and headache. All
3 pts have a rash which started on their mouth, face, and arms with progression to the chest and
abdomen. They all visited the same grocery store within the last week. What is the most appropriate
intervention from triage for these pts?
Immediately initiate contact precautions
, A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-
shaped left pupil is noted on exam.
Witai type of injury is suspecied?
Globe rupture
A trauma patient who is 30 - weeks pregnant arrives at the emergency department following a motor
vehicle collision Which normal physiologic change should be considered when assessing ventilatory
status ?
Increased oxygen consumption
A patient who sustained severe injuries was brought to the emergency department following a high -
speed motor vehicle collision . Interventions for hypovolemic shock have been initiated . What
component of the trauma triad of death is most likely to have begun at the time of injury ?
Coagulopathy
An adult patient involved in a motor vehicle collision is brought to the emergency department of a rural
critical access facility . They complain of neck pain , shortness of breath , and diffuse abdominal pain .
The Glasgow Coma Score is 15. Vital signs are : BP 98/71 mm Hg , HR 125 beats / minute , RR 26 breaths
/ minute , and SpO2 94 % on high - flow oxygen via non - rebreather mask . Which of the following is the
priority intervention for this patient ?
Expedite transfer to the closest trauma center
A patient who weighs 120 kg is brought to the emergency department after sustaining partial thickness
burns to both upper extremities and chest with a total body surface area burned of 27 % . How much
intravenous fluid should be administered in the first 8 hours ?
3240 mL
A trauma patient is being held in the emergency department because there are no available inpatient
beds . The patient sustained a femur fracture and required multiple blood products . The patient now
has blood oozing from abrasions , IV sites , the nose , and gums . What condition is most consistent with
these findings ?
Disseminated intravascular coagulopathy
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 34.60C ( 94.20F ) and an SpO2 of 90 % on oxygen at 15L per
non - rebreather mask . Other findings include ETCO2 24 , scrum lactate of 6 mmol / L , and a pH of 6.8 .
Based on these findings what is the most appropriate intervention
Initiate warming measures
An adult pt 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 pt has received one intravenous fluid bolus of 500
mL of warmed isotonic crystalloid solution. the PaCO2 is 30mmHg (4.0 kPa), and the pulse oximetry is
92%. BP is 142/70 mmHg. What is the most important intervention to manage the cerebral blood flow?
Decrease the rate of manual ventilation
An older adult presents to the emergency department with complaints of dizziness, headache, and
nausea. The pt was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness
and a hematoma is noted to the forehead. The pt is currently on anticoagulant therapy. What is most
likely the cause of their symptoms?
post-concussive syndrome
A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally
relieved by pain medication. Which of the following is the priority nursing intervention?
Elevating the leg to the LEVEL of the heart
(compression/crush- level of the heart)
(regular fracture- above the heart)
A pt involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small
penetrating wound to the 6th intercostal space in the left lateral chest. Which finding is most consistent
with an injury to the diaphragm?
Bowel sounds heard in the lower left chest
A pt has been in the emergency department for several hours waiting to be admitted. They sustained
multiple rib fractures and a femur fracture after a fall. The pt has been awake, alert, and complaining of
leg pain. Their spouse reported that the pt suddenly became anxious and confused. Upon reassessment,
the pt is restless, with respiratory distress and petechiae to his neck. The pt is exhibiting signs and
symptoms most commonly associated with which of the following conditions?
Fat embolism
3 adult pts present at different times during a 1-hour period with a high fever, fatigue, and headache. All
3 pts have a rash which started on their mouth, face, and arms with progression to the chest and
abdomen. They all visited the same grocery store within the last week. What is the most appropriate
intervention from triage for these pts?
Immediately initiate contact precautions
, A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A teardrop-
shaped left pupil is noted on exam.
Witai type of injury is suspecied?
Globe rupture
A trauma patient who is 30 - weeks pregnant arrives at the emergency department following a motor
vehicle collision Which normal physiologic change should be considered when assessing ventilatory
status ?
Increased oxygen consumption
A patient who sustained severe injuries was brought to the emergency department following a high -
speed motor vehicle collision . Interventions for hypovolemic shock have been initiated . What
component of the trauma triad of death is most likely to have begun at the time of injury ?
Coagulopathy
An adult patient involved in a motor vehicle collision is brought to the emergency department of a rural
critical access facility . They complain of neck pain , shortness of breath , and diffuse abdominal pain .
The Glasgow Coma Score is 15. Vital signs are : BP 98/71 mm Hg , HR 125 beats / minute , RR 26 breaths
/ minute , and SpO2 94 % on high - flow oxygen via non - rebreather mask . Which of the following is the
priority intervention for this patient ?
Expedite transfer to the closest trauma center
A patient who weighs 120 kg is brought to the emergency department after sustaining partial thickness
burns to both upper extremities and chest with a total body surface area burned of 27 % . How much
intravenous fluid should be administered in the first 8 hours ?
3240 mL
A trauma patient is being held in the emergency department because there are no available inpatient
beds . The patient sustained a femur fracture and required multiple blood products . The patient now
has blood oozing from abrasions , IV sites , the nose , and gums . What condition is most consistent with
these findings ?
Disseminated intravascular coagulopathy
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 34.60C ( 94.20F ) and an SpO2 of 90 % on oxygen at 15L per
non - rebreather mask . Other findings include ETCO2 24 , scrum lactate of 6 mmol / L , and a pH of 6.8 .
Based on these findings what is the most appropriate intervention
Initiate warming measures
