TNCC EXAM TEST 20203/2024

1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve - CORRECT ANSWER-Hemoglobin does not readily release oxygen for use by the tissues A shift to the left occurs in an environment of low metabolic demand (hypothermia, hypocapnia, alkalosis), increasing hemoglobin's affinity for oxygen. EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports significant damage to the driver's side of the car. The patient is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? - CORRECT ANSWER-After a physical examination if the patient has no radiologic abnormalities on CT A CT is recommended for spinal clearance in an impaired patient. The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total body surface area burned, how much IV fluid would be administered in the first 8 hours? - CORRECT ANSWER-2280 mL Both upper arms = 8%, both lower arms = 6%, and both hands = 5%, yielding 19 * 2 * 120 = 4560 mL. Half of the total is equal to 2280 mL. Superficial burns are not included in the TBSA calculation for fluid resuscitation. Which of the following is an expected finding in a patient with a tube thoracostomy connected to a chest drainage system - CORRECT ANSWER-Fluctuation in the water seal chamber Fluctuation in the water seal chamber indicates the tube is placed correctly in the pleural space. .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. What type of injury is suspected? - CORRECT ANSWER-Globe rupture A teardrop-shaped pupil suggests a globe rupture. .A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? - CORRECT ANSWER-Bradycardia and absent motor function below the level of injury Patients with a complete spinal cord injury will have absent motor function below the level of the lesion. They become hypotensive and bradycardic due to loss of autonomic nervous system function. Which of the following patients warrants referral to a burn center? - CORRECT ANSWER-A 52-year-old diabetic male with a partial-thickness burn to the left lower leg This patient has a 7% TBSA burn with a preexisting medical history that could complicate management, prolong recovery, or affect mortality. You are caring for a patient who was involved in a motor vehicle crash and is 32 weeks pregnant. Findings of your secondary survey include abdominal pain on palpation, fundal height at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cardiotocography. These findings are most consistent with which of the following? - CORRECT ANSWER-Placental abruption The findings of abdominal pain, elevated fundal height, dark bloody show, and fetal distress are most consistent with placental abruption. A 20-year-old male presents to the ED complaining of severe lower abdominal pain after landing hard on the bicycle cross bars while performing an aerial BMX maneuver. Secondary assessment reveals lower abdominal tenderness and scrotal ecchymosis. Which of the following orders would the nurse question? - CORRECT ANSWERStraight catheter for urine sample Insertion of a urinary catheter is contraindicated if urethral transection is suspected. Signs and symptoms of urethral injury include blood at the meatus, perineal ecchymosis, scrotal ecchymosis, and a high-riding or non-palpable prostate. Which of the following occurs during the third impact of a motor vehicle crash? - CORRECT ANSWER-The aorta is torn at its attachment with the ligamentum arteriosum This occurs during the third impact. All of these are considered a critical communication point in trauma care EXCEPT which of the following? - CORRECT ANSWER-Defusings A defusing is part of critical incident stress management but is not considered a critical communication point in trauma care. Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? - CORRECT ANSWER-MARCH The MARCH mnemonic stands for massive hemorrhage, airway, respiration, circulation, and head injury/hypothermia. The MARCH mnemonic recognizes uncontrolled hemorrhage as the major cause of preventable death after injury. You are treating a 27-year-old male in respiratory distress who was involved in a house fire. Calculating total body surface area (TBSA) burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? - CORRECT ANSWER-500 mL/hour Prior to calculating TBSA, this is the recommended starting point for fluid resuscitation for patients 14 years of age and older A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? - CORRECT ANSWER-Diagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for hemodynamically unstable patients or if FAST and CT are not available. An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? - CORRECT ANSWER-Subdural hematoma Subdural hematomas are characterized by nausea, vomiting, headache, changes in level of consciousness, ipsilateral dilated, nonreactive pupil, and unilateral weakness or hemiparesis. These typically occur after a fall or assault. Tearing of the bridging veins is most frequently associated with which brain injury? - CORRECT ANSWER-Subdural hematoma Subdural hematomas are usually caused by tearing of the bridging veins and associated with direct injury to the underlying brain tissue. .During the primary survey of an unconscious patient with multi-system trauma, the nurse notes snoring respirations. What priority nursing intervention should be performed next? - CORRECT ANSWER-Insert an oropharyngeal airway if there is no gag reflex Snoring respirations may indicate airway obstruction from the tongue. Insert an airway adjunct to alleviate obstruction by the tongue. Oropharyngeal airways can be used in patients without a gag reflex. What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? - CORRECT ANSWER-Pulse oximetry and capnography Pulse oximetry measures the percentage of hemoglobin saturated with oxygen. Capnography measures the amount of carbon dioxide exhaled. Carbon dioxide is the end-product of ventilation and a reflection of metabolism and pulmonary function. Which of the following is NOT considered a benefit of debriefings? - CORRECT ANSWER-Identifying individuals who made mistakes during the traumatic event Debriefings are not used to single out individuals who made mistakes. Debriefings are used to provide an opportunity to review performance and identify areas for improvement with a sharing of individual responses. Which of the following is NOT considered goal-directed therapy for cardiogenic shock? - CORRECT ANSWER-Pericardiocentesis A pericardial tamponade is a form of obstructive, not cardiogenic, shock. A patient is brought to the emergency department of a rural hospital following a highspeed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, which of the following is the priority intervention? - CORRECT ANSWER-Initiate transfer to a trauma center Early consideration for transfer to a trauma center is essential to ensure optimal outcomes. The most reassuring finding for a male patient with hip pain after a fall is which of the following? - CORRECT ANSWER-Pelvic stability Uncontrolled hemorrhage is the major cause of preventable death after injury. Unstable pelvic fractures increase the volume of the pelvic cavity and can be life-threatening due to blood loss. EMS brings a patient from a motor vehicle crash. Vital signs are BP 90/49 mm Hg, heart rate 48 beats/minute, respiratory rate 12 breaths/minute, temperature 97.2°F (36.2° C). The patient exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? - CORRECT ANSWER-Complete Incontinence, priapism, and hypotension with bradycardia are manifestations of a complete spinal cord injur