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TNCC Exam 8th edition study
TNCC Exam 8th edition study
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TNCC EXAM 8TH EDITION STUDY1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve 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.ANSWERSEMS 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? After a physical examination if the
patient has no radiologic abnormalities on CT A CT is recommended for spinal clearance in an impaired
patient.ANSWERSThe 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? 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.ANSWERSWhich of the following is an
expected finding in a patient with a tube thoracostomy connected to a chest drainage system
Fluctuation in the water seal chamber Fluctuation in the water seal chamber indicates the tube
is placed correctly in the pleural space.ANSWERS.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? Globe rupture A teardrop-shaped pupil suggests a globe rupture.ANSWERS.A
patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which
other clinical signs? 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.ANSWERSWhich of the
following patients warrants referral to a burn center? 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.ANSWERSYou 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? Placental abruption The findings of abdominal pain, elevated
fundal height, dark bloody show, and fetal distress are most consistent with placental
abruption.ANSWERSA 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? Straight 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.ANSWERSWhich of the following occurs during the third impact of a motor vehicle crash?
The aorta is torn at its attachment with the ligamentum arteriosum This occurs during the third
impact.ANSWERSAll of these are considered a critical communication point in trauma care EXCEPT
which of the following? Defusings A defusing is part of critical incident stress management but is not
, considered a critical communication point in trauma care.ANSWERSWhich of the following mnemonics
can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? 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.ANSWERSYou 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? 500 mL/hour
Prior to calculating TBSA, this is the recommended starting point for fluid resuscitation for patients 14
years of age and olderANSWERSA 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? Diagnostic peritoneal lavage Diagnostic peritoneal lavage is indicated for
hemodynamically unstable patients or if FAST and CT are not available.ANSWERSAn 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? 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.ANSWERSTearing of the
bridging veins is most frequently associated with which brain injury? Subdural hematoma Subdural
hematomas are usually caused by tearing of the bridging veins and associated with direct injury to the
underlying brain tissue.ANSWERS.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? 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.ANSWERSWhat bedside
monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation?
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.ANSWERSWhich
of the following is NOT considered a benefit of debriefings? 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.ANSWERSWhich of the following is NOT considered
goal-directed therapy for cardiogenic shock? Pericardiocentesis A pericardial tamponade is a form of
obstructive, not cardiogenic, shock.ANSWERSA patient is brought to the emergency department of a
rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic
injuries are noted in the primary survey, which of the following is the priority intervention? Initiate
transfer to a trauma center Early consideration for transfer to a trauma center is essential to ensure
optimal outcomes.ANSWERSThe most reassuring finding for a male patient with hip pain after a fall is
which of the following? 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.ANSWERSEMS 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
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