TNCC Practice Exam
A 30-week pregnant trauma patient's vital signs include a blood pressure of 94/62 mm Hg
and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The
emergency nurse interprets the patient's hemodynamic findings as an indication of which of
the following?
a. Decompensated shock
b. Normal vital signs in pregnancy
c. Abruptio placentae
d. Supine hypotension syndrome - correct answer-b. Normal vital signs in pregnancy
Rationale: In pregnancy, the resting heart rate increases by 10 to 20 beats/minute and a
small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure
due to a decrease in peripheral resistance (p. 294). Normal fetal heart rate is between 120
and 160 beats/minute (p. 297).
A patient fell two weeks ago, striking his head. He came to the emergency department with a
persistent headache and nausea. He was diagnosed with a small subdural hematoma and
has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports that
he has been anxious, restless, and shaky. He vomited twice during the night. He tells the
day shift nurse that he couldn't sleep because a young child kept coming into his room. What
is a likely cause for these signs and symptoms?
a. Increased intracranial pressure
b. Alcohol withdrawal
c. Rhabdomyolysis
d. Pulmonary embolus - correct answer-b. Alcohol withdrawal Rationale: Alcohol withdrawal
is a common delayed condition because symptoms are difficult to identify early. Signs
include autonomic hyperactivity, hand tremors, nausea or vomiting, psychomotor agitation,
anxiety, insomnia, hallucinations, or seizures (p. 397).
A patient with a knife injury to the neck has an intact airway and is hemodynamically stable.
He complains of difficulty swallowing and speaking. Further assessment is indicated next for
which of the following conditions?
a. Damage to the spinal cord
b. An expanding pneumothorax
c. Laceration of the carotid artery
d. Injury to the thyroid gland - correct answer-a. Damage to the spinal cord Rationale:
Penetrating neck trauma may include concurrent injuries to the spinal cord, airway, or
vascular neck structures. With an intact airway and hemodynamic stability, the other
common concurrent injury is to the spinal cord (pp. 124, 126).
A patient with a spinal cord injury at C5 is being cared for in the emergency department
while awaiting transport to a trauma center. Which of the following represents the highest
priority for ongoing assessment and management?
a. Maintain adequate respiratory status
b. Administer balanced resuscitation fluid
c. Perform serial assessments of neurologic function
, d. Maintain core temperature - correct answer-a. Maintain adequate respiratory status
Rationale: Spinal cord injuries at C3 to C5 can cause the loss of phrenic nerve function,
resulting in a paralyzed diaphragm and inability to breathe (p. 173, 179).
A trauma nurse cared for a child with devastating burns two weeks ago. She called in sick
for a couple of days and is now back working on the team. Which of the following behaviors
would indicate this nurse is coping well?
a. She is talking about taking the emergency nursing certification examination
b. She keeps requesting to be assigned to the walk-in/ambulatory area
c. She is impatient and snaps at coworkers
d. She is thinking about transferring out of the emergency department - correct answer-a.
She is talking about taking the emergency nursing certification examination Rationale: This
is an indication she is taking positive steps to advance her own practice, a sign of resilience
(p. 338).
Based on proper bleeding control techniques, what is the first step to stop the bleeding of a
penetrating injury to the lower extremity?
a. Elevate the extremity to the level of the heart
b. Initiate direct pressure
c. Apply a tourniquet
d. Cover the open wound with sterile saline dressings - correct answer-b. Initiate direct
pressure Rationale: The first step in controlling any bleeding is direct pressure. If that is not
adequate, the application of a tourniquet may be needed (p. 201-204).
Following a bomb explosion, fragmentation injuries from the bomb or objects in the
environment are examples of which phase of injury?
a. Primary
b. Secondary
c. Tertiary
d. Quaternary - correct answer-b. Secondary Rationale: The secondary phase of a blast
results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating
injuries (p. 20).
In a patient with severe traumatic brain injury, hypocapnia causes:
a. Respiratory acidosis
b. Metabolic acidosis
c. Neurogenic shock
d. Cerebral vasoconstriction - correct answer-d. Cerebral vasoconstriction Rationale:
Hypocapnia, or low levels of carbon dioxide, will cause vasoconstriction, especially in the
cerebral vasculature (p. 98).
The across-the-room observation step in the initial assessment provides the opportunity to:
a. Assess for uncontrolled internal hemorrhage
b. Accurately triage the patient
c. Reprioritize circulation before airway or breathing
d. Activate the trauma team - correct answer-c. Reprioritize circulation before airway or
breathing. Rationale: The across-the-room observation is done at the beginning of the
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