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TNCC Test Exam (9th Edition)-with 100% verified
solutions-2023

Expedite transfer to the closest trauma center
A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical
access facility
...
His GCS is 15
...
Which of
the following is the priority intervention for this patient?

a pertinent medical hx is crucial
Which of the following considerations is the most important when caring for a
geriatric trauma pt?

Mitigation
Following a review of recent drills and a real disaster event, a hospital has identified
deficiencies and is taking steps to minimize the impact of a future disaster
...
Using the American College of
Surgeobs screening guidelines, which assessment finding would prompt the RN to
prepare the pt for a radiologic spine clearance?

hemoglobin does not readily release O2 for use by the tissues
What is the effect of hypothermia on the oxyhemoglobin dissociation curve?

acidosis
Which of the following is a component of the trauma triad of death?

Complete
EMS brings a pt from MVC
...
2F (36
...
The pt
exhibits urinary incontinence and priapism
...
What priority nursing interventions should be preformed
next?

globe rupture
A 35 y/o M presents with facial trauma after being struck in the face with a baseball
...
What type of injury is suspected?

compensated
A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP
110/60, HR96, RR 24
...
Current VS are BP 104/84, HR 108, RR
28
...
The trauma team has administered medications for
drug-assisted intubation and attempted intubation but was unsuccessful
...
What is the most reliable indication of
compartment syndrome in a patient who is unconscious?

worsening pneumothorax
Which of the following is possible complication of positive-pressure ventilation?

pelvic stability
the most reassuring finding for a male pt with hip pain after a fall is which of the
following?

narrowed
Which of the following pulse pressures indicate early hypovolemic shock?

dysrhythmias
Patients with a crush injury should be monitored for which of the following
conditions?

subdural hematoma
Tearing of the bridging veins is most frequently associated with which brain injury?

straight cath for urine sample
A 20 y/o M presents to the ED complaining of severe lower abd pain after landing
hard on the bicycle cross bars while preforming an aerial BMX maneuver
...
Which of the
following orders would the RN question?

placental abruption
You are caring for a pt who was involved in a MVC and is 32 weeks pregnant
...
Varying accelerations and decelerations
are noted on cariocgraphy
...
The pt
is awake and crying with increased work of breathing and pale skin
...
When
significant abd and pelvic injuries are noted in the primary survey, which of the
following is the priority interventions?

bardycardia and absent motor function below the level of injury
A pt with a complete spinal cord injury in neurogenic shock will demonstrate
hypotension and which other clinical signs?

apply splint and elevate above the level of the heart
a 37 y/o F has a deformity of the L wrist after a fall
...
Which of the following is the most appropriate intervention?

the aorta is torn at its attachment with the ligamentum arteriosum
which of the following occurs during the third impact of a motor vehicle crash?

Report your suspicion of maltreatment in accordance with local regulations
a 5 y/o child presents to the ED with bruises to the upper arm and buttocks in various
stages of healing and multiple small, clean, round burns to the back
...

Which of the following is the priority survey
...
Which of the following is the priority nursing
intervention?

velocity
What factor contributes most to the kinetic energy of a body in motion?

subdural hematoma
An elderly patient with a history of anticoagulant use presents after a fall at home
today
...
She has a hematoma to her forehead
and complains of headache, dizziness, and nausea
...
He sustained multiple
rib fractures and a femur fracture after a fall
...
His wife reported that he suddenly became anxious and
confused
...
The pt is exhibiting s/sx most commonly associated with which
of the following conditions?

nausea and vomiting
Which of the following is a late sign of increased intracranial pressure?

serial FAST exams
a 49 y/o restrained driver involved in a MVC presents to the trauma center
complaining of abd, pelvic, and bilateral lower extremity pain
...
The
nurse can anticipate all of these after a negative FAST exam EXCEPT which of the
following?

pericardiocentesis
Which of the following is NOT considered goal-directed therapy for cardiogenic
shock?

endotracheal tube
The trauma nurse knows that placing a bariatric patient in a ramped position
providers better visualization during the insertion of which device?

increased work of breathing?
which of the following assessment findings differentiates a tension pneumothorax
from a simple pneumothorax?

calcium
if a pt has received multiple transfusions of banked blood preserved with citrate,
which electrolyte is most likely to drop and require supplementation?

identifying individuals who made mistakes during the traumatic event
Which of the following is NOT considered a benefit of debriefings?

500 mL/hr
You are treating a 27 y/o M in respiratory distress who was involved in a house fire
...
At
what rate should you begin fluid resuscitation?

advanced age
Which of the following is most likely to contribute to inadequate oxygenation and
ventilation?

a 52 y/o diabetic male with a partial thickness burn to the left lower leg
Which of the following patients warrants referral to a burn center?

dressing removal
A patient arrives with a large open chest wound after being assaulted with a
machete
...
he is now showing signs of anxiety, restlessness, severe
respiratory distress, cyanosis and decreasing blood pressure
...
EMS reports
significant damage to the drivers side of the car
...
When it is appropriate to remove the cervical collar?

MARCH
Which of the following mnemonics can help the nurse prioritize care for a trauma
patient with massive uncontrolled hemorrhage?

What is kinematics?
A branch of mechanics (energy transfer) that refers to motion and does not consider
the concepts of force and mass of the object or body
...
A body in motion will remain in motion until acted
on by an outside force
...
It is only changed from one form to
another
...


What is kinetic energy (KE)?

KE equals 1/2 the mass (M) multiplied by the velocity squared
...

H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces

Where do you listen to auscultate breath sounds?
Auscultate the lungs bilaterally at the second intercostal space midclavicular line and
at the fifth intercostal space at the anterior axillary line
...


Upon initial assessment, what type of oxygen should be used for a pt breathing
effectively?
A tight-fitting nonrebreather mask at 12-15 lpm
...

- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of blood
- Use rapid infusion device based on protocol
- Use NS 0
...

- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)

How do you assess Mnemonic "D"?
DISABILITY
A = Alert
V = Verbal

P = Pain
U = Unresponsive
- GCS
- PERRL?
- Determine presence of lateralizing signs including:
- Unilateral deterioration in motor movements or unequal pupils
- Symptoms that help to locate area of injury in brain

What are the interventions for Disability?
- If assessment indicates a decreased LOC, conduct further investigation during
secondary focused assessments
- If pt is not alert or verbal, continue to monitor for any compromise to ABC's
- If pt demonstrates signs of herniation or neurologic deterioration, consider
hyperventilation
...

- Palpate vertebral column for deformity and areas of tenderness
- Assess rectum for presence/absence of tone, presence of blood

What she be done after the Secondary Assessment?
Reassess:
- Primary survey,
- VS
- Pain
- Any injuries

What are factors that contribute to ineffective ventilation?
- AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age

What medications are used during intubation?
LOAD Mnemonic:
L = Lidocaine
O = Opioids
A = Atropine

D = Defasiculating agents

What are the Rapid Sequence Intubation Steps?
PREPARATION:
- gather equipment, staffing, etc
...

PRETREATMENT:
- Decrease S/E's of intubation
PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent
PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and
aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts
...

- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector
...
If inadvertently placed into trachea, it can be used as a
temporary ET tube
...


What is a Laryngeal Mask Airway?
Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber
collar at the distal end
...


ILMA, does not require laryngoscopy and visualization of the chords
...
(temporary)

Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema

What is Surgical Cricothyrotomy?
Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube
into trachea
...


Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis

How do you confirm ET Tube/Alternative Airway Placement?
- Visualization of the chords
- Using bronchoscope to confirm placement
- Listening to breath sounds over the epigastrum and chest walls while ventilating
the pt
- CO2 detector
- Esophageal detection device
- Chest x-ray

How do you inspect the chest for adequate ventilation?
Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax)

What are you looking for when auscultating lung sounds?
Absence of BS:
- Pneumothorax
- Hemothorax
- Airway Obstruction
Diminished BS:
- Splinting or shallow BS may be a result of pain

What are you looking for when percussing the chest?
Dullness:
- hemothorax
Hyperresonance
- Pneumothorax

What are you looking for when palpating the chest wall, clavicles and neck?
- Tenderness
- Swelling
- subcutaneous emphysema
- step-off deformities
= These may indicate: esophageal, pleural, tracheal or bronchial injuries
...
Tracheal deviation may indicate a tension
pneumothorax or massive hemothorax
...

Most common to affect a trauma pt cause by hypovolemia
...


Some causes:
- Blood loss
- Burns, etc
...

Syndrome that results from ineffective perfusion caused by ineffective perfusion
caused by inadequate contractility of cardiac muscle
...

Results from inadequate circulating blood volume because of an obstruction or
compression of great veins, aorta, pulmonary arteries, or heart itself
...

- Tension pneumothorax may lead to inadequate stroke volume by displacing inferior
vena cava and obstructing venous return to right atrium
...

Results from disruption in SNS control of the tone of blood vessels, which leads to
vasodilation and maldistribution of blood volume and flow
...
Neurogenic shock may result from injury to spinal cord in cervical or upper
thoracic region
...


Septic shock from bacteremia is distributive shock
...


What is vascular response?
As blood volume decreases, peripheral blood vessels vasoconstrict as a result of
sympathetic stimulation via inhibition of baroreceptors
...


What is renal response?
Renal ischemia activates release of renin
...


Renin causes angiotensinogen, normal plasma protein, to release angiotensin I
...


Angiotensin II causes:
- Vasoconstriction of arterioles and some veins
- Stimulation of sympathetic nervous system
- Retention of water by kidneys
- Stimulation of release of aldosterone from the adrenal cortex (sodium retention
hormone)

*Decreased urinary output = early sign renal hypoperfusion and an indicator that
there's systemic hypoperfusion
...

When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine
and norepinephrine) from adrenal medulla will increase
...


Shock stimulates hypothalamus to release corticotropin-releasing hormone that
stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol
...


Cortisol also causes renal retention of water and sodium, a compensatory
mechanism to conserve body water
...

Liver can store excess glucose as glycogen
...


In a compensatory response to shock, hepatic vessels constrict to redirect blood flow
to other vital areas
...

Tachypnea happens for 2 reasons:
1
...
Maintain increased supply of oxygen

* Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to
increase rate of ventilation
...


Explain Irreversible Shock
...

- Inadequate venous return
- inadequate cardiac filling
- decreased coronary artery perfusion
- Membranes of lysosomes breakdown within cells and release digestive enzymes
that cause intracellular damage
...
Brain
2
...
Blood within the nonexpansible cranial vault

As volume of one increases, the volume of another decreases to maintain ICP within
normal range
...
Hypotensive pt w/marginally elevated ICP can be
harmful
...

Cerebral ischemia can lead to increased concentration of CO2 and decreased
concentration of O2 in cerebral vessels
...


What are the early signs and symptoms of increased ICP?
- Headache
- N/V
- Amnesia regarding events around the injury
- Altered LOC
- Restlessness, drowsiness, changes in speech, or loss of judgement

What are the late observable signs of symptoms of increased ICP?
- Dilated, nonreactive pupil
- Unresponsiveness to verbal or painful stimuli
- Abnormal motor posturing patterns
- Widening pulse pressure
- Increased systolic blood pressure
- Changes in RR and pattern
- Bradycardia

What is Cushing's phenomenon or Cushing's Reflex?
Triad of progressive HTN, bradycardia and diminished respiratory effort
...
Uncal herniation
2

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