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Emergency Nurses Association ENA
University
Trauma Nursing Core Course (TNCC)
Assessment
Clinical Competence TNCC Assessment
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TNCC 7 th Edition TNCC ENA Emergency Nurses Association Exam Review Questions and Answers | 100% Pass Guaranteed | Graded A+ | 2025- Clinical Competence TNCC Assessment Exam Trauma Nursing Core Course (TNCC) Assessment Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: -
Define trauma - =Answer>> - Trauma is injury to living
tissue caused by extrinsic agent
- Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to compensate p. 9 Leading cause of death for ages
- over 65
- 5 to 24
3. 25 to 64 - =Answer>> 1. Falls
- MVCs
- poisoning p. 9
Explain 3 phases of injury prevention - =Answer>> Primary:
prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred Tertiary: Improvement of outcomes related to the traumatic injury Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱 Ctrl + Click Here To 📑 ORDER NOW 📑 Follow Link 📱 ORDER NOW 📱 🎓 TO GET INSTANT EXPERT HELP 🎓 📱 ORDER NOW 📱
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Define mechanism of injury (MOI) - =Answer>> How
external energy forces in the environment are transferred to the body p. 25
Newton's First Law of Motion - =Answer>> A body at rest
will remain at rest, and a body in motion will stay in motion p. 26
Newton's Second Law of Motion - =Answer>> Force = Mass
X Acceleration p. 26
Newton's Third Law of Motion - =Answer>> For every
action, there is an equal and opposite reaction p. 26
Law of Conservation of Energy - =Answer>> Energy can
neither be created nor destroyed, but it can change form p. 26
Describe energy forms - =Answer>> - Mechanical (energy
transfer from one object to another in the form of motion)
- Thermal (energy transfer of heat in environment to the host)
- Chemical (heat energy transfer from active chemical substances such as chlorine, drain cleaner, acids, or plants)
- Electrical (energy transfer from light socket, power lines, or lightning)
- Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 External energy forces can be exerted on the body by the
following forces - =Answer>> - Deceleration forces: include
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those applied in falls and collisions where injuries are caused by sudden stop of the body's motion
- Acceleration forces: not as common as deceleration forces and result from a sudden and rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed)
- Compression force is an external force applied at times of impact, explains include:
- Stationary objects such as dashboards or steering wheels, that collide with or push up into a person
- Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or heavy falling objects
- Blast forces p. 27 The degree to which tissues resist destruction under circumstances of energy transfer depends on... -
=Answer>> Their proximity to the impact and their
structural characteristics p. 27 Structural strengths of tissue are described in what three ways?
- =Answer>> -Compression -Tensile -Shear p. 27 Compression strength refers to the tissue's ability to: -
=Answer>> Resist crush force
- Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 Tensile strength describes the tissue's ability to: -
=Answer>> Resist pulling apart when stretched
- Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon) Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 The U.S. Department of Defense classifies blast injuries in five
levels: - =Answer>> - Primary blast injuries: found in those
closest to the detonation, with enclosed space detonation resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel) are most susceptible to rupture with primary blast injuries.
- Secondary injuries: include fragment injuries and generally cause the greatest volume of casualties. They include injuries such as puncture wounds, lacerations, and impaled objects.
- Tertiary injuries: include impacts with larger objects propelled by the blast wind resulting in blunt trauma. These cause high energy transfer and can result in pelvic or femur fractures or major thoracic injuries such as aortic and great vessel rupture.
- Quaternary injuries: result of heat, flame, gas, and smoke. These injuries include external burns and internal burns from inhaled hot gases.
- Quinary injuries are those associated with exposure to hazardous materials from radioactive, biologic, or chemical components of a blast. ch. 4, p. 33 Compression may occur from the effects of chemical
substances and can cause.. - =Answer>> Edema, restricting
or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33- The Haddon Matrix broadened the approach and placed emphasis on countermeasures, such were more effective than changing human behavior. Haddon describes three phases of
the injury event: - =Answer>> Pre-event, Event, Post-event
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For each phase of the event, countermeasures for prevention can be applied. They include: The host (human) The agent (motor vehicle) The physical environment (socioeconomic environment) ch. 4, p. 34
Components of SBAR and its purpose - =Answer>> S:
Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7
Components of DESC and its purpose - =Answer>> D:
Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7
Components of CUS and its purpose - =Answer>> C: I am
Concerned U: I am Uncomfortable S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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What does 'safe practice' mean? - =Answer>> Means taking
into consideration the protection of the team, including:
- observing universal precautions
- donning PPE (gown, gloves, mask) prior to patient's arrival ch. 5, p. 39
What does 'safe care' mean? - =Answer>> Means assuring
the patient is getting to the right hospital in the right amount of time for the right care. American College of Surgeons Committee on Trauma (ACS- COT) developed trauma triage criteria that serves at the international standard to identify the trauma patient who would benefit from resuscitation and care at the right trauma facility with the appropriate resources. ch. 5, p. 40
During primary survey... - =Answer>> Life-threatening
conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 What is the most major cause of preventable death after injury?
- =Answer>> Uncontrolled hemorrhage ch. 5, p. 40
Explain the MARCH mnemonic - =Answer>> M: MASSIVE
HEMORRHAGE
A: AIRWAY
R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41- Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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While in ED, alignment and protection of the cervical spine can
be accomplished by which 2 ways? - =Answer>> - Manual
stabilization
- Immobilization ch. 5, p. 42
Explain the AVPU mnemonic - =Answer>> Used to quickly
assess patient's level of alertness A- ALERT (If any of the responses below are elicited at this point, the airway may be compromised) V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from obstructing airway P - responds to PAIN. U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct someone to check if the patient has a pulse while assessing if the cause of the problem is the airway. Consider reprioritizing the assessment priority to ABC ch. 5, p. 42 Use the jaw-thrust maneuver to open airway and assess for
obstruction when the patient is... - =Answer>> Unable to
open the mouth, responds only to pain, or is unresponsive. ch. 5, p. 42 Once patient has airway in place, assess for proper placement
by... - =Answer>> - Presence of adequate rise and fall of the
chest with assisted ventilation
- Absence of gurgling on auscultation over epigastrium
- Bilateral breath sounds present on auscultation
- CO2 detector device color change ch. 5, p. 43
If patient's airway is NOT patent: - =Answer>> 1. Suction
airway
- Avoid stimulating gag reflex Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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-- inability to maintain adequate oxygenation, causes hypoxemia resulting in anaerobic metabolism and acidosis -- Titrate oxygen delivery for stabilized trauma patients to avoid the detrimental physiologic effects of hyperoxia
- Determine if ventilation is effective -- ETCO2 (end-tidal carbon dioxide) measurement between 35- 45 shows effective ventilation. Level above 50 signifies depressed ventilation -- SpO2 of 94% of higher is associated with effective ventilation ch. 5, p. 44 The major assessment parameters that produce important information within seconds of a patient's arrival are... -
=Answer>> 1. Level of consciousness
- Skin color
- Pulse ch. 5, p. 44 The assessment of circulation during the primary survey
includes... - =Answer>> Early evaluation of the possibility of
hemorrhage in the abdomen and pelvis in any patient who has sustained blunt trauma. In those cases, an emergent abdominal or pelvic assessment may be preformed to include a focused assessment with sonography for trauma (FAST) examination or a radiograph of the pelvis. ch. 5, p. 44 A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). -
=Answer>> a. HYPOVOLEMIA
b. CARDIAC DYSFUNCTION ch. 5, p. 45 The standard approach to treating hypotension in trauma patients has been to infuse large volumes of IV fluids. Recent studies now recommend a different approach and note that an Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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elevated BP may dislodge the body's formation of clots and promote further bleeding. In addition, large volumes of fluid
lead to... - =Answer>> Dilutional coagulopathy which
worsens metabolic acidosis and may cause hypothermia ch. 5, p. 45 _________ therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma,
and platelets. - =Answer>> COMPONENT THERAPY
ch. 5, p. 45
Assess pupils for... - =Answer>> Equality, shape, and
reactivity (PERRL) ch. 5, p. 45 Consider ABGs. A decreased level of consciousness may be an
indicator of... - =Answer>> Decreased cerebral perfusion,
hypoventilation, or acid-base imbalance. ch. 5, p. 46 Hypothermia combined with ______ and ______ is a potentially
lethal combination. - =Answer>> HYPOTENSION and
ACIDOSIS
ch. 5, p. 46
Explain the LMNOP mnemonic - =Answer>> Used to
remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch)
- Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm
- Dysrhythmias (PVCs, a fib, or ST segment changes) may indicate blunt cardiac trauma
- PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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M - Medications currently used, including anticoagulant therapy P - Past medical history (hospitalizations/surgeries) L - Last oral intake E - Events and Environmental factors related to injury ch. 5, p. 48 What are odors you want to be sure to document? -
=Answer>> Alcohol, gasoline, other chemicals
ch. 5, p. 48
Explain the B2-Transferrin test - =Answer>> Gold standard
for identifying CSF otorrhea or rhinorrhea ch. 5, p. 48 What are some circumstances that may lead to unreliable pulse
ox readings? - =Answer>> - Poor peripheral perfusion
- BP cuff inflated above sensor
- CO poisoning (carboxyhemoglobin)
- Methemoglobinemia
- Severe dehydration Pulse ox provides evidence of SaO2 but not PaO2. The non-liner relationship between the two measurements is reflected in the oxyhemoglobin-dissociation curve. ch. 6, p. 65 Oxyhemoglobin-dissociation curve indicates the correlation of tissue oxygneation (PaO2) as it saturates the hemoglobin molecule (SO2). P50 describes the oxygen pressure when the hemoglobin molecule is 50% saturated. Normal P50 is 26.7 mm Hg. A shift in the curve notes changes in the relationship: -
=Answer>> Shift to the RIGHT occurs in an environment of
HIGH metabolic demand. Hemoglobin's affinity for oxygen decreases, making it easier to release the bound oxygen to the tissues. A shift to the right occurs in response to:
- Increased carbon dioxide (hypercapnia)
- Increased temp (hyperthermia) Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- Increased 2,3-diphosphoglycerate levels (a substance in blood that helps O2 move from hemoglobin to the tissues)
- Decreased pH (acidemia) Shift to the LEFT occurs in an environment of LOW metabolic demand. Hemoglobin's affinity for oxygen increases, making it harder to release bound oxygen to the tissues. A shift to the right occurs in response to:
- Decreased carbon dioxide (hypocapnia)
- Decreased temp (hypothermia)
- Decreased 2,3-diphosphoglycerate levels
- Elevated pH (alkalosis)
- Carbon monoxide and methemoglobinemia ch. 6, p. 65 Trauma nurse should be attempting to maintain
NORMOTHERMIA and NORMOCARBIA, which... - =Answer>>
Decreases risk of.. HYPOTHERMIA ACIDOSIS COAGULOPATHY ch. 6, p. 65 Use the DOPE mnemonic to troubleshoot ventilator or
capnography alarms - =Answer>> D - Displaced tube
O - Obstructed or kinked tube P - Pneumothorax E - Equipment failure, such as patient becoming detached from equipment or loss of capnography waveform ch. 6, p. 66
Maintain PaO2 between - =Answer>> 100-200 mm Hg for
ABGs ch. 6, p. 66 RSI pretreatment medications Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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ch. 7, p. 75
Early treatment for septic shock includes... - =Answer>>
Early administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. ch. 7, p. 75 The increase of the diastolic blood pressure with a narrowing
pulse pressure... - =Answer>> May be one of the first
CONCRETE measurements signaling that the patient's circulatory status is compromised. ch. 7, p. 76 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... -
=Answer>> - HIGH levels of EPINEPHRINE cause smooth
muscle relaxation in the airways and causes arteriole smooth muscle contractility (potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use)
- NOREPINEPHRINE increases heart rate, vascular tone through alpha-adrenergic receptor activation, and blood flow to skeletal muscle and triggers the release of glucose from energy stores. ch. 7, p. 77 One of the earliest responses to inadequately pefused tissue
is... - =Answer>> TACHYPNEA
ch. 7, p. 78 As shock progresses, primary goal of the body is to maintain perfusion to vital organs. Sympathetic stimulation has little effect on the cerebral and coronary vessels since they are Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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capable of autoregulation. Cerebral autoregulation maintains a
constant... - =Answer>> cerebral vascular blood flow as
long as the MAP is maintained between 50-150... when autoregulation in the brain fails, perfusion becomes dependent solely on pressure. ch. 7, p. 78 Resuscitation-associated coagulopathy is associated with the
trauma triad of death. It includes... - =Answer>>
HYPOTHERMIA impairs thrombin production and platelet function ACIDOSIS impairs thrombin production COAGULOPATHY results in depletion of clotting factors through hemodilution and impaired ability to produce clotting factors ch. 7, p. 78
Stage I: Compensated Shock - =Answer>> - Anxiety,
lethargy, confusion, restlessness from oxygen being shunted to brainstem
- Systolic BP usually within normal range
- Rising diastolic BP, results in narrowed pulse pressure, which is a reflection of peripheral constriction
- A bounding and/or slightly tachycardic pulse
- Increased RR
- Decreased urine output ch. 7, p. 79 Stage II: Decompenstated or Progressive Shock -
=Answer>> - LOC deteriorates patient becomes obtunded
or unconscious as cell switch to anaerobic metabolism with increasing levels of lactic and pyruvic acids
- Normal or slightly decreased systolic BP
- Narrowing pulse pressure that continues until peripheral vascular vasoconstriction fails to provide cardiovascular support
- HR > 100 beats/min
- Weak, thready pulses Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
