Download TNCC 8th Edition Trauma Care Exam Prep: 8 Practice Sets and more Exams Nursing in PDF only on Docsity!
What are the greatest risks for transport? - ANSWER-Loss of airway patency, displaced obstructive tubes lines or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration in patient status change in vital signs or level of consciousness, injury to the patient and/or team members According to newtons law which of these two force is greater: size or force? - ANSWER- Neither. For each force there is an equal and opposite reaction. What is the relationship between mass and velocity to kinetic energy? - ANSWER- Kinetic energy is equal to 1/2 the mass multiplied the square of its velocity therefore when mass is doubled so is the net energy, however, when velocity is doubled energy is quadrupled. What is tension? - ANSWER-stretching force by pulling at opposite ends What is compression? - ANSWER-Crushing by squeezing together What is bending? - ANSWER-Loading about an axis. Bending causes compression on the side the person is bending toward intention to the opposite side What is shearing? - ANSWER-Damage by tearing or bending by exerting faucet different parts in opposite directions at the same time. What is torsion? - ANSWER-Torsion forces twist ends in opposite directions. What is combined loading? - ANSWER-Any combination of tension compression torsion bending and/or shear. What are the four types of trauma related injuries? - ANSWER-Blunt, penetrating, thermal, or blast. What are contributing factors to injuries related to blunt traumas? - ANSWER-The point of impact on the patient's body, the type of surface that is hit, the tissues ability to resist (bone versus soft tissue, air-filled versus
solid organs), and the trajectory of force. What are the seven patterns of pathway injuries related to motor vehicle accidents? - ANSWER-Up and over, down and under, lateral, rotational, rear, roll over, and ejection. Differentiate between the three impacts of motor vehicle impact sequence.
- ANSWER- The first impact occurs when the vehicle collided with another object. The second impact occurs after the initial impact when the occupant continues to move in the
intubated. Describe the measurement of an NPA - ANSWER-Measure from the tip of the patient's nose to the tip of the patients earlobe.
Measurement of an OPA - ANSWER-Place the proximal end or flange of the airway adjunct at the corner of the mouth to the tip of the mandibular angle. True or false: NPAs and OPAs are definitive airways. - ANSWER-False. When placing one of these? One should consider the potential need for a definitive airway. Name the three ways to confirm ETT placement - ANSWER-Placement of a CO2 monitoring device, Assessing for equal chest rise and fall, and listening at the epigastrium and four lung fields for equal breath sounds. When capnography measurement reads greater than 45MMHG, the nurse should consider increasing or decreasing the ventilation rate? - ANSWER-Increasing the ventilation rate. Doing so would allow the patient to blow off retained CO2. When capnography measurement reads less than 35MMHG, the nurse should consider increasing or decreasing the ventilation rate? - ANSWER-Decreasing the ventilation rate. By doing so, the nurse allows the patient to retain CO2. What are the three stages of shock - ANSWER-Compensated, decompensated or progressive, and irreversible. What are the signs of compensated shock? - ANSWER-Anxiety, confusion, restlessness, increased respiratory rate, narrowing pulse pressure were diastolic increases yet systolic remains unchanged, tachycardia with bounding pulses, and decreased urinary output What are the signs and symptoms of decompensated shock? - ANSWER- Decreased level of consciousness, hypertension, narrow pulse pressure, tachycardia with weak pulses, tachypnea, skin that is cool clammy and cyanotic, base access outside the normal range, and serum lactate levels greater than two to 4MMOL/L. What are the signs and symptoms of irreversible shock? - ANSWER- Obtunded stuporous or comatose state, marked hypertension and heart failure, bradycardia with possible dysrhythmias, decreased and shallow respiratory rate, pale cool and clammy skin, kidney liver and other organ failure, severe acidosis, elevated lactic acid levels, worsening base access on ABGs, coagulopathies with petechiae purpura or bleeding. What are the four types of shock? - ANSWER-Hypovolemic, Cardiogenic, Obstructive, & Distributive
the right side of the heart during systole in the pulmonary artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes. Describe the characteristics of cardiogenic shock - ANSWER-Cardiogenic shock results from pump failure in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin Describe the characteristics of distributive shock. - ANSWER-Distributive shock occurs as a result of Mel distribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm pink and dry skin with a cool core temperature. Describe the characteristics of hypovolemic shock - ANSWER-Hypovolemia is caused by a decrease in the amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities especially long bones. What is the recommended fluid bolus for a trauma? - ANSWER-500 ML's of warmed isotonic crystalloid. Ongoing fluid boluses of 500 ML's should be given judiciously with constant reassessments after administration. What is the minimum permissive hypertension and a trauma patient? - ANSWER-A systolic of greater than or equal to 90 MMHG What is the minimum permissive oxygenation level of a trauma patient? - ANSWER- Greater than or equal to 94% What is Cullen's sign and its significance? - ANSWER-Cullens sign is periumbilical bruising and is indicative of intraperitoneal bleeding Define Cushing's triad - ANSWER-Bradycardia, progressive hypertension (widening pulse pressure), and decreased respiratory effort
What are the early signs of increased Intracranial pressure - ANSWER- headache, vomiting, behavioral changes that begin with restlessness and may progress to confusion, drowsiness, or impaired judgment
Expedite transfer to the closest trauma center -ANS> A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? <>a pertinent medical hx is crucial -ANS> Which of the following considerations is the most important when caring for a geriatric trauma pt? <>Mitigation -ANS> 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. Which phase of the disaster life cycle does this describe? <>Multiple requests for water -ANS> EMS brings a pt who fell while riding his bicycle. 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 -ANS> What is the effect of hypothermia on the oxyhemoglobin dissociation curve? <>acidosis -ANS> Which of the following is a component of the trauma triad of death? <>Complete -ANS> EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? <>flucuation in the water seal chamber -ANS> Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? <>insert an oropharyngeal airway if there is no gag reflex -ANS> During the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? <>globe rupture -ANS> A 35 y/o M 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? <>compensated -ANS> A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock?
<>ventilate with a bag mask device -ANS> An unresponsive trauma pt has an oropharygeal airway in place, shallow and labored respirations, and dusky skin. The trauma team has administered medications for drug-assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? <>within 24 hrs of trauma -ANS> When is the tertiary survey completed fora trauma pt? <>pressure -ANS> An intubated and sedated pt in the ED has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? <>worsening pneumothorax -ANS> Which of the following is possible complication of positive-pressure ventilation? <>pelvic stability -ANS> the most reassuring finding for a male pt with hip pain after a fall is which of the following? <>narrowed -ANS> Which of the following pulse pressures indicate early hypovolemic shock? <>dysrhythmias -ANS> Patients with a crush injury should be monitored for which of the following conditions? <>subdural hematoma -ANS> Tearing of the bridging veins is most frequently associated with which brain injury? <>straight cath for urine sample -ANS> 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. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? <>placental abruption -ANS> You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? <>it can worsen cord damage from an unstable spinal injury -ANS> Which of the following is true about the log-roll? <>defusings -ANS> All of these are considered a critical communication point in trauma care EXCEPT which of the following? <>pulse oximetry and capnography -ANS> What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation?
<>fat embolism -ANS> a pt has been in the ED for several hrs waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon reassessment, the pt is restless with respiratory distress and petechiae to his neck. The pt is exhibiting s/sx most commonly associated with which of the following conditions? <>nausea and vomiting -ANS> Which of the following is a late sign of increased intracranial pressure? <>serial FAST exams -ANS> a 49 y/o restrained driver involved in a MVC presents to the trauma center complaining of abd, pelvic, and bilateral lower extremity pain. VS are stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the following? <>pericardiocentesis -ANS> Which of the following is NOT considered goal-directed therapy for cardiogenic shock? <>endotracheal tube -ANS> 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? -ANS> which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? <>calcium -ANS> 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 -ANS> Which of the following is NOT considered a benefit of debriefings? <>500 mL/hr -ANS> You are treating a 27 y/o M in respiratory distress who was involved in a house fire. Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate should you begin fluid resuscitation? <>advanced age -ANS> 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 -ANS> Which of the following patients warrants referral to a burn center? <>dressing removal -ANS> A patient arrives with a large open chest wound after being assaulted with a machete. Prehospital providers placed a nonporous dressing over the chest wound and taped it on three sides. he is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention?
<>after a physical examination if the pt has no radiologic abnormalities on CT -ANS> EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? <>MARCH -ANS> Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? <>What is kinematics? -ANS> 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. <>What is Newton's First Law? -ANS> A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. <>What is the Law of Conservation of Energy? -ANS> Energy can neither be created nor destroyed. It is only changed from one form to another. <>What is Newton's Second Law? -ANS> Force equals mass multiplied by acceleration of deceleration. <>What is kinetic energy (KE)? -ANS> KE equals 1/2 the mass (M) multiplied by the velocity squared. <>What is the Mnemonic for the Initial Assessment? -ANS> A = Airway with simultaneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) <>What is the Mnemonic for the Secondary Assessment? -ANS> F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). H = Hx and Head-to-toe assessment I = Inspect posterior surfaces <>Where do you listen to auscultate breath sounds? -ANS> Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostal space at the anterior axillary line. <>What are the late signs of breathing compromise? -ANS> - Tracheal deviation
- JVD <>What are signs of ineffective breathing? -ANS> - AMS
- 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? -ANS> - 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. <>What is assessed and intervened for Expose/Environmental Controls? -ANS> - Remove clothing
- Ensure appropriate decontamination if exposed to hazardous material
- Keep pt warm
- Keep clothing for evidence <>What is the first thing assessed under the Secondary Assessment? -ANS> FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE
- ABCDE should be completed
- Labs, X-rays, CT, Foley,
- Family Presence <>What is the second thing assessed under the Secondary Assessment? -ANS> GIVE COMFORT MEASURES
- Talking to pt
- Pharmacologic/Nonpharmacologic pain management
- Observe for physical signs of pain <>What is assessed under the Mnemonic "H"? -ANS> HISTORY / HEAD-TO-TOE ASSESSMENT
- MIVT
- M = Mechanism of injury
- I = Injuries sustained
- V = Vital Signs
- T = Treatment
- Pt generated information
- PMH
- Head-to-toe assessment <>What is assessed under the Mnemonic "I"? -ANS> INSPECT POSTERIOR SURFACES
- While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks and posterior thighs.
- 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? -ANS> Reassess:
- Primary survey,
- VS
- Pain
- Any injuries <>What are factors that contribute to ineffective ventilation? -ANS> - 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? -ANS> LOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents <>What are the Rapid Sequence Intubation Steps? -ANS> PREPARATION:
- gather equipment, staffing, etc. PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration). 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. Ventilate pt 30- seconds between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector. POSTINTUBATION MANAGEMENT:
- Secure ET tube
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oxtimetry
- 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? -ANS> 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? -ANS> Dullness:
- hemothorax Hyperresonance
- Pneumothorax <>What are you looking for when palpating the chest wall, clavicles and neck? -ANS> - Tenderness
- Swelling
- subcutaneous emphysema
- step-off deformities = These may indicate: esophageal, pleural, tracheal or bronchial injuries. Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax. <>What is the DOPE mnemonic? -ANS> D - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing <>Explain Hypovolemic Shock. -ANS> Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes:
- Blood loss
- Burns, etc. <>Explain Cardiogenic Shock. -ANS> Syndrome that results from ineffective perfusion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle.
Some causes:
- MI
- Blunt cardiac injury
- Mitral valve insufficiency
- dysrhythmias
- Cardiac Failure <>Explain Obstructive Shock. -ANS> Results from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes:
- Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume).
- Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium.
- Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock <>Explain Distributive Shock. -ANS> Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. <>What is vascular response? -ANS> As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of baroreceptors. Arterioles constrict to increase TPR and BP. <>What is renal response? -ANS> Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes:
- Vasoconstriction of arterioles and some veins
- Stimulation of sympathetic nervous system
