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TNCC 9th Edition Exam with Q&A 2024- 2025 Which intervention is recommended regarding the use of drug-assisted intubation and rapid sequence intubation? - ANSWER>>Pre-oxygenate to prolong the time to hypoxia Which normal anatomic or physiologic change in an older adult places them at a higher risk for aspiration? - ANSWER>>Relaxed muscles of the oropharynx A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate sacral sparing? - ANSWER>>Voluntary anal sphincter tone An adult patient weighing 75 kg sustained partial and full thickness burns to 32% of their body 2 hours prior to arrival. Intravenous fluid resuscitation was calculated to be 400 mL/hour. The urine output over the last hour was 15mL. What intervention should the nurse anticipate? - ANSWER>>Increase isotonic crystalloid infusion rate
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Which intervention is recommended regarding the use of drug-assisted intubation and rapid sequence intubation? - ANSWER>>Pre-oxygenate to prolong the time to hypoxia Which normal anatomic or physiologic change in an older adult places them at a higher risk for aspiration? - ANSWER>>Relaxed muscles of the oropharynx A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would indicate sacral sparing? - ANSWER>>Voluntary anal sphincter tone An adult patient weighing 75 kg sustained partial and full thickness burns to 32% of their body 2 hours prior to arrival. Intravenous fluid resuscitation was calculated to be 400 mL/hour. The urine output over the last hour was 15mL. What intervention should the nurse anticipate? - ANSWER>>Increase isotonic crystalloid infusion rate A patient is diagnosed with a T12 spinal cord injury following a 20-foot fall. Which finding is consistent with spinal shock? - ANSWER>>Loss of reflexes A patient is brought to the emergency department following a motor vehicle rollover and is complaining of left upper abdominal pain and left shoulder pain. This presentation is most consistent with an injury to which organ? - ANSWER>>Spleen An adult patient is brought to the emergency department following a motor vehicle collision with complaints of neck pain. They have identified as a person in the process of transitioning from male to female. What effect of hormone therapy should be considered when planning care for this patient?
Correct rationale: A person who is in the process of transitioning from male to female will usually be taking female hormones such as estrogen/estradiol to assist with the transition. This can cause a decrease in muscle mass, increased risk of thromboembolism, and possibly increased bone density. These patients would not be taking testosterone. An adult patient presents to the emergency department after sustaining severe facial injuries during an altercation. The patient is awake, confused, and smells heavily of alcohol. Pulse oximetry is 94% on room air. Immediate intubation should be anticipated based on which clinical indicator? - ANSWER>>Severe facial injuries A patient involved in a high-speed rollover is complaining of increased difficulty breathing. There is a small penetrating wound to the sixth intercostal space in the left lateral chest. Which finding is most consistent with an injury to the diaphragm? - ANSWER>>Bowel sounds heard in the left lower chest A severely injured patient has been intubated and is being mechanically ventilated. The patient has received a balanced resuscitation including multiple blood products. Under which circumstance will it be harder for the hemoglobin to release oxygen to the tissues? - ANSWER>>Decreased body temperature A patient with a chest tube is being transported to the intensive care unit and fluctuation is noted in the water seal chamber during inspiration and expiration. What is the best action for the nurse to take? - ANSWER>>Continue to the intensive care unit An adult was thrown against a concrete wall during a factory explosion and sustained a femur fracture, liver laceration, and a small subdural hematoma. These injuries most likely occurred during what level of blast trauma? - ANSWER>>Tertiary
They all visited the same grocery store within the last week. What is the most appropriate intervention from triage for these patients? - ANSWER>>Immediately initiate isolation precautions A trauma patient who is 30-weeks pregnant arrives at the emergency department following a motor vehicle collision. Which normal physiologic change should be considered when assessing ventilatory status? - ANSWER>>Increased oxygen consumption You are caring for a patient who was thrown from a bike and was not wearing a helmet. While performing the head-to-toe assessment, you note clear drainage from the right ear. Which of the following is the most appropriate next step? - ANSWER>>Notify the physician Following a motor vehicle collision, a patient presents with decreased level of consciousness and snoring respirations. It has been determined that it is safe to insert a nasopharyngeal airway. What is most important to consider when preparing to insert the nasopharyngeal airway? - ANSWER>>Improper sizing can cause gastric distention A patient who sustained severe injuries was brought to the emergency department following a high-speed motor vehicle collision. Interventions for hypovolemic shock have been initiated. What component of the trauma triad of death is most likely to have begun at the time of injury? - ANSWER>>Coagulopathy An adult patient was brought to the emergency department following a motorcycle crash. On arrival, the patient is only responsive to pain, has bleeding from the nose, and multiple abrasions and contusions to the face. What is the priority intervention? - ANSWER>>Use a jaw thrust to open the airway and look for signs of obstruction In a motor vehicle collision, which injury pathway is most likely to increase the patient's morbidity and mortality? - ANSWER>>Ejection
An adult trauma patient has received 1 liter of isotonic crystalloid solution, 6 units of packed red blood cells, 6 units of fresh frozen plasma, and 1 combined unit of platelets during the initial fluid resuscitation phase. Re- assessment includes: BP 104/66 mm Hg, HR 112 beats/minute, intermittent ventricular bigeminy on the cardiac monitor, and the presence of muscle tremors. What should the nurse anticipate administering based on these findings? - ANSWER>>Calcium gluconate When transporting an intubated patient, which monitoring adjunct will provide the best real-time information regarding respiratory status? - ANSWER>>Waveform capnography What technique is most appropriate when obtaining a history from a patient who has experienced a sexual assault? - ANSWER>>Applying active listening During the primary survey, which tool is most effective in identifying the need for an airway intervention? - ANSWER>>AVPU What type of wound is most likely to become embedded with gravel or dirt causing a black, blue, or grey discoloration? - ANSWER>>Abrasion An adult patient who sustained a severe head trauma has been intubated and is being manually ventilated via a bag-mask device at a rate of 18 breaths/minute with clear breath sounds bilaterally. The patient has received one intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the pulse oximetry is 96%. BP is 142/70 mm Hg. What is the most important intervention to manage cerebral blood flow? - ANSWER>>Decrease the rate of manual ventilation What type of wound closure is used with infection-prone wounds where the edges are difficult to approximate? - ANSWER>>Secondary
A seriously injured patient is noted to have a weak, thready pulse and cool, clammy skin. There is instability of the pelvis on palpation and blood at the urinary meatus. A pelvic binder is appropriately applied and balanced fluid resuscitation is being managed by the team. What is the priority diagnostic intervention? - ANSWER>>Retrograde urethrogram Correct rationale: The patient is hemodynamically unstable, so quick identification of potential bleeding sources is imperative. A focused assessment sonography for trauma (FAST) exam can be performed at the bedside to identify pathological fluid in the abdominal and pelvic cavities. An adult arrives at the emergency department with superficial burns to the extremities following a house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is the most likely cause of these symptoms? - ANSWER>>Carbon monoxide poisoning What assessment finding is consistent with impending herniation syndrome? - ANSWER>>Unilaterally fixed and dilated pupil A patient presents to the emergency department with a degloving injury involving the entire forearm. What should the nurse consider when planning care for a patient with this injury? - ANSWER>>Surgical intervention will be needed An older adult presents to the emergency department with complaints of dizziness, headache, and nausea. The patient was involved in a motor vehicle collision 10 days ago. There was no loss of consciousness and a hematoma is noted to the forehead. The patient is currently on anticoagulant therapy. What is most likely the cause of their symptoms? - ANSWER>>Post-concussive syndrome A patient presents to the emergency department after jumping from a third story and landing on their right foot then falling to the ground. There is pain and crepitus to the right hip when applying gentle downward and medial
pressure to the iliac crests. This mechanism of injury is most consistent with what type of pelvic fracture? - ANSWER>>Vertical shear fracture What assessment finding on a multi-injured trauma patient is most consistent with adequate end-organ perfusion? - ANSWER>>Urinary output 0.75 mL/kg/hr An adult who fell from a second story roof is brought to the emergency department by private vehicle. The patient is confused with unlabored respirations and has strong, palpable radial pulses. There is an open wound in proximity to an obvious deformity of the left lower extremity. What is the priority intervention? - ANSWER>>Initiate cervical spine stabilization Which measurement is concerning for a patient with head trauma and increased intracranial pressure? - ANSWER>>Brain tissue oxygen tension (PbtO2) of 16 mm Hg (2.1 kPa) Correct rationale: A PaCO2 of 47 mm Hg indicates the patient is retaining carbon dioxide which promotes vasodilation and increases intracranial pressure. What is the priority intervention for a child who has been diagnosed with an atlanto-occipital dislocation following a high-speed motor vehicle collision? - ANSWER>>Maintaining spinal motion restriction