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TNCC 9th Edition Practice Exam
Questions and Answers 202 5
MARCHxmneumonicx-xCORRECTxANSWER- MassivexHemorrhage:xControlxwithxcombatxgauze,xceloxxgauze,xorxchitoxgauze;xreplacementxofxbloo dxlossxwithxwholexbloodxorx1:1:1xratioxofxplasma,xRBC,xandxplateletsxtoxachievexSBPxofx 80 - 90mmHg. Airway:xEstablishxandxmaintainxpatentxairway Respiration:xDecompressxsuspectedxtensionxpneumothorax,xsealxopenxchestxwounds,xandxsupport xventilationxandxoxygenationxasxrequired. Circulation:xProvidexvascularxaccessx(IV/IO)xandxadministerxfluidsxasxrequiredxtoxtreatxshock Headxinjury/Hypothermia:xPreventxorxtreatxhypotensionxandxhypoxiaxtoxpreventxworseningxofxTBIxan dxpreventxorxtreatxhypothermia. AVPUx-xCORRECTxANSWER- AssessingxAlertnessxA:xAlertxandxoriented V:xRespondsxtoxverbalxstimuli P:xRespondsxonlyxtoxpainfulxstimulixU:xUn responsive LACEx-xCORRECTxANSWER- SoftxTissuexInjuriesxL:xLacerations A:xAbrasions,xAvulsionsxC:xC ontusions E:xEdema,xEcchymosis UrinaryxCatheterxContraindicationsx-xCORRECTxANSWER-ifxurethralxtranssectionxisxsuspected:
- bloodxatxthexurethralxmeatus
- perinealxecchymosis
- scrotalxecchymosis
- high-ridingxorxnonpalpablexprostate BreathingxInterventionxReassessmentx-xCORRECTxANSWER-1.xAttachxCO2xdetector
- Listenxoverxepigastrum
- Bilateralxbreathxsoundsxatxmidaxillaryxandxmidclavicularxlines
- Colorxchangexafterx 6 xbreaths
- Monitorxskinxcolor;xgetxxr TroubleshootingxVentilatorxAlarmsx-xCORRECTxANSWER- D:xDisplacedxTubexO:xObstructedxorxKinkedxTube P:xPneumothorax
Thexaveragexbloodxpressurexinxaxsinglexcardiacxcycle,xroughlyxcalculatedxasxthexSBPx+x 2 xxxthexDBP/ Avoidxhypoxemiaxinxthexpatientxwithxheadxtraumax-xCORRECTxANSWER- Axsinglexepisodexofxhypoxemiax(PaO2x<60mmHg)xcanxbexdetrimentalxtoxthexpatient'sxoutcome.xMain tainxpulsexoxxatx95%xorxgreaterxandxobtainxABGxmeasurementxasapxforxpatientxwithxseverexTBI. MaintainxETCO2xbetweenx 35 - 45 xmmHg
ManagexICPxinxthexpatientxwithxheadxtraumax-xCORRECTxANSWER- AnxICPxsustainedxatxgreaterxthanx 22 xmmHgxandxunresponsivextoxtreatmentxisxassociatedxwithxpoorx outcomes IncreasedxICPxAssessmentxFindingsx-xCORRECTxANSWER- Early:xHeadache;xn/v;xamnesia;xbehaviorxchangesx(restlessness,ximpairedxjudgement;xdrowsiness) ;xalteredxlevelxofxconsciousnessx(hyperarousabilityxandxhypoarousability) Late:xDilated,xnonreactivexpupils;xunresponsivextoxverbalxorxpainfulxstimuli;xabnormalxmotorxpostur ingx(flexion,xextension,xflaccidity);xCushingxresponse:xWideningxpulsexpressure,xreflexxbradycardia ,xandxdecreasedxrespiratoryxeffort. CornealxInjuryx-xCORRECTxANSWER- AssessmentxFindings:xPhotophobia,xpain,xeyexredness,xlidxswelling,xFBxsensation Treatment:xTopicalxanesthesia,xtopicalxophthalmicxNSAID,xnoxeyexpatch,xremovexFB,xmayxneedxtopi calxabxxforxlaceration. Followxup:xwithxophthalmologistxinx 24 - 48 xhours;xophthalmologyxconsultationxforxdeepxandxlargexFB OrbitalxFracturex-xCORRECTxANSWER- AssessmentxFindings:xPeriorbitalxecchymosis,xfacialxswelling,xdoublexvision,xenophthalmosx(poste riorxdisplacementxofxeyeballxwithinxorbit,xptosis. Treatment:xNasalx decongestant,xicexpacksxtoxthexorbitx forx 48 xhours,x oralxabxx Followxup:xMayxr equirexsurgery,xophthalmology.xAvoidxblowingxnose,xsneezing,xandxValsalvaxmaneuver Retrobulbarxhematomax-xCORRECTxANSWER- AssessmentxFindings:xSeverexpain,xdecreasedxvisionxorxlossxofxvision,xreducedxeyexmovement,xdou blexvision,xIOP
40mmHg Treatment:xAdministerxmedicationsxtoxdecreasexIOP,xemergencyxdecompressionxviaxlateralxcantho tomy Followxup:xEmergentxconsultationxwithxophthalmology GlobexRupturex-xCORRECTxANSWER-AssessmentxFindings:xIrregularxorxteardrop- xshapedxpupils,xperiorbitalxecchymosis,xdecreasedxvisualxacuityxandxEOM,xseverexsubconjunctivalx
Followxup:xOphthalmologyxconsultationxandxclosexfollowxup. NeckxInjuriesx-xCORRECTxANSWER- 3 xzones. Mortalityxisxthexhighestxwithxinjuriesxtoxzonex 1 xandxpatientsxwhoxhavexdysphonia,xdysphagia,xsubcut aneousxemphysema,xorxhematomasxtoxthexneckxregionxindicatingxvascularxtrauma,xairwayxinjuries,x orxesophagealxinjuriesxthatxmayxnotxbexdiagnosedxonximagingxstudies. Penetratingxthoracicxwoundxbelowxthexfourthxintercostalxspacex-xCORRECTxANSWER- xPenetrationxintoxthexabdominalxcavityxisxsuspectedxuntilxprovenxotherwise ThoracicxSkeletalxFracturesxandxAssociatedxInjuriesx-xCORRECTxANSWER- Sternal:xBluntxcardiacxinjury;xpneumothorax Firstxandxsecondxrib:xGreatxvesselxinjuries,xbrachialxplexusxinjuries,xheadxandxspinalxcordxinjuries Multiplexribsxandxflailxchest:xpulmonaryxcontusion;xpneumothorax;xhemothoraxxLowerxrib sx 7 - 12:xLiverxforxrightxsided;xspleenxforxleftxsided Beck'sxTriadx-xCORRECTxANSWER-Threexsignsxofxacutexcardiacxtamponade:
- Lowxarterialxbloodxpressure
- Distant,xmuffledxheartxsounds
- Distendedxneckxveins Pneumothoraxxwithxpositivexpressurexventilationx-xCORRECTxANSWER- Ventilatedxpatientsxwithxevenxaxsmallxpneumothoraxxarexatxhighxriskxforxexpansionxofxthexpneumoth oraxxorxdevelopmentxofxaxtensionxpneumothorax HemothoraxxManagement:xLarge-BorexChestxTubex-xCORRECTxANSWER- Bloodxisxthickxandxhasxthexabilityxtoxclotxoffxsmallerxdiameterxtubes.xThexlargestxborexchestxtubexforxt hexsizexofxthexpatientxshouldxbexconsideredxtoxavoidxunnecessaryxtubexobstruction PulmonaryxContusionx-xCORRECTxANSWER- Pulmonaryxcontusionsxmayxproducexonlyxvaguexsymptomsxandxbeginxtoxprogressxatx 4 - 6 xhoursxfollowingxthextrauma;xtheyxcanxtakexasxlongxasx 24 - 48 xhoursxtoxfullyxdevelop.xCarexofxaxpulmonaryxcontusionxisxgenerallyxsupportivexinxnature--
maximizingxoxygenationxandxpainxmanagement.xJudiciousxusexofxfluidsxshouldxbexconsideredxtoxprev entxincreasexinxintraparenchymalxhemorrhage,xatelectasis,xorxconsolidationxbyxinfusingxfluidsxintoxth exinjuredxregionxofxthexlung. Pulsusxparadoxusx-xCORRECTxANSWER- decreasexinxsystolicxBPxofxmorexthanx10mmHgxwithxnormalxinspiration.xItxisxcausedxbyxaxfallxinxcardi acxoutputxasxaxresultxofxincreasedxnegativexintrathoracicxpressurexduringxinhalation.xAsxpressurexwi thinxthexthoraxxfalls,xbloodxpoolsxinxthexlargexveinsxofxthexlungsxandxthorax,xandxstrokexvolumexisxdec reased. **NeverxclampxthexCT,xotherwisexaxtensionxpneumothoraxxmayxdevelop
nyxcortexxisxnotxcompletelyxinterruptedxComminuted:xbonexisxspli nteredxintoxfragmentsxGreenstick:xbonexbendsxorxisxbuckled Impacted:xbonexisxwedgedxintoxdistalxandxproximalxfracturexsitesxDisplace d:xbonexfracturexsitesxarexnotxaligned CompartmentxSyndomex-xCORRECTxANSWER-PainxPressure Pulses
ParesthesiaxPar alysisxPallorxPoi kilothermia Hyperkalemiax 12 - 36 xhoursxafterxinjuryxevent ElectricalxBurnsx-xCORRECTxANSWER-Doxnotxlabelxasx'exit'xorx'entrance',xbutxasx'contactxpoint' DisseminatedxIntravascularxCoagulopathyx-xCORRECTxANSWER- Decreasedxplateletxcount,xdecreasedxfibrinogen,xelevatedxfibrinxdegradationxproduct,xelevatedxd- dimer,xprolongedxprothrombinxtime,xprolongedxpartialxthromboplastinxtime
