TNCC 9 TH EDITION FINAL ACTUAL EXAM NEWEST VERSION 2025/2026 QUESTION AND CORRECT DETAILED VERIFIED ANSWERS FROM VERIFIED SOURCES RATED A GRADE.

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?

A. Clean the ear with a cotton-tipped applicator.

B. Pack the ear with gauze.

C. Notify the physician

D. Document and continue the exam.

C. Notify the physician

A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what is the priority intervention?

A. Initiate transfer to a trauma center

B. Attempt family notification

C. Obtain additional imaging studies

D. Place an indwelling urinary catheter

A. Initiate transfer to a trauma center

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?

A. Initiate cervical spine stabilization

B. Apply a splint to the lower extremity

C. Put the patient on portable oxygen.

D. Log roll the patient onto a spine board

A. Initiate cervical spine stabilization

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. 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 92%. BP is 142/70 mm Hg. What is the most important intervention to manage the cerebral blood flow?

A. Decrease the rate of manual ventilation.

B. Initiate another fluid bolus.

C. Recheck endotracheal tube placement.

D. Increase the amount of oxygen delivered.

A. Decrease the rate of manual ventilation.

An adult patient is brought to the emergency department following a vehicle "roll-over" with prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh and a weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial intervention?

A. Application of a tourniquet to the affected extremity

B. Application of a pelvic binder

C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour

D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa)

B. Application of a pelvic binder

2. Which of the following situations could cause functional grief?

A. Inability to live at home

B. Amputation of a limb

C. Loss of one's self-image

D. Destruction of the patient's car

B. Amputation of a limb

Rationale: Preparation and Ongoing Care\Psychosocial Aspects

Functional grief relates to the loss of body function or body parts such as amputation of a limb, paralysis, or loss of sight.

3. What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries?

A. They are likely to be fearful in the emergency department

B. Medical history including current medications

C. Availability of support systems after discharge

D. Accessibility to a primary care physician

B. Medical history including current medications

4. 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?

A. Clean the ear with a cotton-tipped applicator.

B. Pack the ear with gauze.

C. Notify the physician

D. Document and continue the exam.

C. Notify the physician

5. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns?

A. As soon as the patient arrives

B. After removal of clothing

C. Only at a burn center

D. During the circulation assessment

B. After removal of clothing

Rationale: Musculoskeletal and Wounds\Burns

Some fluid will be given initially, but an accurate fluid total is based on percentage of total body surface area which requires a good skin assessment and is calculated after clothing is removed.

6. In a motor vehicle collision, which injury pathway is most likely to increase the patient's morbidity and mortality?

A. Rotational

B. Ejection

C. Lateral

D. Rollover

B. Ejection

7. A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention?

A. Elevating the leg above the level of the heart

B. Repositioning the leg and applying ice

C. Elevating the leg to the level of the heart

D. Preparing the patient for ultrasound of the leg

C. Elevating the leg to the level of the heart

Rationale: Musculoskeletal and Wounds\Musculoskeletal

This patient is exhibiting signs of possible compartment syndrome which is a dangerous complication of fractured extremities. The pain is often out of proportion to the injury and might not respond to pain medications. Elevate the limb to the level of the heart to decrease dependent edema but not above the heart, which can cause increased venous congestion and pressure within the compartment.

8. A teenaged patient presents to the emergency department with left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is most consistent with human trafficking?

A. The individual appears well nourished.

B. Those who are being trafficked rarely seek medical care.

C. It is infrequently associated with substance abuse.

D. Those experiencing human trafficking rarely self-disclose.

D. Those experiencing human trafficking rarely self-disclose.

9. An intubated trauma patient has just been transported back from CT scan. Upon arrival to their room in the emergency department, resistance is noted with bag-mask ventilations and auscultation reveals unequal breath sounds. What is the most appropriate initial intervention for this patient?

A. Place the patient back on the ventilator.

B. Extubated the patient.

C. Reposition the endotracheal tube.

D. Suction the endotracheal tube.

C. Reposition the endotracheal tube.

10. Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax?

A. Increased work of breathing

B. Unilaterally diminished breath sounds

C. Tachycardia

D. Hypotension

D. Hypotension

11. A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what is the priority intervention?

A. Initiate transfer to a trauma center

B. Attempt family notification

C. Obtain additional imaging studies

D. Place an indwelling urinary catheter

A. Initiate transfer to a trauma center

12. A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention?

A. Initiate two intravenous access sites

B. Place the patient on supplemental oxygen

C. Apply direct pressure to the wound

D. Use a tourniquet to control the bleeding

C. Apply direct pressure to the wound

13. A trauma patient involved in a fall from 25 feet has a traumatic brain injury, three anterior rib fractures on the right side, a small pneumothorax on the right, and a Grade III liver injury. The patient was intubated and placed on a ventilator with PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning?

A. Severely diminished breath sounds on the right

B. Guarding in the right upper quadrant

C. Ecchymosis in the right upper quadrant

D. Crepitus to the right chest

A. Severely diminished breath sounds on the right

14. A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most likely an indication of the body's response to these findings?

A. Increased respiratory effort

B. Widening pulse pressure

C. Reflex tachycardia

D. Reflex hypotension

B. Widening pulse pressure

Rationale: Head and Torso Trauma\Head Trauma

This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8 kPa) which is associated with poor outcomes. When the CPP falls below normal levels, the central nervous system initiates the Cushing response in an attempt to increase mean arterial pressure and improve CPP. Cushing response assessment findings include widening pulse pressure, reflex bradycardia, and irregular, decreased respiratory effort.

A patient presents, after a 25-foot fall, with paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention?

A. Surgical intervention

B. Chest tube insertion

C. Needle decompression

D. Airway and ventilation support

D. Airway and ventilation support

18. A trauma patient is being held in the emergency department because there are no available inpatient beds. The patient sustained a femur fracture and required multiple blood products. The patient now has blood oozing from abrasions, IV sites, the nose, and gums. What condition is most consistent with these findings?

A. Rhabdomyolysis

B. Fat embolism

C. Disseminated intravascular coagulopathy

D. Multiple organ dysfunctions syndrome

C. Disseminated intravascular coagulopathy

16. 1. 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?

A. Intracerebral hemorrhage

B. Epidural hematoma

C. Diffuse axonal injury

D. Post-concussive syndrome

D. Post-concussive syndrome

Rationale: Special Populations\Older Adult

Post-concussive syndrome can occur days to weeks after injury or trauma. The other three conditions present as a more rapid decline, especially in patients who are on anticoagulants.

1. Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about injury to which organ?

A. Transverse colon

B. Pancreas

C. Liver

D. Spleen

C. Liver

Rationale: Head and Torso Trauma\Abdominal and Pelvic Trauma

Liver injuries are associated with right, lower rib fractures. They also can present with tenderness, guarding, or rigidity in the right upper quadrant, along with ecchymosis of the right upper quadrant or around the umbilicus, known as Cullen's sign

20. 1. A 35-year-old male 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?

A. Oculomotor nerve palsy

B. Globe rupture

C. Retrobulbar hematoma

D. Retinal detachment

B. Globe rupture

Rationale: Head and Torso Trauma\Head Trauma

The globe of the eye consists of multiple layers. The sclera is the white outer layer, while the cornea covers the iris and pupil. When a full thickness injury occurs to the cornea, sclera, or both, the globe will rupture, causing the shape of the pupil to become irregular or teardrop-shaped

21. 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?

A. Capillary leak syndrome

B. Rhabdomyolysis

C. Carbon monoxide poisoning

D. Hypothermia

C. Carbon monoxide poisoning

22. An adult patient is being treated in the emergency department after falling 30 feet and landing on their head. The patient has been intubated and initial stabilization efforts are ongoing. The vital signs are BP 70/40 mm Hg, HR 44 beats/minute, and respirations are being assisted at 16 breath/minute. The patient's skin is warm, dry, and of a normal color. These findings are most consistent with what type of shock?

A. Spinal

B. Hypovolemic

C. Obstructive

D. Neurogenic

D. Neurogenic

23. 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?

A. Clamp the chest tube

B. Return to the emergency department

C. Assist ventilations with bag-mask device

D. Continue to the intensive care unit

D. Continue to the intensive care unit

24. 1. Which one of the following characteristics is found in high performing teams?

A. Interdisciplinary collaboration

B. Provide on-the-job training

C. Work individually

D. Minimal feedback to decrease confusion

A. Interdisciplinary collaboration

25. 1. 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?

A. Decreased pH

B. Elevated carbon dioxide level

C. Decreased body temperature

D. Increased metabolic demand

Rationale: Primary Assessment\Airway and Ventilation

If the blood is not sufficiently warmed when transfused, it can produce hypothermia. In the oxyhemoglobin dissociation curve, a shift to the left increases the affinity of hemoglobin for oxygen making it harder to release for use by the tissues. Factors that can cause this shift include an elevated pH, decreased carbon dioxide, decreased temperature, and low metabolic demand.

C. Decreased body temperature

A patient with a spinal cord injuryt at C5 is being cared for in the emergency department while awaiting transport to a trauma center. Which of the following represents the highest priority for ongoing assessment and management for this patient?

a. maintain adequate respiratory status

b. administer balanced fluid resucscitation

c. perform serial assessment of neurological function

d. maintain core temperature

A. Maintain respiratory status- injuries at C3-C5 can cause loss of phrenic nerve function, resulting in a paralyzed diaphragm and inability to breathe. Maintenance of respiratory function is the highest priority.

What is the best position for maintaining an open airway in the obese patient?

a. Prone

b. Supine

c. Reverse trendelenburg

d. right lateral recumbent

c. Reverse trendelenburg

An adult patient sustained a knife injury to the neck. The airway is intact and the patient is hemodynamically stable. they complain of difficulty swallowing and speaking. What is the most likely cause of these symptoms.

a. damage to the cervical spine

b. an expanding pneumothorax

c.laceration of the carotid artery

d. injury to the thyroid gland

a. damage to the cervical spine-penetrating neck trauma may include concurrent injuries to the cervical spine and cord, airway. or vascular neck structures. With an intact airway and hemodynamic stability, the other common concurrent injury is to the cervical spine.

The general impression step in the initail assessment provides the opportunity to do which of the following?

a. assess for uncontrolled internal hemorrhage

b. accurately triage the patient

c.Reprioritize circulation before airway and breathing

d. activate the trauma team

c. reprioritize circulation before airway and breathing

the general impression is formed in the beginning of the primary survey to rapidly assess the need to reprioritize before airway or breathing. This is done id uncontolled external hemorrhage is identified.

A trauma nurse cared for a child with devastating burns two weeks ago. The nurse called in sick for a couple of days and is now back working on the team. Which of the following behaviors indicate the nurse is coll.

a. they are talking about taking the emergency nurse certification exam

b. they keep requesting to be assigned to the walk-in ambulatory area

c.they are impaiient and snap at thier coworkers.

d. they are thinking about transferring out of the department

a. this is an indication that the nurse is taking positive steps ti advance thier own practice, a sign of resilience.

Treatment for frostbite can include which of the following interventions?

a. warm the affected part over 30-60 minutes

b. use gentle friction to improve circulation

c.administer tissue plasminogen activator

d. drainage of all large and small blisters

c. admin tpa- with frostbite thrombus formation is a risk. TPA has been effective in maintaining perfusion and decreasing the need for amputation when administered within 24 hours of rewarming.

what is the leading cause of preventable death for the trauma patient in the prehospital environment.

a. airway compromise

b. ineffective ventilation

c. secondary head injury

d. uncontrolled external hemmorage

d. uncontrolled external hemmorage

A patient arrives at the emergency department by private vehicle after sustaining an injury to the right lower extremity while using a saw. There is a large gaping wound to the right thigh area with signifigant bleeding, what is the priority intervention?

a. elevate the etremeity to the level of the heart

b. initate direct pressure

c. apply a tourniquet

d. cover the open wound with sterile saline dressings

b. initate direct pressure

what is the appropriate technique for palpating the pelvis for stability?

a. apply gentle pressure over the illiac crests, downward and laterally

b. apply gentle pressure over the iliac crests, downward and medially

c. apply firm pressure over the iliac crests downward and laterally

d. apply firm pressure over the iliac crests downward and medially

b. apply GENTLE pressure, downward and medially

The vital signs of a pregnant trauma patient at 30 weeks include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following?

a. decompensated shock

b. normal vitalsigns in pregnancy

c. compensated shock

d. supine hypotension syndrome

b. Normal vital signs in pregnancy

resting hr increases 10-20 bpm

small decrease in sbp and a larger decrease in dbp d/t decreased peripheral resistance.

normal fetal heart rate is between 120-160 bpm.

Following a bomb explosion, fragmentation injuries from the bomb or objects in the environment are examples of which phase of injury?

a. primary

b. secondary

c. tertiary

b. quaternary

a. the primary phase-impact of the pressurization wave on body surfaces. Injuries include blast lung, tympanic membrane rupture, abdominal hemmorrhage, globe rupture. and mild traumatic brain injury.

b. the seconday phase results from flying debris, projectiles, and bomb fragments causing lacerations or penetrating injuries.

c. tertiary phase-results from individuals being thrown by the blast and impacting walls, ground or any hard object.

d. quartenary phase-results from any explosion-related illness or injury including hyperglycemia, hypertension, andina, asthma, COPD or sepsis.

A patient involved in an MVC has sustained a fracture to the second rib of the anterior left chest. Which concurrent injury is most commonly associated with this fracture?

a. Blunt cardiac injury

b. Brachial plexus injury

c. Pneumothorax

d. Hemothorax

b. first and second rib fractures are commonly associated with great vessel, head and spinal cord and brachial plexus injuries.

a. blunt cardiac injury-sternal fractures;

c. pneumothorax is most commonly associated with sternal fractures, multiple rib fractures, flail chest

d. Hemothorax is most commonly associated with flail chest of multiple rib fractures

Understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma care provider in which of the following?

a. anticipating the types of injuries that may be present

b. deciding whether law enforcement should be notified

c. determining the need for lab tests

d. predicting the need for a surgical procedure

a. anticipating the types of injuries that may be present

mechanism of injury and energy transfer can assist the provider in anticipating the types of injuries that may be present and their severity

In a patient with severe traumatic brain injury, hypocapnia causes which condition?

a. respiratory acidosis

b. metabolic acidosis

c. neurogenic shock

d. cerebral vasoconstriction

***d. hypocapnia, cause vasoconstriction especially in the cerebral vasculature

a. hypercapnia from inadequate ventilation causes respiratory acidosis, not hypocapnia

b. metabolic acidosis results from tissue hypoperfusion and oxygen deficit, not hypocapnia

c. neurogenic shock is associated with spinal cord injuries and results in generalized vasodilation. Hypocapnia causes vasoconstriction.

Which of the following describes ventilation principles associated with use of a bag-mask device for an adult?

a. compress the bag-mask device at a rate of one breath every six seconds

b. delivers 100 % oxygen

c. squeeze the bag completely for each breath

d. maintain

a. compress the bag-mask at a rate of one breath every six seconds

What is the best measure of the adequacy of cellular perfusion and can help predict the outcome of resuscitation?

a. end tidal CO2

b. Hematocrit level

c. Base deficit

d. Oxygen saturation

c. base deficit- serves as an endpoint measurement of the adequacy of cellular perfusion and, when used in conjunction with serum lactate, helps predict the success of resuscitation.

a. End tidal CO2-end product of ventilation and a reflection of metabolism and pulmonary fxn.

What technique is most appropriate when obtaining a history?

a. sitting next to the patient

b. ensuring the patient answers all questions

c. asking for information only related to the assault

d. applying active listening

d. applying active listening

While performing an assessment on a 13-month old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a sign of possible altered mental status?

a. sunken fontanel

b. crying, but consolable

c. spontaneous movement of arms and legs

d. cooperation with the assessment

d. cooperation with the assessment

A patient fell two weeks ago, striking their head. Today, the patient presented with a persistent headache and nausea and was diagnosed with a small subdural hematoma. The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports the patient has been anxious, restless, shaky, and vomited twice during the night. The patient states they couldn't sleep because a young child kept coming into the room. What is the most likely cause for these signs and symptoms?

B: Alcohol withdrawal is a common delayed condition because symptoms are difficult to identify early. Signs include autonomic hyperactivity, hand tremors, nausea or vomiting, psychomotor agitation, anxiety, insomnia, transient hallucinations, or seizures

A: Signs of increased intracranial pressure include headache, nausea and vomiting, amnesia, behavioral changes, and altered level of consciousness..

C: Signs of rhabdomyolysis include muscle pain or weakness, dark red or brown urine, general weakness or malaise, and elevated creatinine kinase levels.

D: Signs of pulmonary embolus include anxiety, pleuritic chest pain, dyspnea, hypoxemia, hemoptysis, cough, orthopnea, adventitious lung sounds, decreased lung sounds, jugular vein distension, or hypotension.

1. 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. 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 92%. BP is 142/70 mm Hg. What is the most important intervention to manage the cerebral blood flow?

A. Decrease the rate of manual ventilation

B. Initiate another fluid bolus.

C. Recheck endotracheal tube placement.

D. Increase the amount of oxygen delivered.

A. Decrease the rate of manual ventilation

2. Which of the following situations could cause functional grief?

A. Inability to live at home

B. Amputation of a limb

C. Loss of one's self-image

D. Destruction of the patient's car

B. Amputation of a limb

Rationale: Preparation and Ongoing Care\Psychosocial Aspects

Functional grief relates to the loss of body function or body parts such as amputation of a limb, paralysis, or loss of sight.

3. What is the most important consideration during the initial assessment when caring for an older adult who has sustained serious injuries?

A. They are likely to be fearful in the emergency department

B. Medical history including current medications

C. Availability of support systems after discharge

D. Accessibility to a primary care physician

B. Medical history including current medications

4. 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?

A. Clean the ear with a cotton-tipped applicator.

B. Pack the ear with gauze.

C. Notify the physician

D. Document and continue the exam.

C. Notify the physician

5. When should the definitive calculation for intravenous fluid resuscitation rate be performed for a patient with burns?

A. As soon as the patient arrives

B. After removal of clothing

C. Only at a burn center

D. During the circulation assessment

B. After removal of clothing

Rationale: Musculoskeletal and Wounds\Burns

Some fluid will be given initially, but an accurate fluid total is based on percentage of total body surface area which requires a good skin assessment and is calculated after clothing is removed.

6. In a motor vehicle collision, which injury pathway is most likely to increase the patient's morbidity and mortality?

A. Rotational

B. Ejection

C. Lateral

D. Rollover

B. Ejection

7. A patient with a lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention?

A. Elevating the leg above the level of the heart

B. Repositioning the leg and applying ice

C. Elevating the leg to the level of the heart

D. Preparing the patient for ultrasound of the leg

C. Elevating the leg to the level of the heart

Rationale: Musculoskeletal and Wounds\Musculoskeletal

This patient is exhibiting signs of possible compartment syndrome which is a dangerous complication of fractured extremities. The pain is often out of proportion to the injury and might not respond to pain medications. Elevate the limb to the level of the heart to decrease dependent edema but not above the heart, which can cause increased venous congestion and pressure within the compartment.

8. A teenaged patient presents to the emergency department with left arm pain after a ground level fall. The patient identifies as transgender and shares they are homeless. The ED staff are concerned the patient is experiencing human trafficking. What is most consistent with human trafficking?

A. The individual appears well nourished.

B. Those who are being trafficked rarely seek medical care.

C. It is infrequently associated with substance abuse.

D. Those experiencing human trafficking rarely self-disclose.

D. Those experiencing human trafficking rarely self-disclose.

9. An intubated trauma patient has just been transported back from CT scan. Upon arrival to their room in the emergency department, resistance is noted with bag-mask ventilations and auscultation reveals unequal breath sounds. What is the most appropriate initial intervention for this patient?

A. Place the patient back on the ventilator.

B. Extubated the patient.

C. Reposition the endotracheal tube.

D. Suction the endotracheal tube.

C. Reposition the endotracheal tube.

10. Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax?

A. Increased work of breathing

B. Unilaterally diminished breath sounds

C. Tachycardia

D. Hypotension

D. Hypotension

11. A patient is brought to the emergency department of a rural hospital following a high-speed motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what is the priority intervention?

A. Initiate transfer to a trauma center

B. Attempt family notification

C. Obtain additional imaging studies

D. Place an indwelling urinary catheter

A. Initiate transfer to a trauma center

12. A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the priority intervention?

A. Initiate two intravenous access sites

B. Place the patient on supplemental oxygen

C. Apply direct pressure to the wound

D. Use a tourniquet to control the bleeding

C. Apply direct pressure to the wound

13. A trauma patient involved in a fall from 25 feet has a traumatic brain injury, three anterior rib fractures on the right side, a small pneumothorax on the right, and a Grade III liver injury. The patient was intubated and placed on a ventilator with PEEP. Chest tube was deferred at this time. Upon reassessment, which finding is most concerning?

A. Severely diminished breath sounds on the right

B. Guarding in the right upper quadrant

C. Ecchymosis in the right upper quadrant

D. Crepitus to the right chest

A. Severely diminished breath sounds on the right

14. A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most likely an indication of the body's response to these findings?

A. Increased respiratory effort

B. Widening pulse pressure

C. Reflex tachycardia

D. Reflex hypotension

B. Widening pulse pressure

Rationale: Head and Torso Trauma\Head Trauma

This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8 kPa) which is associated with poor outcomes. When the CPP falls below normal levels, the central nervous system initiates the Cushing response in an attempt to increase mean arterial pressure and improve CPP. Cushing response assessment findings include widening pulse pressure, reflex bradycardia, and irregular, decreased respiratory effort.

A patient presents, after a 25-foot fall, with paradoxical chest wall movement to the right lower chest and complaints of shortness of breath. What is the priority intervention?

A. Surgical intervention

B. Chest tube insertion

C. Needle decompression

D. Airway and ventilation support

D. Airway and ventilation support

18. A trauma patient is being held in the emergency department because there are no available inpatient beds. The patient sustained a femur fracture and required multiple blood products. The patient now has blood oozing from abrasions, IV sites, the nose, and gums. What condition is most consistent with these findings?

A. Rhabdomyolysis

B. Fat embolism

C. Disseminated intravascular coagulopathy

D. Multiple organ dysfunctions syndrome

C. Disseminated intravascular coagulopathy

16. 1. 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?

A. Intracerebral hemorrhage

B. Epidural hematoma

C. Diffuse axonal injury

D. Post-concussive syndrome

D. Post-concussive syndrome

Rationale: Special Populations\Older Adult

Post-concussive syndrome can occur days to weeks after injury or trauma. The other three conditions present as a more rapid decline, especially in patients who are on anticoagulants.

1. Your patient was the unrestrained driver involved in a moderate speed motor vehicle collision. Assessment reveals tenderness in the upper right quadrant, crepitus in the lower right ribs, and ecchymosis around the umbilicus. The nurse is concerned about injury to which organ?

A. Transverse colon

B. Pancreas

C. Liver

D. Spleen

C. Liver

Rationale: Head and Torso Trauma\Abdominal and Pelvic Trauma

Liver injuries are associated with right, lower rib fractures. They also can present with tenderness, guarding, or rigidity in the right upper quadrant, along with ecchymosis of the right upper quadrant or around the umbilicus, known as Cullen's sign

20. 1. A 35-year-old male 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?

A. Oculomotor nerve palsy

B. Globe rupture

C. Retrobulbar hematoma

D. Retinal detachment

B. Globe rupture

Rationale: Head and Torso Trauma\Head Trauma

The globe of the eye consists of multiple layers. The sclera is the white outer layer, while the cornea covers the iris and pupil. When a full thickness injury occurs to the cornea, sclera, or both, the globe will rupture, causing the shape of the pupil to become irregular or teardrop-shaped

21. 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?

A. Capillary leak syndrome

B. Rhabdomyolysis

C. Carbon monoxide poisoning

D. Hypothermia

C. Carbon monoxide poisoning

22. An adult patient is being treated in the emergency department after falling 30 feet and landing on their head. The patient has been intubated and initial stabilization efforts are ongoing. The vital signs are BP 70/40 mm Hg, HR 44 beats/minute, and respirations are being assisted at 16 breath/minute. The patient's skin is warm, dry, and of a normal color. These findings are most consistent with what type of shock?

A. Spinal

B. Hypovolemic

C. Obstructive

D. Neurogenic

D. Neurogenic

23. 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?

A. Clamp the chest tube

B. Return to the emergency department

C. Assist ventilations with bag-mask device

D. Continue to the intensive care unit

D. Continue to the intensive care unit

24. 1. Which one of the following characteristics is found in high performing teams?

A. Interdisciplinary collaboration

B. Provide on-the-job training

C. Work individually

D. Minimal feedback to decrease confusion

A. Interdisciplinary collaboration

25. 1. 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?

A. Decreased pH

B. Elevated carbon dioxide level

C. Decreased body temperature

D. Increased metabolic demand

Rationale: Primary Assessment\Airway and Ventilation

If the blood is not sufficiently warmed when transfused, it can produce hypothermia. In the oxyhemoglobin dissociation curve, a shift to the left increases the affinity of hemoglobin for oxygen making it harder to release for use by the tissues. Factors that can cause this shift include an elevated pH, decreased carbon dioxide, decreased temperature, and low metabolic demand.

C. Decreased body temperature

Triage Intervention for Patients with Fever and Rash

Immediately initiate isolation precautions

Facial Trauma with Teardrop-Shaped Pupil

Suspected retrobulbar hematoma

Incomplete Spinal Cord Injury at L1

Indicated by voluntary anal sphincter tone

Complete Spinal Cord Injury Suspicion

Urinary incontinence as a finding

Early Hypovolemic Shock Blood Pressure

Rising systolic blood pressure

Log-roll Maneuver

Recommended for patients with unstable pelvic fractures

Uncontrolled Bleeding Priority Intervention

Apply direct pressure to the wound

Severe Head Trauma Management

Decrease the rate of manual ventilation

Symptoms in Older Adult on Anticoagulant Therapy

Most likely due to epidural hematoma

Priority Nursing Intervention for Calf Pain

Elevating the leg above the level of the heart

Diaphragm Injury from Penetrating Wound

Decreased breath sounds on the left side

Patient with Rib and Femur Fractures

Sudden anxiety and confusion as a concerning sign

Petechiae

Tiny red or purple spots on the skin

American College of Surgeons screening guidelines

Criteria used to determine the need for cervical spine imaging

Blast trauma

Injuries caused by explosions, categorized into primary, secondary, tertiary, or quaternary

Nasopharyngeal airway

Device inserted through the nose to maintain an open airway

Pelvic binder

Device used to stabilize pelvic fractures and reduce bleeding

Balanced resuscitation

Administering various blood products to stabilize a patient

Disaster triage principles

Guidelines for prioritizing care in mass casualty incidents

Needle decompression

Emergency procedure to relieve tension pneumothorax

Tranexamic acid

Medication used to prevent excessive bleeding

Spinal shock

Temporary loss of spinal reflex activity below the level of injury

Mean arterial pressure (MAP)

Average pressure in a patient's arteries during one cardiac cycle

Reflex tachycardia

Increased heart rate in response to low blood pressure

Backboard

Device used to immobilize a patient's spine during transport

Priority Intervention for Active Bleeding

Control the bleeding

Best Position for Intubation Visualization

Ramped

Priority Nursing Intervention for Decreased GCS

Notify the provider of the change

Cause of Functional Grief

Inability to live at home