Free TNCC Trauma Care Questions and Answers 1 — Questions and Answers
Question 1: Why is a serum lactate measurement used during the trauma patient's initial evaluation?
- to measure tissue hypoxia and end-organ perfusion (Correct answer)
- to identify the shock's underlying source
- to monitor ventilation and oxygenation
- to calculate the base deficit required to provide adequate cellular perfusion
Correct answer: to measure tissue hypoxia and end-organ perfusion
Serum lactate is a crucial indicator in trauma because it reflects the body's metabolic response to inadequate oxygen delivery. Elevated lactate levels signify tissue hypoxia and anaerobic metabolism, directly indicating poor end-organ perfusion and the severity of shock. Monitoring lactate helps guide resuscitation efforts to restore adequate oxygenation and perfusion.
Question 2: The trauma patient's vital signs were 100/60 mm Hg, 96 beats per minute, and 24 breaths per minute when they arrived. The patient is agitated and asks "where am I?" frequently. She has dry, cold skin. The patient's vital signs are 104/84 mm Hg, 108 bpm, and 28 breaths per minute. Which stage of shock is the patient exhibiting symptoms and signs of?
- decompensated
- gradual
- compensated (Correct answer)
- irreversible
Correct answer: compensated
The patient's initial vital signs show a narrow pulse pressure, increased heart rate, and increased respiratory rate, which worsen over time. Agitation and dry, cold skin are also classic signs of sympathetic nervous system activation. These indicate that the body's compensatory mechanisms, such as vasoconstriction and increased heart rate, are actively working to maintain blood pressure and vital organ perfusion despite ongoing hypoperfusion, characteristic of compensated shock.
Question 3: That day, an elderly patient who has used anticoagulants in the past comes in after falling at home. She disputes that she ever lost consciousness. In addition to complaining of headache, nausea, and dizziness, she has a hematoma on her forehead. Which of the following best describes her symptoms?
- subdural hematoma (Correct answer)
- hematoma epidural
- axonal damage that is diffuse
- concussion-related syndrome
Correct answer: subdural hematoma
An elderly patient on anticoagulants who falls is at high risk for intracranial bleeding. A subdural hematoma, which involves bleeding between the dura mater and arachnoid mater, often presents with a delayed onset of symptoms like headache, nausea, and dizziness, even without immediate loss of consciousness. The use of anticoagulants significantly increases the risk of such bleeding following trauma.
Question 4: A patient who fell off his bicycle is brought in by EMS. Which evaluation result, according to the American College of Surgeons screening recommendations, would lead the nurse to get the patient ready for radiologic spine clearance?
- alcohol odor on breath (Correct answer)
- Water demands repeated
- many cuts on the extremities
- Unaffected by neurologic impairments and alert
Correct answer: alcohol odor on breath
According to American College of Surgeons screening recommendations (like NEXUS or Canadian C-Spine Rule), patients must be alert, oriented, and free from distracting injuries or altered mental status to undergo clinical spine clearance. An alcohol odor on breath suggests intoxication, which impairs the patient's ability to reliably report pain or neurological deficits. Therefore, radiological imaging is required to rule out spinal injury in such cases.
Question 5: After a high-speed MVC, a passenger is taken to the emergency room of a rural hospital. Which of the following procedures should be prioritized if the main survey reveals substantial damage to the abdomen and pelvis?
- acquired imaging investigations
- insert a stomach tube
- start the trauma center transfer process (Correct answer)
- provide the surgery room nurse a report.
Correct answer: start the trauma center transfer process
A rural hospital may lack the specialized resources, such as immediate access to trauma surgeons, advanced imaging, and operating room capabilities, required for definitive management of severe multi-system trauma. Prioritizing transfer to a higher-level trauma center ensures the patient receives timely, comprehensive care from a specialized trauma team. This critical step significantly improves outcomes for patients with substantial abdominal and pelvic injuries.
Question 6: Which of the following injuries has the LEAST chance of being found right away?
- bowel (Correct answer)
- heart
- liver
- spleen
Correct answer: bowel
Injuries to solid organs like the heart, liver, and spleen often present with immediate and dramatic signs of hemorrhage or organ dysfunction due to their vascularity. In contrast, bowel injuries, especially perforations, can initially be subtle, with symptoms like peritonitis developing gradually over several hours as contents leak into the abdominal cavity. This delayed presentation makes them harder to detect immediately during the initial trauma survey.
Question 7: Which of the following conditions should be kept an eye out for in patients who have had crush injuries?
- Dysrhthmias (Correct answer)
- Polyuria
- Hypernatremia
- Hypercalcemia
Correct answer: Dysrhthmias
Crush injuries cause rhabdomyolysis, where damaged muscle cells release intracellular contents, including potassium, into the bloodstream. This can lead to severe hyperkalemia, a life-threatening electrolyte imbalance that directly affects cardiac conduction. Hyperkalemia can cause various dysrhythmias, making continuous cardiac monitoring essential in patients with crush injuries.
Question 8: Which discovery makes one suspect a whole spinal cord injury?
- Priapism (Correct answer)
- Reflexes intact far from the injury
- Limb weakness in the lower limbs
- Tone of the voluntary anal sphincter
Correct answer: Priapism
Priapism, a persistent and painful erection, is a classic sign of a complete spinal cord injury, particularly at the thoracic or lumbar levels. It results from the loss of sympathetic nervous system control below the level of injury, leading to unopposed parasympathetic activity and uncontrolled vasodilation in the penis. This finding strongly suggests a severe spinal cord injury.
Question 9: Which additional clinical indicators, in addition to hypotension, will a patient with a full spinal cord injury in neurogenic shock exhibit?
- Absence of motor function and tachycardia below the site of damage
- Bradycardia and lack of movement below the injured site (Correct answer)
- Bradycardia and unilateral motor function deficits
- Both respiratory depression and tachycardia
Correct answer: Bradycardia and lack of movement below the injured site
Neurogenic shock results from the loss of sympathetic nervous system tone due to a spinal cord injury, typically above T6. This leads to widespread vasodilation, causing hypotension, and unopposed parasympathetic activity, which manifests as bradycardia. A complete spinal cord injury also results in flaccid paralysis and loss of sensation below the level of injury.
Question 10: A five-year-old child arrives at the emergency department (ED) with many small, clean, circular burns on her back and bruises to her upper arms and buttocks that are in varying states of healing. The primary survey and the pediatric assessment triangle do not reveal any problems. Which nursing intervention is the most important among the following?
- Give the family resources for preventing injuries
- converse therapeutically to ascertain the MOI.
- After applying ice to the bruising, seek wound care advice
- In compliance with local laws, report your suspicions of abuse. (Correct answer)
Correct answer: In compliance with local laws, report your suspicions of abuse.
The description of multiple small, clean, circular burns and bruises in varying stages of healing on a child's back, upper arms, and buttocks is highly suspicious for child abuse. As healthcare professionals, nurses have a legal and ethical obligation to report suspected child abuse to the appropriate authorities. This intervention prioritizes the child's safety and well-being.
Question 11: A patient with a lower extremity fracture reports that his painkillers only somewhat reduce his extreme calf tightness and pain. Which nursing intervention is the most important among the following?
- Getting ready for an ultrasound
- lifting the limb up above the heart's level
- moving and using ice
- bringing the extremities up to the heart's level (Correct answer)
Correct answer: bringing the extremities up to the heart's level
The symptoms of extreme calf tightness and pain, poorly relieved by analgesics, following a lower extremity fracture are highly suggestive of compartment syndrome. Elevating the affected limb above heart level is contraindicated as it can further reduce arterial perfusion and worsen ischemia. Therefore, maintaining the extremity at or slightly below heart level helps optimize blood flow to the compromised tissues, pending definitive surgical intervention.
Free TNCC Trauma Care Questions and Answers 1
Why is a serum lactate measurement used during the trauma patient's initial evaluation?