TNCC Core Content and Skills 2 — Questions and Answers
Question 1: During the secondary survey of a trauma patient, the nurse notes tracheal deviation to the right. Which condition does this most likely indicate?
- Right-sided tension pneumothorax
- Left-sided tension pneumothorax (Correct answer)
- Right-sided hemothorax
- Left-sided simple pneumothorax
Correct answer: Left-sided tension pneumothorax
Tracheal deviation shifts away from the affected side; deviation to the right indicates a left-sided tension pneumothorax pushing mediastinal structures rightward.
Question 2: A patient arrives after a motor vehicle crash with a GCS of 14, BP 88/60, HR 126, and distended neck veins. Which injury is most suspected?
- Massive hemothorax
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Aortic dissection
Correct answer: Cardiac tamponade
Beck's triad (hypotension, distended neck veins, muffled heart sounds) is classic for cardiac tamponade, which impairs ventricular filling.
Question 3: When assessing the 'E' component in the primary survey, what does the trauma nurse evaluate?
- Extremity neurovascular status
- Expose and environment control (Correct answer)
- Electrocardiogram rhythm
- Edema and ecchymosis pattern
Correct answer: Expose and environment control
The 'E' in the ABCDE primary survey stands for Expose/Environment — fully exposing the patient while preventing hypothermia.
Question 4: Which mechanism best explains neurogenic shock in a cervical spinal cord injury patient?
- Massive blood loss from cord hemorrhage
- Loss of sympathetic tone causing vasodilation and bradycardia (Correct answer)
- Activation of the parasympathetic nervous system causing tachycardia
- Systemic inflammatory response to cord edema
Correct answer: Loss of sympathetic tone causing vasodilation and bradycardia
Cervical cord injuries disrupt descending sympathetic pathways, causing peripheral vasodilation and unopposed vagal bradycardia.
Question 5: A patient with an open book pelvic fracture is hemodynamically unstable. What is the FIRST priority intervention?
- CT scan of the pelvis
- Application of a pelvic binder or sheet (Correct answer)
- Emergency surgical exploration
- Bilateral femoral angiography
Correct answer: Application of a pelvic binder or sheet
A pelvic binder reduces pelvic volume, tamponades venous bleeding, and is the first step in stabilizing an unstable pelvic fracture.
Question 6: Which finding on the focused assessment with sonography in trauma (FAST) exam indicates significant intra-abdominal hemorrhage?
- Absence of lung sliding
- Free fluid in Morrison's pouch (Correct answer)
- Pericardial effusion only
- Dilated inferior vena cava
Correct answer: Free fluid in Morrison's pouch
Free fluid (anechoic stripe) in Morrison's pouch between the liver and right kidney indicates intra-abdominal hemorrhage on FAST exam.
Question 7: A trauma patient has a serum lactate of 6 mmol/L. What does this value most strongly indicate?
- Adequate tissue oxygenation
- Significant tissue hypoperfusion and shock (Correct answer)
- Mild dehydration only
- Metabolic alkalosis from stress response
Correct answer: Significant tissue hypoperfusion and shock
Elevated lactate (>4 mmol/L) indicates anaerobic metabolism from tissue hypoperfusion, signaling significant shock.
TNCC Core Content and Skills 2
During the secondary survey of a trauma patient, the nurse notes tracheal deviation to the right.
Which condition does this most likely indicate?