TNCC Core Content and Skills 3 — Questions and Answers
Question 1: In damage control resuscitation (DCR), what ratio of packed red blood cells to fresh frozen plasma is recommended?
- 4:1
- 1:1 (Correct answer)
- 3:1
- 2:1
Correct answer: 1:1
DCR uses a 1:1 ratio of pRBC to FFP (with platelets 1:1:1) to address traumatic coagulopathy and restore all clotting factors.
Question 2: Which intervention is the priority when a trauma patient develops worsening respiratory distress after needle decompression of a tension pneumothorax?
- Repeat the needle decompression at a new site
- Immediately perform a tube thoracostomy (Correct answer)
- Increase the oxygen flow rate
- Obtain a stat portable chest X-ray first
Correct answer: Immediately perform a tube thoracostomy
Needle decompression is temporizing; definitive treatment is chest tube insertion, which must follow if the patient does not improve or deteriorates.
Question 3: The Revised Trauma Score (RTS) incorporates which three physiological parameters?
- GCS, systolic BP, and respiratory rate (Correct answer)
- Heart rate, GCS, and oxygen saturation
- Systolic BP, heart rate, and temperature
- Respiratory rate, pulse oximetry, and GCS
Correct answer: GCS, systolic BP, and respiratory rate
The RTS uses Glasgow Coma Scale, systolic blood pressure, and respiratory rate to quantify injury severity for triage and outcomes.
Question 4: Which sign is most specific for a basilar skull fracture in a trauma patient?
- Periorbital ecchymosis (raccoon eyes)
- Retroauricular ecchymosis (Battle's sign) (Correct answer)
- Epistaxis with clear fluid
- Hemotympanum on otoscopy
Correct answer: Retroauricular ecchymosis (Battle's sign)
Battle's sign (bruising over the mastoid process) is highly specific for a basilar skull fracture involving the posterior fossa.
Question 5: A patient involved in a high-speed crash presents with left flank pain and gross hematuria. CT shows a Grade III renal laceration. What is the typical management?
- Immediate surgical nephrectomy
- Nonoperative management with close monitoring (Correct answer)
- Emergent angioembolization always required
- Immediate urologic stent placement
Correct answer: Nonoperative management with close monitoring
Grade I–III renal lacerations in hemodynamically stable patients are typically managed nonoperatively with serial imaging and monitoring.
Question 6: What is the primary concern with administering high-volume crystalloid resuscitation in hemorrhagic shock?
- Rapid correction of coagulopathy
- Dilutional coagulopathy and worsening of the lethal triad (Correct answer)
- Hypernatremia from saline infusion
- Immediate resolution of acidosis
Correct answer: Dilutional coagulopathy and worsening of the lethal triad
Large-volume crystalloid worsens the lethal triad (hypothermia, acidosis, coagulopathy) by diluting clotting factors and promoting hypothermia.
Question 7: During a trauma resuscitation, a patient's SpO2 drops to 84% despite high-flow O2 via non-rebreather mask. What is the nurse's priority action?
- Order an arterial blood gas immediately
- Prepare for definitive airway management (Correct answer)
- Apply a CPAP mask at 5 cmH2O
- Elevate the head of the bed to 30 degrees
Correct answer: Prepare for definitive airway management
Persistent hypoxia despite supplemental O2 indicates the need for definitive airway management (endotracheal intubation) to secure and protect the airway.
TNCC Core Content and Skills 3
In damage control resuscitation (DCR), what ratio of packed red blood cells to fresh frozen plasma is recommended?