TNCC Initial Assessment 3 — Questions and Answers
Question 1: In the 'Circulation' component of the primary survey, which is the priority intervention for uncontrolled external hemorrhage?
- IV fluid resuscitation
- Direct pressure or tourniquet application (Correct answer)
- Vasopressor administration
- Type and crossmatch for blood products
Correct answer: Direct pressure or tourniquet application
Direct pressure or tourniquet application addresses the source of hemorrhage and takes priority over fluid replacement.
Question 2: A trauma patient has the following vital signs: BP 88/60, HR 130, RR 28, GCS 13. According to the Revised Trauma Score (RTS), which component carries the highest weight?
- Systolic blood pressure
- Respiratory rate
- GCS (Correct answer)
- Heart rate
Correct answer: GCS
In the Revised Trauma Score, GCS has the highest weighted coefficient (0.9368) compared to blood pressure and respiratory rate.
Question 3: During the secondary survey, the nurse notes crepitus over the pelvis. This finding suggests:
- Lumbar spine fracture
- Pelvic ring disruption (Correct answer)
- Hip dislocation
- Femur fracture
Correct answer: Pelvic ring disruption
Crepitus over the pelvis during manual compression suggests a pelvic ring fracture, which can cause massive hemorrhage.
Question 4: Which mechanism of injury should prompt the trauma nurse to suspect a thoracic aortic injury?
- Low-speed motorcycle fall
- Rapid deceleration injury such as a high-speed MVA (Correct answer)
- Direct blunt blow to the chest wall
- Penetrating stab wound to the lateral chest
Correct answer: Rapid deceleration injury such as a high-speed MVA
Rapid deceleration causes shear forces at fixed aortic attachment points, making blunt aortic injury a concern in high-speed MVAs.
Question 5: The 'Get Resuscitation Adjuncts' step during the primary survey includes which of the following?
- Head-to-toe physical examination
- Monitoring (ECG, SpO2, ETCO2), foley catheter, and gastric tube placement (Correct answer)
- Detailed history and allergy review
- Pain scale assessment and psychosocial evaluation
Correct answer: Monitoring (ECG, SpO2, ETCO2), foley catheter, and gastric tube placement
Resuscitation adjuncts include continuous monitoring devices, urinary catheter for output measurement, and gastric decompression.
Question 6: A patient presents after a motor vehicle crash with absent breath sounds on the right and tracheal deviation to the left. The most likely diagnosis is:
- Massive hemothorax
- Tension pneumothorax (Correct answer)
- Open pneumothorax
- Pulmonary contusion
Correct answer: Tension pneumothorax
Absent breath sounds with tracheal deviation away from the affected side indicates tension pneumothorax — a life-threatening emergency.
Question 7: When assessing a trauma patient's pupils during the 'D' (Disability) component, which finding is most concerning for herniation syndrome?
- Bilateral pinpoint pupils
- Unilateral fixed and dilated pupil (Correct answer)
- Bilateral sluggish reaction to light
- Anisocoria less than 1mm
Correct answer: Unilateral fixed and dilated pupil
A unilateral fixed and dilated pupil indicates uncal herniation compressing cranial nerve III — a neurological emergency.
TNCC Initial Assessment 3
In the 'Circulation' component of the primary survey, which is the priority intervention for uncontrolled external hemorrhage?