Trauma Nurse Core Course (TNCC) Practice Exam

A patient with a large open chest wound shows signs of anxiety and severe respiratory distress. What is the most appropriate intervention?

1. Needle decompression

2. Tube thoracostomy

3. Dressing removal

4. Surgical repair

The correct answer is: Dressing removal

In a patient with a large open chest wound accompanied by anxiety and severe respiratory distress, addressing the immediate thoracic injury is critical. The most appropriate intervention in this scenario is to apply a dressing that allows for air to escape but does not permit air to enter the pleural space, which would help to stabilize the patient’s condition. When dealing with an open chest wound, the focus is to secure the wound site and manage the potential for tension pneumothorax. Needle decompression can be indicated when there is tension pneumothorax, but it is not the primary intervention for an open chest wound. Tube thoracostomy is a subsequent measure aimed at ongoing management of pleural space dynamics. Surgical repair is typically reserved for definitive care after initial stabilization. Therefore, the strategy to control the airflow into the chest while ensuring patient safety is paramount, making the correct choice relevant to initial management in trauma care.