TCRN Certification Exam — Questions and Answers

Question 1: A family member requests that the trauma team not tell the patient about a terminal diagnosis. The nurse understands that:

The physician may withhold information if the family requests it
The competent patient has the right to know their diagnosis unless they have waived that right (Correct answer)
Cultural considerations always override patient disclosure rights
Family wishes must be followed to maintain trust

Correct answer: The competent patient has the right to know their diagnosis unless they have waived that right

A competent patient has the ethical and legal right to receive truthful information about their condition; family members cannot override this unless the patient has specifically waived the right to know.

Question 2: Which crystalloid solution is preferred in damage control resuscitation for hemorrhagic shock?

Large volumes of normal saline
Lactated Ringer's in a 1:1:1 ratio with blood products
Hypertonic saline 3%
Balanced resuscitation with PRBCs, FFP, and platelets in 1:1:1 ratio (Correct answer)

Correct answer: Balanced resuscitation with PRBCs, FFP, and platelets in 1:1:1 ratio

Damage control resuscitation uses PRBCs, FFP, and platelets in a 1:1:1 ratio to replicate whole blood and correct trauma-induced coagulopathy.

Question 3: A patient involved in a high-speed motor vehicle collision has significant mid-face trauma, including mobility of the entire maxilla and zygomatic bones, resulting in craniofacial disjunction. Which Le Fort fracture classification does this presentation represent?

Le Fort I
Le Fort III (Correct answer)
Le Fort IV
Le Fort II

Correct answer: Le Fort III

A Le Fort III fracture, also known as craniofacial disjunction, is the most severe type of Le Fort fracture. It involves a transverse fracture line that passes through the nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch, effectively separating the entire facial skeleton from the cranial base. [17, 23, 27] Le Fort I is a horizontal maxillary fracture, and Le Fort II is a pyramidal fracture.

Question 4: A trauma patient is undergoing a Focused Assessment with Sonography for Trauma (FAST) exam. The primary purpose of this examination in the initial assessment of a trauma patient is to detect:

Retroperitoneal hemorrhage.
Specific solid organ injury grades.
Bowel wall thickening or perforation.
The presence of free fluid in the peritoneum or pericardium. (Correct answer)

Correct answer: The presence of free fluid in the peritoneum or pericardium.

The FAST exam is a rapid, non-invasive ultrasound screening tool designed to identify the presence of free fluid (assumed to be blood in the context of trauma) in dependent areas of the peritoneal, pericardial, and pleural spaces. It is used to rapidly identify potential life-threatening hemorrhage, not to grade specific organ injuries, definitively diagnose retroperitoneal bleeding, or identify bowel injuries.

Question 5: Current evidence-based guidelines regarding high-dose methylprednisolone for acute spinal cord injury state that it:

Is recommended as standard of care within 24 hours of injury
Should be reserved for thoracic injuries only
Is no longer recommended as standard care due to complications outweighing benefit (Correct answer)
Should be given within 8 hours for all complete cervical injuries

Correct answer: Is no longer recommended as standard care due to complications outweighing benefit

High-dose methylprednisolone has been removed from standard SCI protocols because risks — including infection, GI bleeding, and pulmonary complications — outweigh the marginal neurological benefit shown in older trials.

Question 6: Which finding would most suggest cardiac tamponade in a trauma patient?

Hyperresonance to percussion and absent breath sounds
Tracheal deviation, flat neck veins, hypotension
Widened pulse pressure and bounding pulses
Beck's triad: hypotension, muffled heart sounds, and distended neck veins (Correct answer)

Correct answer: Beck's triad: hypotension, muffled heart sounds, and distended neck veins

Beck's triad—hypotension, muffled heart sounds, and JVD—classically indicates pericardial tamponade.

Question 7: A trauma patient develops Beck's triad. Which intervention is MOST immediately appropriate?

Fluid bolus and vasopressors
Immediate thoracotomy
Chest tube insertion
Pericardiocentesis (Correct answer)

Correct answer: Pericardiocentesis

Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade; pericardiocentesis decompresses the pericardial sac emergently.

Question 8: A nurse is floated to the trauma unit without adequate orientation. Which action best protects the nurse legally and ethically?

Communicate limitations to the charge nurse and request assignment of only patients within competency (Correct answer)
Perform unfamiliar procedures to avoid slowing the team down
Refuse to work the shift entirely
Accept all assignments without comment to appear cooperative

Correct answer: Communicate limitations to the charge nurse and request assignment of only patients within competency

Nurses must practice within their scope of competence; communicating limitations allows supervisors to make safe assignments and protects both the patient and the nurse.

Question 9: Which radiographic sign on chest X-ray suggests traumatic aortic injury?

Elevated left hemidiaphragm
Pneumomediastinum with subcutaneous emphysema only
Widened mediastinum (>8 cm) with obliteration of the aortic knob (Correct answer)
Unilateral pleural effusion without rib fractures

Correct answer: Widened mediastinum (>8 cm) with obliteration of the aortic knob

A widened mediastinum on chest X-ray is a classic early radiographic sign prompting further evaluation for aortic disruption.

Question 10: A trauma patient is brought in after being assaulted. During the primary survey, the nurse must remove the patient's blood-soaked shirt to assess for chest injuries. Which action demonstrates proper preservation of forensic evidence?

Cutting directly through a large tear in the shirt to speed up removal.
Giving the shirt directly to a police officer before documenting its removal.
Placing the wet shirt in a sealed plastic bag to prevent contamination.
Cutting along the shirt's seams and placing it in a paper bag. (Correct answer)

Correct answer: Cutting along the shirt's seams and placing it in a paper bag.

To preserve evidence, clothing should be handled carefully. Cutting along seams, rather than through existing tears or holes (like bullet or stab wounds), preserves the integrity of the evidence. Each item should be placed in a separate, clearly labeled paper bag; paper allows wet items to dry and prevents the degradation of biological evidence that can occur in plastic bags.

Question 11: A patient arrives with a grossly contaminated Grade III open femur fracture. After controlling hemorrhage and ensuring hemodynamic stability, which intervention is the highest priority to prevent osteomyelitis?

Administering broad-spectrum intravenous antibiotics (Correct answer)
Immediate surgical debridement in the operating room
Obtaining a deep wound culture before irrigation
Covering the wound with a saline-moistened sterile dressing

Correct answer: Administering broad-spectrum intravenous antibiotics

Prompt administration of broad-spectrum intravenous antibiotics is a time-sensitive priority in managing open fractures to prevent infection, such as osteomyelitis. While covering the wound and surgical debridement are also critical steps, initiating systemic antibiotic therapy as soon as possible (ideally within 1-3 hours of injury) has been shown to significantly reduce infection rates. Wound cultures are typically obtained after initial irrigation.

Question 12: An 89-year-old resident of a skilled nursing facility presents with a new onset of confusion and lethargy. Staff report a minor, unwitnessed fall three weeks prior where the patient did not hit their head. This delayed, subacute neurological decline should raise the highest suspicion for which type of injury?

Diffuse axonal injury
Chronic subdural hematoma (Correct answer)
Intraparenchymal hemorrhage
Epidural hematoma

Correct answer: Chronic subdural hematoma

Due to age-related cerebral atrophy, the bridging veins that cross the subdural space are stretched and more susceptible to tearing from even minor trauma. This can cause a slow, insidious bleed, leading to a chronic subdural hematoma that presents with subtle and delayed neurological changes, such as confusion or somnolence, days to weeks after the initial injury.

Question 13: Which intervention is contraindicated in a patient with suspected esophageal perforation from trauma?

Early surgical consultation
CT scan of the chest
NPO status and IV antibiotics
Nasogastric tube insertion by the nurse without further assessment (Correct answer)

Correct answer: Nasogastric tube insertion by the nurse without further assessment

Blind nasogastric tube placement can worsen esophageal perforation; surgical consultation should guide any tube placement.

Question 14: The central venous pressure (CVP) of an adult patient is being monitored, and the pressure is decreasing. Which method is used to confirm hypovolemia?

Rapid fluid infusion of 250 to 500 mL and then evaluation in 10 minutes. (Correct answer)
Decrease rate of IV fluids and observe for further decrease in pressure.
Increase rate of fluids 2 X current rate and evaluate for increase in pressure.
Repeat readings every 5 minutes X 5 to determine further decrease in pressure.

Correct answer: Rapid fluid infusion of 250 to 500 mL and then evaluation in 10 minutes.

A fast fluid infusion of 250 to 500 mL may be administered because hypovolemia is the most frequent cause of a decline in CVP. If the pressure begins to drop again after ten minutes, hypovolemia is likely the cause. Always utilize serial readings to confirm an increase or reduction. The right atrium, right ventricle, and blood flow back into the heart are all evaluated using the CVP, which is the pressure in the superior vena cava close to the right atrium. Depending on the method of measurement, the normal ranges for CVP are 0 to 8 cm H2O or 2 to 6 mm Hg.

Question 15: When providing end-of-life care to a trauma patient whose family is present, which nursing action best supports the family?

Ask the family to wait outside during all care activities to maintain privacy
Allow family presence during resuscitation if desired, assign a dedicated nurse as family support, and provide regular updates (Correct answer)
Initiate family meetings only after the patient dies
Limit information to the next of kin only and discourage questions

Correct answer: Allow family presence during resuscitation if desired, assign a dedicated nurse as family support, and provide regular updates

Family presence and a dedicated support nurse reduce trauma-related grief and improve family satisfaction with end-of-life care.

Question 16: A trauma patient in police custody is being evaluated. Regarding release of medical information to law enforcement, the nurse should:

Allow officers unrestricted access to the patient's chart
Release only the minimum necessary information as required by law or court order (Correct answer)
Provide complete records to law enforcement upon request
Refuse all disclosure regardless of legal requirements

Correct answer: Release only the minimum necessary information as required by law or court order

HIPAA allows disclosure to law enforcement only in specific circumstances and requires release of only the minimum necessary information.

Question 17: A patient arrives following a diving accident with suspected cervical spine injury. What is the FIRST priority for the trauma nurse?

Maintain cervical spine immobilization while managing the airway (Correct answer)
Administer high-dose methylprednisolone within 8 hours
Perform a complete ASIA neurological assessment
Establish two large-bore IV lines immediately

Correct answer: Maintain cervical spine immobilization while managing the airway

Airway management with simultaneous cervical spine stabilization is the first priority in any suspected spinal cord injury, following the primary survey framework.

Question 18: In trauma care, the nurse suspects intimate partner violence (IPV). Which approach is most appropriate?

Report immediately to law enforcement without consulting the patient
Document suspicion in the chart but take no further action unless the patient volunteers information
Interview the patient and partner together to observe their interaction
Screen the patient privately using a validated tool, and provide resources regardless of disclosure (Correct answer)

Correct answer: Screen the patient privately using a validated tool, and provide resources regardless of disclosure

Universal private screening with validated tools ensures patient safety and provides resources without coercion, regardless of whether violence is disclosed.

Question 19: When withdrawing and securing a pistol from a trauma victim's pocket, what should they first think about?

place it in a paper bag
avoid touching the trigger. (Correct answer)
arrange for security personnel to remove the gun.
call the police.

Correct answer: avoid touching the trigger.

avoid touching the trigger.Avoiding hitting the trigger should be the primary priority while withdrawing and securing a firearm from a trauma victim's pocket. Even if it is certain the gun is empty of ammunition, it should still be regarded as loaded. To avoid disturbing fingerprints or residue from gun powder, the gun should be carefully removed while using gloves, and it should always be stored in a safe container rather than a paper bag. Never point the barrel of the gun at anyone else while moving it. If the firearm has a safety feature, it must be activated.

Question 20: Which statement accurately describes the nurse's role regarding informed consent for a trauma procedure?

Witnessing consent means the nurse is confirming the patient's medical decision is correct
The nurse is responsible for explaining all risks and benefits of the procedure
The nurse may witness the patient's signature after the physician has provided the information and the patient verbalizes understanding (Correct answer)
Nurses may obtain informed consent independently for any procedure they perform

Correct answer: The nurse may witness the patient's signature after the physician has provided the information and the patient verbalizes understanding

The nurse's witnessing role confirms the patient signed voluntarily and appeared competent; the responsibility for the informed consent discussion belongs to the procedure provider.

Question 21: Which federal law requires healthcare workers to report suspected child abuse regardless of whether the family consents to the disclosure?

Stark Law
HIPAA Privacy Rule
Mandatory reporting statutes (Correct answer)
EMTALA

Correct answer: Mandatory reporting statutes

Mandatory reporting laws require healthcare providers to report suspected child abuse without requiring parental consent.

Question 22: The trauma nurse's role in organ donation notification when a patient is dying includes which responsibility?

Making the final decision about organ donation on behalf of the family
Discussing donation only if the patient has a donor card on their person
Avoiding the topic until the patient is officially declared dead
Providing compassionate support to the family, ensuring notification of the organ procurement organization (OPO) per hospital protocol (Correct answer)

Correct answer: Providing compassionate support to the family, ensuring notification of the organ procurement organization (OPO) per hospital protocol

Timely OPO notification and compassionate family support are the nurse's core responsibilities in the organ donation process.

Question 23: A patient presents with paradoxical chest wall movement and severe respiratory distress after a motor vehicle crash. Which injury is MOST likely?

Cardiac tamponade
Flail chest (Correct answer)
Hemothorax
Open pneumothorax

Correct answer: Flail chest

Paradoxical movement (segment moves inward on inspiration) is the hallmark of flail chest, caused by fractures of three or more consecutive ribs in two places.

Question 24: An unconscious trauma patient has a suspected cervical spine injury. Which airway method is PREFERRED?

Blind nasotracheal intubation
Rapid sequence intubation (RSI) with in-line stabilization (Correct answer)
Nasopharyngeal airway with jaw thrust only
Cricothyrotomy as the first choice

Correct answer: Rapid sequence intubation (RSI) with in-line stabilization

RSI with manual in-line cervical stabilization is the preferred method as it protects the airway while minimizing cervical movement.

Question 25: Following a tractor accident, a 27-year-old patient is brought into the emergency room with an open, contaminated fracture of the tibia. Which of the following details should you particularly try to get from the patient?

Date of last treatment with antibiotics.
Cause of accident.
Description of environment where accident occurred.
Date of last tetanus shot. (Correct answer)

Correct answer: Date of last tetanus shot.

For all open infected wounds, the time since the most recent tetanus vaccine is particularly crucial. However, if the patient is not immunized, has had fewer than three immunizations, or is unsure about immunization, then the patient should receive both the tetanus toxoid and tetanus immune globulin because tetanus toxoid does not immediately confer immunity while tetanus immune globulin provides temporary immunity right away. Patients who have had three or more immunizations.

Question 26: Using the Rule of Nines in an adult, what percentage of TBSA does a burn covering the entire anterior trunk represent?

36%
18% (Correct answer)
9%
27%

Correct answer: 18%

The anterior trunk (chest and abdomen) represents 18% of TBSA in adults using the Rule of Nines.

Question 27: Which burn depth classification involves destruction of ALL skin layers including subcutaneous tissue, and may appear white, leathery, or charred?

Superficial (first-degree)
Deep tissue injury
Partial-thickness superficial (second-degree)
Full-thickness (third-degree) (Correct answer)

Correct answer: Full-thickness (third-degree)

Full-thickness (third-degree) burns destroy epidermis, dermis, and subcutaneous tissue, presenting as white, leathery, or charred with no pain due to nerve destruction.

Question 28: A patient arrives after a fall from height and is in hemorrhagic shock. The massive transfusion protocol (MTP) has been activated. In addition to blood products, which medication should be administered early to inhibit fibrinolysis and stabilize clot formation?

Sodium bicarbonate
Tranexamic acid (TXA) (Correct answer)
Calcium gluconate
Vasopressin

Correct answer: Tranexamic acid (TXA)

Tranexamic acid (TXA) is an antifibrinolytic agent that prevents the breakdown of blood clots. Studies have shown that its administration within three hours of injury in bleeding trauma patients reduces mortality. It is a key adjunct in damage control resuscitation. Calcium is given to treat hypocalcemia from citrate in blood products, bicarbonate treats severe acidosis, and vasopressors are used for refractory hypotension, but TXA specifically targets clot stability.

Question 29: Which pressure value defines the threshold for decompressive intervention in compartment syndrome?

Compartment pressure >20 mmHg
Compartment pressure >30 mmHg
Compartment pressure >50 mmHg
Compartment pressure within 30 mmHg of diastolic BP (Correct answer)

Correct answer: Compartment pressure within 30 mmHg of diastolic BP

Fasciotomy is indicated when compartment pressure is within 30 mmHg of diastolic BP (delta pressure ≤30 mmHg), as this compromises perfusion.

Question 30: A patient with a complete T2 SCI is 48 hours post-injury. Which early complication poses the GREATEST immediate threat to life?

Urinary tract infection
Heterotopic ossification
Adjustment disorder and depression
Deep vein thrombosis and pulmonary embolism (Correct answer)

Correct answer: Deep vein thrombosis and pulmonary embolism

DVT and PE are leading causes of early mortality in acute SCI due to complete venous stasis from lower extremity paralysis; prophylaxis should be initiated within 72 hours.

Question 31: A TCRN is caring for a minor trauma patient whose parents disagree about treatment. The nurse should:

Treat the patient according to the nurse's own judgment without parental input
Allow the parent present at bedside to make all decisions without further inquiry
Wait until both parents agree before providing any treatment
Follow facility legal counsel guidance and, if urgent, provide stabilizing care while the dispute is resolved (Correct answer)

Correct answer: Follow facility legal counsel guidance and, if urgent, provide stabilizing care while the dispute is resolved

In emergencies, stabilizing care proceeds regardless of parental disagreement; custody and consent disputes are resolved through legal channels.

Question 32: In pediatric trauma, which behavioral finding should alert the trauma nurse to possible child abuse?

Single fracture of the clavicle from a fall
Injuries inconsistent with the developmental stage or the history provided by caregivers (Correct answer)
Bruising over the shins in a child who just learned to walk
Fearfulness during physical exam only

Correct answer: Injuries inconsistent with the developmental stage or the history provided by caregivers

Injuries that don't match the caregiver's explanation or the child's developmental ability are the most important red flags for non-accidental trauma.

Question 33: Which intervention is the priority when a spinal cord injury patient develops autonomic dysreflexia with BP 220/130 mmHg?

Lay the patient flat and apply a cooling blanket
Administer IV morphine for pain
Sit the patient upright and identify and remove the triggering stimulus immediately (Correct answer)
Administer IV normal saline 500 mL bolus

Correct answer: Sit the patient upright and identify and remove the triggering stimulus immediately

Sitting the patient upright uses gravity to lower BP while rapid identification and removal of the offending stimulus is the definitive treatment.

Question 34: A trauma patient is noted to have cerebrospinal fluid (CSF) draining from the ear. The nurse should:

Irrigate the ear canal with sterile saline
Reposition the patient so the affected ear is dependent
Pack the ear canal tightly with sterile gauze to stop the leak
Place a loose sterile dressing to collect fluid and notify the provider; do not pack the ear (Correct answer)

Correct answer: Place a loose sterile dressing to collect fluid and notify the provider; do not pack the ear

CSF otorrhea must not be obstructed; the ear should be loosely covered and the provider notified to prevent meningitis risk.

Question 35: Which of the following is a PRIMARY survey finding that requires IMMEDIATE intervention?

Open pneumothorax (sucking chest wound) (Correct answer)
Open femur fracture with deformity
Positive FAST exam with stable vitals
Suspected pelvic fracture on palpation

Correct answer: Open pneumothorax (sucking chest wound)

An open pneumothorax allows air to enter the pleural space with each breath, rapidly causing respiratory failure and must be immediately sealed with an occlusive dressing.

Question 36: Current guidelines recommend maintaining a mean arterial pressure (MAP) of at least _____ for the first 7 days after acute spinal cord injury to optimize cord perfusion:

65 mmHg
85 mmHg (Correct answer)
75 mmHg
95 mmHg

Correct answer: 85 mmHg

Guidelines recommend MAP ≥ 85 mmHg for 7 days post-acute SCI to support spinal cord perfusion pressure and limit secondary injury, a higher target than general ICU goals.

Question 37: Reimplantation should ideally be done immediately if a patient with facial fractures also has dentoalveolar damage and their permanent teeth have been lost.

60 minutes.
120 minutes
15 minutes.
30 minutes. (Correct answer)

Correct answer: 30 minutes.

Reimplantation should ideally be done within 30 minutes if a patient with facial fractures also has dentoalveolar trauma and their permanent teeth have been lost, as saving the tooth after two hours or if the root has dried out is frequently not viable. Teeth should be kept in a moist setting, such as in NS, if they cannot be promptly reimplanted. Because of their high failure rate and the potential for permanent teeth beneath them to be harmed, pediatric deciduous teeth are typically not reimplanted.

Question 38: A patient with a traumatic brain injury has a sudden drop in GCS from 13 to 7 with ipsilateral pupil dilation. This is MOST consistent with:

Diffuse axonal injury
Subdural hematoma
Epidural hematoma (Correct answer)
Cerebral contusion

Correct answer: Epidural hematoma

Epidural hematoma classically presents with a lucid interval followed by rapid neurological deterioration and ipsilateral (uncal herniation) pupil dilation from arterial bleeding.

Question 39: A 45-year-old male weighing 70 kg was rescued from a house fire and has full-thickness burns to his entire chest and abdomen, and the entire circumference of his right arm. Using the Rule of Nines, what is the total volume of Lactated Ringer's solution to be administered in the first 8 hours of fluid resuscitation according to the Parkland formula?

5,040 mL
15,120 mL
3,780 mL (Correct answer)
7,560 mL

Correct answer: 3,780 mL

First, calculate the Total Body Surface Area (TBSA) burned using the Rule of Nines: Chest (9%) + Abdomen (9%) + Entire Right Arm (9%) = 27% TBSA. Next, use the Parkland formula: 4 mL x Body Weight (kg) x TBSA (%). So, 4 mL x 70 kg x 27% = 7,560 mL. This is the total volume for the first 24 hours. The formula specifies that half of this total volume must be administered in the first 8 hours post-burn. Therefore, 7,560 mL / 2 = 3,780 mL.

Question 40: The resuscitation strategy known as 'permissive hypotension' is employed in certain trauma patients with uncontrolled hemorrhage. For which of the following patient populations is this strategy generally contraindicated?

Patients with a suspected traumatic brain injury (TBI) (Correct answer)
Patients with an unstable pelvic fracture
Patients with extremity amputation and active bleeding
Patients with penetrating abdominal trauma

Correct answer: Patients with a suspected traumatic brain injury (TBI)

Permissive hypotension, or hypotensive resuscitation, aims to maintain a lower-than-normal blood pressure (e.g., SBP 80-90 mmHg) to prevent dislodging newly formed clots before hemorrhage is surgically controlled. However, this strategy is contraindicated in patients with traumatic brain injury (TBI) because maintaining adequate cerebral perfusion pressure (CPP) is critical to prevent secondary brain injury. In TBI, a higher systolic blood pressure is targeted.

Question 41: Which statement about the Health Insurance Portability and Accountability Act (HIPAA) is correct?

HIPAA permits sharing patient information among the treatment team without additional authorization (Correct answer)
HIPAA applies only to electronic health records
HIPAA requires patient consent before emergency treatment can begin
HIPAA prohibits all sharing of patient information within the care team

Correct answer: HIPAA permits sharing patient information among the treatment team without additional authorization

HIPAA's treatment exception allows providers directly involved in care to share information necessary for treatment without additional patient authorization.

Question 42: Which nursing action best demonstrates adherence to the TCRN standard of care in a mass casualty incident?

Providing maximal care to the first patient who arrives regardless of severity
Deferring all triage decisions to the emergency physician
Treating patients in the order they are registered
Implementing START triage to allocate resources based on survivability (Correct answer)

Correct answer: Implementing START triage to allocate resources based on survivability

START (Simple Triage and Rapid Treatment) triage is the evidence-based system used in MCIs to maximize survival by allocating resources based on injury severity and survivability.

Question 43: A patient with a TBI is ordered 3% hypertonic saline. What is the primary goal of this therapy?

Reduce cerebral edema and lower intracranial pressure by creating an osmotic gradient (Correct answer)
Prevent cerebral vasospasm
Increase systemic blood pressure through volume expansion
Correct hyponatremia caused by excessive diuresis

Correct answer: Reduce cerebral edema and lower intracranial pressure by creating an osmotic gradient

Hypertonic saline draws free water out of brain tissue via osmosis, reducing cerebral edema and lowering ICP.

Question 44: A patient rescued from a fire has a cherry-red skin color despite being in respiratory distress. The pulse oximeter reads 99%. The trauma nurse should have the highest suspicion for what condition?

Cyanide poisoning
Methemoglobinemia
Anaphylactic shock
Carbon monoxide poisoning (Correct answer)

Correct answer: Carbon monoxide poisoning

Carbon monoxide has a much higher affinity for hemoglobin than oxygen. It binds to hemoglobin, creating carboxyhemoglobin, which has a bright, cherry-red color. This can cause the classic cherry-red skin finding. A standard pulse oximeter cannot differentiate between oxyhemoglobin and carboxyhemoglobin, leading to a falsely high oxygen saturation reading. The combination of physical signs, mechanism of injury, and a misleadingly high SpO2 are hallmark signs of carbon monoxide poisoning.

Question 45: What is the target systolic blood pressure for a hypotensive patient with a traumatic brain injury (TBI) per ATLS guidelines?

≥90 mmHg (Correct answer)
≥70 mmHg
≥130 mmHg
≥110 mmHg

Correct answer: ≥90 mmHg

Maintaining SBP ≥90 mmHg is critical in TBI to ensure adequate cerebral perfusion pressure and prevent secondary brain injury.

Question 46: A patient brought to the trauma center after a high-speed motor vehicle collision is hemodynamically unstable with a suspected unstable pelvic fracture. After initiating massive transfusion protocol, what is the most appropriate next step for hemorrhage control?

Application of a pelvic binder or sheet. (Correct answer)
Urgent transfer to interventional radiology for angioembolization.
Obtaining a CT scan of the abdomen and pelvis with contrast.
Immediate transfer to the operating room for exploratory laparotomy.

Correct answer: Application of a pelvic binder or sheet.

In a hemodynamically unstable patient with a suspected pelvic fracture, the immediate priority after starting resuscitation is to stabilize the pelvis mechanically. Applying a pelvic binder or sheet provides temporary stabilization, reduces the pelvic volume, and can help control venous and bony bleeding sources, which are the most common causes of hemorrhage in these injuries. While angioembolization or surgery may be necessary, mechanical stabilization is the crucial first intervention.

Question 47: Which type of concussion would be considered in the case of a soccer player who was struck in the head by a ball and experienced temporary bewilderment for ten minutes after the injury before it went away?

Grade 4
Grade 2
Grade 1 (Correct answer)
Grade 3

Correct answer: Grade 1

Grade 1 (Mild): Temporary confusion without coma, and symptoms go away in about 15 minutes.

Question 48: A trauma nurse who begins experiencing nightmares, emotional numbing, and avoidance of trauma cases is likely experiencing:

Burnout only
Depression unrelated to work
Compassion fatigue or secondary traumatic stress (Correct answer)
Normal adjustment to a high-acuity environment

Correct answer: Compassion fatigue or secondary traumatic stress

Compassion fatigue/secondary traumatic stress occurs when caregivers absorb the trauma of their patients, producing PTSD-like symptoms.

Question 49: A patient with a C5 spinal cord injury is most likely to experience which respiratory complication?

Complete apnea requiring immediate intubation regardless of other findings
No respiratory compromise because diaphragm function is preserved
Diaphragmatic breathing only with impaired intercostal and accessory muscle function, requiring close monitoring (Correct answer)
Paradoxical breathing from intercostal spasticity

Correct answer: Diaphragmatic breathing only with impaired intercostal and accessory muscle function, requiring close monitoring

C5 injuries spare the diaphragm (C3-C5) but impair intercostal and accessory muscles, leaving patients at high risk for respiratory fatigue.

Question 50: Which position is recommended for patients with TBI to minimize ICP elevation?

Supine flat with bilateral cervical rolls
Prone position
Trendelenburg position
Head of bed elevated 30 degrees with head midline (Correct answer)

Correct answer: Head of bed elevated 30 degrees with head midline

HOB 30° with neutral head alignment promotes cerebral venous drainage without compromising cerebral perfusion pressure.

Question 51: When there is an abdominal gunshot wound, the trauma nurse should predict that the organ most likely to be damaged is ?

colon
small intestine (Correct answer)
liver
stomach

Correct answer: small intestine

The small intestine (which accounts for half of injuries) is the organ that the trauma nurse should expect to be hurt when a gunshot wound to the abdomen occurs. However, a number of other organs (including the colon, liver, and major veins) could also be hurt depending on the bullet's trajectory and depth of penetration. Close-range high-energy bullet wounds can cause both primary injuries and secondary injuries, such those from broken bones.

Question 52: A trauma patient is found to have a base deficit of -8 mEq/L. This finding indicates:

Normal acid-base status for a trauma patient
Respiratory compensation for metabolic alkalosis
Mild metabolic alkalosis from stress response
Significant tissue hypoperfusion and acidosis (Correct answer)

Correct answer: Significant tissue hypoperfusion and acidosis

A base deficit more negative than -6 mEq/L indicates significant metabolic acidosis from tissue hypoperfusion and is associated with increased mortality.

Question 53: A penetrating chest wound at the fifth intercostal space, left midclavicular line is most likely to injure which structure?

Thoracic aorta
Heart (Correct answer)
Trachea
Left kidney

Correct answer: Heart

The heart occupies the mediastinum between approximately the second and sixth intercostal spaces; a wound at the fifth left ICL puts the left ventricle at high risk.

Question 54: A trauma patient with a catastrophic, non-survivable brain injury has been declared brain dead. The patient is a registered organ donor. According to federal regulations and best practices, what is the most appropriate next step regarding organ donation?

Discontinue all supportive measures as the patient is legally deceased.
The trauma nurse should immediately begin discussing the donation process with the family.
Wait for the family to bring up the topic of organ donation first.
Notify the designated Organ Procurement Organization (OPO) of the patient's status. (Correct answer)

Correct answer: Notify the designated Organ Procurement Organization (OPO) of the patient's status.

Federal regulations require hospitals to notify their designated Organ Procurement Organization (OPO) in a timely manner of all deaths and imminent deaths. The OPO is responsible for determining medical suitability and, through its specially trained staff, approaching the family to discuss donation. This uncouples the donation request from the clinical team and ensures a standardized, sensitive approach. Supportive measures must be continued to maintain organ viability pending the donation process.

Question 55: Using the ASIA Impairment Scale, a patient with incomplete SCI whose key muscles below the injury level have a motor grade less than 3 in the majority is classified as:

ASIA A — complete injury
ASIA D — motor incomplete, most muscles grade ≥ 3
ASIA B — sensory incomplete only
ASIA C — motor incomplete, most muscles grade < 3 (Correct answer)

Correct answer: ASIA C — motor incomplete, most muscles grade < 3

ASIA C denotes incomplete injury with preserved motor function below the level but with most key muscles graded below 3 (antigravity strength).

Question 56: Which mechanism of injury most commonly causes traumatic diaphragmatic rupture?

Penetrating injury to the shoulder
High-energy blunt abdominal trauma causing a sudden increase in intra-abdominal pressure (Correct answer)
Fall onto an outstretched hand
Rib fractures from a direct blow

Correct answer: High-energy blunt abdominal trauma causing a sudden increase in intra-abdominal pressure

Sudden compression of the abdomen raises intra-abdominal pressure beyond the diaphragm's tensile limit, causing it to rupture.

Question 57: A patient arrives at a rural community hospital with a severe, unstable pelvic fracture after a farming accident and is in hemorrhagic shock. The hospital lacks an interventional radiologist and trauma surgeon. According to the Emergency Medical Treatment and Active Labor Act (EMTALA), what is the hospital's primary obligation before transferring the patient to a Level I trauma center?

Contact the hospital's administrator to authorize the transfer costs.
Provide stabilizing treatment to the best of its ability and resources. (Correct answer)
Immediately transfer the patient to the higher level of care.
Obtain written consent for transfer from the patient or family.

Correct answer: Provide stabilizing treatment to the best of its ability and resources.

EMTALA requires that if an emergency medical condition exists, the hospital must provide stabilizing treatment within its capabilities before transferring a patient. This includes initiating resuscitation, controlling external hemorrhage, and providing ongoing care to minimize risks during transport. While consent is necessary, the primary obligation is to stabilize first. A transfer cannot occur until the benefits of transfer outweigh the risks, and the transferring facility has done all it can to stabilize the patient.

Question 58: Which of the following is the primary goal of damage control resuscitation (DCR) in a patient with exsanguinating hemorrhage?

To normalize all vital signs and laboratory values to pre-injury levels in the emergency department.
To aggressively infuse crystalloid fluids to achieve a systolic blood pressure greater than 120 mmHg.
To rapidly transport the patient to the operating room for definitive surgical hemorrhage control.
To restore physiologic stability and correct coagulopathy before surgical intervention. (Correct answer)

Correct answer: To restore physiologic stability and correct coagulopathy before surgical intervention.

Damage control resuscitation (DCR) is a strategy that prioritizes restoring physiologic stability to prevent or reverse the trauma triad of death, allowing the patient to survive until definitive surgical repair can be performed. Key components include permissive hypotension, hemostatic resuscitation with blood products over crystalloids, and prevention of hypothermia and acidosis. The goal is not to normalize all parameters immediately, but to stabilize the patient enough to tolerate surgery.

Question 59: How much mL of fluid should be given during the first eight hours if a burn patient's fluid resuscitation needs have been determined as 12,000 mL/24 hours using the burn/Baxter formula (4 mL of LR X kg body weight X TBSA burned)?

8000 mL.
4000 mL.
6000 mL. (Correct answer)
3000 mL.

Correct answer: 6000 mL.

According to the burn/Baxter formula (4 mL of LR X kg body weight X TBSA burnt), a burn patient's fluid resuscitation needs are estimated to be 12,000 mL/24 hours. Of that amount, 6000 mL (50% of the total) should be given within the first 8 hours and the remaining 6000 mL over the following 16 hours. Burns that have burned 20% or more of the total body surface area (TBSA) call for fluid resuscitation. Instead of using NS, lactated Ringers IV solution is utilized, which might cause hypernatremia and hyperchloremia.

Question 60: Which ECG finding is most associated with myocardial contusion following blunt chest trauma?

Prolonged PR interval only
New right bundle branch block or ST-segment changes (Correct answer)
Left axis deviation
Peaked T waves in V1-V2

Correct answer: New right bundle branch block or ST-segment changes

Myocardial contusion most commonly manifests as new bundle branch block or ST changes on ECG, indicating direct cardiac injury.

Question 61: In the primary survey, the 'E' in ABCDE stands for Exposure. What is the KEY nursing consideration during this step?

Exposing only after IV access is established
Exposing only the injured extremity to preserve modesty
Removing clothing only if the patient consents
Fully undressing the patient while preventing hypothermia (Correct answer)

Correct answer: Fully undressing the patient while preventing hypothermia

Full exposure allows identification of all injuries, but active warming measures must immediately prevent hypothermia, which worsens coagulopathy.

Question 62: A trauma patient has sustained a high-voltage electrical injury. In addition to cutaneous burns at the entrance and exit wounds, for which of the following complications is this patient at highest risk?

Neurogenic shock
Acute respiratory distress syndrome (ARDS)
Cardiac dysrhythmias and rhabdomyolysis (Correct answer)
Acalculous cholecystitis

Correct answer: Cardiac dysrhythmias and rhabdomyolysis

High-voltage electricity can travel through the body, causing significant internal damage. The electrical current can disrupt the heart's normal conduction system, leading to life-threatening dysrhythmias. Furthermore, the massive muscle damage caused by the current leads to rhabdomyolysis, releasing myoglobin into the bloodstream, which can cause acute kidney injury.

Question 63: An 84-year-old male on metoprolol for hypertension presents after a ground-level fall. His blood pressure is 110/68 mmHg, heart rate is 72 bpm, and he has new-onset confusion. Why is his heart rate a potentially unreliable indicator of early hemorrhagic shock?

The patient's confusion suggests a primary neurologic injury, which would cause bradycardia.
Geriatric patients have a decreased circulatory volume, making blood pressure the only reliable sign.
Age-related calcification of the sinoatrial node prevents a tachycardic response.
The beta-blocker medication masks the compensatory tachycardia expected with hypovolemia. (Correct answer)

Correct answer: The beta-blocker medication masks the compensatory tachycardia expected with hypovolemia.

Beta-blockers antagonize beta-adrenergic receptors, which blunts the normal compensatory tachycardic response to blood loss. In geriatric trauma patients on these medications, a heart rate within the normal range can provide false reassurance and mask significant underlying hemorrhage.

Question 64: A patient is extricated from a structural collapse with severe crush injuries to both lower extremities. The trauma nurse should anticipate which hallmark laboratory finding and prioritize which intervention to prevent acute kidney injury?

Decreased hemoglobin; transfusion of packed red blood cells
Hypocalcemia; administration of calcium gluconate
Hyperkalemia; administration of intravenous insulin and dextrose
Elevated creatinine kinase (CK); aggressive intravenous fluid resuscitation (Correct answer)

Correct answer: Elevated creatinine kinase (CK); aggressive intravenous fluid resuscitation

The hallmark laboratory finding for rhabdomyolysis is a markedly elevated creatinine kinase (CK) level, often greater than 5 times the upper limit of normal. The breakdown of muscle releases myoglobin, which is nephrotoxic. The primary intervention to prevent acute kidney injury is aggressive intravenous fluid resuscitation to maintain high urine output and flush the myoglobin through the renal tubules. While electrolyte abnormalities like hyperkalemia occur, treating the underlying cause with fluids is the priority.

Question 65: A patient with a traumatic amputation of the right hand is brought to the ED. How should the amputated part be transported?

Wrapped in a dry sterile dressing only
Placed directly in a container of ice water
Wrapped in moist sterile gauze, placed in a sealed bag on ice (Correct answer)
Submerged in normal saline and transported at room temperature

Correct answer: Wrapped in moist sterile gauze, placed in a sealed bag on ice

The amputated part should be wrapped in moist sterile gauze, sealed in a plastic bag, then placed on ice — direct contact with ice causes tissue damage.

Question 66: A patient arrives after being struck in the anterior neck with a baseball bat. They are hoarse, have subcutaneous emphysema, and are in moderate respiratory distress. What is the most appropriate initial airway management strategy for this patient?

Placement of a supraglottic airway device
Awake surgical cricothyroidotomy or tracheostomy (Correct answer)
Nasotracheal intubation
Rapid sequence intubation (RSI)

Correct answer: Awake surgical cricothyroidotomy or tracheostomy

In patients with suspected severe laryngeal or tracheal trauma, attempts at endotracheal intubation can worsen the injury, create a false passage, or cause complete airway obstruction. [16, 21, 22] Therefore, the safest and most definitive airway is an awake surgical airway (cricothyroidotomy or tracheostomy), performed by an experienced provider, to bypass the injured area.

Question 67: Which factor most commonly contributes to delayed PTSD diagnosis in trauma survivors seen in the emergency setting?

Patients consistently refuse to answer mental health questions
Emergency nurses are not trained to identify PTSD symptoms
Focus on physical injuries and time constraints leading to inadequate psychosocial screening (Correct answer)
Lack of validated PTSD screening tools

Correct answer: Focus on physical injuries and time constraints leading to inadequate psychosocial screening

The acute care setting prioritizes physical stabilization, and time pressure frequently results in psychosocial needs being under-screened.

Question 68: A trauma nurse is subpoenaed to testify about a patient's care. The nurse's best source of information during testimony is:

The contemporaneous medical record documented at the time of care (Correct answer)
A colleague's verbal account of the events
Memory of events recalled after reviewing social media posts
A summary written the night before the deposition

Correct answer: The contemporaneous medical record documented at the time of care

The contemporaneous medical record is the most legally credible and reliable account of the care provided.

Question 69: When a trauma patient expresses suicidal ideation with a specific plan, the nurse should:

Reassure the patient that things will improve and continue routine care
Ask the patient to promise not to act on the plan and document the conversation
Immediately implement safety measures, remove means if possible, notify the provider, and initiate a psychiatric emergency evaluation (Correct answer)
Consult social work but delay psychiatric evaluation until the morning

Correct answer: Immediately implement safety measures, remove means if possible, notify the provider, and initiate a psychiatric emergency evaluation

Suicidal ideation with a plan is a psychiatric emergency requiring immediate safety intervention and psychiatric evaluation.

Question 70: Which of the following best describes the statement made by a coworker to a recently recruited trauma nurse: "The suggestions you made were a complete waste of time, and if you want to get along with the staff you need to stop trying to make changes."

Advice.
Horizontal/Lateral violence. (Correct answer)
Vertical violence.
Discrimination.

Correct answer: Horizontal/Lateral violence.

Horizontal/lateral violence happens when a peer or coworker utilizes threats, insults, rudeness, or even physical violence against another person. Others may be victimized or intimidated into obedient behavior. Horizontal aggression can be overt or subtle. In addition to creating a hostile work atmosphere and eroding self-confidence, horizontal violence also lowers staff morale and increases absenteeism. According to studies, more than half of nurses have encountered horizontal violence at work. There should be a code of conduct and a strategy in place for dealing with horizontal violence at each institution.

Question 71: What is the primary purpose of peer review in trauma nursing practice?

To discipline nurses who make errors
To generate documentation for malpractice litigation
To evaluate clinical performance and identify opportunities for improvement without punitive intent (Correct answer)
To rank nurses by performance for salary decisions

Correct answer: To evaluate clinical performance and identify opportunities for improvement without punitive intent

Peer review in a just culture context is a quality improvement process focused on learning and improvement, not punishment.

Question 72: When calculating the Revised Trauma Score (RTS), which THREE parameters are used?

Systolic BP, heart rate, and respiratory rate
GCS, respiratory rate, and systolic BP (Correct answer)
GCS, heart rate, and oxygen saturation
GCS, pupils, and systolic BP

Correct answer: GCS, respiratory rate, and systolic BP

The Revised Trauma Score uses Glasgow Coma Scale, respiratory rate, and systolic blood pressure, each coded 0–4.

Question 73: Indications of Cushing's triad (bradycardia, hypertension, and abnormal, irregular respirations) may be a marker of when evaluating the ABCDEs of a patient with traumatic brain injury.

cerebral hemisphere damage.
decreased intracerebral pressure.
dilation of ventricles.
brainstem herniation. (Correct answer)

Correct answer: brainstem herniation.

Indications of the Cushing's trifecta (bradycardia, hypertension, and abnormal, irregular respirations) could be a marker of brainstem herniation while evaluating the ABCDEs (Airway, Breath/ventilation, Circulation, Disability, Exposure/environmental control) of a patient with a traumatic brain injury. The most frequent cause of herniation is elevated intracranial pressure, which impairs oxygenation and blood flow to the brain.

Question 74: A trauma patient develops worsening hypoxia 24 hours after admission despite supplemental oxygen. Chest X-ray shows bilateral opacities. Which condition is most likely?

Spontaneous pneumothorax
Diaphragmatic hernia
Pulmonary embolism
Acute respiratory distress syndrome (ARDS) (Correct answer)

Correct answer: Acute respiratory distress syndrome (ARDS)

ARDS following trauma presents with bilateral infiltrates and refractory hypoxia, typically peaking 24–72 hours after injury.

Question 75: A trauma nurse disagrees with a physician's treatment plan for ethical reasons. The most appropriate course of action is to:

Refuse all further care for the patient
Independently change the treatment plan without notifying the physician
Follow the order silently to avoid conflict
Express concerns to the physician, document the discussion, and use the ethics committee if unresolved (Correct answer)

Correct answer: Express concerns to the physician, document the discussion, and use the ethics committee if unresolved

Ethical disagreements should be addressed through direct professional communication and escalation to ethics resources when needed, while continuing safe patient care.

Question 76: Under which circumstance may a trauma nurse legally restrain a patient without a physician's order?

Only after two nurses agree the restraint is needed
Whenever the patient is confused or agitated
Never — physician order must precede any restraint
Immediately when the patient poses an imminent danger to self or others, with a physician order obtained promptly after (Correct answer)

Correct answer: Immediately when the patient poses an imminent danger to self or others, with a physician order obtained promptly after

Emergency restraint is permissible when there is immediate danger, but a physician order must be obtained as soon as possible after application.

Question 77: A patient presents with a deep, contaminated puncture wound from a farm implement. Their tetanus immunization history is unknown. According to current guidelines, what is the most appropriate prophylaxis?

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine only
Tdap vaccine and Tetanus Immune Globulin (TIG) (Correct answer)
No immunoprophylaxis is needed if the wound is thoroughly irrigated
Tetanus Immune Globulin (TIG) only

Correct answer: Tdap vaccine and Tetanus Immune Globulin (TIG)

For a patient with a contaminated, tetanus-prone wound and an unknown or incomplete (<3 doses) vaccination history, guidelines recommend administering both the Tdap vaccine for active immunity and Tetanus Immune Globulin (TIG) for immediate passive immunity. They should be given in separate syringes at different anatomical sites.

Question 78: A patient sustains a complete C5 spinal cord injury. Which functional finding would the nurse expect on assessment?

Full hand function with paralysis limited to the lower extremities
Loss of shoulder shrug with intact elbow flexion
Complete loss of all upper extremity function with intact diaphragm
Intact elbow flexion but inability to extend the wrist (Correct answer)

Correct answer: Intact elbow flexion but inability to extend the wrist

C5 preserves elbow flexion (biceps, C5-C6) but a complete C5 injury eliminates C6-innervated wrist extension, creating this characteristic pattern.

Question 79: Which method for estimating the Total Body Surface Area (TBSA) of a burn is considered the most accurate for pediatric patients because it accounts for the developmental differences in body proportions?

Rule of Fives
Rule of Nines
Lund-Browder chart (Correct answer)
Palmar method

Correct answer: Lund-Browder chart

The Lund-Browder chart is the most accurate method for estimating TBSA in children because it adjusts the percentage assigned to different body parts based on age. Children have proportionally larger heads and smaller legs than adults, a fact that the standard Rule of Nines does not accurately reflect.

Question 80: Which intervention best supports a trauma patient experiencing acute psychological distress in the emergency department?

Leave the patient alone in a quiet room to self-regulate
Discourage the patient from talking about the traumatic event to avoid re-traumatization
Administer sedatives immediately to prevent further agitation
Provide calm, brief explanations of procedures, maintain a therapeutic presence, and involve support persons when possible (Correct answer)

Correct answer: Provide calm, brief explanations of procedures, maintain a therapeutic presence, and involve support persons when possible

Consistent presence, clear communication, and family support reduce anxiety and foster trust during acute trauma care.

Question 81: What does the trauma nurse anticipate the patient to do if the paramedic reports that a patient is in transit with a Glasgow Coma Score of 7?

be intubated and comatose. (Correct answer)
have had brief periods of loss of consciousness but to be alert and responsive.
remain slightly confused but able to follow verbal direction.
exhibit focal neurological defects.

Correct answer: be intubated and comatose.

The trauma nurse anticipates that a patient in transit who has a Glasgow Coma Score of 7 will be intubated and unconscious. Scores of eight or less signify significant brain damage and a high probability of passing away. Oftentimes, intracranial pressure is increased. The range of GSCs is 3 (the lowest and most severe) to 15 (the highest score): - Mild: 13-15. consciousness for a brief period of time. - Modest: 9 to 12. Possible localized neurological deficits: confused but able to follow simple instructions. - Serious 8. The survivor is comatose and needs ventilator support; they most certainly have neurological damage.

Question 82: Which spinal cord syndrome is characterized by disproportionately greater motor weakness in the upper extremities than the lower extremities following a hyperextension mechanism?

Anterior cord syndrome
Brown-Séquard syndrome
Posterior cord syndrome
Central cord syndrome (Correct answer)

Correct answer: Central cord syndrome

Central cord syndrome, most common in older patients with cervical spondylosis after hyperextension, injures the central gray matter and medial corticospinal fibers serving the arms more than the legs.

Question 83: Which professional resource is most appropriate for a trauma nurse experiencing signs of secondary traumatic stress?

Continue working additional shifts to build resilience through exposure
Access the hospital's employee assistance program (EAP) and seek peer support or professional counseling (Correct answer)
Request transfer to a non-trauma unit without discussing symptoms with anyone
Self-medicate with over-the-counter sleep aids until symptoms resolve

Correct answer: Access the hospital's employee assistance program (EAP) and seek peer support or professional counseling

EAP services and peer support programs are specifically designed to help healthcare workers manage secondary traumatic stress and compassion fatigue.

Question 84: A patient is diagnosed with a Le Fort I fracture following an assault. The primary goal in the surgical management of this specific fracture is to restore:

Functional dental occlusion (Correct answer)
Naso-orbital-ethmoid complex
Zygomatic projection
Craniofacial height

Correct answer: Functional dental occlusion

A Le Fort I fracture is a horizontal fracture of the maxilla that separates the tooth-bearing portion of the upper jaw from the rest of the midface. The primary goal of treatment is to restore the patient's pre-injury dental occlusion (how the teeth fit together) and ensure proper masticatory function. [14, 29] This is typically achieved through open reduction and internal fixation, often with the use of intermaxillary fixation to guide the reduction.

Question 85: What are the main symptoms of a broken mandible?

impaired sensation in chin and floor of mouth.
dental avulsion and pain in mandibular area.
malocclusion and ecchymosis of floor of the mouth. (Correct answer)
pain and edema in chin and neck area.

Correct answer: malocclusion and ecchymosis of floor of the mouth.

Malocclusion and ecchymosis of the mouth floor are the main symptoms of mandibular fracture. There can be a gap between the teeth. Blunt trauma causes the majority of wounds, and numerous fractures may be present. Although bleeding may happen if the fracture tears an artery, such as the inferior alveolar artery, bleeding from blunt injuries is uncommon. Most of the time, pressure application, fracture reduction, and/or local anesthetic with epinephrine are enough to stop the bleeding.

Question 86: Post-traumatic seizures in TBI patients are classified as immediate (within 24 hours), early (1–7 days), or late (>7 days). Which type is associated with the highest risk of developing epilepsy?

Early seizures
Immediate seizures
Late seizures (Correct answer)
All types carry equal risk

Correct answer: Late seizures

Late post-traumatic seizures, occurring more than 7 days after injury, indicate permanent epileptogenic changes and are strongly associated with ongoing epilepsy.

Question 87: A geriatric trauma patient takes beta-blockers daily. Which assessment finding may be masked by this medication?

Decreased respiratory rate
Tachycardia (Correct answer)
Altered mental status
Hypotension

Correct answer: Tachycardia

Beta-blockers blunt the compensatory tachycardia response to hemorrhage, making heart rate an unreliable indicator of shock in these patients.

Question 88: A competent adult trauma patient refuses a blood transfusion on religious grounds. The nurse should:

Contact the patient's family to override the refusal
Obtain a court order to override the patient's wishes
Administer the blood transfusion to save the patient's life
Document the refusal, notify the physician, and respect the patient's autonomous decision (Correct answer)

Correct answer: Document the refusal, notify the physician, and respect the patient's autonomous decision

Competent adults have the legal and ethical right to refuse any medical treatment, including life-saving interventions, and this must be respected and documented.

Question 89: When caring for a patient in a halo vest cervical stabilization device, what item is MOST critical to keep immediately at the bedside at all times?

A rigid cervical collar as a backup immobilization device
A wrench or tool to quickly remove the anterior vest bolts for chest access (Correct answer)
A spare sheepskin liner for pressure management
A spare set of halo pins and torque wrench for tightening

Correct answer: A wrench or tool to quickly remove the anterior vest bolts for chest access

A wrench must be immediately accessible to rapidly remove the anterior halo vest bolts and access the chest for CPR in the event of cardiac arrest.

Question 90: Under EMTALA, a trauma center is obligated to do which of the following for any patient who presents to the emergency department?

Obtain insurance authorization before treatment
Contact the patient's primary care physician before evaluation
Provide a medical screening examination regardless of ability to pay (Correct answer)
Transfer the patient to a facility that accepts their insurance

Correct answer: Provide a medical screening examination regardless of ability to pay

EMTALA requires hospitals to provide a medical screening examination and stabilizing treatment to all patients regardless of insurance or payment status.

Question 91: A patient with blunt abdominal trauma has a positive FAST exam. The patient is hemodynamically unstable. What is the appropriate next step?

Repeat FAST exam in 30 minutes
CT scan of the abdomen and pelvis
Diagnostic peritoneal lavage
Immediate surgical intervention (Correct answer)

Correct answer: Immediate surgical intervention

A hemodynamically unstable patient with free fluid on FAST requires immediate surgery; delaying for CT increases mortality risk.

Question 92: A 40-year-old person with cardiac arrhythmias is given mannitol to lower elevated intracranial pressure brought on by a traumatic brain injury. The arrhythmias are most likely caused by which of the following electrolyte imbalances connected to mannitol administration?

Hyperkalemia (Correct answer)
Hypermagnesemia
Hypernatremia
Hypokalemia

Correct answer: Hyperkalemia

When mannitol is administered to treat cerebral edema, it may lead to hyperkalemia, a fluid and electrolyte imbalance, and cardiac arrhythmias. An osmotic diuretic called mannitol reduces intracranial pressure and brain mass, especially after traumatic brain injury. It also increases potassium levels and salt and water excretion. Urticaria, hypotension, tachycardia, fever, and vomiting are a few other side effects. The blood-brain barrier's cells may be reduced in size with mannitol in order to facilitate the passage of other drugs through it. After injection, cerebral spinal fluid pressure should start to drop within 15 minutes.

Question 93: Which clinical finding is the earliest sign of increasing intracranial pressure (ICP)?

Fixed and dilated pupils
Cushing's triad
Decerebrate posturing
Altered level of consciousness or restlessness (Correct answer)

Correct answer: Altered level of consciousness or restlessness

Altered level of consciousness, including subtle confusion or restlessness, is the earliest and most sensitive indicator of rising ICP.

Question 94: A trauma patient presents with periorbital ecchymosis (raccoon eyes), postauricular ecchymosis (Battle's sign), and clear fluid draining from the nares. Which type of head injury are these findings most indicative of?

Basilar skull fracture (Correct answer)
Diffuse axonal injury
Epidural hematoma
Le Fort III fracture

Correct answer: Basilar skull fracture

The classic signs of a basilar skull fracture include periorbital ecchymosis (raccoon eyes), postauricular ecchymosis (Battle's sign), hemotympanum (blood behind the eardrum), and cerebrospinal fluid (CSF) rhinorrhea or otorrhea. [2, 3, 4, 5] These signs result from fractures to the bones at the base of the skull.

Question 95: Which finding is most consistent with a massive hemothorax on initial assessment?

Distended neck veins
Tracheal deviation toward the affected side
Hyperresonance on percussion
Dullness to percussion with decreased breath sounds (Correct answer)

Correct answer: Dullness to percussion with decreased breath sounds

Massive hemothorax produces dullness to percussion due to blood accumulation and absent breath sounds from lung compression.

Question 96: A patient with a complete C6 SCI is preparing for discharge. Which functional skill is a realistic independent goal for this injury level?

Complete independence in bathing without any adaptive equipment
Unsupported sitting balance without upper extremity prop support
Ambulation with knee-ankle-foot orthoses and forearm crutches
Independent intermittent self-catheterization using a tenodesis grip technique (Correct answer)

Correct answer: Independent intermittent self-catheterization using a tenodesis grip technique

C6 preserves wrist extension, enabling the tenodesis grip — a passive hand closure when the wrist is extended — which allows patients to perform self-catheterization and other ADLs independently.

Question 97: A trauma nurse administers the wrong medication dose to a patient. The nurse's immediate priority after addressing the patient's safety is to:

Inform only the charge nurse verbally and take no further action
Tell the patient nothing to avoid causing anxiety
Complete an incident/variance report and notify the treating physician (Correct answer)
Document the correct dose in the medical record to avoid liability

Correct answer: Complete an incident/variance report and notify the treating physician

After ensuring patient safety, the nurse must notify the physician and complete an incident report to facilitate investigation and prevent recurrence.

Question 98: A patient is brought in after a suicide attempt by drug overdose. After medical stabilization, which nursing action is the priority?

Ensure one-to-one observation, remove harmful objects from the environment, and initiate a psychiatric consultation (Correct answer)
Administer antidepressants and reassess in 24 hours
Discharge the patient with outpatient therapy referral immediately
Allow the family to take the patient home if they agree to supervise

Correct answer: Ensure one-to-one observation, remove harmful objects from the environment, and initiate a psychiatric consultation

After medical stabilization, immediate safety measures—constant observation, environmental safety, psychiatric evaluation—are the nursing priority.

Question 99: Neurogenic shock following spinal cord injury is characterized by which hemodynamic pattern?

Normal blood pressure with tachycardia
Hypotension with bradycardia and warm, vasodilated extremities (Correct answer)
Hypertension with reflex bradycardia
Hypotension with tachycardia and vasoconstriction

Correct answer: Hypotension with bradycardia and warm, vasodilated extremities

Loss of sympathetic tone in neurogenic shock produces vasodilation and bradycardia, distinguishing it from hypovolemic shock.

Question 100: A trauma nurse suspects a patient is a victim of human trafficking. The priority nursing action is to:

Ask the accompanying person to translate the screening questions
Immediately confront the accompanying individual
Assess the patient privately, screen using a validated tool, and report to appropriate authorities per facility policy (Correct answer)
Discharge the patient without intervention to avoid retaliation

Correct answer: Assess the patient privately, screen using a validated tool, and report to appropriate authorities per facility policy

Private assessment using a validated trafficking screening tool, followed by reporting per policy, is the safest and most effective evidence-based response.

Question 101: After a skiing accident that broke the patient's tibia and fibula, the left leg was put in a long-leg plaster cast. Even though the cast is still damp, the patient claims it is hot and uncomfortable. The sense of heat most likely means which of the following?

Normal reaction. (Correct answer)
Infection.
Anxiety.
Ill-fitting cast.

Correct answer: Normal reaction.

It is natural to experience the cast as hot and painful because heat is produced while it is drying. The patient needs to be reminded to make sure the cast is left exposed until it has dried completely (between 24 and 48 hours). The leg should be maintained elevated to reduce swelling, but it can also be supported by a pillow to assist avoid the cast from drying out in an unintended form. Every two hours, the patient should be rolled over so that air can circulate around the cast and dry evenly.

Question 102: A patient with a closed tibial fracture after a motorcycle crash requires escalating doses of opioid analgesia. Which early clinical finding is most indicative of developing acute compartment syndrome?

A cool, pale extremity
Inability to move the toes (paralysis)
Pain that is out of proportion to the injury (Correct answer)
Absence of a distal pulse

Correct answer: Pain that is out of proportion to the injury

Pain out of proportion to the injury, especially pain with passive stretching of the muscles in the affected compartment, is the earliest and most sensitive sign of acute compartment syndrome. Pulselessness, paralysis, and pallor are all considered very late and ominous signs, indicating significant vascular compromise and nerve damage have already occurred.

Question 103: Pulmonary contusion is best described as which of the following?

Air leak into the pleural space from the lung surface
Fractured rib penetrating the lung parenchyma
Bruising of lung tissue causing alveolar hemorrhage and edema without laceration (Correct answer)
Collapse of an entire lung lobe

Correct answer: Bruising of lung tissue causing alveolar hemorrhage and edema without laceration

Pulmonary contusion is direct injury to lung parenchyma causing alveolar hemorrhage and edema, worsening over 24–48 hours.

Question 104: Which document designates a person to make healthcare decisions on behalf of a patient who becomes incapacitated?

POLST form
Do-not-resuscitate order
Durable power of attorney for healthcare (Correct answer)
Living will

Correct answer: Durable power of attorney for healthcare

A durable power of attorney for healthcare designates a specific person (healthcare proxy) to make medical decisions if the patient cannot do so.

Question 105: What is the most immediate intervention for an open (sucking) chest wound?

Initiate positive pressure ventilation before any dressing
Needle decompression at the second intercostal space
Pack the wound with sterile gauze
Apply a three-sided occlusive dressing and prepare for chest tube (Correct answer)

Correct answer: Apply a three-sided occlusive dressing and prepare for chest tube

A three-sided occlusive dressing allows air to escape on expiration while preventing air from entering on inspiration.

Question 106: Autonomic dysreflexia in a patient with a spinal cord injury above T6 is most commonly triggered by which cause?

Pain from a minor abrasion
Hypoglycemia
Hyponatremia
A distended bladder or bowel (Correct answer)

Correct answer: A distended bladder or bowel

Bladder distension is the most common trigger of autonomic dysreflexia, causing massive sympathetic stimulation below the injury level.

Question 107: Cushing's triad, the late sign of increased ICP, includes which three findings?

Tachycardia, hypertension, and tachypnea
Tachycardia, hypotension, and bradypnea
Bradycardia, hypertension, and irregular respirations (Correct answer)
Bradycardia, hypotension, and apnea

Correct answer: Bradycardia, hypertension, and irregular respirations

Cushing's triad—bradycardia, hypertension, and irregular respirations—is a late, ominous sign of brainstem herniation.

Question 108: A patient with blunt chest trauma has paradoxical chest wall movement. Which intervention takes priority?

Administer high-flow oxygen and prepare for intubation (Correct answer)
Place the patient in Trendelenburg position
Apply a bulky dressing over the flail segment
Obtain a stat chest X-ray before any intervention

Correct answer: Administer high-flow oxygen and prepare for intubation

Flail chest with paradoxical movement causes respiratory failure, so oxygen delivery and airway management take top priority.

Question 109: Which of the following patients is least likely to require monitoring of intracranial pressure?

Four-year old with extensive subarachnoid hemorrhage.
Fifty-year old female with head injury, Glasgow coma score of 14, and BP of 95/60. (Correct answer)
Forty-five-year-old head injury patient with BP of 80/40 and unilateral posturing.
Sixteen-year-old with acute head injury and unable to follow commands.

Correct answer: Fifty-year old female with head injury, Glasgow coma score of 14, and BP of 95/60.

Most patients with mild to severe head injuries and a Glasgow coma score of 13 to 15 do not need ICP monitoring. If a person is >40, postures, and has hypotension (90 systolic), they usually need to be monitored if they have suffered a significant head injury (even with a normal CT scan). With subarachnoid and intraventricular hemorrhage, cerebrovascular accident, brain tumors, brain abscesses/infections, and hydrocephalus, ICP monitoring may be necessary. ICP threshold values range from 20 to 25 mm HG for adults and 20 mm HG for children.

Question 110: Which factor is the strongest risk indicator for completed suicide in a trauma patient?

Mild depression without prior history
Chronic low back pain
A previous suicide attempt (Correct answer)
Social isolation without prior attempt

Correct answer: A previous suicide attempt

A prior suicide attempt is the single strongest predictor of future completed suicide.

Question 111: Of the following, which is a strict no-no for nasotracheal intubation?

Facial trauma.
Apnea. (Correct answer)
Skull fracture.
Cervical spine injury

Correct answer: Apnea.

Nasotracheal intubation is completely contraindicated in cases of apnea. The main warning signs are a clinched jaw but with an intact gag reflex and acute respiratory distress due to a suspected or verified cervical spine injury. Depending on where the fractures are and how severe they are, facial and skull fractures may occasionally be contraindicated. The nares must be large enough to accommodate sizes 7 to 8 endotracheal tubes. Prior to inserting the tube, an anti-decongestant, such as phenylephrine 0.5 mg, is typically given to the nose.

Question 112: A 26-year-old female who is 28 weeks pregnant presents after a fall. Her vital signs are stable. Which of the following fetal heart rate patterns is the earliest and most sensitive indicator of fetal distress?

Sustained fetal bradycardia. (Correct answer)
Occasional early decelerations.
A baseline variability of 10 bpm.
A consistent rate of 140 bpm.

Correct answer: Sustained fetal bradycardia.

The normal fetal heart rate is typically between 110-160 bpm. Sustained fetal bradycardia (a rate below 110 bpm) is an ominous sign of fetal distress and may indicate significant maternal compromise (even before maternal vital signs change), placental abruption, or uterine rupture. It requires immediate investigation and intervention.

Question 113: A ventilator-dependent C5 SCI patient develops increased secretions and diminished breath sounds in the right lower lobe. What is the PRIORITY nursing intervention?

Increase PEEP on the ventilator settings
Perform chest physiotherapy and assisted (quad) cough technique (Correct answer)
Increase FiO2 to 100% until secretions clear
Request urgent bedside bronchoscopy

Correct answer: Perform chest physiotherapy and assisted (quad) cough technique

Pulmonary hygiene with chest physiotherapy and assisted coughing is the priority nursing intervention to clear secretions in high-level SCI patients who have lost the independent ability to cough.

Question 114: A trauma patient is receiving a massive transfusion protocol (MTP). To mitigate the 'trauma triad of death,' which balanced ratio of blood products is most commonly recommended?

1 unit PRBCs : 1 unit FFP : 1 unit platelets (Correct answer)
1 unit PRBCs : 1 unit FFP : 2 units platelets
1 unit packed red blood cells (PRBCs) : 2 units fresh frozen plasma (FFP) : 1 unit platelets
2 units PRBCs : 1 unit FFP : 1 unit platelets

Correct answer: 1 unit PRBCs : 1 unit FFP : 1 unit platelets

Current evidence and massive transfusion protocols (MTPs) advocate for a balanced resuscitation approach to mimic whole blood and combat coagulopathy. The most widely accepted ratio is 1:1:1, consisting of one unit of packed red blood cells, one unit of fresh frozen plasma, and one unit of apheresis platelets (or a 6-pack of pooled platelets).

Question 115: Which of the following interventions is the priority for a hemodynamically unstable patient with a severe pelvic fracture and a positive FAST exam?

Application of a pelvic binder and transfer to the operating room. (Correct answer)
CT scan to delineate the pelvic fracture pattern.
Insertion of a suprapubic catheter for bladder decompression.
Immediate transfer for angiographic embolization.

Correct answer: Application of a pelvic binder and transfer to the operating room.

In a patient who is hemodynamically unstable with both a pelvic fracture and evidence of intra-abdominal hemorrhage (positive FAST), the priority is controlling both sources of bleeding. A pelvic binder should be applied immediately to address the pelvic bleeding. The patient should then be taken directly to the operating room for an exploratory laparotomy to control the intra-abdominal source of hemorrhage. Delaying for a CT scan or angioembolization is inappropriate in a patient with ongoing instability and a positive FAST.

Question 116: Tranexamic acid (TXA) is MOST effective when given within what time frame after injury?

Within 6 hours
Within 3 hours (Correct answer)
Within 30 minutes
Within 1 hour

Correct answer: Within 3 hours

TXA reduces mortality when given within 3 hours of injury; evidence from the CRASH-2 trial shows no benefit and possible harm when given after 3 hours.

Question 117: A trauma patient arrives with a GCS of 8. What is the PRIORITY nursing intervention?

Administer supplemental oxygen via non-rebreather mask
Obtain IV access
Apply cervical collar
Prepare for definitive airway management (Correct answer)

Correct answer: Prepare for definitive airway management

A GCS ≤8 indicates inability to protect the airway, making definitive airway management (intubation) the priority intervention.

Question 118: A patient with a C5 spinal cord injury would be expected to retain which motor function?

Elbow flexion (Correct answer)
Diaphragmatic breathing only
Wrist extension
Hand grip

Correct answer: Elbow flexion

C5 innervates the biceps, allowing elbow flexion; wrist extension requires C6, hand grip requires C7–C8.

Question 119: A patient with a pelvic fracture from a crush injury has ongoing hemodynamic instability despite resuscitation. Which intervention should the trauma nurse anticipate FIRST?

External fixation in the OR
Application of a pelvic binder (Correct answer)
Angioembolization
Emergent laparotomy

Correct answer: Application of a pelvic binder

A pelvic binder is the immediate intervention to reduce pelvic volume and tamponade venous bleeding before more definitive treatment.

Question 120: According to the NEXUS (National Emergency X-Radiography Utilization Study) low-risk criteria, which of the following findings would require cervical spine imaging in a trauma patient?

Absence of posterior midline cervical spine tenderness
No evidence of intoxication
A distracting painful injury, such as a femur fracture (Correct answer)
Normal level of alertness

Correct answer: A distracting painful injury, such as a femur fracture

The NEXUS criteria are used to clinically clear the cervical spine without imaging. Imaging is required if any of the five criteria are met: 1) posterior midline cervical tenderness, 2) focal neurologic deficit, 3) altered level of consciousness, 4) evidence of intoxication, or 5) a distracting painful injury. [1, 13] A distracting injury may prevent the patient from accurately reporting neck pain.

Question 121: A trauma nurse notices a pattern of preventable complications on the unit. The most appropriate professional response is to:

Ignore isolated incidents unless a patient dies
Report concerns only to external regulatory agencies
Blame individual nurses involved in each case
Present findings through the quality improvement process to identify systemic causes (Correct answer)

Correct answer: Present findings through the quality improvement process to identify systemic causes

Quality improvement processes are the appropriate mechanism to investigate recurring adverse events and implement systemic solutions.

Question 122: Which statement best reflects the trauma-informed care principle of 'safety'?

Creating an environment where patients feel physically and emotionally safe and in control of their care (Correct answer)
Restraining patients immediately when they display agitation
Ensuring the hospital is physically secure from external threats
Administering anxiolytics prophylactically to all trauma patients

Correct answer: Creating an environment where patients feel physically and emotionally safe and in control of their care

Trauma-informed safety means minimizing re-traumatization by giving patients information, choices, and a sense of control in their environment.

Question 123: A well-known public figure is admitted to the trauma center, and a person claiming to be their sibling calls the unit asking for a detailed medical update. The patient is intubated and cannot give permission. To comply with HIPAA, what is the nurse's most appropriate action?

Use professional judgment to verify the caller's identity before providing limited, relevant information. (Correct answer)
State that no information can be given over the phone due to HIPAA.
Provide a detailed update to the caller to ensure the family is informed.
Refer the caller to the hospital's public relations department for an official statement.

Correct answer: Use professional judgment to verify the caller's identity before providing limited, relevant information.

The HIPAA Privacy Rule allows healthcare providers to share information with a patient's family or friends involved in their care if the provider determines, based on professional judgment, that it is in the patient's best interest, especially when the patient is incapacitated. However, the provider must take reasonable steps to verify the identity and authority of the person requesting the information before disclosing any Protected Health Information (PHI). A blanket refusal may be inappropriate, while giving a detailed update without verification is a clear violation.

Question 124: Which chest injury is characterized by multiple rib fractures in two or more places creating a free-floating segment?

Pulmonary contusion
Diaphragmatic rupture
Flail chest (Correct answer)
Open pneumothorax

Correct answer: Flail chest

Flail chest occurs when multiple contiguous ribs fracture in two or more places, creating a segment that moves independently.

Question 125: A patient is admitted after being trapped in a burning building. They are hoarse, have carbonaceous sputum, and singed nasal hairs. What is the highest priority intervention for this patient?

Preparing for early endotracheal intubation (Correct answer)
Initiating intravenous fluid resuscitation
Administering 100% oxygen via a non-rebreather mask
Obtaining a carboxyhemoglobin level

Correct answer: Preparing for early endotracheal intubation

The presence of hoarseness, carbonaceous sputum, and singed nasal hairs are strong indicators of a significant inhalation injury. The airway can become edematous and obstructed rapidly. Therefore, the highest priority is to secure the airway with early endotracheal intubation before progressive swelling makes it impossible. While oxygen and fluid resuscitation are crucial, they are secondary to securing a patent airway.

Question 126: A trauma patient refuses a blood transfusion for religious reasons. The nurse's most appropriate action is:

Document the refusal, notify the physician and ethics team, ensure the patient has decision-making capacity, and explore alternative treatments (Correct answer)
Accept the refusal without further assessment or documentation
Administer the transfusion anyway because it is a life-saving measure
Sedate the patient and proceed with transfusion

Correct answer: Document the refusal, notify the physician and ethics team, ensure the patient has decision-making capacity, and explore alternative treatments

A competent adult has the right to refuse treatment; the nurse must document, communicate, verify capacity, and work within ethical and legal frameworks.

Question 127: Which sign is MOST suggestive of a basilar skull fracture?

Frontal scalp laceration with visible bone
Battle's sign (ecchymosis over mastoid) and raccoon eyes (Correct answer)
Temporal scalp hematoma
Unilateral facial nerve palsy

Correct answer: Battle's sign (ecchymosis over mastoid) and raccoon eyes

Battle's sign (retroauricular ecchymosis) and periorbital ecchymosis (raccoon eyes) are classic late signs of basilar skull fracture.

Question 128: A trauma patient is brought in unconscious without family present. The nurse needs to perform an invasive procedure. Which legal doctrine allows treatment to proceed without consent?

Informed consent
Substitute consent
Expressed consent
Implied consent (Correct answer)

Correct answer: Implied consent

Implied consent allows emergency treatment of unconscious patients when it is reasonable to assume they would consent if able.

Question 129: Which element is NOT required to establish nursing malpractice in a court of law?

Breach of the standard of care
Malicious intent by the nurse (Correct answer)
Duty owed to the patient
Causation and damages

Correct answer: Malicious intent by the nurse

Malpractice requires duty, breach, causation, and damages — malicious intent is not a required element; negligence is sufficient.

Question 130: A patient with a basilar skull fracture may exhibit which classic finding?

Babinski reflex bilaterally
Lhermitte's sign
Battle's sign or raccoon eyes with possible CSF rhinorrhea or otorrhea (Correct answer)
Absent corneal reflexes only

Correct answer: Battle's sign or raccoon eyes with possible CSF rhinorrhea or otorrhea

Basilar skull fractures classically produce periorbital or mastoid ecchymosis (raccoon eyes/Battle's sign) and possible CSF leaks.

Question 131: Which type of intracranial hematoma is associated with a lucid interval followed by rapid deterioration?

Intracerebral hemorrhage
Epidural hematoma (Correct answer)
Subdural hematoma
Diffuse axonal injury

Correct answer: Epidural hematoma

Epidural hematoma, classically from middle meningeal artery rupture, produces a lucid interval before rapid neurological decline.

Question 132: When informing a family of a patient's critical condition, which communication strategy is most appropriate?

Provide information in a busy hallway to be efficient
Delegate all family communication to the social worker exclusively
Deliver only positive information to prevent distress
Use clear, jargon-free language in a private space, and allow time for questions and emotional responses (Correct answer)

Correct answer: Use clear, jargon-free language in a private space, and allow time for questions and emotional responses

Private, honest, compassionate communication with time for questions is the standard for delivering difficult news to trauma families.

Question 133: Secondary brain injury after TBI is primarily caused by which mechanism?

The initial kinetic energy transfer from impact
Genetic predisposition to neuronal death
Hypoxia, hypotension, cerebral edema, and elevated ICP occurring after the primary injury (Correct answer)
Inflammatory response that only begins 72 hours post-injury

Correct answer: Hypoxia, hypotension, cerebral edema, and elevated ICP occurring after the primary injury

Secondary brain injury results from systemic and intracranial processes after the initial insult—all of which are potentially preventable.

Question 134: A 28-year-old male arrives after a motorcycle crash with a suspected high thoracic spinal cord injury. He is hypotensive (BP 80/40 mmHg), bradycardic (HR 48 bpm), and his skin is warm and dry. These findings are most characteristic of which type of shock?

Hemorrhagic shock
Neurogenic shock (Correct answer)
Cardiogenic shock
Spinal shock

Correct answer: Neurogenic shock

Neurogenic shock, a form of distributive shock, results from a loss of sympathetic tone following a significant spinal cord injury (typically above T6). This leads to unopposed parasympathetic stimulation, causing vasodilation (hypotension, warm/dry skin) and bradycardia. Hemorrhagic shock would present with tachycardia and cool, clammy skin. Cardiogenic shock involves pump failure. Spinal shock is a temporary loss of reflex function below the level of injury and is not a true circulatory shock state.

Question 135: Spinal shock is defined as which of the following phenomena following acute spinal cord injury?

Cardiovascular collapse from loss of sympathetic vasomotor tone
Vasodilation with hypotension and compensatory tachycardia
Transient depression of all spinal reflexes and flaccid paralysis below the injury level (Correct answer)
Severe neuropathic pain radiating from the spinal cord injury site

Correct answer: Transient depression of all spinal reflexes and flaccid paralysis below the injury level

Spinal shock is a transient state of depressed cord function below the injury, characterized by flaccidity and absent reflexes; return of the bulbocavernosus reflex marks its resolution.

Question 136: A trauma nurse who acts as a patient advocate is primarily responsible for:

Documenting all care without questioning orders
Minimizing family involvement to streamline care
Agreeing with all physician decisions to support the medical team
Ensuring the patient's rights, preferences, and needs are communicated and protected (Correct answer)

Correct answer: Ensuring the patient's rights, preferences, and needs are communicated and protected

Patient advocacy means actively protecting and promoting the patient's rights, preferences, and best interests within the healthcare system.

Question 137: Which clinical finding best distinguishes neurogenic shock from hemorrhagic shock in a trauma patient with spinal cord injury?

Hypotension with tachycardia and diaphoresis
Hypertension with bradycardia and flushing
Hypotension with tachycardia and cool clammy skin
Hypotension with bradycardia and warm vasodilated skin (Correct answer)

Correct answer: Hypotension with bradycardia and warm vasodilated skin

Neurogenic shock results from loss of sympathetic tone, producing hypotension paired with paradoxical bradycardia and peripheral vasodilation, contrasting with the tachycardia of hemorrhagic shock.

Question 138: A severely injured trauma patient is developing the 'trauma triad of death.' Which of the following components is NOT part of this lethal triad?

Acidosis
Coagulopathy
Hypocalcemia (Correct answer)
Hypothermia

Correct answer: Hypocalcemia

The classic 'trauma triad of death' is a vicious cycle consisting of hypothermia, metabolic acidosis, and coagulopathy. Each component exacerbates the others, leading to a rapid physiological decline. While hypocalcemia is a critical concern in massive transfusion (often called the 'trauma diamond of death' when included), it is not part of the original triad.

Question 139: Which action constitutes proper chain-of-custody handling for forensic evidence collected in the trauma bay?

Delegating all evidence handling to law enforcement without documentation
Placing evidence in a common storage area accessible to all staff
Documenting each person who handles the evidence and sealing it in labeled bags (Correct answer)
Cutting through bullet holes in clothing to remove garments quickly

Correct answer: Documenting each person who handles the evidence and sealing it in labeled bags

Proper chain of custody requires continuous documentation of everyone who handles evidence and maintaining sealed, labeled containers to preserve evidentiary integrity.

Question 140: When checking intracranial pressure in an adult, the trauma nurse must be informed of what the usual range is?

15 to 20 mm Hg.
5 to 10 mm Hg.
10 to 15 mm Hg. (Correct answer)
20 to 25 mm Hg.

Correct answer: 10 to 15 mm Hg.

The trauma nurse must be aware that the typical range for intracranial pressure in adults is 10 to 15 mm Hg when doing so. When there is internal bleeding in the brain, the brain initially tries to reduce the volume of CSF by increasing absorption and decreasing blood flow, but when the brain is unable to do so, the ICP starts to rise very quickly, which can sometimes cause brain shift and herniation syndromes as well as compression of the tissue. If the disease is not corrected right away, death might occur in a matter of hours.

Question 141: Which behavior by a trauma nurse best exemplifies the principle of justice in clinical practice?

Giving preference to patients who are pleasant and cooperative
Allocating extra resources to patients whose families are most insistent
Treating uninsured patients less urgently to prioritize paying patients
Providing equitable care to all patients regardless of race, socioeconomic status, or insurance (Correct answer)

Correct answer: Providing equitable care to all patients regardless of race, socioeconomic status, or insurance

Justice requires fair, equitable distribution of care and resources without discrimination based on personal characteristics or financial status.

Question 142: A patient with suspected aortic disruption is most likely to have which mechanism of injury?

Direct blow to the sternum during CPR
High-speed deceleration injury such as a motor vehicle crash or fall from height (Correct answer)
Low-speed rear-end collision
Penetrating stab wound to the abdomen

Correct answer: High-speed deceleration injury such as a motor vehicle crash or fall from height

Traumatic aortic disruption typically results from rapid deceleration forces that shear the aorta at fixed anatomic points.

Question 143: In the acute trauma setting, which imaging modality is MOST appropriate for initial evaluation of suspected thoracic vertebral injury in a hemodynamically unstable patient?

Plain anteroposterior and lateral X-rays of the thoracic spine
CT scan of the chest and thoracic spine (Correct answer)
MRI of the thoracic spine with contrast
Myelography to assess cord compression

Correct answer: CT scan of the chest and thoracic spine

CT is preferred for acute spinal trauma evaluation because it is faster, more sensitive for bony injury, and readily available alongside standard trauma imaging protocols.

Question 144: A patient's GCS is calculated as: eyes open to voice (3), confused verbal response (4), localizes to pain (5). What is the total GCS score?

13
10
11
12 (Correct answer)

Correct answer: 12

GCS = E3 + V4 + M5 = 12, indicating moderate brain injury.

Question 145: Which action violates a trauma patient's right to confidentiality?

Discussing a patient's injuries with a curious coworker who is not involved in the patient's care (Correct answer)
Reporting a gunshot wound to law enforcement as required by state law
Sharing information with the patient's surgeon for continuity of care
Disclosing information to the organ procurement organization after brain death

Correct answer: Discussing a patient's injuries with a curious coworker who is not involved in the patient's care

Sharing patient information with staff who have no care-related need-to-know violates HIPAA and the patient's right to privacy.

Question 146: A patient with a traumatic knee dislocation undergoes successful closed reduction in the emergency department. Distal pulses are strong and palpable post-reduction. What is the most critical next assessment to rule out a limb-threatening injury?

Performing hourly passive range of motion
Measuring an Ankle-Brachial Index (ABI) (Correct answer)
Applying a knee immobilizer for comfort
Obtaining post-reduction radiographs

Correct answer: Measuring an Ankle-Brachial Index (ABI)

Knee dislocations have a high incidence of popliteal artery injury, which can occur even with palpable distal pulses due to an intimal tear. The standard of care is to measure the Ankle-Brachial Index (ABI). An ABI of less than 0.9 warrants further vascular imaging, such as a CT angiogram. While post-reduction x-rays are necessary, assessing for vascular injury is the most critical priority to prevent limb loss.

Question 147: When assessing pupils in a TBI patient, which finding indicates the most critical concern?

One fixed, dilated pupil on the side of a known hematoma (Correct answer)
Anisocoria of 0.5 mm present since childhood
Both pupils 3 mm and reactive
Bilateral 4 mm pupils that react sluggishly

Correct answer: One fixed, dilated pupil on the side of a known hematoma

Ipsilateral fixed, dilated pupil indicates uncal herniation with CN III compression, a neurosurgical emergency.

Question 148: An intubated trauma patient's ventilator shows rising peak airway pressures with sudden hemodynamic deterioration. What should the nurse suspect?

Pulmonary embolism
Endotracheal tube displacement into the esophagus
Tension pneumothorax (Correct answer)
Ventilator malfunction

Correct answer: Tension pneumothorax

Rising peak pressures combined with hemodynamic collapse in a ventilated patient strongly suggests tension pneumothorax.

Question 149: Which intervention is the highest priority for a hemodynamically stable pregnant patient at 32 weeks gestation who sustained blunt abdominal trauma and is immobilized on a backboard?

Placing a wedge under the right hip to achieve left uterine displacement. (Correct answer)
Obtaining an immediate portable abdominal x-ray to assess for fetal skeletal injury.
Administering a 1-liter bolus of Lactated Ringer's solution.
Applying a fetal heart rate monitor to establish a baseline.

Correct answer: Placing a wedge under the right hip to achieve left uterine displacement.

After 20 weeks gestation, the gravid uterus can compress the inferior vena cava and aorta when the patient is supine, leading to supine hypotensive syndrome. This reduces venous return, decreases maternal cardiac output, and compromises uteroplacental perfusion. Tilting the patient or displacing the uterus to the left is a critical, immediate intervention to ensure adequate circulation for both mother and fetus.

Question 150: An 11-month-old child tried to get out of his highchair and fell, banging his head on the tile floor. At 48 hours, he had a seizure, showed signs of a subdural hematoma, including fever, right-side weakness, poor feeding, and significant lethargy. Which emergency procedure is most necessary?

Intravenous mannitol.
Surgical evacuation of hematoma. (Correct answer)
Insertion of an intracranial pressure-monitoring device.
Intravenous hypertonic saline solution.

Correct answer: Surgical evacuation of hematoma.

Acute subdural hematoma, which most frequently affects children 1 and is frequently caused by trauma, abuse, or falls, is an emergency that necessitates rapid surgical evacuation of the hematoma because it presses against the brain and can end in death. During surgery, an ICP device may be implanted to track pressure. An osmotic diuretic called mannitol decreases ICP associated with traumatic brain damage while increasing salt and water excretion. Hyponatremia, cerebral edema, and elevated intracranial pressure related to traumatic brain injury are decreased by hypertonic saline solution.

Question 151: Diffuse axonal injury (DAI) is best diagnosed by which imaging modality?

Plain skull X-ray
CT scan of the head without contrast
Cerebral angiography
MRI of the brain (Correct answer)

Correct answer: MRI of the brain

MRI is far superior to CT for detecting the small axonal shearing injuries characteristic of DAI, especially in white matter.

Question 152: A trauma patient is a registered organ donor. The patient is declared brain dead. The nurse's role includes:

Obtaining family consent before notifying the OPO
Notifying the organ procurement organization (OPO) and maintaining physiologic stability of the donor (Correct answer)
Immediately withdrawing all supportive care
Documenting the donor status but taking no further action until the family decides

Correct answer: Notifying the organ procurement organization (OPO) and maintaining physiologic stability of the donor

Federal law requires hospitals to notify the OPO of all potential donors, and physiologic support must be maintained to preserve organ viability.

Question 153: A trauma nurse is caring for a patient with circumferential, full-thickness burns to the entire left leg. Which of the following assessment findings would be the earliest and most critical indication for an escharotomy?

Deep, aching pain in the affected limb
Delayed capillary refill in the toes
Absent distal pulses on palpation
Weak or absent signal on Doppler ultrasound (Correct answer)

Correct answer: Weak or absent signal on Doppler ultrasound

While delayed capillary refill and pain are concerning, a weak or absent signal on Doppler ultrasound is a more definitive and critical sign of compromised arterial flow, necessitating immediate intervention with an escharotomy to relieve pressure and restore circulation. Waiting for pulses to be absent by palpation may indicate irreversible damage.

Question 154: A TCRN discovers a colleague charted a procedure that was never performed. The most appropriate first action is to:

Report the finding through the facility's chain of command or risk management (Correct answer)
Confront the colleague publicly on the unit
Correct the chart entry yourself without notifying anyone
Ignore it since it did not harm the patient

Correct answer: Report the finding through the facility's chain of command or risk management

Falsified documentation is fraudulent and must be reported through proper channels such as the chain of command or risk management.

Question 155: A trauma nurse is assessing a patient with a penetrating neck injury located in Zone II. Which of the following is considered a 'hard sign' of significant vascular or airway injury, mandating immediate surgical exploration?

Dysphonia
Pulsatile external bleeding (Correct answer)
Subcutaneous emphysema
Non-expanding hematoma

Correct answer: Pulsatile external bleeding

Hard signs of penetrating neck trauma indicate a high probability of significant injury and often require immediate surgical intervention. These signs include active, pulsatile bleeding, an expanding hematoma, shock, diminished carotid pulse, bruit or thrill, and signs of airway obstruction like stridor. [7, 18] Dysphonia, non-expanding hematoma, and subcutaneous emphysema are considered 'soft signs,' which warrant further diagnostic evaluation but not necessarily immediate surgery.

Question 156: When monitoring a patient after pericardiocentesis for traumatic tamponade, which improvement indicates successful decompression?

Increasing blood pressure, decreasing JVD, and improving heart sounds (Correct answer)
Onset of pulsus paradoxus
Rising central venous pressure
Decreasing blood pressure and widening pulse pressure

Correct answer: Increasing blood pressure, decreasing JVD, and improving heart sounds

Successful pericardiocentesis relieves pericardial compression, resulting in improved cardiac output demonstrated by rising BP and resolving JVD.

Question 157: A morbidly obese trauma patient (BMI 48) requires endotracheal intubation. Which of the following is a primary challenge associated with airway management in this patient population?

Inherent instability of the cervical spine due to excess weight.
Rapid oxygen desaturation during periods of apnea. (Correct answer)
Increased likelihood of a posterior laryngeal anatomy.
Resistance to standard doses of induction agents.

Correct answer: Rapid oxygen desaturation during periods of apnea.

Bariatric patients have a significantly reduced functional residual capacity (FRC) and increased oxygen consumption. This combination means their oxygen reserves are depleted very quickly during apneic periods, such as during intubation, leading to rapid and profound desaturation.

Question 158: Autonomic dysreflexia is a potentially life-threatening complication that occurs primarily in patients with spinal cord injuries at what level or above?

L1
T10
T6 (Correct answer)
C1 only

Correct answer: T6

Autonomic dysreflexia occurs with injuries at T6 or above because the splanchnic sympathetic outflow (T6-L2) can no longer be modulated by descending supraspinal inhibitory signals.

Question 159: Which intervention is CONTRAINDICATED in a patient with a suspected anterior cranial fossa fracture who needs airway suctioning?

Endotracheal suctioning post-intubation
Nasopharyngeal suctioning (Correct answer)
Oral suctioning with a Yankauer catheter
In-line suctioning via ETT

Correct answer: Nasopharyngeal suctioning

Nasopharyngeal suctioning (and nasogastric tube insertion) is contraindicated with anterior cranial fossa fracture due to risk of intracranial placement through the cribriform plate.

Question 160: A patient with a pelvic fracture has gross hematuria. A CT cystogram reveals extravasation of contrast into the peritoneal cavity. Which of the following is the most definitive management for this type of injury?

Serial abdominal examinations and bed rest.
Surgical exploration and repair. (Correct answer)
Placement of a suprapubic catheter.
Prolonged Foley catheter drainage for 10-14 days.

Correct answer: Surgical exploration and repair.

The finding of contrast in the peritoneal cavity on a cystogram confirms an intraperitoneal bladder rupture. This type of injury requires surgical exploration and repair to prevent complications such as urinary ascites, peritonitis, and sepsis. Conservative management with catheter drainage alone is typically reserved for uncomplicated extraperitoneal bladder ruptures.

Question 161: The patient's temperature should typically be decreased and maintained at? with targeted temperature management (TTM), also known as therapeutic hypothermia.

24 to 28° C.
30 to 32° C.
32 to 36° C. (Correct answer)
28 to 30° C.

Correct answer: 32 to 36° C.

The patient's temperature should typically be decreased and maintained at 32 to 36° C with targeted temperature management (TTM), also known as therapeutic hypothermia. (Normal temperature is around 37° C). TTM is normally kept for 24 hours or so. In cases of sepsis, recent surgery (within two weeks), coagulopathy, or pre-existing coma, hypothermia is not advised. Ice packs, cooling blankets, helmets, and cool infusions or instillations can all be used to cool someone down.

Question 162: An 84-year-old patient is admitted after a fall, presenting with a fractured hip. The nurse notes several large bruises on the patient's back in various stages of healing and that the patient appears fearful when their caregiver is in the room. What is the nurse's primary legal responsibility in this situation?

Ask the caregiver to explain the origin of the bruises.
Report the suspicion of elder abuse to Adult Protective Services. (Correct answer)
Document the findings and monitor for further signs of abuse.
Ask the patient if they feel safe at home with the caregiver present.

Correct answer: Report the suspicion of elder abuse to Adult Protective Services.

Nurses are legally mandated reporters. When there is a reasonable suspicion of elder abuse or neglect, the nurse has a legal duty to report it to the designated state authority, typically Adult Protective Services. The report is based on suspicion; proof is not required. Confronting the caregiver or waiting for more evidence can delay intervention and potentially endanger the patient.

Question 163: Grief following traumatic death of a patient is a normal response for trauma nurses. Which statement about nurse grief is true?

Nurses who grieve patient deaths are not suited for trauma nursing
Nurse grief should always be expressed openly in front of patients
Acknowledging grief and participating in debriefs or memorials promotes resilience and reduces burnout (Correct answer)
Grief in nurses only becomes problematic if it lasts more than 24 hours

Correct answer: Acknowledging grief and participating in debriefs or memorials promotes resilience and reduces burnout

Debriefing, peer support, and rituals of acknowledgment allow nurses to process grief healthily, supporting long-term resilience.

Question 164: Which scenario represents a conflict of interest that a trauma nurse must disclose or avoid?

Accepting gifts from a medical device company while making product recommendations to the unit (Correct answer)
Attending a hospital-sponsored continuing education event
Reporting a near-miss incident anonymously through the hospital system
Seeking consultation from a specialist for a complex patient case

Correct answer: Accepting gifts from a medical device company while making product recommendations to the unit

Accepting gifts from industry while influencing product decisions creates a conflict of interest that must be disclosed or avoided to maintain professional integrity.

Question 165: Rapid sequence intubation (RSI) is most commonly used to:

reduce tracheal trauma.
speed intubation.
reduce the risk of gastric aspiration. (Correct answer)
prevent esophageal trauma.

Correct answer: reduce the risk of gastric aspiration.

To lower the risk of stomach aspiration, rapid sequence intubation (RSI) is utilized to anesthetize and intubate the non-fasting patient. Patients who are very fat, pregnant, or who have stomach reflux may also benefit from RSI. Prior to RSI, two intravenous lines should be set up and the patient pre-oxygenated for about three minutes. To block the esophagus and avoid aspiration, utilize the Sellick's maneuver, which involves applying pressure to the cricoid with the thumb and index finger on the outside. Thiopental, Entamide®, and propofol are used as induction agents, and suxamethonium is used as a muscle relaxant. A laryngoscopy is used to insert an endotracheal tube 60 seconds after the muscle relaxant, inflate and secure the cuff, and check the location with a capnometer.

Question 166: A patient with blunt abdominal trauma is complaining of acute, sharp pain in the left shoulder. This finding, known as Kehr's sign, is most indicative of an injury to which organ?

Stomach
Left Kidney
Spleen (Correct answer)
Liver

Correct answer: Spleen

Kehr's sign is referred pain to the left shoulder caused by irritation of the diaphragm from blood in the peritoneal cavity. This sign is a classic clinical indicator of a ruptured or injured spleen, as the phrenic nerve (which innervates the diaphragm) shares the same nerve roots (C3-C5) as the supraclavicular nerves that supply the shoulder area.

Question 167: A patient arrives after a high-speed MVC with a seat-belt sign across the abdomen. Which injury pattern should the trauma nurse suspect?

Splenic laceration only
Chance fracture with hollow viscus injury (Correct answer)
Liver laceration with diaphragmatic rupture
Aortic transection

Correct answer: Chance fracture with hollow viscus injury

A seat-belt sign across the abdomen is classically associated with Chance fractures (lumbar flexion-distraction) and hollow viscus (bowel) injuries from the lap belt.

Question 168: Which assessment finding is MOST consistent with a tension pneumothorax?

Tracheal deviation toward the affected side with crackles
Tracheal deviation away from the affected side with absent breath sounds (Correct answer)
Symmetric chest rise with SpO2 of 88%
Bilateral breath sounds with dullness to percussion

Correct answer: Tracheal deviation away from the affected side with absent breath sounds

Tension pneumothorax causes tracheal deviation away from the affected (collapsed) side due to mediastinal shift, along with absent breath sounds.

Question 169: An adult patient arrives unresponsive after a motor vehicle collision and requires an immediate exploratory laparotomy for suspected internal hemorrhage. No family is present, and the patient has no identification. Which legal principle allows the trauma team to proceed with the life-saving surgery?

EMTALA Mandate
Implied Consent (Correct answer)
Informed Consent
Substituted Judgment

Correct answer: Implied Consent

The doctrine of implied consent is used in emergency situations where a patient is unable to give consent due to their condition (e.g., unconsciousness). The law assumes that a reasonable person would consent to life-saving treatment if they were able. Informed consent requires a conscious, competent patient; substituted judgment involves a surrogate decision-maker; and EMTALA governs screening and stabilization, not the consent for specific procedures.

Question 170: Which medication is the FIRST-LINE treatment for anaphylaxis in a trauma patient who develops a hypersensitivity reaction to blood products?

Diphenhydramine 50 mg IV
Methylprednisolone 125 mg IV
Albuterol nebulized treatment
Epinephrine 0.3 mg IM (Correct answer)

Correct answer: Epinephrine 0.3 mg IM

Epinephrine 0.3 mg IM (anterolateral thigh) is the first-line treatment for anaphylaxis regardless of context.

Question 171: What does the L stand for when using the acronym AMPLE to quickly acquire crucial information about the patient's history?

loss of blood
last meal (Correct answer)
legal directives.
length of time since injury.

Correct answer: last meal

The letter L stands for ""Last Meal"" when the acronym AMPLE is used to quickly gather vital information about the patient's history; this information is that which is required to give the patient emergency care. In the event that the patient is unconscious, a friend or family member may give information: A = Allergies M = stands for medicines, all current. P = Previous conditions and operations L = stands for last meal (time, volume, and size). E = The Injury's Environment or Related Events

Question 172: A 22-year-old involved in a skiing accident has an isolated, closed femur fracture. Forty-eight hours after the injury, the patient becomes acutely confused, develops respiratory distress, and has a petechial rash across the chest and axillae. These findings are most characteristic of which complication?

Pulmonary Embolism
Compartment Syndrome
Rhabdomyolysis
Fat Embolism Syndrome (FES) (Correct answer)

Correct answer: Fat Embolism Syndrome (FES)

This patient is exhibiting the classic triad of Fat Embolism Syndrome (FES): neurologic changes (confusion), respiratory insufficiency (respiratory distress), and a pathognomonic petechial rash. FES typically occurs 24-72 hours after a long bone or pelvic fracture. The other options do not present with this specific combination of symptoms.

Question 173: Which statement about pediatric head trauma and TBI is correct?

GCS cannot be used in pediatric patients under 5 years old
Pediatric skulls are thicker and less compliant, providing greater protection
Children have a larger head-to-body ratio than adults, making them more susceptible to acceleration-deceleration injuries (Correct answer)
Children tolerate increased ICP better than adults due to open fontanelles until age 18

Correct answer: Children have a larger head-to-body ratio than adults, making them more susceptible to acceleration-deceleration injuries

Children's disproportionately large heads make them more vulnerable to rotational and acceleration-deceleration forces.

Question 174: A 7-year-old child is brought to the trauma center after being struck by a car. Assessment reveals a fractured right femur, right-sided pulmonary contusions, and a left-sided epidural hematoma. This classic pattern of injuries in a pediatric pedestrian is known as:

Pediatric Impact Triad
Cushing's Triad
Beck's Triad
Waddell's Triad (Correct answer)

Correct answer: Waddell's Triad

Waddell's Triad describes a common injury pattern in pediatric pedestrians struck by vehicles. It consists of: 1) ipsilateral (same side) femur/tibial fracture from the initial bumper impact, 2) ipsilateral thoracic or abdominal injuries from the fender/hood, and 3) a contralateral (opposite side) head injury as the child is thrown to the ground.

Question 175: In a pediatric trauma patient, which finding MOST reliably indicates significant blood loss?

Tachycardia with altered mental status (Correct answer)
Decreased urine output
Hypotension
Pale skin

Correct answer: Tachycardia with altered mental status

Children compensate well and maintain blood pressure until late; tachycardia combined with altered mental status is an earlier and more reliable sign of significant hemorrhage.

Question 176: A patient with a substance use disorder is admitted after trauma. Which approach best reflects trauma-informed, non-stigmatizing care?

Withhold pain medication to avoid worsening addiction
Discharge as soon as medically stable without referral
Document 'drug-seeking behavior' in the chart to alert future providers
Treat withdrawal and pain proactively, use respectful language, and involve addiction medicine consultants as appropriate (Correct answer)

Correct answer: Treat withdrawal and pain proactively, use respectful language, and involve addiction medicine consultants as appropriate

Trauma-informed care recognizes substance use disorder as a chronic illness; proactive treatment and specialist involvement reduce harm.

Question 177: A trauma nurse is assessing a restrained driver from a frontal impact collision and notes a linear ecchymosis across the lower abdomen. This finding, known as the 'seatbelt sign,' should raise the highest suspicion for which type of injury?

Splenic laceration
Lumbar spine fracture
Hollow viscus injury (Correct answer)
Diaphragmatic rupture

Correct answer: Hollow viscus injury

The 'seatbelt sign' is strongly associated with underlying intra-abdominal injuries, particularly hollow viscus injuries like bowel perforation or mesenteric lacerations. The mechanism involves the compression of the bowel between the seatbelt and the vertebral column during sudden deceleration. While solid organ and spine injuries can also occur, the highest index of suspicion should be for bowel and mesenteric trauma.

TCRN Certification Exam

The TCRN (Trauma Certified Registered Nurse) exam, administered by BCEN, validates the specialized knowledge and skills of nurses caring for trauma patients across the continuum of care.

175

Questions

180 min

Time Limit

64%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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