Mixed Deck — All TCRN Topics Flashcards

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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

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.

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?

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.

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

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.

A trauma patient has breath sounds on the right but gastric sounds audible over the left chest. Which injury does this suggest?

Answer: Left diaphragmatic rupture with herniation of abdominal contents

Bowel sounds auscultated in the chest cavity indicate diaphragmatic rupture with herniation of abdominal organs into the thorax.

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?

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.

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

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.

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

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.

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

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.

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

Answer: Tachycardia

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

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

Answer: Elbow flexion

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

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

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.

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?

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.

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?

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.

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

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.