TCRN Special Patient Populations Questions and Answers

Question 1

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?

Accepted Answer

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

Answer

Age-related calcification of the sinoatrial node prevents a tachycardic response.

Answer

The patient's confusion suggests a primary neurologic injury, which would cause bradycardia.

Answer

Geriatric patients have a decreased circulatory volume, making blood pressure the only reliable sign.

Question 2

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:

Accepted Answer

Waddell's Triad

Answer

Cushing's Triad

Answer

Beck's Triad

Answer

Pediatric Impact Triad

Question 3

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?

Accepted Answer

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

Answer

Administering a 1-liter bolus of Lactated Ringer's solution.

Answer

Obtaining an immediate portable abdominal x-ray to assess for fetal skeletal injury.

Answer

Applying a fetal heart rate monitor to establish a baseline.

Question 4

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?

Accepted Answer

Chronic subdural hematoma

Answer

Epidural hematoma

Answer

Diffuse axonal injury

Answer

Intraparenchymal hemorrhage

Question 5

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?

Accepted Answer

Rapid oxygen desaturation during periods of apnea.

Answer

Increased likelihood of a posterior laryngeal anatomy.

Answer

Resistance to standard doses of induction agents.

Answer

Inherent instability of the cervical spine due to excess weight.

Question 6

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?

Accepted Answer

Sustained fetal bradycardia.

Answer

A consistent rate of 140 bpm.

Answer

Occasional early decelerations.

Answer

A baseline variability of 10 bpm.