TCRN Thoracic and Cardiovascular Trauma 1 — Questions and Answers
Question 1: A trauma patient presents with absent breath sounds on the left, tracheal deviation to the right, and hypotension. Which condition should the nurse suspect first?
- Hemothorax
- Tension pneumothorax (Correct answer)
- Pulmonary contusion
- Flail chest
Correct answer: Tension pneumothorax
Tension pneumothorax causes tracheal deviation away from the affected side along with hemodynamic compromise.
Question 2: Which finding is most consistent with a massive hemothorax on initial assessment?
- Tracheal deviation toward the affected side
- Hyperresonance on percussion
- Dullness to percussion with decreased breath sounds (Correct answer)
- Distended neck veins
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 3: A patient with blunt chest trauma has paradoxical chest wall movement. Which intervention takes priority?
- Apply a bulky dressing over the flail segment
- Administer high-flow oxygen and prepare for intubation (Correct answer)
- Place the patient in Trendelenburg position
- 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 4: Which ECG finding is most associated with myocardial contusion following blunt chest trauma?
- Peaked T waves in V1-V2
- New right bundle branch block or ST-segment changes (Correct answer)
- Prolonged PR interval only
- Left axis deviation
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 5: During chest tube insertion for hemothorax, the nurse notes 1,500 mL of blood drains immediately. What is the priority action?
- Clamp the chest tube to slow blood loss
- Document findings and reassess in 30 minutes
- Notify the surgeon immediately for possible operative intervention (Correct answer)
- Increase IV fluid rate to compensate for blood loss
Correct answer: Notify the surgeon immediately for possible operative intervention
Immediate drainage of ≥1,000–1,500 mL indicates massive hemothorax requiring surgical evaluation for operative control.
Question 6: A patient with suspected aortic disruption is most likely to have which mechanism of injury?
- Low-speed rear-end collision
- High-speed deceleration injury such as a motor vehicle crash or fall from height (Correct answer)
- Penetrating stab wound to the abdomen
- Direct blow to the sternum during CPR
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.
TCRN Thoracic and Cardiovascular Trauma 1
A trauma patient presents with absent breath sounds on the left, tracheal deviation to the right, and hypotension.
Which condition should the nurse suspect first?