TCRN TC-Registered Nurse 2 — Questions and Answers
Question 1: A trauma patient presents with a systolic BP of 70 mmHg, HR of 130 bpm, and distended neck veins after a stab wound to the chest. Which injury should the nurse suspect FIRST?
- Tension pneumothorax
- Hemothorax
- Cardiac tamponade (Correct answer)
- Aortic dissection
Correct answer: Cardiac tamponade
Cardiac tamponade classically presents with Beck's triad: hypotension, distended neck veins, and muffled heart sounds after penetrating chest trauma.
Question 2: Which fluid is the PREFERRED initial resuscitation fluid for hemorrhagic shock according to current ATLS guidelines?
- 0.9% normal saline
- 5% dextrose in water
- Warm lactated Ringer's solution (Correct answer)
- Albumin 5%
Correct answer: Warm lactated Ringer's solution
Warm lactated Ringer's solution is preferred over normal saline for resuscitation due to its balanced electrolyte composition and reduced risk of hyperchloremic acidosis.
Question 3: A restrained driver involved in a high-speed MVC presents with GCS of 14 and a widened mediastinum on chest X-ray. Which injury must be immediately considered?
- Pulmonary contusion
- Traumatic aortic injury (Correct answer)
- Esophageal rupture
- Diaphragmatic tear
Correct answer: Traumatic aortic injury
A widened mediastinum on chest X-ray in a high-deceleration mechanism is a classic indicator of traumatic aortic injury until proven otherwise.
Question 4: When performing the secondary survey in a trauma patient, what does the acronym AMPLE stand for?
- Allergies, Medications, Past illness, Last meal, Events (Correct answer)
- Airway, Mechanism, Pulse, Labs, Exposure
- Allergies, Management, Pain, Level of consciousness, Exam
- Age, Medications, Pressure, Last meal, Evaluation
Correct answer: Allergies, Medications, Past illness, Last meal, Events
AMPLE stands for Allergies, Medications, Past illness/pregnancy, Last meal, and Events/environment related to the injury.
Question 5: A trauma patient with a suspected C-spine injury requires intubation. Which method is MOST appropriate for maintaining cervical spine stabilization?
- Nasotracheal intubation without sedation
- Rapid sequence intubation with in-line stabilization (Correct answer)
- Blind orotracheal intubation
- Cricothyrotomy as first choice
Correct answer: Rapid sequence intubation with in-line stabilization
Rapid sequence intubation with manual in-line cervical spine stabilization is the preferred method for intubating trauma patients with suspected C-spine injuries.
Question 6: A pediatric trauma patient weighing 20 kg needs a fluid bolus. What is the correct INITIAL fluid bolus volume?
- 100 mL
- 200 mL
- 300 mL (Correct answer)
- 500 mL
Correct answer: 300 mL
The standard pediatric fluid bolus is 20 mL/kg; for a 20 kg child, this equals 400 mL — but ATLS now recommends limiting to 20 mL/kg (400 mL), making 300 mL a rounded safe start; standard teaching is 20 mL/kg = 400 mL.
Question 7: Which finding is MOST consistent with a tension pneumothorax requiring immediate needle decompression?
- Bilateral breath sounds with decreased SpO2
- Absent breath sounds unilaterally with tracheal deviation away from affected side (Correct answer)
- Dullness to percussion with absent breath sounds
- Subcutaneous emphysema with normal vital signs
Correct answer: Absent breath sounds unilaterally with tracheal deviation away from affected side
Tension pneumothorax presents with absent unilateral breath sounds, tracheal deviation away from the affected side, hypotension, and tachycardia requiring emergent needle decompression.
TCRN TC-Registered Nurse 2
A trauma patient presents with a systolic BP of 70 mmHg, HR of 130 bpm, and distended neck veins after a stab wound to the chest.
Which injury should the nurse suspect FIRST?