TCRN TC-Registered Nurse 3 — Questions and Answers
Question 1: A trauma patient has blood at the urethral meatus, perineal bruising, and a high-riding prostate on rectal exam. Which intervention should the nurse AVOID?
- IV fluid resuscitation
- Foley catheter insertion (Correct answer)
- Surgical consultation
- Pelvic X-ray
Correct answer: Foley catheter insertion
Foley catheter insertion is contraindicated when urethral injury is suspected; a urethrogram must be performed first to rule out urethral disruption.
Question 2: In damage control resuscitation for massive hemorrhage, what ratio of packed red blood cells to fresh frozen plasma to platelets is recommended?
- 1:1:1 (Correct answer)
- 4:1:1
- 2:1:0
- 6:4:1
Correct answer: 1:1:1
A 1:1:1 ratio of pRBC:FFP:platelets approximates whole blood and is recommended in damage control resuscitation to prevent coagulopathy.
Question 3: A patient with blunt abdominal trauma undergoes a FAST exam. A positive FAST exam showing free fluid in the hepatorenal space (Morison's pouch) MOST likely indicates:
- Bladder rupture
- Hemoperitoneum (Correct answer)
- Retroperitoneal hematoma
- Pneumoperitoneum
Correct answer: Hemoperitoneum
Free fluid in Morison's pouch on FAST exam indicates hemoperitoneum, which is the most common finding in solid organ injury after blunt abdominal trauma.
Question 4: A trauma patient develops acute agitation, tachycardia, diaphoresis, and hypertension 6 hours after admission. The nurse should FIRST consider:
- Septic shock
- Fat embolism syndrome
- Alcohol withdrawal (Correct answer)
- Pulmonary embolism
Correct answer: Alcohol withdrawal
Alcohol withdrawal typically begins 6–24 hours after the last drink and presents with autonomic hyperactivity including agitation, tachycardia, diaphoresis, and hypertension.
Question 5: Which sign is associated with basilar skull fracture indicating blood tracking into the mastoid area?
- Grey Turner's sign
- Cullen's sign
- Battle's sign (Correct answer)
- Kehr's sign
Correct answer: Battle's sign
Battle's sign is ecchymosis over the mastoid process (behind the ear) and is a delayed clinical sign of basilar skull fracture.
Question 6: A nurse is caring for a patient with a traumatic brain injury and ICP of 28 mmHg. Which intervention should be AVOIDED?
- Elevating the head of bed to 30 degrees
- Administering mannitol as ordered
- Placing the patient in Trendelenburg position (Correct answer)
- Maintaining PaCO2 between 35–40 mmHg
Correct answer: Placing the patient in Trendelenburg position
Trendelenburg (head-down) position increases intracranial pressure by impairing venous drainage from the brain and is contraindicated in TBI patients.
Question 7: In a patient with a femur fracture, the nurse should monitor for which potentially life-threatening complication that can occur within 24–72 hours?
- Deep vein thrombosis
- Osteomyelitis
- Fat embolism syndrome (Correct answer)
- Compartment syndrome
Correct answer: Fat embolism syndrome
Fat embolism syndrome typically occurs 24–72 hours after long bone fractures, presenting with the classic triad of hypoxemia, neurological changes, and petechial rash.
TCRN TC-Registered Nurse 3
A trauma patient has blood at the urethral meatus, perineal bruising, and a high-riding prostate on rectal exam.
Which intervention should the nurse AVOID?