TCRN TC-Registered Nurse 4 — Questions and Answers
Question 1: A patient with a suspected spinal cord injury at T4 presents with bradycardia and hypotension but warm, flushed skin. This presentation is MOST consistent with:
- Hemorrhagic shock
- Neurogenic shock (Correct answer)
- Septic shock
- Obstructive shock
Correct answer: Neurogenic shock
Neurogenic shock results from loss of sympathetic tone after high spinal cord injury, causing hypotension with paradoxical bradycardia and warm, vasodilated skin.
Question 2: Which of the following is a definitive airway in trauma management?
- Nasopharyngeal airway
- Oropharyngeal airway
- Cuffed endotracheal tube (Correct answer)
- Supraglottic airway device
Correct answer: Cuffed endotracheal tube
A cuffed endotracheal tube provides a definitive airway by protecting against aspiration and allowing controlled ventilation, which is the standard in trauma airway management.
Question 3: A trauma patient is on a ventilator and the nurse notes rising peak airway pressures with decreased breath sounds on the left. The MOST immediate action is to:
- Increase the PEEP setting
- Obtain a chest X-ray
- Perform immediate needle decompression on the left (Correct answer)
- Suction the endotracheal tube
Correct answer: Perform immediate needle decompression on the left
Rising peak airway pressures with absent unilateral breath sounds in a ventilated trauma patient indicates tension pneumothorax requiring emergent needle decompression without delay for imaging.
Question 4: A motorcyclist without a helmet is brought in with a GCS of 9. CT shows epidural hematoma with midline shift. Which pupillary finding is MOST expected?
- Bilateral pinpoint pupils
- Bilateral fixed and dilated pupils
- Unilateral fixed dilated pupil on the side of the hematoma (blown pupil) (Correct answer)
- Normal reactive pupils bilaterally
Correct answer: Unilateral fixed dilated pupil on the side of the hematoma (blown pupil)
Epidural hematoma causes ipsilateral uncal herniation compressing cranial nerve III, resulting in a fixed, dilated (blown) pupil on the same side as the hematoma.
Question 5: Permissive hypotension in a penetrating trauma patient WITHOUT head injury targets a systolic BP of approximately:
- 90–100 mmHg
- 70–80 mmHg (Correct answer)
- 50–60 mmHg
- 110–120 mmHg
Correct answer: 70–80 mmHg
Permissive hypotension targets a systolic BP of 70–80 mmHg in penetrating trauma without TBI to reduce clot disruption while maintaining organ perfusion until surgical hemorrhage control.
Question 6: A patient with pelvic fracture has a pelvic binder applied in the field. The nurse should place the binder at which anatomical level?
- At the iliac crests
- At the level of the greater trochanters (Correct answer)
- At the umbilicus
- At the symphysis pubis
Correct answer: At the level of the greater trochanters
A pelvic binder must be placed at the level of the greater trochanters, not the iliac crests, to effectively compress the pelvic ring and reduce hemorrhage.
Question 7: Which assessment finding in an abdominal trauma patient MOST strongly indicates the need for emergent operative intervention?
- Mild periumbilical tenderness with normal vitals
- Rigid abdomen with signs of peritonitis and hemodynamic instability (Correct answer)
- Positive FAST with normal vital signs
- Guarding on palpation with HR of 88 bpm
Correct answer: Rigid abdomen with signs of peritonitis and hemodynamic instability
A rigid abdomen with peritonitis signs combined with hemodynamic instability indicates massive intra-abdominal injury requiring emergent operative hemorrhage control.
TCRN TC-Registered Nurse 4
A patient with a suspected spinal cord injury at T4 presents with bradycardia and hypotension but warm, flushed skin.
This presentation is MOST consistent with: