TCRN TC-Registered Nurse 5 — Questions and Answers
Question 1: A burn patient has circumferential burns of both lower extremities. The nurse assesses absent distal pulses and tense compartments. The PRIORITY intervention is:
- Increase IV fluid rate immediately
- Elevate both legs above heart level
- Prepare the patient for escharotomy (Correct answer)
- Apply compression dressings
Correct answer: Prepare the patient for escharotomy
Circumferential burns with absent distal pulses indicate compartment syndrome requiring escharotomy to release the restricting eschar and restore perfusion.
Question 2: Using the Rule of Nines in an adult patient, a burn covering the entire right arm and the front of the right leg equals what total body surface area (TBSA)?
- 18%
- 27%
- 22.5% (Correct answer)
- 13.5%
Correct answer: 22.5%
The right arm is 9% TBSA and the front of one leg is 9% divided by 2 = 4.5% — but standard teaching: right arm = 9%, anterior right leg = 9%/2 = 4.5%, but front of right leg alone is 9%; combined = 9 + 9 = 18% — however anterior leg only = 9%; right arm = 9%; total = 18%. Answer depends on interpretation; anterior right leg = 9%, right arm = 9%, total = 18%.
Question 3: A patient with a traumatic amputation of the right hand arrives in the trauma bay. After controlling hemorrhage, what is the CORRECT method for preserving the amputated part?
- Place the part directly in ice water
- Wrap in dry sterile gauze and place in a sealed bag on ice
- Wrap in moist sterile gauze, place in a sealed bag, then place on ice (Correct answer)
- Soak the part in normal saline and keep at room temperature
Correct answer: Wrap in moist sterile gauze, place in a sealed bag, then place on ice
The amputated part should be wrapped in moist sterile gauze, placed in a sealed plastic bag, and then placed on ice to preserve tissue viability without causing frostbite from direct ice contact.
Question 4: A trauma patient's arterial blood gas shows: pH 7.28, PaCO2 38, HCO3 16, PaO2 92 on 4L NC. This pattern is MOST consistent with:
- Respiratory acidosis
- Metabolic alkalosis
- Metabolic acidosis (Correct answer)
- Respiratory alkalosis
Correct answer: Metabolic acidosis
A low pH with low bicarbonate and a normal PaCO2 indicates metabolic acidosis, which in trauma is commonly caused by lactic acidosis from poor perfusion.
Question 5: Which of the following describes the 'lethal triad' in trauma that must be aggressively prevented?
- Hypoxia, hypercarbia, and hypovolemia
- Hypothermia, acidosis, and coagulopathy (Correct answer)
- Hypotension, tachycardia, and altered mental status
- Anemia, thrombocytopenia, and hypofibrinogenemia
Correct answer: Hypothermia, acidosis, and coagulopathy
The lethal triad of trauma consists of hypothermia, acidosis, and coagulopathy — each worsens the others, creating a cycle leading to death if not aggressively corrected.
Question 6: A trauma nurse is preparing to administer tranexamic acid (TXA) to a severely injured patient. TXA is MOST effective when administered within what timeframe after injury?
- Within 30 minutes
- Within 3 hours (Correct answer)
- Within 6 hours
- Within 12 hours
Correct answer: Within 3 hours
Based on the CRASH-2 trial, tranexamic acid is most effective and should be administered within 3 hours of injury to reduce mortality from hemorrhage; after 3 hours it may increase mortality.
Question 7: A patient with crush syndrome involving both lower extremities is at HIGHEST risk for which life-threatening complication?
- Disseminated intravascular coagulation
- Hypernatremia
- Acute renal failure from myoglobinuria (Correct answer)
- Respiratory alkalosis
Correct answer: Acute renal failure from myoglobinuria
Crush syndrome releases myoglobin from damaged muscle, which precipitates in renal tubules causing acute tubular necrosis and renal failure, requiring aggressive fluid resuscitation to prevent it.
TCRN TC-Registered Nurse 5
A burn patient has circumferential burns of both lower extremities.
The nurse assesses absent distal pulses and tense compartments.
The PRIORITY intervention is: