TCRN TCR-Nurse 3 — Questions and Answers
Question 1: In a pediatric trauma patient, which finding MOST reliably indicates significant blood loss?
- Hypotension
- Tachycardia with altered mental status (Correct answer)
- Decreased urine output
- Pale skin
Correct answer: Tachycardia with altered mental status
Children compensate well and maintain blood pressure until late; tachycardia combined with altered mental status is an earlier and more reliable sign of significant hemorrhage.
Question 2: The BEST indicator of adequate fluid resuscitation in a trauma patient is:
- Normalization of heart rate
- Urine output of 0.5 mL/kg/hr in adults (Correct answer)
- Resolution of base deficit
- Return of systolic BP to baseline
Correct answer: Urine output of 0.5 mL/kg/hr in adults
Urine output of 0.5 mL/kg/hr in adults reflects adequate end-organ perfusion and is the gold standard for fluid resuscitation monitoring.
Question 3: A trauma patient develops Beck's triad. Which intervention is MOST immediately appropriate?
- Chest tube insertion
- Pericardiocentesis (Correct answer)
- Immediate thoracotomy
- Fluid bolus and vasopressors
Correct answer: Pericardiocentesis
Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade; pericardiocentesis decompresses the pericardial sac emergently.
Question 4: Which burn depth classification involves destruction of ALL skin layers including subcutaneous tissue, and may appear white, leathery, or charred?
- Superficial (first-degree)
- Partial-thickness superficial (second-degree)
- Full-thickness (third-degree) (Correct answer)
- Deep tissue injury
Correct answer: Full-thickness (third-degree)
Full-thickness (third-degree) burns destroy epidermis, dermis, and subcutaneous tissue, presenting as white, leathery, or charred with no pain due to nerve destruction.
Question 5: Using the Rule of Nines in an adult, what percentage of TBSA does a burn covering the entire anterior trunk represent?
- 9%
- 18% (Correct answer)
- 27%
- 36%
Correct answer: 18%
The anterior trunk (chest and abdomen) represents 18% of TBSA in adults using the Rule of Nines.
Question 6: A patient with a traumatic brain injury has a sudden drop in GCS from 13 to 7 with ipsilateral pupil dilation. This is MOST consistent with:
- Diffuse axonal injury
- Epidural hematoma (Correct answer)
- Subdural hematoma
- Cerebral contusion
Correct answer: Epidural hematoma
Epidural hematoma classically presents with a lucid interval followed by rapid neurological deterioration and ipsilateral (uncal herniation) pupil dilation from arterial bleeding.
Question 7: Which pressure value defines the threshold for decompressive intervention in compartment syndrome?
- Compartment pressure >20 mmHg
- Compartment pressure >30 mmHg
- Compartment pressure within 30 mmHg of diastolic BP (Correct answer)
- Compartment pressure >50 mmHg
Correct answer: Compartment pressure within 30 mmHg of diastolic BP
Fasciotomy is indicated when compartment pressure is within 30 mmHg of diastolic BP (delta pressure ≤30 mmHg), as this compromises perfusion.
TCRN TCR-Nurse 3
In a pediatric trauma patient, which finding MOST reliably indicates significant blood loss?