TCRN TCR-Nurse 4 — Questions and Answers
Question 1: A patient arrives after a high-speed MVC with a seat-belt sign across the abdomen. Which injury pattern should the trauma nurse suspect?
- Splenic laceration only
- Liver laceration with diaphragmatic rupture
- Chance fracture with hollow viscus injury (Correct answer)
- Aortic transection
Correct answer: Chance fracture with hollow viscus injury
A seat-belt sign across the abdomen is classically associated with Chance fractures (lumbar flexion-distraction) and hollow viscus (bowel) injuries from the lap belt.
Question 2: Which crystalloid solution is preferred in damage control resuscitation for hemorrhagic shock?
- Large volumes of normal saline
- Lactated Ringer's in a 1:1:1 ratio with blood products
- Balanced resuscitation with PRBCs, FFP, and platelets in 1:1:1 ratio (Correct answer)
- Hypertonic saline 3%
Correct answer: Balanced resuscitation with PRBCs, FFP, and platelets in 1:1:1 ratio
Damage control resuscitation uses PRBCs, FFP, and platelets in a 1:1:1 ratio to replicate whole blood and correct trauma-induced coagulopathy.
Question 3: A geriatric trauma patient takes beta-blockers daily. Which assessment finding may be masked by this medication?
- Hypotension
- Tachycardia (Correct answer)
- Altered mental status
- Decreased respiratory rate
Correct answer: Tachycardia
Beta-blockers blunt the compensatory tachycardia response to hemorrhage, making heart rate an unreliable indicator of shock in these patients.
Question 4: A patient with a pelvic fracture from a crush injury has ongoing hemodynamic instability despite resuscitation. Which intervention should the trauma nurse anticipate FIRST?
- Emergent laparotomy
- Application of a pelvic binder (Correct answer)
- Angioembolization
- External fixation in the OR
Correct answer: Application of a pelvic binder
A pelvic binder is the immediate intervention to reduce pelvic volume and tamponade venous bleeding before more definitive treatment.
Question 5: Tranexamic acid (TXA) is MOST effective when given within what time frame after injury?
- Within 30 minutes
- Within 1 hour
- Within 3 hours (Correct answer)
- Within 6 hours
Correct answer: Within 3 hours
TXA reduces mortality when given within 3 hours of injury; evidence from the CRASH-2 trial shows no benefit and possible harm when given after 3 hours.
Question 6: An unconscious trauma patient has a suspected cervical spine injury. Which airway method is PREFERRED?
- Nasopharyngeal airway with jaw thrust only
- Rapid sequence intubation (RSI) with in-line stabilization (Correct answer)
- Cricothyrotomy as the first choice
- Blind nasotracheal intubation
Correct answer: Rapid sequence intubation (RSI) with in-line stabilization
RSI with manual in-line cervical stabilization is the preferred method as it protects the airway while minimizing cervical movement.
Question 7: A trauma patient is found to have a base deficit of -8 mEq/L. This finding indicates:
- Mild metabolic alkalosis from stress response
- Significant tissue hypoperfusion and acidosis (Correct answer)
- Respiratory compensation for metabolic alkalosis
- Normal acid-base status for a trauma patient
Correct answer: Significant tissue hypoperfusion and acidosis
A base deficit more negative than -6 mEq/L indicates significant metabolic acidosis from tissue hypoperfusion and is associated with increased mortality.
TCRN TCR-Nurse 4
A patient arrives after a high-speed MVC with a seat-belt sign across the abdomen.
Which injury pattern should the trauma nurse suspect?