TCRN TCR-Nurse 5 — Questions and Answers
Question 1: Which of the following is a PRIMARY survey finding that requires IMMEDIATE intervention?
- Open femur fracture with deformity
- Open pneumothorax (sucking chest wound) (Correct answer)
- Positive FAST exam with stable vitals
- Suspected pelvic fracture on palpation
Correct answer: Open pneumothorax (sucking chest wound)
An open pneumothorax allows air to enter the pleural space with each breath, rapidly causing respiratory failure and must be immediately sealed with an occlusive dressing.
Question 2: In the primary survey, the 'E' in ABCDE stands for Exposure. What is the KEY nursing consideration during this step?
- Exposing only the injured extremity to preserve modesty
- Fully undressing the patient while preventing hypothermia (Correct answer)
- Exposing only after IV access is established
- Removing clothing only if the patient consents
Correct answer: Fully undressing the patient while preventing hypothermia
Full exposure allows identification of all injuries, but active warming measures must immediately prevent hypothermia, which worsens coagulopathy.
Question 3: A patient with a traumatic amputation of the right hand is brought to the ED. How should the amputated part be transported?
- Placed directly in a container of ice water
- Wrapped in a dry sterile dressing only
- Wrapped in moist sterile gauze, placed in a sealed bag on ice (Correct answer)
- Submerged in normal saline and transported at room temperature
Correct answer: Wrapped in moist sterile gauze, placed in a sealed bag on ice
The amputated part should be wrapped in moist sterile gauze, sealed in a plastic bag, then placed on ice — direct contact with ice causes tissue damage.
Question 4: Which sign is MOST suggestive of a basilar skull fracture?
- Battle's sign (ecchymosis over mastoid) and raccoon eyes (Correct answer)
- Frontal scalp laceration with visible bone
- Unilateral facial nerve palsy
- Temporal scalp hematoma
Correct answer: Battle's sign (ecchymosis over mastoid) and raccoon eyes
Battle's sign (retroauricular ecchymosis) and periorbital ecchymosis (raccoon eyes) are classic late signs of basilar skull fracture.
Question 5: A trauma patient develops neurogenic shock after a cervical spinal cord injury. What hemodynamic pattern differentiates neurogenic shock from hemorrhagic shock?
- Hypotension with tachycardia and cool skin
- Hypotension with bradycardia and warm skin (Correct answer)
- Hypotension with normal HR and diaphoresis
- Hypotension with tachycardia and warm skin
Correct answer: Hypotension with bradycardia and warm skin
Neurogenic shock presents with hypotension, bradycardia, and warm/flushed skin due to loss of sympathetic tone — unlike hemorrhagic shock which causes tachycardia and vasoconstriction.
Question 6: Which intervention is CONTRAINDICATED in a patient with a suspected anterior cranial fossa fracture who needs airway suctioning?
- Oral suctioning with a Yankauer catheter
- Nasopharyngeal suctioning (Correct answer)
- Endotracheal suctioning post-intubation
- In-line suctioning via ETT
Correct answer: Nasopharyngeal suctioning
Nasopharyngeal suctioning (and nasogastric tube insertion) is contraindicated with anterior cranial fossa fracture due to risk of intracranial placement through the cribriform plate.
Question 7: A trauma nurse is caring for a pregnant patient at 28 weeks gestation with blunt abdominal trauma. Which position BEST improves maternal hemodynamics?
- Supine with legs elevated 15 degrees
- Left lateral tilt of 15–30 degrees (Correct answer)
- Right lateral decubitus
- Reverse Trendelenburg
Correct answer: Left lateral tilt of 15–30 degrees
Left lateral tilt displaces the uterus off the inferior vena cava, preventing aortocaval compression and improving venous return and cardiac output.
TCRN TCR-Nurse 5
Which of the following is a PRIMARY survey finding that requires IMMEDIATE intervention?