TCRN TCRN Musculoskeletal and Wound Care 3 — Questions and Answers
Question 1: A patient with a pelvic fracture is hemodynamically unstable despite 2L crystalloid. The MOST appropriate next intervention is:
- Pelvic binder application and activation of massive transfusion protocol (Correct answer)
- Immediate CT pelvis to characterize the fracture pattern
- Foley catheter insertion to monitor urinary output
- Bilateral femoral artery cutdowns for rapid access
Correct answer: Pelvic binder application and activation of massive transfusion protocol
A pelvic binder reduces pelvic volume and tamponades venous bleeding while the massive transfusion protocol addresses hemorrhagic shock.
Question 2: Which Gustilo-Anderson classification of open fracture carries the highest risk of infection and amputation?
- Type IIIC (Correct answer)
- Type IIIA
- Type IIIB
- Type II
Correct answer: Type IIIC
Gustilo Type IIIC involves arterial injury requiring repair, carrying infection rates up to 50% and amputation rates exceeding 25%.
Question 3: A patient presents with inability to fully extend the knee after a dashboard impact. The patella is palpable superiorly. What is the most likely injury?
- Patellar tendon rupture (Correct answer)
- Quadriceps tendon rupture
- Tibial plateau fracture
- Patellar fracture with displacement
Correct answer: Patellar tendon rupture
Patellar tendon rupture results in proximal migration of the patella (patella alta) and inability to actively extend the knee.
Question 4: A burn patient has burns covering the anterior torso and both anterior lower extremities. Using the Rule of Nines, what percentage TBSA is burned?
- 27%
- 36% (Correct answer)
- 18%
- 45%
Correct answer: 36%
Anterior torso = 18%, each anterior lower extremity = 9% (×2 = 18%); total = 36% TBSA.
Question 5: Which finding in a wound suggests the presence of necrotizing fasciitis requiring emergent surgical debridement?
- Skin that appears normal overlying a rapidly spreading infection with crepitus (Correct answer)
- Purulent drainage with surrounding erythema
- Wound dehiscence with exposed subcutaneous fat
- Localized fluctuance indicating abscess formation
Correct answer: Skin that appears normal overlying a rapidly spreading infection with crepitus
Necrotizing fasciitis classically shows deceptively normal overlying skin with rapid spread, crepitus from gas-producing organisms, and systemic toxicity.
Question 6: A patient with a C5 spinal cord injury reports increased spasticity and a new pressure injury over the sacrum. Which nursing intervention is PRIORITY?
- Assess for and relieve the noxious stimulus causing autonomic dysreflexia trigger (Correct answer)
- Reposition the patient and apply a hydrocolloid dressing immediately
- Administer antispasmodic medication as ordered
- Notify the physician for a new pressure injury staging
Correct answer: Assess for and relieve the noxious stimulus causing autonomic dysreflexia trigger
In SCI at or above T6, a pressure injury can trigger autonomic dysreflexia, a life-threatening hypertensive emergency requiring immediate stimulus removal.
Question 7: Which dressing type is MOST appropriate for a heavily exudating stage III pressure injury with no signs of infection?
- Foam dressing (Correct answer)
- Transparent film dressing
- Dry gauze dressing
- Hydrocolloid dressing
Correct answer: Foam dressing
Foam dressings are highly absorbent and ideal for heavily exudating wounds, maintaining a moist environment without causing maceration.
TCRN TCRN Musculoskeletal and Wound Care 3
A patient with a pelvic fracture is hemodynamically unstable despite 2L crystalloid.
The MOST appropriate next intervention is: