TCRN Trauma Certified Registered Nursing 2 — Questions and Answers
Question 1: A trauma patient arrives with a Glasgow Coma Scale (GCS) score of 8. Which component breakdown best reflects this score?
- Eye opening 2, Verbal 3, Motor 3
- Eye opening 3, Verbal 2, Motor 3
- Eye opening 2, Verbal 2, Motor 4 (Correct answer)
- Eye opening 1, Verbal 3, Motor 4
Correct answer: Eye opening 2, Verbal 2, Motor 4
GCS = Eye (1-4) + Verbal (1-5) + Motor (1-6); 2+2+4=8 is a valid combination reflecting severe neurological compromise.
Question 2: Which finding is the MOST reliable early indicator of hemorrhagic shock in an adult trauma patient?
- Hypotension below 90 mmHg systolic
- Tachycardia greater than 100 bpm (Correct answer)
- Decreased urine output below 0.5 mL/kg/hr
- Altered mental status
Correct answer: Tachycardia greater than 100 bpm
Tachycardia is the earliest compensatory response to hemorrhage, occurring before hypotension or oliguria become apparent.
Question 3: A patient sustains a stab wound to the right chest and develops absent breath sounds on the right with tracheal deviation to the left. The priority intervention is:
- Immediate chest X-ray
- Needle decompression of the right chest (Correct answer)
- Placement of a chest tube on the right
- High-flow oxygen via non-rebreather mask
Correct answer: Needle decompression of the right chest
Tracheal deviation away from the affected side with absent breath sounds indicates tension pneumothorax, requiring immediate needle decompression at the 2nd intercostal space, midclavicular line.
Question 4: Which burn injury requires immediate transport to a burn center according to American Burn Association criteria?
- Superficial burns covering 5% TBSA in a 30-year-old
- Partial-thickness burns covering 12% TBSA in a 25-year-old (Correct answer)
- Superficial partial-thickness burns on the forearm
- Minor chemical splash to the anterior forearm
Correct answer: Partial-thickness burns covering 12% TBSA in a 25-year-old
Partial-thickness burns exceeding 10% TBSA in adults meet ABA criteria for burn center referral.
Question 5: In a patient with suspected increased intracranial pressure (ICP), which nursing intervention should be AVOIDED?
- Elevating the head of bed to 30 degrees
- Maintaining PaCO2 between 35-45 mmHg
- Routine suctioning every 2 hours regardless of need (Correct answer)
- Keeping the room quiet and minimizing stimulation
Correct answer: Routine suctioning every 2 hours regardless of need
Routine suctioning stimulates coughing and Valsalva maneuver, transiently elevating ICP and worsening cerebral perfusion.
Question 6: A trauma patient in hemorrhagic shock is receiving massive transfusion. The TCRN should monitor for which complication of massive blood transfusion?
- Hyperkalemia, hypocalcemia, and hypothermia (Correct answer)
- Hypokalemia, hypercalcemia, and hyperthermia
- Metabolic alkalosis and hypernatremia
- Thrombocytosis and hypermagnesemia
Correct answer: Hyperkalemia, hypocalcemia, and hypothermia
Massive transfusion causes hypothermia from cold blood products, hypocalcemia from citrate binding calcium, and hyperkalemia from hemolysis of stored RBCs.
Question 7: Which classification correctly describes a Grade III splenic laceration per the AAST Organ Injury Scale?
- Subcapsular hematoma less than 10% surface area
- Laceration more than 3 cm parenchymal depth or involving trabecular vessels (Correct answer)
- Laceration involving segmental or hilar vessels with major devascularization
- Completely shattered spleen
Correct answer: Laceration more than 3 cm parenchymal depth or involving trabecular vessels
AAST Grade III splenic injury involves lacerations greater than 3 cm depth or trabecular vessel involvement, distinguishing it from lower-grade subcapsular injuries.
TCRN Trauma Certified Registered Nursing 2
A trauma patient arrives with a Glasgow Coma Scale (GCS) score of 8.
Which component breakdown best reflects this score?