TCRN Trauma Certified Registered Nursing 3 — Questions and Answers
Question 1: A patient involved in a high-speed MVC presents with hypotension, distended neck veins, and muffled heart sounds. This triad is MOST consistent with:
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Hemothorax
- Aortic disruption
Correct answer: Cardiac tamponade
Beck's triad—hypotension, distended neck veins, and muffled heart sounds—is the classic presentation of cardiac tamponade from pericardial blood accumulation.
Question 2: When using the Parkland formula for fluid resuscitation in a 70 kg adult with 40% TBSA burns, how much lactated Ringer's should be given in the first 8 hours?
- 5,600 mL (Correct answer)
- 11,200 mL
- 2,800 mL
- 8,400 mL
Correct answer: 5,600 mL
Parkland formula: 4 mL × kg × %TBSA = 4×70×40=11,200 mL total; half (5,600 mL) is given in the first 8 hours post-burn.
Question 3: A pediatric trauma patient weighing 20 kg requires a fluid bolus for suspected hemorrhagic shock. The appropriate initial bolus is:
- 500 mL normal saline
- 400 mL lactated Ringer's (Correct answer)
- 300 mL normal saline
- 200 mL lactated Ringer's
Correct answer: 400 mL lactated Ringer's
Pediatric initial fluid resuscitation is 20 mL/kg of isotonic crystalloid; 20 mL × 20 kg = 400 mL.
Question 4: Which mechanism of injury is MOST associated with a duodenal hematoma in a pediatric patient?
- Fall from height greater than 10 feet
- Lap belt injury from a motor vehicle collision
- Direct blow to the epigastrium from bicycle handlebars (Correct answer)
- Penetrating abdominal wound
Correct answer: Direct blow to the epigastrium from bicycle handlebars
Handlebar injuries cause a direct compressive force to the epigastrium, trapping the duodenum against the spine and causing hematoma formation.
Question 5: A TCRN is caring for a patient with a traumatic brain injury. The cerebral perfusion pressure (CPP) is calculated as:
- MAP minus ICP (Correct answer)
- Systolic BP minus diastolic BP
- MAP plus ICP
- ICP minus MAP
Correct answer: MAP minus ICP
CPP = MAP − ICP; the target CPP in TBI management is typically 60-70 mmHg to ensure adequate cerebral blood flow.
Question 6: A patient presents with paradoxical chest wall movement after blunt chest trauma. This finding indicates:
- Open pneumothorax
- Flail chest with underlying pulmonary contusion (Correct answer)
- Tension pneumothorax
- Massive hemothorax
Correct answer: Flail chest with underlying pulmonary contusion
Paradoxical movement (inward during inspiration, outward during expiration) occurs when a flail segment moves opposite to the chest wall, typically with underlying pulmonary contusion.
Question 7: Which assessment finding in a trauma patient indicates neurogenic shock rather than hypovolemic shock?
- Tachycardia with cool, clammy skin
- Bradycardia with warm, flushed skin (Correct answer)
- Tachycardia with diaphoresis
- Bradycardia with pale, mottled skin
Correct answer: Bradycardia with warm, flushed skin
Neurogenic shock causes loss of sympathetic tone, resulting in paradoxical bradycardia and vasodilation (warm, flushed skin), unlike the compensatory tachycardia and vasoconstriction of hypovolemic shock.
TCRN Trauma Certified Registered Nursing 3
A patient involved in a high-speed MVC presents with hypotension, distended neck veins, and muffled heart sounds.
This triad is MOST consistent with: