TCRN Trauma Certified Registered Nursing 4 — Questions and Answers
Question 1: A trauma patient with a pelvic fracture suddenly develops hemodynamic instability. The PRIORITY nursing intervention is:
- Prepare the patient for exploratory laparotomy
- Apply a commercial pelvic binder or sheet wrap (Correct answer)
- Insert two large-bore IVs and infuse normal saline rapidly
- Obtain a CT scan of the pelvis with contrast
Correct answer: Apply a commercial pelvic binder or sheet wrap
A pelvic binder reduces pelvic volume, providing tamponade of venous and arterial bleeding from an unstable pelvic fracture, and is the immediate priority before imaging or surgery.
Question 2: Which laboratory value is the BEST early indicator of tissue hypoperfusion in a trauma patient?
- Hemoglobin and hematocrit
- Serum lactate (Correct answer)
- Base excess
- Serum bicarbonate
Correct answer: Serum lactate
Serum lactate reflects anaerobic metabolism from tissue hypoperfusion and rises early in shock before other markers change significantly.
Question 3: A patient presents with a traumatic amputation of the right hand. After hemorrhage control, proper handling of the amputated part includes:
- Placing the part directly in ice water to preserve tissue
- Wrapping in moist sterile gauze, placing in a sealed bag, then on ice (Correct answer)
- Keeping the part dry and at room temperature
- Immersing in normal saline solution directly
Correct answer: Wrapping in moist sterile gauze, placing in a sealed bag, then on ice
The amputated part should be wrapped in moist sterile gauze, placed in a sealed plastic bag, and then placed on ice to cool without freezing the tissue.
Question 4: In damage control resuscitation, the target ratio for packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelets is:
- 4:2:1
- 1:1:1 (Correct answer)
- 2:1:1
- 3:1:1
Correct answer: 1:1:1
A 1:1:1 ratio of pRBCs:FFP:platelets mimics whole blood and is the current evidence-based standard for damage control resuscitation in hemorrhagic shock.
Question 5: Which spinal injury pattern is associated with a 'chance fracture'?
- Hyperextension injury at C4-C5
- Flexion-distraction injury at the thoracolumbar junction from lap belt use (Correct answer)
- Compression fracture of L1 from axial loading
- Rotational injury of the thoracic spine
Correct answer: Flexion-distraction injury at the thoracolumbar junction from lap belt use
A Chance fracture is a horizontal fracture through all three columns of a vertebra caused by flexion-distraction force, classically from a lap belt in a crash.
Question 6: A trauma nurse is evaluating a patient's pupils after head injury. Unilateral fixed and dilated pupil indicates:
- Bilateral occipital lobe injury
- Uncal herniation with CN III compression on the ipsilateral side (Correct answer)
- Metabolic encephalopathy
- Pontine hemorrhage
Correct answer: Uncal herniation with CN III compression on the ipsilateral side
Uncal herniation causes ipsilateral CN III compression, resulting in a fixed, dilated pupil on the same side as the expanding hematoma.
Question 7: Which of the following is an indication for emergent surgical airway (cricothyrotomy) in a trauma patient?
- GCS of 10 with intact gag reflex
- Failed intubation with inability to ventilate by BVM (Correct answer)
- Anticipated difficult airway with SpO2 of 95%
- Combative patient requiring sedation
Correct answer: Failed intubation with inability to ventilate by BVM
The 'cannot intubate, cannot oxygenate' scenario mandates an emergency surgical airway as a life-saving measure.
TCRN Trauma Certified Registered Nursing 4
A trauma patient with a pelvic fracture suddenly develops hemodynamic instability.
The PRIORITY nursing intervention is: