TCRN Trauma Certified Registered Nursing 5 — Questions and Answers
Question 1: A patient with a suspected cervical spine injury needs airway management. Which technique is preferred?
- Nasotracheal intubation without any neck manipulation
- Oral intubation with manual in-line stabilization (MILS) (Correct answer)
- Blind nasotracheal intubation as first choice in unconscious patients
- Awake fiberoptic intubation without spinal precautions
Correct answer: Oral intubation with manual in-line stabilization (MILS)
Oral intubation with manual in-line stabilization maintains spinal alignment while securing a definitive airway and is the recommended approach in trauma.
Question 2: A restrained driver in an MVC complains of left shoulder pain after abdominal trauma with no external injury. This finding most likely suggests:
- Clavicle fracture from the seat belt
- Kehr's sign indicating splenic injury with diaphragmatic irritation (Correct answer)
- Brachial plexus injury from airbag deployment
- Rotator cuff tear from bracing the steering wheel
Correct answer: Kehr's sign indicating splenic injury with diaphragmatic irritation
Kehr's sign is referred left shoulder pain caused by diaphragmatic irritation from blood or fluid pooling near the spleen, a hallmark of splenic injury.
Question 3: When performing a secondary survey on a trauma patient, the TCRN discovers a pelvic instability on rock testing. The appropriate next action is:
- Repeat the rock test to confirm findings
- Apply a pelvic binder and avoid further manipulation (Correct answer)
- Obtain a portable AP pelvis X-ray before any intervention
- Place the patient in Trendelenburg position immediately
Correct answer: Apply a pelvic binder and avoid further manipulation
Once pelvic instability is detected, further manipulation worsens hemorrhage; a pelvic binder should be applied and the pelvis should not be retested.
Question 4: A trauma patient receives tranexamic acid (TXA). The medication is MOST effective when administered within what time frame from injury?
- Within 6 hours
- Within 3 hours (Correct answer)
- Within 1 hour
- Within 12 hours
Correct answer: Within 3 hours
The CRASH-2 trial demonstrated TXA is most effective within 3 hours of injury; administration after 3 hours may increase mortality.
Question 5: Which acid-base disturbance is MOST commonly seen in the early phase of severe hemorrhagic shock?
- Respiratory alkalosis
- Metabolic alkalosis
- Metabolic acidosis with elevated anion gap (Correct answer)
- Respiratory acidosis
Correct answer: Metabolic acidosis with elevated anion gap
Tissue hypoperfusion leads to anaerobic metabolism and lactic acid accumulation, producing a high anion gap metabolic acidosis.
Question 6: A trauma patient develops sudden onset of agitation, dyspnea, petechiae on the chest and axillae, and hypoxia 24 hours after a long bone fracture. The TCRN suspects:
- Pulmonary embolism from deep vein thrombosis
- Fat embolism syndrome (Correct answer)
- Acute respiratory distress syndrome (ARDS)
- Tension pneumothorax from a missed rib fracture
Correct answer: Fat embolism syndrome
Fat embolism syndrome classically presents 24-72 hours after long bone fractures with the triad of hypoxia, neurological changes, and petechial rash on the upper body.
Question 7: Which intervention is the HIGHEST priority for a trauma patient presenting with an open (sucking) chest wound?
- Immediate chest tube insertion at the bedside
- Apply a three-sided occlusive dressing to seal the wound (Correct answer)
- Intubation and mechanical ventilation
- Portable chest X-ray to assess pneumothorax size
Correct answer: Apply a three-sided occlusive dressing to seal the wound
A three-sided (vented) occlusive dressing seals the wound on inspiration while allowing air to escape on expiration, preventing tension pneumothorax development.
TCRN Trauma Certified Registered Nursing 5
A patient with a suspected cervical spine injury needs airway management.
Which technique is preferred?