TNCC - Trauma Nurse Core Curriculum Thoracic and Abdominal Trauma Questions and Answers 1

Question 1

A patient with blunt chest trauma from a steering wheel impact is noted to have a segment of their right chest wall that retracts inward during inspiration and bulges outward during expiration. This physical finding is the most definitive sign of which injury?

Accepted Answer

Flail chest

Answer

Flail chest is defined by fractures of three or more adjacent ribs in two or more places, creating a free-floating segment. This segment moves independently and opposite to the rest of the chest wall during respiration, a sign known as paradoxical motion, which is the hallmark clinical finding of the injury. [11, 12, 17, 18]

Question 2

A patient arrives after a penetrating wound to the central chest. The nurse assesses hypotension, distended jugular veins, and muffled heart sounds. These findings, known as Beck's Triad, are the classic signs of which life-threatening condition?

Accepted Answer

Pericardial (cardiac) tamponade

Answer

Beck's Triad consists of hypotension, jugular venous distention, and muffled heart sounds. This triad is the classic presentation for acute pericardial (cardiac) tamponade, where fluid accumulation in the pericardial sac compresses the heart, impairing its ability to pump blood effectively. [3, 6, 7, 9]

Question 3

A patient involved in a motor vehicle collision reports left upper quadrant abdominal pain that radiates to the tip of the left shoulder. This finding, known as Kehr's sign, is highly suggestive of an injury to which organ?

Accepted Answer

Spleen

Answer

Kehr's sign is referred pain to the left shoulder caused by irritation of the diaphragm from blood, most commonly associated with a splenic injury or rupture. The phrenic nerve, which innervates the diaphragm, shares nerve roots (C3-C5) with the supraclavicular nerves that supply the shoulder area. [1, 2, 10, 16]

Question 4

A trauma patient presents with absent breath sounds on the right, tracheal deviation to the left, severe respiratory distress, and hypotension. What is the immediate, life-saving intervention for this condition?

Accepted Answer

Perform an immediate needle decompression.

Answer

The patient's signs and symptoms are classic for a tension pneumothorax, a life-threatening emergency where air is trapped in the pleural space, causing mediastinal shift and cardiovascular collapse. The immediate intervention is to relieve the pressure by performing a needle decompression. This is a temporizing measure performed before the definitive treatment of a chest tube (tube thoracostomy). [13, 27, 29, 30]

Question 5

A patient arrives with an abdominal evisceration following a stab wound. What is the most appropriate initial management of the exposed abdominal contents?

Accepted Answer

Cover the exposed contents with a sterile, saline-moistened dressing.

Answer

The standard of care for an abdominal evisceration is to cover the exposed organs with a sterile dressing moistened with sterile saline to prevent drying, heat loss, and further contamination. The bowel should not be forced back into the abdomen. [4, 5, 15, 23]

TNCC - Trauma Nurse Core Curriculum Practice Test

TNCC - Trauma Nurse Core Curriculum Practice Test

TNCC - Trauma Nurse Core Curriculum Thoracic and Abdominal Trauma Questions and Answers 1