TNCC Shock and Fluid Resuscitation

Question 1

Which type of shock is characterized by decreased cardiac output due to impaired myocardial contractility following blunt chest trauma?

Accepted Answer

Cardiogenic shock

Answer

Cardiogenic shock from blunt cardiac injury (myocardial contusion) results in decreased contractility and reduced cardiac output despite adequate intravascular volume.

Question 2

During massive transfusion protocol, which electrolyte abnormality is most likely to cause cardiac arrest?

Accepted Answer

Hyperkalemia

Answer

Hyperkalemia from stored blood products (potassium leaks from aged RBCs) can cause fatal cardiac dysrhythmias including ventricular fibrillation and asystole during massive transfusion.

Question 3

A trauma patient receiving crystalloid resuscitation develops worsening metabolic acidosis. Which crystalloid is LEAST likely to cause hyperchloremic acidosis?

Accepted Answer

Lactated Ringer's solution

Answer

Lactated Ringer's solution has a chloride concentration (109 mEq/L) closer to plasma (98-106 mEq/L) and contains lactate buffer, making it less likely to cause hyperchloremic metabolic acidosis compared to normal saline (154 mEq/L chloride).

Question 4

Tranexamic acid (TXA) administration in trauma hemorrhage is most effective when given within what time frame from injury?

Accepted Answer

3 hours

Answer

The CRASH-2 trial demonstrated that TXA reduces mortality from hemorrhage when administered within 3 hours of injury. Administration after 3 hours may increase mortality.

Question 5

Which assessment finding differentiates obstructive shock from hypovolemic shock?

Accepted Answer

Distended neck veins are present in obstructive shock but flat in hypovolemic shock

Answer

Obstructive shock (cardiac tamponade, tension pneumothorax) presents with distended neck veins from impaired venous return to the heart, while hypovolemic shock presents with flat neck veins from volume depletion.

TNCC - Trauma Nurse Core Curriculum Practice Test

TNCC - Trauma Nurse Core Curriculum Practice Test

TNCC Shock and Fluid Resuscitation