TNCC Thoracic and Abdominal Trauma 3

Question 1

A patient with left lower rib fractures (ribs 9-12) should be evaluated for injury to which organ?

Accepted Answer

Spleen

Answer

Left lower rib fractures (ribs 9-12) overlie the spleen, and direct fracture fragments or transmitted force significantly increases the risk of splenic injury.

Question 2

Tracheobronchial injury following blunt chest trauma should be suspected when:

Accepted Answer

A chest tube has been placed but there is a persistent large air leak and the lung fails to re-expand

Answer

A persistent large air leak through the chest tube with failure of the lung to re-expand despite adequate drainage suggests a tracheobronchial disruption — air is entering the pleural space faster than the chest tube can evacuate it.

Question 3

A patient with a deceleration injury has a widened mediastinum on chest X-ray. This finding is most concerning for:

Accepted Answer

Traumatic aortic disruption

Answer

A widened mediastinum (>8 cm on supine AP film) after deceleration injury is the classic screening finding for traumatic aortic disruption, requiring urgent CT angiography for definitive evaluation.

Question 4

Diagnostic peritoneal lavage (DPL) is considered positive for significant intra-abdominal hemorrhage when the red blood cell count exceeds:

Accepted Answer

100,000/mm³

Answer

A DPL is positive for blunt trauma when the RBC count in the lavage fluid exceeds 100,000/mm³ (for penetrating trauma, the threshold is lower at 10,000-20,000/mm³).

Question 5

A patient presents after a motor vehicle collision with a rigid, distended abdomen, absent bowel sounds, and involuntary guarding. These findings are most consistent with:

Accepted Answer

Peritonitis from hollow viscus perforation

Answer

A rigid, distended abdomen with absent bowel sounds and involuntary guarding indicates peritoneal irritation from hollow viscus perforation, with bowel contents contaminating the peritoneal cavity.

TNCC - Trauma Nurse Core Curriculum Practice Test

TNCC - Trauma Nurse Core Curriculum Practice Test

TNCC Thoracic and Abdominal Trauma 3