TNCC Thoracic Trauma 2

Question 1

Fractures of which ribs are associated with the greatest risk of great vessel injury and highest mortality?

Accepted Answer

Ribs 1 and 2

Answer

First and second rib fractures require tremendous force to break and are associated with injuries to great vessels, bronchi, and the brachial plexus, indicating extreme energy transfer.

Question 2

What is the primary pathophysiologic concern with pulmonary contusion?

Accepted Answer

Hemorrhage into lung parenchyma impairing gas exchange

Answer

Pulmonary contusion causes hemorrhage and edema within lung parenchyma, reducing alveolar function and causing hypoxia that often worsens over the first 24-48 hours.

Question 3

Traumatic aortic disruption most commonly occurs at which anatomical location?

Accepted Answer

Aortic isthmus at the ligamentum arteriosum

Answer

The aortic isthmus just distal to the left subclavian artery is the most common site of traumatic aortic injury because differential deceleration forces act at this transition between mobile and fixed aorta.

Question 4

Which chest tube output threshold most commonly indicates the need for surgical thoracotomy in hemothorax?

Accepted Answer

1,000-1,500 mL immediately or greater than 200 mL/hr ongoing

Answer

Immediate drainage of 1,000-1,500 mL or ongoing output exceeding 200 mL/hr for 2-4 hours indicates active hemorrhage that the patient cannot self-tamponade and requires surgical control.

Question 5

Which assessment finding most reliably distinguishes tension pneumothorax from simple pneumothorax?

Accepted Answer

Tracheal deviation and hemodynamic instability

Answer

Tracheal deviation away from the affected side and hemodynamic instability (hypotension, shock) indicate mediastinal shift and obstructive shock, which are hallmarks of tension pneumothorax.

(TNCC) Trauma Nursing Core Course Certified Practice Test

(TNCC) Trauma Nursing Core Course Certified Practice Test

TNCC Thoracic Trauma 2