BARKLEY TCRN TRAUMA CERTIFICATION REVIEW EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Trauma Systems and Mechanism of Injury
Pathophysiology of Shock and Hemorrhage
Neurological and Head Trauma
Thoracic and Abdominal Trauma
Orthopedic and Spinal Trauma
Burn and Environmental Trauma
Special Populations (Pediatric, Geriatric, Pregnant)
Psychosocial and Ethical Issues in Trauma
Emergency Preparedness and Mass Casualty Incidents
Introduction:
This comprehensive examination is designed to assess the candidate's readiness for the Barkley TCRN Trauma
Certification Review Exam. It evaluates a deep understanding of the continuum of trauma care, from the initial
pre-hospital phase through to rehabilitation. The assessment tests critical thinking, clinical decision-making, and
the ability to apply current evidence-based guidelines to complex, real-world trauma scenarios. The exam is
comprised of multiple-choice questions, many of which are presented in a scenario-based format, requiring the
,test-taker to prioritize interventions, interpret clinical data, and anticipate potential complications. Mastery of this
content demonstrates a commitment to excellence in trauma nursing.
SECTION ONE: QUESTIONS 1-100
1. A 24-year-old male is involved in a high-speed motor vehicle collision (MVC). He arrives in the ED with a GCS
of 14, is hypotensive, and has a distended, rigid abdomen. Which of the following is the priority nursing
intervention?
A. Prepare for immediate abdominal ultrasound (FAST exam)
B. Administer a 1-liter bolus of normal saline
C. Initiate a type and crossmatch for blood products
D. Notify the surgical team for potential emergency surgery
🟢C
🔴 RATIONALE: The patient is showing signs of hypovolemic shock (hypotension) with a likely source in the
abdomen. While ultrasound and surgery are critical, the immediate priority for the nurse is to prepare for the
administration of blood products. Type and crossmatch must be done to ensure compatible blood is available
for massive transfusion. The FAST exam and surgical consultation will happen concurrently, but preparing blood
products is a direct nursing action that supports the emergent resuscitation.
2. In a patient with a suspected pelvic fracture from a crush injury, which of the following assessment findings is
the most sensitive indicator of a life-threatening hemorrhage?
,A. Pain upon palpation of the iliac crests
B. A positive pelvic compression test
C. The presence of a scrotal or perineal hematoma
D. Hemodynamic instability
🟢D
🔴 RATIONALE: While A, B, and C are indicative of a pelvic fracture, hemodynamic instability (tachycardia,
hypotension) is the most crucial sign of active, life-threatening hemorrhage. Pelvic fractures can result in
significant retroperitoneal bleeding, and hemodynamic changes are the key clinical marker of severity. A stable
patient with a pelvic fracture can be managed with a pelvic binder and monitoring, whereas an unstable patient
requires immediate hemorrhage control and massive transfusion.
3. A 6-year-old child is brought to the ED after falling from a second-story window. The child is crying and
complaining of a headache. The primary survey reveals a patent airway and adequate breathing. Vital signs are
BP 100/65, HR 130, RR 24. Which of the following is the most appropriate next step in the care of this patient?
A. Immobilize the cervical spine and perform a rapid neurological assessment
B. Administer a dose of acetaminophen for the headache
C. Prepare for immediate intubation due to the heart rate
D. Apply high-flow oxygen via a non-rebreather mask
🟢A
🔴 RATIONALE: This patient has a significant mechanism of injury (fall from height) and is complaining of a
headache, which is a major indicator of potential head and cervical spine injury. The priority is to immobilize the
cervical spine to prevent further injury and perform a rapid neurological assessment to establish a baseline.
, Intubation is not indicated based on the vital signs provided, and oxygen is not typically required for a child
with normal SpO2. Pain management is important but should not precede a thorough assessment and spinal
precautions.
4. A 45-year-old male presents with a stab wound to the left chest. He is tachypneic with diminished breath
sounds on the left side. Which of the following findings on the primary survey would indicate a tension
pneumothorax?
A. Jugular venous distention and hypotension
B. Subcutaneous emphysema and tachycardia
C. Bilateral wheezing and a productive cough
D. A tracheal shift to the left
🟢A
🔴 RATIONALE: A tension pneumothorax is a life-threatening condition where air accumulates in the pleural
space, causing a shift of the mediastinum and compression of the heart and great vessels. The classic signs are
hypotension (from decreased venous return), jugular venous distention (from increased pressure), and tracheal
deviation away from the affected side. A tracheal shift to the left would indicate the tension is on the right.
Subcutaneous emphysema can be present but is not the hallmark sign.
5. A trauma patient with a known history of chronic obstructive pulmonary disease (COPD) is receiving
mechanical ventilation. The nurse notes a sudden drop in oxygen saturation, decreased breath sounds on the
right, and a significant increase in peak airway pressures. What is the most likely cause?
A. A kink in the endotracheal tube
B. A right mainstem intubation
ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains:
Trauma Systems and Mechanism of Injury
Pathophysiology of Shock and Hemorrhage
Neurological and Head Trauma
Thoracic and Abdominal Trauma
Orthopedic and Spinal Trauma
Burn and Environmental Trauma
Special Populations (Pediatric, Geriatric, Pregnant)
Psychosocial and Ethical Issues in Trauma
Emergency Preparedness and Mass Casualty Incidents
Introduction:
This comprehensive examination is designed to assess the candidate's readiness for the Barkley TCRN Trauma
Certification Review Exam. It evaluates a deep understanding of the continuum of trauma care, from the initial
pre-hospital phase through to rehabilitation. The assessment tests critical thinking, clinical decision-making, and
the ability to apply current evidence-based guidelines to complex, real-world trauma scenarios. The exam is
comprised of multiple-choice questions, many of which are presented in a scenario-based format, requiring the
,test-taker to prioritize interventions, interpret clinical data, and anticipate potential complications. Mastery of this
content demonstrates a commitment to excellence in trauma nursing.
SECTION ONE: QUESTIONS 1-100
1. A 24-year-old male is involved in a high-speed motor vehicle collision (MVC). He arrives in the ED with a GCS
of 14, is hypotensive, and has a distended, rigid abdomen. Which of the following is the priority nursing
intervention?
A. Prepare for immediate abdominal ultrasound (FAST exam)
B. Administer a 1-liter bolus of normal saline
C. Initiate a type and crossmatch for blood products
D. Notify the surgical team for potential emergency surgery
🟢C
🔴 RATIONALE: The patient is showing signs of hypovolemic shock (hypotension) with a likely source in the
abdomen. While ultrasound and surgery are critical, the immediate priority for the nurse is to prepare for the
administration of blood products. Type and crossmatch must be done to ensure compatible blood is available
for massive transfusion. The FAST exam and surgical consultation will happen concurrently, but preparing blood
products is a direct nursing action that supports the emergent resuscitation.
2. In a patient with a suspected pelvic fracture from a crush injury, which of the following assessment findings is
the most sensitive indicator of a life-threatening hemorrhage?
,A. Pain upon palpation of the iliac crests
B. A positive pelvic compression test
C. The presence of a scrotal or perineal hematoma
D. Hemodynamic instability
🟢D
🔴 RATIONALE: While A, B, and C are indicative of a pelvic fracture, hemodynamic instability (tachycardia,
hypotension) is the most crucial sign of active, life-threatening hemorrhage. Pelvic fractures can result in
significant retroperitoneal bleeding, and hemodynamic changes are the key clinical marker of severity. A stable
patient with a pelvic fracture can be managed with a pelvic binder and monitoring, whereas an unstable patient
requires immediate hemorrhage control and massive transfusion.
3. A 6-year-old child is brought to the ED after falling from a second-story window. The child is crying and
complaining of a headache. The primary survey reveals a patent airway and adequate breathing. Vital signs are
BP 100/65, HR 130, RR 24. Which of the following is the most appropriate next step in the care of this patient?
A. Immobilize the cervical spine and perform a rapid neurological assessment
B. Administer a dose of acetaminophen for the headache
C. Prepare for immediate intubation due to the heart rate
D. Apply high-flow oxygen via a non-rebreather mask
🟢A
🔴 RATIONALE: This patient has a significant mechanism of injury (fall from height) and is complaining of a
headache, which is a major indicator of potential head and cervical spine injury. The priority is to immobilize the
cervical spine to prevent further injury and perform a rapid neurological assessment to establish a baseline.
, Intubation is not indicated based on the vital signs provided, and oxygen is not typically required for a child
with normal SpO2. Pain management is important but should not precede a thorough assessment and spinal
precautions.
4. A 45-year-old male presents with a stab wound to the left chest. He is tachypneic with diminished breath
sounds on the left side. Which of the following findings on the primary survey would indicate a tension
pneumothorax?
A. Jugular venous distention and hypotension
B. Subcutaneous emphysema and tachycardia
C. Bilateral wheezing and a productive cough
D. A tracheal shift to the left
🟢A
🔴 RATIONALE: A tension pneumothorax is a life-threatening condition where air accumulates in the pleural
space, causing a shift of the mediastinum and compression of the heart and great vessels. The classic signs are
hypotension (from decreased venous return), jugular venous distention (from increased pressure), and tracheal
deviation away from the affected side. A tracheal shift to the left would indicate the tension is on the right.
Subcutaneous emphysema can be present but is not the hallmark sign.
5. A trauma patient with a known history of chronic obstructive pulmonary disease (COPD) is receiving
mechanical ventilation. The nurse notes a sudden drop in oxygen saturation, decreased breath sounds on the
right, and a significant increase in peak airway pressures. What is the most likely cause?
A. A kink in the endotracheal tube
B. A right mainstem intubation
