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 Resuscitation & Stabilization
Systemic & Multi-System Trauma
Neurological Trauma & Management
Thoracic & Abdominal Trauma
Orthopedic, Soft Tissue, & Wound Trauma
Special Populations (Pediatric, Geriatric, Obstetric)
Thermal, Electrical, & Environmental Injuries
Psychosocial, Legal, & Ethical Issues in Trauma
Introduction
This comprehensive review examination is designed to rigorously assess the cognitive knowledge base and clinical
decision-making skills essential for the trauma-certified registered nurse. The content mirrors the blueprint of the
Board of Certification for Emergency Nursing (BCEN) TCRN examination. Questions are structured in a multiple-
choice, scenario-based format that emphasizes the application of theoretical knowledge to real-world clinical
situations. This assessment focuses on critical thinking, prioritization, and the synthesis of complex patient data to
guide life-saving interventions. It serves as a definitive tool for evaluating readiness and identifying areas for
focused study in the high-stakes environment of trauma nursing.
,SECTION ONE: QUESTIONS 1 – 100
1. A trauma patient is brought in with a suspected spinal cord injury. Which of the following assessment
findings is most concerning for neurogenic shock?
A. Hypertension and tachycardia
B. Bradycardia and hypotension
C. Tachycardia and tachypnea
D. Hypotension and fever
🟢 B. Bradycardia and hypotension
🔴 RATIONALE: Neurogenic shock, resulting from a loss of sympathetic tone, is characterized by hypotension
and bradycardia. Options A, C, and D do not represent the classic hallmark of neurogenic shock, which is a loss
of vasomotor tone leading to vasodilation and a relative hypovolemic state without compensatory tachycardia.
2. During the primary survey of a patient with a facial fracture, what is the priority intervention?
A. Administering broad-spectrum antibiotics
B. Applying a cervical collar
C. Establishing a definitive airway
D. Controlling external hemorrhage
🟢 C. Establishing a definitive airway
🔴 RATIONALE: Facial fractures can lead to airway compromise due to edema, bleeding, or obstruction.
Establishing a definitive airway is the priority intervention in the primary survey (A-B-Cs) before addressing
other issues. While a cervical collar and hemorrhage control are important, they are secondary to ensuring a
patent and protected airway.
,3. A patient arrives with a stab wound to the left lower chest. Which finding during the secondary survey is
most indicative of a diaphragmatic injury?
A. Absent breath sounds on the left side
B. Bowel sounds auscultated in the left chest
C. Subcutaneous emphysema over the chest wall
D. Jugular venous distention
🟢 B. Bowel sounds auscultated in the left chest
🔴 RATIONALE: Auscultation of bowel sounds in the chest is a pathognomonic sign of a diaphragmatic rupture
with herniation of abdominal contents. While absent breath sounds, subcutaneous emphysema, and JVD can
occur with other thoracic injuries, the presence of bowel sounds is specific to diaphragmatic injury.
4. Following a motor vehicle collision, a patient has a flail chest segment. The immediate goal of treatment is
to:
A. Stabilize the flail segment with sandbags
B. Intubate the patient for positive pressure ventilation
C. Provide adequate analgesia and pulmonary support
D. Perform an emergency thoracotomy
🟢 C. Provide adequate analgesia and pulmonary support
🔴 RATIONALE: The primary treatment for flail chest is to manage the underlying pulmonary contusion with
aggressive pain control, supplemental oxygen, and pulmonary hygiene to prevent atelectasis. Intubation is
reserved for respiratory failure. Sandbags are contraindicated as they can restrict chest wall movement.
, 5. What is the most common cause of preventable death in trauma patients?
A. Central nervous system injury
B. Uncontrolled hemorrhage
C. Sepsis from wound contamination
D. Myocardial contusion
🟢 B. Uncontrolled hemorrhage
🔴 RATIONALE: Uncontrolled hemorrhage is the leading cause of preventable death in trauma patients. The
focus of initial trauma management is to identify and control sources of bleeding to prevent exsanguination.
While CNS injuries and sepsis are significant causes of mortality, they are not as immediately preventable as
hemorrhage.
6. A patient's GCS score drops from 15 to 12. What is the first nursing action?
A. Re-assess in 15 minutes to monitor trend
B. Prepare for immediate endotracheal intubation
C. Reassess the airway, breathing, and circulation
D. Administer 2mg of IV Naloxone
🟢 C. Reassess the airway, breathing, and circulation
🔴 RATIONALE: A decrease in GCS indicates neurological deterioration, which can compromise the airway. The
nurse's first action is to reassess the ABCs to ensure the patient's airway is protected and breathing is adequate.
While intubation may be indicated later, the initial priority is to verify and support basic life-sustaining
functions.
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Trauma Resuscitation & Stabilization
Systemic & Multi-System Trauma
Neurological Trauma & Management
Thoracic & Abdominal Trauma
Orthopedic, Soft Tissue, & Wound Trauma
Special Populations (Pediatric, Geriatric, Obstetric)
Thermal, Electrical, & Environmental Injuries
Psychosocial, Legal, & Ethical Issues in Trauma
Introduction
This comprehensive review examination is designed to rigorously assess the cognitive knowledge base and clinical
decision-making skills essential for the trauma-certified registered nurse. The content mirrors the blueprint of the
Board of Certification for Emergency Nursing (BCEN) TCRN examination. Questions are structured in a multiple-
choice, scenario-based format that emphasizes the application of theoretical knowledge to real-world clinical
situations. This assessment focuses on critical thinking, prioritization, and the synthesis of complex patient data to
guide life-saving interventions. It serves as a definitive tool for evaluating readiness and identifying areas for
focused study in the high-stakes environment of trauma nursing.
,SECTION ONE: QUESTIONS 1 – 100
1. A trauma patient is brought in with a suspected spinal cord injury. Which of the following assessment
findings is most concerning for neurogenic shock?
A. Hypertension and tachycardia
B. Bradycardia and hypotension
C. Tachycardia and tachypnea
D. Hypotension and fever
🟢 B. Bradycardia and hypotension
🔴 RATIONALE: Neurogenic shock, resulting from a loss of sympathetic tone, is characterized by hypotension
and bradycardia. Options A, C, and D do not represent the classic hallmark of neurogenic shock, which is a loss
of vasomotor tone leading to vasodilation and a relative hypovolemic state without compensatory tachycardia.
2. During the primary survey of a patient with a facial fracture, what is the priority intervention?
A. Administering broad-spectrum antibiotics
B. Applying a cervical collar
C. Establishing a definitive airway
D. Controlling external hemorrhage
🟢 C. Establishing a definitive airway
🔴 RATIONALE: Facial fractures can lead to airway compromise due to edema, bleeding, or obstruction.
Establishing a definitive airway is the priority intervention in the primary survey (A-B-Cs) before addressing
other issues. While a cervical collar and hemorrhage control are important, they are secondary to ensuring a
patent and protected airway.
,3. A patient arrives with a stab wound to the left lower chest. Which finding during the secondary survey is
most indicative of a diaphragmatic injury?
A. Absent breath sounds on the left side
B. Bowel sounds auscultated in the left chest
C. Subcutaneous emphysema over the chest wall
D. Jugular venous distention
🟢 B. Bowel sounds auscultated in the left chest
🔴 RATIONALE: Auscultation of bowel sounds in the chest is a pathognomonic sign of a diaphragmatic rupture
with herniation of abdominal contents. While absent breath sounds, subcutaneous emphysema, and JVD can
occur with other thoracic injuries, the presence of bowel sounds is specific to diaphragmatic injury.
4. Following a motor vehicle collision, a patient has a flail chest segment. The immediate goal of treatment is
to:
A. Stabilize the flail segment with sandbags
B. Intubate the patient for positive pressure ventilation
C. Provide adequate analgesia and pulmonary support
D. Perform an emergency thoracotomy
🟢 C. Provide adequate analgesia and pulmonary support
🔴 RATIONALE: The primary treatment for flail chest is to manage the underlying pulmonary contusion with
aggressive pain control, supplemental oxygen, and pulmonary hygiene to prevent atelectasis. Intubation is
reserved for respiratory failure. Sandbags are contraindicated as they can restrict chest wall movement.
, 5. What is the most common cause of preventable death in trauma patients?
A. Central nervous system injury
B. Uncontrolled hemorrhage
C. Sepsis from wound contamination
D. Myocardial contusion
🟢 B. Uncontrolled hemorrhage
🔴 RATIONALE: Uncontrolled hemorrhage is the leading cause of preventable death in trauma patients. The
focus of initial trauma management is to identify and control sources of bleeding to prevent exsanguination.
While CNS injuries and sepsis are significant causes of mortality, they are not as immediately preventable as
hemorrhage.
6. A patient's GCS score drops from 15 to 12. What is the first nursing action?
A. Re-assess in 15 minutes to monitor trend
B. Prepare for immediate endotracheal intubation
C. Reassess the airway, breathing, and circulation
D. Administer 2mg of IV Naloxone
🟢 C. Reassess the airway, breathing, and circulation
🔴 RATIONALE: A decrease in GCS indicates neurological deterioration, which can compromise the airway. The
nurse's first action is to reassess the ABCs to ensure the patient's airway is protected and breathing is adequate.
While intubation may be indicated later, the initial priority is to verify and support basic life-sustaining
functions.
