TCAR (Trauma Care After Resuscitation) Final
Exam 1 Practice Test 2026
Questions with Correct Answers and Rationales
1. A patient with acute decompensated heart failure (ADHF) has
crackles in both lungs, an S3 gallop, and oxygen saturation of 88% on
2 L nasal cannula. Which intervention should the nurse implement
first?
A) Administer furosemide IV push
B) Place the patient in high-Fowler's position
C) Start a nitroglycerin drip
D) Draw BNP and troponin levels
*B) Place the patient in high-Fowler's position *
Rationale: Positioning is the immediate, non-invasive intervention that
reduces preload and improves oxygenation by decreasing venous return and
allowing better lung expansion. Diuretics and nitroglycerin follow after
positioning .
2. Which hemodynamic parameter is most consistent with cardiogenic
shock?
A) Cardiac index > 4.0 L/min/m², SVR < 600 dynes/sec/cm⁻⁵
B) Cardiac index < 2.2 L/min/m², SVR > 1200 dynes/sec/cm⁻⁵
C) Cardiac index < 1.8 L/min/m², SVR < 800 dynes/sec/cm⁻⁵
D) Cardiac index > 3.5, SVR normal
*B) Cardiac index < 2.2 L/min/m², SVR > 1200 dynes/sec/cm⁻⁵ *
Rationale: Cardiogenic shock is characterized by low cardiac output (cardiac
index < 2.2) with compensatory systemic vasoconstriction (high SVR). The
,body attempts to maintain blood pressure by increasing peripheral vascular
resistance .
3. A patient with an intra-aortic balloon pump (IABP) has a blood
pressure of 85/50, HR 110, and urine output 20 mL over 2 hours. The
nurse notes decreased augmentation on the IABP waveform. What is
the priority action?
A) Increase the IABP trigger sensitivity
B) Assess for proper timing and catheter position
C) Administer a fluid bolus
D) Notify the provider for possible balloon removal
*B) Assess for proper timing and catheter position *
Rationale: Decreased augmentation on the IABP waveform suggests timing
issues (early/late inflation or deflation) or catheter migration. The nurse
should assess the waveform before escalating interventions .
4. A patient post-cardiac arrest has return of spontaneous circulation
(ROSC). Which targeted temperature management (TTM) intervention
is appropriate?
A) Maintain core temperature at 37.5°C for 24 hours
B) Cool the patient to 32-36°C for 24 hours
C) Apply warming blankets immediately
D) Administer antipyretics to maintain normothermia
*B) Cool the patient to 32-36°C for 24 hours *
Rationale: Targeted temperature management (TTM) at 32-36°C for 24 hours
is recommended post-cardiac arrest to reduce neurological injury by
decreasing cerebral oxygen demand and inflammation .
,5. A patient with a new diagnosis of heart failure with reduced ejection
fraction (HFrEF) is started on carvedilol. The nurse knows that this
medication should be:
A) Held if heart rate < 70
B) Started at a low dose and titrated slowly
C) Given with a full meal to increase absorption
D) Avoided if patient has diabetes
*B) Started at a low dose and titrated slowly *
Rationale: Beta-blockers in HFrEF require low, slow initiation to prevent acute
decompensation. Heart rate target is > 55-60 bpm. Carvedilol is beneficial
even in diabetic patients .
6. A patient with a temporary transvenous pacemaker has a heart rate
of 50 and no pacing spikes seen. The nurse should first:
A) Increase the mA output
B) Change the battery
C) Check connections and pacing threshold
D) Prepare for emergent transcutaneous pacing
*C) Check connections and pacing threshold *
Rationale: Loss of capture is often due to loose connections, lead
dislodgement, or increased threshold. The nurse should troubleshoot
connections first before escalating interventions .
7. Which lab value is most concerning in a patient receiving a
continuous heparin infusion for a pulmonary embolism?
, A) aPTT 85 seconds (goal 60-80)
B) Platelets 90,000/µL (baseline 220,000)
C) INR 1.2
D) Hemoglobin 11 g/dL
*B) Platelets 90,000/µL (baseline 220,000) *
Rationale: A drop in platelets > 50% from baseline or an absolute count <
100,000 suggests heparin-induced thrombocytopenia (HIT). Heparin should
be stopped immediately if HIT is suspected .
8. A patient with acute myocardial infarction develops a new harsh
holosystolic murmur at the apex. The nurse suspects:
A) Ventricular septal rupture
B) Papillary muscle rupture
C) Acute pericarditis
D) Aortic stenosis
*B) Papillary muscle rupture *
Rationale: Papillary muscle rupture causes acute mitral regurgitation,
presenting with a holosystolic murmur at the apex that radiates to the axilla.
Ventricular septal rupture presents with a harsh murmur at the left sternal
border .
9. A patient with acute pericarditis has a friction rub on exam. Which
instruction is most important?
A) "Lie flat to reduce pain"
B) "Sit up and lean forward"
C) "Avoid ibuprofen due to bleeding risk"
D) "Restrict all activity until rub resolves"
Exam 1 Practice Test 2026
Questions with Correct Answers and Rationales
1. A patient with acute decompensated heart failure (ADHF) has
crackles in both lungs, an S3 gallop, and oxygen saturation of 88% on
2 L nasal cannula. Which intervention should the nurse implement
first?
A) Administer furosemide IV push
B) Place the patient in high-Fowler's position
C) Start a nitroglycerin drip
D) Draw BNP and troponin levels
*B) Place the patient in high-Fowler's position *
Rationale: Positioning is the immediate, non-invasive intervention that
reduces preload and improves oxygenation by decreasing venous return and
allowing better lung expansion. Diuretics and nitroglycerin follow after
positioning .
2. Which hemodynamic parameter is most consistent with cardiogenic
shock?
A) Cardiac index > 4.0 L/min/m², SVR < 600 dynes/sec/cm⁻⁵
B) Cardiac index < 2.2 L/min/m², SVR > 1200 dynes/sec/cm⁻⁵
C) Cardiac index < 1.8 L/min/m², SVR < 800 dynes/sec/cm⁻⁵
D) Cardiac index > 3.5, SVR normal
*B) Cardiac index < 2.2 L/min/m², SVR > 1200 dynes/sec/cm⁻⁵ *
Rationale: Cardiogenic shock is characterized by low cardiac output (cardiac
index < 2.2) with compensatory systemic vasoconstriction (high SVR). The
,body attempts to maintain blood pressure by increasing peripheral vascular
resistance .
3. A patient with an intra-aortic balloon pump (IABP) has a blood
pressure of 85/50, HR 110, and urine output 20 mL over 2 hours. The
nurse notes decreased augmentation on the IABP waveform. What is
the priority action?
A) Increase the IABP trigger sensitivity
B) Assess for proper timing and catheter position
C) Administer a fluid bolus
D) Notify the provider for possible balloon removal
*B) Assess for proper timing and catheter position *
Rationale: Decreased augmentation on the IABP waveform suggests timing
issues (early/late inflation or deflation) or catheter migration. The nurse
should assess the waveform before escalating interventions .
4. A patient post-cardiac arrest has return of spontaneous circulation
(ROSC). Which targeted temperature management (TTM) intervention
is appropriate?
A) Maintain core temperature at 37.5°C for 24 hours
B) Cool the patient to 32-36°C for 24 hours
C) Apply warming blankets immediately
D) Administer antipyretics to maintain normothermia
*B) Cool the patient to 32-36°C for 24 hours *
Rationale: Targeted temperature management (TTM) at 32-36°C for 24 hours
is recommended post-cardiac arrest to reduce neurological injury by
decreasing cerebral oxygen demand and inflammation .
,5. A patient with a new diagnosis of heart failure with reduced ejection
fraction (HFrEF) is started on carvedilol. The nurse knows that this
medication should be:
A) Held if heart rate < 70
B) Started at a low dose and titrated slowly
C) Given with a full meal to increase absorption
D) Avoided if patient has diabetes
*B) Started at a low dose and titrated slowly *
Rationale: Beta-blockers in HFrEF require low, slow initiation to prevent acute
decompensation. Heart rate target is > 55-60 bpm. Carvedilol is beneficial
even in diabetic patients .
6. A patient with a temporary transvenous pacemaker has a heart rate
of 50 and no pacing spikes seen. The nurse should first:
A) Increase the mA output
B) Change the battery
C) Check connections and pacing threshold
D) Prepare for emergent transcutaneous pacing
*C) Check connections and pacing threshold *
Rationale: Loss of capture is often due to loose connections, lead
dislodgement, or increased threshold. The nurse should troubleshoot
connections first before escalating interventions .
7. Which lab value is most concerning in a patient receiving a
continuous heparin infusion for a pulmonary embolism?
, A) aPTT 85 seconds (goal 60-80)
B) Platelets 90,000/µL (baseline 220,000)
C) INR 1.2
D) Hemoglobin 11 g/dL
*B) Platelets 90,000/µL (baseline 220,000) *
Rationale: A drop in platelets > 50% from baseline or an absolute count <
100,000 suggests heparin-induced thrombocytopenia (HIT). Heparin should
be stopped immediately if HIT is suspected .
8. A patient with acute myocardial infarction develops a new harsh
holosystolic murmur at the apex. The nurse suspects:
A) Ventricular septal rupture
B) Papillary muscle rupture
C) Acute pericarditis
D) Aortic stenosis
*B) Papillary muscle rupture *
Rationale: Papillary muscle rupture causes acute mitral regurgitation,
presenting with a holosystolic murmur at the apex that radiates to the axilla.
Ventricular septal rupture presents with a harsh murmur at the left sternal
border .
9. A patient with acute pericarditis has a friction rub on exam. Which
instruction is most important?
A) "Lie flat to reduce pain"
B) "Sit up and lean forward"
C) "Avoid ibuprofen due to bleeding risk"
D) "Restrict all activity until rub resolves"
