Emergency Nursing Practice Exam –
Trauma & Acute Care Review
Section 1: Triage & Initial Assessment (Questions
1-25)
1. The emergency nurse is triaging patients following a mass casualty incident. Which patient should
be assigned the highest priority (Red tag)?
A) A patient with a minor laceration and stable vital signs
B) A patient with a tension pneumothorax and respiratory distress
C) A patient with a closed femur fracture and intact pulses
D) A patient with minor abrasions and no systemic symptoms
Answer: B) A patient with a tension pneumothorax and respiratory distress
Rationale: In mass casualty triage, the Red tag (immediate) is assigned to patients with life-threatening
conditions that are treatable, such as tension pneumothorax, airway obstruction, or severe hemorrhage.
Green tags are for minor injuries, Yellow for delayed, and Black for deceased or expectant.
2. The nurse is assessing a trauma patient. Which finding is a priority in the primary survey?
A) Capillary refill time of 3 seconds
B) Respiratory rate of 28 breaths/min
C) Displacement of the trachea
D) Abrasion on the left arm
Answer: C) Displacement of the trachea
Rationale: The primary survey follows the ABCDE approach: Airway, Breathing, Circulation, Disability,
Exposure. Tracheal deviation is a late sign of tension pneumothorax, a life-threatening condition
requiring immediate decompression. This takes priority over other findings.
3. The nurse is assessing a patient with a suspected spinal cord injury. Which immobilization device
should be applied?
A) Hard cervical collar and long backboard
B) Soft cervical collar
C) Head immobilizer only
, D) No immobilization needed
Answer: A) Hard cervical collar and long backboard
Rationale: Patients with suspected spinal cord injury should be immobilized with a hard cervical collar
and a long backboard to prevent further spinal cord damage. The patient should be log-rolled for
placement on the board.
4. The nurse is assessing an unconscious patient who was involved in a motor vehicle accident. Which
Glasgow Coma Scale (GCS) score indicates a severe head injury?
A) 15
B) 12
C) 8
D) 5
Answer: D) 5
Rationale: A GCS score of 3-8 indicates severe head injury. A score of 9-12 indicates moderate injury, and
13-15 indicates mild injury. A GCS of 5 indicates deep coma requiring immediate intervention.
5. The nurse is performing a FAST (Focused Assessment with Sonography for Trauma) exam. Which
finding indicates a positive FAST exam?
A) Free fluid in the peritoneal cavity
B) Aortic dissection
C) Pulmonary contusion
D) Intracranial hemorrhage
Answer: A) Free fluid in the peritoneal cavity
Rationale: The FAST exam is used in trauma to detect free fluid (blood) in the peritoneal cavity,
pericardial sac, or pleural space. A positive FAST exam indicates intra-abdominal bleeding and may
require surgical intervention.
6. The nurse is assessing a patient with a gunshot wound to the chest. Which finding indicates a
tension pneumothorax?
A) Tracheal deviation to the contralateral side
B) Tracheal deviation to the ipsilateral side
C) Subcutaneous emphysema
D) Decreased breath sounds on the contralateral side
Answer: A) Tracheal deviation to the contralateral side
Rationale: Tension pneumothorax causes pressure in the pleural space, shifting the mediastinum and
trachea to the opposite (contralateral) side. This is a life-threatening emergency requiring needle
decompression.
,7. The nurse is assessing a patient who was in a motor vehicle accident. The patient has abdominal
tenderness and a positive FAST exam. Which injury is suspected?
A) Blunt abdominal trauma with intra-abdominal bleeding
B) Penetrating trauma
C) Pelvic fracture
D) Spinal cord injury
Answer: A) Blunt abdominal trauma with intra-abdominal bleeding
Rationale: A positive FAST exam in a patient with abdominal tenderness and a history of blunt trauma
suggests intra-abdominal bleeding from organ injury (spleen, liver, or bowel). Immediate surgical
consultation is needed.
8. The nurse is performing a primary survey on a trauma patient. Which step follows "Circulation" in
the ABCDE algorithm?
A) Airway
B) Breathing
C) Disability
D) Exposure
Answer: C) Disability
Rationale: The ABCDE algorithm stands for Airway (with cervical spine protection), Breathing,
Circulation, Disability (neurological assessment), and Exposure/Environmental control. Circulation
includes hemorrhage control and IV access.
9. The nurse is assessing a patient with a flail chest. Which finding is characteristic?
A) Paradoxical chest wall movement
B) Tracheal deviation
C) Subcutaneous emphysema
D) Absent breath sounds
Answer: A) Paradoxical chest wall movement
Rationale: Flail chest occurs when multiple rib fractures cause a segment of the chest wall to move
paradoxically (inward during inspiration, outward during expiration). This is often associated with
pulmonary contusion and may require mechanical ventilation.
10. The nurse is caring for a patient who has sustained a penetrating neck injury. Which finding is
most concerning?
A) Expanding hematoma
B) Laceration with bleeding
, C) Pain on palpation
D) Mild swelling
Answer: A) Expanding hematoma
Rationale: An expanding hematoma in a penetrating neck injury indicates active bleeding and possible
vascular injury. This requires immediate surgical intervention to prevent airway compromise and
exsanguination.
11. The nurse is assessing a patient with a suspected pelvic fracture. Which finding is most
concerning?
A) Pain and swelling in the pelvic area
B) Blood at the urethral meatus
C) Instability on pelvic compression
D) All of the above
Answer: D) All of the above
Rationale: Pelvic fractures can cause significant hemorrhage. Signs include pain, swelling, instability, and
blood at the urethral meatus (indicating urethral injury). Pelvic stabilization is essential to prevent
further bleeding.
12. The nurse is administering a tetanus vaccine to a patient with a laceration. Which patient requires
tetanus prophylaxis?
A) A patient with a clean, minor wound who had a tetanus shot 5 years ago
B) A patient with a contaminated wound who had a tetanus shot 10 years ago
C) A patient with a clean wound who had a tetanus shot 2 years ago
D) A patient with no previous tetanus immunization
Answer: B) A patient with a contaminated wound who had a tetanus shot 10 years ago
Rationale: Tetanus prophylaxis is recommended for patients with contaminated wounds if their last
tetanus shot was >5 years ago. For clean, minor wounds, prophylaxis is recommended if >10 years have
passed. Patients with no previous immunization need tetanus immunoglobulin.
13. The nurse is assessing a patient who has sustained a crush injury to the leg. Which finding
indicates compartment syndrome?
A) Pain out of proportion to injury
B) Pulselessness
C) Paresthesia
D) All of the above
Trauma & Acute Care Review
Section 1: Triage & Initial Assessment (Questions
1-25)
1. The emergency nurse is triaging patients following a mass casualty incident. Which patient should
be assigned the highest priority (Red tag)?
A) A patient with a minor laceration and stable vital signs
B) A patient with a tension pneumothorax and respiratory distress
C) A patient with a closed femur fracture and intact pulses
D) A patient with minor abrasions and no systemic symptoms
Answer: B) A patient with a tension pneumothorax and respiratory distress
Rationale: In mass casualty triage, the Red tag (immediate) is assigned to patients with life-threatening
conditions that are treatable, such as tension pneumothorax, airway obstruction, or severe hemorrhage.
Green tags are for minor injuries, Yellow for delayed, and Black for deceased or expectant.
2. The nurse is assessing a trauma patient. Which finding is a priority in the primary survey?
A) Capillary refill time of 3 seconds
B) Respiratory rate of 28 breaths/min
C) Displacement of the trachea
D) Abrasion on the left arm
Answer: C) Displacement of the trachea
Rationale: The primary survey follows the ABCDE approach: Airway, Breathing, Circulation, Disability,
Exposure. Tracheal deviation is a late sign of tension pneumothorax, a life-threatening condition
requiring immediate decompression. This takes priority over other findings.
3. The nurse is assessing a patient with a suspected spinal cord injury. Which immobilization device
should be applied?
A) Hard cervical collar and long backboard
B) Soft cervical collar
C) Head immobilizer only
, D) No immobilization needed
Answer: A) Hard cervical collar and long backboard
Rationale: Patients with suspected spinal cord injury should be immobilized with a hard cervical collar
and a long backboard to prevent further spinal cord damage. The patient should be log-rolled for
placement on the board.
4. The nurse is assessing an unconscious patient who was involved in a motor vehicle accident. Which
Glasgow Coma Scale (GCS) score indicates a severe head injury?
A) 15
B) 12
C) 8
D) 5
Answer: D) 5
Rationale: A GCS score of 3-8 indicates severe head injury. A score of 9-12 indicates moderate injury, and
13-15 indicates mild injury. A GCS of 5 indicates deep coma requiring immediate intervention.
5. The nurse is performing a FAST (Focused Assessment with Sonography for Trauma) exam. Which
finding indicates a positive FAST exam?
A) Free fluid in the peritoneal cavity
B) Aortic dissection
C) Pulmonary contusion
D) Intracranial hemorrhage
Answer: A) Free fluid in the peritoneal cavity
Rationale: The FAST exam is used in trauma to detect free fluid (blood) in the peritoneal cavity,
pericardial sac, or pleural space. A positive FAST exam indicates intra-abdominal bleeding and may
require surgical intervention.
6. The nurse is assessing a patient with a gunshot wound to the chest. Which finding indicates a
tension pneumothorax?
A) Tracheal deviation to the contralateral side
B) Tracheal deviation to the ipsilateral side
C) Subcutaneous emphysema
D) Decreased breath sounds on the contralateral side
Answer: A) Tracheal deviation to the contralateral side
Rationale: Tension pneumothorax causes pressure in the pleural space, shifting the mediastinum and
trachea to the opposite (contralateral) side. This is a life-threatening emergency requiring needle
decompression.
,7. The nurse is assessing a patient who was in a motor vehicle accident. The patient has abdominal
tenderness and a positive FAST exam. Which injury is suspected?
A) Blunt abdominal trauma with intra-abdominal bleeding
B) Penetrating trauma
C) Pelvic fracture
D) Spinal cord injury
Answer: A) Blunt abdominal trauma with intra-abdominal bleeding
Rationale: A positive FAST exam in a patient with abdominal tenderness and a history of blunt trauma
suggests intra-abdominal bleeding from organ injury (spleen, liver, or bowel). Immediate surgical
consultation is needed.
8. The nurse is performing a primary survey on a trauma patient. Which step follows "Circulation" in
the ABCDE algorithm?
A) Airway
B) Breathing
C) Disability
D) Exposure
Answer: C) Disability
Rationale: The ABCDE algorithm stands for Airway (with cervical spine protection), Breathing,
Circulation, Disability (neurological assessment), and Exposure/Environmental control. Circulation
includes hemorrhage control and IV access.
9. The nurse is assessing a patient with a flail chest. Which finding is characteristic?
A) Paradoxical chest wall movement
B) Tracheal deviation
C) Subcutaneous emphysema
D) Absent breath sounds
Answer: A) Paradoxical chest wall movement
Rationale: Flail chest occurs when multiple rib fractures cause a segment of the chest wall to move
paradoxically (inward during inspiration, outward during expiration). This is often associated with
pulmonary contusion and may require mechanical ventilation.
10. The nurse is caring for a patient who has sustained a penetrating neck injury. Which finding is
most concerning?
A) Expanding hematoma
B) Laceration with bleeding
, C) Pain on palpation
D) Mild swelling
Answer: A) Expanding hematoma
Rationale: An expanding hematoma in a penetrating neck injury indicates active bleeding and possible
vascular injury. This requires immediate surgical intervention to prevent airway compromise and
exsanguination.
11. The nurse is assessing a patient with a suspected pelvic fracture. Which finding is most
concerning?
A) Pain and swelling in the pelvic area
B) Blood at the urethral meatus
C) Instability on pelvic compression
D) All of the above
Answer: D) All of the above
Rationale: Pelvic fractures can cause significant hemorrhage. Signs include pain, swelling, instability, and
blood at the urethral meatus (indicating urethral injury). Pelvic stabilization is essential to prevent
further bleeding.
12. The nurse is administering a tetanus vaccine to a patient with a laceration. Which patient requires
tetanus prophylaxis?
A) A patient with a clean, minor wound who had a tetanus shot 5 years ago
B) A patient with a contaminated wound who had a tetanus shot 10 years ago
C) A patient with a clean wound who had a tetanus shot 2 years ago
D) A patient with no previous tetanus immunization
Answer: B) A patient with a contaminated wound who had a tetanus shot 10 years ago
Rationale: Tetanus prophylaxis is recommended for patients with contaminated wounds if their last
tetanus shot was >5 years ago. For clean, minor wounds, prophylaxis is recommended if >10 years have
passed. Patients with no previous immunization need tetanus immunoglobulin.
13. The nurse is assessing a patient who has sustained a crush injury to the leg. Which finding
indicates compartment syndrome?
A) Pain out of proportion to injury
B) Pulselessness
C) Paresthesia
D) All of the above
