TRAUMA NURSE SPECIALIST (TNS) CERTIFICATION:
TRAUMA ASSESSMENT & INITIAL RESUSCITATION
PRACTICE TEST
Section 1: Questions 1–30
Question 1.
An adult male involved in a high-speed motor vehicle collision is brought into the trauma bay. He
is intubated, sedated, and paralyzed in the field. During your primary survey, you note absent
breath sounds on the left side, tracheal deviation to the right, and acute hemodynamic instability
with a blood pressure of 78/42 mmHg. What is the immediate priority nursing intervention?
A. Perform needle decompression at the second intercostal space, midclavicular line, on the left
side. B. Immediately obtain a stat portable chest radiograph to confirm a tension pneumothorax.
C. Prepare for emergency intubation and check tube placement for a right mainstem intubation.
D. Administer a 1,000 mL rapid bolus of warmed lactated Ringer's solution under pressure.
Correct Answer: A Rationale:
1. Why the correct answer is best: The patient exhibits classic clinical indicators of a
tension pneumothorax (absent breath sounds, tracheal deviation, and obstructive shock
hypotension). A tension pneumothorax is a life-threatening clinical diagnosis that
requires immediate needle decompression without waiting for radiological confirmation.
2. Why each incorrect option is less appropriate: Option B delays lifesaving intervention for
imaging, which is dangerous in unstable patients. Option C focuses on tube positioning,
but the physical signs point directly to pleural air accumulation rather than mainstem
placement. Option D attempts to treat obstructive shock with fluids, which will not relieve
intrathoracic pressure or restore venous return.
3. Key trauma-care principle: Treating tension pneumothorax based on clinical findings
rather than diagnostic imaging during the primary survey.
Question 2.
A trauma nurse is managing an obtunded patient following an assault with a baseball bat to the
face. The patient has massive midface instability, active hemorrhage into the oropharynx, and
gurgling respirations with an oxygen saturation of 84%. Attempts at blind nasotracheal
intubation are unsuccessful. What is the most appropriate next intervention?
,A. Insert a dual-lumen esophageal obturator airway device. B. Perform an immediate surgical or
percutaneous cricothyroidotomy. C. Apply high-flow nasal cannula oxygen at 15 L/min and
logroll the patient. D. Administer a neuromuscular blocking agent and perform rapid sequence
intubation via direct laryngoscopy.
Correct Answer: B Rationale:
1. Why the correct answer is best: This represents a classic "cannot intubate, cannot
oxygenate" (CICO) scenario accompanied by severe midface disruption (which rules out
nasotracheal routes) and airway obstruction. A surgical or percutaneous
cricothyroidotomy is the definitive rescue airway intervention of choice.
2. Why each incorrect option is less appropriate: Option A is outdated and inadequate for
managing complex airway protection in major trauma. Option C fails to address the
anatomical obstruction and hypoxia. Option D using oral direct laryngoscopy in severe
midface trauma can worsen hemorrhage and anatomical distortion, increasing the risk of
complete airway failure.
3. Key trauma-care principle: Establishing a surgical airway when upper airway anatomy is
disrupted and standard or blind intubation techniques fail.
Question 3.
A multi-trauma patient is admitted following a fall from a 30-foot scaffolding. During the
secondary survey, you note that the patient has lost all deep tendon reflexes, is flaccid, and
exhibits a blood pressure of 80/50 mmHg with a heart rate of 58 beats per minute. Skin is warm
and dry. What type of shock is this patient experiencing, and what is the primary management
goal?
A. Hypovolemic shock; aggressive crystalloid resuscitation targeting normotension. B.
Cardiogenic shock; administration of inotropic agents and volume restriction. C. Neurogenic
shock; maintenance of spinal cord perfusion via vasopressors and fluid balance. D. Septic
shock; immediate broad-spectrum antibiotic initiation and blood cultures.
Correct Answer: C Rationale:
1. Why the correct answer is best: The presentation of hypotension paired with
bradycardia, warm/dry skin, and areflexia below the level of injury is classic for
neurogenic shock secondary to high spinal cord injury. Management centers on restoring
perfusion to the spinal cord using vasopressors and judicious fluid resuscitation.
2. Why each incorrect option is less appropriate: Option A misidentifies the shock type;
neurogenic shock involves distributive vasodilation, not pure volume loss, and excessive
fluids can cause pulmonary edema. Option B describes heart failure, which does not
match the warm skin or spinal history. Option D pertains to infection-related shock, which
does not occur acutely within minutes of trauma.
, 3. Key trauma-care principle: Recognizing distributive shock characterized by the loss of
sympathetic tone and managing it with targeted volume and vasopressor support to
protect spinal cord perfusion.
Question 4.
A patient is brought in after an explosion injury. They have sustained multiple traumatic injuries,
are actively bleeding from a lower extremity wound, and have a core body temperature of 34.2
degrees Celsius (93.5 degrees Fahrenheit). Laboratory draws reveal a worsening metabolic
acidosis. Which component of the lethal triad of trauma is this patient exhibiting, and what
physiological cascade does it trigger?
A. Coagulopathy; leads directly to rapid platelet consumption and bone marrow failure. B.
Hypothermia; inhibits the enzymatic reactions of the coagulation cascade, worsening bleeding.
C. Acidosis; causes direct mechanical destruction of red blood cell membranes. D.
Hyperglycemia; induces severe osmotic diuresis and intravascular volume depletion.
Correct Answer: B Rationale:
1. Why the correct answer is best: A core temperature below 35 degrees Celsius
constitutes hypothermia, which is one vertex of the lethal triad (hypothermia, acidosis,
coagulopathy). Hypothermia directly suppresses coagulation factor enzyme kinetics,
impairing clot formation and accelerating hemorrhage.
2. Why each incorrect option is less appropriate: Option A misattributes the primary cause
of hypothermia. Option C reverses cause and effect regarding acidosis and cell
destruction. Option D refers to metabolic alterations unrelated to the classic trauma triad
components.
3. Key trauma-care principle: Understanding and actively reversing the lethal triad of
trauma to prevent irreversible physiological collapse.
Question 5.
During the primary survey of a pedestrian struck by a car, you note a widened pulse pressure,
progressive bradycardia, and irregular respirations. The patient's Glasgow Coma Scale score
has dropped from 12 to 8 over 15 minutes. What pathological process is unfolding, and what
immediate nursing action should be avoided?
A. Cushing's triad indicating rising intracranial pressure; avoid hyperventilating the patient to
prophylactic extremes. B. Early neurogenic shock; avoid administering any intravenous
crystalloids. C. Hemorrhagic shock stage IV; avoid applying a pelvic binder. D. Transtentorial
uncal herniation; avoid maintaining a head-of-bed elevation.
Correct Answer: A Rationale:
TRAUMA ASSESSMENT & INITIAL RESUSCITATION
PRACTICE TEST
Section 1: Questions 1–30
Question 1.
An adult male involved in a high-speed motor vehicle collision is brought into the trauma bay. He
is intubated, sedated, and paralyzed in the field. During your primary survey, you note absent
breath sounds on the left side, tracheal deviation to the right, and acute hemodynamic instability
with a blood pressure of 78/42 mmHg. What is the immediate priority nursing intervention?
A. Perform needle decompression at the second intercostal space, midclavicular line, on the left
side. B. Immediately obtain a stat portable chest radiograph to confirm a tension pneumothorax.
C. Prepare for emergency intubation and check tube placement for a right mainstem intubation.
D. Administer a 1,000 mL rapid bolus of warmed lactated Ringer's solution under pressure.
Correct Answer: A Rationale:
1. Why the correct answer is best: The patient exhibits classic clinical indicators of a
tension pneumothorax (absent breath sounds, tracheal deviation, and obstructive shock
hypotension). A tension pneumothorax is a life-threatening clinical diagnosis that
requires immediate needle decompression without waiting for radiological confirmation.
2. Why each incorrect option is less appropriate: Option B delays lifesaving intervention for
imaging, which is dangerous in unstable patients. Option C focuses on tube positioning,
but the physical signs point directly to pleural air accumulation rather than mainstem
placement. Option D attempts to treat obstructive shock with fluids, which will not relieve
intrathoracic pressure or restore venous return.
3. Key trauma-care principle: Treating tension pneumothorax based on clinical findings
rather than diagnostic imaging during the primary survey.
Question 2.
A trauma nurse is managing an obtunded patient following an assault with a baseball bat to the
face. The patient has massive midface instability, active hemorrhage into the oropharynx, and
gurgling respirations with an oxygen saturation of 84%. Attempts at blind nasotracheal
intubation are unsuccessful. What is the most appropriate next intervention?
,A. Insert a dual-lumen esophageal obturator airway device. B. Perform an immediate surgical or
percutaneous cricothyroidotomy. C. Apply high-flow nasal cannula oxygen at 15 L/min and
logroll the patient. D. Administer a neuromuscular blocking agent and perform rapid sequence
intubation via direct laryngoscopy.
Correct Answer: B Rationale:
1. Why the correct answer is best: This represents a classic "cannot intubate, cannot
oxygenate" (CICO) scenario accompanied by severe midface disruption (which rules out
nasotracheal routes) and airway obstruction. A surgical or percutaneous
cricothyroidotomy is the definitive rescue airway intervention of choice.
2. Why each incorrect option is less appropriate: Option A is outdated and inadequate for
managing complex airway protection in major trauma. Option C fails to address the
anatomical obstruction and hypoxia. Option D using oral direct laryngoscopy in severe
midface trauma can worsen hemorrhage and anatomical distortion, increasing the risk of
complete airway failure.
3. Key trauma-care principle: Establishing a surgical airway when upper airway anatomy is
disrupted and standard or blind intubation techniques fail.
Question 3.
A multi-trauma patient is admitted following a fall from a 30-foot scaffolding. During the
secondary survey, you note that the patient has lost all deep tendon reflexes, is flaccid, and
exhibits a blood pressure of 80/50 mmHg with a heart rate of 58 beats per minute. Skin is warm
and dry. What type of shock is this patient experiencing, and what is the primary management
goal?
A. Hypovolemic shock; aggressive crystalloid resuscitation targeting normotension. B.
Cardiogenic shock; administration of inotropic agents and volume restriction. C. Neurogenic
shock; maintenance of spinal cord perfusion via vasopressors and fluid balance. D. Septic
shock; immediate broad-spectrum antibiotic initiation and blood cultures.
Correct Answer: C Rationale:
1. Why the correct answer is best: The presentation of hypotension paired with
bradycardia, warm/dry skin, and areflexia below the level of injury is classic for
neurogenic shock secondary to high spinal cord injury. Management centers on restoring
perfusion to the spinal cord using vasopressors and judicious fluid resuscitation.
2. Why each incorrect option is less appropriate: Option A misidentifies the shock type;
neurogenic shock involves distributive vasodilation, not pure volume loss, and excessive
fluids can cause pulmonary edema. Option B describes heart failure, which does not
match the warm skin or spinal history. Option D pertains to infection-related shock, which
does not occur acutely within minutes of trauma.
, 3. Key trauma-care principle: Recognizing distributive shock characterized by the loss of
sympathetic tone and managing it with targeted volume and vasopressor support to
protect spinal cord perfusion.
Question 4.
A patient is brought in after an explosion injury. They have sustained multiple traumatic injuries,
are actively bleeding from a lower extremity wound, and have a core body temperature of 34.2
degrees Celsius (93.5 degrees Fahrenheit). Laboratory draws reveal a worsening metabolic
acidosis. Which component of the lethal triad of trauma is this patient exhibiting, and what
physiological cascade does it trigger?
A. Coagulopathy; leads directly to rapid platelet consumption and bone marrow failure. B.
Hypothermia; inhibits the enzymatic reactions of the coagulation cascade, worsening bleeding.
C. Acidosis; causes direct mechanical destruction of red blood cell membranes. D.
Hyperglycemia; induces severe osmotic diuresis and intravascular volume depletion.
Correct Answer: B Rationale:
1. Why the correct answer is best: A core temperature below 35 degrees Celsius
constitutes hypothermia, which is one vertex of the lethal triad (hypothermia, acidosis,
coagulopathy). Hypothermia directly suppresses coagulation factor enzyme kinetics,
impairing clot formation and accelerating hemorrhage.
2. Why each incorrect option is less appropriate: Option A misattributes the primary cause
of hypothermia. Option C reverses cause and effect regarding acidosis and cell
destruction. Option D refers to metabolic alterations unrelated to the classic trauma triad
components.
3. Key trauma-care principle: Understanding and actively reversing the lethal triad of
trauma to prevent irreversible physiological collapse.
Question 5.
During the primary survey of a pedestrian struck by a car, you note a widened pulse pressure,
progressive bradycardia, and irregular respirations. The patient's Glasgow Coma Scale score
has dropped from 12 to 8 over 15 minutes. What pathological process is unfolding, and what
immediate nursing action should be avoided?
A. Cushing's triad indicating rising intracranial pressure; avoid hyperventilating the patient to
prophylactic extremes. B. Early neurogenic shock; avoid administering any intravenous
crystalloids. C. Hemorrhagic shock stage IV; avoid applying a pelvic binder. D. Transtentorial
uncal herniation; avoid maintaining a head-of-bed elevation.
Correct Answer: A Rationale:
