THORACIC TRAUMA: TNS CERTIFICATION
PRACTICE EXAM QUESTIONS AND ANSWERS
100% CORRECT!
This document provides advanced practice questions focused on thoracic trauma for Trauma
Nurse Specialist (TNS) exam preparation. These questions emphasize clinical judgment,
pathophysiology, and rapid intervention.
Table of Contents
1. Section 1: Practice Questions (1–30)
2. Section 2: Answer Key
3. Section 3: High-Yield Thoracic Trauma Review
Section 1: Questions 1–30
Question 1. A 35-year-old female is brought to the ED after a steering wheel impact. She is in
respiratory distress, has absent breath sounds on the right, and her trachea is deviated to the
left. Her blood pressure is $78/40\text{ mmHg}$. What is the priority intervention?
A. Immediate endotracheal intubation.
B. Obtain a portable chest X-ray to confirm the diagnosis.
C. Perform a needle decompression in the 4th or 5th intercostal space, mid-axillary line.
D. Insert a $36\text{ French}$ chest tube in the right mid-clavicular line.
Correct Answer: C. Perform a needle decompression in the 4th or 5th intercostal space,
mid-axillary line.
Rationale:
1. Why the correct answer is best: The patient exhibits signs of a tension pneumothorax
(respiratory distress, absent breath sounds, tracheal deviation, and hypotension). This is
a clinical diagnosis, and needle decompression is the immediate life-saving treatment to
relieve pressure before a formal chest tube is placed.
2. Why each incorrect option is less appropriate: X-ray should never delay treatment for
a suspected tension pneumothorax. Intubation does not solve the pressure problem and
, can actually worsen a tension pneumothorax. A chest tube is the definitive treatment, but
needle decompression is faster for immediate stabilization.
3. Key Trauma Principle: Tension pneumothorax is a clinical diagnosis; decompression
must occur prior to imaging.
Question 2. A patient is admitted with a "sucking chest wound" following a stabbing. The nurse
has applied a non-porous dressing taped on three sides. During assessment, the patient
develops sudden severe dyspnea and tachycardia. What should the nurse do first?
A. Apply a fourth side of tape to create a seal.
B. Remove the dressing completely.
C. Increase the oxygen flow rate.
D. Assist with a STAT needle thoracostomy.
Correct Answer: B. Remove the dressing completely.
Rationale:
1. Why the correct answer is best: If a patient with an open pneumothorax (sucking chest
wound) worsens after a 3-sided dressing is applied, the dressing may be acting as an
occlusive seal, converting the open pneumothorax into a tension pneumothorax.
Removing the dressing allows the trapped air to escape.
2. Why each incorrect option is less appropriate: Taping the fourth side would
guarantee a tension pneumothorax. Oxygen does not address the underlying
mechanical pressure.
3. Key Trauma Principle: Occlusive dressings on the chest require constant vigilance for
the development of tension physiology.
Question 3. A patient with a massive hemothorax has a chest tube inserted, and $1600\text{
mL}$ of blood is immediately evacuated. What is the most appropriate next step in
management?
A. Clamp the chest tube to prevent further blood loss.
B. Monitor the patient for the next 4 hours for any additional drainage.
C. Prepare the patient for an emergency thoracotomy.
D. Administer a $2\text{ liter}$ bolus of normal saline.
Correct Answer: C. Prepare the patient for an emergency thoracotomy.
Rationale:
, 1. Why the correct answer is best: Indications for urgent thoracotomy in hemothorax
include an initial output of $> 1500\text{ mL}$ of blood or continued drainage of $>
200\text{ mL/hr}$ for 2–4 hours.
2. Why each incorrect option is less appropriate: Clamping the tube would cause a
tension hemothorax. Monitoring is insufficient given the massive volume loss. Fluid
resuscitation is needed, but the source of the hemorrhage must be surgically addressed.
3. Key Trauma Principle: Specific volume thresholds in chest tube drainage guide the
decision for operative intervention.
Question 4. An elderly patient fell and sustained fractures of ribs 7 through 10 on the left side.
The nurse should be most concerned about potential injury to which organ?
A. Liver B. Spleen C. Heart D. Gallbladder
Correct Answer: B. Spleen
Rationale:
1. Why the correct answer is best: The lower ribs protect the solid organs of the upper
abdomen. Fractures of the left lower ribs (9–11) are highly associated with splenic injury.
2. Why each incorrect option is less appropriate: The liver is on the right side. The
heart is superior to these ribs. The gallbladder is also on the right.
3. Key Trauma Principle: Rib fracture locations are predictive markers for underlying solid
organ injury.
Question 5. A patient presents with muffled heart tones, jugular venous distention (JVD), and
hypotension after blunt chest trauma. Breath sounds are equal bilaterally. Which condition is
most likely?
A. Tension pneumothorax
B. Cardiac tamponade
C. Massive hemothorax
D. Myocardial infarction
Correct Answer: B. Cardiac tamponade
Rationale:
1. Why the correct answer is best: These three signs (muffled heart tones, JVD, and
hypotension) constitute Beck's Triad, which is classic for cardiac tamponade. The
presence of equal breath sounds helps rule out tension pneumothorax.
PRACTICE EXAM QUESTIONS AND ANSWERS
100% CORRECT!
This document provides advanced practice questions focused on thoracic trauma for Trauma
Nurse Specialist (TNS) exam preparation. These questions emphasize clinical judgment,
pathophysiology, and rapid intervention.
Table of Contents
1. Section 1: Practice Questions (1–30)
2. Section 2: Answer Key
3. Section 3: High-Yield Thoracic Trauma Review
Section 1: Questions 1–30
Question 1. A 35-year-old female is brought to the ED after a steering wheel impact. She is in
respiratory distress, has absent breath sounds on the right, and her trachea is deviated to the
left. Her blood pressure is $78/40\text{ mmHg}$. What is the priority intervention?
A. Immediate endotracheal intubation.
B. Obtain a portable chest X-ray to confirm the diagnosis.
C. Perform a needle decompression in the 4th or 5th intercostal space, mid-axillary line.
D. Insert a $36\text{ French}$ chest tube in the right mid-clavicular line.
Correct Answer: C. Perform a needle decompression in the 4th or 5th intercostal space,
mid-axillary line.
Rationale:
1. Why the correct answer is best: The patient exhibits signs of a tension pneumothorax
(respiratory distress, absent breath sounds, tracheal deviation, and hypotension). This is
a clinical diagnosis, and needle decompression is the immediate life-saving treatment to
relieve pressure before a formal chest tube is placed.
2. Why each incorrect option is less appropriate: X-ray should never delay treatment for
a suspected tension pneumothorax. Intubation does not solve the pressure problem and
, can actually worsen a tension pneumothorax. A chest tube is the definitive treatment, but
needle decompression is faster for immediate stabilization.
3. Key Trauma Principle: Tension pneumothorax is a clinical diagnosis; decompression
must occur prior to imaging.
Question 2. A patient is admitted with a "sucking chest wound" following a stabbing. The nurse
has applied a non-porous dressing taped on three sides. During assessment, the patient
develops sudden severe dyspnea and tachycardia. What should the nurse do first?
A. Apply a fourth side of tape to create a seal.
B. Remove the dressing completely.
C. Increase the oxygen flow rate.
D. Assist with a STAT needle thoracostomy.
Correct Answer: B. Remove the dressing completely.
Rationale:
1. Why the correct answer is best: If a patient with an open pneumothorax (sucking chest
wound) worsens after a 3-sided dressing is applied, the dressing may be acting as an
occlusive seal, converting the open pneumothorax into a tension pneumothorax.
Removing the dressing allows the trapped air to escape.
2. Why each incorrect option is less appropriate: Taping the fourth side would
guarantee a tension pneumothorax. Oxygen does not address the underlying
mechanical pressure.
3. Key Trauma Principle: Occlusive dressings on the chest require constant vigilance for
the development of tension physiology.
Question 3. A patient with a massive hemothorax has a chest tube inserted, and $1600\text{
mL}$ of blood is immediately evacuated. What is the most appropriate next step in
management?
A. Clamp the chest tube to prevent further blood loss.
B. Monitor the patient for the next 4 hours for any additional drainage.
C. Prepare the patient for an emergency thoracotomy.
D. Administer a $2\text{ liter}$ bolus of normal saline.
Correct Answer: C. Prepare the patient for an emergency thoracotomy.
Rationale:
, 1. Why the correct answer is best: Indications for urgent thoracotomy in hemothorax
include an initial output of $> 1500\text{ mL}$ of blood or continued drainage of $>
200\text{ mL/hr}$ for 2–4 hours.
2. Why each incorrect option is less appropriate: Clamping the tube would cause a
tension hemothorax. Monitoring is insufficient given the massive volume loss. Fluid
resuscitation is needed, but the source of the hemorrhage must be surgically addressed.
3. Key Trauma Principle: Specific volume thresholds in chest tube drainage guide the
decision for operative intervention.
Question 4. An elderly patient fell and sustained fractures of ribs 7 through 10 on the left side.
The nurse should be most concerned about potential injury to which organ?
A. Liver B. Spleen C. Heart D. Gallbladder
Correct Answer: B. Spleen
Rationale:
1. Why the correct answer is best: The lower ribs protect the solid organs of the upper
abdomen. Fractures of the left lower ribs (9–11) are highly associated with splenic injury.
2. Why each incorrect option is less appropriate: The liver is on the right side. The
heart is superior to these ribs. The gallbladder is also on the right.
3. Key Trauma Principle: Rib fracture locations are predictive markers for underlying solid
organ injury.
Question 5. A patient presents with muffled heart tones, jugular venous distention (JVD), and
hypotension after blunt chest trauma. Breath sounds are equal bilaterally. Which condition is
most likely?
A. Tension pneumothorax
B. Cardiac tamponade
C. Massive hemothorax
D. Myocardial infarction
Correct Answer: B. Cardiac tamponade
Rationale:
1. Why the correct answer is best: These three signs (muffled heart tones, JVD, and
hypotension) constitute Beck's Triad, which is classic for cardiac tamponade. The
presence of equal breath sounds helps rule out tension pneumothorax.
