TNS: TRAUMA NURSE SPECIALIST
CERTIFICATION
70 Comprehensive Exam Practice Questions & Verified Answers
Section 1: Initial Assessment, Airway, & Resuscitation
Q1: What is the primary priority during the initial assessment of a trauma patient
displaying massive external hemorrhage?
A) Administer high-flow nasal cannula oxygen
B) Apply direct pressure or a tourniquet to control life-threatening bleeding
C) Perform a rapid neurological examination
D) Obtain a 12-lead electrocardiogram
Answer: B) Apply direct pressure or a tourniquet to control life-threatening bleeding
Explanation: Under the MARCH protocol (Massive Hemorrhage, Airway, Respiration,
Circulation, Head/Hypothermia), active exsanguinating hemorrhage must be addressed before
managing the airway. Uncontrolled arterial bleeding can cause fatal shock within minutes.
Q2: Which physical finding distinguishes a tension pneumothorax from a simple
pneumothorax during the primary survey?
A) Unilateral diminished breath sounds
B) Severe hypotension and tracheal deviation away from the affected side
C) Tachypnea and localized pleuritic chest pain
D) Subcutaneous emphysema over the clavicle
Answer: B) Severe hypotension and tracheal deviation away from the affected side
Explanation: A tension pneumothorax creates continuous positive intrathoracic pressure that
shifts the mediastinum, compresses the superior vena cava, severely reduces venous return,
and leads to obstructive shock.
Q3: What immediate intervention is indicated for a patient with a tension pneumothorax
who demonstrates sudden hemodynamic collapse?
A) Emergent needle decompression or finger thoracostomy
B) Endotracheal intubation with positive pressure ventilation
,C) Immediate chest x-ray to confirm diagnoses
D) Rapid infusion of 2 liters of warmed normal saline
Answer: A) Emergent needle decompression or finger thoracostomy
Explanation: Tension pneumothorax is a clinical diagnosis requiring immediate decompression
without waiting for radiologic confirmation. Placing positive pressure ventilation before
decompressing will worsen the tension effect.
Q4: What physiological parameter measured via end-tidal CO2 (EtCO2) capnography
indicates effective chest compressions and successful return of spontaneous circulation
(ROSC)?
A) EtCO2 persistently below 10 mmHg
B) Sudden sustained increase in EtCO2 above 35-40 mmHg
C) Gradual decrease in EtCO2 waveform height
D) Complete loss of capnography square waveform
Answer: B) Sudden sustained increase in EtCO2 above 35-40 mmHg
Explanation: EtCO2 reflects pulmonary blood flow and metabolic output. A sudden rise in
EtCO2 during CPR signals restored spontaneous circulation and enhanced metabolic perfusion
to the lungs.
Q5: Which induction agent used in Rapid Sequence Intubation (RSI) is preferred for
hemodynamically unstable trauma patients due to its minimal impact on blood pressure?
A) Propofol
B) Etomidate or Ketamine
C) Midazolam
D) High-dose Thiopental
Answer: B) Etomidate or Ketamine
Explanation: Etomidate maintains cardiovascular stability with minimal vasodilation, while
Ketamine releases endogenous catecholamines that help maintain systemic vascular resistance
in hypovolemic patients.
Q6: What airway intervention is contraindicated in a patient with suspected basilar skull
fracture and extensive midface trauma?
A) Endotracheal intubation via direct laryngoscopy
B) Nasopharyngeal airway (NPA) insertion
C) Oropharyngeal airway (OPA) insertion in an unconscious patient
D) Surgical cricothyroidotomy
Answer: B) Nasopharyngeal airway (NPA) insertion
Explanation: Basilar skull fractures disrupt the cribriform plate. Inserting a nasopharyngeal
, airway or nasogastric tube risks accidental intracranial displacement through the fractured bony
floor.
Q7: What is the primary purpose of maintaining manual inline cervical spine stabilization
during airway management?
A) To keep the patient's head completely flexed
B) To prevent subluxation and secondary spinal cord injury during glottic visualization
C) To facilitate easier passage of a nasogastric tube
D) To reduce intracranial pressure during intubation
Answer: B) To prevent subluxation and secondary spinal cord injury during glottic visualization
Explanation: Laryngoscopy involves neck extension forces. Manual inline stabilization holds
the head and neck neutral, preventing movement of potentially unstable cervical spine fractures.
Q8: What condition is indicated by a widened pulse pressure, bradycardia, and irregular
respiratory patterns in a patient with severe traumatic brain injury?
A) Hypovolemic shock
B) Cushing's Triad signaling impending brain herniation
C) Neurogenic shock
D) Acute pulmonary embolism
Answer: B) Cushing's Triad signaling impending brain herniation
Explanation: Cushing's Triad (systolic hypertension with widened pulse pressure, reflex
bradycardia, and irregular respirations) is a late sign of markedly increased intracranial pressure
and impending brainstem herniation.
Q9: What initial fluid resuscitation strategy is recommended in hemorrhagic shock to
avoid disrupting early clot formation and worsening bleeding?
A) Aggressive crystalloid boluses to achieve a blood pressure of 140/90 mmHg
B) Permissive hypotension targeting a mean arterial pressure of 60-65 mmHg (or systolic
80-90 mmHg)
C) Continuous infusion of hypotonic D5W solution
D) Administering vasopressors prior to volume restoration
Answer: B) Permissive hypotension targeting a mean arterial pressure of 60-65 mmHg (or
systolic 80-90 mmHg)
Explanation: Permissive hypotension limits fluid resuscitation until active surgical hemorrhage
control is achieved. Excessive fluid administration raises pressure, dislodges immature clots,
dilutes coagulation factors, and worsens hypothermia.
CERTIFICATION
70 Comprehensive Exam Practice Questions & Verified Answers
Section 1: Initial Assessment, Airway, & Resuscitation
Q1: What is the primary priority during the initial assessment of a trauma patient
displaying massive external hemorrhage?
A) Administer high-flow nasal cannula oxygen
B) Apply direct pressure or a tourniquet to control life-threatening bleeding
C) Perform a rapid neurological examination
D) Obtain a 12-lead electrocardiogram
Answer: B) Apply direct pressure or a tourniquet to control life-threatening bleeding
Explanation: Under the MARCH protocol (Massive Hemorrhage, Airway, Respiration,
Circulation, Head/Hypothermia), active exsanguinating hemorrhage must be addressed before
managing the airway. Uncontrolled arterial bleeding can cause fatal shock within minutes.
Q2: Which physical finding distinguishes a tension pneumothorax from a simple
pneumothorax during the primary survey?
A) Unilateral diminished breath sounds
B) Severe hypotension and tracheal deviation away from the affected side
C) Tachypnea and localized pleuritic chest pain
D) Subcutaneous emphysema over the clavicle
Answer: B) Severe hypotension and tracheal deviation away from the affected side
Explanation: A tension pneumothorax creates continuous positive intrathoracic pressure that
shifts the mediastinum, compresses the superior vena cava, severely reduces venous return,
and leads to obstructive shock.
Q3: What immediate intervention is indicated for a patient with a tension pneumothorax
who demonstrates sudden hemodynamic collapse?
A) Emergent needle decompression or finger thoracostomy
B) Endotracheal intubation with positive pressure ventilation
,C) Immediate chest x-ray to confirm diagnoses
D) Rapid infusion of 2 liters of warmed normal saline
Answer: A) Emergent needle decompression or finger thoracostomy
Explanation: Tension pneumothorax is a clinical diagnosis requiring immediate decompression
without waiting for radiologic confirmation. Placing positive pressure ventilation before
decompressing will worsen the tension effect.
Q4: What physiological parameter measured via end-tidal CO2 (EtCO2) capnography
indicates effective chest compressions and successful return of spontaneous circulation
(ROSC)?
A) EtCO2 persistently below 10 mmHg
B) Sudden sustained increase in EtCO2 above 35-40 mmHg
C) Gradual decrease in EtCO2 waveform height
D) Complete loss of capnography square waveform
Answer: B) Sudden sustained increase in EtCO2 above 35-40 mmHg
Explanation: EtCO2 reflects pulmonary blood flow and metabolic output. A sudden rise in
EtCO2 during CPR signals restored spontaneous circulation and enhanced metabolic perfusion
to the lungs.
Q5: Which induction agent used in Rapid Sequence Intubation (RSI) is preferred for
hemodynamically unstable trauma patients due to its minimal impact on blood pressure?
A) Propofol
B) Etomidate or Ketamine
C) Midazolam
D) High-dose Thiopental
Answer: B) Etomidate or Ketamine
Explanation: Etomidate maintains cardiovascular stability with minimal vasodilation, while
Ketamine releases endogenous catecholamines that help maintain systemic vascular resistance
in hypovolemic patients.
Q6: What airway intervention is contraindicated in a patient with suspected basilar skull
fracture and extensive midface trauma?
A) Endotracheal intubation via direct laryngoscopy
B) Nasopharyngeal airway (NPA) insertion
C) Oropharyngeal airway (OPA) insertion in an unconscious patient
D) Surgical cricothyroidotomy
Answer: B) Nasopharyngeal airway (NPA) insertion
Explanation: Basilar skull fractures disrupt the cribriform plate. Inserting a nasopharyngeal
, airway or nasogastric tube risks accidental intracranial displacement through the fractured bony
floor.
Q7: What is the primary purpose of maintaining manual inline cervical spine stabilization
during airway management?
A) To keep the patient's head completely flexed
B) To prevent subluxation and secondary spinal cord injury during glottic visualization
C) To facilitate easier passage of a nasogastric tube
D) To reduce intracranial pressure during intubation
Answer: B) To prevent subluxation and secondary spinal cord injury during glottic visualization
Explanation: Laryngoscopy involves neck extension forces. Manual inline stabilization holds
the head and neck neutral, preventing movement of potentially unstable cervical spine fractures.
Q8: What condition is indicated by a widened pulse pressure, bradycardia, and irregular
respiratory patterns in a patient with severe traumatic brain injury?
A) Hypovolemic shock
B) Cushing's Triad signaling impending brain herniation
C) Neurogenic shock
D) Acute pulmonary embolism
Answer: B) Cushing's Triad signaling impending brain herniation
Explanation: Cushing's Triad (systolic hypertension with widened pulse pressure, reflex
bradycardia, and irregular respirations) is a late sign of markedly increased intracranial pressure
and impending brainstem herniation.
Q9: What initial fluid resuscitation strategy is recommended in hemorrhagic shock to
avoid disrupting early clot formation and worsening bleeding?
A) Aggressive crystalloid boluses to achieve a blood pressure of 140/90 mmHg
B) Permissive hypotension targeting a mean arterial pressure of 60-65 mmHg (or systolic
80-90 mmHg)
C) Continuous infusion of hypotonic D5W solution
D) Administering vasopressors prior to volume restoration
Answer: B) Permissive hypotension targeting a mean arterial pressure of 60-65 mmHg (or
systolic 80-90 mmHg)
Explanation: Permissive hypotension limits fluid resuscitation until active surgical hemorrhage
control is achieved. Excessive fluid administration raises pressure, dislodges immature clots,
dilutes coagulation factors, and worsens hypothermia.
