TNS Exam / Trauma Nurse Specialist Certification exam verified with
correct answers plus rationales
1. A trauma patient arrives after a high-speed motor vehicle collision. The patient is
restless, tachycardic, hypotensive, and has cool, pale skin. Which intervention should the
trauma nurse prioritize?
A. Obtain a detailed medical history
B. Begin rapid assessment and hemorrhage control
C. Administer oral fluids
D. Place the patient in a sitting position
Answer: B. Begin rapid assessment and hemorrhage control.
Rationale: The findings are consistent with hemorrhagic shock. Immediate trauma assessment
and control of life-threatening bleeding take priority.
2. A patient with blunt chest trauma suddenly develops severe respiratory distress,
hypotension, absent breath sounds on the right, and tracheal deviation. Which condition
should the nurse suspect?
A. Simple pneumothorax
B. Pulmonary contusion
C. Tension pneumothorax
D. Hemothorax
Answer: C. Tension pneumothorax.
Rationale: Severe respiratory compromise, hypotension, unilateral absent breath sounds, and
tracheal deviation are classic findings of tension pneumothorax, a life-threatening obstructive
shock condition requiring immediate decompression.
3. A trauma patient develops hypotension, muffled heart sounds, and jugular venous
distention after penetrating chest trauma. Which condition is most likely?
A. Cardiac tamponade
B. Massive hemothorax
C. Neurogenic shock
D. Pulmonary embolism
Answer: A. Cardiac tamponade.
,Rationale: Hypotension, muffled heart sounds, and jugular venous distention are associated with
cardiac tamponade. In trauma, rapid recognition and definitive intervention are critical.
4. A patient with a suspected spinal cord injury suddenly develops hypotension and
bradycardia without evidence of major blood loss. Which type of shock is most likely?
A. Hypovolemic shock
B. Neurogenic shock
C. Septic shock
D. Cardiogenic shock
Answer: B. Neurogenic shock.
Rationale: Neurogenic shock can occur after significant spinal cord injury and is characterized
by loss of sympathetic vascular tone, producing hypotension often accompanied by bradycardia.
5. A patient with a lower-leg fracture reports increasing pain that is severe and
disproportionate to the injury. Pain increases with passive stretching of the toes. Which
complication should the nurse suspect?
A. Deep-vein thrombosis
B. Compartment syndrome
C. Cellulitis
D. Peripheral neuropathy
Answer: B. Compartment syndrome.
Rationale: Severe pain out of proportion to the injury and pain with passive stretch are early
warning signs of acute compartment syndrome. Prompt recognition is essential to prevent
ischemic tissue damage.
6. During the primary survey of a trauma patient, which sequence is most appropriate?
A. Disability, exposure, airway, breathing, circulation
B. Airway, breathing, circulation, disability, exposure
C. Circulation, airway, exposure, disability, breathing
D. Exposure, circulation, breathing, airway, disability
Answer: B. Airway, breathing, circulation, disability, exposure.
,Rationale: The trauma primary survey follows the systematic ABCDE approach, allowing
immediate identification and treatment of life-threatening problems.
7. A trauma patient requires rapid transfusion because of uncontrolled hemorrhage.
Which complication should the nurse closely monitor for during massive transfusion?
A. Hypercalcemia
B. Hypothermia and coagulopathy
C. Hypernatremia
D. Respiratory alkalosis only
Answer: B. Hypothermia and coagulopathy.
Rationale: Massive transfusion can contribute to hypothermia, dilutional coagulopathy, and
electrolyte abnormalities. Trauma resuscitation therefore requires close monitoring of
temperature, coagulation, and metabolic status.
8. A patient rescued from a house fire has facial burns, soot around the mouth, hoarseness,
and increasing respiratory distress. What is the priority concern?
A. Infection
B. Airway edema
C. Fluid overload
D. Hypoglycemia
Answer: B. Airway edema.
Rationale: Facial burns, soot, hoarseness, and respiratory symptoms suggest inhalation injury.
Progressive airway edema can rapidly compromise the airway, making early airway
management critical.
9. Which finding is most concerning in a patient with traumatic brain injury?
A. Mild headache that is improving
B. Increasing level of consciousness
C. New unequal pupils with decreasing level of consciousness
D. Small superficial scalp abrasion
Answer: C. New unequal pupils with decreasing level of consciousness.
, Rationale: A change in neurologic status accompanied by unequal pupils may indicate
increasing intracranial pressure or herniation and requires immediate intervention.
10. A trauma patient becomes increasingly confused several hours after apparently
successful resuscitation. Which nursing action is most appropriate?
A. Assume the confusion is expected after trauma
B. Reassess the patient systematically for new or evolving complications
C. Discontinue monitoring
D. Encourage the patient to ambulate
Answer: B. Reassess the patient systematically for new or evolving complications.
Rationale: Trauma patients can deteriorate after initial stabilization. Reassessment is an
essential component of ongoing trauma care and may identify bleeding, neurologic
deterioration, respiratory complications, infection, or other problems.
11. A trauma patient has a Glasgow Coma Scale score of 7. Which intervention should the
nurse anticipate?
A. Oral fluids
B. Airway protection
C. Ambulation
D. Routine discharge
Answer: B. Airway protection.
Rationale: A GCS of 8 or less indicates severe neurologic impairment and inability to reliably
protect the airway. Airway management should be anticipated.
12. Which Glasgow Coma Scale component assesses the patient's ability to respond to
verbal commands?
A. Eye opening
B. Verbal response
C. Motor response
D. Pupillary response
Answer: C. Motor response.
Rationale: The motor component evaluates the patient's ability to obey commands and respond
to painful stimuli.
correct answers plus rationales
1. A trauma patient arrives after a high-speed motor vehicle collision. The patient is
restless, tachycardic, hypotensive, and has cool, pale skin. Which intervention should the
trauma nurse prioritize?
A. Obtain a detailed medical history
B. Begin rapid assessment and hemorrhage control
C. Administer oral fluids
D. Place the patient in a sitting position
Answer: B. Begin rapid assessment and hemorrhage control.
Rationale: The findings are consistent with hemorrhagic shock. Immediate trauma assessment
and control of life-threatening bleeding take priority.
2. A patient with blunt chest trauma suddenly develops severe respiratory distress,
hypotension, absent breath sounds on the right, and tracheal deviation. Which condition
should the nurse suspect?
A. Simple pneumothorax
B. Pulmonary contusion
C. Tension pneumothorax
D. Hemothorax
Answer: C. Tension pneumothorax.
Rationale: Severe respiratory compromise, hypotension, unilateral absent breath sounds, and
tracheal deviation are classic findings of tension pneumothorax, a life-threatening obstructive
shock condition requiring immediate decompression.
3. A trauma patient develops hypotension, muffled heart sounds, and jugular venous
distention after penetrating chest trauma. Which condition is most likely?
A. Cardiac tamponade
B. Massive hemothorax
C. Neurogenic shock
D. Pulmonary embolism
Answer: A. Cardiac tamponade.
,Rationale: Hypotension, muffled heart sounds, and jugular venous distention are associated with
cardiac tamponade. In trauma, rapid recognition and definitive intervention are critical.
4. A patient with a suspected spinal cord injury suddenly develops hypotension and
bradycardia without evidence of major blood loss. Which type of shock is most likely?
A. Hypovolemic shock
B. Neurogenic shock
C. Septic shock
D. Cardiogenic shock
Answer: B. Neurogenic shock.
Rationale: Neurogenic shock can occur after significant spinal cord injury and is characterized
by loss of sympathetic vascular tone, producing hypotension often accompanied by bradycardia.
5. A patient with a lower-leg fracture reports increasing pain that is severe and
disproportionate to the injury. Pain increases with passive stretching of the toes. Which
complication should the nurse suspect?
A. Deep-vein thrombosis
B. Compartment syndrome
C. Cellulitis
D. Peripheral neuropathy
Answer: B. Compartment syndrome.
Rationale: Severe pain out of proportion to the injury and pain with passive stretch are early
warning signs of acute compartment syndrome. Prompt recognition is essential to prevent
ischemic tissue damage.
6. During the primary survey of a trauma patient, which sequence is most appropriate?
A. Disability, exposure, airway, breathing, circulation
B. Airway, breathing, circulation, disability, exposure
C. Circulation, airway, exposure, disability, breathing
D. Exposure, circulation, breathing, airway, disability
Answer: B. Airway, breathing, circulation, disability, exposure.
,Rationale: The trauma primary survey follows the systematic ABCDE approach, allowing
immediate identification and treatment of life-threatening problems.
7. A trauma patient requires rapid transfusion because of uncontrolled hemorrhage.
Which complication should the nurse closely monitor for during massive transfusion?
A. Hypercalcemia
B. Hypothermia and coagulopathy
C. Hypernatremia
D. Respiratory alkalosis only
Answer: B. Hypothermia and coagulopathy.
Rationale: Massive transfusion can contribute to hypothermia, dilutional coagulopathy, and
electrolyte abnormalities. Trauma resuscitation therefore requires close monitoring of
temperature, coagulation, and metabolic status.
8. A patient rescued from a house fire has facial burns, soot around the mouth, hoarseness,
and increasing respiratory distress. What is the priority concern?
A. Infection
B. Airway edema
C. Fluid overload
D. Hypoglycemia
Answer: B. Airway edema.
Rationale: Facial burns, soot, hoarseness, and respiratory symptoms suggest inhalation injury.
Progressive airway edema can rapidly compromise the airway, making early airway
management critical.
9. Which finding is most concerning in a patient with traumatic brain injury?
A. Mild headache that is improving
B. Increasing level of consciousness
C. New unequal pupils with decreasing level of consciousness
D. Small superficial scalp abrasion
Answer: C. New unequal pupils with decreasing level of consciousness.
, Rationale: A change in neurologic status accompanied by unequal pupils may indicate
increasing intracranial pressure or herniation and requires immediate intervention.
10. A trauma patient becomes increasingly confused several hours after apparently
successful resuscitation. Which nursing action is most appropriate?
A. Assume the confusion is expected after trauma
B. Reassess the patient systematically for new or evolving complications
C. Discontinue monitoring
D. Encourage the patient to ambulate
Answer: B. Reassess the patient systematically for new or evolving complications.
Rationale: Trauma patients can deteriorate after initial stabilization. Reassessment is an
essential component of ongoing trauma care and may identify bleeding, neurologic
deterioration, respiratory complications, infection, or other problems.
11. A trauma patient has a Glasgow Coma Scale score of 7. Which intervention should the
nurse anticipate?
A. Oral fluids
B. Airway protection
C. Ambulation
D. Routine discharge
Answer: B. Airway protection.
Rationale: A GCS of 8 or less indicates severe neurologic impairment and inability to reliably
protect the airway. Airway management should be anticipated.
12. Which Glasgow Coma Scale component assesses the patient's ability to respond to
verbal commands?
A. Eye opening
B. Verbal response
C. Motor response
D. Pupillary response
Answer: C. Motor response.
Rationale: The motor component evaluates the patient's ability to obey commands and respond
to painful stimuli.
