TCRN EXAM PREP |ACTUAL QUESTIONS AND
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
1)
The trauma nurse is caring for a 6-year-old child who sustained a tackle while participating in
a youth football game. The patient's mother states, "He got the wind knocked out of him."
Vital signs are:
HR 120 beats/min
BP 85/50 mmHg
RR 26 breaths/min
SpO2 92% (room air)
Based on the injury pattern, the nurse suspects which injury is MOST likely?
Possible answer(s):
Cardiac contusion
Tension pneumothorax
Pulmonary contusion
Splenic rupture
CORRECT ANSWER
Pulmonary contusion
The chest wall of a child allows for pulmonary contusions without rib fractures. The child is
not actively hypotensive or showing signs of a tension pneumothorax. Cardiac contusion can
lead to decreased cardiac output, tachycardia, and ventricular ectopy. Splenic rupture will
cause hypotension, which this child is not experiencing.
1
,2)
An infant with a history of Trisomy 21 is being evaluated status post motor vehicle collision.
The nurse anticipates which of the following may be related to traumatic injury rather than a
history of Trisomy 21?
Possible answer(s):
atlantoaxial instability
limp extremities
tongue obstruction
bulging fontanels
CORRECT ANSWER
Bulging fontanels
Limp extremities, tongue obstruction and atlantoaxial instability may all be common in
patients with Down syndrome (Trisomy 21). Bulging fontanels are a sign of increased
intracranial pressure in the infant patient, and should be considered to be related to
traumatic injury.
3)
An opportunity for improvement is identified following a patient delay transferring to the
operating room and a corrective action plan is implemented. Which of the following
provides the BEST example of loop closure?
Possible answers:
Communicating with the operating room staff on how to appropriately schedule cases
Measuring the time to the operating room for the next 10 patients.
Documenting an educational letter sent to the involved surgeon
2
,Recording discussion of the issue in peer review minutes
CORRECT ANSWER
Measuring the time to the operating room for the next 10 patients.
Comments:
Effective performance improvement demonstrates that corrective action has had the desired
effect as determined by continuous monitoring and evaluation. Demonstrating that the time
to the operating room is within limits is the best way to demonstrate effective loop closure
of this performance improvement event. The others are examples of actionable items but
they don't provide the best, complete loop closure that specific measurable time objectives
would.
During a debrief of a trauma activation, the surgeon is concerned that the resuscitation
effort was very disorganized from pre-hospital report and throughout the initial trauma care.
What is the BEST example of an intervention to improve team communication in future
resuscitations?
Possible answers:
Creating a standardized pre-hospital reporting tool
Initiating pre-arrival huddles
Identifying roles upon patient arrival
Allowing silence for pre-hospital providers report
CORRECT ANSWER
Initiating pre-arrival huddles
Clear communication of the patient plan, roles and responsibilities, and providing an
opportunity to discuss staff concerns are part of the pre-arrival huddle. The team leader can
communicate anticipated resuscitative goals, clarify assignments, and assist in prioritizing
3
, care. Allowing pre-hospital staff an uninterrupted opportunity to provide report as well as
creating a standardized tool will address the potential loss of pertinent information during
the pre-hospital hand-off but will not address the overall team communication issue.
Identification of roles should be done prior to the patient arrival.
A patient is being transported by prehospital personnel after being involved in a motor
vehicle collision. The patient's assessment reveals an intact airway and the following vitals:
BP: 110/72 (mmHg)HR: 119 (beats/min)RR: 26 (breaths/min)Glasgow Coma Scale (GCS)
score: 9
The MOST appropriate destination for transport is:
Possible answers:
level 3 trauma center 10 minutes away
level 1 trauma center 20 minutes away
level 2 trauma center 30 minutes away
non-trauma center 5 minutes away
CORRECT ANSWER
level 1 trauma center 20 minutes away
The patient has injuries as a result of a high-risk auto crash that need to be addressed at a
trauma center. A level 1 trauma center provides the highest level of trauma care with in-
house neurosurgery coverage and is closer than the level 2 center. A level 3 trauma center is
not required to provide continuous in-house neurosurgery coverage. Due to the patient's
GCS less than or equal to 13, the patient should be evaluated by the closest trauma center
with preferential evaluation at the highest-level trauma center.
4
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
1)
The trauma nurse is caring for a 6-year-old child who sustained a tackle while participating in
a youth football game. The patient's mother states, "He got the wind knocked out of him."
Vital signs are:
HR 120 beats/min
BP 85/50 mmHg
RR 26 breaths/min
SpO2 92% (room air)
Based on the injury pattern, the nurse suspects which injury is MOST likely?
Possible answer(s):
Cardiac contusion
Tension pneumothorax
Pulmonary contusion
Splenic rupture
CORRECT ANSWER
Pulmonary contusion
The chest wall of a child allows for pulmonary contusions without rib fractures. The child is
not actively hypotensive or showing signs of a tension pneumothorax. Cardiac contusion can
lead to decreased cardiac output, tachycardia, and ventricular ectopy. Splenic rupture will
cause hypotension, which this child is not experiencing.
1
,2)
An infant with a history of Trisomy 21 is being evaluated status post motor vehicle collision.
The nurse anticipates which of the following may be related to traumatic injury rather than a
history of Trisomy 21?
Possible answer(s):
atlantoaxial instability
limp extremities
tongue obstruction
bulging fontanels
CORRECT ANSWER
Bulging fontanels
Limp extremities, tongue obstruction and atlantoaxial instability may all be common in
patients with Down syndrome (Trisomy 21). Bulging fontanels are a sign of increased
intracranial pressure in the infant patient, and should be considered to be related to
traumatic injury.
3)
An opportunity for improvement is identified following a patient delay transferring to the
operating room and a corrective action plan is implemented. Which of the following
provides the BEST example of loop closure?
Possible answers:
Communicating with the operating room staff on how to appropriately schedule cases
Measuring the time to the operating room for the next 10 patients.
Documenting an educational letter sent to the involved surgeon
2
,Recording discussion of the issue in peer review minutes
CORRECT ANSWER
Measuring the time to the operating room for the next 10 patients.
Comments:
Effective performance improvement demonstrates that corrective action has had the desired
effect as determined by continuous monitoring and evaluation. Demonstrating that the time
to the operating room is within limits is the best way to demonstrate effective loop closure
of this performance improvement event. The others are examples of actionable items but
they don't provide the best, complete loop closure that specific measurable time objectives
would.
During a debrief of a trauma activation, the surgeon is concerned that the resuscitation
effort was very disorganized from pre-hospital report and throughout the initial trauma care.
What is the BEST example of an intervention to improve team communication in future
resuscitations?
Possible answers:
Creating a standardized pre-hospital reporting tool
Initiating pre-arrival huddles
Identifying roles upon patient arrival
Allowing silence for pre-hospital providers report
CORRECT ANSWER
Initiating pre-arrival huddles
Clear communication of the patient plan, roles and responsibilities, and providing an
opportunity to discuss staff concerns are part of the pre-arrival huddle. The team leader can
communicate anticipated resuscitative goals, clarify assignments, and assist in prioritizing
3
, care. Allowing pre-hospital staff an uninterrupted opportunity to provide report as well as
creating a standardized tool will address the potential loss of pertinent information during
the pre-hospital hand-off but will not address the overall team communication issue.
Identification of roles should be done prior to the patient arrival.
A patient is being transported by prehospital personnel after being involved in a motor
vehicle collision. The patient's assessment reveals an intact airway and the following vitals:
BP: 110/72 (mmHg)HR: 119 (beats/min)RR: 26 (breaths/min)Glasgow Coma Scale (GCS)
score: 9
The MOST appropriate destination for transport is:
Possible answers:
level 3 trauma center 10 minutes away
level 1 trauma center 20 minutes away
level 2 trauma center 30 minutes away
non-trauma center 5 minutes away
CORRECT ANSWER
level 1 trauma center 20 minutes away
The patient has injuries as a result of a high-risk auto crash that need to be addressed at a
trauma center. A level 1 trauma center provides the highest level of trauma care with in-
house neurosurgery coverage and is closer than the level 2 center. A level 3 trauma center is
not required to provide continuous in-house neurosurgery coverage. Due to the patient's
GCS less than or equal to 13, the patient should be evaluated by the closest trauma center
with preferential evaluation at the highest-level trauma center.
4
