1
SSM TCAR EXAM 2025 ACTUAL EXAM COMPLETE
QUESTIONS WITH DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
A patient is admitted for multiple rib fractures related to a fall. Three days after
hospital admission, the patient is pulling low volumes on his incentive
spirometer. The optimal course of action is to
continue with the current plan of care.
increase progressive mobilization.
reduce spirometer use to every 4 hr.
discontinue analgesic agents. - (answers)increase progressive mobilization.
Mobility is a crucial aspect of all trauma patient's recovery. Anything that the
trauma nurse can do to facilitate progressively increased mobility is important.
Early ambulation can reduce hospital-acquired infections like pneumonia and
reduces ventilator days, VTE, and length of stay
Four days after admission, a multiply-injured patient's condition deteriorates.
His vital signs are: BP 91/46; HR 139/min; RR 24/min. Urine output is 15 mL/hr,
and he's cool and mottled. The pulse oximeter is only sensing intermittently.
These findings are consistent with
an anaphylactic reaction.
neurogenic shock.
hemorrhagic hypovolemia.
early sepsis - (answers)early sepsis
Although trauma patients can develop sepsis at any time during their hospital
stay, symptom onset is unusual in the first couple of days. Patients begin to
exhibit sepsis findings as infection and inflammation progress, usually not
before hospital Day 3-4. This patient has a low mean pressure (MAP = SBP +
, 2
DBP + DBP/3 = 61 mm Hg), a shock index of 1.52 (HR/SBP), which is well above
the adult norm of 0.5-0.7, a wide pulse pressure (91 - 46 = 45 mm Hg), and an
elevated respiratory rate (24/min). These vital sign findings are all consistent
with septic shock, as are low urine output and poor distal perfusion (cool
mottled skin and poor pulse oximeter sensing). The patient with hemorrhagic
hypovolemic shock would have the same findings EXCEPT pulse pressure is
narrow. The patient in neurogenic shock loses sympathetic stimulation below
the level of injury. Therefore, neurogenic shock patients are not tachycardic,
their pulse pressure is wide, urine production is adequate, and their skin is
warm and dry. The anaphylactic patient is tachycardic, hypotensive, and has a
wide pulse pressure, but also has signs of an allergic reaction, such as hives,
edema, and airway compromise
Which patient is at the highest risk for a severe deceleration injury?
A 4-year-old who fell from an upper bunk bed to a hard floor
A 23-year-old who was fully ejected from moving vehicle
40-year-old lap-belted driver who collided with a steering wheel
An 83-year-old who fell from standing to a carpeted floor - (answers)A 23-year-
old who was fully ejected from moving vehicle
Of these individuals, the 23-year-old ejected from a moving vehicle is at the
highest risk for a serious deceleration injury. Deceleration injuries occur when
the body comes to an abrupt stop. This is the opposite of an acceleration
injury, where the body is thrown into motion. Deceleration injuries are more
common. Coming to a sudden stop can apply tremendous force to the body
surface (collision #2) and to internal body structures (collision #3). Both a
patient's SPEED and DECELERATION DISTANCE predict injury probability.
Therefore, significant deceleration injury often occurs in situations involving
high speeds and an abrupt slowdown, as in the case of ejection from a moving
vehicle. Such events are associated with significant morbidity and mortality
, 3
A patient who was hit with a baseball bat was admitted to the hospital with
multiple facial fractures. There is clear fluid draining from her nose. This finding
suggests that the patient has
an ethmoid bone fracture.
a LeFort I fracture.
a zygomatic fracture.
an orbital blowout fracture - (answers)an ethmoid bone fracture
Clear or blood-tinged fluid draining from the nose of a trauma patient suggests
an ethmoid fracture. The cribriform plate of the ethmoid bone (just behind the
nose) is the thinnest point in the entire skull. When fractured, the dura mater is
torn, allowing CSF to leak out of the nose through the break (CSF rhinorrhea).
Maxillary fractures are common in patients sustaining mid-face trauma. A Le
Fort I fracture is a horizontal fracture through the body of the maxilla just
below the nose. In the Le Fort I fracture patient, speech is difficult, and pulling
on the upper teeth causes the teeth and hard palate to wiggle. The patient
with an orbital blowout fracture has visual impairment, periorbital ecchymosis,
facial numbness ipsilateral to the injury, and direction of gaze limitations
In the trauma patient population, the most frequent injury mechanism for all
age groups is
auto-pedestrian incidents.
fire and burn injuries.
falls.
motor vehicle crashes - (answers)falls.
Falls are by far the most frequent mechanism of injury that leads to injury. In
the US alone, there are 43,000 fatal falls each year, 85% of these occuring in
patients over the age of 65
, 4
The goals of damage control surgery in the trauma patient include each of the
following EXCEPT
restoration of normal physiology.
active hemorrhage control.
early blood product transfusion.
repair of all traumatic injuries - (answers)repair of all traumatic injuries
Damage control surgery is indicated for patients with life- or limb-threatening
thoracic, abdominal, pelvic, or orthopedic trauma. The primary goal is to
restore normal physiology, NOT normal anatomy. Damage control surgery
usually involves early blood product transfusion. Surgeons strive to get in, halt
the hemorrhage, reperfused ischemic tissues, control any intestinal content
leaks, and get out. Only lifesaving interventions should be performed on cold,
acidotic, coagulopathic individuals. Once the patient is hemodynamically and
metabolically stable, definitive surgical repairs of all appropriate injuries can be
performed, often within less than 24 hours.
Two hours after critical care unit admission, a patient who sustained a severe
head injury quickly develops dilated pupils that do not respond to light. Which
is the most likely explanation?
Downward brain herniation
Severe meningeal irritation
Cerebral contusion blossoming
Spontaneous subarachnoid bleeding - (answers)Downward brain herniation
When the brain squeezes through the foramen magnum, herniation is the
result. As the brain under pressure moves downward, it compresses the cranial
nerves against the base of the skull. Compression of the oculomotor nerve (CN
SSM TCAR EXAM 2025 ACTUAL EXAM COMPLETE
QUESTIONS WITH DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
A patient is admitted for multiple rib fractures related to a fall. Three days after
hospital admission, the patient is pulling low volumes on his incentive
spirometer. The optimal course of action is to
continue with the current plan of care.
increase progressive mobilization.
reduce spirometer use to every 4 hr.
discontinue analgesic agents. - (answers)increase progressive mobilization.
Mobility is a crucial aspect of all trauma patient's recovery. Anything that the
trauma nurse can do to facilitate progressively increased mobility is important.
Early ambulation can reduce hospital-acquired infections like pneumonia and
reduces ventilator days, VTE, and length of stay
Four days after admission, a multiply-injured patient's condition deteriorates.
His vital signs are: BP 91/46; HR 139/min; RR 24/min. Urine output is 15 mL/hr,
and he's cool and mottled. The pulse oximeter is only sensing intermittently.
These findings are consistent with
an anaphylactic reaction.
neurogenic shock.
hemorrhagic hypovolemia.
early sepsis - (answers)early sepsis
Although trauma patients can develop sepsis at any time during their hospital
stay, symptom onset is unusual in the first couple of days. Patients begin to
exhibit sepsis findings as infection and inflammation progress, usually not
before hospital Day 3-4. This patient has a low mean pressure (MAP = SBP +
, 2
DBP + DBP/3 = 61 mm Hg), a shock index of 1.52 (HR/SBP), which is well above
the adult norm of 0.5-0.7, a wide pulse pressure (91 - 46 = 45 mm Hg), and an
elevated respiratory rate (24/min). These vital sign findings are all consistent
with septic shock, as are low urine output and poor distal perfusion (cool
mottled skin and poor pulse oximeter sensing). The patient with hemorrhagic
hypovolemic shock would have the same findings EXCEPT pulse pressure is
narrow. The patient in neurogenic shock loses sympathetic stimulation below
the level of injury. Therefore, neurogenic shock patients are not tachycardic,
their pulse pressure is wide, urine production is adequate, and their skin is
warm and dry. The anaphylactic patient is tachycardic, hypotensive, and has a
wide pulse pressure, but also has signs of an allergic reaction, such as hives,
edema, and airway compromise
Which patient is at the highest risk for a severe deceleration injury?
A 4-year-old who fell from an upper bunk bed to a hard floor
A 23-year-old who was fully ejected from moving vehicle
40-year-old lap-belted driver who collided with a steering wheel
An 83-year-old who fell from standing to a carpeted floor - (answers)A 23-year-
old who was fully ejected from moving vehicle
Of these individuals, the 23-year-old ejected from a moving vehicle is at the
highest risk for a serious deceleration injury. Deceleration injuries occur when
the body comes to an abrupt stop. This is the opposite of an acceleration
injury, where the body is thrown into motion. Deceleration injuries are more
common. Coming to a sudden stop can apply tremendous force to the body
surface (collision #2) and to internal body structures (collision #3). Both a
patient's SPEED and DECELERATION DISTANCE predict injury probability.
Therefore, significant deceleration injury often occurs in situations involving
high speeds and an abrupt slowdown, as in the case of ejection from a moving
vehicle. Such events are associated with significant morbidity and mortality
, 3
A patient who was hit with a baseball bat was admitted to the hospital with
multiple facial fractures. There is clear fluid draining from her nose. This finding
suggests that the patient has
an ethmoid bone fracture.
a LeFort I fracture.
a zygomatic fracture.
an orbital blowout fracture - (answers)an ethmoid bone fracture
Clear or blood-tinged fluid draining from the nose of a trauma patient suggests
an ethmoid fracture. The cribriform plate of the ethmoid bone (just behind the
nose) is the thinnest point in the entire skull. When fractured, the dura mater is
torn, allowing CSF to leak out of the nose through the break (CSF rhinorrhea).
Maxillary fractures are common in patients sustaining mid-face trauma. A Le
Fort I fracture is a horizontal fracture through the body of the maxilla just
below the nose. In the Le Fort I fracture patient, speech is difficult, and pulling
on the upper teeth causes the teeth and hard palate to wiggle. The patient
with an orbital blowout fracture has visual impairment, periorbital ecchymosis,
facial numbness ipsilateral to the injury, and direction of gaze limitations
In the trauma patient population, the most frequent injury mechanism for all
age groups is
auto-pedestrian incidents.
fire and burn injuries.
falls.
motor vehicle crashes - (answers)falls.
Falls are by far the most frequent mechanism of injury that leads to injury. In
the US alone, there are 43,000 fatal falls each year, 85% of these occuring in
patients over the age of 65
, 4
The goals of damage control surgery in the trauma patient include each of the
following EXCEPT
restoration of normal physiology.
active hemorrhage control.
early blood product transfusion.
repair of all traumatic injuries - (answers)repair of all traumatic injuries
Damage control surgery is indicated for patients with life- or limb-threatening
thoracic, abdominal, pelvic, or orthopedic trauma. The primary goal is to
restore normal physiology, NOT normal anatomy. Damage control surgery
usually involves early blood product transfusion. Surgeons strive to get in, halt
the hemorrhage, reperfused ischemic tissues, control any intestinal content
leaks, and get out. Only lifesaving interventions should be performed on cold,
acidotic, coagulopathic individuals. Once the patient is hemodynamically and
metabolically stable, definitive surgical repairs of all appropriate injuries can be
performed, often within less than 24 hours.
Two hours after critical care unit admission, a patient who sustained a severe
head injury quickly develops dilated pupils that do not respond to light. Which
is the most likely explanation?
Downward brain herniation
Severe meningeal irritation
Cerebral contusion blossoming
Spontaneous subarachnoid bleeding - (answers)Downward brain herniation
When the brain squeezes through the foramen magnum, herniation is the
result. As the brain under pressure moves downward, it compresses the cranial
nerves against the base of the skull. Compression of the oculomotor nerve (CN
