TCRN CERTIFICATION EXAM 2026 –
COMPLETE TEST BANK WITH + REAL
EXAM QUESTIONS & DETAILED
ANSWERS
1. A 45-year-old male is brought to the trauma bay after a high-
speed motor vehicle collision. His initial vital signs are: HR 130, BP
85/50, RR 28, O2 saturation 92% on room air. He is pale,
diaphoretic, and confused. Which classification of hemorrhagic
shock is he most likely experiencing?
A. Class I
B. Class II
C. Class III
D. Class IV
Correct ,,,,answer,,,: C
Rationale: Class III hemorrhagic shock is characterized by blood loss of
30-40% (1500-2000 mL), presenting with tachycardia (120-140),
hypotension, tachypnea, altered mental status, and decreased pulse
pressure. Class I (up to 15%) shows minimal symptoms, Class II (15-
30%) shows tachycardia without hypotension, and Class IV (>40%)
shows profound hypotension with absent pulses .
2. A 28-year-old restrained driver involved in a frontal collision
presents with bruising across the chest and abdomen in a "seat belt
sign" pattern. Which injury is MOST commonly associated with
,this finding?
A. Liver laceration
B. Splenic rupture
C. Small bowel perforation
D. Renal contusion
Correct ,,,,answer,,,: C
Rationale: The "seat belt sign" (patterned bruising across chest and
abdomen) is associated with a 6-8% incidence of hollow viscous injury,
particularly small bowel perforation. The rapid deceleration compresses
the bowel against the vertebral column, causing intramural hematoma or
perforation. Solid organ injuries can occur but are less specific to this
finding .
3. During the primary survey of an unconscious intubated trauma
patient, the ventilator alarms "high pressure." The nurse notes
absent breath sounds on the right side and tracheal deviation to the
left. What is the priority intervention?
A. Obtain a stat chest X-ray
B. Perform needle decompression
C. Increase sedation
D. Reposition the endotracheal tube
Correct ,,,,answer,,,: B
Rationale: This presentation is consistent with tension pneumothorax, a
life-threatening condition requiring immediate decompression. The high-
pressure alarm, absent breath sounds, and tracheal deviation indicate air
trapping in the pleural space. Needle decompression (14-gauge catheter
in 2nd intercostal space, midclavicular line) must precede diagnostic
studies .
,4. Which finding in a trauma patient with suspected increased
intracranial pressure (ICP) represents Cushing's triad?
A. Hypotension, bradycardia, hypothermia
B. Hypertension, tachycardia, tachypnea
C. Hypertension, bradycardia, irregular respirations
D. Hypotension, tachycardia, irregular respirations
Correct ,,,,answer,,,: C
Rationale: Cushing's triad—hypertension, bradycardia, and irregular
respirations—is a late sign of increased ICP and impending brain
herniation. This reflex response occurs as the body attempts to maintain
cerebral perfusion pressure.
5. A 35-year-old stabbed in the right lower chest has an eFAST
exam showing pericardial fluid without collapse of cardiac
chambers. What is the priority intervention?
A. CT chest with angiography
B. Pericardiocentesis with surgical backup
C. Serial eFAST exams
D. Urgent echocardiogram
Correct ,,,,answer,,,: B
Rationale: Pericardial fluid in a penetrating chest trauma patient with
stable appearing cardiac chambers suggests early cardiac tamponade.
Pericardiocentesis is both diagnostic and therapeutic but should only be
performed in conjunction with surgical capability as needle
decompression may be temporizing. CT or echo would delay definitive
treatment .
6. In a pediatric trauma patient, which finding indicates impending
respiratory failure requiring immediate airway intervention?
A. GCS of 14
, B. Nasal flaring and grunting
C. Bradycardia with respiratory distress
D. Oxygen saturation of 88% on non-rebreather
Correct ,,,,answer,,,: C
Rationale: Bradycardia in a child with respiratory distress is a late sign
of impending arrest. Children maintain cardiac output through
tachycardia; when bradycardia develops, it indicates severe hypoxia and
impending cardiopulmonary failure. Nasal flaring (compensatory) and
desaturation (concerning but earlier) precede bradycardia .
7. A trauma patient has a pelvic binder in place following a fall from
height. Which finding would indicate the need for pelvic binder
release?
A. Blood pressure of 100/60 mmHg
B. Lateral thigh circumference increase of 4 cm
C. Absent distal pulses
D. Urinary output of 30 mL/hr
Correct ,,,,answer,,,: B
Rationale: Compartment syndrome of the gluteal/thigh region can occur
with prolonged pelvic binder use. A 4 cm increase in thigh
circumference indicates significant swelling suggesting impending
compartment syndrome, requiring binder release (after hemodynamic
stabilization and pelvic fixation). Absent pulses may indicate binder too
tight but require assessment before release .
8. Which medication is MOST appropriate for initial management
of a trauma patient with agitation and suspected traumatic brain
injury?
A. Haloperidol
B. Lorazepam
COMPLETE TEST BANK WITH + REAL
EXAM QUESTIONS & DETAILED
ANSWERS
1. A 45-year-old male is brought to the trauma bay after a high-
speed motor vehicle collision. His initial vital signs are: HR 130, BP
85/50, RR 28, O2 saturation 92% on room air. He is pale,
diaphoretic, and confused. Which classification of hemorrhagic
shock is he most likely experiencing?
A. Class I
B. Class II
C. Class III
D. Class IV
Correct ,,,,answer,,,: C
Rationale: Class III hemorrhagic shock is characterized by blood loss of
30-40% (1500-2000 mL), presenting with tachycardia (120-140),
hypotension, tachypnea, altered mental status, and decreased pulse
pressure. Class I (up to 15%) shows minimal symptoms, Class II (15-
30%) shows tachycardia without hypotension, and Class IV (>40%)
shows profound hypotension with absent pulses .
2. A 28-year-old restrained driver involved in a frontal collision
presents with bruising across the chest and abdomen in a "seat belt
sign" pattern. Which injury is MOST commonly associated with
,this finding?
A. Liver laceration
B. Splenic rupture
C. Small bowel perforation
D. Renal contusion
Correct ,,,,answer,,,: C
Rationale: The "seat belt sign" (patterned bruising across chest and
abdomen) is associated with a 6-8% incidence of hollow viscous injury,
particularly small bowel perforation. The rapid deceleration compresses
the bowel against the vertebral column, causing intramural hematoma or
perforation. Solid organ injuries can occur but are less specific to this
finding .
3. During the primary survey of an unconscious intubated trauma
patient, the ventilator alarms "high pressure." The nurse notes
absent breath sounds on the right side and tracheal deviation to the
left. What is the priority intervention?
A. Obtain a stat chest X-ray
B. Perform needle decompression
C. Increase sedation
D. Reposition the endotracheal tube
Correct ,,,,answer,,,: B
Rationale: This presentation is consistent with tension pneumothorax, a
life-threatening condition requiring immediate decompression. The high-
pressure alarm, absent breath sounds, and tracheal deviation indicate air
trapping in the pleural space. Needle decompression (14-gauge catheter
in 2nd intercostal space, midclavicular line) must precede diagnostic
studies .
,4. Which finding in a trauma patient with suspected increased
intracranial pressure (ICP) represents Cushing's triad?
A. Hypotension, bradycardia, hypothermia
B. Hypertension, tachycardia, tachypnea
C. Hypertension, bradycardia, irregular respirations
D. Hypotension, tachycardia, irregular respirations
Correct ,,,,answer,,,: C
Rationale: Cushing's triad—hypertension, bradycardia, and irregular
respirations—is a late sign of increased ICP and impending brain
herniation. This reflex response occurs as the body attempts to maintain
cerebral perfusion pressure.
5. A 35-year-old stabbed in the right lower chest has an eFAST
exam showing pericardial fluid without collapse of cardiac
chambers. What is the priority intervention?
A. CT chest with angiography
B. Pericardiocentesis with surgical backup
C. Serial eFAST exams
D. Urgent echocardiogram
Correct ,,,,answer,,,: B
Rationale: Pericardial fluid in a penetrating chest trauma patient with
stable appearing cardiac chambers suggests early cardiac tamponade.
Pericardiocentesis is both diagnostic and therapeutic but should only be
performed in conjunction with surgical capability as needle
decompression may be temporizing. CT or echo would delay definitive
treatment .
6. In a pediatric trauma patient, which finding indicates impending
respiratory failure requiring immediate airway intervention?
A. GCS of 14
, B. Nasal flaring and grunting
C. Bradycardia with respiratory distress
D. Oxygen saturation of 88% on non-rebreather
Correct ,,,,answer,,,: C
Rationale: Bradycardia in a child with respiratory distress is a late sign
of impending arrest. Children maintain cardiac output through
tachycardia; when bradycardia develops, it indicates severe hypoxia and
impending cardiopulmonary failure. Nasal flaring (compensatory) and
desaturation (concerning but earlier) precede bradycardia .
7. A trauma patient has a pelvic binder in place following a fall from
height. Which finding would indicate the need for pelvic binder
release?
A. Blood pressure of 100/60 mmHg
B. Lateral thigh circumference increase of 4 cm
C. Absent distal pulses
D. Urinary output of 30 mL/hr
Correct ,,,,answer,,,: B
Rationale: Compartment syndrome of the gluteal/thigh region can occur
with prolonged pelvic binder use. A 4 cm increase in thigh
circumference indicates significant swelling suggesting impending
compartment syndrome, requiring binder release (after hemodynamic
stabilization and pelvic fixation). Absent pulses may indicate binder too
tight but require assessment before release .
8. Which medication is MOST appropriate for initial management
of a trauma patient with agitation and suspected traumatic brain
injury?
A. Haloperidol
B. Lorazepam
