BARKLEY CTRN TRAUMA NURSING PRACTICE EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains:
1. Principles of Trauma Nursing and the Continuum of Care
2. Pathophysiology of Shock and Multi-System Organ Failure
3. Assessment and Management of Neurological Trauma
4. Assessment and Management of Thoracic and Abdominal Trauma
5. Assessment and Management of Musculoskeletal and Spinal Trauma
6. Trauma Resuscitation, Airway Management, and Procedural Sedation
7. Psychosocial Aspects, Legal, and Ethical Issues in Trauma Care
8. Disaster Management, Triage, and Mass Casualty Incidents
9. Special Populations: Pediatric, Geriatric, and Pregnant Trauma Patients
Introduction:
This comprehensive examination is designed to rigorously assess the knowledge, critical thinking, and clinical
decision-making skills of the trauma nurse. It evaluates competency in the core principles of trauma care, from the
initial assessment and resuscitation through the continuum of care to rehabilitation. The exam integrates
foundational theory with applied professional knowledge, regulatory and legal compliance, ethics, and real-world
scenarios. Utilizing a multiple-choice format, it challenges the nurse to apply evidence-based practice in high-
stakes situations, emphasizing the prioritization, intervention, and evaluation skills essential for delivering expert
care to the injured patient.
SECTION ONE: QUESTIONS 1-100
,1. A 45-year-old male is brought to the emergency department following a high-speed motor vehicle
collision. He is intubated and sedated. Which assessment finding is the most sensitive indicator of adequate
tissue perfusion in this patient?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 88 bpm
C. Urine output of 45 mL/hr
D. Serum lactate level of 1.2 mmol/L
🟢 D. Serum lactate level of 1.2 mmol/L
🔴 RATIONALE: Serum lactate is a highly sensitive marker of anaerobic metabolism and tissue hypoperfusion. A
normal lactate level (<2 mmol/L) indicates adequate tissue oxygenation, even in the presence of normotension.
Blood pressure and heart rate can be normal in the compensatory stages of shock, and urine output can be
affected by other factors such as diuretics.
2. During the primary survey of a trauma patient, you note jugular venous distension, tracheal deviation to
the left, and absent breath sounds on the right side. What is the priority intervention?
A. Needle decompression of the right chest
B. Endotracheal intubation
C. Administration of a fluid bolus
D. Placement of a left-sided chest tube
🟢 A. Needle decompression of the right chest
🔴 RATIONALE: The presentation of JVD, tracheal deviation, and absent breath sounds is indicative of a tension
pneumothorax on the right side. This is a life-threatening condition requiring immediate needle decompression
,to release the trapped air and relieve pressure on the heart and great vessels.
3. The trauma team is preparing for the arrival of a patient with a suspected pelvic fracture following a fall
from a height. Which of the following is the most appropriate initial method to temporize hemorrhage from
an unstable pelvic fracture?
A. Application of a pelvic binder
B. Initiation of massive transfusion protocol
C. Intravenous administration of tranexamic acid (TXA)
D. Application of military anti-shock trousers (MAST)
🟢 A. Application of a pelvic binder
🔴 RATIONALE: A pelvic binder provides circumferential compression, reducing pelvic volume and stabilizing
fracture fragments, which is crucial for tamponading venous bleeding and reducing pelvic hemorrhage. MAST
trousers are no longer recommended. TXA and MTP are important adjuncts but do not directly address the
mechanical source of bleeding.
4. A 22-year-old patient with a penetrating abdominal injury is in the operating room. Which of the
following findings would be the most definitive indicator for immediate surgical exploration?
A. Generalized abdominal tenderness
B. Free intraperitoneal air on CT scan
C. Abdominal distension
D. Evisceration of omentum
🟢 B. Free intraperitoneal air on CT scan
, 🔴 RATIONALE: Free intraperitoneal air (pneumoperitoneum) is a definitive sign of hollow viscus perforation,
which necessitates immediate surgical exploration. Tenderness, distension, and evisceration are signs that may
warrant exploration but are not as definitive or immediate.
5. A patient with a severe traumatic brain injury (TBI) has an ICP reading of 22 mmHg and a CPP of 55
mmHg. Which of the following interventions is most appropriate to manage elevated ICP?
A. Administer 3% hypertonic saline
B. Elevate the head of the bed to 45 degrees
C. Administer mannitol 0.5-1 g/kg IV
D. Start a propofol infusion for deep sedation
🟢 C. Administer mannitol 0.5-1 g/kg IV
🔴 RATIONALE: The patient has elevated ICP (>20 mmHg) and a CPP below 60 mmHg (normal is 60-70).
Mannitol is an osmotic diuretic that reduces ICP by drawing water from the brain parenchyma into the
intravascular space, thereby improving CPP. Elevating the HOB is a basic measure but is insufficient in this
scenario. Hypertonic saline is an alternative but the most standard initial medical therapy is mannitol.
6. A patient with a flail chest segment is being managed with pain control and oxygen. Which assessment
finding would indicate the need for immediate intubation and mechanical ventilation?
A. Respiratory rate of 24
B. SpO2 of 90% on 4L nasal cannula
C. PaCO2 of 55 mmHg
D. Use of accessory muscles
🟢 C. PaCO2 of 55 mmHg
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains:
1. Principles of Trauma Nursing and the Continuum of Care
2. Pathophysiology of Shock and Multi-System Organ Failure
3. Assessment and Management of Neurological Trauma
4. Assessment and Management of Thoracic and Abdominal Trauma
5. Assessment and Management of Musculoskeletal and Spinal Trauma
6. Trauma Resuscitation, Airway Management, and Procedural Sedation
7. Psychosocial Aspects, Legal, and Ethical Issues in Trauma Care
8. Disaster Management, Triage, and Mass Casualty Incidents
9. Special Populations: Pediatric, Geriatric, and Pregnant Trauma Patients
Introduction:
This comprehensive examination is designed to rigorously assess the knowledge, critical thinking, and clinical
decision-making skills of the trauma nurse. It evaluates competency in the core principles of trauma care, from the
initial assessment and resuscitation through the continuum of care to rehabilitation. The exam integrates
foundational theory with applied professional knowledge, regulatory and legal compliance, ethics, and real-world
scenarios. Utilizing a multiple-choice format, it challenges the nurse to apply evidence-based practice in high-
stakes situations, emphasizing the prioritization, intervention, and evaluation skills essential for delivering expert
care to the injured patient.
SECTION ONE: QUESTIONS 1-100
,1. A 45-year-old male is brought to the emergency department following a high-speed motor vehicle
collision. He is intubated and sedated. Which assessment finding is the most sensitive indicator of adequate
tissue perfusion in this patient?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 88 bpm
C. Urine output of 45 mL/hr
D. Serum lactate level of 1.2 mmol/L
🟢 D. Serum lactate level of 1.2 mmol/L
🔴 RATIONALE: Serum lactate is a highly sensitive marker of anaerobic metabolism and tissue hypoperfusion. A
normal lactate level (<2 mmol/L) indicates adequate tissue oxygenation, even in the presence of normotension.
Blood pressure and heart rate can be normal in the compensatory stages of shock, and urine output can be
affected by other factors such as diuretics.
2. During the primary survey of a trauma patient, you note jugular venous distension, tracheal deviation to
the left, and absent breath sounds on the right side. What is the priority intervention?
A. Needle decompression of the right chest
B. Endotracheal intubation
C. Administration of a fluid bolus
D. Placement of a left-sided chest tube
🟢 A. Needle decompression of the right chest
🔴 RATIONALE: The presentation of JVD, tracheal deviation, and absent breath sounds is indicative of a tension
pneumothorax on the right side. This is a life-threatening condition requiring immediate needle decompression
,to release the trapped air and relieve pressure on the heart and great vessels.
3. The trauma team is preparing for the arrival of a patient with a suspected pelvic fracture following a fall
from a height. Which of the following is the most appropriate initial method to temporize hemorrhage from
an unstable pelvic fracture?
A. Application of a pelvic binder
B. Initiation of massive transfusion protocol
C. Intravenous administration of tranexamic acid (TXA)
D. Application of military anti-shock trousers (MAST)
🟢 A. Application of a pelvic binder
🔴 RATIONALE: A pelvic binder provides circumferential compression, reducing pelvic volume and stabilizing
fracture fragments, which is crucial for tamponading venous bleeding and reducing pelvic hemorrhage. MAST
trousers are no longer recommended. TXA and MTP are important adjuncts but do not directly address the
mechanical source of bleeding.
4. A 22-year-old patient with a penetrating abdominal injury is in the operating room. Which of the
following findings would be the most definitive indicator for immediate surgical exploration?
A. Generalized abdominal tenderness
B. Free intraperitoneal air on CT scan
C. Abdominal distension
D. Evisceration of omentum
🟢 B. Free intraperitoneal air on CT scan
, 🔴 RATIONALE: Free intraperitoneal air (pneumoperitoneum) is a definitive sign of hollow viscus perforation,
which necessitates immediate surgical exploration. Tenderness, distension, and evisceration are signs that may
warrant exploration but are not as definitive or immediate.
5. A patient with a severe traumatic brain injury (TBI) has an ICP reading of 22 mmHg and a CPP of 55
mmHg. Which of the following interventions is most appropriate to manage elevated ICP?
A. Administer 3% hypertonic saline
B. Elevate the head of the bed to 45 degrees
C. Administer mannitol 0.5-1 g/kg IV
D. Start a propofol infusion for deep sedation
🟢 C. Administer mannitol 0.5-1 g/kg IV
🔴 RATIONALE: The patient has elevated ICP (>20 mmHg) and a CPP below 60 mmHg (normal is 60-70).
Mannitol is an osmotic diuretic that reduces ICP by drawing water from the brain parenchyma into the
intravascular space, thereby improving CPP. Elevating the HOB is a basic measure but is insufficient in this
scenario. Hypertonic saline is an alternative but the most standard initial medical therapy is mannitol.
6. A patient with a flail chest segment is being managed with pain control and oxygen. Which assessment
finding would indicate the need for immediate intubation and mechanical ventilation?
A. Respiratory rate of 24
B. SpO2 of 90% on 4L nasal cannula
C. PaCO2 of 55 mmHg
D. Use of accessory muscles
🟢 C. PaCO2 of 55 mmHg
