ABDOMINAL AND PELVIC TRAUMA: TNS CERTIFICATION
PRACTICE EXAM QUESTIONS AND ANSWERS 100%
CORRECT!
This document provides advanced practice questions focused on abdominal and pelvic
trauma for Trauma Nurse Specialist (TNS) exam preparation. These questions
emphasize clinical judgment, management of hemorrhagic shock, and identification of
occult injuries.
Table of Contents
1. Section 1: Practice Questions (1–30)
2. Section 2: Answer Key
3. Section 3: High-Yield Abdominal & Pelvic Trauma Review
Section 1: Questions 1–30
Question 1. A 42-year-old male is brought to the trauma bay after a high-speed motor
vehicle collision. He is hemodynamically unstable with a blood pressure of $82/40\text{
mmHg}$. A Focused Assessment with Sonography for Trauma (FAST) exam is
performed and is negative. What is the most appropriate next step?
A. Discharge the patient from the trauma bay.
B. Proceed to a CT scan of the abdomen and pelvis.
C. Perform a Diagnostic Peritoneal Aspirate (DPA) or Lavage (DPL).
D. Repeat the FAST exam in 2 hours.
Correct Answer: C. Perform a Diagnostic Peritoneal Aspirate (DPA) or Lavage (DPL).
Rationale:
1. Why the correct answer is best: In a hemodynamically unstable patient with a
high suspicion of abdominal injury but a negative FAST, a DPA/DPL is the next
step. FAST has a higher rate of false negatives in the early stages of bleeding or
in patients with retroperitoneal injuries. DPA is faster and more sensitive for
determining if the source of shock is intraperitoneal.
, 2. Why each incorrect option is less appropriate: CT scans are only for
hemodynamically stable patients. Discharging or waiting 2 hours would be lethal
for a patient in active shock.
3. Key Trauma Principle: Hemodynamic instability dictates the diagnostic
pathway; unstable patients stay in the resuscitation area or go to the OR.
Question 2. A patient presents with a "seatbelt sign" (ecchymosis across the lower
abdomen) following a head-on collision. Which injury pattern should the nurse be most
concerned about?
A. Splenic laceration and rib fractures.
B. Hollow viscus injury and a Chance fracture of the lumbar spine.
C. Diaphragmatic rupture and pulmonary contusion.
D. Pelvic ring disruption and urethral injury.
Correct Answer: B. Hollow viscus injury and a Chance fracture of the lumbar spine.
Rationale:
1. Why the correct answer is best: The "seatbelt sign" is highly associated with
deceleration injuries causing compression of the bowel against the spine (hollow
viscus injury) and a distraction fracture of the lumbar spine (Chance fracture).
2. Why each incorrect option is less appropriate: While other injuries can occur,
the seatbelt sign is the specific hallmark of this lumbar/hollow viscus dyad.
3. Key Trauma Principle: Specific physical exam markers (like the seatbelt sign)
serve as "red flags" for specific injury patterns.
Question 3. A patient with a Grade III splenic laceration is being managed
non-operatively. Which assessment finding would most likely indicate a failure of
non-operative management?
A. A stable Hemoglobin of $9.0\text{ g/dL}$.
B. Development of Kehr’s sign (left shoulder pain).
C. An increase in heart rate from $90\text{ to }115\text{ bpm}$ and increasing abdominal
girth.
D. Tenderness localized to the left upper quadrant.
, Correct Answer: C. An increase in heart rate from $90\text{ to }115\text{ bpm}$ and
increasing abdominal girth.
Rationale:
1. Why the correct answer is best: Tachycardia and increasing girth are signs of
ongoing hemorrhage and potential loss of hemodynamic stability, which are
absolute indications for surgical intervention.
2. Why each incorrect option is less appropriate: Kehr's sign is common in
splenic injury and doesn't necessarily mean the patient is failing management.
Localized tenderness is expected. A stable hemoglobin is a positive sign.
3. Key Trauma Principle: Hemodynamic stability is the primary requirement for
continuing non-operative management of solid organ injuries.
Question 4. A patient is diagnosed with an "open book" pelvic fracture. Which
intervention is the priority for stabilizing the pelvic ring and reducing pelvic volume?
A. Immediate application of an external fixator in the OR.
B. Internal rotation of the lower extremities and application of a pelvic binder at the
greater trochanters.
C. Placing the patient in a Trendelenburg position.
D. Sandbagging the patient's hips.
Correct Answer: B. Internal rotation of the lower extremities and application of a pelvic
binder at the greater trochanters.
Rationale:
1. Why the correct answer is best: A pelvic binder reduces the volume of the
pelvic cavity, creating a "tamponade" effect on venous bleeding. Proper
placement is over the greater trochanters, not the iliac crests. Internal rotation of
the legs helps close the pelvic ring.
2. Why each incorrect option is less appropriate: External fixation is a
secondary step. Trendelenburg is contraindicated in trauma. Sandbags are
insufficient to stabilize a disrupted pelvic ring.
3. Key Trauma Principle: Pelvic hemorrhage is often venous; reducing the pelvic
volume is the most effective initial method of control.
PRACTICE EXAM QUESTIONS AND ANSWERS 100%
CORRECT!
This document provides advanced practice questions focused on abdominal and pelvic
trauma for Trauma Nurse Specialist (TNS) exam preparation. These questions
emphasize clinical judgment, management of hemorrhagic shock, and identification of
occult injuries.
Table of Contents
1. Section 1: Practice Questions (1–30)
2. Section 2: Answer Key
3. Section 3: High-Yield Abdominal & Pelvic Trauma Review
Section 1: Questions 1–30
Question 1. A 42-year-old male is brought to the trauma bay after a high-speed motor
vehicle collision. He is hemodynamically unstable with a blood pressure of $82/40\text{
mmHg}$. A Focused Assessment with Sonography for Trauma (FAST) exam is
performed and is negative. What is the most appropriate next step?
A. Discharge the patient from the trauma bay.
B. Proceed to a CT scan of the abdomen and pelvis.
C. Perform a Diagnostic Peritoneal Aspirate (DPA) or Lavage (DPL).
D. Repeat the FAST exam in 2 hours.
Correct Answer: C. Perform a Diagnostic Peritoneal Aspirate (DPA) or Lavage (DPL).
Rationale:
1. Why the correct answer is best: In a hemodynamically unstable patient with a
high suspicion of abdominal injury but a negative FAST, a DPA/DPL is the next
step. FAST has a higher rate of false negatives in the early stages of bleeding or
in patients with retroperitoneal injuries. DPA is faster and more sensitive for
determining if the source of shock is intraperitoneal.
, 2. Why each incorrect option is less appropriate: CT scans are only for
hemodynamically stable patients. Discharging or waiting 2 hours would be lethal
for a patient in active shock.
3. Key Trauma Principle: Hemodynamic instability dictates the diagnostic
pathway; unstable patients stay in the resuscitation area or go to the OR.
Question 2. A patient presents with a "seatbelt sign" (ecchymosis across the lower
abdomen) following a head-on collision. Which injury pattern should the nurse be most
concerned about?
A. Splenic laceration and rib fractures.
B. Hollow viscus injury and a Chance fracture of the lumbar spine.
C. Diaphragmatic rupture and pulmonary contusion.
D. Pelvic ring disruption and urethral injury.
Correct Answer: B. Hollow viscus injury and a Chance fracture of the lumbar spine.
Rationale:
1. Why the correct answer is best: The "seatbelt sign" is highly associated with
deceleration injuries causing compression of the bowel against the spine (hollow
viscus injury) and a distraction fracture of the lumbar spine (Chance fracture).
2. Why each incorrect option is less appropriate: While other injuries can occur,
the seatbelt sign is the specific hallmark of this lumbar/hollow viscus dyad.
3. Key Trauma Principle: Specific physical exam markers (like the seatbelt sign)
serve as "red flags" for specific injury patterns.
Question 3. A patient with a Grade III splenic laceration is being managed
non-operatively. Which assessment finding would most likely indicate a failure of
non-operative management?
A. A stable Hemoglobin of $9.0\text{ g/dL}$.
B. Development of Kehr’s sign (left shoulder pain).
C. An increase in heart rate from $90\text{ to }115\text{ bpm}$ and increasing abdominal
girth.
D. Tenderness localized to the left upper quadrant.
, Correct Answer: C. An increase in heart rate from $90\text{ to }115\text{ bpm}$ and
increasing abdominal girth.
Rationale:
1. Why the correct answer is best: Tachycardia and increasing girth are signs of
ongoing hemorrhage and potential loss of hemodynamic stability, which are
absolute indications for surgical intervention.
2. Why each incorrect option is less appropriate: Kehr's sign is common in
splenic injury and doesn't necessarily mean the patient is failing management.
Localized tenderness is expected. A stable hemoglobin is a positive sign.
3. Key Trauma Principle: Hemodynamic stability is the primary requirement for
continuing non-operative management of solid organ injuries.
Question 4. A patient is diagnosed with an "open book" pelvic fracture. Which
intervention is the priority for stabilizing the pelvic ring and reducing pelvic volume?
A. Immediate application of an external fixator in the OR.
B. Internal rotation of the lower extremities and application of a pelvic binder at the
greater trochanters.
C. Placing the patient in a Trendelenburg position.
D. Sandbagging the patient's hips.
Correct Answer: B. Internal rotation of the lower extremities and application of a pelvic
binder at the greater trochanters.
Rationale:
1. Why the correct answer is best: A pelvic binder reduces the volume of the
pelvic cavity, creating a "tamponade" effect on venous bleeding. Proper
placement is over the greater trochanters, not the iliac crests. Internal rotation of
the legs helps close the pelvic ring.
2. Why each incorrect option is less appropriate: External fixation is a
secondary step. Trendelenburg is contraindicated in trauma. Sandbags are
insufficient to stabilize a disrupted pelvic ring.
3. Key Trauma Principle: Pelvic hemorrhage is often venous; reducing the pelvic
volume is the most effective initial method of control.
