, Question 1
A patient with a gunshot wound to the right anterior chest is hypotensive with
distended neck veins, absent right breath sounds, and tracheal deviation to the
left. Which intervention should the nurse anticipate FIRST?
A. Emergent pericardiocentesis
B. Needle decompression at the 2nd intercostal space midclavicular line
C. Rapid IV fluid bolus of 2 L lactated Ringer's
D. Chest tube insertion at the 5th intercostal space
Correct Answer: B - Needle decompression at the 2nd intercostal
space midclavicular line
RATIONALE
The findings indicate tension pneumothorax (hypotension, distended
neck veins, absent breath sounds, tracheal deviation). Immediate
needle decompression at the 2nd ICS midclavicular line (or 5th ICS
anterior axillary line) relieves pressure before definitive chest tube
placement. Pericardiocentesis is for cardiac tamponade, which lacks
tracheal deviation and unilateral absent breath sounds.
Question 2
Which assessment finding best differentiates neurogenic shock from
hypovolemic shock in a trauma patient with a T4 spinal cord injury?
A. Tachycardia with cool, clammy extremities
B. Bradycardia with warm, dry extremities
C. Narrow pulse pressure with delayed capillary refill
D. Elevated SVR with compensatory vasoconstriction
Correct Answer: B - Bradycardia with warm, dry extremities
Page 2
, RATIONALE
Neurogenic shock results from loss of sympathetic tone above T6,
causing bradycardia, vasodilation, and warm dry skin. Hypovolemic
shock presents with tachycardia, cool clammy skin, and increased
SVR as compensatory mechanisms remain intact.
Question 3
A trauma patient's initial hematocrit is 42%, but 30 minutes after a 2 L
crystalloid bolus it drops to 28%. Which interpretation is most accurate?
A. Acute blood loss of approximately 1.5 L has occurred
B. The drop reflects hemodilution from crystalloid, not necessarily acute
blood loss
C. The patient is developing DIC
D. The hematocrit change is diagnostic of a retroperitoneal bleed
Correct Answer: B - The drop reflects hemodilution from
crystalloid, not necessarily acute blood loss
RATIONALE
In acute trauma, hematocrit is unreliable because it reflects
proportional dilution. A rapid crystalloid bolus dilutes RBC mass,
lowering hematocrit without proportional blood loss. Serial hematocrit
trends with hemodynamic status guide resuscitation.
Question 4
Which finding in a patient with a suspected basilar skull fracture requires
immediate nursing intervention?
A. Bilateral periorbital ecchymosis (raccoon eyes)
B. Clear fluid leaking from the ear
C. Battle's sign behind the ear
D. Hemotympanum
Correct Answer: B - Clear fluid leaking from the ear
Page 3
, RATIONALE
CSF otorrhea indicates a dural tear and increased risk of meningitis.
While raccoon eyes, Battle's sign, and hemotympanum are also signs
of basilar skull fracture, CSF leak requires immediate intervention
(avoid packing, elevate head, monitor for infection).
Question 5
A patient with a pelvic fracture becomes suddenly hypotensive and tachycardic
after a logroll. Which action should the nurse take FIRST?
A. Apply a pelvic binder at the greater trochanters
B. Administer a 1 L normal saline bolus
C. Obtain a stat pelvic X-ray
D. Prepare for external fixation
Correct Answer: A - Apply a pelvic binder at the greater
trochanters
RATIONALE
Pelvic fractures can cause massive retroperitoneal bleeding. Applying
a pelvic binder at the greater trochanters stabilizes the pelvis and
reduces bleeding. Fluid resuscitation and imaging follow, but
mechanical stabilization is the immediate priority.
Question 6
Which parameter is the most sensitive early indicator of inadequate perfusion
in a trauma patient with compensated shock?
A. Serum lactate
B. Base deficit
C. Urine output
D. Mean arterial pressure
Correct Answer: A - Serum lactate
Page 4
A patient with a gunshot wound to the right anterior chest is hypotensive with
distended neck veins, absent right breath sounds, and tracheal deviation to the
left. Which intervention should the nurse anticipate FIRST?
A. Emergent pericardiocentesis
B. Needle decompression at the 2nd intercostal space midclavicular line
C. Rapid IV fluid bolus of 2 L lactated Ringer's
D. Chest tube insertion at the 5th intercostal space
Correct Answer: B - Needle decompression at the 2nd intercostal
space midclavicular line
RATIONALE
The findings indicate tension pneumothorax (hypotension, distended
neck veins, absent breath sounds, tracheal deviation). Immediate
needle decompression at the 2nd ICS midclavicular line (or 5th ICS
anterior axillary line) relieves pressure before definitive chest tube
placement. Pericardiocentesis is for cardiac tamponade, which lacks
tracheal deviation and unilateral absent breath sounds.
Question 2
Which assessment finding best differentiates neurogenic shock from
hypovolemic shock in a trauma patient with a T4 spinal cord injury?
A. Tachycardia with cool, clammy extremities
B. Bradycardia with warm, dry extremities
C. Narrow pulse pressure with delayed capillary refill
D. Elevated SVR with compensatory vasoconstriction
Correct Answer: B - Bradycardia with warm, dry extremities
Page 2
, RATIONALE
Neurogenic shock results from loss of sympathetic tone above T6,
causing bradycardia, vasodilation, and warm dry skin. Hypovolemic
shock presents with tachycardia, cool clammy skin, and increased
SVR as compensatory mechanisms remain intact.
Question 3
A trauma patient's initial hematocrit is 42%, but 30 minutes after a 2 L
crystalloid bolus it drops to 28%. Which interpretation is most accurate?
A. Acute blood loss of approximately 1.5 L has occurred
B. The drop reflects hemodilution from crystalloid, not necessarily acute
blood loss
C. The patient is developing DIC
D. The hematocrit change is diagnostic of a retroperitoneal bleed
Correct Answer: B - The drop reflects hemodilution from
crystalloid, not necessarily acute blood loss
RATIONALE
In acute trauma, hematocrit is unreliable because it reflects
proportional dilution. A rapid crystalloid bolus dilutes RBC mass,
lowering hematocrit without proportional blood loss. Serial hematocrit
trends with hemodynamic status guide resuscitation.
Question 4
Which finding in a patient with a suspected basilar skull fracture requires
immediate nursing intervention?
A. Bilateral periorbital ecchymosis (raccoon eyes)
B. Clear fluid leaking from the ear
C. Battle's sign behind the ear
D. Hemotympanum
Correct Answer: B - Clear fluid leaking from the ear
Page 3
, RATIONALE
CSF otorrhea indicates a dural tear and increased risk of meningitis.
While raccoon eyes, Battle's sign, and hemotympanum are also signs
of basilar skull fracture, CSF leak requires immediate intervention
(avoid packing, elevate head, monitor for infection).
Question 5
A patient with a pelvic fracture becomes suddenly hypotensive and tachycardic
after a logroll. Which action should the nurse take FIRST?
A. Apply a pelvic binder at the greater trochanters
B. Administer a 1 L normal saline bolus
C. Obtain a stat pelvic X-ray
D. Prepare for external fixation
Correct Answer: A - Apply a pelvic binder at the greater
trochanters
RATIONALE
Pelvic fractures can cause massive retroperitoneal bleeding. Applying
a pelvic binder at the greater trochanters stabilizes the pelvis and
reduces bleeding. Fluid resuscitation and imaging follow, but
mechanical stabilization is the immediate priority.
Question 6
Which parameter is the most sensitive early indicator of inadequate perfusion
in a trauma patient with compensated shock?
A. Serum lactate
B. Base deficit
C. Urine output
D. Mean arterial pressure
Correct Answer: A - Serum lactate
Page 4
