TCRN PRACTICE QUESTIONS AND
ANSWERS
A ttranscranial tdoppler tis tobtained tfor ta tpatient twith ta ttraumatic tsubarachnoid
themorrhage. tThe tdoppler tis tpositive tfor tvasospasm. tThe ttrauma tnurse twould
texpect twhich tof tthe tfollowing tmedications tto tbe tprescribed? t- tcorrect tanswers t-A
tvasospasm tis ta tknown tcomplication tof tsubarachnoid themorrhages. tCalcium tchannel
tblockers tare tused tto tprevent tor treverse tvasospasms tand tare tfrequently tused tin tthe
ttreatment tof ta tsubarachnoid themorrhage. tMetoprolol, tHydralazine tand tLisinopril tare
tnot tcalcium tchannel tblockers tand twould tnot tbe teffective tto tprevent tand ttreat
tvasospasms tcaused tby ta tsubarachnoid themorrhage
Which tchamber tof tthe theart tis tmost tlikely tto tbe taffected tin tblunt tcardiac tinjuries? t-
tcorrect tanswers t-Given tthe tanatomical tposition tof tthe theart tin tthe tchest, tthe tright
tventricle tis tmost texposed tto tthe tanterior tportion tof tthe tchest twall tand tis tmost tlikely
tto tbe tinjured tin ta tblunt tcardiac tinjury. tPatients twith tblunt tcardiac tinjuries tfrequently
,texperience tsigns tof tright tventricular tfailure. tAdditional tfindings tthat tare tassociated
twith tblunt tcardiac tinjuries tinclude thypotension, tatrial tfibrillation, tunexplained tsinus
ttachycardia, tmultiple tPVCs, tST tsegment tchanges tand tright tbundle tbranch tblocks.
tThe tleft tatrium, tright tatrium tand tleft tventricle tare tless tlikely tto tbe tinjured tin ta tblunt
tcardiac tinjury.
A twidened tmediastinum tis tnoted ton tthe tchest tx-ray tof ta ttraumatically tinjured
thypotensive tpatient. tThe ttrauma tnurse twould tanticipate tgathering twhich tof tthe
tfollowing tpieces tof tequipment tas tthe thighest tpriority tin tthis tscenario? t- tcorrect
tanswers t-A twidened tmediastinum ton tchest tx-ray, taccompanied tby thypotension, tis
tstrongly tindicative tof tan taortic tinjury. tOne tof tthe tmost tlife-threatening tcomplications
tof tan taortic tinjury tis tblood tloss, twhich tcan tbe ttreated tby tgiving tblood tproducts tvia
ta trapid ttransfuser. tAlthough tpatient tassessment tmay tbe tenhanced tby tinserting tan
tarterial tline, tthis tis tless tof ta tpriority tthan tgiving tfluids trapidly. tA tchest ttube tis
tplaced tin tthe tpleural tspace trather tthan tthe tmediastinum tand tis ttherefore tnot
tindicated tin tthis tscenario. tSimilarly, tthere tis tnothing tin tthis tscenario tthat tindicates ta
tpericardiocentesis tis tindicated tso tthis tis tnot ta thigher tpriority tthan tpreparing ta trapid
ttransfuser.
A tproperly tapplied tpelvic tbinder tsits tacross tthe: t- tcorrect tanswers t-A tproperly
tapplied tpelvic tbinder tis tapplied tacross tthe tgreater ttrochanters tof tthe tfemur. tThis
tallows tfor toptimal tcompression tof tthe tpelvis tto tcontrol tbleeding. tApplying tit tacross
tthe tmidshaft tof tthe tfemur tis ttoo tlow tand twould tprovide tno ttherapeutic tbenefit.
tApplying tit tacross tthe tpelvic tring tor tthe tiliac tcrests tis ttoo thigh tand tcould tactually
tseparate tthe tpelvis tfurther, tincreasing tbleeding tand tinternal tdamage.
Treatment tfor tan textraperitoneal tbladder trupture twill tmost tlikely tinclude: t- tcorrect
tanswers t-Bladder tlacerations tthat tare tlocated tbelow tthe tpelvic tperitoneum tare
tdiagnosed tas tan textraperitoneal tbladder trupture. tIf ta tlaceration tis tfound talong twith
tpelvic tperitoneum, tit twould tthen tbe tclassified tas tan tintraperitoneal tbladder trupture.
tManagement tof tan textraperitoneal tbladder trupture tinvolves turinary tcatheterization
t(urethral tor tsuprapubic) tto tfacilitate turinary tdrainage tfrom tthe tbladder.
tIntraperitoneal tbladder truptures trequire tsurgical tintervention tfor tdefinitive tclosure. tAn
tisolated textraperitoneal tbladder trupture tdoes tnot trequire temergent tsurgical trepair tor
tinterventional tradiology.
Hyperextension tof tthe tneck tis tknown tto tcause: t- tcorrect tanswers t-Hyperextension tof
tthe tneck t(the thead tsnapping tbackwards tcommonly tseen tin t"whiplash" tinjuries)
tcauses tcompression tand tdamage tto tthe tposterior tportion tof tthe tspinal tcord. tIn
tanterior tcord tsyndrome, tthe tmechanism tof tinjury tis tthe topposite tof tposterior tcord
tsyndrome t(a thyperflexion tinjury twhere tthe tneck thyperextends tforward t- tchin tto
tchest) tcausing tinjury tto tthe tanterior tportion tof tthe tspinal tcord. tA tcauda tequina
tsyndrome tcauses tinjury tto tthe tsacral tnerve troots twithin tthe tspinal tcanal tand tis
tcaused tby tfalling tdirectly ton tthe tsacrum. tBrown-Sequard tSyndrome tcaused tby
tpenetrating ttrauma tto tthe tlateral taspect tof tthe tspinal tcord twill tcause ta tleft tto tright
tphenomenon tinstead tof ta ttop tdown tphenomenon.
, A tpatient thas ta tZone tII tpenetrating tneck tinjury twith tpenetration tthrough tthe
tplatysma. tThe ttrauma tnurse tknows tthat tthis tpatient tis tat tincreased trisk tof tinjury tto:
t- tcorrect tanswers t-The tplatysma tis ta tmuscle tin tthe tneck tthat tgives tsupport tand
tprotection tto tthe tvital tstructures tunderneath tit. tAny ttime tthere tis tpenetration tthrough
tthe tplatysma, tthere tis tan tincreased trisk tof tdamage tto tthe tunderlying tstructures tin
tthe tneck. tThe tneck tis tdivided tinto tthree tzones. tZone tI textends tfrom tthe tsternal
tnotch tand tclavicle tup tto tthe tcricothyroid tcartilage. tZone tII textends tfrom tthe
tcricothyroid tcartilage tupward tto tthe tangle tof tthe tmandible. tZone tIII textends tfrom
tthe tangle tof tthe tmandible tto tthe tbase tof tthe tskull. tStructures tfound tin tZone tI
tinclude tthe tsubclavian tartery, tvertebral tartery, tlung tapices, ttrachea, tthyroid tand
tesophagus. tZone tII tincludes tthe tinternal tjugular tvein, tesophagus, tlarynx, tvagus
tnerve, tcarotid tartery tand tvertebral tartery. tZone tIII tincludes tthe tsalivary tand tparotid
tglands, tcranial tnerves tIX-XII, tvertebral tartery, tdistal tcarotid tartery, tand tdistal tjugular
tvein.
A tpregnant tpatient's tfundal theight tis tpalpated t6 tcm tabove tthe tumbilicus. tWhat tis
tthe testimated tgestational tage tof tthe tfetus? t- tcorrect tanswers t-Fundal theight tis
tdefined tas tthe tdistance tfrom tthe tpubic tbone tto tthe ttop tof tthe tuterus tin tcentimeters.
tIn tgeneral, tthe tfundus treaches tthe tumbilicus tby t20 tweeks. tEvery tcentimeter tpast
tthat tpoint tis tmeasured tas t1 tweek. tIf tevery tone tcentimeter tabove tthe tumbilicus
tequals tone tweek, tthen tthe tpatient tis tapproximately t26 tweeks tgestation.
Appropriate tcare tfor tan tamputated tbody tpart tincludes: t- tcorrect tanswers t-When
tcaring tfor tan tamputated tbody tpart, tthe ttrauma tnurse tshould tclean tthe tpart
tremoving tany tdirt tand tdebris, twrapping tthe tpart tin ta tslightly tsaline tmoistened
tgauze, tand tthen tplacing tit tin ta tsealed tplastic tbag. tAt tthis ttime, tthe tpart tshould tbe
tplaced tin ta tsecond tbag tcontaining ta tmixture tof tice tand twater. tIt tis timperative tthat
tthe tpart tdoes tnot tfreeze tor tdoes tnot tcome tinto tcontact twith twater t(which tis
thypotonic tto tbody ttissue). tAlso tensure tthat tthe tamputated tpart tis tproperly tlabeled
twith tthe tpatient tinformation.
Decontamination twith twater tis tdiscouraged tin tpatients texposed tto tpowdered: t-
tcorrect tanswers t-Dry tchemicals tthat tshould tnot tbe tirrigated twith twater tinclude tdry
tlime, telemental tmetals t(including tsodium, tpotassium, tmagnesium tlithium tand
tphosphorus) tand tphenol. tWhen texposed tto twater tthese tsubstances twill tcause ta
tharmful texothermic tor t"heat tproducing" treaction tburning tthe tpatient's tskin. tThey
tmay talso trelease tpossible thazardous tbyproducts tinto tthe tair. tSulfuric tacid, tmuriatic
tacid tand tcement tcan tall tbe tirrigated twith tcopious tamounts tof twater t(although ta
tmuch tof tthe tdry tchemical tas tpossible tshould tbe tbrushed toff tbefore tirrigation twith
twater tis tinitiated)
Hypovolemic tshock tis tmost tlikely tto tbe tcaused tby: t- tcorrect tanswers t-Hypovolemic
tshock tis tcaused tby tfluid tloss t(e.g. tbleeding tor tdiarrhea) tor tthird tspacing tof tfluids.
tThe tinflammatory tresponse tcaused tby ta tburn tleads tto tcapillary tpermeability
tresulting tin tthe tthird tspacing tof tfluids twhich tresults tin thypovolemic tshock. tCervical
ANSWERS
A ttranscranial tdoppler tis tobtained tfor ta tpatient twith ta ttraumatic tsubarachnoid
themorrhage. tThe tdoppler tis tpositive tfor tvasospasm. tThe ttrauma tnurse twould
texpect twhich tof tthe tfollowing tmedications tto tbe tprescribed? t- tcorrect tanswers t-A
tvasospasm tis ta tknown tcomplication tof tsubarachnoid themorrhages. tCalcium tchannel
tblockers tare tused tto tprevent tor treverse tvasospasms tand tare tfrequently tused tin tthe
ttreatment tof ta tsubarachnoid themorrhage. tMetoprolol, tHydralazine tand tLisinopril tare
tnot tcalcium tchannel tblockers tand twould tnot tbe teffective tto tprevent tand ttreat
tvasospasms tcaused tby ta tsubarachnoid themorrhage
Which tchamber tof tthe theart tis tmost tlikely tto tbe taffected tin tblunt tcardiac tinjuries? t-
tcorrect tanswers t-Given tthe tanatomical tposition tof tthe theart tin tthe tchest, tthe tright
tventricle tis tmost texposed tto tthe tanterior tportion tof tthe tchest twall tand tis tmost tlikely
tto tbe tinjured tin ta tblunt tcardiac tinjury. tPatients twith tblunt tcardiac tinjuries tfrequently
,texperience tsigns tof tright tventricular tfailure. tAdditional tfindings tthat tare tassociated
twith tblunt tcardiac tinjuries tinclude thypotension, tatrial tfibrillation, tunexplained tsinus
ttachycardia, tmultiple tPVCs, tST tsegment tchanges tand tright tbundle tbranch tblocks.
tThe tleft tatrium, tright tatrium tand tleft tventricle tare tless tlikely tto tbe tinjured tin ta tblunt
tcardiac tinjury.
A twidened tmediastinum tis tnoted ton tthe tchest tx-ray tof ta ttraumatically tinjured
thypotensive tpatient. tThe ttrauma tnurse twould tanticipate tgathering twhich tof tthe
tfollowing tpieces tof tequipment tas tthe thighest tpriority tin tthis tscenario? t- tcorrect
tanswers t-A twidened tmediastinum ton tchest tx-ray, taccompanied tby thypotension, tis
tstrongly tindicative tof tan taortic tinjury. tOne tof tthe tmost tlife-threatening tcomplications
tof tan taortic tinjury tis tblood tloss, twhich tcan tbe ttreated tby tgiving tblood tproducts tvia
ta trapid ttransfuser. tAlthough tpatient tassessment tmay tbe tenhanced tby tinserting tan
tarterial tline, tthis tis tless tof ta tpriority tthan tgiving tfluids trapidly. tA tchest ttube tis
tplaced tin tthe tpleural tspace trather tthan tthe tmediastinum tand tis ttherefore tnot
tindicated tin tthis tscenario. tSimilarly, tthere tis tnothing tin tthis tscenario tthat tindicates ta
tpericardiocentesis tis tindicated tso tthis tis tnot ta thigher tpriority tthan tpreparing ta trapid
ttransfuser.
A tproperly tapplied tpelvic tbinder tsits tacross tthe: t- tcorrect tanswers t-A tproperly
tapplied tpelvic tbinder tis tapplied tacross tthe tgreater ttrochanters tof tthe tfemur. tThis
tallows tfor toptimal tcompression tof tthe tpelvis tto tcontrol tbleeding. tApplying tit tacross
tthe tmidshaft tof tthe tfemur tis ttoo tlow tand twould tprovide tno ttherapeutic tbenefit.
tApplying tit tacross tthe tpelvic tring tor tthe tiliac tcrests tis ttoo thigh tand tcould tactually
tseparate tthe tpelvis tfurther, tincreasing tbleeding tand tinternal tdamage.
Treatment tfor tan textraperitoneal tbladder trupture twill tmost tlikely tinclude: t- tcorrect
tanswers t-Bladder tlacerations tthat tare tlocated tbelow tthe tpelvic tperitoneum tare
tdiagnosed tas tan textraperitoneal tbladder trupture. tIf ta tlaceration tis tfound talong twith
tpelvic tperitoneum, tit twould tthen tbe tclassified tas tan tintraperitoneal tbladder trupture.
tManagement tof tan textraperitoneal tbladder trupture tinvolves turinary tcatheterization
t(urethral tor tsuprapubic) tto tfacilitate turinary tdrainage tfrom tthe tbladder.
tIntraperitoneal tbladder truptures trequire tsurgical tintervention tfor tdefinitive tclosure. tAn
tisolated textraperitoneal tbladder trupture tdoes tnot trequire temergent tsurgical trepair tor
tinterventional tradiology.
Hyperextension tof tthe tneck tis tknown tto tcause: t- tcorrect tanswers t-Hyperextension tof
tthe tneck t(the thead tsnapping tbackwards tcommonly tseen tin t"whiplash" tinjuries)
tcauses tcompression tand tdamage tto tthe tposterior tportion tof tthe tspinal tcord. tIn
tanterior tcord tsyndrome, tthe tmechanism tof tinjury tis tthe topposite tof tposterior tcord
tsyndrome t(a thyperflexion tinjury twhere tthe tneck thyperextends tforward t- tchin tto
tchest) tcausing tinjury tto tthe tanterior tportion tof tthe tspinal tcord. tA tcauda tequina
tsyndrome tcauses tinjury tto tthe tsacral tnerve troots twithin tthe tspinal tcanal tand tis
tcaused tby tfalling tdirectly ton tthe tsacrum. tBrown-Sequard tSyndrome tcaused tby
tpenetrating ttrauma tto tthe tlateral taspect tof tthe tspinal tcord twill tcause ta tleft tto tright
tphenomenon tinstead tof ta ttop tdown tphenomenon.
, A tpatient thas ta tZone tII tpenetrating tneck tinjury twith tpenetration tthrough tthe
tplatysma. tThe ttrauma tnurse tknows tthat tthis tpatient tis tat tincreased trisk tof tinjury tto:
t- tcorrect tanswers t-The tplatysma tis ta tmuscle tin tthe tneck tthat tgives tsupport tand
tprotection tto tthe tvital tstructures tunderneath tit. tAny ttime tthere tis tpenetration tthrough
tthe tplatysma, tthere tis tan tincreased trisk tof tdamage tto tthe tunderlying tstructures tin
tthe tneck. tThe tneck tis tdivided tinto tthree tzones. tZone tI textends tfrom tthe tsternal
tnotch tand tclavicle tup tto tthe tcricothyroid tcartilage. tZone tII textends tfrom tthe
tcricothyroid tcartilage tupward tto tthe tangle tof tthe tmandible. tZone tIII textends tfrom
tthe tangle tof tthe tmandible tto tthe tbase tof tthe tskull. tStructures tfound tin tZone tI
tinclude tthe tsubclavian tartery, tvertebral tartery, tlung tapices, ttrachea, tthyroid tand
tesophagus. tZone tII tincludes tthe tinternal tjugular tvein, tesophagus, tlarynx, tvagus
tnerve, tcarotid tartery tand tvertebral tartery. tZone tIII tincludes tthe tsalivary tand tparotid
tglands, tcranial tnerves tIX-XII, tvertebral tartery, tdistal tcarotid tartery, tand tdistal tjugular
tvein.
A tpregnant tpatient's tfundal theight tis tpalpated t6 tcm tabove tthe tumbilicus. tWhat tis
tthe testimated tgestational tage tof tthe tfetus? t- tcorrect tanswers t-Fundal theight tis
tdefined tas tthe tdistance tfrom tthe tpubic tbone tto tthe ttop tof tthe tuterus tin tcentimeters.
tIn tgeneral, tthe tfundus treaches tthe tumbilicus tby t20 tweeks. tEvery tcentimeter tpast
tthat tpoint tis tmeasured tas t1 tweek. tIf tevery tone tcentimeter tabove tthe tumbilicus
tequals tone tweek, tthen tthe tpatient tis tapproximately t26 tweeks tgestation.
Appropriate tcare tfor tan tamputated tbody tpart tincludes: t- tcorrect tanswers t-When
tcaring tfor tan tamputated tbody tpart, tthe ttrauma tnurse tshould tclean tthe tpart
tremoving tany tdirt tand tdebris, twrapping tthe tpart tin ta tslightly tsaline tmoistened
tgauze, tand tthen tplacing tit tin ta tsealed tplastic tbag. tAt tthis ttime, tthe tpart tshould tbe
tplaced tin ta tsecond tbag tcontaining ta tmixture tof tice tand twater. tIt tis timperative tthat
tthe tpart tdoes tnot tfreeze tor tdoes tnot tcome tinto tcontact twith twater t(which tis
thypotonic tto tbody ttissue). tAlso tensure tthat tthe tamputated tpart tis tproperly tlabeled
twith tthe tpatient tinformation.
Decontamination twith twater tis tdiscouraged tin tpatients texposed tto tpowdered: t-
tcorrect tanswers t-Dry tchemicals tthat tshould tnot tbe tirrigated twith twater tinclude tdry
tlime, telemental tmetals t(including tsodium, tpotassium, tmagnesium tlithium tand
tphosphorus) tand tphenol. tWhen texposed tto twater tthese tsubstances twill tcause ta
tharmful texothermic tor t"heat tproducing" treaction tburning tthe tpatient's tskin. tThey
tmay talso trelease tpossible thazardous tbyproducts tinto tthe tair. tSulfuric tacid, tmuriatic
tacid tand tcement tcan tall tbe tirrigated twith tcopious tamounts tof twater t(although ta
tmuch tof tthe tdry tchemical tas tpossible tshould tbe tbrushed toff tbefore tirrigation twith
twater tis tinitiated)
Hypovolemic tshock tis tmost tlikely tto tbe tcaused tby: t- tcorrect tanswers t-Hypovolemic
tshock tis tcaused tby tfluid tloss t(e.g. tbleeding tor tdiarrhea) tor tthird tspacing tof tfluids.
tThe tinflammatory tresponse tcaused tby ta tburn tleads tto tcapillary tpermeability
tresulting tin tthe tthird tspacing tof tfluids twhich tresults tin thypovolemic tshock. tCervical
