TCRN Practice Questions
A transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrhage. The
doppler is positive for vasospasm. The trauma nurse would expect which of the following
medications to be prescribed? - ANS-A vasospasm is a known complication of subarachnoid
hemorrhages. Calcium channel blockers are used to prevent or reverse vasospasms and are
frequently used in the treatment of a subarachnoid hemorrhage. Metoprolol, Hydralazine and
Lisinopril are not calcium channel blockers and would not be effective to prevent and treat
vasospasms caused by a subarachnoid hemorrhage
Which chamber of the heart is most likely to be affected in blunt cardiac injuries? - ANS-Given
the anatomical position of the heart in the chest, the right ventricle is most exposed to the
anterior portion of the chest wall and is most likely to be injured in a blunt cardiac injury. Patients
with blunt cardiac injuries frequently experience signs of right ventricular failure. Additional
findings that are associated with blunt cardiac injuries include hypotension, atrial fibrillation,
unexplained sinus tachycardia, multiple PVCs, ST segment changes and right bundle branch
blocks. The left atrium, right atrium and left ventricle are less likely to be injured in a blunt
cardiac injury.
A widened mediastinum is noted on the chest x-ray of a traumatically injured hypotensive
patient. The trauma nurse would anticipate gathering which of the following pieces of equipment
as the highest priority in this scenario? - ANS-A widened mediastinum on chest x-ray,
accompanied by hypotension, is strongly indicative of an aortic injury. One of the most
life-threatening complications of an aortic injury is blood loss, which can be treated by giving
blood products via a rapid transfuser. Although patient assessment may be enhanced by
inserting an arterial line, this is less of a priority than giving fluids rapidly. A chest tube is placed
in the pleural space rather than the mediastinum and is therefore not indicated in this scenario.
Similarly, there is nothing in this scenario that indicates a pericardiocentesis is indicated so this
is not a higher priority than preparing a rapid transfuser.
A properly applied pelvic binder sits across the: - ANS-A properly applied pelvic binder is
applied across the greater trochanters of the femur. This allows for optimal compression of the
pelvis to control bleeding. Applying it across the midshaft of the femur is too low and would
provide no therapeutic benefit. Applying it across the pelvic ring or the iliac crests is too high
and could actually separate the pelvis further, increasing bleeding and internal damage.
Treatment for an extraperitoneal bladder rupture will most likely include: - ANS-Bladder
lacerations that are located below the pelvic peritoneum are diagnosed as an extraperitoneal
,bladder rupture. If a laceration is found along with pelvic peritoneum, it would then be classified
as an intraperitoneal bladder rupture. Management of an extraperitoneal bladder rupture
involves urinary catheterization (urethral or suprapubic) to facilitate urinary drainage from the
bladder. Intraperitoneal bladder ruptures require surgical intervention for definitive closure. An
isolated extraperitoneal bladder rupture does not require emergent surgical repair or
interventional radiology.
Hyperextension of the neck is known to cause: - ANS-Hyperextension of the neck (the head
snapping backwards commonly seen in "whiplash" injuries) causes compression and damage to
the posterior portion of the spinal cord. In anterior cord syndrome, the mechanism of injury is the
opposite of posterior cord syndrome (a hyperflexion injury where the neck hyperextends forward
- chin to chest) causing injury to the anterior portion of the spinal cord. A cauda equina
syndrome causes injury to the sacral nerve roots within the spinal canal and is caused by falling
directly on the sacrum. Brown-Sequard Syndrome caused by penetrating trauma to the lateral
aspect of the spinal cord will cause a left to right phenomenon instead of a top down
phenomenon.
A patient has a Zone II penetrating neck injury with penetration through the platysma. The
trauma nurse knows that this patient is at increased risk of injury to: - ANS-The platysma is a
muscle in the neck that gives support and protection to the vital structures underneath it. Any
time there is penetration through the platysma, there is an increased risk of damage to the
underlying structures in the neck. The neck is divided into three zones. Zone I extends from the
sternal notch and clavicle up to the cricothyroid cartilage. Zone II extends from the cricothyroid
cartilage upward to the angle of the mandible. Zone III extends from the angle of the mandible
to the base of the skull. Structures found in Zone I include the subclavian artery, vertebral artery,
lung apices, trachea, thyroid and esophagus. Zone II includes the internal jugular vein,
esophagus, larynx, vagus nerve, carotid artery and vertebral artery. Zone III includes the
salivary and parotid glands, cranial nerves IX-XII, vertebral artery, distal carotid artery, and distal
jugular vein.
A pregnant patient's fundal height is palpated 6 cm above the umbilicus. What is the estimated
gestational age of the fetus? - ANS-Fundal height is defined as the distance from the pubic
bone to the top of the uterus in centimeters. In general, the fundus reaches the umbilicus by 20
weeks. Every centimeter past that point is measured as 1 week. If every one centimeter above
the umbilicus equals one week, then the patient is approximately 26 weeks gestation.
Appropriate care for an amputated body part includes: - ANS-When caring for an amputated
body part, the trauma nurse should clean the part removing any dirt and debris, wrapping the
part in a slightly saline moistened gauze, and then placing it in a sealed plastic bag. At this time,
the part should be placed in a second bag containing a mixture of ice and water. It is imperative
that the part does not freeze or does not come into contact with water (which is hypotonic to
body tissue). Also ensure that the amputated part is properly labeled with the patient
information.
, Decontamination with water is discouraged in patients exposed to powdered: - ANS-Dry
chemicals that should not be irrigated with water include dry lime, elemental metals (including
sodium, potassium, magnesium lithium and phosphorus) and phenol. When exposed to water
these substances will cause a harmful exothermic or "heat producing" reaction burning the
patient's skin. They may also release possible hazardous byproducts into the air. Sulfuric acid,
muriatic acid and cement can all be irrigated with copious amounts of water (although a much of
the dry chemical as possible should be brushed off before irrigation with water is initiated)
Hypovolemic shock is most likely to be caused by: - ANS-Hypovolemic shock is caused by fluid
loss (e.g. bleeding or diarrhea) or third spacing of fluids. The inflammatory response caused by
a burn leads to capillary permeability resulting in the third spacing of fluids which results in
hypovolemic shock. Cervical spinal injuries contribute to neurogenic rather than hypovolemic
shock. Although an epidural hematoma causes blood loss, the epidural space is relatively small,
so blood accumulation would not be enough to result in hypovolemic shock. A tension
pneumothorax would cause obstructive shock.
The best method for assessing capillary refill on a two-week old traumatically injured neonate is
to blanch the: - ANS-The circulatory system of the neonate is not well developed and perfusion
to the fingers is not complete, therefore using the tip of the finger is reserved for older children,
adolescents and adults. It is generally recommended to use the forehead, sole of the foot, the
sternum or the palm of the hand as opposed to the skin over the iliac crest or the tip of the
child's tongue
Enteral feedings are initiated on a traumatically injured patient and several days later, the
trauma nurse notes a significant elevation in serum blood urea nitrogen (BUN) and creatinine.
The trauma nurse should suspect this may be caused by: - ANS-One of the effects of
overfeeding the traumatically injured patient is azotemia (elevated BUN and creatinine) and the
dietician should be notified of azotemia if it is noted so that an adjustment in calories may be
made. Insufficient protein in the diet does not cause azotemia. Although bleeding ulcers may
cause elevations in blood urea nitrogen, they do not tend to cause elevations in creatinine.
Feeding a patient too quickly after trauma does not cause elevations in BUN and creatinine
A trauma center refers a challenging case to an outside reviewer to validate their review of
deficiencies associated with the care of the traumatically injured patient. What type of
performance review process is this? - ANS-The first stage of performance improvement is a
primary review. The goal at this level of review is to be able to provide immediate feedback and
resolution of any deficiencies in care provided. Events that require further investigation will
follow into the category of a secondary review and these reviews are done in a step-by-step
approach, usually by the trauma medical director or designee. Immediate resolution and
feedback can be possible at the end of secondary review, and the issue may be resolved. If the
issue is not resolved, it should be referred for a multidisciplinary committee review for further
analysis. This type of analysis would be classified as a tertiary review. If further escalation of
review is required this would be considered a quaternary review. A quaternary review is either
performed by the hospital quality committee, or it is sentfor an external peer review. This type of
A transcranial doppler is obtained for a patient with a traumatic subarachnoid hemorrhage. The
doppler is positive for vasospasm. The trauma nurse would expect which of the following
medications to be prescribed? - ANS-A vasospasm is a known complication of subarachnoid
hemorrhages. Calcium channel blockers are used to prevent or reverse vasospasms and are
frequently used in the treatment of a subarachnoid hemorrhage. Metoprolol, Hydralazine and
Lisinopril are not calcium channel blockers and would not be effective to prevent and treat
vasospasms caused by a subarachnoid hemorrhage
Which chamber of the heart is most likely to be affected in blunt cardiac injuries? - ANS-Given
the anatomical position of the heart in the chest, the right ventricle is most exposed to the
anterior portion of the chest wall and is most likely to be injured in a blunt cardiac injury. Patients
with blunt cardiac injuries frequently experience signs of right ventricular failure. Additional
findings that are associated with blunt cardiac injuries include hypotension, atrial fibrillation,
unexplained sinus tachycardia, multiple PVCs, ST segment changes and right bundle branch
blocks. The left atrium, right atrium and left ventricle are less likely to be injured in a blunt
cardiac injury.
A widened mediastinum is noted on the chest x-ray of a traumatically injured hypotensive
patient. The trauma nurse would anticipate gathering which of the following pieces of equipment
as the highest priority in this scenario? - ANS-A widened mediastinum on chest x-ray,
accompanied by hypotension, is strongly indicative of an aortic injury. One of the most
life-threatening complications of an aortic injury is blood loss, which can be treated by giving
blood products via a rapid transfuser. Although patient assessment may be enhanced by
inserting an arterial line, this is less of a priority than giving fluids rapidly. A chest tube is placed
in the pleural space rather than the mediastinum and is therefore not indicated in this scenario.
Similarly, there is nothing in this scenario that indicates a pericardiocentesis is indicated so this
is not a higher priority than preparing a rapid transfuser.
A properly applied pelvic binder sits across the: - ANS-A properly applied pelvic binder is
applied across the greater trochanters of the femur. This allows for optimal compression of the
pelvis to control bleeding. Applying it across the midshaft of the femur is too low and would
provide no therapeutic benefit. Applying it across the pelvic ring or the iliac crests is too high
and could actually separate the pelvis further, increasing bleeding and internal damage.
Treatment for an extraperitoneal bladder rupture will most likely include: - ANS-Bladder
lacerations that are located below the pelvic peritoneum are diagnosed as an extraperitoneal
,bladder rupture. If a laceration is found along with pelvic peritoneum, it would then be classified
as an intraperitoneal bladder rupture. Management of an extraperitoneal bladder rupture
involves urinary catheterization (urethral or suprapubic) to facilitate urinary drainage from the
bladder. Intraperitoneal bladder ruptures require surgical intervention for definitive closure. An
isolated extraperitoneal bladder rupture does not require emergent surgical repair or
interventional radiology.
Hyperextension of the neck is known to cause: - ANS-Hyperextension of the neck (the head
snapping backwards commonly seen in "whiplash" injuries) causes compression and damage to
the posterior portion of the spinal cord. In anterior cord syndrome, the mechanism of injury is the
opposite of posterior cord syndrome (a hyperflexion injury where the neck hyperextends forward
- chin to chest) causing injury to the anterior portion of the spinal cord. A cauda equina
syndrome causes injury to the sacral nerve roots within the spinal canal and is caused by falling
directly on the sacrum. Brown-Sequard Syndrome caused by penetrating trauma to the lateral
aspect of the spinal cord will cause a left to right phenomenon instead of a top down
phenomenon.
A patient has a Zone II penetrating neck injury with penetration through the platysma. The
trauma nurse knows that this patient is at increased risk of injury to: - ANS-The platysma is a
muscle in the neck that gives support and protection to the vital structures underneath it. Any
time there is penetration through the platysma, there is an increased risk of damage to the
underlying structures in the neck. The neck is divided into three zones. Zone I extends from the
sternal notch and clavicle up to the cricothyroid cartilage. Zone II extends from the cricothyroid
cartilage upward to the angle of the mandible. Zone III extends from the angle of the mandible
to the base of the skull. Structures found in Zone I include the subclavian artery, vertebral artery,
lung apices, trachea, thyroid and esophagus. Zone II includes the internal jugular vein,
esophagus, larynx, vagus nerve, carotid artery and vertebral artery. Zone III includes the
salivary and parotid glands, cranial nerves IX-XII, vertebral artery, distal carotid artery, and distal
jugular vein.
A pregnant patient's fundal height is palpated 6 cm above the umbilicus. What is the estimated
gestational age of the fetus? - ANS-Fundal height is defined as the distance from the pubic
bone to the top of the uterus in centimeters. In general, the fundus reaches the umbilicus by 20
weeks. Every centimeter past that point is measured as 1 week. If every one centimeter above
the umbilicus equals one week, then the patient is approximately 26 weeks gestation.
Appropriate care for an amputated body part includes: - ANS-When caring for an amputated
body part, the trauma nurse should clean the part removing any dirt and debris, wrapping the
part in a slightly saline moistened gauze, and then placing it in a sealed plastic bag. At this time,
the part should be placed in a second bag containing a mixture of ice and water. It is imperative
that the part does not freeze or does not come into contact with water (which is hypotonic to
body tissue). Also ensure that the amputated part is properly labeled with the patient
information.
, Decontamination with water is discouraged in patients exposed to powdered: - ANS-Dry
chemicals that should not be irrigated with water include dry lime, elemental metals (including
sodium, potassium, magnesium lithium and phosphorus) and phenol. When exposed to water
these substances will cause a harmful exothermic or "heat producing" reaction burning the
patient's skin. They may also release possible hazardous byproducts into the air. Sulfuric acid,
muriatic acid and cement can all be irrigated with copious amounts of water (although a much of
the dry chemical as possible should be brushed off before irrigation with water is initiated)
Hypovolemic shock is most likely to be caused by: - ANS-Hypovolemic shock is caused by fluid
loss (e.g. bleeding or diarrhea) or third spacing of fluids. The inflammatory response caused by
a burn leads to capillary permeability resulting in the third spacing of fluids which results in
hypovolemic shock. Cervical spinal injuries contribute to neurogenic rather than hypovolemic
shock. Although an epidural hematoma causes blood loss, the epidural space is relatively small,
so blood accumulation would not be enough to result in hypovolemic shock. A tension
pneumothorax would cause obstructive shock.
The best method for assessing capillary refill on a two-week old traumatically injured neonate is
to blanch the: - ANS-The circulatory system of the neonate is not well developed and perfusion
to the fingers is not complete, therefore using the tip of the finger is reserved for older children,
adolescents and adults. It is generally recommended to use the forehead, sole of the foot, the
sternum or the palm of the hand as opposed to the skin over the iliac crest or the tip of the
child's tongue
Enteral feedings are initiated on a traumatically injured patient and several days later, the
trauma nurse notes a significant elevation in serum blood urea nitrogen (BUN) and creatinine.
The trauma nurse should suspect this may be caused by: - ANS-One of the effects of
overfeeding the traumatically injured patient is azotemia (elevated BUN and creatinine) and the
dietician should be notified of azotemia if it is noted so that an adjustment in calories may be
made. Insufficient protein in the diet does not cause azotemia. Although bleeding ulcers may
cause elevations in blood urea nitrogen, they do not tend to cause elevations in creatinine.
Feeding a patient too quickly after trauma does not cause elevations in BUN and creatinine
A trauma center refers a challenging case to an outside reviewer to validate their review of
deficiencies associated with the care of the traumatically injured patient. What type of
performance review process is this? - ANS-The first stage of performance improvement is a
primary review. The goal at this level of review is to be able to provide immediate feedback and
resolution of any deficiencies in care provided. Events that require further investigation will
follow into the category of a secondary review and these reviews are done in a step-by-step
approach, usually by the trauma medical director or designee. Immediate resolution and
feedback can be possible at the end of secondary review, and the issue may be resolved. If the
issue is not resolved, it should be referred for a multidisciplinary committee review for further
analysis. This type of analysis would be classified as a tertiary review. If further escalation of
review is required this would be considered a quaternary review. A quaternary review is either
performed by the hospital quality committee, or it is sentfor an external peer review. This type of
