TCRN COMPLETE STUDY GUIDE TEST.
1)
The trauma nurse is caring for a 6-year-old child who sustained a tackle while participating in a youth
football game. The patient's mother states, "He got the wind knocked out of him." Vital signs are:
HR 120 beats/min
BP 85/50 mmHg
RR 26 breaths/min
SpO2 92% (room air)
Based on the injury pattern, the nurse suspects which injury is MOST likely?
Possible answer(s):
Cardiac contusion
Tension pneumothorax
Pulmonary contusion
Splenic rupture - CORRECT ANSWER Pulmonary contusion
The chest wall of a child allows for pulmonary contusions without rib fractures. The child is not actively
hypotensive or showing signs of a tension pneumothorax. Cardiac contusion can lead to decreased
cardiac output, tachycardia, and ventricular ectopy. Splenic rupture will cause hypotension, which this
child is not experiencing.
2)
An infant with a history of Trisomy 21 is being evaluated status post motor vehicle collision. The nurse
anticipates which of the following may be related to traumatic injury rather than a history of Trisomy
21?
Possible answer(s):
atlantoaxial instability
,limp extremities
tongue obstruction
bulging fontanels - CORRECT ANSWER Bulging fontanels
Limp extremities, tongue obstruction and atlantoaxial instability may all be common in patients with
Down syndrome (Trisomy 21). Bulging fontanels are a sign of increased intracranial pressure in the
infant patient, and should be considered to be related to traumatic injury.
3)
An opportunity for improvement is identified following a patient delay transferring to the operating
room and a corrective action plan is implemented. Which of the following provides the BEST example of
loop closure?
Possible answers:
Communicating with the operating room staff on how to appropriately schedule cases
Measuring the time to the operating room for the next 10 patients.
Documenting an educational letter sent to the involved surgeon
Recording discussion of the issue in peer review minutes - CORRECT ANSWER Measuring the time to the
operating room for the next 10 patients.
Comments:
Effective performance improvement demonstrates that corrective action has had the desired effect as
determined by continuous monitoring and evaluation. Demonstrating that the time to the operating
room is within limits is the best way to demonstrate effective loop closure of this performance
improvement event. The others are examples of actionable items but they don't provide the best,
complete loop closure that specific measurable time objectives would.
During a debrief of a trauma activation, the surgeon is concerned that the resuscitation effort was very
disorganized from pre-hospital report and throughout the initial trauma care. What is the BEST example
of an intervention to improve team communication in future resuscitations?
,Possible answers:
Creating a standardized pre-hospital reporting tool
Initiating pre-arrival huddles
Identifying roles upon patient arrival
Allowing silence for pre-hospital providers report - CORRECT ANSWER Initiating pre-arrival huddles
Clear communication of the patient plan, roles and responsibilities, and providing an opportunity to
discuss staff concerns are part of the pre-arrival huddle. The team leader can communicate anticipated
resuscitative goals, clarify assignments, and assist in prioritizing care. Allowing pre-hospital staff an
uninterrupted opportunity to provide report as well as creating a standardized tool will address the
potential loss of pertinent information during the pre-hospital hand-off but will not address the overall
team communication issue. Identification of roles should be done prior to the patient arrival.
A patient is being transported by prehospital personnel after being involved in a motor vehicle collision.
The patient's assessment reveals an intact airway and the following vitals:
BP: 110/72 (mmHg)HR: 119 (beats/min)RR: 26 (breaths/min)Glasgow Coma Scale (GCS) score: 9
The MOST appropriate destination for transport is:
Possible answers:
level 3 trauma center 10 minutes away
level 1 trauma center 20 minutes away
level 2 trauma center 30 minutes away
non-trauma center 5 minutes away - CORRECT ANSWER level 1 trauma center 20 minutes away
The patient has injuries as a result of a high-risk auto crash that need to be addressed at a trauma
center. A level 1 trauma center provides the highest level of trauma care with in-house neurosurgery
coverage and is closer than the level 2 center. A level 3 trauma center is not required to provide
continuous in-house neurosurgery coverage. Due to the patient's GCS less than or equal to 13, the
patient should be evaluated by the closest trauma center with preferential evaluation at the highest-
level trauma center.
, A patient presents following a motor vehicle collision and has an unstable pelvis. The PRIORITY
intervention is:
Possible answers:
administration of analgesics.
application of a pelvic binder.
initiation of massive transfusion protocol.
infusion of crystalloid fluid - CORRECT ANSWER application of a pelvic binder.
Pelvic fractures can result in blood loss of 3000mL. Use of a pelvic binder will assist to tamponade the
bleeding in the pelvis and assist with hemostasis. Blood product transfusion is preferred over crystalloid
infusion, however preventing further hemorrhage is the immediate priority. Analgesic administration is
important but is not the first priority.
The nurse is caring for a patient who is morbidly obese. The patient sustained a head injury and requires
intubation. When initially placing the patient on a ventilator, the nurse should anticipate an order for
Possible answers:
FiO2 of 21-25%
PEEP of 5-10 cm H2O
respiratory rate of 25-30 breaths/min.
tidal volume of 750-1000 mL. - CORRECT ANSWER tidal volume of 750-1000 mL.
Ventilator settings for a patient with obesity are based on ideal body weight and healthy lungs. A PEEP
of 5-10 H2O is often required in patients who are morbidly obese. A tidal volume of 750-1000 mL is too
high. Patients often require a FiO2 of at least 30. Even with a head injury, tachypnea with a respiratory
rate of 25-30 is high for this patient.
1)
The trauma nurse is caring for a 6-year-old child who sustained a tackle while participating in a youth
football game. The patient's mother states, "He got the wind knocked out of him." Vital signs are:
HR 120 beats/min
BP 85/50 mmHg
RR 26 breaths/min
SpO2 92% (room air)
Based on the injury pattern, the nurse suspects which injury is MOST likely?
Possible answer(s):
Cardiac contusion
Tension pneumothorax
Pulmonary contusion
Splenic rupture - CORRECT ANSWER Pulmonary contusion
The chest wall of a child allows for pulmonary contusions without rib fractures. The child is not actively
hypotensive or showing signs of a tension pneumothorax. Cardiac contusion can lead to decreased
cardiac output, tachycardia, and ventricular ectopy. Splenic rupture will cause hypotension, which this
child is not experiencing.
2)
An infant with a history of Trisomy 21 is being evaluated status post motor vehicle collision. The nurse
anticipates which of the following may be related to traumatic injury rather than a history of Trisomy
21?
Possible answer(s):
atlantoaxial instability
,limp extremities
tongue obstruction
bulging fontanels - CORRECT ANSWER Bulging fontanels
Limp extremities, tongue obstruction and atlantoaxial instability may all be common in patients with
Down syndrome (Trisomy 21). Bulging fontanels are a sign of increased intracranial pressure in the
infant patient, and should be considered to be related to traumatic injury.
3)
An opportunity for improvement is identified following a patient delay transferring to the operating
room and a corrective action plan is implemented. Which of the following provides the BEST example of
loop closure?
Possible answers:
Communicating with the operating room staff on how to appropriately schedule cases
Measuring the time to the operating room for the next 10 patients.
Documenting an educational letter sent to the involved surgeon
Recording discussion of the issue in peer review minutes - CORRECT ANSWER Measuring the time to the
operating room for the next 10 patients.
Comments:
Effective performance improvement demonstrates that corrective action has had the desired effect as
determined by continuous monitoring and evaluation. Demonstrating that the time to the operating
room is within limits is the best way to demonstrate effective loop closure of this performance
improvement event. The others are examples of actionable items but they don't provide the best,
complete loop closure that specific measurable time objectives would.
During a debrief of a trauma activation, the surgeon is concerned that the resuscitation effort was very
disorganized from pre-hospital report and throughout the initial trauma care. What is the BEST example
of an intervention to improve team communication in future resuscitations?
,Possible answers:
Creating a standardized pre-hospital reporting tool
Initiating pre-arrival huddles
Identifying roles upon patient arrival
Allowing silence for pre-hospital providers report - CORRECT ANSWER Initiating pre-arrival huddles
Clear communication of the patient plan, roles and responsibilities, and providing an opportunity to
discuss staff concerns are part of the pre-arrival huddle. The team leader can communicate anticipated
resuscitative goals, clarify assignments, and assist in prioritizing care. Allowing pre-hospital staff an
uninterrupted opportunity to provide report as well as creating a standardized tool will address the
potential loss of pertinent information during the pre-hospital hand-off but will not address the overall
team communication issue. Identification of roles should be done prior to the patient arrival.
A patient is being transported by prehospital personnel after being involved in a motor vehicle collision.
The patient's assessment reveals an intact airway and the following vitals:
BP: 110/72 (mmHg)HR: 119 (beats/min)RR: 26 (breaths/min)Glasgow Coma Scale (GCS) score: 9
The MOST appropriate destination for transport is:
Possible answers:
level 3 trauma center 10 minutes away
level 1 trauma center 20 minutes away
level 2 trauma center 30 minutes away
non-trauma center 5 minutes away - CORRECT ANSWER level 1 trauma center 20 minutes away
The patient has injuries as a result of a high-risk auto crash that need to be addressed at a trauma
center. A level 1 trauma center provides the highest level of trauma care with in-house neurosurgery
coverage and is closer than the level 2 center. A level 3 trauma center is not required to provide
continuous in-house neurosurgery coverage. Due to the patient's GCS less than or equal to 13, the
patient should be evaluated by the closest trauma center with preferential evaluation at the highest-
level trauma center.
, A patient presents following a motor vehicle collision and has an unstable pelvis. The PRIORITY
intervention is:
Possible answers:
administration of analgesics.
application of a pelvic binder.
initiation of massive transfusion protocol.
infusion of crystalloid fluid - CORRECT ANSWER application of a pelvic binder.
Pelvic fractures can result in blood loss of 3000mL. Use of a pelvic binder will assist to tamponade the
bleeding in the pelvis and assist with hemostasis. Blood product transfusion is preferred over crystalloid
infusion, however preventing further hemorrhage is the immediate priority. Analgesic administration is
important but is not the first priority.
The nurse is caring for a patient who is morbidly obese. The patient sustained a head injury and requires
intubation. When initially placing the patient on a ventilator, the nurse should anticipate an order for
Possible answers:
FiO2 of 21-25%
PEEP of 5-10 cm H2O
respiratory rate of 25-30 breaths/min.
tidal volume of 750-1000 mL. - CORRECT ANSWER tidal volume of 750-1000 mL.
Ventilator settings for a patient with obesity are based on ideal body weight and healthy lungs. A PEEP
of 5-10 H2O is often required in patients who are morbidly obese. A tidal volume of 750-1000 mL is too
high. Patients often require a FiO2 of at least 30. Even with a head injury, tachypnea with a respiratory
rate of 25-30 is high for this patient.
