TCRN PRACTICE QUESTIONS WITH 100% ACCURATE ANSWERS
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? - (ANSWER)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? - (ANSWER)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? - (ANSWER)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: - (ANSWER)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: - (ANSWER)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
,TCRN PRACTICE QUESTIONS WITH 100% ACCURATE ANSWERS
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: - (ANSWER)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: - (ANSWER)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? - (ANSWER)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: - (ANSWER)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.
, TCRN PRACTICE QUESTIONS WITH 100% ACCURATE ANSWERS
Decontamination with water is discouraged in patients exposed to powdered: - (ANSWER)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: - (ANSWER)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: - (ANSWER)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: - (ANSWER)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? - (ANSWER)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
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? - (ANSWER)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? - (ANSWER)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? - (ANSWER)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: - (ANSWER)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: - (ANSWER)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
,TCRN PRACTICE QUESTIONS WITH 100% ACCURATE ANSWERS
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: - (ANSWER)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: - (ANSWER)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? - (ANSWER)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: - (ANSWER)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.
, TCRN PRACTICE QUESTIONS WITH 100% ACCURATE ANSWERS
Decontamination with water is discouraged in patients exposed to powdered: - (ANSWER)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: - (ANSWER)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: - (ANSWER)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: - (ANSWER)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? - (ANSWER)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
