TCRN Review UPDATED ACTUAL Questions and CORRECT Answers
1. administration of a short-acting beta-blocker An unrestrained driver involved
(Short-acting beta-blockers should be adminis- in a high-speed motor vehicle
tered in a patient who is hemodynamically stable collision is evaluated at a rural,
to decrease heart rate and decrease MAP until non-trauma facility without surgi-
definitive treatment can be completed) cal capabilities. The patient ini-
tially displayed dyspnea, tachyp-
nea and hypotension that stabi-
lized after volume resuscitation. A
chest x-ray reveals a widened me-
diastinum. The nurse should an-
ticipate
2. splinting materials (Splinting of limbs is crucial A patient arrives to the emergency
to attempt to avoid further injury following frost- department with frostbite to the
bite) lower limbs. Which of the follow-
ing should the nurse prepare to
initiate for this patient's care?
3. hypophosphatemia, hypokalemia, hypomagne- Refeeding syndrome is character-
semia (Three lab values that decrease in patients ized by which combination of the
who are suffering from refeeding syndrome are following
phosphate, potassium, and magnesium)
4. vasopressor therapy (Cerebral perfusion pres- The nurse is caring for a patient
sure (CPP) is frequently used to measure cere- who has sustained a traumatic
bral perfusion and is calculated by subtracting brain injury. Intracranial pressure
the intracranial pressure from the mean arteri- is 19 mmHg and the mean arterial
al pressure (MAP-ICP). The recommended target pressure is 60 mmHg. The nurse
for optimal outcomes is a CPP of 60-70 mmHg) should anticipate an order for
5. An adult patient arrives to the
emergency department after a
, CT cystography (CT cystogram has a high sen- high-speed, rollover MVC. They
sitivity and specificity for detecting evidence of have an obvious unstable pelvis
rupture) on exam. The nurse understands
which of the following provides
the MOST definitive diagnosis of
bladder rupture?
6. initiate vasopressors (Blood pressure in the The nurse is caring for a pa-
spinal cord injured patient is first managed with tient with a C5 tetraplegic injury
isotonic crystalloid administration and once in- on hospital day two. The patient
travascular volume has been optimized, vasoac- does not have any active bleed-
tive agents are used. Current guidelines recom- ing. Mean arterial pressure is 60
mend a systolic BP >90 mmHg and a MAP of mmHg. The nurse should antici-
85-90 mmHg to optimize blood flow to the cord pate orders to
and prevent secondary injury)
7. Insertion of a nasal or oral gastric tube (Patients A patient has experienced 30%
with greater than 20% burns require a nasal or TBSA burns with suspected in-
oral gastric tube as they will experience gastro- halation injuries. Following air-
paresis and probably emesis.) way protection, which intervention
should be prioritized?
8. exploratory laparotomy (Diaphragm injuries are A patient presents to the emer-
confirmed with laparotomies. DPL, FAST and CT gency department after being
scans can all miss diaphragm injuries) stabbed in the left hemidi-
aphragm area. Which of the fol-
lowing should the nurse antici-
pate to diagnose an injury to the
diaphragm?
9. Small bowel perforation (Small bowel and colon A patient arrives to the ED com-
injuries occur most frequently from a sudden plaining of abdominal pain 24
increase of intraluminal pressure. Signs of small hours after a bicycle accident, in
, bowel injuries are typically more delayed then which they flew over the handle-
liver or splenic injuries. Diaphragmatic tear is bars. Assessment reveals abdomi-
associated with bowel sounds auscultation over nal distention/rigidity, bruising to
the lung fields. Liver and splenic injuries are as- the lower abdomen, absent bow-
sociated with upper abdominal pain) el sounds, tachycardia, and hy-
potension. Which injury would the
nurse MOST likely expect?
10. draw serial hemoglobin and hematocrits A CT scan of a patient's abdomen
(Non-surgical treatment is the most common reveals a grade II spleen lacer-
method of management for patients with spleen ation without contrast extravasa-
injuries. Lab studies include serial hemoglobin tion. The MOST appropriate plan
and hematocrit.) of action should be to
11. when the pH of the tears from the eye is 7.0 A patient arrives in the emergency
(Irrigation following chemical eye injuries is com- department after ammonia was
plete when the pH of the tears in the cul-de-sac splashed in their eye. The trauma
of the eye reaches 7.0.) team immediately begins irriga-
tion of the eye with sterile isotonic
saline. Suflcient irrigation of the
eye is determined
12. remove any overlying dressing to the affected A patient presents with decreased
eye (Care should be taken to avoid any pressure vision, pain, and periorbital ec-
over the globe of the eye. Application of a rigid chymosis in the right eye following
eye shield is recommended to protect the affect- isolated blunt force trauma to the
ed eye) face. A cervical collar was applied,
and an ice pack and dry gauze
dressing to the face are in place
on arrival. The NEXT MOST appro-
priate intervention is to
13.
, primary (Primary injury prevention focuses on Local high school students are
preventing an injury or event before it occurs; planning an event to address
therefore, educating students on the danger of drinking and driving. This is an
drinking and driving would be an example of example of which of the follow-
primary prevention. Secondary prevention aims ing types of injury prevention pro-
to reduce the impact of an injury or event that grams?
has already occurred. This is done by detecting
and treating disease or injury as soon as possible
to halt or slow its progress. Tertiary prevention
focuses on optimizing the outcome and aims to
soften the impact of an ongoing injury through
medical interventions and rehabilitation. This is
done by helping people manage long-term, of-
ten-complex health problems and injuries. Qua-
ternary prevention methods consists of avoiding
excessive or unnecessary interventions or cost in
the healthcare system.)
14. 4 to 6 (Ischemia from acute compartment syn- Muscle necrosis associated with
drome can cause irreversible muscle necrosis in compartment syndrome can occur
as few as 4 hours following the injury) within how many hours?
15. wearing a lap seatbelt across the thighs and hip The nurse is preparing a presen-
bones (Seatbelts should be worn below the preg- tation for a group of pregnant
nant woman's abdomen to decrease harm to the women on injury prevention, with
fetus during motor vehicle accidents) a focus on third trimester risk fac-
tors. The nurse should include
16. Continuous cardiac monitoring (Hydrofluoric A patient presents to the emer-
acid can cause alterations in electrolytes, espe- gency department complaining of
cially hypocalcemia necessitating cardiac moni- burning in their hand after ex-
toring to detect electrolyte-induced arrhythmias. posure to hydrofluoric acid. The
1. administration of a short-acting beta-blocker An unrestrained driver involved
(Short-acting beta-blockers should be adminis- in a high-speed motor vehicle
tered in a patient who is hemodynamically stable collision is evaluated at a rural,
to decrease heart rate and decrease MAP until non-trauma facility without surgi-
definitive treatment can be completed) cal capabilities. The patient ini-
tially displayed dyspnea, tachyp-
nea and hypotension that stabi-
lized after volume resuscitation. A
chest x-ray reveals a widened me-
diastinum. The nurse should an-
ticipate
2. splinting materials (Splinting of limbs is crucial A patient arrives to the emergency
to attempt to avoid further injury following frost- department with frostbite to the
bite) lower limbs. Which of the follow-
ing should the nurse prepare to
initiate for this patient's care?
3. hypophosphatemia, hypokalemia, hypomagne- Refeeding syndrome is character-
semia (Three lab values that decrease in patients ized by which combination of the
who are suffering from refeeding syndrome are following
phosphate, potassium, and magnesium)
4. vasopressor therapy (Cerebral perfusion pres- The nurse is caring for a patient
sure (CPP) is frequently used to measure cere- who has sustained a traumatic
bral perfusion and is calculated by subtracting brain injury. Intracranial pressure
the intracranial pressure from the mean arteri- is 19 mmHg and the mean arterial
al pressure (MAP-ICP). The recommended target pressure is 60 mmHg. The nurse
for optimal outcomes is a CPP of 60-70 mmHg) should anticipate an order for
5. An adult patient arrives to the
emergency department after a
, CT cystography (CT cystogram has a high sen- high-speed, rollover MVC. They
sitivity and specificity for detecting evidence of have an obvious unstable pelvis
rupture) on exam. The nurse understands
which of the following provides
the MOST definitive diagnosis of
bladder rupture?
6. initiate vasopressors (Blood pressure in the The nurse is caring for a pa-
spinal cord injured patient is first managed with tient with a C5 tetraplegic injury
isotonic crystalloid administration and once in- on hospital day two. The patient
travascular volume has been optimized, vasoac- does not have any active bleed-
tive agents are used. Current guidelines recom- ing. Mean arterial pressure is 60
mend a systolic BP >90 mmHg and a MAP of mmHg. The nurse should antici-
85-90 mmHg to optimize blood flow to the cord pate orders to
and prevent secondary injury)
7. Insertion of a nasal or oral gastric tube (Patients A patient has experienced 30%
with greater than 20% burns require a nasal or TBSA burns with suspected in-
oral gastric tube as they will experience gastro- halation injuries. Following air-
paresis and probably emesis.) way protection, which intervention
should be prioritized?
8. exploratory laparotomy (Diaphragm injuries are A patient presents to the emer-
confirmed with laparotomies. DPL, FAST and CT gency department after being
scans can all miss diaphragm injuries) stabbed in the left hemidi-
aphragm area. Which of the fol-
lowing should the nurse antici-
pate to diagnose an injury to the
diaphragm?
9. Small bowel perforation (Small bowel and colon A patient arrives to the ED com-
injuries occur most frequently from a sudden plaining of abdominal pain 24
increase of intraluminal pressure. Signs of small hours after a bicycle accident, in
, bowel injuries are typically more delayed then which they flew over the handle-
liver or splenic injuries. Diaphragmatic tear is bars. Assessment reveals abdomi-
associated with bowel sounds auscultation over nal distention/rigidity, bruising to
the lung fields. Liver and splenic injuries are as- the lower abdomen, absent bow-
sociated with upper abdominal pain) el sounds, tachycardia, and hy-
potension. Which injury would the
nurse MOST likely expect?
10. draw serial hemoglobin and hematocrits A CT scan of a patient's abdomen
(Non-surgical treatment is the most common reveals a grade II spleen lacer-
method of management for patients with spleen ation without contrast extravasa-
injuries. Lab studies include serial hemoglobin tion. The MOST appropriate plan
and hematocrit.) of action should be to
11. when the pH of the tears from the eye is 7.0 A patient arrives in the emergency
(Irrigation following chemical eye injuries is com- department after ammonia was
plete when the pH of the tears in the cul-de-sac splashed in their eye. The trauma
of the eye reaches 7.0.) team immediately begins irriga-
tion of the eye with sterile isotonic
saline. Suflcient irrigation of the
eye is determined
12. remove any overlying dressing to the affected A patient presents with decreased
eye (Care should be taken to avoid any pressure vision, pain, and periorbital ec-
over the globe of the eye. Application of a rigid chymosis in the right eye following
eye shield is recommended to protect the affect- isolated blunt force trauma to the
ed eye) face. A cervical collar was applied,
and an ice pack and dry gauze
dressing to the face are in place
on arrival. The NEXT MOST appro-
priate intervention is to
13.
, primary (Primary injury prevention focuses on Local high school students are
preventing an injury or event before it occurs; planning an event to address
therefore, educating students on the danger of drinking and driving. This is an
drinking and driving would be an example of example of which of the follow-
primary prevention. Secondary prevention aims ing types of injury prevention pro-
to reduce the impact of an injury or event that grams?
has already occurred. This is done by detecting
and treating disease or injury as soon as possible
to halt or slow its progress. Tertiary prevention
focuses on optimizing the outcome and aims to
soften the impact of an ongoing injury through
medical interventions and rehabilitation. This is
done by helping people manage long-term, of-
ten-complex health problems and injuries. Qua-
ternary prevention methods consists of avoiding
excessive or unnecessary interventions or cost in
the healthcare system.)
14. 4 to 6 (Ischemia from acute compartment syn- Muscle necrosis associated with
drome can cause irreversible muscle necrosis in compartment syndrome can occur
as few as 4 hours following the injury) within how many hours?
15. wearing a lap seatbelt across the thighs and hip The nurse is preparing a presen-
bones (Seatbelts should be worn below the preg- tation for a group of pregnant
nant woman's abdomen to decrease harm to the women on injury prevention, with
fetus during motor vehicle accidents) a focus on third trimester risk fac-
tors. The nurse should include
16. Continuous cardiac monitoring (Hydrofluoric A patient presents to the emer-
acid can cause alterations in electrolytes, espe- gency department complaining of
cially hypocalcemia necessitating cardiac moni- burning in their hand after ex-
toring to detect electrolyte-induced arrhythmias. posure to hydrofluoric acid. The
