Trauma Care After Resuscitation (TCAR) Post-Test Exam
Questions and Answers |Fall 2025/2026 Update | 100%
Correct
QUESTION 1:
During the secondary survey of a trauma patient, which finding most strongly suggests an
evolving tension pneumothorax?
A. Diminished breath sounds bilaterally
B. Jugular venous distension with tracheal deviation
C. Equal chest rise and fall
D. Bradycardia and hypotension
CORRECT ANSWER: B
RATIONALE: Jugular venous distension with tracheal deviation indicates pressure build-up in the
pleural space pushing mediastinal structures. Equal chest rise (C) suggests adequate ventilation;
bilateral diminution (A) and bradycardia (D) are nonspecific.
QUESTION 2:
Which fluid resuscitation strategy is most consistent with damage control resuscitation
principles?
A. Rapid infusion of large volumes of crystalloids
B. Administration of balanced blood products in a 1:1:1 ratio
C. Using hypotonic solutions to reduce cellular edema
D. Delaying transfusion until hemoglobin < 7 g/dL
CORRECT ANSWER: B
RATIONALE: Balanced blood product transfusion mimics whole blood and reduces dilutional
coagulopathy. Large-volume crystalloids (A) worsen acidosis, hypothermia, and coagulopathy.
QUESTION 3:
A trauma patient presents with a GCS of 7 after motor vehicle collision. What is the priority
intervention?
A. Obtain a CT scan of the head
B. Administer high-flow oxygen via nasal cannula
C. Secure the airway with endotracheal intubation
D. Perform a neurological reassessment every 15 minutes
,CORRECT ANSWER: C
RATIONALE: A GCS ≤ 8 mandates airway control to protect from aspiration and hypoventilation.
Imaging and reassessments follow stabilization.
QUESTION 4:
During assessment of a patient with blunt abdominal trauma, the presence of Kehr’s sign
indicates likely injury to the:
A. Spleen
B. Liver
C. Kidney
D. Diaphragm
CORRECT ANSWER: A
RATIONALE: Kehr’s sign (left shoulder pain due to diaphragmatic irritation by blood) is classic for
splenic injury.
QUESTION 5:
Which intervention helps prevent secondary brain injury after severe head trauma?
A. Hyperventilation to maintain PaCO₂ < 25 mmHg
B. Maintaining normothermia and adequate cerebral perfusion pressure
C. Restricting fluids to minimize cerebral edema
D. Routine use of corticosteroids
CORRECT ANSWER: B
RATIONALE: Prevention centers on optimizing oxygenation, perfusion, and temperature.
Hyperventilation (A) risks cerebral vasoconstriction.
QUESTION 6:
After femur fracture stabilization, a patient develops dyspnea, confusion, and petechial rash.
What is the most likely diagnosis?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Air embolism
D. Compartment syndrome
,CORRECT ANSWER: B
RATIONALE: Classic triad of fat embolism: respiratory distress, neurologic changes, and
petechiae, typically within 24–72 hours of long-bone injury.
QUESTION 7:
Which of the following best reflects the goal of trauma nursing resuscitation education (TCAR)?
A. To imitate ATLS physician protocol
B. To integrate pathophysiologic understanding into nursing interventions post-resuscitation
C. To train nurses to perform advanced surgical airway procedures
D. To emphasize prehospital trauma triage
CORRECT ANSWER: B
RATIONALE: TCAR focuses on evidence-based acute care nursing management beyond initial
stabilization, grounded in pathophysiologic reasoning.
QUESTION 8:
A patient with chest trauma develops muffled heart sounds and hypotension. Which diagnostic
finding clinches cardiac tamponade?
A. Pulsus paradoxus
B. Narrow pulse pressure with JVD
C. ECG with electrical alternans
D. Bradycardia with distant lung sounds
CORRECT ANSWER: C
RATIONALE: Electrical alternans on ECG is diagnostic of tamponade, confirming suspicion from
Beck’s triad (hypotension, JVD, muffled heart sounds).
QUESTION 9:
Which laboratory pattern is most consistent with early hypovolemic shock?
A. Elevated lactate and base deficit
B. Normal lactate, low sodium
C. Increased hematocrit due to hemoconcentration
D. Increased creatinine due to rhabdomyolysis
, CORRECT ANSWER: A
RATIONALE: Tissue hypoperfusion causes anaerobic metabolism → lactic acidosis and negative
base excess.
QUESTION 10:
In a patient with pelvic fracture and hypotension, initial management includes:
A. Trendelenburg positioning
B. Pelvic binder application and early transfusion
C. IV fluids only
D. Waiting for radiographic confirmation before intervention
CORRECT ANSWER: B
RATIONALE: Pelvic binder minimizes bleeding and stabilizes fragments while blood resuscitation
addresses hypovolemia.
QUESTION 11:
A trauma patient presents with respiratory distress after submersion in fresh water. What is the
primary pathophysiologic mechanism?
A. Alveolar surfactant washout leading to atelectasis
B. Aspiration pneumonia from bacterial contamination
C. Bronchospasm due to cold water
D. Pulmonary embolism secondary to venous air
CORRECT ANSWER: A
RATIONALE: Freshwater aspiration causes loss of surfactant and alveolar collapse, leading to
impaired gas exchange and hypoxemia.
QUESTION 12:
The nurse notes clear fluid draining from a patient’s ear after a basilar skull fracture. Which
action is most appropriate?
A. Pack the ear canal with gauze
B. Test the fluid for glucose or β-2 transferrin
C. Insert an otoscope for closer examination
D. Apply firm head dressing to stop the leak
Questions and Answers |Fall 2025/2026 Update | 100%
Correct
QUESTION 1:
During the secondary survey of a trauma patient, which finding most strongly suggests an
evolving tension pneumothorax?
A. Diminished breath sounds bilaterally
B. Jugular venous distension with tracheal deviation
C. Equal chest rise and fall
D. Bradycardia and hypotension
CORRECT ANSWER: B
RATIONALE: Jugular venous distension with tracheal deviation indicates pressure build-up in the
pleural space pushing mediastinal structures. Equal chest rise (C) suggests adequate ventilation;
bilateral diminution (A) and bradycardia (D) are nonspecific.
QUESTION 2:
Which fluid resuscitation strategy is most consistent with damage control resuscitation
principles?
A. Rapid infusion of large volumes of crystalloids
B. Administration of balanced blood products in a 1:1:1 ratio
C. Using hypotonic solutions to reduce cellular edema
D. Delaying transfusion until hemoglobin < 7 g/dL
CORRECT ANSWER: B
RATIONALE: Balanced blood product transfusion mimics whole blood and reduces dilutional
coagulopathy. Large-volume crystalloids (A) worsen acidosis, hypothermia, and coagulopathy.
QUESTION 3:
A trauma patient presents with a GCS of 7 after motor vehicle collision. What is the priority
intervention?
A. Obtain a CT scan of the head
B. Administer high-flow oxygen via nasal cannula
C. Secure the airway with endotracheal intubation
D. Perform a neurological reassessment every 15 minutes
,CORRECT ANSWER: C
RATIONALE: A GCS ≤ 8 mandates airway control to protect from aspiration and hypoventilation.
Imaging and reassessments follow stabilization.
QUESTION 4:
During assessment of a patient with blunt abdominal trauma, the presence of Kehr’s sign
indicates likely injury to the:
A. Spleen
B. Liver
C. Kidney
D. Diaphragm
CORRECT ANSWER: A
RATIONALE: Kehr’s sign (left shoulder pain due to diaphragmatic irritation by blood) is classic for
splenic injury.
QUESTION 5:
Which intervention helps prevent secondary brain injury after severe head trauma?
A. Hyperventilation to maintain PaCO₂ < 25 mmHg
B. Maintaining normothermia and adequate cerebral perfusion pressure
C. Restricting fluids to minimize cerebral edema
D. Routine use of corticosteroids
CORRECT ANSWER: B
RATIONALE: Prevention centers on optimizing oxygenation, perfusion, and temperature.
Hyperventilation (A) risks cerebral vasoconstriction.
QUESTION 6:
After femur fracture stabilization, a patient develops dyspnea, confusion, and petechial rash.
What is the most likely diagnosis?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Air embolism
D. Compartment syndrome
,CORRECT ANSWER: B
RATIONALE: Classic triad of fat embolism: respiratory distress, neurologic changes, and
petechiae, typically within 24–72 hours of long-bone injury.
QUESTION 7:
Which of the following best reflects the goal of trauma nursing resuscitation education (TCAR)?
A. To imitate ATLS physician protocol
B. To integrate pathophysiologic understanding into nursing interventions post-resuscitation
C. To train nurses to perform advanced surgical airway procedures
D. To emphasize prehospital trauma triage
CORRECT ANSWER: B
RATIONALE: TCAR focuses on evidence-based acute care nursing management beyond initial
stabilization, grounded in pathophysiologic reasoning.
QUESTION 8:
A patient with chest trauma develops muffled heart sounds and hypotension. Which diagnostic
finding clinches cardiac tamponade?
A. Pulsus paradoxus
B. Narrow pulse pressure with JVD
C. ECG with electrical alternans
D. Bradycardia with distant lung sounds
CORRECT ANSWER: C
RATIONALE: Electrical alternans on ECG is diagnostic of tamponade, confirming suspicion from
Beck’s triad (hypotension, JVD, muffled heart sounds).
QUESTION 9:
Which laboratory pattern is most consistent with early hypovolemic shock?
A. Elevated lactate and base deficit
B. Normal lactate, low sodium
C. Increased hematocrit due to hemoconcentration
D. Increased creatinine due to rhabdomyolysis
, CORRECT ANSWER: A
RATIONALE: Tissue hypoperfusion causes anaerobic metabolism → lactic acidosis and negative
base excess.
QUESTION 10:
In a patient with pelvic fracture and hypotension, initial management includes:
A. Trendelenburg positioning
B. Pelvic binder application and early transfusion
C. IV fluids only
D. Waiting for radiographic confirmation before intervention
CORRECT ANSWER: B
RATIONALE: Pelvic binder minimizes bleeding and stabilizes fragments while blood resuscitation
addresses hypovolemia.
QUESTION 11:
A trauma patient presents with respiratory distress after submersion in fresh water. What is the
primary pathophysiologic mechanism?
A. Alveolar surfactant washout leading to atelectasis
B. Aspiration pneumonia from bacterial contamination
C. Bronchospasm due to cold water
D. Pulmonary embolism secondary to venous air
CORRECT ANSWER: A
RATIONALE: Freshwater aspiration causes loss of surfactant and alveolar collapse, leading to
impaired gas exchange and hypoxemia.
QUESTION 12:
The nurse notes clear fluid draining from a patient’s ear after a basilar skull fracture. Which
action is most appropriate?
A. Pack the ear canal with gauze
B. Test the fluid for glucose or β-2 transferrin
C. Insert an otoscope for closer examination
D. Apply firm head dressing to stop the leak
