TCAR POST | TCAR POST TEST EXAM / ACTUAL 3.
EXAM VERIFIED QUESTIONS AND CORRECT A trauma patient with blunt abdominal injury presents with tachycardia,
hypotension, and distended abdomen. Which organ is most likely the source of
DETAILED ANSWERS WITH RATIONALES bleeding?
GRADED A+ LATEST A. Pancreas
1. B. Spleen
A patient involved in a high-speed MVC is found unresponsive with irregular C. Small intestine
respirations and unequal pupils. Which injury is most likely responsible? D. Gallbladder
A. Basilar skull fracture Answer: B. Spleen
B. Epidural hematoma Rationale: The spleen is the most commonly injured organ in blunt abdominal
C. Diffuse axonal injury trauma, especially from MVCs and left-sided impacts.
D. Subdural hematoma
Answer: C. Diffuse axonal injury 4.
Rationale: Rapid acceleration-deceleration causes widespread shearing of axons,
When performing the secondary survey, the nurse’s primary goal is to:
leading to coma and abnormal respirations without focal bleeding. Epidural and
subdural bleeds usually have a lucid interval; basilar fractures present with raccoon A. Identify immediate life-threatening conditions
eyes or otorrhea. B. Maintain airway patency
C. Detect all other injuries after initial stabilization
D. Prepare for diagnostic imaging
2.
Answer: C. Detect all other injuries after initial stabilization
During the primary survey, which assessment finding takes highest priority for Rationale: After the primary survey (ABCs) is complete and life-threatening
immediate intervention? issues are managed, the secondary survey is a head-to-toe assessment for
A. Absent radial pulses bilaterally additional injuries.
B. Diminished breath sounds on the right
C. Open femur fracture with bleeding
5.
D. GCS score of 10
A patient with a suspected pelvic fracture becomes hypotensive and tachycardic.
Answer: B. Diminished breath sounds on the right
What should the nurse do first?
Rationale: Airway and breathing come before circulation. Diminished breath
sounds suggest tension pneumothorax or hemothorax—life-threatening until A. Apply a pelvic binder
decompressed. B. Start two large-bore IV lines
,C. Insert Foley catheter to check urine output 8.
D. Prepare for CT scan
A 25-year-old with a basilar skull fracture should be monitored closely for:
Answer: A. Apply a pelvic binder
A. Airway obstruction
Rationale: Stabilizing the pelvis reduces pelvic volume and venous bleeding—key
B. Intracranial hemorrhage
in hemorrhage control before IV or imaging.
C. CSF leak
D. Carotid dissection
6. Answer: C. CSF leak
Rationale: Basilar fractures often tear the dura, causing CSF rhinorrhea or
A 6-year-old is struck by a car and presents with unequal breath sounds, tracheal
otorrhea, creating infection risk (meningitis).
deviation, and hypotension. What’s the most appropriate immediate intervention?
A. Obtain chest X-ray
B. Needle decompression in 2nd ICS midclavicular 9.
C. Intubate the child
A patient has a chest tube placed for hemothorax. Output suddenly stops, and the
D. Administer IV fluids
patient becomes tachypneic and hypotensive. The nurse suspects:
Answer: B. Needle decompression
A. Tube dislodgement or kinking
Rationale: Signs indicate tension pneumothorax—an emergency requiring
B. Re-expansion pulmonary edema
immediate decompression before imaging or intubation.
C. Resolution of bleeding
D. Infection
7. Answer: A. Tube dislodgement or kinking
Rationale: Sudden cessation of drainage with distress suggests obstruction or
In trauma resuscitation, what best indicates effective fluid resuscitation?
displacement of the tube—requires immediate assessment.
A. MAP above 70 mm Hg
B. Urine output ≥ 0.5 mL/kg/hr
C. HR < 90 bpm 10.
D. Improved capillary refill
Which trauma patient should the nurse triage first for evaluation?
Answer: B. Urine output ≥ 0.5 mL/kg/hr
A. 40-year-old with femur fracture
Rationale: Adequate renal perfusion reflects restored end-organ perfusion; urine
B. 25-year-old with open chest wound
output is the most reliable bedside indicator.
C. 60-year-old with scalp laceration
D. 19-year-old with arm fracture and stable vitals
,Answer: B. 25-year-old with open chest wound C. Normal after chest compressions
Rationale: Sucking chest wounds threaten ventilation and oxygenation—life- D. Sign of flail chest
threatening; immediate occlusive dressing required.
Answer: B. Suggests subcutaneous emphysema
Rationale: Air leaking from the lung or airways into subcutaneous tissues causes
crackling (crepitus) under the skin.
11.
Which finding in a spinal cord injury patient suggests neurogenic shock?
14.
A. Cool, clammy skin and tachycardia
B. Warm, dry skin and bradycardia A GCS of 8 indicates:
C. Hypertension and tachycardia
A. Mild head injury
D. Weak peripheral pulses with diaphoresis
B. Moderate head injury
Answer: B. Warm, dry skin and bradycardia C. Severe head injury
Rationale: Loss of sympathetic tone causes vasodilation and unopposed D. Normal neurological status
parasympathetic activity → hypotension, bradycardia, warm dry skin.
Answer: C. Severe head injury
Rationale: GCS 13–15 = mild; 9–12 = moderate; ≤ 8 = severe—requires airway
protection and close monitoring.
12.
In a penetrating abdominal trauma, which action should be avoided?
15.
A. Cover protruding viscera with moist dressing
B. Remove the impaled object to control bleeding After a high-speed crash, a patient has chest pain, muffled heart sounds, and
C. Monitor for hypovolemic shock jugular vein distension. What is the priority intervention?
D. Prepare for emergent laparotomy
A. Administer diuretics
Answer: B. Remove the impaled object B. Perform pericardiocentesis
Rationale: Never remove impaled objects; they may tamponade bleeding. C. Apply oxygen and monitor
Stabilize in place until surgical removal. D. Prepare for chest tube
Answer: B. Perform pericardiocentesis
Rationale: Classic Beck’s triad (JVD, hypotension, muffled heart sounds)
13.
indicates cardiac tamponade—requires immediate decompression.
A nurse notes crepitus over the chest wall of a patient after blunt trauma. What is
the significance?
A. Indicates cardiac tamponade
B. Suggests subcutaneous emphysema from pneumothorax
, 16. Answer: C. Concussion
Rationale: Brief LOC followed by confusion without focal deficits = concussion
Which of the following indicates compensated shock?
(mild TBI).
A. Tachycardia with normal BP
B. Hypotension with cool skin
C. Bradycardia and warm skin 19.
D. Unresponsiveness
Which action best prevents secondary brain injury after trauma?
Answer: A. Tachycardia with normal BP
A. Administering hypertonic saline
Rationale: Early compensatory mechanisms maintain BP despite decreased
B. Maintaining normoxia and normocapnia
perfusion; tachycardia is often the first sign.
C. Elevating HOB 90°
D. Avoiding analgesics
17. Answer: B. Maintain normoxia/normocapnia
Rationale: Prevent hypoxia and hyper/hypocapnia to reduce cerebral ischemia—
In trauma, a lactate level of 6 mmol/L most likely reflects:
critical in secondary injury prevention.
A. Adequate tissue perfusion
B. Hypoperfusion and anaerobic metabolism
C. Liver failure 20.
D. Normal metabolic response
The most reliable indicator of cerebral perfusion is:
Answer: B. Hypoperfusion
A. Systolic BP
Rationale: Elevated lactate indicates anaerobic metabolism from tissue hypoxia—
B. Mean arterial pressure
an early marker of shock.
C. Glasgow Coma Scale
D. Cerebral perfusion pressure
18. Answer: D. Cerebral perfusion pressure (CPP)
Rationale: CPP = MAP − ICP; reflects actual perfusion of the brain.
A 16-year-old football player presents after a helmet-to-helmet collision, transient
LOC, now alert but confused. What is the likely diagnosis?
A. Diffuse axonal injury 21.
B. Skull fracture
A trauma patient develops widening pulse pressure and bradycardia. Which
C. Concussion
condition is suspected?
D. Contusion
A. Hypovolemic shock
B. Neurogenic shock
EXAM VERIFIED QUESTIONS AND CORRECT A trauma patient with blunt abdominal injury presents with tachycardia,
hypotension, and distended abdomen. Which organ is most likely the source of
DETAILED ANSWERS WITH RATIONALES bleeding?
GRADED A+ LATEST A. Pancreas
1. B. Spleen
A patient involved in a high-speed MVC is found unresponsive with irregular C. Small intestine
respirations and unequal pupils. Which injury is most likely responsible? D. Gallbladder
A. Basilar skull fracture Answer: B. Spleen
B. Epidural hematoma Rationale: The spleen is the most commonly injured organ in blunt abdominal
C. Diffuse axonal injury trauma, especially from MVCs and left-sided impacts.
D. Subdural hematoma
Answer: C. Diffuse axonal injury 4.
Rationale: Rapid acceleration-deceleration causes widespread shearing of axons,
When performing the secondary survey, the nurse’s primary goal is to:
leading to coma and abnormal respirations without focal bleeding. Epidural and
subdural bleeds usually have a lucid interval; basilar fractures present with raccoon A. Identify immediate life-threatening conditions
eyes or otorrhea. B. Maintain airway patency
C. Detect all other injuries after initial stabilization
D. Prepare for diagnostic imaging
2.
Answer: C. Detect all other injuries after initial stabilization
During the primary survey, which assessment finding takes highest priority for Rationale: After the primary survey (ABCs) is complete and life-threatening
immediate intervention? issues are managed, the secondary survey is a head-to-toe assessment for
A. Absent radial pulses bilaterally additional injuries.
B. Diminished breath sounds on the right
C. Open femur fracture with bleeding
5.
D. GCS score of 10
A patient with a suspected pelvic fracture becomes hypotensive and tachycardic.
Answer: B. Diminished breath sounds on the right
What should the nurse do first?
Rationale: Airway and breathing come before circulation. Diminished breath
sounds suggest tension pneumothorax or hemothorax—life-threatening until A. Apply a pelvic binder
decompressed. B. Start two large-bore IV lines
,C. Insert Foley catheter to check urine output 8.
D. Prepare for CT scan
A 25-year-old with a basilar skull fracture should be monitored closely for:
Answer: A. Apply a pelvic binder
A. Airway obstruction
Rationale: Stabilizing the pelvis reduces pelvic volume and venous bleeding—key
B. Intracranial hemorrhage
in hemorrhage control before IV or imaging.
C. CSF leak
D. Carotid dissection
6. Answer: C. CSF leak
Rationale: Basilar fractures often tear the dura, causing CSF rhinorrhea or
A 6-year-old is struck by a car and presents with unequal breath sounds, tracheal
otorrhea, creating infection risk (meningitis).
deviation, and hypotension. What’s the most appropriate immediate intervention?
A. Obtain chest X-ray
B. Needle decompression in 2nd ICS midclavicular 9.
C. Intubate the child
A patient has a chest tube placed for hemothorax. Output suddenly stops, and the
D. Administer IV fluids
patient becomes tachypneic and hypotensive. The nurse suspects:
Answer: B. Needle decompression
A. Tube dislodgement or kinking
Rationale: Signs indicate tension pneumothorax—an emergency requiring
B. Re-expansion pulmonary edema
immediate decompression before imaging or intubation.
C. Resolution of bleeding
D. Infection
7. Answer: A. Tube dislodgement or kinking
Rationale: Sudden cessation of drainage with distress suggests obstruction or
In trauma resuscitation, what best indicates effective fluid resuscitation?
displacement of the tube—requires immediate assessment.
A. MAP above 70 mm Hg
B. Urine output ≥ 0.5 mL/kg/hr
C. HR < 90 bpm 10.
D. Improved capillary refill
Which trauma patient should the nurse triage first for evaluation?
Answer: B. Urine output ≥ 0.5 mL/kg/hr
A. 40-year-old with femur fracture
Rationale: Adequate renal perfusion reflects restored end-organ perfusion; urine
B. 25-year-old with open chest wound
output is the most reliable bedside indicator.
C. 60-year-old with scalp laceration
D. 19-year-old with arm fracture and stable vitals
,Answer: B. 25-year-old with open chest wound C. Normal after chest compressions
Rationale: Sucking chest wounds threaten ventilation and oxygenation—life- D. Sign of flail chest
threatening; immediate occlusive dressing required.
Answer: B. Suggests subcutaneous emphysema
Rationale: Air leaking from the lung or airways into subcutaneous tissues causes
crackling (crepitus) under the skin.
11.
Which finding in a spinal cord injury patient suggests neurogenic shock?
14.
A. Cool, clammy skin and tachycardia
B. Warm, dry skin and bradycardia A GCS of 8 indicates:
C. Hypertension and tachycardia
A. Mild head injury
D. Weak peripheral pulses with diaphoresis
B. Moderate head injury
Answer: B. Warm, dry skin and bradycardia C. Severe head injury
Rationale: Loss of sympathetic tone causes vasodilation and unopposed D. Normal neurological status
parasympathetic activity → hypotension, bradycardia, warm dry skin.
Answer: C. Severe head injury
Rationale: GCS 13–15 = mild; 9–12 = moderate; ≤ 8 = severe—requires airway
protection and close monitoring.
12.
In a penetrating abdominal trauma, which action should be avoided?
15.
A. Cover protruding viscera with moist dressing
B. Remove the impaled object to control bleeding After a high-speed crash, a patient has chest pain, muffled heart sounds, and
C. Monitor for hypovolemic shock jugular vein distension. What is the priority intervention?
D. Prepare for emergent laparotomy
A. Administer diuretics
Answer: B. Remove the impaled object B. Perform pericardiocentesis
Rationale: Never remove impaled objects; they may tamponade bleeding. C. Apply oxygen and monitor
Stabilize in place until surgical removal. D. Prepare for chest tube
Answer: B. Perform pericardiocentesis
Rationale: Classic Beck’s triad (JVD, hypotension, muffled heart sounds)
13.
indicates cardiac tamponade—requires immediate decompression.
A nurse notes crepitus over the chest wall of a patient after blunt trauma. What is
the significance?
A. Indicates cardiac tamponade
B. Suggests subcutaneous emphysema from pneumothorax
, 16. Answer: C. Concussion
Rationale: Brief LOC followed by confusion without focal deficits = concussion
Which of the following indicates compensated shock?
(mild TBI).
A. Tachycardia with normal BP
B. Hypotension with cool skin
C. Bradycardia and warm skin 19.
D. Unresponsiveness
Which action best prevents secondary brain injury after trauma?
Answer: A. Tachycardia with normal BP
A. Administering hypertonic saline
Rationale: Early compensatory mechanisms maintain BP despite decreased
B. Maintaining normoxia and normocapnia
perfusion; tachycardia is often the first sign.
C. Elevating HOB 90°
D. Avoiding analgesics
17. Answer: B. Maintain normoxia/normocapnia
Rationale: Prevent hypoxia and hyper/hypocapnia to reduce cerebral ischemia—
In trauma, a lactate level of 6 mmol/L most likely reflects:
critical in secondary injury prevention.
A. Adequate tissue perfusion
B. Hypoperfusion and anaerobic metabolism
C. Liver failure 20.
D. Normal metabolic response
The most reliable indicator of cerebral perfusion is:
Answer: B. Hypoperfusion
A. Systolic BP
Rationale: Elevated lactate indicates anaerobic metabolism from tissue hypoxia—
B. Mean arterial pressure
an early marker of shock.
C. Glasgow Coma Scale
D. Cerebral perfusion pressure
18. Answer: D. Cerebral perfusion pressure (CPP)
Rationale: CPP = MAP − ICP; reflects actual perfusion of the brain.
A 16-year-old football player presents after a helmet-to-helmet collision, transient
LOC, now alert but confused. What is the likely diagnosis?
A. Diffuse axonal injury 21.
B. Skull fracture
A trauma patient develops widening pulse pressure and bradycardia. Which
C. Concussion
condition is suspected?
D. Contusion
A. Hypovolemic shock
B. Neurogenic shock
