Trauma Nursing Process-TNP FINAL EXAM
QUESTIONS AND CORRECT ANSWERS
Question 1: In the primary survey of a multi-trauma patient according to ATLS
and Trauma Nurse Specialist (TNS) principles, what is the correct sequence of
assessment and immediate management priorities?
A. Disability, Exposure, Airway, Breathing, Circulation
B. Airway with cervical spine protection, Breathing, Circulation with hemorrhage
control, Disability, Exposure/Environmental control
C. Circulation, Airway, Breathing, Disability, Exposure
D. Breathing, Circulation, Airway, Disability, Exposure
CORRECT ANSWER: B. Airway with cervical spine protection, Breathing,
Circulation with hemorrhage control, Disability, Exposure/Environmental
control
Rationale: The ABCDE approach is the foundation of trauma resuscitation. Airway is
assessed first while simultaneously protecting the cervical spine. Life-threatening
conditions in each component are identified and managed before moving to the
next. This systematic sequence is emphasized throughout TNS training.
Question 2: A 28-year-old male arrives after a high-speed motor vehicle
collision. He is tachycardic (HR 128), hypotensive (BP 88/54), and has a
distended, tender abdomen. Which class of hemorrhagic shock is this patient
most likely experiencing, and what is the approximate blood volume loss?
A. Class I – up to 15% blood volume loss
B. Class II – 15–30% blood volume loss
C. Class III – 30–40% blood volume loss
D. Class IV – greater than 40% blood volume loss
CORRECT ANSWER: C. Class III – 30–40% blood volume loss
Rationale: Class III hemorrhagic shock is characterized by marked tachycardia,
hypotension, anxiety or confusion, and decreased urine output, corresponding to
30–40% blood volume loss. Immediate volume resuscitation and control of
hemorrhage are required. TNS education stresses rapid recognition of shock class
to guide intervention.
Question 3: During the secondary survey of a trauma patient, the nurse notes
unequal breath sounds, tracheal deviation away from the affected side, and
progressive respiratory distress. What is the most likely diagnosis, and what
immediate intervention is indicated?
Page 1 of 66
,A. Simple pneumothorax – oxygen and observation
B. Tension pneumothorax – needle decompression followed by chest tube insertion
C. Hemothorax – immediate thoracotomy
D. Pulmonary contusion – positive-pressure ventilation only
Page 2 of 66
,CORRECT ANSWER: B. Tension pneumothorax – needle decompression
followed by chest tube insertion
Rationale: Tension pneumothorax is a life-threatening condition identified in the
primary or secondary survey. Classic signs include absent breath sounds, tracheal
deviation, and hemodynamic compromise. Immediate needle decompression
converts it to an open pneumothorax, followed by definitive chest tube placement.
Question 4: A trauma patient with a suspected pelvic fracture is
hemodynamically unstable despite initial fluid resuscitation. Which nursing
intervention is most appropriate to help control hemorrhage from the pelvic
injury?
A. Log-rolling the patient frequently to inspect the back
B. Application of a pelvic binder or sheet to stabilize the pelvis and reduce pelvic
volume
C. Placing the patient in high Fowler’s position
D. Aggressive external massage of the pelvic area
CORRECT ANSWER: B. Application of a pelvic binder or sheet to stabilize the
pelvis and reduce pelvic volume
Rationale: Unstable pelvic fractures can cause massive retroperitoneal hemorrhage.
Circumferential compression with a commercial binder or improvised sheet reduces
pelvic volume and tamponades bleeding. This is a key temporizing measure taught
in TNS courses while definitive care is arranged.
Question 5: According to TNS and trauma nursing standards, what is the
preferred initial fluid for resuscitation of a severely injured adult trauma
patient with hemorrhagic shock before blood products are available?
A. D5W
B. Lactated Ringer’s or normal saline in controlled volumes while preparing for
blood product administration
C. 5% albumin as the first-line agent
D. Hypertonic saline exclusively
CORRECT ANSWER: B. Lactated Ringer’s or normal saline in controlled
volumes while preparing for blood product administration
Rationale: Current trauma resuscitation emphasizes balanced crystalloids as the
initial fluid of choice while rapidly moving toward blood product-based
resuscitation (damage-control resuscitation). Excessive crystalloid is avoided. TNS
training aligns with ATLS and current evidence-based guidelines.
Question 6: A patient with a severe traumatic brain injury has a Glasgow Coma
Scale score of 7. What is the most appropriate immediate airway management
Page 3 of 66
, decision?
A. Continue high-flow oxygen via nasal cannula and observe
B. Endotracheal intubation with in-line cervical spine stabilization to protect the
airway and control ventilation
C. Insertion of a nasopharyngeal airway only
D. Non-invasive positive-pressure ventilation without intubation
CORRECT ANSWER: B. Endotracheal intubation with in-line cervical spine
stabilization to protect the airway and control ventilation
Rationale: A GCS ≤ 8 is a strong indication for definitive airway management.
Intubation protects against aspiration, allows control of PaCO₂, and prevents
secondary brain injury. Cervical spine protection is maintained throughout the
procedure.
Question 7: Which of the following best describes the concept of “damage-
control resuscitation” as taught in Trauma Nurse Specialist programs?
A. Aggressive crystalloid loading to achieve normal blood pressure as quickly as
possible
B. Permissive hypotension (in appropriate patients), early blood product
administration in balanced ratios, and limited crystalloid use until hemorrhage is
controlled
C. Immediate surgical exploration of every trauma patient
D. Delaying all fluid resuscitation until the operating room
CORRECT ANSWER: B. Permissive hypotension (in appropriate patients), early
blood product administration in balanced ratios, and limited crystalloid use
until hemorrhage is controlled
Rationale: Damage-control resuscitation prioritizes stopping bleeding, preventing
coagulopathy, and avoiding over-resuscitation. It is a core concept in modern
trauma care emphasized in TNS education.
Question 8: A 45-year-old patient sustains full-thickness burns to the entire
right arm, anterior chest, and anterior neck. Using the Rule of Nines, what is
the approximate total body surface area (TBSA) burned?
A. 9%
B. 18%
C. 27%
D. 36%
CORRECT ANSWER: C. 27%
Page 4 of 66
QUESTIONS AND CORRECT ANSWERS
Question 1: In the primary survey of a multi-trauma patient according to ATLS
and Trauma Nurse Specialist (TNS) principles, what is the correct sequence of
assessment and immediate management priorities?
A. Disability, Exposure, Airway, Breathing, Circulation
B. Airway with cervical spine protection, Breathing, Circulation with hemorrhage
control, Disability, Exposure/Environmental control
C. Circulation, Airway, Breathing, Disability, Exposure
D. Breathing, Circulation, Airway, Disability, Exposure
CORRECT ANSWER: B. Airway with cervical spine protection, Breathing,
Circulation with hemorrhage control, Disability, Exposure/Environmental
control
Rationale: The ABCDE approach is the foundation of trauma resuscitation. Airway is
assessed first while simultaneously protecting the cervical spine. Life-threatening
conditions in each component are identified and managed before moving to the
next. This systematic sequence is emphasized throughout TNS training.
Question 2: A 28-year-old male arrives after a high-speed motor vehicle
collision. He is tachycardic (HR 128), hypotensive (BP 88/54), and has a
distended, tender abdomen. Which class of hemorrhagic shock is this patient
most likely experiencing, and what is the approximate blood volume loss?
A. Class I – up to 15% blood volume loss
B. Class II – 15–30% blood volume loss
C. Class III – 30–40% blood volume loss
D. Class IV – greater than 40% blood volume loss
CORRECT ANSWER: C. Class III – 30–40% blood volume loss
Rationale: Class III hemorrhagic shock is characterized by marked tachycardia,
hypotension, anxiety or confusion, and decreased urine output, corresponding to
30–40% blood volume loss. Immediate volume resuscitation and control of
hemorrhage are required. TNS education stresses rapid recognition of shock class
to guide intervention.
Question 3: During the secondary survey of a trauma patient, the nurse notes
unequal breath sounds, tracheal deviation away from the affected side, and
progressive respiratory distress. What is the most likely diagnosis, and what
immediate intervention is indicated?
Page 1 of 66
,A. Simple pneumothorax – oxygen and observation
B. Tension pneumothorax – needle decompression followed by chest tube insertion
C. Hemothorax – immediate thoracotomy
D. Pulmonary contusion – positive-pressure ventilation only
Page 2 of 66
,CORRECT ANSWER: B. Tension pneumothorax – needle decompression
followed by chest tube insertion
Rationale: Tension pneumothorax is a life-threatening condition identified in the
primary or secondary survey. Classic signs include absent breath sounds, tracheal
deviation, and hemodynamic compromise. Immediate needle decompression
converts it to an open pneumothorax, followed by definitive chest tube placement.
Question 4: A trauma patient with a suspected pelvic fracture is
hemodynamically unstable despite initial fluid resuscitation. Which nursing
intervention is most appropriate to help control hemorrhage from the pelvic
injury?
A. Log-rolling the patient frequently to inspect the back
B. Application of a pelvic binder or sheet to stabilize the pelvis and reduce pelvic
volume
C. Placing the patient in high Fowler’s position
D. Aggressive external massage of the pelvic area
CORRECT ANSWER: B. Application of a pelvic binder or sheet to stabilize the
pelvis and reduce pelvic volume
Rationale: Unstable pelvic fractures can cause massive retroperitoneal hemorrhage.
Circumferential compression with a commercial binder or improvised sheet reduces
pelvic volume and tamponades bleeding. This is a key temporizing measure taught
in TNS courses while definitive care is arranged.
Question 5: According to TNS and trauma nursing standards, what is the
preferred initial fluid for resuscitation of a severely injured adult trauma
patient with hemorrhagic shock before blood products are available?
A. D5W
B. Lactated Ringer’s or normal saline in controlled volumes while preparing for
blood product administration
C. 5% albumin as the first-line agent
D. Hypertonic saline exclusively
CORRECT ANSWER: B. Lactated Ringer’s or normal saline in controlled
volumes while preparing for blood product administration
Rationale: Current trauma resuscitation emphasizes balanced crystalloids as the
initial fluid of choice while rapidly moving toward blood product-based
resuscitation (damage-control resuscitation). Excessive crystalloid is avoided. TNS
training aligns with ATLS and current evidence-based guidelines.
Question 6: A patient with a severe traumatic brain injury has a Glasgow Coma
Scale score of 7. What is the most appropriate immediate airway management
Page 3 of 66
, decision?
A. Continue high-flow oxygen via nasal cannula and observe
B. Endotracheal intubation with in-line cervical spine stabilization to protect the
airway and control ventilation
C. Insertion of a nasopharyngeal airway only
D. Non-invasive positive-pressure ventilation without intubation
CORRECT ANSWER: B. Endotracheal intubation with in-line cervical spine
stabilization to protect the airway and control ventilation
Rationale: A GCS ≤ 8 is a strong indication for definitive airway management.
Intubation protects against aspiration, allows control of PaCO₂, and prevents
secondary brain injury. Cervical spine protection is maintained throughout the
procedure.
Question 7: Which of the following best describes the concept of “damage-
control resuscitation” as taught in Trauma Nurse Specialist programs?
A. Aggressive crystalloid loading to achieve normal blood pressure as quickly as
possible
B. Permissive hypotension (in appropriate patients), early blood product
administration in balanced ratios, and limited crystalloid use until hemorrhage is
controlled
C. Immediate surgical exploration of every trauma patient
D. Delaying all fluid resuscitation until the operating room
CORRECT ANSWER: B. Permissive hypotension (in appropriate patients), early
blood product administration in balanced ratios, and limited crystalloid use
until hemorrhage is controlled
Rationale: Damage-control resuscitation prioritizes stopping bleeding, preventing
coagulopathy, and avoiding over-resuscitation. It is a core concept in modern
trauma care emphasized in TNS education.
Question 8: A 45-year-old patient sustains full-thickness burns to the entire
right arm, anterior chest, and anterior neck. Using the Rule of Nines, what is
the approximate total body surface area (TBSA) burned?
A. 9%
B. 18%
C. 27%
D. 36%
CORRECT ANSWER: C. 27%
Page 4 of 66
