TCRN 2024
1. 1)
The trauma nurse is caring for a 6-year-old child who sustained a tackle
while participating in a youth football game. The patient's mother states, "He
got the wind knocked out of him." Vital signs are:
HR 120 beats/min
BP 85/50 mmHg
RR 26 breaths/min
SpO2 92% (room air)
Based on the injury pattern, the nurse suspects which injury is MOST likely?
Possible answer(s):
Cardiac contusion
Tension pneumothorax
Pulmonary contusion
Splenic rupture: Pulmonary contusion
The chest wall of a child allows for pulmonary contusions without rib fractures. The
child is not actively hypotensive or showing signs of a tension pneumothorax. Car-
1/
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diac contusion can lead to decreased cardiac output, tachycardia, and ventricular
ectopy. Splenic rupture will cause hypotension, which this child is not experiencing
2. 2)
An infant with a history of Trisomy 21 is being evaluated status post motor
vehicle collision. The nurse anticipates which of the following may be
related to traumatic injury rather than a history of Trisomy 21?
Possible answer(s):
atlantoaxial instability
limp extremities
tongue obstruction
bulging fontanels: Bulging fontanels
Limp extremities, tongue obstruction and atlantoaxial instability may all be
common in patients with Down syndrome (Trisomy 21). Bulging fontanels are a
sign of increased intracranial pressure in the infant patient, and should be
considered to be related to traumatic injury.
3. 3)
An opportunity for improvement is identified following a patient delay transfer
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ring to the operating room and a corrective action plan is implemented.
Which of the following provides the BEST example of loop closure?
Possible answers:
Communicating with the operating room staff on how to appropriately sched
ule cases
Measuring the time to the operating room for the next 10 patients.
Documenting an educational letter sent to the involved surgeon
Recording discussion of the issue in peer review minutes: Measuring the time
to the operating room for the next 10 patients.
Comments:
Effective performance improvement demonstrates that corrective action has had
the desired effect as determined by continuous monitoring and evaluation.
Demon- strating that the time to the operating room is within limits is the best way
to demonstrate effective loop closure of this performance improvement event. The
others are examples of actionable items but they don't provide the best, complete
loop closure that specific measurable time objectives would.
3/
124
,TCRN 2024
4. During a debrief of a trauma activation, the surgeon is concerned that
the resuscitation effort was very disorganized from pre-hospital report and
throughout the initial trauma care. What is the BEST example of an interven-
tion to improve team communication in future resuscitations?
Possible answers:
Creating a standardized pre-hospital reporting tool
Initiating pre-arrival huddles
Identifying roles upon patient arrival
Allowing silence for pre-hospital providers report: Initiating pre-arrival huddles
Clear communication of the patient plan, roles and responsibilities, and providing
an opportunity to discuss staff concerns are part of the pre-arrival huddle. The
team leader can communicate anticipated resuscitative goals, clarify assignments,
and assist in prioritizing care. Allowing pre-hospital staff an uninterrupted
opportunity to provide report as well as creating a standardized tool will address
the potential loss of pertinent information during the pre-hospital hand-off but will
not address the
4/
124
1. 1)
The trauma nurse is caring for a 6-year-old child who sustained a tackle
while participating in a youth football game. The patient's mother states, "He
got the wind knocked out of him." Vital signs are:
HR 120 beats/min
BP 85/50 mmHg
RR 26 breaths/min
SpO2 92% (room air)
Based on the injury pattern, the nurse suspects which injury is MOST likely?
Possible answer(s):
Cardiac contusion
Tension pneumothorax
Pulmonary contusion
Splenic rupture: Pulmonary contusion
The chest wall of a child allows for pulmonary contusions without rib fractures. The
child is not actively hypotensive or showing signs of a tension pneumothorax. Car-
1/
124
,TCRN 2024
diac contusion can lead to decreased cardiac output, tachycardia, and ventricular
ectopy. Splenic rupture will cause hypotension, which this child is not experiencing
2. 2)
An infant with a history of Trisomy 21 is being evaluated status post motor
vehicle collision. The nurse anticipates which of the following may be
related to traumatic injury rather than a history of Trisomy 21?
Possible answer(s):
atlantoaxial instability
limp extremities
tongue obstruction
bulging fontanels: Bulging fontanels
Limp extremities, tongue obstruction and atlantoaxial instability may all be
common in patients with Down syndrome (Trisomy 21). Bulging fontanels are a
sign of increased intracranial pressure in the infant patient, and should be
considered to be related to traumatic injury.
3. 3)
An opportunity for improvement is identified following a patient delay transfer
2/
124
,TCRN 2024
ring to the operating room and a corrective action plan is implemented.
Which of the following provides the BEST example of loop closure?
Possible answers:
Communicating with the operating room staff on how to appropriately sched
ule cases
Measuring the time to the operating room for the next 10 patients.
Documenting an educational letter sent to the involved surgeon
Recording discussion of the issue in peer review minutes: Measuring the time
to the operating room for the next 10 patients.
Comments:
Effective performance improvement demonstrates that corrective action has had
the desired effect as determined by continuous monitoring and evaluation.
Demon- strating that the time to the operating room is within limits is the best way
to demonstrate effective loop closure of this performance improvement event. The
others are examples of actionable items but they don't provide the best, complete
loop closure that specific measurable time objectives would.
3/
124
,TCRN 2024
4. During a debrief of a trauma activation, the surgeon is concerned that
the resuscitation effort was very disorganized from pre-hospital report and
throughout the initial trauma care. What is the BEST example of an interven-
tion to improve team communication in future resuscitations?
Possible answers:
Creating a standardized pre-hospital reporting tool
Initiating pre-arrival huddles
Identifying roles upon patient arrival
Allowing silence for pre-hospital providers report: Initiating pre-arrival huddles
Clear communication of the patient plan, roles and responsibilities, and providing
an opportunity to discuss staff concerns are part of the pre-arrival huddle. The
team leader can communicate anticipated resuscitative goals, clarify assignments,
and assist in prioritizing care. Allowing pre-hospital staff an uninterrupted
opportunity to provide report as well as creating a standardized tool will address
the potential loss of pertinent information during the pre-hospital hand-off but will
not address the
4/
124
