TCRN Exam Questions 100% Correct Answers | Verified | Latest Version, Exams of Advanced Education

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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 - Correct Answer-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. Cardiac contusion can lead to decreased cardiac output, tachycardia, and ventricular ectopy. Splenic rupture will cause hypotension, which this child is not experiencing.

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 - Correct Answer-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.

An opportunity for improvement is identified following a patient delay transferring 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 schedule 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 - Correct Answer-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. Demonstrating 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.

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 intervention 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 - Correct Answer- 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 overall team communication issue. Identification of roles should be done prior to the patient arrival.

A patient is being transported by prehospital personnel after being involved in a motor vehicle collision. The patient's assessment reveals an intact airway and the following vitals: BP: 110/72 (mmHg)HR: 119 (beats/min)RR: 26 (breaths/min)Glasgow Coma Scale (GCS) score: 9 The MOST appropriate destination for transport is: Possible answers: level 3 trauma center 10 minutes away level 1 trauma center 20 minutes away level 2 trauma center 30 minutes away non-trauma center 5 minutes away - Correct Answer-level 1 trauma center 20 minutes away The patient has injuries as a result of a high-risk auto crash that need to be addressed at a trauma center. A level 1 trauma center provides the highest level of trauma care with in-house neurosurgery coverage and is closer than the level 2 center. A level 3 trauma center is not required to provide continuous in-house neurosurgery coverage. Due to the patient's GCS less than or equal to 13, the patient should be evaluated by the closest trauma center with preferential evaluation at the highest-level trauma center.

A patient presents following a motor vehicle collision and has an unstable pelvis. The PRIORITY intervention is: Possible answers: administration of analgesics. application of a pelvic binder. initiation of massive transfusion protocol. infusion of crystalloid fluid - Correct Answer-application of a pelvic binder. Pelvic fractures can result in blood loss of 3000mL. Use of a pelvic binder will assist to tamponade the bleeding in the pelvis and assist with hemostasis. Blood product transfusion is preferred over crystalloid infusion, however preventing further hemorrhage is the immediate priority. Analgesic administration is important but is not the first priority. The nurse is caring for a patient who is morbidly obese. The patient sustained a head injury and requires intubation. When initially placing the patient on a ventilator, the nurse should anticipate an order for Possible answers: FiO2 of 21-25%

PEEP of 5-10 cm H2O respiratory rate of 25-30 breaths/min. tidal volume of 750-1000 mL. - Correct Answer-tidal volume of 750- 1000 mL. Ventilator settings for a patient with obesity are based on ideal body weight and healthy lungs. A PEEP of 5-10 H2O is often required in patients who are morbidly obese. A tidal volume of 750-1000 mL is too high. Patients often require a FiO2 of at least 30. Even with a head injury, tachypnea with a respiratory rate of 25-30 is high for this patient. The trauma program manager of a verified trauma center recognizes this important outreach obligation to local rural area resources: Possible answers: Injury prevention supplies Professional education Clinical practice guidelines Medical supply resources - Correct Answer-Professional education Trauma centers verified through the American College of Surgeons have an obligation to extend education in the form of professional education, consultation, or community outreach. Medical and injury

prevention supplies are not an obligation of a verified trauma center. Clinical practice guidelines are institution specific and not an educational obligation for the verified trauma center to provide to other facilities. When appropriately triaging patients, and in order to ensure they are all treated fairly, the trauma nurse may encounter this type of ethical dilemma: Possible answers: Fidelity Veracity Justice Beneficence - Correct Answer-Justice Veracity is defined as truth telling; Fidelity is keeping one's promise; beneficence is to do good; and justice is fairness. A patient who is currently 30 weeks pregnant presents to the emergency department after a motor vehicle collision. The patient has absent breath sounds on the right and an oxygen saturation of 75% and falling despite supplemental oxygen placement. What intervention should the nurse anticipate?

Possible answers: Repositioning to elevate the patient's right side. Needle decompression at the 1st intercostal space. Raising the head of the bed to 45 degrees. Preparing for immediate intubation. - Correct Answer-Needle decompression at the 1st intercostal space. Absent breath sounds and a falling oxygen saturation suggest a pneumothorax. The location for the needle decompression is elevated 1 - 2 intercostal spaces due to the patient's pregnancy and current anatomical location of the lungs. Raising the head of the bed may be indicated but not until cervical spine clearance is obtained. Repositioning the patient to elevate their right side will increase venous return through the inferior vena cava but will not reinflate the lung. The nurse is caring for a patient with a traumatic brain injury. The patient demonstrates hyperarousal alternating with hypoarousal levels of consciousness. The PRIORITY goal of care for this patient is: Possible answers: a PaO2 of less than 60 mm Hg an end-tidal carbon dioxide (ETCO2) level between 35 and 45 mm Hg.

an end-tidal carbon dioxide (ETCO2) level at least 46 mm Hg an oxygen saturation level between 90% and 94% - Correct Answer-an end-tidal carbon dioxide (ETCO2) level between 35 and 45 mm Hg. The goal for adequate oxygenation and ventilation in head trauma patients is to maintain oxygen saturation greater than or equal to 95% and ETCO2 between 35 and 45 mm Hg. The PaO2 of less than 60 would not provide adequate oxygenation. The nurse is monitoring a patient for intracranial hypertension. The nurse should understand that which of the following increases cerebral blood volume? Possible answers: hyperthermia elevated PaO hypothermia hypocapnia - Correct Answer-hyperthermia: Anything that causes an increase in metabolic rate (e.g. hyperthermia) can increase cerebral blood flow. A reduction in metabolic rate (e.g. from hypothermia, hypocapnia) decreases cerebral blood flow. High PaO2 levels have not been shown to affect cerebral blood flow in either direction.

The nurse is caring for a patient with a C5 tetraplegic injury on hospital day two. The patient does not have any active bleeding. Mean arterial pressure is 60 mmHg. The nurse should anticipate orders to Possible answers: position the patient in reverse Trendelenburg. administer hypertonic saline. initiate vasopressors. maintain hypothermia. - Correct Answer-initiate vasopressors. Blood pressure in the spinal cord injured patient is first managed with isotonic crystalloid administration and once intravascular volume has been optimized, vasoactive agents are used. Patients with SCI are poikilothermic and need to maintain normothermia. Current guidelines recommend a systolic BP >90 mmHg and a MAP of 85- 90 mmHg to optimize blood flow to the cord and prevent secondary injury. Placing a patient in reverse Trendelenburg would not be indicated. The nurse understands their role of advocacy as a trauma nurse is BEST displayed by participating in:

Possible answers: a recruitment event for a trauma nursing professional organization. a local news program to publicize the need for hemorrhage control courses. a hemorrhage control instructor course for continuing education. a quality improvement project related to pre-hospital hemorrhage control. - Correct Answer-a local news program to publicize the need for hemorrhage control courses. Advocacy is an act of raising our voice in favor of a cause or policy. The only example of this is participating in a local news program to publicize the need for hemorrhage control training. The other answers are examples of professional development not advocacy. Placing a tourniquet on an extremity after a penetrating injury is what level of injury prevention? Primary tertiary quaternary secondary - Correct Answer-Secondary

A tourniquet is secondary injury prevention because it's aim is to reduce/eliminate blood loss from initial injury. It does not prevent the penetrating injury itself (primary), and the healing process is variable on additional factors aside from the tourniquet (tertiary). There is no quaternary level of injury prevention, however, quaternary injuries may be sustained from certain types of trauma. When defining roles in a trauma resuscitation, it is most important that the team leader ensures that each team member has a role that is advancing their professional practice. one they prefer performing. one they are competent performing. within their scope of practice. advancing their professional practice. - Correct Answer-Within their scope of practice There are many aspects the team leader should consider, but this process should start with assigning roles within the scope of practice of the team member. After that is established, the team leader should then establish competence level. Roles assigned may not always be favorable or advancing professional practice, but they meet the needs of the team for the needs of the patient.

The nurse recently admitted a patient to the floor following a motor vehicle collision earlier that morning. At the end of the shift, the patient complains of lower abdominal pain. Upon assessment, there is periumbilical bruising, known as which sign? Kehr Cullen Grey Turner Rovsing - Correct Answer-Cullen Cullen sign is periumbical bruising indicative of intraperitoneal bleeding, Grey Turner sign is flank bruising indicating retroperitoneal bleeding, Kehr sign is shoulder pain indicating intraperitoneal bleeding, Rovsing sign is right lower quadrant pain elicited by palpation of the left lower quadrant, indicative of appendicitis. A patient arrives in the trauma bay after a motor vehicle crash with a past medical history of trisomy-21. The PRIORITY intervention is: cervical spine immobilization supplemental oxygen application. large bore vascular access. capillary blood glucose measurement. - Correct Answer-cervical spine immobilization.

Patients with a past medical history of trisomy 21 are pre-disposed to atlanto-axial instability, with some references stating that it can impact up to 60% of the population. Although the interventions of large bore vascular access and knowing the capillary blood glucose are important, the priority should be consideration on maintaining cervical spine immobilization to reduce the risk of additional trauma. There is no indication for the application of supplemental oxygenation in this case. Which patient has the highest priority transfer to a burn center? 34 - year-old unrestrained driver in a motor vehicle explosion 8 - year-old with superficial burn to 25% of their total body surface area 32 - year-old with perineal burns after falling into a camp fire 45 - year-old with partial-thickness burn to 5% of their total body surface area - Correct Answer- 32 - year-old with perineal burns after falling into a camp fire Burns to the perineum require transfer to a burn center. An 8-year-old with superficial burns (or sunburn) does not require transfer nor does a patient with a partial thickness burn <10% of the TBSA. Trauma trumps burn unless the burn poses the greater risk of morbidity or mortality, which is not indicated in this case.

The nurse is triaging patients in the emergency department who were injured in a multi-car collision. The highest priority for treatment in an emergency department with limited resources is a 22 - year-old with RR 28 breaths/min, femur deformity and strong palpable pulse. 14 - year-old with Glasgow Coma Score of 3, no palpable pulse and apneic. 28 - year-old pregnant patient, Glasgow Coma Score of 14, HR 110 beats/min and palpable radial pulses. 30 - year-old with pelvic instability and absent radial pulses. - Correct Answer- 30 - year-old with pelvic instability and absent radial pulses. Using Simple Triage and Rapid Treatment (START) triage concepts, the order of priority is the hypotensive patient with pelvic instability, the pregnant patient, and then the femur deformity. The 14-year-old would be expectant and is a last priority for intervention. When should the FIRST crisis incident stress management (CISM) defusing session occur after a critical incident? 2 hours 12 hours 48 hours

24 hours - Correct Answer-2 hours CISM defusing sessions should occur 2 hours (or within several hours) after a critical incident. This session is crucial to check in on all staff involved and are informal/less structured. Any additional times are too far away from the occurrence and are not in the window to defuse. Debriefing sessions should take place within 72 hours. Several patients have arrived at the trauma center following a motor vehicle crash involving a large family. A crowd of family members is now gathering in the ED waiting room. The PRIORITY is to provide reassurance that the patients will recover. call local law enforcement. designate a point of contact for message clarity. ask the crowd to relocate to the hospital lobby. - Correct Answer- designate a point of contact for message clarity. Having a point of contact for message clarity will help to prevent escalation when multiple members of a patient's family are present. It is important to provide a designated place, but moving the family to a hospital lobby is not required at this time. Contacting local law enforcement is not needed at this time as the crowd is not escalating or showing behaviors of concern. Providing inaccurate reassurances

or false hope is not a recommended support for nursing to provide families during crisis. A 3-year-old child presents post-motor vehicle collision. During the discharge, which of the following statements by the parent should alert the nurse that further education is needed regarding proper child restraints? "I guess I need to buy a new car seat." "I'm grateful she was in a car seat. It saved her." "Thank goodness the car seat isn't broken. I can still use it." "I need to wait for a ride, so I can have a car seat available." - Correct Answer-"Thank goodness the car seat isn't broken. I can still use it." The National Highway Traffic Safety Administration (NHTSA) recommends that a car seat be replaced after a moderate or severe motor vehicle crash. In a substantial crash, the crash forces may be enough to damage a child's car seat even if there is no visible damage to the plastic. A patient arrives in the emergency department after ammonia was splashed in their eye. The trauma team immediately begins irrigation of the eye with sterile isotonic saline. Sufficient irrigation of the eye is determined

when the pH of the tears from the eye is 7.0. after an alkaline antidote solution is applied. after an acidic antidote solution is applied. when pH of the tears from the eye is 7.5. - Correct Answer-when the pH of the tears from the eye is 7.0. Irrigation following chemical eye injuries is complete when the pH of the tears in the cul-de-sac of the eye reaches 7.0. Application of antidote solutions is not acceptable. A patient presents after a motor vehicle collision with respiratory distress and paradoxical chest movement of the right chest. The patient has visible lung sliding on the eFAST exam. What PRIORITY intervention would the trauma nurse anticipate? Invasive ventilation Gastric decompression Noninvasive ventilation Chest tube placement - Correct Answer-Invasive ventilation Patients with flail chest will present with paradoxical chest movement. Treatment for patients in respiratory distress with flail chest includes definitive airway placement with positive pressure ventilation. With visible lung sliding on the eFAST, a pneumothorax is

not evident and a chest tube is not indicated. Gastric decompression would occur after the airway is intact. A nurse contacts the physician when the patient's Cut, Annoyed, Guilty and Eye (CAGE) score is 3. This is an example of a brief intervention referral to treatment. a referral to a food insecurity program. identifying skin breakdown risk. identifying fall risk. - Correct Answer-a brief intervention referral to treatment. CAGE is a standardized tool to evaluate alcohol use patterns. Any assessment finding over 2 is considered at risk. The American College of Surgeons requires screening, brief intervention and referral to treatment for those identified as at risk. The CAGE score does not indicate food insecurity risk. Fall risk uses different tools such as the Morse or Schmid tool. The Braden scale identifies the risk of skin breakdown. The nurse is caring for a patient who has sustained a hyphema. Which of the following patient reports would the nurse find the MOST concerning? photophobia

ophthalmalgia diplopia ephiphora - Correct Answer-diplopia Visual changes (including diplopia) in patients with hyphema can indicate the development of secondary glaucoma or the need to further evaluate surrounding structures. Pain (opthalmalgia) and photophobia can be expected findings in patients with hyphema. Ephiphora or watery eyes is not a concern in patients with hyphema. A new injury prevention coordinator wants to identify which mechanism of injuries the trauma program should address. The BEST resource for this coordinator would be the: state's trauma registry. World Health Organization Injuries and Violence information. institution's trauma registry. Centers for Disease Control and Prevention (CDC) Injury Statistics Data. - Correct Answer-institution's trauma registry. An institution's injury prevention program should be based on the top three mechanisms of injury of that institution. This data can be obtained through data in the institution's trauma registry.

An 8-year-old child sustained a complete spinal cord injury at the level of T5. The child is being transferred to an inpatient rehabilitation center. Which comment from the child indicates an understanding of their injury? "The new hospital is going to help my mom take care of me at home." "At the new hospital I get to take a bath all by myself." "I am going to the new hospital so I can feel my legs again." "When I leave this new hospital, I will be able to walk again." - Correct Answer-"The new hospital is going to help my mom take care of me at home." Care of the trauma patient revolves around attempts at maximizing abilities to function independently despite injuries. Rehabilitation will help both the child and the parent learn how to perform daily life activities. Rehabilitation does not change a diagnoses or long term results from injury. Walking, bathing independently, and regaining sensation with a complete spinal cord injury at this level is not possible. A patient presents to the emergency department with posturing and convulsions following a motor vehicle collision. A CT scan shows an intracerebral hemorrhage. The patient's current vital signs are heart rate of 83 beats per min, blood pressure of 82/40 mmHg, and respirations are being assisted with ventilations via bag mask device. The nurse will anticipate the administration of

mannitol (Osmitrol) hypotonic saline hypertonic saline nicardipine (Cardene) - Correct Answer-hypertonic saline Administration of hypertonic saline will help to decrease the patient's ICP without concern for diuresis. Hypotonic saline should be avoided due to increased risk of cerebral edema. Nicardipine is not clinically indicated due to the hypotension. Mannitol is to be avoided due to its potential diuretic effects and potential hypotension. A patient with a thoracic spinal cord injury is being helped into a seated position. Which intervention would assist the patient's respiratory status? An abdominal binder. A thoracic lumbar sacral orthosis. A bronchodilator. A leukotriene inhibitor. - Correct Answer-An abdominal binder. An abdominal binder can be used with patients sustaining a spinal cord injury to assist in supporting the viscera and bringing the diaphragm into a better resting position. The abdominal binder should be placed between the costal margins and the iliac crests, with the lower portion being tighter than the cephalic. The thoracic lumbar

sacral orthosis does not promote more efficient respiratory status. Leukotriene inhibitors may be administered but do not offer immediate assistance. Bronchodilators may be administered for constriction within the airway but not as a measure to assist with maintaining a seated position. The nurse is reviewing the laboratory results for a trauma patient who was injured during a building collapse and trapped under a concrete block for 6 hours. The value MOST suggestive that the patient is suffering from crush syndrome is serum potassium level 7.5 mEq/L creatine kinase (CK) 5000U/L INR 2.5 lactate level 7mg/dL - Correct Answer-serum potassium level 7.5 mEq/L Crush syndrome results after prolonged entrapment or a crushing injury. Due to cellular necrosis resulting from the increased compartment pressures, potassium is liberated from the cells and results in an elevated potassium level. Elevated potassium can lead to sudden death in victims of crush injuries. The elevation of the other laboratory values does not indicate crush syndrome. A patient with a subdural hematoma with an associated midline shift and multiple rib fractures is currently at a hospital without

neurosurgical capabilities. The MOST appropriate facility to transfer this patient for continued care is a: hospital with neurosurgical capabilities 1 mile away. level II trauma center 15 miles away. level I trauma center 45 miles away. level III trauma center 2 miles away. - Correct Answer-level II trauma center 15 miles away. Patients should be transferred to the closest appropriate hospital with verified trauma centers preferred. Level III trauma centers typically do not have neurosurgical capabilities. A Level II center that is closer than the Level I center would be MOST appropriate for this patient. The MOST important benefit of continuous reassessment of the trauma patient is: increased patient satisfaction. early identification of instability. prevention of falls on the inpatient unit. avoidance of patient decompensation. - Correct Answer-early identification of instability.