TCRN Exam Questions and Answers (2025) Study Guide, Exams of Nursing

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TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Shock - Correct Answer ✅ Lack of oxygen to the cells Hypovolemic Shock - Correct Answer ✅ Lack of volume ex: hemorrhage, burns Distributive Shock - Correct Answer ✅ Maldistribution of blood (pooled in extremities) Decreased preload ex: neurogenic shock Cardiogenic Shock - Correct Answer ✅ Inadequate cardiac output ex: blunt cardiac trauma Obstructive Shock - Correct Answer ✅ Inability of blood to enter or exit heart properly ex: tamponade, tension pneumothorax Systemic Inflammatory Response Syndrome (SIRS) - Correct Answer ✅ Severe tissue trauma activates an inflammatory TCRN EXAM Questions and Answers (Latest update 2025) Study Guide response leading to vasodilation, capillary permeability, and coagulation Early (Compensated) Shock - Correct Answer ✅ Normal BP Weak, thready pulse Deep and rapid RR Normal lactic levels Anxious Late (Decompensated) Shock - Correct Answer ✅ Decreased BP Tachycardia Shallow and rapid RR Increased Lactic Decreased LOC Decreased urinary output BUN to Creatinine Ratio - Correct Answer ✅ Normal - 10:1 Indicated effective renal function TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Type AB - Correct Answer ✅ RBC: Type A, B, AB, O Plasma: AB Type O - Correct Answer ✅ RBC: Type O Plasma: Type A, B, AB, O Universal Donor of RBC and Plasma - Correct Answer ✅ Universal donor of RBC: O negative Universal donor of Plasma: AB negative Cryoprecipitate - Correct Answer ✅ Concentrate of coagulation factors obtained from fresh frozen plasma Increases fibrinogen in the bloodstream Blood Transfusion in Peds - Correct Answer ✅ One unit of blood is 10ml/kg Complications of MTP - Correct Answer ✅ Hypothermia - warm all fluids and blood Hypocalcemia - replace calcium TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Acidosis - sodium bicarb TRALI - stop transfusion, supplemental oxygen Transfusion-Related Acute Lung Injury (TRALI) - Correct Answer ✅ Pulmonary edema due to rapid blood administration MTP Protocol - Correct Answer ✅ 1 : 1 : 1 RBC : Plasma : Platelet Blood Loss Grades - Correct Answer ✅ I - Loss of 15% with normal BP II - Loss of 15-30% with normal BP III - Loss: of 31-40% with lowered BP IV - Loss > 40% with hemodynamic instability Permissive Hypotension - Correct Answer ✅ Maintaining BP as low as 70/40 so allow for clotting. Contra-indicated in head injuries, peds, and elderly TCRN EXAM Questions and Answers (Latest update 2025) Study Guide SCIWORA - Correct Answer ✅ Spinal Cord Injury WithOut Radiological Abnormality Common in Age < 2 yrs Significance of Bariatric Patients - Correct Answer ✅ Increased HR and RR at baseline Increased abdominal pressures Increased risk of coagulopathies SBIRT - Correct Answer ✅ Comprehensive intervention to deliver treatment for substance use disorders Screening Brief Intervention Referral to Treatment Triad of Abusive Brain Injury - Correct Answer ✅ Subdural Hemorrhage Retinal Hemorrhage Decreased LOC TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Sentinel Event - Correct Answer ✅ An unexpected occurrence involving death or serious physical or psychological injury, not related to the natural course of the patient's illness Best Studied using Root Cause Analysis Trauma Center Designation vs Verification - Correct Answer ✅ Designated by the state Verified by American College of Surgeons Qualifications to be Trauma Center - Correct Answer ✅ - Treatment protocols for resuscitation -Data Reporting -Active outreach program in community -Disaster planning National Trauma Data Bank - Correct Answer ✅ A collection of trauma data research and benchmarking TCRN EXAM Questions and Answers (Latest update 2025) Study Guide COBRA / EMTALA - Correct Answer ✅ Patient must be offered medical screening exam > discharge, admitted, or transfer to another facility > Must have a receiving facility, accepting physician, and signed certification EMTALA also covers that consent can be waived in case of emergency Types of Review - Correct Answer ✅ Primary - review of patient's chart in real time Secondary - Review after patient is discharged Tertiary - Peer Review (via committee or M&Ms) Quaternary - Hospital's quality committee, or external review Steps of Disaster Management - Correct Answer ✅ Mitigation Preparedness Response Recovery TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Compassion Fatigue - Correct Answer ✅ Loss of nurse's ability to empathize and provide compassionate care to patients Secondary Traumatic Stress leading to Burnout Autonomy - Correct Answer ✅ Ability of individual to determine his/her own course of action ex: not receiving blood due to religious reasons Beneficence - Correct Answer ✅ Duty of health care providers to be a benefit to the patients ex: prevent or remove harm from the patient Non-maleficence - Correct Answer ✅ Do no harm ex: honor DNR status of patient Veracity - Correct Answer ✅ Honesty, providing all information needed to make balanced decision ex: review all risks and benefits of surgery prior to consent TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Middle Fossa - Around ears (Could affect hearing) Posterior Fossa - Posterior portion of the head (Could lose gag reflex, or movement of the neck or tongue) Cerebral Contusion - Correct Answer ✅ Bruising on the surface of the brain Three Meninges - Correct Answer ✅ Pia Arachnoid Dura Meninges PAD the brain Epidural Bleed - Correct Answer ✅ Between the skull and dura mater Arterial Symptoms: Unconscious then brief lucid period, then rapid decline of LOC Treatment: Burr hole TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Subdural Bleed - Correct Answer ✅ Between the dura and arachnoid mater Venous Symptoms: Similar to epidural, but slower onset Treatment: Craniectomy Sub arachnoid Bleed - Correct Answer ✅ Between the arachnoid and pia mater Symptoms: Worst headache of my life Treatment: Surgery Diffuse Axonal Injury - Correct Answer ✅ Disruption of the axons in the cerebrum Symptoms: Posturing, Coma, Hyperthermia Levels of Consciousness - Correct Answer ✅ Alert Lethargic - sleepy Obtunded - responses to loud voice or shaking Stuporous - Responds to painful stimuli TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Comatose - Not responding to painful stimuli Full Outline of UnResponsiveness (FOUR) - Correct Answer ✅ Eye response Motor response Brainstem reflexes Respirations Cushing's Triad - Correct Answer ✅ Signs of increased intracranial pressure: Hypertension with a widened pulse pressure Bradycardia Irregular respirations Tests for CSF leakage - Correct Answer ✅ "Halo" test Reagent strip - test for glucose Cerebral Perfusion Pressure (CPP) - Correct Answer ✅ CPP = MAP - ICP TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Central Cord Injury - Correct Answer ✅ Greater loss of motor function in upper vs lower extremities More likely to affect lateral cord Brown-Sequard Injury - Correct Answer ✅ Loss of motor function on same side of injury Loss of pain and temp on opposite side of injury Cauda-Equina Syndrome - Correct Answer ✅ Damage to lower spinal cord, resulting in problems with bowel and bladder control Spinal Shock - Correct Answer ✅ Temporary neurological deficits immediately after spinal injury Islands of Sparing - Correct Answer ✅ Areas without deficits due to a partial cord injury TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Sensory Assessment in SCI - Correct Answer ✅ Start from areas of decreased sensation and move towards areas of increased sensation Neurogenic Shock - Correct Answer ✅ Activation of parasympathetic nervous system causing vasodilation, hypotension and bradycardia Treat with fluids, and vasopressors Autonomic Dysreflexia symptoms - Correct Answer ✅ Hypertension Bradycardia Headache Goose bumps (piloerection) Sweating above the level of the spinal injury Cool clammy skin below the level of the spinal injury Mandibular Fracture - Correct Answer ✅ Malocclusion of the jaw Dental involvement TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Le Fort Fractures - Correct Answer ✅ Orbital Fracture - Correct Answer ✅ Concerned for ocular entrapment Treatment for Maxillofacial Trauma - Correct Answer ✅ Allow patient to assume position that they can tolerate Suction as needed Assess for surgical airway Intraocular Pressure - Correct Answer ✅ Above 20 is elevated Normal Ocular pH - Correct Answer ✅ 7.0 - 7.4 Hyphema - Correct Answer ✅ Bleeding in the anterior chamber of the eye due to ruptured vessel in the iris High risk of secondary bleeding occurring on the 3-4 day TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Paradoxical chest wall movement - Correct Answer ✅ Sinking of the flail segment during inspiration, and bulging of the flail chest segment during exhalation (opposite of normal) Treatment for Rib Fractures - Correct Answer ✅ Pain management Oxygenation Euvolemia Chest Physiotherapy Suctioning Aortic Trauma Symptoms - Correct Answer ✅ Higher systolic in the right upper extremity compared to the left upper. Difference of 20. Precordial Systolic Murmur Treatment for Aortic Injuries - Correct Answer ✅ Permissive Hypotension Beta-blockers Surgery TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Ankle Brachial Index - Correct Answer ✅ Ratio to determine severity of peripheral vascular disease ABI = Ankle SBP / Brachial SBP ABI Measurements - Correct Answer ✅ Greater than 0.9 : Normal 0.6 - 0.9 : Mild 0.3 - 0.6 : Moderate Less than 0.3 : Critical Ischemia Pericardial Tamponade - Correct Answer ✅ Collection of fluid in the pericardial sac Symptoms: Beck's Triad, Pulsus Alternans, Paradoxical pulse, Narrowed pulse pressure, PEA Treatment: Pericardiocentesis, Open thoracotomy Beck's Triad - Correct Answer ✅ Muffled heart tones Systemic Hypotension Distended neck veins TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Paradoxical Pulse - Correct Answer ✅ Decrease of more than 10 in arterial pressure during inspiration Pulsus Alternans - Correct Answer ✅ Alternating morphology of the QRS complex Blunt Cardiac Injury - Correct Answer ✅ Symptoms: CP, ST elevation, Right sided heart failure Treatment: Positive Inotropes (Ex: Dobutamine) Pneumothorax - Correct Answer ✅ Air in the pleural cavity May cause a "sucking sound" on inhalation Treatment: Three-sided occlusive dressing Tension Pneumothroax - Correct Answer ✅ Pneumo with excessive pressure, pushing the heart over to opposite side of injury. Obstructive shock Treatment: Needle thoracostomy, then chest tube TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Extracorporeal Membrane Oxygenation (ECMO) - Correct Answer ✅ System that circulates the blood through an oxygenation system, to allow for the heart and lungs to recover Ruptured Diaphragm - Correct Answer ✅ Symptoms: Heart sounds shift to the right side Pain to LEFT shoulder Signs of obstructive shock Dysphagia Dyspnea Confirmed by laparotomy Treatment: Surgery Seatbelt Sign - Correct Answer ✅ Bruising along the lower abdomen Concern for small bowl injury and fractures of the lumbar spine TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Steps for Abdominal Assessment - Correct Answer ✅ Visualization Auscultation Percussion Palpation Tympany vs Dullness - Correct Answer ✅ Tympany - Hyperresonance, Air, Hollow organs Dullness - Hyporesonance, Fluid, Solid organs Narrowed vs Widened Pulse Pressure - Correct Answer ✅ Narrowed - Concerned for bleeding Widened - Concerned for head injuries Rebound Tenderness - Correct Answer ✅ Pain that increases when pressure is removed due to irritation caused by presence of blood, enzymes, and bacterial contaminants Hollow Organs - Correct Answer ✅ Esophagus, Stomach, Small intestine, Large intestine TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Complications of Hollow Organ Injuries - Correct Answer ✅ Hematomas can cause obstructions hours or days after trauma Expected elevated WBC count, amylase, and lactic acid levels Escaping air can cause tympany and abdominal distention Rebound Tenderness Solid Organs - Correct Answer ✅ Spleen, Liver, Pancreas, Kidneys Injury to the Spleen - Correct Answer ✅ LUQ pain, Left shoulder pain Concerned for major blood loss Vulnerable to infections Treatment: Splenorrhaphy (surgical repair) or Splenectomy Long-term complications from a Splenectomy - Correct Answer ✅ Vulnerable to infections caused by encapsulated bacteria: TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Retroperitoneal Bleeding - Correct Answer ✅ Cullen's Sign Bruising to the flanks Anterior vs Posterior Urethral Trauma - Correct Answer ✅ Anterior - At end of urethra. More common in males. Usually due to straddle injuries or external forces. Posterior - Close to bladder. Almost always associated with pelvic fractures Types of Bladder Rupture - Correct Answer ✅ Intraperitoneal - Top of bladder is ruptured into abdomen, can cause rebound tenderness and abdominal distention Extraperitoneal - Bottom of bladder is ruptured, can cause suprapubic swelling and tenderness Coopernail's Sign - Correct Answer ✅ Bruising to the scrotum or labia Urinoma - Correct Answer ✅ Collection of urine located outside the kidney or bladder TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Treatment: Percutaneous drain Complications of Renal Injury - Correct Answer ✅ Hemorrhage Infection AKI Long term complication - Hypertension Acute Kidney Injury (AKI) - Correct Answer ✅ Rapid loss of renal function due to damage to the kidneys Pre-Renal Failure - Correct Answer ✅ Poor blood flow to the kidneys Treatment: Fluids, vasopressors, inotropes Intra-Renal Failure - Correct Answer ✅ Damage to the kidneys due to nephrotoxins or ischemic sources Treatment: Withdraw nephrotoxins, diuretics TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Post-Renal Failure - Correct Answer ✅ Injury to the urinary collection system Treatment: Relieve obstruction, urinary catheterization Expected Lab Values in Renal Failure - Correct Answer ✅ Elevated Creatinine Elevated BUN Elevated Potassium Decreased HnH Hemodialysis vs CRRT - Correct Answer ✅ Hemodialysis - Shorter treatments, but rapid shifts in electrolytes CRRT - Slower corrections, but requires more anticoagulation Respiratory Changes in Pregnant Patients - Correct Answer ✅ Elevated diaphragm Increased respiratory rate Decreased CO2 and Bicarb TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Emergency Delivery - Correct Answer ✅ To deliver shoulders, direct head downward to deliver anterior shoulder first Then, upward to deliver posterior shoulder Fundal Height - Correct Answer ✅ 12 weeks - Pubic Symphysis 20 weeks - Umbilicus 40 weeks - Xyphoid Process Fetal Heart Rate - Correct Answer ✅ Normal: 120-160 Fetal Tachycardia: Early distress Fetal Bradycardia: Late distress If pregnant mother becomes pulseless... - Correct Answer ✅ CPR above the center of the sternum Displace Uterus laterally C-section if beyond 24 weeks TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Incidence - Correct Answer ✅ Number of people affected by an injury during a specific time period Morbidity - Correct Answer ✅ Number of people injured after traumatic incident Mortality - Correct Answer ✅ Number of deaths in a specified time frame Direct, Additional, and Indirect Costs - Correct Answer ✅ Direct - Measurable costs of healthcare (Ex: Medical care, rehab) Additional - Additional outside of healthcare (Ex: police, fire, property damage) Indirect - Value of foregone productivity (Ex: Cost of training someone new due to someone being injured) Prevalence - Correct Answer ✅ Number of affected persons with particular injury in the population at a specified time divided by the whole population. High prevalence - high survivability TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Low prevalence - low survivability Injury Prevention Programs - Correct Answer ✅ Primary - Prevent occurrence of injury. Ex: Require fence around pool Secondary - Reduce the severity of injury. Ex: CPR class required for pool owners Tertiary - Improvement in outcomes related to traumatic injury. Ex: Easy access to helicopter 4 E's in Prevention Programs - Correct Answer ✅ Engineering Enforcement Educational Economic Prehospital Care priority - Correct Answer ✅ Airway Breathing Bleeding Controlled Spinal Precaution TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Ventilator Associated Pneumonia (VAP) Prevention Tactics - Correct Answer ✅ Minimize sedation Elevate HOB Perform oral care Suctioning Inpatient Nutrition - Correct Answer ✅ Enterally (Stomach) is preferred over parenteral (IV) to reduce risk of sepsis Initiate nutrition 24-48 hours after trauma and 6 hours for burn patients Rehabilitation Results - Correct Answer ✅ Restoration - Ability to recover normal function Compensation - Replace normal function with other strategies Adaptation - Change lifestyle to adapt to disability Skilled Nursing Facility vs Long Term Care Hospital - Correct Answer ✅ Determined by the anticipated length of stay and complexity of patient's needs TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Living Will - Correct Answer ✅ A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes Durable Power of Attorney - Correct Answer ✅ Designates a surrogate decision maker when an individual is unable to make decisions Determining Brain Death - Correct Answer ✅ First, Remove all conditions that could impair neurologic function (Normalize electrolytes, Euthermia, Sedation) Then, Hyperoxygenative for at least 10 minutes Remove ventilator support If O2 drops by 10%, restart ventilator to preserve organs If there is no spontaneous respiratory effort, then patient is brain dead Timeline for Tissue Donation - Correct Answer ✅ 10 hours for bone 6 to 10 hours for heart valves TCRN EXAM Questions and Answers (Latest update 2025) Study Guide 24 hours for skin and cornea Eye Donation - Correct Answer ✅ Keep HOB elevated Instill artificial tears Tape eyes closed Carbon Monoxide (CO) Poisoning - Correct Answer ✅ 5-10% - Headache, dizziness 10-20% - Dyspnea, N/V, Flushed skin 20-40% - Confusion, Lethargy, Angina 40-60% - Dysrhythmias, Seizures, Coma >60% - Cherry-red skin, Death Treatment of CO Poisoning - Correct Answer ✅ 100% oxygen COHb has a half life of 4 hours on room air But only 1 hour on 100% O2 Treatment for Smoke Inhalation - Correct Answer ✅ N- acetylcysteine via inhalation TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Full Thickness Burns - Correct Answer ✅ All layers of skin Leathery Insensitive to light tough Requires surgical grafting Complication fo Electrical Burns - Correct Answer ✅ Cardiac arrhythmias Rhabdomyolysis Compartment Syndrome Parkland Formula for Electrical Burns - Correct Answer ✅ TBSA x 4 ml x body weight in kg Urinary output goal of 1-1.5 ml/kg/hour Decontamination Zones - Correct Answer ✅ Hot - Assisting in undressing and life-saving medical care Warm - Cover open wounds, wash patient down Cold - Decontaminated individuals, appropriate medical care TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Dry Chemicals - Correct Answer ✅ Brush remaining chemical off the skin before cleaning with water Hydrofluoric acid - Correct Answer ✅ Apply calcium chloride gel Monitor for hypocalcemia Tar and Asphalt - Correct Answer ✅ Cool compresses Remove with fat emollient (vasoline, bacitracin, cooking oil) Hydrocarbons - Correct Answer ✅ Methane, ethane, propane Lead to skin necrosis, respiratory failure, and hepatic injury Phenols - Correct Answer ✅ Alcohol found in household disinfectants Treat with 50% polyethylene glycol (PEG) Compartment Syndrome Five P's - Correct Answer ✅ Pain Paresthesia TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Paralysis Pallor Pulselessness Compartment Syndrome Measurements - Correct Answer ✅ Above 20 is elevated Compartment Syndrome Treatments - Correct Answer ✅ Remove external pressure (casts, splints) Elevate limb to the level of the heart Anticipate fasciotomy Rhabdomyolysis - Correct Answer ✅ Release of myoglobin from severe muscle destruction Symptoms: Myoglobinuria Elevated CK, potassium, phosphorus Decreased calcium levels Rhabdo Treatment - Correct Answer ✅ IV fluid administration with a goal of 200-300 ml/hour of urine TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Hydrocolloid Dressings - Correct Answer ✅ Absorbent gel- forming agents with outer adhesive film Hydrogels - Correct Answer ✅ Provide moist wound environment Use in yellow wounds (absorbs exudate) Alginates - Correct Answer ✅ Consist of calcium and seaweed Absorbs wound exudate Silver-impregnated dressings - Correct Answer ✅ Provide antimicrobial activity Type of Debridement - Correct Answer ✅ Surgical - Cutting away necrotic tissue Biologic - Maggots or enzymes Autolytic - Hydrocolloid dressings Mechanical - Wet to Dry (manually removing dead tissue) TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Suture Removal - Correct Answer ✅ Facial: 3-5 days Scalp: 7-10 days Trunk: 7-10 days Arm and leg: 10-14 days Joint sutures: 14 days FOOSH - Correct Answer ✅ Fall On Out-Stretched Hand Monteggia's Fracture - Correct Answer ✅ Fracture of proximal 1/3 of ulna with dislocation of radial head Nightstick Fracture - Correct Answer ✅ A fracture of the mid- shaft of the ulna from a direct blow Smith's Fracture - Correct Answer ✅ Fracture of the distal radius, angled downward Fall on back of hand Colle's Fracture - Correct Answer ✅ Fracture of the distal radius, angled upward TCRN EXAM Questions and Answers (Latest update 2025) Study Guide Fall on flexed wrist Anterior vs Posterior Hip Dislocation - Correct Answer ✅ Anterior - Abduction Posterior - Adduction Don Juan or "Lover's Fracture" - Correct Answer ✅ Calcaneus fracture due to landing feet-first Associated with tibial plateau fractures and lumbar fractures Treatment of Fracture / Dislocations - Correct Answer ✅ Apply splint Elevate extremity (Level of heart with compartment syndrome, above the level of heart without) Apply ice 20 min out of each hour, Then switch of heat after 48-72 hours Hypocalcemia affects on ECG - Correct Answer ✅ QT prolongation