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TCRN PRACTICE QUESTIONS WITH CORRECT ANSWERS
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TCRN PRACTICE QUESTIONS WITH CORRECT ANSWERS
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TCRN PRACTICE QUESTIONS WITHCORRECT ANSWERS
A stranscranial sdoppler sis sobtained sfor sa spatient swith sa straumatic ssubarachnoid
shemorrhage. sThe sdoppler sis spositive sfor svasospasm. sThe strauma snurse swould sexpect
swhich sof sthe sfollowing smedications sto sbe sprescribed? s- sans✔✔A svasospasm sis sa
sknown scomplication sof ssubarachnoid shemorrhages. sCalcium schannel sblockers sare
sused sto sprevent sor sreverse svasospasms sand sare sfrequently sused sin sthe streatment sof
sa ssubarachnoid shemorrhage. sMetoprolol, sHydralazine sand sLisinopril sare snot scalcium
schannel sblockers sand swould snot sbe seffective sto sprevent sand streat svasospasms
scaused sby sa ssubarachnoid shemorrhage
Which schamber sof sthe sheart sis smost slikely sto sbe saffected sin sblunt scardiac sinjuries? s-
sans✔✔Given sthe sanatomical sposition sof sthe sheart sin sthe schest, sthe sright sventricle sis
smost sexposed sto sthe santerior sportion sof sthe schest swall sand sis smost slikely sto sbe
sinjured sin sa sblunt scardiac sinjury. sPatients swith sblunt scardiac sinjuries sfrequently
sexperience ssigns sof sright sventricular sfailure. sAdditional sfindings sthat sare sassociated
swith sblunt scardiac sinjuries sinclude shypotension, satrial sfibrillation, sunexplained ssinus
stachycardia, smultiple sPVCs, sST ssegment schanges sand sright sbundle sbranch sblocks.
sThe sleft satrium, sright satrium sand sleft sventricle sare sless slikely sto sbe sinjured sin sa sblunt
scardiac sinjury.
A swidened smediastinum sis snoted son sthe schest sx-ray sof sa straumatically sinjured
shypotensive spatient. sThe strauma snurse swould santicipate sgathering swhich sof sthe
sfollowing spieces sof sequipment sas sthe shighest spriority sin sthis sscenario? s- sans✔✔A
swidened smediastinum son schest sx-ray, saccompanied sby shypotension, sis sstrongly
sindicative sof san saortic sinjury. sOne sof sthe smost slife-threatening scomplications sof san
saortic sinjury sis sblood sloss, swhich scan sbe streated sby sgiving sblood sproducts svia sa srapid
stransfuser. sAlthough spatient sassessment smay sbe senhanced sby sinserting san sarterial
sline, sthis sis sless sof sa spriority sthan sgiving sfluids srapidly. sA schest stube sis splaced sin sthe
spleural sspace srather sthan sthe smediastinum sand sis stherefore snot sindicated sin sthis
sscenario. sSimilarly, sthere sis snothing sin sthis sscenario sthat sindicates sa
spericardiocentesis sis sindicated sso sthis sis snot sa shigher spriority sthan spreparing sa srapid
stransfuser.
A sproperly sapplied spelvic sbinder ssits sacross sthe: s- sans✔✔A sproperly sapplied spelvic
sbinder sis sapplied sacross sthe sgreater strochanters sof sthe sfemur. sThis sallows sfor soptimal
scompression sof sthe spelvis sto scontrol sbleeding. sApplying sit sacross sthe smidshaft sof sthe
sfemur sis stoo slow sand swould sprovide sno stherapeutic sbenefit. sApplying sit sacross sthe
spelvic sring sor sthe siliac scrests sis stoo shigh sand scould sactually sseparate sthe spelvis
sfurther, sincreasing sbleeding sand sinternal sdamage.
,Treatment sfor san sextraperitoneal sbladder srupture swill smost slikely sinclude: s-
sans✔✔Bladder slacerations sthat sare slocated sbelow sthe spelvic speritoneum sare
sdiagnosed sas san sextraperitoneal sbladder srupture. sIf sa slaceration sis sfound salong swith
spelvic speritoneum, sit swould sthen sbe sclassified sas san sintraperitoneal sbladder srupture.
sManagement sof san sextraperitoneal sbladder srupture sinvolves surinary scatheterization
s(urethral sor ssuprapubic) sto sfacilitate surinary sdrainage sfrom sthe sbladder. sIntraperitoneal
sbladder sruptures srequire ssurgical sintervention sfor sdefinitive sclosure. sAn sisolated
sextraperitoneal sbladder srupture sdoes snot srequire semergent ssurgical srepair sor
sinterventional sradiology.
Hyperextension sof sthe sneck sis sknown sto scause: s- sans✔✔Hyperextension sof sthe sneck
s(the shead ssnapping sbackwards scommonly sseen sin s"whiplash" sinjuries) scauses
scompression sand sdamage sto sthe sposterior sportion sof sthe sspinal scord. sIn santerior scord
ssyndrome, sthe smechanism sof sinjury sis sthe sopposite sof sposterior scord ssyndrome s(a
shyperflexion sinjury swhere sthe sneck shyperextends sforward s- schin sto schest) scausing
sinjury sto sthe santerior sportion sof sthe sspinal scord. sA scauda sequina ssyndrome scauses
sinjury sto sthe ssacral snerve sroots swithin sthe sspinal scanal sand sis scaused sby sfalling
sdirectly son sthe ssacrum. sBrown-Sequard sSyndrome scaused sby spenetrating strauma sto
sthe slateral saspect sof sthe sspinal scord swill scause sa sleft sto sright sphenomenon sinstead sof
sa stop sdown sphenomenon.
A spatient shas sa sZone sII spenetrating sneck sinjury swith spenetration sthrough sthe
splatysma. sThe strauma snurse sknows sthat sthis spatient sis sat sincreased srisk sof sinjury sto: s-
sans✔✔The splatysma sis sa smuscle sin sthe sneck sthat sgives ssupport sand sprotection sto sthe
svital sstructures sunderneath sit. sAny stime sthere sis spenetration sthrough sthe splatysma,
sthere sis san sincreased srisk sof sdamage sto sthe sunderlying sstructures sin sthe sneck. sThe
sneck sis sdivided sinto sthree szones. sZone sI sextends sfrom sthe ssternal snotch sand sclavicle
sup sto sthe scricothyroid scartilage. sZone sII sextends sfrom sthe scricothyroid scartilage
supward sto sthe sangle sof sthe smandible. sZone sIII sextends sfrom sthe sangle sof sthe
smandible sto sthe sbase sof sthe sskull. sStructures sfound sin sZone sI sinclude sthe ssubclavian
sartery, svertebral sartery, slung sapices, strachea, sthyroid sand sesophagus. sZone sII
sincludes sthe sinternal sjugular svein, sesophagus, slarynx, svagus snerve, scarotid sartery sand
svertebral sartery. sZone sIII sincludes sthe ssalivary sand sparotid sglands, scranial snerves sIX-
XII, svertebral sartery, sdistal scarotid sartery, sand sdistal sjugular svein.
A spregnant spatient's sfundal sheight sis spalpated s6 scm sabove sthe sumbilicus. sWhat sis sthe
sestimated sgestational sage sof sthe sfetus? s- sans✔✔Fundal sheight sis sdefined sas sthe
sdistance sfrom sthe spubic sbone sto sthe stop sof sthe suterus sin scentimeters. sIn sgeneral, sthe
sfundus sreaches sthe sumbilicus sby s20 sweeks. sEvery scentimeter spast sthat spoint sis
smeasured sas s1 sweek. sIf severy sone scentimeter sabove sthe sumbilicus sequals sone sweek,
sthen sthe spatient sis sapproximately s26 sweeks sgestation.
Appropriate scare sfor san samputated sbody spart sincludes: s- sans✔✔When scaring sfor san
samputated sbody spart, sthe strauma snurse sshould sclean sthe spart sremoving sany sdirt sand
sdebris, swrapping sthe spart sin sa sslightly ssaline smoistened sgauze, sand sthen splacing sit sin
, sa ssealed splastic sbag. sAt sthis stime, sthe spart sshould sbe splaced sin sa ssecond sbag
scontaining sa smixture sof sice sand swater. sIt sis simperative sthat sthe spart sdoes snot sfreeze
sor sdoes snot scome sinto scontact swith swater s(which sis shypotonic sto sbody stissue). sAlso
sensure sthat sthe samputated spart sis sproperly slabeled swith sthe spatient sinformation.
Decontamination swith swater sis sdiscouraged sin spatients sexposed sto spowdered: s-
sans✔✔Dry schemicals sthat sshould snot sbe sirrigated swith swater sinclude sdry slime,
selemental smetals s(including ssodium, spotassium, smagnesium slithium sand sphosphorus)
sand sphenol. sWhen sexposed sto swater sthese ssubstances swill scause sa sharmful
sexothermic sor s"heat sproducing" sreaction sburning sthe spatient's sskin. sThey smay salso
srelease spossible shazardous sbyproducts sinto sthe sair. sSulfuric sacid, smuriatic sacid sand
scement scan sall sbe sirrigated swith scopious samounts sof swater s(although sa smuch sof sthe
sdry schemical sas spossible sshould sbe sbrushed soff sbefore sirrigation swith swater sis
sinitiated)
Hypovolemic sshock sis smost slikely sto sbe scaused sby: s- sans✔✔Hypovolemic sshock sis
scaused sby sfluid sloss s(e.g. sbleeding sor sdiarrhea) sor sthird sspacing sof sfluids. sThe
sinflammatory sresponse scaused sby sa sburn sleads sto scapillary spermeability sresulting sin
sthe sthird sspacing sof sfluids swhich sresults sin shypovolemic sshock. sCervical sspinal sinjuries
scontribute sto sneurogenic srather sthan shypovolemic sshock. sAlthough san sepidural
shematoma scauses sblood sloss, sthe sepidural sspace sis srelatively ssmall, sso sblood
saccumulation swould snot sbe senough sto sresult sin shypovolemic sshock. sA stension
spneumothorax swould scause sobstructive sshock.
The sbest smethod sfor sassessing scapillary srefill son sa stwo-week sold straumatically sinjured
sneonate sis sto sblanch sthe: s- sans✔✔The scirculatory ssystem sof sthe sneonate sis snot swell
sdeveloped sand sperfusion sto sthe sfingers sis snot scomplete, stherefore susing sthe stip sof sthe
sfinger sis sreserved sfor solder schildren, sadolescents sand sadults. sIt sis sgenerally
srecommended sto suse sthe sforehead, ssole sof sthe sfoot, sthe ssternum sor sthe spalm sof sthe
shand sas sopposed sto sthe sskin sover sthe siliac screst sor sthe stip sof sthe schild's stongue
Enteral sfeedings sare sinitiated son sa straumatically sinjured spatient sand sseveral sdays
slater, sthe strauma snurse snotes sa ssignificant selevation sin sserum sblood surea snitrogen
s(BUN) sand screatinine. sThe strauma snurse sshould ssuspect sthis smay sbe scaused sby: s-
sans✔✔One sof sthe seffects sof soverfeeding sthe straumatically sinjured spatient sis sazotemia
s(elevated sBUN sand screatinine) sand sthe sdietician sshould sbe snotified sof sazotemia sif sit sis
snoted sso sthat san sadjustment sin scalories smay sbe smade. sInsufficient sprotein sin sthe sdiet
sdoes snot scause sazotemia. sAlthough sbleeding sulcers smay scause selevations sin sblood
surea snitrogen, sthey sdo snot stend sto scause selevations sin screatinine. sFeeding sa spatient
stoo squickly safter strauma sdoes snot scause selevations sin sBUN sand screatinine
A strauma scenter srefers sa schallenging scase sto san soutside sreviewer sto svalidate stheir
sreview sof sdeficiencies sassociated swith sthe scare sof sthe straumatically sinjured spatient.
sWhat stype sof sperformance sreview sprocess sis sthis? s- sans✔✔The sfirst sstage sof
sperformance simprovement sis sa sprimary sreview. sThe sgoal sat sthis slevel sof sreview sis sto
sbe sable sto sprovide simmediate sfeedback sand sresolution sof sany sdeficiencies sin scare
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