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TCRN 2024 EXAM QUESTIONS AND ANSWERS
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TCRN 2024 EXAM QUESTIONS AND ANSWERS
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TCRN 2024 EXAM QUESTIONS AND ANSWERS1)
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 - Answers -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.
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 - Answers -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)
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 - Answers -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 - Answers -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 - Answers -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 - Answers -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. - Answers -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 - Answers -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 - Answers -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. - Answers -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.
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