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150 TCRN TEST EXAM QUESTIONS WITH ANSWERS FOR 2022 NEW EXAMS
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150 TCRN TEST EXAM QUESTIONS WITH ANSWERS FOR 2022 NEW EXAMS
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150 TCRN TEST EXAM QUESTIONS WITH ANSWERS FOR2022 NEW EXAMS
Fluid resuscitation is administered to a traumatically injured patient. After resuscitation, the
trauma nurse evaluates the patient's response to that resuscitation to determine whether
additional fluids should be administered. Which of the following factors is most likely to impact
this evaluation? - CORRECT ANSWER Beta-blockers blunt changes in the pulse and blood
pressure. This may both reduce changes associated with recognizing hypovolemia but it can
also reduce changes associated with the response to treatment. Many times the blood pressure
falls and the pulse rises with hypovolemia and the opposite happens after fluid resuscitation.
When the patient is on beta-blockers, these changes may not occur. Although it is more
difficult to assess for changes in skin color in dark-skinned individuals, skin changes are
generally not used to evaluate the effectiveness of fluid resuscitation and further resuscitation
would not be based on changes in skin color. The presence of lower extremity trauma does not
influence evaluation of fluid resuscitation nor the need for additional fluids. A body mass index
of 21 kg/m2 is within normal limits and is unlikely to affect resuscitation or the evaluation of
resuscitation
50% polyethylene glycol will be used as part of the treatment for: - CORRECT ANSWER 50%
polyethylene glycol is known to increase the solubility of phenols in water and should be used
as part of the decontamination process in patients exposed to phenols. It will have no
therapeutic effect for patients with pancreatic trauma, carbon monoxide poisoning (treated with
100% oxygen) or acute respiratory distress syndrome (treated with appropriate ventilator
management and prone positioning)
A reagent strip that tests for glucose is used in the assessment of a traumatically injured
patient. What injury is likely suspected? - CORRECT ANSWER A basilar skull fracture may
result in leakage of cerebrospinal fluid, which is rich in glucose. Reagent strips that test for
glucose can be used to assist the diagnosis of basilar skull fracture by checking fluid coming
from the nose or ears for glucose. A reagent strip that tests for glucose will not be therapeutic
in assessing for a bladder rupture, diffuse axonal injury or a ruptured amniotic sac.
When administering large volumes of blood products, the trauma nurse should monitor for
which of the following findings which could indicate hypocalcemia? - CORRECT ANSWER A
classic finding associated with hypocalcemia is QT prolongation. ST elevation is more common
with cardiac ischemia and not associated with hypocalcemia. Tall peaked T waves and
flattening of the P wave are both associated with hyperkalemia, not hypocalcemia
The trauma nurse knows that treatment for a patient with non-operative abdominal trauma has
been effective if: - CORRECT ANSWER A goal of treatment after abdominal trauma is a
return of the base deficit to normal. This indicates adequate fluid resuscitation and is associated
with positive outcomes. Although serum amylase levels should be monitored because elevations
in these levels may indicate pancreatic or bowel trauma, changes in serum amylase levels are
not associated with effective treatment, but rather associated with the injuries themselves.
Intraabdominal pressures should be below 10 mm Hg. An intaabdominal pressure above 12 mm
Hg indicates intraabominal hypertension, indicating a need for further. Hyperrresonance to
percussion in the abdomen is an indication of hollow organ injury and is not a goal of treatment
,Which of the following statements, made by a patient being discharged home with the
diagnosis of a hyphema, indicates FURTHER teaching is warranted? - CORRECT ANSWER
A hyphema is a collection of blood in the anterior chamber of the eye. An isolated hyphema may
be treated at home but the patient should be encouraged to rest and avoid any activities which
could increase intraocular pressure and cause further bleeding. Patients will be encouraged to
keep their head elevated 30 to 45 degrees on pillows, to rest their eyes (avoid activities such as
watching television or reading) and to watch for signs of new bleeding (which can include vagal
stimulation in the form of nausea and vomiting.) Ibuprofen and other medications which can
increase the risk of bleeding should be avoided.
A Kleihauer-Betke test may be used to determine: - CORRECT ANSWER A Kleihauer-Betke
test is used to determine the presence of fetal blood in maternal circulation and is often positive
in patients with placental abruption. The Kleihauer-Betke test is not useful in determining pain
levels nor will it help determine the presence of pancreatic trauma. It is not associated with
acute respiratory distress syndrome
Adoption of a mass transfusion protocol should help reduce the incidence of: - CORRECT
ANSWER A mass transfusion protocol may prevent the onset of a systemic inflammatory
response syndrome (SIRS). The onset of SIRS is related to tissue trauma and prolonged tissue
hypoxia. Early, aggressive fluid and blood resuscitation may decrease tissue hypoxia. Fat
emboli are the result of a large bone fracture and the incidence of these is not affected by MTP.
Post-renal failure is caused by obstructions in the lower genitourinary tract and the incidence
of this complication is not altered by MTP. Abdominal compartment syndrome is the result of
excessive fluid in the peritoneum. While MTP is not directly associated with abdominal
compartment syndrome, the fluids administered during activation of MTP could worsen rather
than reduce the incidence of abdominal compartment syndrome
Which of the following goals of care is most appropriate for a patient with a maxillary fracture?
- CORRECT ANSWER A maxillary fracture causes loss of bony structure to the mid-face
which can cause loss of integrity of the airway. This can be exacerbated by bleeding and edema
in the airway, further putting the ability to maintain the airway in jeopardy. When caring for
patients with a maxillary fracture, maintenance of airway is always a high priority. Alterations
in visual acuity associated with maxillary fractures likely occurred at the time of injury and
treatment is unlikely to alter this outcome. Maxillary fractures are not splinted, they are
surgically repaired. Treatment will not reduce cerebrospinal fluid leakage; therefore, this is not
a goal of care
Which of the following blood urea nitrogen ratios is associated with effective fluid
resuscitation? - CORRECT ANSWER A normal blood urea nitrogen (BUN) to creatinine ratio
is 10:1 and indicates effective renal functioning. If the BUN to creatinine ratio increases, that is
an indication of hypovolemia (e.g. 20:1, 30:1 or 40:1)
One goal of an effective performance improvement program would be to reduce the: -
CORRECT ANSWER A performance improvement program is meant to improve the care
delivered. Improvement in care is measured differently by different people. Patients tend to
measure success by improving quality outcomes (not reducing quantities of outcomes). Care
providers tend to measure success by increasing the quality of the care delivery process (not
, reducing the quality of the process). Payors tend to measure success through reduced costs.
Reducing the number of providers is not a direct goal of the performance improvement process
The highest priority intervention for a patient with indications of a ruptured uterus is: -
CORRECT ANSWER A ruptured uterus causes significant blood loss resulting in life-
threatening blood loss. Therefore, the priority intervention would be initiation of an
intravenous line so that fluid resuscitation can be commenced. Transfer to the surgical suite
will also be required but this does not constitute a higher priority than initiation of an
intravenous line. Terbutaline may be used to abate premature labor but has no therapeutic
effect for a ruptured uterus. Cardiotocographic monitoring is not indicated for a ruptured
uterus and is not a higher priority than initiation of an intravenous line
Which activity must proceed measurement of bladder pressures used to monitor abdominal
compartment syndrome? - CORRECT ANSWER A set amount of fluid must be administered
into the bladder before bladder pressures can be measured. Once the fluid is instilled, the
catheter must be clamped until the measurement is complete. Although administration of
analgesia is not contraindicated, it is not required to obtain a bladder pressure. The head of the
bed should be flat, not elevated 30 degrees in order to measure bladder pressures. There is no
need to administer 500 mL boluses of crystalloid solution prior to measuring bladder pressure
The trauma nurse knows that the best way to increase fibrinogen levels in a patient with
coagulopathies is to administer: - CORRECT ANSWER A single bag of cryoprecipitate
contains 350 mg of fibrinogen. Administering either Vitamin K or platelets will not elevate
fibrinogen levels. Although fresh frozen plasma may have some fibrinogen in it, this blood
product does not contain as much fibrinogen as cryoprecipitate.
Which of the following findings indicates that the family member of a traumatically injured
patient has entered a state of crisis? - CORRECT ANSWER A state of crisis is marked by
failure of usual coping mechanisms. The individual can no longer function normally, often
becoming anxious, disorganized and panicky. They may regress and become paralyzed, being
unable to make simple decisions (like deciding what to eat for a meal). They may digress to less
functional behaviors like violence or substance abuse. Complaints of nausea and lack of appetite,
bad dreams interrupting sleep and verbalizing a strong desire to stay close to an injured loved
one are all expected responses that may occur after learning of a loved one being traumatically
injured and are not specific symptoms of a state of crisis
Performing a tertiary exam on a traumatically injured patient serves the purpose of: -
CORRECT ANSWER A tertiary exam is carried out 24 to 72 hours after admission (and may
be repeated especially if a patient regains consciousness). It involves a repeat of the primary and
secondary survey as well as a review of the patient's diagnostic studies and is useful in
identifying injuries that may have been missed during the initial resuscitation. The control of
hemorrhage should have been accomplished as part of the primary survey. If a patient continues
to hemorrhage at the time of the tertiary exam, then their condition is likely very poor.
Radiographic studies should be facilitated as part of the secondary exam and will then be
reviewed as part of the tertiary exam. The purpose of the tertiary exam is not to recognize
psychosocial trauma
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