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TCRN practice questions

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Question 1Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A trauma prevention coalition distributes free booster seats and teaches caregivers how to install them correctly. This initiative is best classified as:

  1. Tertiary prevention
  2. Harm reduction
  3. Secondary prevention
  4. Primary prevention Correct answer.

Explanation

Primary prevention aims to keep the injury event from occurring at all, and correct child restraint use reduces both the likelihood and the severity of injury in a crash. Secondary prevention addresses severity or early detection once an injurious event has begun, and tertiary prevention limits disability after injury. Device distribution combined with caregiver education is a classic primary prevention strategy.

Question 2Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

The Glasgow Coma Scale total score ranges from:

  1. 1 to 15
  2. 0 to 15
  3. 3 to 15 Correct answer.
  4. 3 to 12

Explanation

The GCS sums eye opening (1–4), verbal response (1–5), and best motor response (1–6), so the lowest possible total is 3 and the highest is 15. A total of 8 or less generally indicates severe injury with a need to protect the airway.

Question 3Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

During a mass-casualty incident using START triage, an adult who is ambulating and following simple commands is tagged:

  1. Green (minor) Correct answer.
  2. Red (immediate)
  3. Black (expectant)
  4. Yellow (delayed)

Explanation

In START, the first step is to direct all patients who can walk to a designated area; they are classified as green (minor) and reassessed later. Non-ambulatory patients are then sorted by respirations, perfusion, and mental status into red, yellow, or black categories.

Question 4Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

The "golden hour" of trauma care refers to:

  1. The interval from EMS arrival to arrival at the trauma center
  2. The 60 minutes during which operative intervention must begin
  3. The first 60 minutes after the patient arrives in the emergency department
  4. The hour after injury, when rapid resuscitation most improves survival Correct answer.

Explanation

The golden hour concept holds that definitive assessment and resuscitation begun within roughly the first hour after injury yields the best chance of survival. It is a principle about elapsed time from injury, not a rigid rule tied to one setting or a mandatory operative deadline.

Question 5Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which nursing action best prevents the hypothermia component of the lethal triad in a hypotensive trauma patient?

  1. Withholding all IV fluids until hemorrhage is controlled
  2. Leaving the patient uncovered to allow frequent reassessment
  3. Administering warmed IV fluids and blood products Correct answer.
  4. Applying ice packs to swollen extremities

Explanation

Hypothermia, acidosis, and coagulopathy form the lethal triad, and warming fluids and blood products along with external warming and removal of wet clothing limits heat loss. Cold resuscitation fluids worsen coagulopathy and should be avoided in the actively bleeding patient.

Question 6Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Eight months after a traumatic brain injury, a patient works with a vocational specialist on a modified-duty return to work. This service is best classified as:

  1. Tertiary prevention Correct answer.
  2. Secondary prevention
  3. Primary prevention
  4. Harm reduction

Explanation

Tertiary prevention is the phase of injury control focused on reducing disability and maximizing function after injury, and vocational rehabilitation with return to work is a core example. Primary prevention occurs before the event and secondary prevention around the time of the event.

Question 7Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which capability distinguishes a Level I trauma center from a Level II center?

  1. Continuous emergency department coverage
  2. Trauma research and surgical residency education Correct answer.
  3. Availability of a computed tomography scanner
  4. Acceptance of transfers from other hospitals

Explanation

Both Level I and Level II centers provide 24-hour in-house surgical coverage and definitive care, but Level I centers add leadership in trauma research, resident education, and system-wide prevention and planning. These scholarly and system obligations are what separate Level I from Level II.

Question 8Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

The most common cause of preventable death in the injured patient is:

  1. Uncontrolled hemorrhage Correct answer.
  2. Airway obstruction
  3. Sepsis
  4. Tension pneumothorax

Explanation

Uncontrolled hemorrhage, including occult bleeding into the chest, abdomen, pelvis, and long bones, accounts for the largest share of preventable trauma deaths. Airway and breathing problems cause early deaths but are fewer in number and are usually correctable in a functioning trauma system.

Question 9Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which statement reflects correct application of a commercial tourniquet for an exsanguinating extremity injury?

  1. Place it proximal to the wound and tighten until bleeding stops Correct answer.
  2. Loosen it every 10 minutes to check for distal pulses
  3. Place it directly over the open wound to compress the bleeding vessel
  4. Place it distal to the wound when the injury is located in the thigh

Explanation

A tourniquet is applied 2 to 3 inches proximal to the bleeding site, avoiding joints, and tightened until hemorrhage stops. It stays in place with the application time documented until the patient reaches surgical control.

Question 10Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

For an otherwise healthy adult with an actively bleeding pelvic fracture and no brain injury, the recommended pre-definitive-control systolic blood pressure target is about:

  1. 140 mm Hg
  2. 120 mm Hg
  3. 90 mm Hg Correct answer.
  4. 70 mm Hg

Explanation

Permissive hypotension targets a systolic pressure of roughly 80 to 90 mm Hg until hemorrhage is controlled, aiming to limit clot disruption and dilutional coagulopathy. Patients with traumatic brain injury are excluded because they need higher pressures to maintain cerebral perfusion.

Question 11Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A massive transfusion protocol for a hemorrhaging trauma patient is best balanced at which ratio of plasma to platelets to red cells?

  1. 1:1:4
  2. 4:1:1
  3. 1:1:1 Correct answer.
  4. 2:1:1

Explanation

Balanced resuscitation approximates reconstituted whole blood with roughly equal units of plasma, platelets, and packed red cells. This approach reduces dilutional coagulopathy compared with red-cell-predominant strategies.

Question 12Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

The primary goal of damage control laparotomy in an exsanguinating patient is to:

  1. Achieve definitive repair of all injured organs in one operation
  2. Control hemorrhage and contamination, then resuscitate in the ICU Correct answer.
  3. Create a stoma rather than a primary bowel anastomosis
  4. Complete a full abdominal washout before leaving the operating room

Explanation

Damage control surgery is staged: rapid control of bleeding and contamination with temporary abdominal closure, followed by intensive correction of hypothermia, acidosis, and coagulopathy before definitive repair. Attempting full repair in a physiologically deranged patient increases mortality.

Question 13Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

In the trauma resuscitation area, the secondary survey is begun:

  1. Only after the computed tomography scan is completed
  2. After the primary survey is complete and resuscitation is under way Correct answer.
  3. At the scene before transport
  4. Immediately on arrival, before the airway is assessed

Explanation

The secondary survey is a head-to-toe history and physical examination performed once life-threatening problems identified in the primary survey have been treated and resuscitation has begun. Performing it earlier risks missing airway, breathing, or circulation threats.

Question 14Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A hemodynamically stable, alert patient with no neurologic deficit arrives on a long backboard. Best practice is to:

  1. Remove the backboard as soon as it is safe to do so Correct answer.
  2. Transfer the patient onto a second backboard for transport
  3. Keep the backboard in place until after the CT scan
  4. Leave the backboard on for 24 hours of observation

Explanation

A long backboard is a transport device, and prolonged use is associated with pressure injury, pain, and respiratory restriction. Once the patient is clinically stable and spinal motion restriction can be maintained on the stretcher, the board should be removed promptly.

Question 15Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which statement about early mobilization of critically ill trauma patients is supported by current evidence?

  1. Bed rest for the first week prevents secondary injury
  2. Mobilization should be delayed until after the patient has been extubated and is breathing spontaneously
  3. Mobilization clearly increases the rate of unplanned extubation
  4. Mobilizing within 24 to 48 hours is safe and shortens stay Correct answer.

Explanation

Protocolized early mobilization, including in-bed cycling and out-of-bed activity, is feasible and safe even in intubated patients and is associated with less ICU-acquired weakness and shorter length of stay. Prolonged bed rest promotes atelectasis, deep vein thrombosis, and delirium.

Question 16Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

One month after a highway crash, a patient has nightmares, flashbacks, hypervigilance, and avoids driving. The most appropriate action is to:

  1. Restrict visits and reduce stimulation until symptoms pass
  2. Screen with a validated tool and refer for trauma-focused therapy Correct answer.
  3. Reassure the patient that these symptoms resolve without treatment
  4. Advise immediate return to driving to overcome the fear

Explanation

Persistent re-experiencing, avoidance, hyperarousal, and negative mood lasting beyond a month suggest post-traumatic stress disorder, which responds to trauma-focused psychotherapy. Validated instruments such as the PCL-5 support assessment and referral.

Question 17Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which mechanism of injury meets adult trauma triage criteria for transport to a trauma center?

  1. Fall from a height greater than 20 feet Correct answer.
  2. Fall from standing onto a carpeted floor
  3. Lifting a heavy box and developing back pain
  4. Bicycle crash at walking speed without helmet

Explanation

Falls of more than 20 feet for adults, or two to three times the child's height for children, are high-energy mechanisms that meet criteria for trauma center transport. Lower-energy mechanisms meet criteria only when physiologic or anatomic findings are also present.

Question 18Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient has abbreviated injury scale scores of 3 for head, 2 for chest, 2 for abdomen, and 1 for extremity. The injury severity score is:

  1. 22
  2. 9
  3. 16
  4. 17 Correct answer.

Explanation

The ISS sums the squares of the three highest AIS scores drawn from different body regions: 3² + 2² + 2² = 9 + 4 + 4 = 17. A score of 16 or greater conventionally defines major trauma.

Question 19Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

The revised trauma score is calculated from which three variables?

  1. Glasgow Coma Scale, systolic blood pressure, and respiratory rate Correct answer.
  2. Glasgow Coma Scale, heart rate, and respiratory rate
  3. Injury Severity Score, age, and Glasgow Coma Scale
  4. Glasgow Coma Scale, systolic blood pressure, and temperature

Explanation

The RTS uses weighted coded values of the Glasgow Coma Scale, systolic blood pressure, and respiratory rate to produce a physiologic score from 0 to 12. It is a component of TRISS and is used to estimate probability of survival.

Question 20Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which statement about geriatric trauma is accurate?

  1. Mortality is higher than in younger patients with equal injury severity Correct answer.
  2. Age over 65 is not considered a factor in trauma triage criteria
  3. Older adults consistently require larger crystalloid boluses than younger adults
  4. Pre-existing comorbidities are uncommon in injured older adults

Explanation

Older adults have less physiologic reserve and higher mortality at equivalent injury severity, which is why age and mechanism lower the threshold for trauma center transport. Anticoagulant use, osteoporosis, and comorbidities further increase risk.

Question 21Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient who meets physiologic trauma triage criteria is taken by EMS to a nearby non-trauma hospital instead of a trauma center 25 minutes away. In trauma system quality review, this event is classified as:

  1. Undertriage Correct answer.
  2. A sentinel event requiring reporting to the state
  3. Overtriage
  4. Appropriate diversion

Explanation

Undertriage occurs when an injured patient who meets triage criteria is not transported to the appropriate level of trauma center. Overtriage is transport of a patient who did not need trauma center resources, and systems accept some overtriage specifically to minimize undertriage.

Question 22Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which set of variables is used to calculate TRISS?

  1. GCS, base deficit, lactate, and age
  2. RTS, ISS, age, and mechanism Correct answer.
  3. ISS, age, and hospital length of stay
  4. RTS and ISS alone

Explanation

TRISS combines the physiologic Revised Trauma Score, the anatomic Injury Severity Score, patient age, and a blunt-versus-penetrating mechanism coefficient to estimate probability of survival. It is widely used in trauma registry analysis and quality improvement.

Question 23Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

An 82-year-old taking warfarin for atrial fibrillation has a small subdural hematoma after a ground-level fall, with an INR of 3.2. The priority intervention is:

  1. Protamine sulfate administration
  2. Platelet transfusion to improve clot formation
  3. Prothrombin complex concentrate plus intravenous vitamin K Correct answer.
  4. Observation in the emergency department with a repeat head CT in 24 hours

Explanation

Warfarin-related intracranial hemorrhage requires rapid reversal with a prothrombin complex concentrate plus intravenous vitamin K, along with neurosurgical consultation. The concentrate restores vitamin K–dependent factor activity within minutes, whereas vitamin K alone takes many hours.

Question 24Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Using the Haddon matrix, which factor is a host factor in the event phase of a motorcycle crash?

  1. The rider's helmet use at the moment of impact Correct answer.
  2. Rider training required before licensure
  3. Time for EMS to reach the crash scene
  4. Roadway design and signage at the curve

Explanation

The Haddon matrix crosses host, agent, and environment with pre-event, event, and post-event phases. A rider's helmet use at the moment of impact is a host characteristic in the event phase because it modifies energy transfer during the crash itself.

Question 25Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which finding best supports abdominal compartment syndrome in a resuscitated trauma patient with a distended abdomen and rising airway pressures?

  1. Peak airway pressure of 30 cmH2O with normal bladder pressure
  2. Bladder pressure of 24 mm Hg with new organ dysfunction Correct answer.
  3. Oliguria that resolves after a 1-liter fluid bolus
  4. Bladder pressure of 12 mm Hg with normal urine output

Explanation

Abdominal compartment syndrome is sustained intra-abdominal pressure above 20 mm Hg accompanied by new organ dysfunction, and bladder pressure is the standard surrogate measurement. Treatment is decompression, usually by opening the abdomen.

Question 26Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

During the primary survey, a trauma patient has gurgling respirations and a Glasgow Coma Scale score of 12. Which action should the nurse take first?

  1. Suction the oropharynx Correct answer.
  2. Apply high-flow oxygen by mask
  3. Obtain a lateral cervical spine radiograph
  4. Insert an oral airway

Explanation

The primary survey begins with airway assessment while protecting the cervical spine. Gurgling indicates blood, vomit, or secretions in the airway, so suctioning is the immediate priority. An oral airway may be helpful after the airway is cleared, but it does not remove liquid obstruction.

Question 27Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with a penetrating right chest injury has absent right breath sounds, hypotension, and distended neck veins. Which intervention is indicated immediately?

  1. Needle decompress the right chest Correct answer.
  2. Obtain a chest radiograph
  3. Perform endotracheal intubation before decompression
  4. Perform pericardiocentesis

Explanation

Tension pneumothorax is a clinical diagnosis and requires immediate decompression without waiting for imaging. The combination of unilateral absent breath sounds, hypotension, and distended neck veins supports this diagnosis. Needle decompression relieves intrathoracic pressure and restores venous return.

Question 28Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

During prehospital transport of a hypotensive trauma patient, which action best reduces the risk of worsening coagulopathy?

  1. Remove all clothing and keep the ambulance cool
  2. Apply active warming and limit crystalloid infusion Correct answer.
  3. Hyperventilate the patient to reduce intracranial pressure
  4. Infuse large volumes of room-temperature crystalloid

Explanation

Hypothermia contributes to the lethal triad of hypothermia, acidosis, and coagulopathy. Active warming and avoiding unnecessary crystalloid help preserve coagulation and perfusion. Large-volume room-temperature fluids worsen hypothermia and dilute clotting factors.

Question 29Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A restrained driver wearing only a lap belt has a lumbar flexion-distraction injury. Which additional injury is most associated with this restraint pattern?

  1. Bowel or mesenteric injury Correct answer.
  2. Tracheal rupture
  3. Aortic transection
  4. Femoral shaft fracture with displacement

Explanation

A lap-belt-only restraint compresses the abdominal viscera and can produce a flexion-distraction injury of the lumbar spine, often called a Chance fracture. The same force can injure the small bowel or mesentery. A shoulder belt helps distribute force and reduce this pattern.

Question 30Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

What is the primary purpose of the FAST examination during initial trauma resuscitation?

  1. Detect free intraperitoneal or pericardial fluid Correct answer.
  2. Measure intra-abdominal pressure directly
  3. Assess for a retroperitoneal hematoma
  4. Identify the exact site of solid-organ laceration

Explanation

FAST is a rapid bedside ultrasound examination used to detect free fluid in the pericardial and intraperitoneal spaces. It helps identify patients who may need immediate operative intervention. It does not reliably grade solid-organ injury or evaluate the retroperitoneum.

Question 31Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which intervention is most effective for preventing joint contractures in a patient immobilized after multiple trauma?

  1. Using tight restraints to limit movement
  2. Daily passive and active range of motion Correct answer.
  3. Elevating all extremities on pillows continuously
  4. Maintaining complete bed rest until pain resolves

Explanation

Contractures develop when joints remain immobile, so daily passive and active range-of-motion exercises are essential. Early mobility and proper positioning further reduce risk. Complete rest and restraints promote stiffness and functional loss.

Question 32Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which strategy is most effective for preventing recurrent falls in an older adult discharged after a ground-level fall?

  1. Prescribing a walker without assessment
  2. Discontinuing all prescribed medications without provider review
  3. Home safety checks plus balance training Correct answer.
  4. Recommending bed rest for 6 weeks

Explanation

Fall prevention after an older adult’s fall is multifactorial. Home hazard reduction combined with strength and balance training addresses both environmental and physical risk factors. Medications should be reviewed by a provider rather than stopped independently.

Question 33Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which finding is an indication for spinal motion restriction after blunt trauma?

  1. Midline neck pain with posterior tenderness Correct answer.
  2. Isolated ankle deformity with normal mentation
  3. Alcohol intoxication alone with no complaints
  4. A small forehead laceration with no pain

Explanation

Midline neck pain and posterior tenderness suggest possible ligamentous or bony injury and warrant spinal motion restriction. The decision should be based on validated clinical criteria and mechanism. Isolated extremity deformity or minor soft-tissue injury without neck symptoms does not by itself require restriction.

Question 34Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

For a young adult with penetrating torso trauma and active hemorrhage, which systolic blood pressure target is appropriate before surgical hemorrhage control?

  1. 80 to 90 mm Hg Correct answer.
  2. 130 to 150 mm Hg
  3. 160 to 180 mm Hg
  4. 100 to 120 mm Hg

Explanation

Permissive hypotension limits ongoing hemorrhage until surgical control is achieved. In a young adult without traumatic brain injury, a systolic pressure of about 80 to 90 mm Hg is commonly targeted. Higher pressures can disrupt clots and increase bleeding.

Question 35Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

During massive transfusion, which electrolyte abnormality should the nurse anticipate?

  1. Hypernatremia
  2. Hyperphosphatemia
  3. Hyperkalemia
  4. Hypocalcemia Correct answer.

Explanation

Citrate used as a preservative in banked blood binds ionized calcium, so hypocalcemia is common during massive transfusion. It can cause paresthesias, tetany, hypotension, and arrhythmias. Calcium replacement is often required.

Question 36Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with a chest tube after blunt chest trauma has which finding that suggests ongoing intrathoracic hemorrhage?

  1. Serosanguineous drainage of 50 mL over the first 8 hours
  2. Bubbling in the water seal chamber
  3. Bloody drainage of 250 mL per hour for 3 hours Correct answer.
  4. Decreased drainage after repositioning

Explanation

Chest tube output of more than 200 mL per hour for 2 to 4 hours suggests ongoing intrathoracic bleeding and may require operative intervention. The nurse should notify the provider and monitor hemodynamics. Bubbling suggests an air leak rather than hemorrhage.

Question 37Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which finding distinguishes neurogenic shock from hemorrhagic shock in a trauma patient?

  1. Narrow pulse pressure with tachycardia
  2. Prolonged capillary refill greater than 3 seconds
  3. Bradycardia plus hypotension Correct answer.
  4. Cool, clammy skin with mottling

Explanation

Neurogenic shock results from loss of sympathetic tone after spinal cord injury, producing hypotension with bradycardia or lack of tachycardia. Hemorrhagic shock typically causes tachycardia and cool, clammy skin. However, hemorrhage must be excluded before attributing hypotension to neurogenic shock.

Question 38Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with severe burns develops painful decreased range of motion and periarticular calcification. Which complication is most likely?

  1. Joint dislocation
  2. Septic arthritis
  3. Heterotopic ossification Correct answer.
  4. Complex regional pain syndrome

Explanation

Heterotopic ossification is abnormal bone formation in soft tissue after trauma or burns. It causes pain, decreased range of motion, and periarticular calcification on imaging. Early range-of-motion exercises and rehabilitation help preserve function.

Question 39Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A 3-year-old child who has outgrown a rear-facing car seat should be restrained in which type of seat?

  1. A booster seat using the vehicle lap and shoulder belt
  2. A rear-facing infant carrier
  3. The vehicle lap belt alone
  4. A forward-facing car seat with a harness Correct answer.

Explanation

Once a child outgrows the rear-facing seat by height or weight, the next appropriate step is a forward-facing car seat with a harness. Booster seats are used after the child outgrows the forward-facing harnessed seat. A lap belt alone is not appropriate for a young child.

Question 40Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which prehospital action most improves outcomes for a trauma patient with suspected hemorrhagic shock?

  1. Performing a detailed secondary survey before leaving the scene
  2. Early trauma center notification and rapid transport Correct answer.
  3. Delaying transport to start a large IV line
  4. Administering oral fluids to maintain hydration

Explanation

For suspected hemorrhagic shock, minimizing scene time and notifying the trauma center early facilitate rapid definitive care. Transport should not be delayed for nonessential procedures. Oral fluids are unsafe in a patient who may require surgery.

Question 41Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which intervention helps prevent secondary brain injury in a patient with severe traumatic brain injury?

  1. Maintaining hyperventilation to a PaCO2 of 25 mm Hg
  2. Maintaining normoxia and avoiding hypotension Correct answer.
  3. Allowing systolic blood pressure below 90 mm Hg
  4. Keeping the head of bed flat at all times

Explanation

Secondary brain injury is worsened by hypoxia and hypotension, so maintaining oxygenation and adequate blood pressure is essential. Hyperventilation is avoided unless there is impending herniation because it can reduce cerebral perfusion. The head of bed is usually elevated to promote venous drainage.

Question 42Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with a complete cervical spinal cord injury has hypotension and bradycardia after hemorrhage is excluded. Which initial fluid strategy is appropriate?

  1. Strict fluid restriction to prevent edema
  2. Cautious fluids, then vasopressors Correct answer.
  3. Rapid infusion of five liters of crystalloid
  4. Hypertonic saline as the first-line pressor

Explanation

After hemorrhage is excluded, neurogenic shock is managed with cautious volume resuscitation followed by vasopressors if hypotension persists. Bradycardia may require atropine. Excessive fluid can cause pulmonary edema without correcting the underlying loss of sympathetic tone.

Question 43Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which nursing action is most effective for preventing pressure injuries in a patient with a spinal cord injury during rehabilitation?

  1. Limiting nutritional intake to reduce moisture
  2. Scheduled repositioning with skin inspection Correct answer.
  3. Massaging reddened areas over bony prominences
  4. Applying tight straps to keep the patient still

Explanation

Pressure injuries are prevented through scheduled repositioning, skin inspection, pressure-relieving surfaces, and adequate nutrition. Massaging reddened areas can damage tissue. Tight straps increase pressure and shear.

Question 44Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which discharge planning approach best supports reintegration for a patient with multiple trauma and new functional limitations?

  1. Coordinating rehab, home changes, and caregiver training Correct answer.
  2. Providing written instructions only at the time of discharge
  3. Delaying family involvement until the first clinic visit
  4. Referring only to a support group after discharge

Explanation

Successful reintegration requires coordination across rehabilitation, home modification, and caregiver education. Family involvement should begin early and continue through transition. Written instructions alone or a single referral do not address the complex needs of trauma survivors.

Question 45Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with a new thoracic spinal cord injury becomes dizzy and hypotensive when first sitting up. Which action is most appropriate?

  1. Place the patient in Trendelenburg for 30 minutes
  2. Give a rapid intravenous fluid bolus of 2 liters
  3. Raise the head slowly with an abdominal binder Correct answer.
  4. Return the patient to supine and abandon mobilization

Explanation

Orthostatic hypotension is common after spinal cord injury because of lost sympathetic tone. Gradual positioning, abdominal binders, and compression stockings help maintain venous return and blood pressure. Mobilization should be progressed cautiously rather than abandoned.

Question 46Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which trauma patient is most likely to benefit from tranexamic acid?

  1. A patient with an isolated closed tibia fracture 12 hours after injury
  2. A patient with hemorrhagic shock treated within 3 hours of injury Correct answer.
  3. A patient with a small subdural hematoma 8 hours after injury
  4. A patient with chronic anemia and no active bleeding

Explanation

Tranexamic acid reduces mortality when given early to patients with trauma-related hemorrhage, ideally within 3 hours of injury. It is an antifibrinolytic, so it is most useful during active bleeding. It is not indicated for chronic anemia or late isolated injuries.

Question 47Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which method best evaluates whether a trauma death was preventable?

  1. Multidisciplinary peer review using set criteria Correct answer.
  2. Reviewing only the autopsy report
  3. Counting deaths per 100 admissions
  4. Reviewing the patient's insurance status

Explanation

Preventability review requires structured multidisciplinary peer review with accepted criteria, including clinical timelines, decisions, and system factors. Autopsy alone or administrative data cannot determine preventability. The process supports trauma quality improvement and system changes.

Question 48Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with an open tibia fracture and active bleeding arrives 4 hours after injury. Which action is most important to reduce infection risk?

  1. Obtain an MRI before debridement
  2. Give IV antibiotics and proceed to debridement Correct answer.
  3. Irrigate the wound with povidone-iodine and close it
  4. Delay antibiotics until culture results

Explanation

Open fractures require early intravenous antibiotics and prompt surgical debridement to reduce infection risk. Antibiotics should not be delayed for culture results. Primary closure of a contaminated open fracture wound is generally avoided.

Question 49Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

A patient with a traumatic brain injury has frequent agitation and poor safety awareness before discharge. Which is the most appropriate next step for community reintegration?

  1. Supervised activities plus caregiver education Correct answer.
  2. Obtain a driver's license evaluation immediately
  3. Return to work without restrictions
  4. Discharge home alone with written instructions

Explanation

Agitation and poor safety awareness increase the risk of injury and failed reintegration. Supervised structured activities and caregiver education provide a safe transition while rehabilitation continues. Unrestricted work, driving, or living alone would be unsafe at this stage.

Question 50Clinical trauma care across the continuum (injury prevention, prehospital, acute care, rehabilitation, reintegration)

Which criterion is most appropriate before a patient with moderate traumatic brain injury resumes driving?

  1. A formal driving evaluation Correct answer.
  2. Resolution of all headaches
  3. Six weeks after hospital discharge
  4. A normal head CT scan

Explanation

Driving after traumatic brain injury requires assessment of cognition, reaction time, visual function, and safety awareness. A formal driving evaluation is the most appropriate criterion for resuming driving. Symptom resolution, imaging, or a fixed time interval alone do not establish fitness to drive.