Trauma Certified Registered Nurse (TCRN) Exam Practice Test

Preparing for the Trauma Certified Registered Nurse (TCRN) exam? You want targeted practice that mirrors the real test: up-to-date clinical scenarios, clear answers, and explanations that teach not just tell. This PrepPool TCRN Practice Test package gives you realistic, high-yield trauma MCQs built from current exam blueprints and real clinical priorities so you can study smarter and pass with confidence.

What is a Trauma Certified Registered Nurse?

A Trauma Certified Registered Nurse (TCRN) is an RN who has demonstrated advanced knowledge and clinical competence in the care of trauma patients across the continuum from prehospital stabilization and emergency resuscitation to operative management, ICU care, and rehabilitation. The certification validates expertise in trauma systems, triage, hemorrhage control, airway and ventilator management, traumatic brain and spinal cord injury care, burn management, and multisystem trauma coordination. Whether you’re a frontline trauma registered nurse, an ED nurse, or an ICU nurse who manages critically injured patients, TCRN certification signals mastery of trauma care.

About this TCRN Practice Exam

This product is a comprehensive practice package based on the full set of questions and answers provided above. It includes 500 exam-style trauma MCQs across multiple focused modules, each with a single-best-answer format and human-tone, evidence-driven explanations so you learn the “why” behind every correct answer. Questions are written to simulate exam style and clinical decision points you’ll face as a trauma registered nurse. Content is refreshed for 2026 clinical relevance and covers high-yield scenarios used by exam writers and educators.

What you Will Learn form Our TCRN Practice Test?

The exam content covers the full spectrum of high-value TCRN topics so your preparation is defensible and comprehensive:

• Initial assessment & Advanced Trauma Life Support (ATLS) priorities: primary survey, rapid sequence airway, and circulation management.
• Hemorrhage control and damage-control resuscitation: pelvic binders, MTP, massive transfusion ratios, TXA timing.
• Airway & ventilatory strategies: RSI, lung-protective ventilation, management of inhalation injury, one-lung isolation, ECMO basics.
• Thoracic trauma: tension pneumothorax, hemothorax, flail chest, cardiac tamponade, emergency thoracotomy.
• Abdominal trauma: FAST/CT interpretation, hollow viscus injury, diagnostic laparoscopy vs laparotomy, splenic/liver management.
• Vascular trauma: hard/soft signs, ABI, CTA indications, extremity ischemia, AV fistula/pseudoaneurysm.
• Orthopedic & limb salvage: fracture stabilization, compartment syndrome diagnosis and fasciotomy, crush injury/rhabdomyolysis.
• Neurosurgical & spine care: ICP/CPP targets, Cushing’s triad, spinal shock vs neurogenic shock, imaging clearance.
• Burns & soft-tissue: Parkland resuscitation, escharotomy, inhalation injury, wound debridement and timing of coverage.
• Pediatric, geriatric & special populations: differing physiologic responses, medication effects (beta-blockers, anticoagulants).
• Toxic exposures & smoke inhalation: CO vs cyanide management (hydroxocobalamin), near-drowning respiratory failure.
• Critical care complications: ARDS, ventilator-associated events, abdominal compartment syndrome, transfusion reactions (TRALI, hemolytic).
• Infectious & wound issues: contaminated wounds, farm injuries, tetanus management, necrotizing infections.
• Mass-casualty triage, ethics & legal considerations: utilitarian triage principles, dynamic triage reassessment.
• Diagnostics & monitoring: bedside ultrasound (FAST), intracompartmental pressure, bladder pressure, serial lactate, ionized calcium in MTP.

Who can take this TCRN Practice exam?

• Trauma registered nurses preparing for TCRN certification.
• Emergency department, critical care, and surgical nurses seeking trauma competency.
• Nurse trainers and educators building course material or simulation scenarios.
• Nursing students or new grads with trauma rotations who want a focused exam-prep boost.

Useful for

• Passing the TCRN exam with confidence.
• Transitioning from general medical-surgical or ED nursing into trauma care roles.
• Nurse trainers preparing classroom tests, mock exams, or competency assessments.
• Unit directors who want a validated bank of trauma MCQs for staff credentialing.

How long does it take to become a trauma nurse?

Becoming a trauma specialty nurse is a staged process: obtain your RN license (diploma/associate/BSN — 2–4 years depending on the program), gain relevant clinical experience (most trauma/ED units require 1–3 years of bedside critical care or emergency practice), complete employer-level orientation and trauma courses (ATLS, TNCC), and then prepare for certification (several weeks to months of focused study). Many nurses are eligible to sit for the TCRN exam after 2 years of trauma experience; timelines vary by country and credentialing body. Use this practice test to compress your study time and target weak areas faster.

Why choose PrepPool for TCRN Practice Test?

• Clinically accurate, up-to-date content: every question is crafted from current trauma practice priorities.
• Exam-style format: single-best-answer MCQs with realistic case stems and distractors that challenge clinical reasoning.
• High-value explanations: each answer includes a clear, concise rationale that teaches the underlying principle so you retain concepts.
• Wide coverage: 500+ trauma MCQs spanning all major domains you’re tested on — airway, hemorrhage, neuro, thoracic, burns, vascular, and more.
• Instructor-ready resources: produce printable exams, randomized tests, and answer keys for group teaching.
• Built for nurse trainers and self-study: use single questions for teaching points or assemble full practice exams.

Study tips (practical, focused)

• Practice actively: do timed blocks of 25–50 questions, then review every explanation — learning happens in the debrief.
• Focus on patterns: note recurring themes (e.g., massive transfusion thresholds, airway red flags, indications for OR vs IR) and make one-page cheat sheets.
• Simulate exam conditions: use a quiet space and strict timing to build stamina and pacing.
• Drill weak topics: use the question bank’s tagging (neuro, chest, burns, coagulation) to target low-confidence domains.
• Teach back: explain an incorrect question aloud to a peer or nurse trainer — teaching cements understanding.
• Integrate guidelines: pair MCQs with current trauma protocols (ATLS, institutional massive transfusion protocols) for real-world application.
• Rest and repeat: schedule short, frequent study sessions rather than marathon cramming — retention is cumulative.

This resource helps anyone aiming for trauma certified registered nurse status, trauma registered nurse roles, or nurse trauma certification; it’s also a practical toolkit for the nurse trainer building curriculum and for those who prefer trauma MCQs as the backbone of exam prep.

Ready to prepare the smart way? PrepPool’s TCRN Practice Test gives you focused exposure to the clinical decisions that matter. Start a timed practice set today and close the gap between knowledge and certification success.

Sample Questions and Answers

A 28-year-old motorcyclist arrives after a high-speed crash. He’s unconscious, with snoring respirations and oxygen saturation 84%. What’s the nurse’s first action in airway management?

A. Give high-flow oxygen by non-rebreather
B. Insert nasopharyngeal airway
C. Open airway with jaw-thrust and prepare for rapid sequence intubation (RSI)
D. Bag-valve mask (BVM) ventilation with two-person technique
Answer: C.
Explanation: In trauma with suspected cervical spine injury and compromised ventilation, maintain manual in-line stabilization and perform a jaw-thrust, not head tilt-chin lift. Prepare for definitive airway via RSI because unconscious patient with low SpO₂ needs secure airway. Nasopharyngeal airway is contraindicated with suspected basilar skull fracture. BVM is a temporizing measure if immediate intubation isn’t possible, but prioritizing airway protection with RSI and spine precautions is correct.

During primary survey, a penetrating chest wound with hypotension and muffled heart sounds is noted. What is the most likely diagnosis requiring immediate intervention?

A. Tension pneumothorax
B. Massive hemothorax
C. Cardiac tamponade
D. Open pneumothorax (“sucking” chest wound)
Answer: C.
Explanation: Beck’s triad (hypotension, muffled heart sounds, distended neck veins) suggests cardiac tamponade from pericardial fluid limiting cardiac filling. In penetrating trauma, pericardial tamponade requires urgent pericardiocentesis or emergency thoracotomy depending on stability. Tension pneumothorax presents with absent breath sounds and tracheal deviation; massive hemothorax has dullness to percussion and decreased breath sounds. Open pneumothorax causes sucking sound and respiratory compromise.

A trauma patient with progressive respiratory distress, decreased breath sounds on one side, neck vein distention, and tracheal deviation is most likely experiencing:

A. Cardiac tamponade
B. Tension pneumothorax
C. Massive pulmonary embolism
D. Flail chest
Answer: B.
Explanation: Tension pneumothorax occurs when air accumulates under pressure in pleural space, shifting mediastinum and compressing contralateral lung and great vessels. Classic signs: severe respiratory distress, absent/decreased breath sounds on affected side, hypotension, distended neck veins, tracheal deviation away from affected side. It’s a clinical diagnosis and requires immediate decompression (needle thoracostomy followed by chest tube).

Which parameter is most useful for early detection of hemorrhagic shock in an adult trauma patient?

A. Heart rate
B. Systolic blood pressure
C. Base deficit (arterial)
D. Urine output
Answer: C.
Explanation: Base deficit (metabolic acidosis measure) reflects tissue hypoperfusion and is a sensitive early marker of hemorrhagic shock and oxygen debt; it often changes before persistent hypotension appears. Heart rate and blood pressure are influenced by compensatory mechanisms and medications; urine output is useful but lags. Base deficit helps guide resuscitation, transfusion and predicts severity and mortality in trauma.

The best initial fluid choice for a hypotensive adult trauma patient without traumatic brain injury is:

A. Crystalloid (normal saline or balanced solution) bolus
B. 5% albumin
C. Packed red blood cells (PRBCs) immediately
D. Hypertonic saline
Answer: A.
Explanation: For initial resuscitation, isotonic crystalloids (balanced solutions preferred) are standard to restore perfusion rapidly when blood products are not immediately available. In ongoing major hemorrhage, early blood transfusion and activation of massive transfusion protocols become necessary. Albumin isn’t first-line in acute hemorrhage, and hypertonic saline is not routine for general hypotension except specific research settings or TBI protocols.

A patient with suspected traumatic brain injury (TBI) has GCS 7 and asymmetric pupils (right pupil dilated). Which action is highest priority?

A. Give mannitol immediately at 1 g/kg
B. Intubate and secure airway with ICP-protective strategy, prepare for neurosurgical consult
C. Start broad-spectrum antibiotics
D. Give hypertonic saline bolus and wait for CT
Answer: B.
Explanation: GCS ≤8 mandates airway protection via endotracheal intubation with rapid sequence intubation using ICP-protective measures (preoxygenation, minimize stimulation, short-acting agents). Asymmetric/dilated pupil indicates rising intracranial pressure/uncal herniation; emergent neurosurgical consultation is required. Mannitol or hypertonic saline are temporizing measures after securing airway/ventilation and while arranging definitive care, not before airway control.

Which statement about spinal immobilization in trauma is correct?

A. All trauma patients should be cervical-spine immobilized with backboard and hard collar.
B. Cervical immobilization is unnecessary if patient is alert and reports no neck pain.
C. Use selective immobilization based on validated decision rules (e.g., NEXUS, Canadian C-spine) in alert patients.
D. Immobilize only if there is midline neck tenderness.
Answer: C.
Explanation: Routine spine immobilization for all trauma is no longer recommended due to harms (delays, respiratory compromise, pressure injuries). Use validated rules like NEXUS or Canadian C-spine rule to determine need in alert, stable patients. These consider mechanism, intoxication, focal neurologic deficits and midline tenderness. If criteria indicate risk, immobilize and image. Clinical judgment is essential.

A patient with crush injury is at highest immediate risk for which metabolic disturbance during reperfusion?

A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia only
D. Hyponatremia
Answer: B.
Explanation: Crush injury releases intracellular potassium on reperfusion, producing life-threatening hyperkalemia that can cause dysrhythmias. Also rhabdomyolysis releases myoglobin causing AKI; metabolic acidosis and hyperphosphatemia can occur. Early recognition, ECG monitoring, and treatment (calcium, insulin/dextrose, bicarbonate, kayexalate/diuretics, dialysis) are necessary. Hypokalemia is not expected in reperfusion phase.

The FAST (Focused Assessment with Sonography for Trauma) exam is most sensitive for detecting:

A. Small pneumothorax
B. Pericardial effusion and intra-abdominal free fluid
C. Retroperitoneal hemorrhage
D. Solid organ lacerations with vascular injury details
Answer: B.
Explanation: FAST is a rapid bedside ultrasound exam reliably detecting pericardial effusion (tamponade risk) and intraperitoneal free fluid in trauma (especially hemoperitoneum). It’s less sensitive for retroperitoneal bleeding, small pneumothorax (extended FAST improves pneumothorax detection), and doesn’t characterize detailed solid organ injury — CT is needed for anatomy and grading in stable patients.

A 65-year-old on warfarin sustains a head injury and has a small subdural hematoma on CT. What’s crucial for initial management?

A. Observation only due to small size
B. Reverse anticoagulation promptly (vitamin K ± prothrombin complex concentrate) and neurosurgical consult
C. Start aspirin to prevent ischemia
D. Delay reversal to allow clot stabilization
Answer: B.
Explanation: In anticoagulated patients with intracranial hemorrhage, rapid reversal of anticoagulation reduces progression risk. For warfarin, give vitamin K and prothrombin complex concentrate (PCC) for rapid correction; fresh frozen plasma is alternative but slower. Timely neurosurgical involvement and frequent neuro checks/CT follow-up are needed. Observation alone risks hematoma expansion and worse outcomes.

Which of the following is the earliest clinical sign of compartment syndrome in the limb?

A. Late pallor and pulselessness
B. Increasing pain out of proportion to exam and pain with passive stretch
C. Numbness and paralysis only
D. Elevated creatine kinase
Answer: B.
Explanation: The earliest and most reliable sign is severe pain disproportionate to exam and pain with passive stretch of involved muscles. Paresthesia, tense swelling follow. Pallor, pulselessness and paralysis are late signs and indicate advanced ischemia. CK elevation and other lab markers may occur but are not earliest clinical indicators; diagnostic fasciometry or compartment pressure measurement can assist when unclear.

In massive transfusion protocol (MTP) for trauma, which transfusion ratio is commonly recommended to reduce coagulopathy?

A. PRBC only until Hb > 9 g/dL
B. 1:1:1 for PRBC:platelets:plasma (approximate)
C. PRBC:plasma 4:1
D. Platelets first, then PRBCs
Answer: B.
Explanation: Contemporary MTPs favor balanced transfusion approximating 1:1:1 of packed red blood cells, fresh frozen plasma (or PCC alternatives) and platelets to reduce trauma-induced coagulopathy, improve hemostasis and outcomes. Early tranexamic acid (within 3 hours) is also beneficial. Unbalanced large-volume PRBC resuscitation alone worsens coagulopathy and dilutional issues.

Which medication is evidence-based for early use in adult trauma patients with severe hemorrhage to reduce mortality if given within 3 hours?

A. Tranexamic acid (TXA)
B. Recombinant factor VIIa routinely
C. High-dose steroids
D. Epsilon aminocaproic acid always
Answer: A.
Explanation: TXA, an antifibrinolytic, given early (within 3 hours of injury) reduces mortality in bleeding trauma patients per CRASH-2 and subsequent data. It should be used when significant hemorrhage is suspected. Recombinant factor VIIa isn’t used routinely due to thrombotic risk and unclear mortality benefit. EACA is another antifibrinolytic but less commonly used; steroids are not indicated.

In blunt chest trauma with a flail chest segment and respiratory compromise, the most appropriate next step is:

A. Emergent chest tube only
B. Pain control, aggressive pulmonary toilet; consider intubation and mechanical ventilation with PEEP if respiratory failure
C. Immediate rib fixation surgery in ED
D. High-flow oxygen and discharge home if stable
Answer: B.
Explanation: Flail chest causes paradoxical chest wall motion and pain leading to hypoventilation and pneumonia risk. Management focuses on adequate analgesia (including regional blocks), aggressive pulmonary hygiene, and respiratory support. If respiratory failure or severe hypoxia, intubation and ventilation with appropriate PEEP and pain control are required. Surgical fixation is considered in select cases but not first in ED for immediate stabilization.

Pediatric trauma differs from adults because:

A. Children have lower metabolic reserve and narrow physiologic compensation, showing hypotension earlier.
B. Children tolerate blood loss better than adults and show no change in vitals.
C. Children compensate with heart rate and maintain blood pressure until late — hypotension is a late and ominous sign.
D. Children don’t get spinal injuries.
Answer: C.
Explanation: Children maintain blood pressure via compensatory tachycardia and vasoconstriction for longer; hypotension is a late sign and indicates significant decompensation. Their physiology and body proportions differ — larger head, flexible ribs — and they have greater chance of internal injury despite benign external signs. Thus, clinicians must have a low threshold for evaluation and aggressive support in pediatric trauma.

A trauma patient with penetrating abdominal wound is hemodynamically stable. Which is the best next step?

A. Immediate laparotomy in OR
B. Local wound exploration only
C. CT abdomen/pelvis with IV contrast to evaluate intra-abdominal injury
D. Observe overnight with serial exams without imaging
Answer: C.
Explanation: In stable patients with penetrating abdominal trauma, CT with IV contrast is appropriate to evaluate trajectory, organ injury, and need for operative management. Unstable patients with peritonitis or ongoing bleeding go straight to OR. Local wound exploration may be used in select cases but CT provides comprehensive information for stable patients and guides management.

Which sign suggests neurogenic shock after spinal cord injury?

A. Hypertension and tachycardia
B. Hypotension with bradycardia and warm dry skin due to loss of sympathetic tone
C. Hypertension with bounding pulses
D. Hypotension with cold clammy skin due to hemorrhage
Answer: B.
Explanation: Neurogenic shock from high spinal cord injury causes loss of sympathetic tone leading to hypotension, bradycardia (unopposed vagal tone), and warm dry skin due to peripheral vasodilation. Differentiate from hypovolemic shock (tachycardia, cool clammy skin). Management includes volume support and vasopressors to maintain perfusion, and immobilization with definitive spinal care.

The most appropriate prophylaxis against venous thromboembolism (VTE) in most adult trauma patients when bleeding risk controlled is:

A. Mechanical prophylaxis only (SCDs) indefinitely
B. Early pharmacologic prophylaxis with low molecular weight heparin (LMWH) when safe, plus mechanical methods
C. No prophylaxis due to risk of bleeding
D. Aspirin only
Answer: B.
Explanation: Once hemorrhage is controlled and bleeding risk acceptable, early pharmacologic prophylaxis (LMWH preferred) combined with mechanical methods reduces VTE incidence in trauma patients. Timing should be individualized based on injuries (e.g., intracranial hemorrhage stabilization) and surgical procedures. SCDs alone are less effective. Aspirin is not adequate for VTE prevention in this setting.

A burn patient has circumferential full-thickness burn to the lower leg with progressive pain and diminishing distal pulses. Nurse suspects:

A. Superficial infection
B. Compartment syndrome — escharotomy needed
C. Normal postburn swelling only — observe
D. Cellulitis — start antibiotics
Answer: B.
Explanation: Circumferential full-thickness burns can create an inelastic eschar that compromises perfusion leading to compartment syndrome. Signs: increasing pain (especially with passive stretch), tense limb, diminished pulses. Escharotomy (and fasciotomy if needed) restores circulation and is time-sensitive. Observation risks ischemia. Antibiotics are for infection, not initial perfusion compromise.

In trauma patients with suspected massive hemorrhage, point-of-care lactate trending is most useful to:

A. Diagnose specific organ injury
B. Guide resuscitation by indicating adequacy of tissue perfusion and predicting ongoing shock
C. Replace hemoglobin measurement
D. Identify infection only
Answer: B.
Explanation: Lactate is a marker of tissue hypoperfusion and anaerobic metabolism; trends help assess response to resuscitation and ongoing oxygen debt. High or rising lactate despite therapy suggests inadequate perfusion and worse prognosis. It doesn’t localize injury or replace hemoglobin measurement. Lactate may also be elevated in sepsis, but in acute trauma it’s primarily used to monitor shock and guide interventions.

Which antibiotic prophylaxis is appropriate for an open fracture encountered in the trauma bay?

A. No antibiotics for first 24 hours
B. IV first-generation cephalosporin (e.g., cefazolin) started as soon as possible
C. Oral amoxicillin at discharge only
D. Vancomycin only for all open fractures
Answer: B.
Explanation: Early IV antibiotics, typically a first-generation cephalosporin like cefazolin, started as soon as possible reduces infection in open fractures. For high-risk farm injuries or contamination, add gram-negative coverage (e.g., gentamicin) and consider tetanus prophylaxis. Vancomycin reserved for MRSA risk or in combination when indicated. Delaying antibiotics increases infection risk.

A trauma patient with multiple long-bone fractures has dark brown urine and rising creatinine. Most likely process and initial management?

A. Myoglobinuria from rhabdomyolysis; aggressive IV fluids, alkalinize urine, monitor electrolytes, nephrology consult if needed
B. Hematuria from bladder injury; catheterize and observe only
C. Contrast nephropathy; stop contrast
D. Pre-renal azotemia due to dehydration; give diuretics
Answer: A.
Explanation: Rhabdomyolysis after muscle crush/long-bone fractures causes myoglobin release producing dark urine and acute tubular necrosis. Early treatment: aggressive isotonic IV fluids to maintain urine output, consider urine alkalinization, monitor and treat hyperkalemia, and involve nephrology for dialysis if refractory. Hematuria and contrast injury are different mechanisms and require different management.

Which intervention reduces secondary brain injury in severe TBI?

A. Allow hypercapnia to increase cerebral blood flow
B. Maintain adequate oxygenation (PaO₂ >60 mmHg), prevent hypotension (SBP <90 mmHg), control ICP
C. Keep systolic BP low to limit hemorrhage
D. Avoid glucose monitoring to reduce interventions
Answer: B.
Explanation: Secondary brain injury prevention focuses on maintaining adequate oxygenation and cerebral perfusion — avoid hypoxia (PaO₂ <60 mmHg) and hypotension (SBP <90 mmHg) — and controlling ICP to prevent herniation. Hypercapnia increases cerebral blood flow and ICP and is harmful; controlled normocapnia or mild hypocapnia may be used in specific circumstances. Glycemic control and temperature management are also important.

Which lab abnormality is classic for acute traumatic coagulopathy within the first hours after severe hemorrhage?

A. Low INR, high fibrinogen
B. Elevated PT/INR, low fibrinogen, platelet dysfunction (consumptive coagulopathy)
C. Isolated thrombocytosis
D. Hypercalcemia only
Answer: B.
Explanation: Trauma-induced coagulopathy typically presents early with prolonged PT/INR, low fibrinogen, and platelet dysfunction due to consumption, dilution, hypothermia, and acidosis. This worsens bleeding and is associated with worse outcomes. Early recognition and balanced transfusion, fibrinogen replacement, warming and correction of acidosis are critical to correct coagulopathy.

For an unstable trauma patient in extremis where ED thoracotomy might be considered, which scenario is an indication?

A. Blunt trauma with no signs of life on arrival after prolonged CPR (>15 minutes)
B. Penetrating chest trauma with witnessed signs of life and recent loss of vital signs in ED (short prehospital CPR)
C. Any unstable trauma patient regardless of mechanism
D. Isolated limb amputation with hypotension
Answer: B.
Explanation: Emergency department thoracotomy is considered in select patients: penetrating thoracic trauma with witnessed signs of life and recent loss of vitals (short prehospital CPR) may benefit. Blunt trauma or prolonged prehospital CPR without signs of life generally carry poor prognosis and are not routine indications. Indiscriminate thoracotomy is not beneficial and carries high morbidity.

Which of the following is the correct initial management step for suspected tension pneumothorax in prehospital or ED when immediate chest tube placement is delayed?

A. Immediate IV antibiotics
B. Needle decompression in the second intercostal space mid-clavicular line (or fifth intercostal mid-axillary in some protocols) followed by chest tube placement
C. Start anticoagulation
D. Treat with corticosteroids
Answer: B.
Explanation: Tension pneumothorax requires immediate decompression to relieve intrathoracic pressure: needle decompression followed promptly by tube thoracostomy. Common sites: 2nd intercostal space mid-clavicular or 5th intercostal mid-axillary depending on protocol and rescuer skill. Antibiotics, anticoagulation, or steroids are not appropriate immediate treatments.

Which clinical finding increases suspicion for an occult pelvic fracture with significant hemorrhage?

A. Isolated ankle pain only
B. Pelvic instability or widening on exam, hypotension without obvious source, and high-energy mechanism
C. Normal pelvic exam and stable vitals
D. Shoulder pain only
Answer: B.
Explanation: High-energy mechanisms with hypotension and no clear bleeding source should prompt evaluation for pelvic fracture hemorrhage. Pelvic instability, widened symphysis, or deformity suggest pelvic ring injury, which can cause massive bleeding. Immediate pelvic binders, hemodynamic resuscitation, and interventional radiology for embolization or surgical stabilization may be required. Normal exam doesn’t exclude pelvic injury.

What is the priority nursing action when caring for a patient who has just undergone emergent thoracotomy and repair for penetrating cardiac injury?

A. Immediate extubation in ICU
B. Continuous invasive hemodynamic monitoring, adequate analgesia, carefully titrated fluids and inotropes as needed, and frequent neuro/hemorrhage checks
C. Start aggressive diuresis to reduce cardiac preload
D. No monitoring beyond routine vitals every 8 hours
Answer: B.
Explanation: Postoperative care after thoracotomy/cardiac repair requires high-acuity monitoring: arterial line, central venous pressure or other hemodynamic support, titrated fluids and inotropes, analgesia, ventilation support, and surveillance for bleeding, tamponade recurrence, arrhythmias and organ perfusion. Extubation depends on stability; diuresis can be harmful if patient is hypovolemic. Frequent assessments are critical.

A trauma patient is in septic shock secondary to post-traumatic pneumonia. Which initial bundle elements are time-sensitive and highest priority?

A. Early broad-spectrum antibiotics, obtain cultures, and aggressive source control plus fluid resuscitation and vasopressors to maintain MAP ≥65 mmHg
B. Delay antibiotics until cultures return
C. Start steroids only
D. Use anticoagulation only
Answer: A.
Explanation: In sepsis/septic shock, early administration of broad-spectrum antibiotics after appropriate cultures, prompt source control, fluid resuscitation, and vasopressor support to maintain MAP ≥65 mmHg are critical and time-sensitive — delays increase mortality. Steroids are adjunctive in refractory shock; anticoagulation addresses VTE risk but is not first-line for sepsis.

Ethical triage: In a mass casualty incident, which principle guides immediate decision making for triage in the ED?

A. Treat sicker patients first regardless of survivability
B. Maximize lives saved — prioritize patients with greatest chance of survival given limited resources (utilitarian approach), using standardized triage (START/JumpSTART)
C. First-come, first-served only
D. Treat pediatric patients last
Answer: B.
Explanation: In mass casualty events, triage aims to maximize overall survival: allocate scarce resources to those most likely to benefit using standardized triage systems (e.g., START for adults, JumpSTART for children). This utilitarian approach differs from usual one-on-one care. First-come/first-served is inefficient; triage protocols help rapid categorization and resource allocation.