A 40-year-old pedestrian struck by a car has BP 80/46 mmHg and an open-book pelvic fracture on the AP pelvic film. A pelvic binder is in place with its center over the iliac crests. What should the nurse do?

Reposition the binder over the greater trochanters

Remove the binder and rock the pelvis to assess stability

Tighten the binder at its current position

Add a second binder over the lower abdomen

An 8-month-old is brought in secured to a rigid board after a vehicle crash. The infant's neck is visibly flexed with the chin near the chest, and respirations are noisy. What is the FIRST action to improve airway alignment?

Place padding under the torso from shoulders to hips

Remove the cervical collar and let the head rest freely

Place a folded towel under the occiput to lift the head

Perform a head-tilt, chin-lift to extend the neck

A 30-year-old with a C5 spinal cord injury has BP 78/42, HR 46, and warm, dry skin. FAST is negative, the pelvis is stable, and 1 liter of crystalloid produced no change. Which intervention should the nurse anticipate?

Norepinephrine infusion titrated to the prescribed MAP goal

An additional 3 liters of crystalloid over 1 hour

Permissive hypotension with a target SBP of 80 mmHg

Phenylephrine infusion titrated to the prescribed MAP goal

To score the motor response of an unresponsive patient, the nurse applies nail-bed pressure. The patient flexes the arm at the elbow away from the stimulus. What should the nurse do next?

Apply a trapezius pinch or supraorbital pressure to test for localization

Repeat nail-bed pressure on the other hand before recording any score

Apply a sternal rub, because it is the preferred standardized central stimulus

Record the motor score as 4, because withdrawal from pain was observed

A 28-year-old has a stab wound to the left neck with dark, steady bleeding from the wound. He is alert and speaking clearly. Which action is MOST appropriate?

Apply direct pressure with an occlusive dressing over the wound

Place the patient in reverse Trendelenburg to slow venous bleeding

Apply a circumferential pressure dressing around the neck

Probe the wound gently to determine whether the platysma is violated

A 68-year-old driver was struck on the driver's side. The AP pelvic film shows a lateral compression pattern with pubic rami and sacral fractures. BP 108/70 mmHg. Which statement is MOST accurate?

Most common pattern; often has associated organ injuries

It increases pelvic volume and requires binder tightening

It indicates vertical displacement and complete instability

It is the pattern most associated with urethral injury

A driver struck the steering wheel and has a sternal fracture. Which finding requires continuous cardiac monitoring and echocardiography?

New right bundle branch block with a rising troponin

Sternal tenderness with a normal ECG and a normal troponin

Seatbelt-pattern ecchymosis across the anterior chest wall

Sinus rhythm at 88/min with a normal troponin level

TCRN – Trauma Certified Registered Nurse

Free TCRN Practice Questions

10 sample questions for the TCRN – Trauma Certified Registered Nurse, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Head and Neck, Continuum of Care, Trunk and Pelvis, Musculoskeletal and Wound, Special Populations, Professional Practice.

Question 1 · Head and Neck
A 34-year-old motorcyclist opens his eyes only to a trapezius pinch, speaks random words without any conversational exchange, and reaches across to push the examiner's hand off his shoulder. What is his Glasgow Coma Scale score?
- A.11
- B.8
- C.9
- D.10
Show answer and explanation
Answer: D. 10
Eye opening to pressure scores 2, inappropriate words score 3, and reaching to remove a central stimulus is localization, scoring 5, for a total of 10. Scoring the motor response as withdrawal (4) gives 9, a common error when the examiner does not recognize purposeful movement toward the stimulus.
Question 2 · Head and Neck
A 33-year-old with a gunshot wound to the right lateral neck is alert with BP 118/74 mmHg. Which finding indicates the need for immediate operative exploration?
- A.Expanding, pulsatile hematoma
- B.Odynophagia when swallowing
- C.Mild hoarseness
- D.Stable, nonexpanding hematoma
Show answer and explanation
Answer: A. Expanding, pulsatile hematoma
An expanding or pulsatile hematoma is a hard sign of major vascular injury and an indication for immediate intervention, with early airway control before anatomy is distorted. Hoarseness, odynophagia, and a nonexpanding hematoma are soft signs evaluated with CT angiography in a stable patient.
Question 3 · Trunk and Pelvis
A 40-year-old pedestrian struck by a car has BP 80/46 mmHg and an open-book pelvic fracture on the AP pelvic film. A pelvic binder is in place with its center over the iliac crests. What should the nurse do?
- A.Reposition the binder over the greater trochanters
- B.Remove the binder and rock the pelvis to assess stability
- C.Tighten the binder at its current position
- D.Add a second binder over the lower abdomen
Show answer and explanation
Answer: A. Reposition the binder over the greater trochanters
A binder must be centered over the greater trochanters, at the level of the pubic symphysis, to reduce pelvic volume; over the iliac crests it is ineffective and may widen the ring. Tightening a misplaced binder does not correct this. Rocking the pelvis dislodges clot and worsens bleeding.
Question 4 · Special Populations
An 8-month-old is brought in secured to a rigid board after a vehicle crash. The infant's neck is visibly flexed with the chin near the chest, and respirations are noisy. What is the FIRST action to improve airway alignment?
- A.Remove the cervical collar and let the head rest freely
- B.Place padding under the torso from shoulders to hips
- C.Place a folded towel under the occiput to lift the head
- D.Perform a head-tilt, chin-lift to extend the neck
Show answer and explanation
Answer: B. Place padding under the torso from shoulders to hips
An infant's large occiput flexes the neck on a flat surface; padding beneath the torso raises the body to bring the airway into neutral alignment while maintaining spinal motion restriction. Padding under the head increases flexion. A head-tilt, chin-lift is avoided with possible spinal injury; a jaw thrust is used instead.
Question 5 · Head and Neck
A 30-year-old with a C5 spinal cord injury has BP 78/42, HR 46, and warm, dry skin. FAST is negative, the pelvis is stable, and 1 liter of crystalloid produced no change. Which intervention should the nurse anticipate?
- A.An additional 3 liters of crystalloid over 1 hour
- B.Permissive hypotension with a target SBP of 80 mmHg
- C.Norepinephrine infusion titrated to the prescribed MAP goal
- D.Phenylephrine infusion titrated to the prescribed MAP goal
Show answer and explanation
Answer: C. Norepinephrine infusion titrated to the prescribed MAP goal
Neurogenic shock from loss of sympathetic tone causes hypotension with bradycardia; after hemorrhage is excluded and fluid fails, a vasopressor with alpha and beta activity such as norepinephrine supports both pressure and heart rate. Pure alpha agonists like phenylephrine can cause reflex bradycardia and worsen it. Spinal cord injury requires higher, not permissive, MAP targets.
Question 6 · Special Populations
To score the motor response of an unresponsive patient, the nurse applies nail-bed pressure. The patient flexes the arm at the elbow away from the stimulus. What should the nurse do next?
- A.Apply a trapezius pinch or supraorbital pressure to test for localization
- B.Repeat nail-bed pressure on the other hand before recording any score
- C.Apply a sternal rub, because it is the preferred standardized central stimulus
- D.Record the motor score as 4, because withdrawal from pain was observed
Show answer and explanation
Answer: A. Apply a trapezius pinch or supraorbital pressure to test for localization
Peripheral pressure can elicit reflex flexion, so a central stimulus such as trapezius pinch or supraorbital notch pressure is needed to determine whether the patient can localize, which scores 5. Current GCS teaching favors trapezius or supraorbital pressure over sternal rub, which can bruise and is less standardized.
Question 7 · Head and Neck
A 28-year-old has a stab wound to the left neck with dark, steady bleeding from the wound. He is alert and speaking clearly. Which action is MOST appropriate?
- A.Place the patient in reverse Trendelenburg to slow venous bleeding
- B.Apply a circumferential pressure dressing around the neck
- C.Apply direct pressure with an occlusive dressing over the wound
- D.Probe the wound gently to determine whether the platysma is violated
Show answer and explanation
Answer: C. Apply direct pressure with an occlusive dressing over the wound
Open venous neck wounds are covered with an occlusive dressing and direct pressure to control bleeding and prevent venous air embolism. Probing can dislodge clot and cause exsanguination, and circumferential dressings can compromise the airway; head-up positioning increases the risk of air entry into an open neck vein.
Question 8 · Trunk and Pelvis
A 68-year-old driver was struck on the driver's side. The AP pelvic film shows a lateral compression pattern with pubic rami and sacral fractures. BP 108/70 mmHg. Which statement is MOST accurate?
- A.It increases pelvic volume and requires binder tightening
- B.Most common pattern; often has associated organ injuries
- C.It indicates vertical displacement and complete instability
- D.It is the pattern most associated with urethral injury
Show answer and explanation
Answer: B. Most common pattern; often has associated organ injuries
Lateral compression is the most common Young-Burgess pattern; it reduces pelvic volume but is frequently associated with injuries to other body regions. Increased pelvic volume is characteristic of anteroposterior compression. Vertical shear produces vertical displacement.
Question 9 · Head and Neck
A 9-month-old fell down a flight of stairs in a walker. The infant opens her eyes only to painful stimuli, cries only in response to pain, and withdraws from a painful stimulus. What is her GCS?
- A.7
- B.10
- C.8
- D.9
Show answer and explanation
Answer: D. 9
Using the pediatric GCS, eye opening to pain scores 2, crying to pain scores 3 on the infant verbal scale, and withdrawal from pain scores 4 on the infant motor scale, for a total of 9. A score of 10 would require withdrawal to touch or an irritable but consolable cry. A total of 8 or less would indicate severe injury requiring definitive airway consideration.
Question 10 · Continuum of Care
A driver struck the steering wheel and has a sternal fracture. Which finding requires continuous cardiac monitoring and echocardiography?
- A.New right bundle branch block with a rising troponin
- B.Sternal tenderness with a normal ECG and a normal troponin
- C.Seatbelt-pattern ecchymosis across the anterior chest wall
- D.Sinus rhythm at 88/min with a normal troponin level
Show answer and explanation
Answer: A. New right bundle branch block with a rising troponin
New conduction abnormalities or arrhythmias with elevated troponin indicate blunt cardiac injury and require monitoring and echocardiography for wall motion abnormalities. A normal ECG and normal troponin essentially exclude clinically significant blunt cardiac injury, even with a sternal fracture or chest wall bruising.

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