TCRN Practice Questions (2026) — Free Sample Questions with Answers

Answer: A

Rising intracranial pressure with impending herniation: Correct. Widened pulse pressure with hypertension, bradycardia and irregular respirations (Cushing's triad) plus a new unilateral blown pupil signal brainstem compression from rising ICP.

Neurogenic shock from an associated cervical cord injury: Neurogenic shock causes hypotension with bradycardia, not marked hypertension with a widened pulse pressure and pupil changes.

Early compensated hemorrhagic shock from a missed injury: Compensated hemorrhage produces tachycardia and a narrowed pulse pressure, the opposite of this picture.

Autonomic dysreflexia triggered by a distended bladder: Autonomic dysreflexia occurs in established cord injuries at T6 or above and does not explain falling GCS and a dilating pupil.

Cushing's triad (hypertension with widened pulse pressure, bradycardia, irregular respirations) is a late sign of rising ICP and impending herniation — an emergency.

Answer: C

Obtain a portable chest radiograph to confirm diagnosis: Tension pneumothorax is a clinical diagnosis; delaying for imaging in an unstable patient can be fatal.

Start a 2-liter warmed crystalloid bolus by rapid infuser: Fluids do not relieve the mechanical obstruction to venous return that is causing the shock.

Assist with an immediate needle or finger decompression: Correct. Obstructive shock from tension pneumothorax needs immediate decompression, followed by chest tube placement.

Seal the wound with an occlusive dressing taped on all sides: Sealing a wound on all sides can create or worsen tension physiology; a sucking wound gets a vented dressing.

Tension pneumothorax = hypotension, absent breath sounds, JVD, tracheal deviation (late): decompress immediately; never wait for the x-ray.

Answer: B

Absent dorsalis pedis and posterior tibial pulses: Pulselessness is a late finding; compartment pressures that cause tissue ischemia are usually far below arterial pressure.

Pain on passive stretch of the toes: Correct. Pain out of proportion to the injury and pain with passive stretch of the muscles in the compartment are the earliest signs.

Complete paralysis of foot dorsiflexion: Paralysis signals established nerve and muscle injury and is a late sign.

Pale, cool skin over the foot and toes: Pallor and coolness are late findings tied to arterial compromise.

Compartment syndrome: pain out of proportion and pain on passive stretch come first; pulselessness, pallor and paralysis are late. Loosen dressings/bivalve the cast, keep the limb at heart level, notify for fasciotomy.

Answer: A

Displace the uterus to the left or tilt the board left: Correct. In the supine position the gravid uterus compresses the inferior vena cava; left uterine displacement or tilting the board restores venous return.

Place the patient in Trendelenburg position: Trendelenburg does not relieve caval compression and may impair ventilation.

Start a vasopressor infusion to raise blood pressure: Vasopressors reduce uteroplacental blood flow and do not fix the mechanical cause.

Remove spinal motion restriction and sit her upright: Spinal precautions can be maintained while tilting the whole board; sitting her up abandons them unnecessarily.

After about 20 weeks, prevent supine hypotension with manual left uterine displacement or a 15–30° left tilt of the whole board; the best fetal resuscitation is maternal resuscitation.

Answer: B

Give 2 liters of crystalloid before releasing any blood products: Large crystalloid volumes dilute clotting factors and worsen acidosis and hypothermia; blood products should start early.

Transfuse plasma, platelets and red cells in a balanced ratio: Correct. Damage control resuscitation uses a balanced ratio approaching 1:1:1 of plasma, platelets and red cells to prevent dilutional coagulopathy.

Give red cells only until the hemoglobin returns to normal: Red cells alone do not replace clotting factors or platelets and lead to coagulopathy.

Withhold plasma until the INR result exceeds 2.0: Waiting for lab values delays treatment; in massive hemorrhage plasma is given empirically with red cells.

Damage control resuscitation: minimize crystalloid, give blood products early in a balanced (≈1:1:1) ratio, permissive hypotension until hemorrhage control, and guide later therapy with viscoelastic testing.

Answer: C

Minor (green): Green is for walking wounded; this patient cannot walk.

Delayed (yellow): Delayed requires RR 30 or less, adequate perfusion and the ability to follow commands.

Immediate (red): Correct. In START, a respiratory rate over 30 breaths/min places the patient in the immediate category.

Expectant (black): Expectant is for patients who do not breathe even after the airway is repositioned.

START: walking → green; not breathing after airway repositioning → black; RR > 30, capillary refill > 2 sec/no radial pulse, or cannot follow commands → red; otherwise yellow.