Trauma & emergency care NCLEX-RN Practice Questions help you sharpen clinical judgment for high-stakes, time-sensitive situations commonly faced in the emergency department and prehospital settings. This topic-wise set focuses on Physiological Adaptation, reinforcing how to stabilize airways, support breathing and circulation, and recognize early decompensation. You’ll practice prioritizing interventions for shock, chest and head trauma, burns, environmental emergencies, and mass-transfusion care, with emphasis on evidence-based sequences, monitoring parameters, and complication prevention. Designed for M. Pharma students preparing for the NCLEX-RN, these questions drill down into pathophysiology-driven decisions, interpretation of key findings (e.g., lactate, ionized calcium, compartment pressures), and safe implementation of life-saving therapies. Use them to build speed, accuracy, and confidence under exam pressure.
Q1. A trauma patient with blunt chest injury suddenly develops severe dyspnea, tracheal deviation to the left, distended neck veins, and hypotension. Which provider-prescribed intervention should the nurse anticipate and prepare for immediately?
- High-flow oxygen and obtain a stat chest X-ray before any invasive procedure
- Immediate needle decompression at the 4th–5th intercostal space, anterior to mid-axillary line, on the right, followed by chest tube placement
- Prepare for thoracotomy only if oxygen therapy fails to improve status
- Administer IV diuretic to reduce intrathoracic pressure
Correct Answer: Immediate needle decompression at the 4th–5th intercostal space, anterior to mid-axillary line, on the right, followed by chest tube placement
Q2. A victim of a high-speed MVC arrives with suspected cervical spine injury and snoring respirations. Which airway maneuver is most appropriate initially?
- Head-tilt/chin-lift to open the airway
- Jaw-thrust maneuver with manual in-line stabilization
- Hyperextend the neck to optimize airway patency
- Insert a nasopharyngeal airway without stabilization
Correct Answer: Jaw-thrust maneuver with manual in-line stabilization
Q3. A client with severe TBI shows decreasing level of consciousness. Which change most strongly indicates rising intracranial pressure requiring immediate action?
- Tachycardia and narrow pulse pressure
- Bradycardia with widening pulse pressure and irregular respirations
- Tachypnea with respiratory alkalosis
- Polyuria and hypotension
Correct Answer: Bradycardia with widening pulse pressure and irregular respirations
Q4. A client presents with an open tibial fracture and active bleeding. What is the nurse’s priority action?
- Attempt to realign the bone ends to control bleeding
- Apply direct pressure with sterile gauze and cover the exposed bone with a sterile moist dressing
- Elevate the leg above the heart and apply ice directly to the bone
- Remove any embedded debris before applying a dressing
Correct Answer: Apply direct pressure with sterile gauze and cover the exposed bone with a sterile moist dressing
Q5. Four hours after a long-leg cast is applied for a tibial fracture, the client reports severe pain unrelieved by opioids, with paresthesias and pallor of the foot. What is the priority nursing action?
- Raise the leg on several pillows above heart level to reduce swelling
- Apply heat to improve circulation
- Notify the provider immediately and keep the limb at heart level while preparing to loosen or bivalve the cast per orders
- Administer additional opioid and reassess in one hour
Correct Answer: Notify the provider immediately and keep the limb at heart level while preparing to loosen or bivalve the cast per orders
Q6. A 70-kg adult with 36% TBSA partial-thickness burns arrives two hours post-injury. Using the Parkland formula (4 mL × kg × %TBSA), how much lactated Ringer’s should infuse in the first 8 hours from the time of burn?
- 2,520 mL
- 5,040 mL
- 7,560 mL
- 10,080 mL
Correct Answer: 5,040 mL
Q7. A patient with high-voltage electrical injury is brought to the ED. What is the most critical immediate monitoring priority?
- Serial hemoglobin every 30 minutes
- Continuous cardiac monitoring for dysrhythmias
- Daily wound cultures
- Hourly capillary blood glucose checks
Correct Answer: Continuous cardiac monitoring for dysrhythmias
Q8. A trauma patient is receiving a massive transfusion. The nurse notes perioral tingling, hypotension, and a prolonged QT interval. Which intervention addresses the most likely cause?
- Administer IV calcium gluconate and check ionized calcium
- Increase the blood infusion rate to improve perfusion
- Administer IV magnesium sulfate
- Stop all transfusions and give broad-spectrum antibiotics
Correct Answer: Administer IV calcium gluconate and check ionized calcium
Q9. A client with suspected hemorrhagic shock after a femur fracture arrives pale, cool, and hypotensive with a thready pulse. What is the priority initial intervention?
- Start two large-bore IVs and infuse rapid isotonic crystalloids
- Obtain a full medication history before starting IV fluids
- Administer vasopressors before fluids to prevent hemodilution
- Place the client in high Fowler’s position to improve breathing
Correct Answer: Start two large-bore IVs and infuse rapid isotonic crystalloids
Q10. A patient with suspected basilar skull fracture requires gastric decompression. Which order should the nurse question?
- Insert an orogastric tube
- Insert a nasogastric tube
- Maintain head of bed at 30 degrees
- Frequent neuro checks every hour
Correct Answer: Insert a nasogastric tube
Q11. Following blunt abdominal trauma, which assessment most strongly suggests splenic injury?
- Right shoulder pain and RUQ tenderness
- Left shoulder pain (Kehr sign) with LUQ tenderness
- Periumbilical ecchymosis (Cullen sign)
- Grey-Turner sign with right flank bruising
Correct Answer: Left shoulder pain (Kehr sign) with LUQ tenderness
Q12. An unstable pelvic fracture is suspected in a hypotensive trauma patient. Which immediate intervention best reduces ongoing hemorrhage?
- Apply a pelvic binder at the level of the greater trochanters
- Place the patient in Trendelenburg position
- Logroll frequently to assess for skin breakdown
- Apply direct pressure over the pubic symphysis
Correct Answer: Apply a pelvic binder at the level of the greater trochanters
Q13. A burn victim presents with hoarseness, singed nasal hairs, facial burns, and carbonaceous sputum. What is the best immediate action?
- Administer nebulized bronchodilators and observe for one hour
- Prepare for early endotracheal intubation
- Start high-dose steroids to reduce airway edema
- Place a nasopharyngeal airway and reassess
Correct Answer: Prepare for early endotracheal intubation
Q14. After a crush injury, a patient has peaked T waves on ECG, K+ 6.5 mEq/L, dark brown urine, and severe muscle pain. What is the priority immediate intervention?
- Administer IV calcium gluconate to stabilize the myocardium
- Start oral kayexalate and observe
- Restrict fluids to prevent edema
- Administer IV loop diuretic only
Correct Answer: Administer IV calcium gluconate to stabilize the myocardium
Q15. A patient in anaphylaxis after a peanut exposure has wheezing and hypotension. What is the correct first-line medication and route?
- IV epinephrine 0.3 mg (1 mg/mL)
- IM epinephrine 0.3 mg (1 mg/mL) into the mid-outer thigh
- Nebulized epinephrine 0.3 mg
- Subcutaneous epinephrine 0.3 mg (1 mg/mL) in the upper arm
Correct Answer: IM epinephrine 0.3 mg (1 mg/mL) into the mid-outer thigh
Q16. A runner presents with heat stroke: temperature 41.2°C (106.2°F), confusion, and hot, dry skin. Which action is most appropriate?
- Administer antipyretics and warm IV fluids
- Initiate rapid cooling (ice-water immersion or evaporative cooling) and stop when core temp reaches 39°C (102.2°F)
- Place the patient under a cooling blanket only
- Delay cooling until lab results return
Correct Answer: Initiate rapid cooling (ice-water immersion or evaporative cooling) and stop when core temp reaches 39°C (102.2°F)
Q17. A hypothermic drowning victim (core temp 28°C/82.4°F) is in ventricular fibrillation. Which action is appropriate according to resuscitation guidelines?
- Administer epinephrine every 3–5 minutes and defibrillate repeatedly
- Attempt up to three defibrillations and withhold epinephrine until core temp >30°C while continuing active rewarming
- Do not defibrillate until the core temp reaches 36°C
- Stop resuscitation due to poor prognosis at this temperature
Correct Answer: Attempt up to three defibrillations and withhold epinephrine until core temp >30°C while continuing active rewarming
Q18. A near-drowning patient is alert with mild cough and normal chest X-ray. Which order should the nurse question?
- Continuous pulse oximetry and observation
- Prophylactic broad-spectrum antibiotics
- Repeat chest imaging if respiratory status worsens
- Monitor for delayed ARDS
Correct Answer: Prophylactic broad-spectrum antibiotics
Q19. In managing a traumatic amputation in the field, which instruction is correct?
- Place the amputated part directly on ice to preserve tissue
- Wrap the amputated part in sterile moist gauze, seal in a bag, and place that bag on ice
- Soak the amputated part in sterile saline and keep it warm
- Clean the amputated part vigorously with antiseptic
Correct Answer: Wrap the amputated part in sterile moist gauze, seal in a bag, and place that bag on ice
Q20. A patient with a chest tube for hemothorax suddenly becomes dyspneic; drainage abruptly stops, and there are dependent loops of tubing visible. What is the best initial nursing action?
- Clamp the chest tube immediately
- Increase wall suction to maximum
- Assess the patient and system; straighten tubing to remove dependent loops and check for kinks; notify provider if not resolved
- Remove the chest tube and apply an occlusive dressing
Correct Answer: Assess the patient and system; straighten tubing to remove dependent loops and check for kinks; notify provider if not resolved
Q21. Using the Emergency Severity Index (ESI), which patient requires ESI level 1 (immediate life-saving intervention)?
- 65-year-old with ankle sprain and pain 8/10
- 22-year-old with mild asthma exacerbation, speaking full sentences
- 40-year-old unresponsive trauma patient with agonal respirations and SpO₂ 70%
- 55-year-old with chest pain relieved by rest
Correct Answer: 40-year-old unresponsive trauma patient with agonal respirations and SpO₂ 70%
Q22. A patient with flail chest shows paradoxical chest movement, increasing work of breathing, and SpO₂ 88% on high-flow oxygen. What is the priority intervention?
- Apply an abdominal binder to stabilize the chest
- Provide adequate analgesia and prepare for positive-pressure ventilation with possible intubation
- Restrict fluids to prevent pulmonary edema
- Encourage incentive spirometry only
Correct Answer: Provide adequate analgesia and prepare for positive-pressure ventilation with possible intubation
Q23. A client with a high thoracic spinal cord injury becomes hypotensive with bradycardia and warm, flushed skin below the lesion. What type of shock is most likely?
- Septic shock
- Neurogenic shock
- Hypovolemic shock
- Cardiogenic shock
Correct Answer: Neurogenic shock
Q24. After massive fluid resuscitation, a trauma patient has tense, distended abdomen, rising peak airway pressures on the ventilator, oliguria, and hypotension. Bladder pressure is markedly elevated. What is the anticipated intervention?
- Administer diuretics and observe
- Increase PEEP to improve oxygenation
- Emergent decompressive laparotomy
- Discontinue fluids and start vasopressors only
Correct Answer: Emergent decompressive laparotomy
Q25. A chemical splash to the eye occurs in a laboratory. What is the priority first action?
- Instill topical anesthetic then call ophthalmology before irrigation
- Begin immediate continuous irrigation with normal saline and monitor conjunctival pH until neutral
- Apply an eye patch and transport to the ED
- Administer systemic steroids before irrigation
Correct Answer: Begin immediate continuous irrigation with normal saline and monitor conjunctival pH until neutral
Q26. A trauma patient presents with hypotension, jugular venous distention, muffled heart sounds, and pulsus paradoxus. What is the priority intervention?
- Administer high-dose diuretics
- Prepare for pericardiocentesis
- Place the patient in Trendelenburg position
- Start nitroglycerin infusion
Correct Answer: Prepare for pericardiocentesis
Q27. Fifteen minutes after starting a unit of PRBCs, a client develops fever, chills, back pain, and dark urine. What is the nurse’s first action?
- Slow the infusion rate and reassess in 10 minutes
- Stop the transfusion, keep the IV line open with normal saline using new tubing, and notify the provider and blood bank
- Administer acetaminophen and continue the transfusion
- Flush the existing tubing with saline and resume
Correct Answer: Stop the transfusion, keep the IV line open with normal saline using new tubing, and notify the provider and blood bank
Q28. A hypotensive blunt abdominal trauma patient has a positive FAST exam. What is the most appropriate next step?
- Obtain a contrast CT scan before further interventions
- Immediate operative management with emergent laparotomy
- Observe in the ED for serial abdominal exams
- Discharge with return precautions
Correct Answer: Immediate operative management with emergent laparotomy
Q29. In the ED, a patient arrives with a sucking chest wound from a stabbing. What is the appropriate immediate dressing technique?
- Apply a non-occlusive gauze dressing
- Apply an occlusive dressing taped on three sides
- Apply an occlusive dressing taped on all four sides
- Leave the wound open to air
Correct Answer: Apply an occlusive dressing taped on three sides
Q30. Prehospital, when is a traction splint for a mid-shaft femur fracture contraindicated?
- When there is isolated mid-shaft femur injury
- When distal pulses are present
- When there is a suspected pelvic fracture
- When pain is severe
Correct Answer: When there is a suspected pelvic fracture
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