Trauma Nurse Specialist Exam UPDATED
ACTUAL QUESTIONS AND CORRECT
ANSWERS
2 peritoneal membranes - CORRECT ANSWER Parietal and Visceral
What does the parietal peritoneum line - CORRECT ANSWER abdominal wall
What does the visceral peritoneum cover - CORRECT ANSWER Viscera or organs
Peritoneal fluid - CORRECT ANSWER separates the two layers
Fxn of peritoneal fluid - CORRECT ANSWER serves as a lubricant; allows viscera to move
easily without friction
Organs of the RUQ - CORRECT ANSWER Liver
Gallbladder
Ascending and transverse colon
Organs of the LUQ - CORRECT ANSWER Spleen
Stomach
Left Lobe of liver
Left colic flexure
Transverse colon
Organs of the LLQ - CORRECT ANSWER Sigmoid colon
Portion of descending colon
Portion of duodenum
Organs of the RLQ - CORRECT ANSWER Cecum
,Appendix
Portion of ascending colon
Hollow vs Solid organs - CORRECT ANSWER hollow organs have increased pain, solid are
bleeding organs but not as much pain
Solid organs - CORRECT ANSWER liver, spleen, pancreas, kidneys
Hollow organs - CORRECT ANSWER Gallbladder, stomach, intestines
Order of abdominal assessment - CORRECT ANSWER look, listen and feel, complete serial
abdominal exams
Foley cath contraindication - CORRECT ANSWER blood at urinary meatus, high riding
prostate, perineal hematoma
Inspection of abdomen - CORRECT ANSWER scars, protrusion, lesions, contour, distended
(fluid, fat, feces, fetus, fibroid) symmetry, skin color, visible pulsations, pelvic or perineal
bleeding/drainage, RR, resp pattern, depth
Auscultate abdomen - CORRECT ANSWER normal bowel sounds every 5-15 seconds
What does the TNS suspect if the pt experiences pain from stethoscope - CORRECT
ANSWER peritoneal inflammation
Decreased or absent bowel sounds may indicate - CORRECT ANSWER peritoneal irritation,
extra-abdominal injuries may cause ileus
Borborygmi - CORRECT ANSWER hyperactive bowel sounds
Suspect when bowel sounds are heard in the chest - CORRECT ANSWER diaphragmatic
rupture
,Vascular sounds auscultated in the abdomen - CORRECT ANSWER a bruit noted if an artery
partially occluded
Purpose of abdominal percussion - CORRECT ANSWER to detect air, fluid or tissue; may
amplify subtle rebound tenderness after injury
What do dull sounds indicate in abdomen - CORRECT ANSWER organ margins, accumulation
of free fluid
What do tympanic sounds indicate in abdomen - CORRECT ANSWER air, gas
Balance sign - CORRECT ANSWER shifting of dullness over LUQ when pt lies on left side
What does Balance sign suggest - CORRECT ANSWER Splenic rupture
Purpose of abdominal palpation - CORRECT ANSWER assess location of pain, involuntary
muscle guarding, tonicity of abdominal wall, flank and back musculature
Guarding - CORRECT ANSWER Voluntary vs involuntary muscle contraction
Rigidity - CORRECT ANSWER hard as a board
Purpose of deep palpation - CORRECT ANSWER looking for rebound tenderness, palpate
organ margins
Markel sign - CORRECT ANSWER heel drop test: have pt stand on toes and drop heels
Positive Markel sing - CORRECT ANSWER if pain is aggravated in abdomen
Digital rectal exam findings - CORRECT ANSWER blood indicates bowel perforation,
sphincter tone suggests spinal integrity, prostate location to determine urethral tear
, S&S of peritonitis - CORRECT ANSWER board-like abdomen, increased rigidity, dim or
absent BS, involuntary guarding, rebound tenderness
Kehr's sign - CORRECT ANSWER referred pain to left shoulder
What does Kehr's sign suggest - CORRECT ANSWER peritoneal or diaphragmatic irritation;
usually splenic rupture
Cullen's sign - CORRECT ANSWER blue discoloration around umbilicus
What does Cullen's sign suggest - CORRECT ANSWER intraperitoneal hemorrhage
Grey-Turner's sign - CORRECT ANSWER discoloration of lower abdomen and flanks due to
infiltration of extraperitoneal tissue with blood
What does Grey-Turner's sign suggest - CORRECT ANSWER acute hemorrhagic pancreatitis
or renal trauma
Seat belt sign - CORRECT ANSWER injury to bladder, improperly placed, thoracic abdominal
trauma
Indications for exploratory lap - CORRECT ANSWER persistent and'or recurring shock w/o
identifiable source
Evisceration
Peritonitis
Frank blood per gastric tube or rectum
Retained stabbing implement
Free air or retroperitoneal air on xray
Positive ancillary test
Suspected diaphragmatic rupture
Intraperitoneal bladder rupture
ACTUAL QUESTIONS AND CORRECT
ANSWERS
2 peritoneal membranes - CORRECT ANSWER Parietal and Visceral
What does the parietal peritoneum line - CORRECT ANSWER abdominal wall
What does the visceral peritoneum cover - CORRECT ANSWER Viscera or organs
Peritoneal fluid - CORRECT ANSWER separates the two layers
Fxn of peritoneal fluid - CORRECT ANSWER serves as a lubricant; allows viscera to move
easily without friction
Organs of the RUQ - CORRECT ANSWER Liver
Gallbladder
Ascending and transverse colon
Organs of the LUQ - CORRECT ANSWER Spleen
Stomach
Left Lobe of liver
Left colic flexure
Transverse colon
Organs of the LLQ - CORRECT ANSWER Sigmoid colon
Portion of descending colon
Portion of duodenum
Organs of the RLQ - CORRECT ANSWER Cecum
,Appendix
Portion of ascending colon
Hollow vs Solid organs - CORRECT ANSWER hollow organs have increased pain, solid are
bleeding organs but not as much pain
Solid organs - CORRECT ANSWER liver, spleen, pancreas, kidneys
Hollow organs - CORRECT ANSWER Gallbladder, stomach, intestines
Order of abdominal assessment - CORRECT ANSWER look, listen and feel, complete serial
abdominal exams
Foley cath contraindication - CORRECT ANSWER blood at urinary meatus, high riding
prostate, perineal hematoma
Inspection of abdomen - CORRECT ANSWER scars, protrusion, lesions, contour, distended
(fluid, fat, feces, fetus, fibroid) symmetry, skin color, visible pulsations, pelvic or perineal
bleeding/drainage, RR, resp pattern, depth
Auscultate abdomen - CORRECT ANSWER normal bowel sounds every 5-15 seconds
What does the TNS suspect if the pt experiences pain from stethoscope - CORRECT
ANSWER peritoneal inflammation
Decreased or absent bowel sounds may indicate - CORRECT ANSWER peritoneal irritation,
extra-abdominal injuries may cause ileus
Borborygmi - CORRECT ANSWER hyperactive bowel sounds
Suspect when bowel sounds are heard in the chest - CORRECT ANSWER diaphragmatic
rupture
,Vascular sounds auscultated in the abdomen - CORRECT ANSWER a bruit noted if an artery
partially occluded
Purpose of abdominal percussion - CORRECT ANSWER to detect air, fluid or tissue; may
amplify subtle rebound tenderness after injury
What do dull sounds indicate in abdomen - CORRECT ANSWER organ margins, accumulation
of free fluid
What do tympanic sounds indicate in abdomen - CORRECT ANSWER air, gas
Balance sign - CORRECT ANSWER shifting of dullness over LUQ when pt lies on left side
What does Balance sign suggest - CORRECT ANSWER Splenic rupture
Purpose of abdominal palpation - CORRECT ANSWER assess location of pain, involuntary
muscle guarding, tonicity of abdominal wall, flank and back musculature
Guarding - CORRECT ANSWER Voluntary vs involuntary muscle contraction
Rigidity - CORRECT ANSWER hard as a board
Purpose of deep palpation - CORRECT ANSWER looking for rebound tenderness, palpate
organ margins
Markel sign - CORRECT ANSWER heel drop test: have pt stand on toes and drop heels
Positive Markel sing - CORRECT ANSWER if pain is aggravated in abdomen
Digital rectal exam findings - CORRECT ANSWER blood indicates bowel perforation,
sphincter tone suggests spinal integrity, prostate location to determine urethral tear
, S&S of peritonitis - CORRECT ANSWER board-like abdomen, increased rigidity, dim or
absent BS, involuntary guarding, rebound tenderness
Kehr's sign - CORRECT ANSWER referred pain to left shoulder
What does Kehr's sign suggest - CORRECT ANSWER peritoneal or diaphragmatic irritation;
usually splenic rupture
Cullen's sign - CORRECT ANSWER blue discoloration around umbilicus
What does Cullen's sign suggest - CORRECT ANSWER intraperitoneal hemorrhage
Grey-Turner's sign - CORRECT ANSWER discoloration of lower abdomen and flanks due to
infiltration of extraperitoneal tissue with blood
What does Grey-Turner's sign suggest - CORRECT ANSWER acute hemorrhagic pancreatitis
or renal trauma
Seat belt sign - CORRECT ANSWER injury to bladder, improperly placed, thoracic abdominal
trauma
Indications for exploratory lap - CORRECT ANSWER persistent and'or recurring shock w/o
identifiable source
Evisceration
Peritonitis
Frank blood per gastric tube or rectum
Retained stabbing implement
Free air or retroperitoneal air on xray
Positive ancillary test
Suspected diaphragmatic rupture
Intraperitoneal bladder rupture
