Trauma-Informed Care - 2026 Nursing Practices

1. What is the fundamental shift in perspective associated with trauma- informed care (TIC)? A. Asking "What is wrong with you?" to "What are your symptoms?" B. Asking "What is wrong with you?" to "What happened to you?" C. Focusing on curing the trauma completely D. Ignoring the past to focus on the future Correct Answer: B. Asking "What is wrong with you?" to "What happened to you?" life experiences. Rationale: TIC requires a paradigm shift from blaming to understanding the patient's 2. According to SAMHSA, what are the "Four Rs" of trauma-informed care? A. Realize, Recognize, Respond, Resist re-traumatization B. React, Reflect, Respond, Recover C. Review, Revise, Respond, Reassess D. Realize, Remember, Remind, Resist Correct Answer: A. Realize, Recognize, Respond, Resist re-traumatization Rationale: These 4 Rs summarize the essential steps organizations and individuals must take in TIC. 3. Which of the following is NOT one of the six key principles of a trauma- informed approach? A. Safety B. Trustworthiness and Transparency C. Mandatory disclosure of trauma D. Empowerment, V oice, and Choice Correct Answer: C. Mandatory disclosure of trauma Rationale: Forcing disclosure can be re-traumatizing. TIC focuses on creating a safe environment regardless of disclosure. 4. What does "ACEs" stand for in the context of trauma? A. Acute Childhood Emergencies B. Adverse Childhood Experiences C. Adult Coping Evaluations D. Advanced Care Events Correct Answer: B. Adverse Childhood Experiences Rationale: The ACE study demonstrated a strong link between childhood trauma and poor adult health outcomes. 5. A higher ACE score is correlated with an increased risk for which of the following? A. Improved resilience B. Chronic diseases such as heart disease and diabetes C. Decreased risk of substance use D. Higher pain tolerance Correct Answer: B. Chronic diseases such as heart disease and diabetes Rationale: High ACE scores are linked to toxic stress, which negatively affects immune and endocrine systems leading to chronic illness. 6. What happens to the amygdala during a traumatic event? A. It becomes underactive and ignores the threat B. It shrinks in size instantly C. It becomes hyperactive and initiates the fight, flight, or freeze response D. It takes over logical thinking functions Correct Answer: C. It becomes hyperactive and initiates the fight, flight, or freeze response Rationale: The amygdala is the brain's alarm system and triggers survival mechanisms during trauma. 7. Which part of the brain is responsible for logical thinking and is often impaired during a trauma trigger? A. Brainstem B. Prefrontal cortex C. Cerebellum D. Occipital lobe Correct Answer: B. Prefrontal cortex Rationale: The prefrontal cortex, which handles executive functions and rational thought, can go "offline" during a trauma response. 8. What is "re-traumatization" in a healthcare setting? A. Discussing past traumas in therapy B. Any situation or environment that resembles an individual's trauma literally or symbolically C. Developing PTSD symptoms for the first time D. A physical injury that occurs twice Correct Answer: B. Any situation or environment that resembles an individual's trauma literally or symbolically Rationale: Re-traumatization happens when a healthcare interaction unintentionally mirrors past abuse or powerlessness. 9. Which action by a nurse promotes the TIC principle of "Safety"? A. Leaving the exam room door locked B. Performing procedures quickly without explanation C. Explaining what will happen before touching the patient D. Standing between the patient and the door Correct Answer: C. Explaining what will happen before touching the patient Rationale: Providing clear expectations and asking permission before touch creates physical and psychological safety. 10. What is a common physiological sign that a patient is experiencing a trauma trigger? A. Deep, slow breathing B. Tachycardia and diaphoresis C. Decreased blood pressure D. Somnolence Correct Answer: B. Tachycardia and diaphoresis Rationale: Triggers activate the sympathetic nervous system, causing increased heart rate, sweating, and rapid breathing. 11. The principle of "Trustworthiness and Transparency" involves: A. Sharing the patient's trauma history with the entire unit B. Making decisions without patient input to save time C. Maintaining clear boundaries and explaining the reasons for care decisions D. Promising outcomes that cannot be guaranteed Correct Answer: C. Maintaining clear boundaries and explaining the reasons for care decisions Rationale: Transparency builds trust, which is often severely damaged in trauma survivors. 12. How does TIC view "non-compliant" behavior? A. As an intentional act of defiance B. As a sign of low intelligence C. As a coping mechanism or survival response related to trauma D. As a reason for discharge Correct Answer: C. As a coping mechanism or survival response related to trauma Rationale: Behaviors often labeled as "difficult" are frequently adaptive responses to past trauma. 13. Which statement best demonstrates the principle of "Collaboration and Mutuality"? A. "I am the nurse, so you need to follow my instructions." B. "We need to do this blood draw now." C. "Let's work together to figure out the best way to do your dressing change." D. "The doctor ordered this, so you have to take it." Correct Answer: C. "Let's work together to figure out the best way to do your dressing change." Rationale: Collaboration levels the power dynamic and involves the patient as a partner in their care. 14. What does the term "vicarious trauma" refer to? A. Trauma experienced directly by the patient B. The emotional residue of exposure that counselors and nurses have from working with trauma survivors C. A fabricated trauma history D. Trauma that occurs in childhood Correct Answer: B. The emotional residue of exposure that counselors and nurses have from working with trauma survivors Rationale: Vicarious trauma involves a shift in the healthcare worker's worldview due to repeated exposure to others' traumatic stories. 15. What is the most effective initial response when a patient becomes agitated and triggered? A. Restrain the patient B. Give a PRN sedative immediately C. Remain calm, use a low voice, and provide a safe space D. Confront the patient about their behavior Correct Answer: C. Remain calm, use a low voice, and provide a safe space Rationale: De-escalation requires the nurse to act as a calming, regulating presence (co-regulation) rather than matching the patient's anxiety. 16. Universal trauma precautions mean that a nurse should: A. Assume every patient has a trauma history and treat them accordingly B. Screen every patient for specific abuse history upon admission C. Wear PPE with all patients D. Avoid physical touch with all patients Correct Answer: A. Assume every patient has a trauma history and treat them accordingly Rationale: Because trauma is so prevalent, TIC should be applied universally to prevent re-traumatization, similar to universal infection precautions. 17. Which is an example of an institutional practice that can be re- traumatizing? A. Giving patients choices about appointment times B. Requiring patients to undress completely when only a localized exam is needed C. Using plain language on consent forms D. Asking permission before initiating touch Correct Answer: B. Requiring patients to undress completely when only a localized exam is needed Rationale: Unnecessary loss of privacy and autonomy can trigger feelings of vulnerability and loss of control, mirroring abuse. 18. The "Window of Tolerance" refers to: A. The time allowed for a patient visit B. The optimal zone of arousal where a person can function and process information effectively C. The legal timeframe to report abuse D. The duration of a trauma response Correct Answer: B. The optimal zone of arousal where a person can function and process information effectively Rationale: Trauma narrows this window, making individuals more prone to hyperarousal (fight/flight) or hypoarousal (freeze/dissociation). 19. If a patient is dissociating (hypoarousal) during an assessment, the nurse should: A. Shout to get their attention B. Leave the room immediately C. Help ground the patient using sensory input like naming objects in the room D. Document that the patient is ignoring the nurse Correct Answer: C. Help ground the patient using sensory input like naming objects in the room Rationale: Grounding techniques help bring the patient back to the present moment and re-engage their prefrontal cortex. 20. What is "toxic stress"? A. Normal stress from work or school B. Prolonged activation of the stress response systems without protective buffering C. Stress caused by environmental toxins D. A brief period of anxiety before a procedure Correct Answer: B. Prolonged activation of the stress response systems without protective buffering Rationale: Toxic stress changes brain architecture and increases the risk of stress- related disease and cognitive impairment. 21. In TIC, what is meant by "Empowerment, Voice, and Choice"? A. Allowing patients to prescribe their own medications B. Recognizing patients' strengths and giving them a say in their treatment C. Ensuring the nurse has the final say in all decisions D. Discharging patients who do not agree with the plan of care Correct Answer: B. Recognizing patients' strengths and giving them a say in their treatment Rationale: Trauma strips away power; TIC seeks to restore it by involving patients in decision-making and validating their preferences. 22. Which nursing intervention is best for a patient who has a history of sexual assault and needs a pelvic exam? A. Tell the patient to "relax and it will be over soon." B. Proceed quickly without talking to minimize the time spent. C. Offer a chaperone, explain every step, and establish a "stop" signal. D. Prescribe anti-anxiety medication prior to the exam. Correct Answer: C. Offer a chaperone, explain every step, and establish a "stop" signal. Rationale: Giving the patient control (a stop signal) and predictability (explaining steps) minimizes powerlessness and re-traumatization. 23. How does intersectionality apply to trauma-informed care? A. It refers to road safety in community nursing. B. It recognizes that overlapping identities (race, gender, class) create unique experiences of trauma and discrimination. C. It is a surgical term for healing tissues. D. It means all traumas are treated exactly the same way. Correct Answer: B. It recognizes that overlapping identities (race, gender, class) create unique experiences of trauma and discrimination. Rationale: Systemic traumas like racism or transphobia compound individual traumas and must be acknowledged in care.