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BCEN TCRNFree Trauma Certified Registered Nurse practice test
10 real BCEN TCRN practice questions with instant answers and explanations — no account, no credit card, no email. Score yourself, then unlock the full bank of 600questions whenever you’re ready. The BCEN TCRN passing score is 96 / 150 scored items correct (criterion-referenced, not curved).
A 22-year-old male arrives at the emergency department following a head-on motor vehicle collision while restrained only by a lap belt. The vehicle did not overturn, and he was able to exit the car independently. Which vertebra is most likely to have sustained injury?
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Q1. A 22-year-old male arrives at the emergency department following a head-on motor vehicle collision while restrained only by a lap belt. The vehicle did not overturn, and he was able to exit the car independently. Which vertebra is most likely to have sustained injury?
Correct answer: A. L1
Flexion-distraction injuries (Chance fractures) are commonly referred to as seatbelt fractures. They occur when a lap belt restrains the lower spine and pelvis while the upper body flexes forward during impact. The upper lumbar and lower thoracic region is most frequently involved. Among the listed options, L1 falls within this vulnerable zone.
Q2. A 24-year-old female sustains a T10 spinal cord injury during a skiing collision. She has complete motor and sensory loss below the injury level, yet the cord does not appear fully severed. One day after admission, her mother asks whether her daughter will walk again. What is the trauma nurse's best reply?
Correct answer: C. "It may take several days before we understand the full extent of the injury."
The patient may be experiencing spinal shock, which can mask the true extent of neurological damage for days. Declaring permanent deficits at this stage is premature. Offering surgical guarantees is similarly inappropriate. Redirecting to family feelings avoids the question rather than answering it.
Q3. A 24-year-old male is brought to the ED after a high-speed crash. He has bilateral periorbital bruising, nasal deformity, and clear fluid draining from his nose. What is the nurse's highest priority assessment?
Correct answer: B. Monitor for changes in level of consciousness
The clinical picture is consistent with a basilar skull fracture, which carries significant risk of intracranial injury. Detecting neurological deterioration early is essential to prevent secondary brain injury. While glucose testing can help identify CSF leakage, it is secondary to neurological monitoring. Applying a dressing may obscure drainage and does not address rising intracranial pressure. Imaging is important but not the immediate priority.
Q4. A 27-year-old woman arrives in the emergency department with an arrow impaled in her skull, entering superior to the left orbit and exiting through the left temporal region. Blood is seeping from the entry site. Which intervention is most appropriate?
Correct answer: A. Immobilize the arrow in place without disturbing it
Penetrating objects embedded in the skull must be stabilized in place rather than removed at the bedside, as removal can disrupt tamponade and cause additional tissue damage. Surgical extraction is required. Cutting or modifying the arrow disturbs it and risks further trauma. Applying pressure to the entry wound will not stop internal bleeding and may elevate intracranial pressure.
Q5. A 31-year-old male is admitted following a motorcycle collision. He is alert with a GCS of 15 but reports numbness in both hands and has diminished motor strength bilaterally in the upper extremities. Which incomplete spinal cord syndrome does this presentation most suggest?
Correct answer: B. Central cord syndrome
Central cord syndrome is the most frequent incomplete spinal cord injury and characteristically produces greater motor weakness in the upper limbs than the lower limbs, often following a cervical hyperextension mechanism. Anterior cord syndrome affects motor function and pain/temperature sensation below the lesion while sparing proprioception. Brown-Séquard involves hemisection with ipsilateral motor loss and contralateral sensory loss. Posterior cord syndrome impairs proprioception and vibration while preserving motor function.
Q6. A 34-year-old female who was a restrained passenger in a motor vehicle collision is responsive only to painful stimuli and cannot maintain her airway. What is the most frequent cause of airway obstruction in unresponsive or obtunded patients?
Correct answer: C. Tongue
In non-alert patients, the relaxation of pharyngeal muscles allows the tongue to fall backward and occlude the airway, making it the leading cause of obstruction. Vomitus is a secondary but less frequent cause. Hematoma and edema can obstruct the airway but represent a far smaller proportion of cases.
Q7. A 34-year-old male presents to the emergency room with subconjunctival hemorrhage following a motor vehicle accident. Which statement accurately describes this injury?
Correct answer: C. It typically resolves without permanent effects on vision
Subconjunctival hemorrhage involves bleeding within the conjunctival tissue. Blood is typically reabsorbed over days to weeks, and permanent visual impairment is uncommon. While an association with serious orbital or intraocular trauma exists, it is infrequent. Absolute statements such as 'never associated' are incorrect.
Q8. A 34-year-old male presents after receiving a forceful blow to the throat. He has tachypnea, a hoarse voice, and hemoptysis. Which intervention is the priority?
Correct answer: C. Secure the airway using the approach that causes the least additional trauma
The clinical findings indicate tracheal injury. Standard intubation may worsen damage to the already injured airway, and aggressive manipulation can cause edema that makes subsequent airway access impossible. Cricothyrotomy may become necessary, but the guiding principle is to establish a definitive airway while minimizing further trauma. Imaging is secondary to securing the airway.
Q9. A 35-year-old female sustains a C5 spinal cord injury after falling 25 feet from a ladder. Which category of shock poses the greatest risk for this patient?
Correct answer: C. Distributive shock
Spinal cord injuries at or above T6 can disrupt the neurological control of vasomotor tone, leading to peripheral vasodilation and fluid redistribution—the hallmark of distributive (neurogenic) shock. Hypovolemic shock involves fluid loss; obstructive shock results from circulatory obstruction; cardiogenic shock stems from pump failure. None of these are the primary concern in isolated cervical cord injury.
Q10. A 42-year-old female presents after a motor vehicle collision with bilateral periorbital ecchymosis (raccoon eyes). Which facial fracture pattern is most consistent with this finding?
Correct answer: D. Le Fort III
Le Fort III is a craniofacial disjunction fracture that passes through the orbits, causing bilateral periorbital bruising (raccoon eyes). Le Fort I is a horizontal fracture through the maxilla that does not involve the orbits. Le Fort II is a pyramidal fracture that may spare the orbital rim. Mandibular fractures do not produce periorbital ecchymosis.
Exam facts and objectives sourced from the official BCEN (Board of Certification for Emergency Nursing) certification page. Last reviewed June 2026.
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