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Question 1

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A 28-year-old patient presents with a Glasgow Coma Scale (GCS) score of 13. Which GCS category BEST describes this finding?

Severe traumatic brain injury

Moderate traumatic brain injury

Mild traumatic brain injury

Normal neurologic function

to track

2026 Statistics

Key Facts: TCRN Exam

175

Total Items

BCEN TCRN exam page

150 + 25

Scored + Unscored

BCEN TCRN exam page

96/150

Passing Standard

BCEN TCRN exam page (effective 2025-11-29)

Exam Time

BCEN TCRN exam page

$285/$380

Member / Nonmember Fee

BCEN TCRN exam page

Nov 29, 2025

Current Content Outline Effective Date

BCEN TCRN Exam Content Outline

4 years

Recertification Cycle

BCEN TCRN FAQ

BCEN lists the TCRN exam at 175 total items (150 scored + 25 unscored pretest), 3-hour test time, and a passing standard of 96 scored items. The updated TCRN Content Outline (effective November 29, 2025) includes 6 domains: Head and Neck (20.7%), Trunk and Pelvis (25.3%), Musculoskeletal and Wound (8.7%), Special Populations (14.7%), Continuum of Care (24%), and Professional Practice (6.7%). BCEN recommends 2+ years of trauma nursing experience before testing.

Sample TCRN Practice Questions

Try these sample questions to test your TCRN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 197+ question experience with AI tutoring.

1A 28-year-old patient presents with a Glasgow Coma Scale (GCS) score of 13. Which GCS category BEST describes this finding?

A.Severe traumatic brain injury

B.Moderate traumatic brain injury

C.Mild traumatic brain injury

D.Normal neurologic function

Explanation: A GCS score of 13 indicates moderate traumatic brain injury. GCS scoring: 13-15 = mild TBI, 9-12 = moderate TBI, 3-8 = severe TBI. This patient requires close monitoring for potential deterioration.

2Which finding is the hallmark of an epidural hematoma on CT imaging?

A.Crescent-shaped blood collection crossing suture lines

B.Lens-shaped (biconvex) blood collection not crossing suture lines

C.Diffuse cerebral edema with loss of gray-white differentiation

D.Multiple punctate hemorrhages throughout the brain parenchyma

Explanation: Epidural hematomas appear as lens-shaped (biconvex) blood collections that do not cross suture lines due to the tight attachment of the dura to the skull at sutures. This is caused by arterial bleeding, most commonly from the middle meningeal artery.

3A patient with a cervical spinal cord injury presents with hypotension, bradycardia, and warm, dry skin. These findings are MOST consistent with:

A.Hypovolemic shock

B.Cardiogenic shock

C.Neurogenic shock

D.Septic shock

Explanation: Neurogenic shock results from loss of sympathetic tone below the level of spinal cord injury. Classic findings include hypotension with bradycardia (not tachycardia as seen in hypovolemic shock) and warm, dry skin due to loss of vasoconstriction.

4Which vital sign change is the earliest indicator of increased intracranial pressure (ICP)?

A.Decreasing blood pressure

B.Widening pulse pressure

C.Change in level of consciousness

D.Bradycardia

Explanation: The earliest and most sensitive indicator of increased ICP is a change in level of consciousness. Vital sign changes (Cushing triad: hypertension, bradycardia, irregular respirations) are late findings and indicate severe, life-threatening increased ICP.

5A patient with bilateral mandibular fractures presents with tongue displacement causing airway obstruction. What is the IMMEDIATE priority intervention?

A.Apply a cervical collar

B.Perform endotracheal intubation

C.Pull the tongue forward and secure it

D.Prepare for emergent tracheostomy

Explanation: In bilateral mandibular fractures, the tongue may fall posteriorly and obstruct the airway. The immediate intervention is to pull the tongue forward (often using a suture or towel clip) and secure it to prevent airway obstruction. This simple maneuver can be life-saving.

6A patient with a severe traumatic brain injury has an ICP monitor placed. The current ICP is 25 mmHg. Which intervention should be performed FIRST?

A.Administer mannitol 1 g/kg IV

B.Elevate the head of the bed to 30 degrees

C.Initiate hyperventilation to achieve PaCO2 of 25 mmHg

D.Administer propofol for sedation

Explanation: The first intervention for elevated ICP should be positioning - elevate the head of the bed to 30 degrees with the head in neutral position to promote venous drainage. This simple, low-risk intervention should be attempted before medications or hyperventilation.

7Which finding distinguishes spinal shock from neurogenic shock in a patient with acute spinal cord injury?

A.Spinal shock causes hypotension; neurogenic shock does not

B.Spinal shock causes temporary loss of reflexes; neurogenic shock causes permanent loss

C.Spinal shock is temporary and resolves in days to weeks; neurogenic shock is an acute hemodynamic emergency

D.Spinal shock affects only motor function; neurogenic shock affects only autonomic function

Explanation: Spinal shock is a temporary condition characterized by loss of reflexes, flaccidity, and loss of sensation below the level of injury that typically resolves in days to weeks. Neurogenic shock is an acute hemodynamic emergency from loss of sympathetic tone causing hypotension and bradycardia.

8A patient presents with a "battle sign" (mastoid ecchymosis) following head trauma. This finding indicates:

A.Acute epidural hematoma

B.Basilar skull fracture

C.Cervical spine injury

D.Frontal lobe contusion

Explanation: Battle sign (mastoid ecchymosis) is a late finding indicating basilar skull fracture, typically appearing 24-48 hours after injury. Other signs include raccoon eyes (periorbital ecchymosis), CSF rhinorrhea/otorrhea, and hemotympanum.

9A patient with a C5 complete spinal cord injury is being managed in the ICU. Which nursing intervention is MOST important to prevent complications?

A.Perform range of motion exercises twice daily

B.Monitor for autonomic dysreflexia

C.Apply thigh-high compression stockings

D.Maintain strict bed rest for 6 weeks

Explanation: Patients with spinal cord injuries at T6 or above are at risk for autonomic dysreflexia, a life-threatening condition causing severe hypertension, bradycardia, and pounding headache. Nurses must monitor for triggers (bladder distention, bowel impaction, skin irritation) and signs of this emergency.

10A 45-year-old patient presents with unequal pupils (right pupil 6mm, left pupil 3mm) after head trauma. The right pupil is nonreactive. This finding is MOST consistent with:

A.Direct injury to the left optic nerve

B.Transtentorial herniation with uncal compression

C.Oculomotor nerve palsy from basilar skull fracture

D.Physiologic anisocoria

Explanation: A unilaterally dilated, nonreactive pupil in a head trauma patient is a sign of transtentorial (uncal) herniation. The ipsilateral oculomotor nerve (CN III) is compressed, causing pupillary dilation. This is a neurosurgical emergency requiring immediate intervention.

About the TCRN Exam

TCRN is BCEN's specialty certification for nurses providing trauma care across the continuum. The exam tests clinical judgment in head/neck trauma, trunk/pelvis injuries, musculoskeletal and wound management, special populations considerations, continuum of care, and professional trauma nursing practice.

Questions

175 scored questions

Time Limit

3 hours

Passing Score

96 out of 150 scored items

Exam Fee

$285 ENA/BCEN members / $380 non-members (BCEN (Board of Certification for Emergency Nursing))

TCRN Exam Content Outline

20.7%

Clinical Practice: Head and Neck

Traumatic brain injury, spinal cord injury, secondary brain injury prevention, ocular trauma, maxillofacial injuries, and neck trauma

25.3%

Clinical Practice: Trunk and Pelvis

Thoracic trauma, abdominal trauma, pelvic trauma, and genitourinary trauma management

8.7%

Clinical Practice: Musculoskeletal and Wound

Long bone fractures, compartment syndrome, amputations, soft tissue injuries, and burn trauma

14.7%

Special Populations

Pediatric, geriatric, pregnant, and bariatric trauma considerations; victims of violence; substance use; and comorbidities

24%

Continuum of Care for Trauma

Resuscitation, shock management, acute care, complications, psychosocial issues, rehabilitation, injury prevention, and patient transfer

6.7%

Professional Practice

Quality improvement, disaster management, patient safety, team well-being, regulations, education, and ethical issues

How to Pass the TCRN Exam

What You Need to Know

Passing score: 96 out of 150 scored items
Exam length: 175 questions
Time limit: 3 hours
Exam fee: $285 ENA/BCEN members / $380 non-members

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

TCRN Study Tips from Top Performers

1Study by the 2025 BCEN domain weighting - prioritize Trunk and Pelvis (25.3%) and Continuum of Care (24%) as the largest sections

2Use first-action drills for trauma scenarios (airway protection, hemorrhage control, shock recognition) because TCRN heavily tests priority decisions

3Master head and neck trauma management - understand ICP, secondary brain injury prevention, and spinal cord injury priorities

4Practice mixed, timed 50-question blocks to match exam pacing and transition quickly between trauma domains

5Review special populations considerations - pediatric, geriatric, and pregnant trauma patients have unique assessment and management needs

6Add a weekly professional practice review block (quality improvement, disaster, regulations) to protect points in the non-clinical domain

Frequently Asked Questions

How many questions are on the TCRN exam?

BCEN lists 175 total items: 150 scored items and 25 unscored pretest items. You have 3 hours to complete the exam.

What score do I need to pass TCRN?

BCEN lists the TCRN passing standard as 96 correct out of 150 scored items.

How long is the TCRN exam?

BCEN lists a 3-hour testing appointment for TCRN.

What changed for TCRN in November 2025?

BCEN released an updated TCRN Exam Content Outline effective November 29, 2025. Key changes include: Trunk and Pelvis are now combined (25.3%), Extremity/Wound is now Musculoskeletal and Wound (8.7%), Special Considerations is now Special Populations (14.7%), and Professional Issues is now Professional Practice (6.7%). The passing score is now 96/150.

How much does TCRN cost?

BCEN's current TCRN fees are $285 for ENA/BCEN members and $380 for non-members.

Who can take the TCRN exam?

BCEN requires active unrestricted RN licensure. Two years of trauma nursing experience is recommended before testing. TCRN is ideal for emergency, trauma ICU, and surgical nurses involved in trauma care.

How often do I renew TCRN?

BCEN certifications follow a 4-year recertification cycle. You can recertify by continuing education hours or by retaking the exam.