TNCC Final Exam 2025|2026 – Trauma Nursing Core Course
Assessment Questions and Answers 100%Accuracy (Graded A+)
I have created a comprehensive 50-question TNCC 9th Edition final exam. This is a substantial
educational resource covering all the required domains with current 2025/2026 updates.
TNCC 9th Edition Final Examination
2025/2026 Test Cycle - Comprehensive Review
SECTION I: INITIAL ASSESSMENT & THE TRAUMA NURSING PROCESS (P-T-A-R)
(Questions 1-7)
Question 1
A 34-year-old male arrives via EMS following a high-speed motorcycle collision. He is speaking clearly,
has a patent airway, and is breathing spontaneously at 24 breaths/minute. His radial pulse is palpable
but thready at 128 bpm, and his skin is cool and diaphoretic. According to the P-T-A-R (Primary Survey,
Triage/Transport, Assessment, Reassessment) trauma nursing process, which action takes immediate
priority?
A. Establish two large-bore IV lines and begin fluid resuscitation
B. Apply supplemental oxygen and obtain a full set of vital signs
C. Perform the primary survey to identify immediate life threats
D. Obtain a detailed history using the AMPLE mnemonic
Correct Answer: C
Rationale: The P-T-A-R framework establishes that the Primary Survey always takes precedence in
trauma resuscitation. This systematic approach (Airway with cervical spine protection, Breathing,
Circulation, Disability, Exposure/Environment) is designed to rapidly identify and address immediately
life-threatening conditions. While this patient shows signs of compensated shock (tachycardia, cool
diaphoretic skin, thready pulse), the nurse must first complete the primary survey to ensure no other
immediate threats exist—such as a tension pneumothorax or uncontrolled external hemorrhage—that
could rapidly decompensate the patient. Option A (fluid resuscitation) is important for hemorrhagic
shock but should not precede identification of all life threats. Option B (supplemental oxygen) addresses
breathing but is not the comprehensive priority. Option D (AMPLE history) occurs during the secondary
survey, not during initial assessment. The TNCC 9th Edition emphasizes that the primary survey drives
immediate interventions and should be completed within minutes of patient arrival. Once life threats
are identified and managed, the nurse proceeds through the remaining P-T-A-R phases:
,Triage/Transport decisions, comprehensive Assessment (secondary survey), and continuous
Reassessment.
Question 2
During the primary survey of a 28-year-old female pedestrian struck by a vehicle, the trauma team
leader auscultates breath sounds that are present but diminished on the right side, accompanied by
respiratory distress and oxygen saturation of 88% on room air. The patient is anxious and has tracheal
deviation to the left. Which life-threatening condition must be addressed immediately, and what is the
correct intervention sequence?
A. Open pneumothorax; apply sterile occlusive dressing taped on three sides
B. Tension pneumothorax; perform immediate needle decompression
C. Massive hemothorax; initiate autotransfusion and chest tube insertion
D. Flail chest; stabilize with sandbags and provide analgesia
Correct Answer: B
Rationale: The clinical presentation—respiratory distress, tracheal deviation away from the affected
side, diminished breath sounds, and hypoxemia—constitutes the classic triad for tension
pneumothorax. This is an immediately life-threatening condition caused by progressive accumulation of
air in the pleural space under pressure, leading to mediastinal shift, compression of the contralateral
lung, and impaired venous return to the heart. The TNCC 9th Edition (updated for 2025/2026) specifies
needle decompression at the 4th or 5th intercostal space at the anterior axillary line using a 14-gauge,
3.25-inch needle catheter. This location avoids the thicker chest wall musculature at the midclavicular
line (previously recommended) and reduces risk of cardiac or vascular injury. The needle should be
inserted over the superior aspect of the rib to avoid the neurovascular bundle. Option A describes open
pneumothorax, which presents with a sucking chest wound and does not cause tracheal deviation.
Option C (massive hemothorax) would present with dullness to percussion and shock, not tracheal
deviation. Option D (flail chest) presents with paradoxical chest wall movement. Tension pneumothorax
is a clinical diagnosis—do not wait for chest X-ray confirmation before intervening.
Question 3
A 45-year-old unrestrained driver presents after a frontal MVC. The primary survey reveals a patent
airway, bilateral breath sounds, and strong radial pulses at 110 bpm. During the exposure phase, the
nurse notes a 15cm laceration on the patient's thigh with steady dark red bleeding and a fractured pelvis
with significant instability on gentle compression. According to current C-ABC priorities for trauma with
uncontrolled hemorrhage, which intervention takes precedence?
A. Immediate endotracheal intubation for airway protection
B. Direct pressure and hemostatic dressing application to the thigh wound
C. Application of a pelvic binder and initiation of massive transfusion protocol
D. Insertion of bilateral chest tubes for potential occult hemothorax
,Correct Answer: C
Rationale: The C-ABC approach (Catastrophic hemorrhage control first, then Airway, Breathing,
Circulation) represents a paradigm shift in trauma resuscitation for patients with uncontrolled bleeding.
This patient has two sources of potentially catastrophic hemorrhage: the thigh laceration (likely venous
but significant) and the unstable pelvic fracture, which can disrupt the pelvic venous plexus and cause
retroperitoneal hemorrhage exceeding 4 liters. The TNCC 9th Edition emphasizes that mechanical
stabilization of pelvic fractures with a binder reduces pelvic volume, promotes tamponade of bleeding
vessels, and can reduce mortality by 20-30%. While the thigh wound requires control (Option B), the
pelvic fracture represents a larger hemorrhage risk and takes priority for immediate intervention. The
massive transfusion protocol should be initiated early for hemodynamically unstable patients with
suspected major hemorrhage. Option A (intubation) is not immediately indicated as the airway is patent.
Option D (prophylactic chest tubes) is inappropriate without evidence of thoracic injury. Current
evidence supports 1:1:1 balanced resuscitation with plasma, platelets, and red blood cells to prevent
coagulopathy.
Question 4
During the secondary survey of a 62-year-old male who fell 20 feet from a ladder, the nurse notes
Battle's sign, raccoon eyes, and clear fluid draining from the right ear. The patient is increasingly
somnolent but follows commands. Which combination of injuries should the nurse anticipate based on
these findings?
A. Basilar skull fracture with potential temporal bone involvement
B. Le Fort III fracture with associated orbital blowout
C. Cervical spine fracture with vertebral artery dissection
D. Traumatic brain injury with cerebral spinal fluid rhinorrhea only
Correct Answer: A
Rationale: The triad of Battle's sign (mastoid ecchymosis), raccoon eyes (periorbital ecchymosis), and
otorrhea is pathognomonic for basilar skull fracture, specifically involving the temporal or petrous
portions of the skull. Battle's sign typically appears 24-48 hours post-injury as blood tracks from the
middle cranial fossa to the mastoid region. Raccoon eyes result from anterior cranial fossa fracture with
blood tracking into the periorbital tissues. Clear fluid from the ear represents cerebrospinal fluid (CSF)
otorrhea, indicating dural tear with communication between the subarachnoid space and the external
auditory canal. The TNCC 9th Edition emphasizes that these findings indicate a high-risk injury requiring
immediate neurosurgical consultation, antibiotic prophylaxis (due to risk of meningitis), and strict
avoidance of nasogastric tube insertion (risk of intracranial penetration). Option B (Le Fort III) presents
with facial instability and malocclusion but not these specific signs. Option C (cervical spine injury) would
not cause these cranial findings. The nurse should also assess for seventh cranial nerve palsy and
hearing loss, which commonly accompany temporal bone fractures.
Question 5
, A trauma patient arrives with the following vital signs: HR 134, BP 82/54, RR 28, SpO2 94% on 15L NRB,
temperature 35.8°C (96.4°F). The trauma team has controlled external hemorrhage and established IV
access. According to the principles of balanced resuscitation and damage control resuscitation, which
blood product administration strategy is most appropriate?
A. Infuse 2 liters of warmed crystalloid followed by O-negative PRBCs
B. Administer plasma, platelets, and PRBCs in a 1:1:1 ratio
C. Transfuse PRBCs only until Type & Cross is completed
D. Give cryoprecipitate first to correct coagulopathy
Correct Answer: B
Rationale: Damage control resuscitation (DCR) and balanced transfusion represent current evidence-
based practice for patients in hemorrhagic shock. The 1:1:1 ratio (1 unit plasma : 1 unit platelets : 1 unit
PRBCs) mimics whole blood composition and addresses the "lethal triad" of hypothermia, acidosis, and
coagulopathy that develops in massive hemorrhage. The TNCC 9th Edition emphasizes that crystalloid
resuscitation (Option A) is limited to 1-2 liters maximum and should not delay blood products, as
excessive crystalloid dilutes clotting factors and exacerbates coagulopathy. Option C (PRBCs only) fails to
replace clotting factors consumed in trauma. Option D (cryoprecipitate first) is incorrect as it addresses
fibrinogen deficiency but not the comprehensive coagulopathy of trauma. The patient presents with
Class III hemorrhagic shock (blood loss >30-40% circulating volume) evidenced by tachycardia,
hypotension, tachypnea, and hypothermia. Massive transfusion protocol activation should occur for
patients requiring >10 units PRBCs in 24 hours or >4 units in 1 hour. All blood products must be warmed
to prevent hypothermia-induced coagulopathy.
Question 6
During reassessment of a trauma patient 30 minutes post-arrival, the nurse notes the patient's Glasgow
Coma Scale (GCS) score has decreased from 14 to 11 (E3, V3, M5). The patient was previously alert and
oriented. Which sequence of actions best reflects appropriate trauma nursing reassessment priorities?
A. Notify the physician, obtain a CT scan, and prepare for intubation
B. Reassess airway, breathing, and circulation; then investigate neurologic changes
C. Administer mannitol 1g/kg for suspected increased intracranial pressure
D. Perform a detailed extremity examination to identify occult injuries
Correct Answer: B
Rationale: The Reassessment phase of P-T-A-R follows the same systematic approach as the primary
survey. A deterioration in GCS of 2 or more points indicates a significant change in neurologic status,
but the nurse must first ensure that airway, breathing, and circulation remain adequate before
attributing the change solely to neurologic causes. Hypoxemia and hypotension are the two most
common secondary insults that worsen traumatic brain injury outcomes. The TNCC 9th Edition
emphasizes that hypotension doubles mortality in TBI patients, and hypoxemia causes irreversible
neuronal damage. Therefore, the nurse must immediately reassess: Airway patency and protection (GCS
<8 requires intubation), Breathing adequacy (SpO2 >94%, EtCO2 35-45 mmHg), and Circulation (MAP
Assessment Questions and Answers 100%Accuracy (Graded A+)
I have created a comprehensive 50-question TNCC 9th Edition final exam. This is a substantial
educational resource covering all the required domains with current 2025/2026 updates.
TNCC 9th Edition Final Examination
2025/2026 Test Cycle - Comprehensive Review
SECTION I: INITIAL ASSESSMENT & THE TRAUMA NURSING PROCESS (P-T-A-R)
(Questions 1-7)
Question 1
A 34-year-old male arrives via EMS following a high-speed motorcycle collision. He is speaking clearly,
has a patent airway, and is breathing spontaneously at 24 breaths/minute. His radial pulse is palpable
but thready at 128 bpm, and his skin is cool and diaphoretic. According to the P-T-A-R (Primary Survey,
Triage/Transport, Assessment, Reassessment) trauma nursing process, which action takes immediate
priority?
A. Establish two large-bore IV lines and begin fluid resuscitation
B. Apply supplemental oxygen and obtain a full set of vital signs
C. Perform the primary survey to identify immediate life threats
D. Obtain a detailed history using the AMPLE mnemonic
Correct Answer: C
Rationale: The P-T-A-R framework establishes that the Primary Survey always takes precedence in
trauma resuscitation. This systematic approach (Airway with cervical spine protection, Breathing,
Circulation, Disability, Exposure/Environment) is designed to rapidly identify and address immediately
life-threatening conditions. While this patient shows signs of compensated shock (tachycardia, cool
diaphoretic skin, thready pulse), the nurse must first complete the primary survey to ensure no other
immediate threats exist—such as a tension pneumothorax or uncontrolled external hemorrhage—that
could rapidly decompensate the patient. Option A (fluid resuscitation) is important for hemorrhagic
shock but should not precede identification of all life threats. Option B (supplemental oxygen) addresses
breathing but is not the comprehensive priority. Option D (AMPLE history) occurs during the secondary
survey, not during initial assessment. The TNCC 9th Edition emphasizes that the primary survey drives
immediate interventions and should be completed within minutes of patient arrival. Once life threats
are identified and managed, the nurse proceeds through the remaining P-T-A-R phases:
,Triage/Transport decisions, comprehensive Assessment (secondary survey), and continuous
Reassessment.
Question 2
During the primary survey of a 28-year-old female pedestrian struck by a vehicle, the trauma team
leader auscultates breath sounds that are present but diminished on the right side, accompanied by
respiratory distress and oxygen saturation of 88% on room air. The patient is anxious and has tracheal
deviation to the left. Which life-threatening condition must be addressed immediately, and what is the
correct intervention sequence?
A. Open pneumothorax; apply sterile occlusive dressing taped on three sides
B. Tension pneumothorax; perform immediate needle decompression
C. Massive hemothorax; initiate autotransfusion and chest tube insertion
D. Flail chest; stabilize with sandbags and provide analgesia
Correct Answer: B
Rationale: The clinical presentation—respiratory distress, tracheal deviation away from the affected
side, diminished breath sounds, and hypoxemia—constitutes the classic triad for tension
pneumothorax. This is an immediately life-threatening condition caused by progressive accumulation of
air in the pleural space under pressure, leading to mediastinal shift, compression of the contralateral
lung, and impaired venous return to the heart. The TNCC 9th Edition (updated for 2025/2026) specifies
needle decompression at the 4th or 5th intercostal space at the anterior axillary line using a 14-gauge,
3.25-inch needle catheter. This location avoids the thicker chest wall musculature at the midclavicular
line (previously recommended) and reduces risk of cardiac or vascular injury. The needle should be
inserted over the superior aspect of the rib to avoid the neurovascular bundle. Option A describes open
pneumothorax, which presents with a sucking chest wound and does not cause tracheal deviation.
Option C (massive hemothorax) would present with dullness to percussion and shock, not tracheal
deviation. Option D (flail chest) presents with paradoxical chest wall movement. Tension pneumothorax
is a clinical diagnosis—do not wait for chest X-ray confirmation before intervening.
Question 3
A 45-year-old unrestrained driver presents after a frontal MVC. The primary survey reveals a patent
airway, bilateral breath sounds, and strong radial pulses at 110 bpm. During the exposure phase, the
nurse notes a 15cm laceration on the patient's thigh with steady dark red bleeding and a fractured pelvis
with significant instability on gentle compression. According to current C-ABC priorities for trauma with
uncontrolled hemorrhage, which intervention takes precedence?
A. Immediate endotracheal intubation for airway protection
B. Direct pressure and hemostatic dressing application to the thigh wound
C. Application of a pelvic binder and initiation of massive transfusion protocol
D. Insertion of bilateral chest tubes for potential occult hemothorax
,Correct Answer: C
Rationale: The C-ABC approach (Catastrophic hemorrhage control first, then Airway, Breathing,
Circulation) represents a paradigm shift in trauma resuscitation for patients with uncontrolled bleeding.
This patient has two sources of potentially catastrophic hemorrhage: the thigh laceration (likely venous
but significant) and the unstable pelvic fracture, which can disrupt the pelvic venous plexus and cause
retroperitoneal hemorrhage exceeding 4 liters. The TNCC 9th Edition emphasizes that mechanical
stabilization of pelvic fractures with a binder reduces pelvic volume, promotes tamponade of bleeding
vessels, and can reduce mortality by 20-30%. While the thigh wound requires control (Option B), the
pelvic fracture represents a larger hemorrhage risk and takes priority for immediate intervention. The
massive transfusion protocol should be initiated early for hemodynamically unstable patients with
suspected major hemorrhage. Option A (intubation) is not immediately indicated as the airway is patent.
Option D (prophylactic chest tubes) is inappropriate without evidence of thoracic injury. Current
evidence supports 1:1:1 balanced resuscitation with plasma, platelets, and red blood cells to prevent
coagulopathy.
Question 4
During the secondary survey of a 62-year-old male who fell 20 feet from a ladder, the nurse notes
Battle's sign, raccoon eyes, and clear fluid draining from the right ear. The patient is increasingly
somnolent but follows commands. Which combination of injuries should the nurse anticipate based on
these findings?
A. Basilar skull fracture with potential temporal bone involvement
B. Le Fort III fracture with associated orbital blowout
C. Cervical spine fracture with vertebral artery dissection
D. Traumatic brain injury with cerebral spinal fluid rhinorrhea only
Correct Answer: A
Rationale: The triad of Battle's sign (mastoid ecchymosis), raccoon eyes (periorbital ecchymosis), and
otorrhea is pathognomonic for basilar skull fracture, specifically involving the temporal or petrous
portions of the skull. Battle's sign typically appears 24-48 hours post-injury as blood tracks from the
middle cranial fossa to the mastoid region. Raccoon eyes result from anterior cranial fossa fracture with
blood tracking into the periorbital tissues. Clear fluid from the ear represents cerebrospinal fluid (CSF)
otorrhea, indicating dural tear with communication between the subarachnoid space and the external
auditory canal. The TNCC 9th Edition emphasizes that these findings indicate a high-risk injury requiring
immediate neurosurgical consultation, antibiotic prophylaxis (due to risk of meningitis), and strict
avoidance of nasogastric tube insertion (risk of intracranial penetration). Option B (Le Fort III) presents
with facial instability and malocclusion but not these specific signs. Option C (cervical spine injury) would
not cause these cranial findings. The nurse should also assess for seventh cranial nerve palsy and
hearing loss, which commonly accompany temporal bone fractures.
Question 5
, A trauma patient arrives with the following vital signs: HR 134, BP 82/54, RR 28, SpO2 94% on 15L NRB,
temperature 35.8°C (96.4°F). The trauma team has controlled external hemorrhage and established IV
access. According to the principles of balanced resuscitation and damage control resuscitation, which
blood product administration strategy is most appropriate?
A. Infuse 2 liters of warmed crystalloid followed by O-negative PRBCs
B. Administer plasma, platelets, and PRBCs in a 1:1:1 ratio
C. Transfuse PRBCs only until Type & Cross is completed
D. Give cryoprecipitate first to correct coagulopathy
Correct Answer: B
Rationale: Damage control resuscitation (DCR) and balanced transfusion represent current evidence-
based practice for patients in hemorrhagic shock. The 1:1:1 ratio (1 unit plasma : 1 unit platelets : 1 unit
PRBCs) mimics whole blood composition and addresses the "lethal triad" of hypothermia, acidosis, and
coagulopathy that develops in massive hemorrhage. The TNCC 9th Edition emphasizes that crystalloid
resuscitation (Option A) is limited to 1-2 liters maximum and should not delay blood products, as
excessive crystalloid dilutes clotting factors and exacerbates coagulopathy. Option C (PRBCs only) fails to
replace clotting factors consumed in trauma. Option D (cryoprecipitate first) is incorrect as it addresses
fibrinogen deficiency but not the comprehensive coagulopathy of trauma. The patient presents with
Class III hemorrhagic shock (blood loss >30-40% circulating volume) evidenced by tachycardia,
hypotension, tachypnea, and hypothermia. Massive transfusion protocol activation should occur for
patients requiring >10 units PRBCs in 24 hours or >4 units in 1 hour. All blood products must be warmed
to prevent hypothermia-induced coagulopathy.
Question 6
During reassessment of a trauma patient 30 minutes post-arrival, the nurse notes the patient's Glasgow
Coma Scale (GCS) score has decreased from 14 to 11 (E3, V3, M5). The patient was previously alert and
oriented. Which sequence of actions best reflects appropriate trauma nursing reassessment priorities?
A. Notify the physician, obtain a CT scan, and prepare for intubation
B. Reassess airway, breathing, and circulation; then investigate neurologic changes
C. Administer mannitol 1g/kg for suspected increased intracranial pressure
D. Perform a detailed extremity examination to identify occult injuries
Correct Answer: B
Rationale: The Reassessment phase of P-T-A-R follows the same systematic approach as the primary
survey. A deterioration in GCS of 2 or more points indicates a significant change in neurologic status,
but the nurse must first ensure that airway, breathing, and circulation remain adequate before
attributing the change solely to neurologic causes. Hypoxemia and hypotension are the two most
common secondary insults that worsen traumatic brain injury outcomes. The TNCC 9th Edition
emphasizes that hypotension doubles mortality in TBI patients, and hypoxemia causes irreversible
neuronal damage. Therefore, the nurse must immediately reassess: Airway patency and protection (GCS
<8 requires intubation), Breathing adequacy (SpO2 >94%, EtCO2 35-45 mmHg), and Circulation (MAP
