TNCC WRITTEN EXAM SCRIPT 9TH EDITION
2026 QUESTIONS WITH CORRECT ANSWERS
◉ What are signs of ineffective breathing? Answer: - AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and
expiration
- Use of accessory muscles or abdominal muscles or both or
diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask
device, as indicated
- Anticipate definitive airway management to support ventilation.
◉ Upon initial assessment, what type of oxygen should be used for a
pt breathing effectively? Answer: A tight-fitting nonrebreather mask
at 12-15 lpm.
◉ What intervention should be done if a pt presents with effective
circulation? Answer: - Insert 2 large caliber IV's
, - Administer warmed isotonic crystalloid solution at an appropriate
rate
◉ What are signs of ineffective circulation? Answer: - Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
◉ What are the interventions for Effective/Ineffective Circulation?
Answer: - Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic
crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of
blood
- Use rapid infusion device based on protocol
,- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)
◉ What are factors that contribute to ineffective ventilation?
Answer: - AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age
◉ What medications are used during intubation? Answer: LOAD
Mnemonic:
L = Lidocaine
, O = Opioids
A = Atropine
D = Defasiculating agents
◉ What are the Rapid Sequence Intubation Steps? Answer:
PREPARATION:
- gather equipment, staffing, etc.
PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration).
PRETREATMENT:
- Decrease S/E's of intubation
PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent
PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of
vomiting and aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts.
Ventilate pt 30-60 seconds between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector.
POSTINTUBATION MANAGEMENT:
2026 QUESTIONS WITH CORRECT ANSWERS
◉ What are signs of ineffective breathing? Answer: - AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and
expiration
- Use of accessory muscles or abdominal muscles or both or
diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask
device, as indicated
- Anticipate definitive airway management to support ventilation.
◉ Upon initial assessment, what type of oxygen should be used for a
pt breathing effectively? Answer: A tight-fitting nonrebreather mask
at 12-15 lpm.
◉ What intervention should be done if a pt presents with effective
circulation? Answer: - Insert 2 large caliber IV's
, - Administer warmed isotonic crystalloid solution at an appropriate
rate
◉ What are signs of ineffective circulation? Answer: - Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
◉ What are the interventions for Effective/Ineffective Circulation?
Answer: - Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic
crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of
blood
- Use rapid infusion device based on protocol
,- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation)
◉ What are factors that contribute to ineffective ventilation?
Answer: - AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
- Preexisting hx of respiratory diseases
- Increased age
◉ What medications are used during intubation? Answer: LOAD
Mnemonic:
L = Lidocaine
, O = Opioids
A = Atropine
D = Defasiculating agents
◉ What are the Rapid Sequence Intubation Steps? Answer:
PREPARATION:
- gather equipment, staffing, etc.
PREOXYGENATION:
- Use 100% O2 (prevent risk of aspiration).
PRETREATMENT:
- Decrease S/E's of intubation
PARALYSIS WITH INDUCTION:
- Pt has LOC, then administer neuromuscular blocking agent
PROTECTION AND POSITIONING:
- Apply pressure over cricoid cartilage (minimizes likelihood of
vomiting and aspiration
PLACEMENT WITH PROOF
- Each attempt NOT to exceed 30 seconds, max of 3 attempts.
Ventilate pt 30-60 seconds between attempts.
- After intubation, inflate the cuff
- Confirm tube placement w/exhaled CO2 detector.
POSTINTUBATION MANAGEMENT:
