TNCC 9th Edition Final Exam
Practice Test
Questions with Answers and Detailed Rationales
Based on the ENA TNCC 9th Edition
Provider Manual
Exam Format:
50 multiple-choice questions
Open-book format (as per ENA guidelines)
Timed: 60-90 minutes recommended
Passing Score: 80% (40/50 correct)
, Table of Contents by Topic
Topic Questions
Trauma Nursing Process & Primary Survey (A-B-C-D-E) Q1-Q10
Airway & Ventilation Management Q11-Q16
Shock, Hemorrhage & Fluid Resuscitation Q17-Q22
Head & Spinal Trauma Q23-Q28
Thoracic & Abdominal Trauma Q29-Q33
Musculoskeletal & Burn Trauma Q34-Q38
Special Populations (Pediatric, Geriatric, Pregnant, Obese, LGBTQ+) Q39-Q45
Psychosocial Aspects & Disaster Management Q46-Q50
Section 1: Trauma Nursing Process & Primary Survey (A-B-C-D-E)
1. The correct sequence of the Trauma Nursing Process (TNP) is:
A) Triage → Primary Survey → Secondary Survey → Reassessment
B) Preparation and Triage → Primary Survey (A-B-C-D-E) → Secondary Survey →
Reassessment
C) Assessment → Intervention → Evaluation → Transfer
D) Primary Survey → History Taking → Secondary Survey → Disposition
Answer: B
Rationale: The Trauma Nursing Process (TNP) follows a systematic sequence
,designed to identify and intervene in life-threatening conditions . It begins
with Preparation and Triage, followed by the Primary Survey (A-B-C-D-E) to
address immediate threats, then the Secondary Survey (head-to-toe assessment
and history), and concludes with Reassessment to evaluate response to
interventions. This structured approach ensures no life threat is missed .
2. During the primary survey, the "A" stands for:
A) Airway with simultaneous cervical spine stabilization
B) Alertness and level of consciousness
C) Auscultation of breath sounds
D) Access for IV fluids
Answer: A
Rationale: In the primary survey, "A" stands for Airway with simultaneous
cervical spine stabilization. Any patient with significant mechanism of injury is
assumed to have a cervical spine injury until proven otherwise. The jaw-thrust
maneuver is the preferred airway opening technique as it maintains spinal
alignment . Option B is part of "D" (Disability). Option C is part of "B" (Breathing).
Option D is part of "C" (Circulation).
,3. A patient arrives with a Glasgow Coma Scale (GCS) score of 7. What is the
priority intervention?
A. Obtain a head CT scan
B. Administer mannitol
C. Secure a definitive airway
D. Place in Trendelenburg position
Answer: C
Rationale: A GCS of 8 or less indicates severe traumatic brain injury (TBI) and an
inability to protect the airway due to depressed mental status . Securing a
definitive airway (intubation) is the priority to prevent hypoxemia, hypercapnia,
and aspiration. Airway always comes before diagnostic imaging (A) or specific
treatments for intracranial pressure (B).
4. Which finding during the "B" (Breathing) assessment of the primary survey
requires immediate intervention?
A. Respiratory rate of 18 breaths/min
B. Absent breath sounds on one side with tracheal deviation
C. Oxygen saturation of 95% on room air
D. Mild chest wall ecchymosis
Answer: B
Rationale: Absent breath sounds on one side with tracheal deviation is a
, hallmark sign of tension pneumothorax, a life-threatening condition requiring
immediate needle decompression . The trachea deviates away from the affected
side due to pressure buildup. Options A and C are within normal range.
Ecchymosis (D) is a finding but not immediately life-threatening.
5. A patient has no palpable radial pulse but has a strong central
(carotid/femoral) pulse. According to TNCC hemodynamic classification, this
corresponds to an estimated blood loss of:
A) <750 mL
B) 750-1,500 mL
C) 1,500-2,000 mL
D) >2,000 mL
Answer: C
Rationale: TNCC classifies hemorrhage based on pulse quality and mental status:
Absent radial pulse + strong central pulse = Class III hemorrhage (1,500-2,000 mL
loss)
Absent radial + weak central = Class IV (>2,000 mL)
Present radial but tachycardic = Class I-II (<1,500 mL)
6. During the "C" (Circulation) assessment, which finding is most concerning?
,A. Heart rate of 110 beats/min
B. Cool, pale, diaphoretic skin
C. Blood pressure 130/80 mmHg
D. Capillary refill of 2 seconds
Answer: B
Rationale: Cool, pale, diaphoretic skin indicates hypoperfusion and
compensatory vasoconstriction (shock). The body shunts blood away from the
skin to preserve core organ perfusion. Tachycardia (A) is also a sign of shock, but
cool skin reflects the body's compensation. BP (C) may be normal or even
elevated in early shock (compensated). Capillary refill >2 seconds (D) is also a sign
of shock.
7. According to TNCC guidelines, what is the initial fluid bolus for an adult
trauma patient in hypovolemic shock?
A) 500 mL of 0.9% normal saline
B) 1 liter of Lactated Ringer's solution
C) 2 liters of warmed isotonic crystalloid
D) 1 unit of O-negative blood
Answer: C
Rationale: TNCC recommends an initial bolus of 2 liters of warmed isotonic
crystalloid (Lactated Ringer's or Normal Saline) for adults in hypovolemic shock .
Warmed fluids prevent hypothermia, which worsens coagulopathy. Options A and
,B are insufficient volumes. Blood products (D) are indicated after the initial
crystalloid bolus if the patient remains unstable.
8. The "D" (Disability) assessment in the primary survey evaluates:
A) Drug allergies and current medications
B) Neurological status using the AVPU scale or GCS, and pupillary response
C) Digestive system and bowel sounds
D) Determination of discharge plan
Answer: B
Rationale: "D" stands for Disability—a rapid neurologic assessment using
the AVPU scale (Alert, Verbal, Pain, Unresponsive) or Glasgow Coma Scale (GCS) ,
along with pupillary examination (size, symmetry, reactivity). This identifies acute
neurologic deterioration . Allergies and medications (A) are part of the secondary
survey (AMPLE history). Bowel sounds (C) are secondary survey. Disposition (D) is
later.
9. The "E" in the primary survey stands for:
A) Eyes – pupillary examination
B) Electrocardiogram monitoring
, C) Exposure with environmental control
D) Extremity splinting
Answer: C
Rationale: "E" stands for Exposure with environmental control. The patient is
completely undressed to allow full examination for hidden injuries, while
simultaneously preventing hypothermia using warm blankets, warmed IV fluids,
and increased room temperature . Hypothermia worsens coagulopathy and
acidosis (the "lethal triad").
10. Which statement about the secondary survey is correct?
A) It is performed before the primary survey
B) It includes a head-to-toe assessment and AMPLE history
C) It focuses only on the chief complaint
D) It is omitted in unstable patients
Answer: B
Rationale: The secondary survey is a comprehensive head-to-toe
assessment and AMPLE history (Allergies, Medications, Past medical history, Last
meal, Events/Environment) . It is performed after the primary survey is complete
and life threats are addressed. In unstable patients, it may be abbreviated or
deferred, but the goal is to complete it before the patient leaves the ED.
Practice Test
Questions with Answers and Detailed Rationales
Based on the ENA TNCC 9th Edition
Provider Manual
Exam Format:
50 multiple-choice questions
Open-book format (as per ENA guidelines)
Timed: 60-90 minutes recommended
Passing Score: 80% (40/50 correct)
, Table of Contents by Topic
Topic Questions
Trauma Nursing Process & Primary Survey (A-B-C-D-E) Q1-Q10
Airway & Ventilation Management Q11-Q16
Shock, Hemorrhage & Fluid Resuscitation Q17-Q22
Head & Spinal Trauma Q23-Q28
Thoracic & Abdominal Trauma Q29-Q33
Musculoskeletal & Burn Trauma Q34-Q38
Special Populations (Pediatric, Geriatric, Pregnant, Obese, LGBTQ+) Q39-Q45
Psychosocial Aspects & Disaster Management Q46-Q50
Section 1: Trauma Nursing Process & Primary Survey (A-B-C-D-E)
1. The correct sequence of the Trauma Nursing Process (TNP) is:
A) Triage → Primary Survey → Secondary Survey → Reassessment
B) Preparation and Triage → Primary Survey (A-B-C-D-E) → Secondary Survey →
Reassessment
C) Assessment → Intervention → Evaluation → Transfer
D) Primary Survey → History Taking → Secondary Survey → Disposition
Answer: B
Rationale: The Trauma Nursing Process (TNP) follows a systematic sequence
,designed to identify and intervene in life-threatening conditions . It begins
with Preparation and Triage, followed by the Primary Survey (A-B-C-D-E) to
address immediate threats, then the Secondary Survey (head-to-toe assessment
and history), and concludes with Reassessment to evaluate response to
interventions. This structured approach ensures no life threat is missed .
2. During the primary survey, the "A" stands for:
A) Airway with simultaneous cervical spine stabilization
B) Alertness and level of consciousness
C) Auscultation of breath sounds
D) Access for IV fluids
Answer: A
Rationale: In the primary survey, "A" stands for Airway with simultaneous
cervical spine stabilization. Any patient with significant mechanism of injury is
assumed to have a cervical spine injury until proven otherwise. The jaw-thrust
maneuver is the preferred airway opening technique as it maintains spinal
alignment . Option B is part of "D" (Disability). Option C is part of "B" (Breathing).
Option D is part of "C" (Circulation).
,3. A patient arrives with a Glasgow Coma Scale (GCS) score of 7. What is the
priority intervention?
A. Obtain a head CT scan
B. Administer mannitol
C. Secure a definitive airway
D. Place in Trendelenburg position
Answer: C
Rationale: A GCS of 8 or less indicates severe traumatic brain injury (TBI) and an
inability to protect the airway due to depressed mental status . Securing a
definitive airway (intubation) is the priority to prevent hypoxemia, hypercapnia,
and aspiration. Airway always comes before diagnostic imaging (A) or specific
treatments for intracranial pressure (B).
4. Which finding during the "B" (Breathing) assessment of the primary survey
requires immediate intervention?
A. Respiratory rate of 18 breaths/min
B. Absent breath sounds on one side with tracheal deviation
C. Oxygen saturation of 95% on room air
D. Mild chest wall ecchymosis
Answer: B
Rationale: Absent breath sounds on one side with tracheal deviation is a
, hallmark sign of tension pneumothorax, a life-threatening condition requiring
immediate needle decompression . The trachea deviates away from the affected
side due to pressure buildup. Options A and C are within normal range.
Ecchymosis (D) is a finding but not immediately life-threatening.
5. A patient has no palpable radial pulse but has a strong central
(carotid/femoral) pulse. According to TNCC hemodynamic classification, this
corresponds to an estimated blood loss of:
A) <750 mL
B) 750-1,500 mL
C) 1,500-2,000 mL
D) >2,000 mL
Answer: C
Rationale: TNCC classifies hemorrhage based on pulse quality and mental status:
Absent radial pulse + strong central pulse = Class III hemorrhage (1,500-2,000 mL
loss)
Absent radial + weak central = Class IV (>2,000 mL)
Present radial but tachycardic = Class I-II (<1,500 mL)
6. During the "C" (Circulation) assessment, which finding is most concerning?
,A. Heart rate of 110 beats/min
B. Cool, pale, diaphoretic skin
C. Blood pressure 130/80 mmHg
D. Capillary refill of 2 seconds
Answer: B
Rationale: Cool, pale, diaphoretic skin indicates hypoperfusion and
compensatory vasoconstriction (shock). The body shunts blood away from the
skin to preserve core organ perfusion. Tachycardia (A) is also a sign of shock, but
cool skin reflects the body's compensation. BP (C) may be normal or even
elevated in early shock (compensated). Capillary refill >2 seconds (D) is also a sign
of shock.
7. According to TNCC guidelines, what is the initial fluid bolus for an adult
trauma patient in hypovolemic shock?
A) 500 mL of 0.9% normal saline
B) 1 liter of Lactated Ringer's solution
C) 2 liters of warmed isotonic crystalloid
D) 1 unit of O-negative blood
Answer: C
Rationale: TNCC recommends an initial bolus of 2 liters of warmed isotonic
crystalloid (Lactated Ringer's or Normal Saline) for adults in hypovolemic shock .
Warmed fluids prevent hypothermia, which worsens coagulopathy. Options A and
,B are insufficient volumes. Blood products (D) are indicated after the initial
crystalloid bolus if the patient remains unstable.
8. The "D" (Disability) assessment in the primary survey evaluates:
A) Drug allergies and current medications
B) Neurological status using the AVPU scale or GCS, and pupillary response
C) Digestive system and bowel sounds
D) Determination of discharge plan
Answer: B
Rationale: "D" stands for Disability—a rapid neurologic assessment using
the AVPU scale (Alert, Verbal, Pain, Unresponsive) or Glasgow Coma Scale (GCS) ,
along with pupillary examination (size, symmetry, reactivity). This identifies acute
neurologic deterioration . Allergies and medications (A) are part of the secondary
survey (AMPLE history). Bowel sounds (C) are secondary survey. Disposition (D) is
later.
9. The "E" in the primary survey stands for:
A) Eyes – pupillary examination
B) Electrocardiogram monitoring
, C) Exposure with environmental control
D) Extremity splinting
Answer: C
Rationale: "E" stands for Exposure with environmental control. The patient is
completely undressed to allow full examination for hidden injuries, while
simultaneously preventing hypothermia using warm blankets, warmed IV fluids,
and increased room temperature . Hypothermia worsens coagulopathy and
acidosis (the "lethal triad").
10. Which statement about the secondary survey is correct?
A) It is performed before the primary survey
B) It includes a head-to-toe assessment and AMPLE history
C) It focuses only on the chief complaint
D) It is omitted in unstable patients
Answer: B
Rationale: The secondary survey is a comprehensive head-to-toe
assessment and AMPLE history (Allergies, Medications, Past medical history, Last
meal, Events/Environment) . It is performed after the primary survey is complete
and life threats are addressed. In unstable patients, it may be abbreviated or
deferred, but the goal is to complete it before the patient leaves the ED.
