TNCC 8th Edition 45 Questions & Answers 2026/2027 Complete
Solution with Detailed Rationales | Complete Exam-Style Questions |
Graded A+ Pass Guaranteed
SECTION I: Primary Survey and Trauma Triage
Question 1
During the primary survey of a trauma patient, the nurse identifies a patent airway but
notes gurgling respirations and decreased oxygen saturation. Which intervention should
the nurse perform first?
A. Apply a non-rebreather mask at 15 L/min
B. Insert an oropharyngeal airway and suction the oropharynx
C. Initiate bag-valve-mask ventilation
D. Prepare for emergent endotracheal intubation
Correct Answer: B
Rationale: Option B is correct because gurgling respirations indicate the presence of
blood, vomitus, or secretions in the oropharynx that are compromising the airway.
According to the TNCC primary survey algorithm, the first step in airway management is
to open the airway and clear secretions using suction. An oropharyngeal airway may be
inserted to maintain patency if the patient does not have a gag reflex. Option A is
incorrect because applying oxygen without first clearing the airway will not address the
underlying obstruction and may force debris deeper. Option C is incorrect because
bag-valve-mask ventilation is indicated when the patient is apneic or has inadequate
respiratory effort, not when the primary problem is airway obstruction from secretions.
Option D is incorrect because while intubation may be necessary, it is not the first
intervention; the airway must be cleared and assessed first.
,Question 2
A 32-year-old male is brought to the emergency department after a motorcycle crash.
He is alert but complaining of severe chest pain and difficulty breathing. His respiratory
rate is 32 breaths/min, oxygen saturation is 88% on room air, and breath sounds are
absent on the left side. Tracheal deviation is noted to the right. Which condition should
the nurse anticipate and prepare to assist with immediately?
A. Hemothorax
B. Tension pneumothorax
C. Flail chest
D. Pulmonary contusion
Correct Answer: B
Rationale: Option B is correct because the combination of absent breath sounds on the
affected side, severe respiratory distress, hypoxemia, and tracheal deviation away from
the affected side is pathognomonic for tension pneumothorax. This is a life-threatening
condition requiring immediate needle decompression followed by chest tube insertion.
Option A is incorrect because while hemothorax can cause absent breath sounds and
respiratory distress, it does not typically cause tracheal deviation away from the
affected side unless the blood volume is massive. Option C is incorrect because flail
chest presents with paradoxical chest wall movement and respiratory compromise but
does not cause absent breath sounds or tracheal deviation. Option D is incorrect
because pulmonary contusion causes respiratory distress and hypoxemia but does not
produce absent breath sounds or tracheal deviation.
Question 3
A trauma patient presents with a heart rate of 128 beats/min, blood pressure of 82/54
mmHg, cool and clammy skin, and delayed capillary refill. The nurse recognizes that
these findings are most consistent with which class of hemorrhagic shock according to
ATLS classification?
,A. Class I hemorrhagic shock
B. Class II hemorrhagic shock
C. Class III hemorrhagic shock
D. Class IV hemorrhagic shock
Correct Answer: C
Rationale: Option C is correct because Class III hemorrhagic shock is characterized by
blood loss of 30-40% of total blood volume (1500-2000 mL in a 70-kg adult), presenting
with tachycardia (>120 beats/min), hypotension (systolic BP <90 mmHg), cool and
clammy skin, delayed capillary refill (>2 seconds), and altered mental status. This
represents uncompensated shock where the body's compensatory mechanisms are
failing. Option A is incorrect because Class I shock involves <15% blood loss with
minimal clinical signs and normal vital signs. Option B is incorrect because Class II
shock involves 15-30% blood loss with tachycardia (100-120 beats/min) but normal
blood pressure due to compensatory vasoconstriction. Option D is incorrect because
Class IV shock involves >40% blood loss with profound hypotension, bradycardia (in
terminal stages), and imminent death.
Question 4
During the primary survey, a trauma patient is found to have a Glasgow Coma Scale
(GCS) score of 8 (E2, V2, M4). Which action is the priority for the trauma nurse?
A. Complete the secondary survey to identify all injuries
B. Prepare the patient for emergent intubation to protect the airway
C. Obtain a detailed history from the patient
D. Perform a focused neurological examination including pupillary response
Correct Answer: B
Rationale: Option B is correct because a GCS score of 8 or less indicates a severe
traumatic brain injury with a high risk of airway compromise due to loss of protective
airway reflexes. According to ATLS and TNCC guidelines, patients with a GCS ≤8 require
, emergent intubation to protect the airway, prevent hypoxia, and control ventilation.
Option A is incorrect because the secondary survey should not be performed until the
primary survey is complete and life-threatening conditions are addressed; airway
protection takes precedence. Option C is incorrect because a patient with a GCS of 8
cannot provide a reliable history, and attempting to do so delays critical interventions.
Option D is incorrect because while pupillary assessment is important, it does not take
precedence over airway protection in a patient with a GCS of 8.
Question 5
A trauma patient arrives with a stab wound to the right upper quadrant of the abdomen.
During the primary survey, the nurse notes that the patient is hypotensive, tachycardic,
and has a rigid, distended abdomen. Which phase of the primary survey is most directly
compromised, and what is the immediate nursing intervention?
A. Airway; insert an oropharyngeal airway
B. Breathing; apply a non-rebreather mask
C. Circulation; initiate two large-bore IVs and administer crystalloid fluids
D. Disability; assess the Glasgow Coma Scale
Correct Answer: C
Rationale: Option C is correct because the patient's presentation (hypotension,
tachycardia, rigid and distended abdomen following penetrating abdominal trauma)
indicates hemorrhagic shock due to intra-abdominal bleeding, which is a circulation
problem. The immediate intervention is to establish two large-bore IV lines (14- or
16-gauge) and initiate fluid resuscitation with crystalloids, followed by blood products
as indicated. Option A is incorrect because there is no indication of airway compromise
in this scenario. Option B is incorrect because while oxygen should be administered, the
primary life threat is circulatory collapse from hemorrhage, not respiratory failure.
Option D is incorrect because although disability assessment is part of the primary
survey, it does not address the immediate threat of exsanguination.
Solution with Detailed Rationales | Complete Exam-Style Questions |
Graded A+ Pass Guaranteed
SECTION I: Primary Survey and Trauma Triage
Question 1
During the primary survey of a trauma patient, the nurse identifies a patent airway but
notes gurgling respirations and decreased oxygen saturation. Which intervention should
the nurse perform first?
A. Apply a non-rebreather mask at 15 L/min
B. Insert an oropharyngeal airway and suction the oropharynx
C. Initiate bag-valve-mask ventilation
D. Prepare for emergent endotracheal intubation
Correct Answer: B
Rationale: Option B is correct because gurgling respirations indicate the presence of
blood, vomitus, or secretions in the oropharynx that are compromising the airway.
According to the TNCC primary survey algorithm, the first step in airway management is
to open the airway and clear secretions using suction. An oropharyngeal airway may be
inserted to maintain patency if the patient does not have a gag reflex. Option A is
incorrect because applying oxygen without first clearing the airway will not address the
underlying obstruction and may force debris deeper. Option C is incorrect because
bag-valve-mask ventilation is indicated when the patient is apneic or has inadequate
respiratory effort, not when the primary problem is airway obstruction from secretions.
Option D is incorrect because while intubation may be necessary, it is not the first
intervention; the airway must be cleared and assessed first.
,Question 2
A 32-year-old male is brought to the emergency department after a motorcycle crash.
He is alert but complaining of severe chest pain and difficulty breathing. His respiratory
rate is 32 breaths/min, oxygen saturation is 88% on room air, and breath sounds are
absent on the left side. Tracheal deviation is noted to the right. Which condition should
the nurse anticipate and prepare to assist with immediately?
A. Hemothorax
B. Tension pneumothorax
C. Flail chest
D. Pulmonary contusion
Correct Answer: B
Rationale: Option B is correct because the combination of absent breath sounds on the
affected side, severe respiratory distress, hypoxemia, and tracheal deviation away from
the affected side is pathognomonic for tension pneumothorax. This is a life-threatening
condition requiring immediate needle decompression followed by chest tube insertion.
Option A is incorrect because while hemothorax can cause absent breath sounds and
respiratory distress, it does not typically cause tracheal deviation away from the
affected side unless the blood volume is massive. Option C is incorrect because flail
chest presents with paradoxical chest wall movement and respiratory compromise but
does not cause absent breath sounds or tracheal deviation. Option D is incorrect
because pulmonary contusion causes respiratory distress and hypoxemia but does not
produce absent breath sounds or tracheal deviation.
Question 3
A trauma patient presents with a heart rate of 128 beats/min, blood pressure of 82/54
mmHg, cool and clammy skin, and delayed capillary refill. The nurse recognizes that
these findings are most consistent with which class of hemorrhagic shock according to
ATLS classification?
,A. Class I hemorrhagic shock
B. Class II hemorrhagic shock
C. Class III hemorrhagic shock
D. Class IV hemorrhagic shock
Correct Answer: C
Rationale: Option C is correct because Class III hemorrhagic shock is characterized by
blood loss of 30-40% of total blood volume (1500-2000 mL in a 70-kg adult), presenting
with tachycardia (>120 beats/min), hypotension (systolic BP <90 mmHg), cool and
clammy skin, delayed capillary refill (>2 seconds), and altered mental status. This
represents uncompensated shock where the body's compensatory mechanisms are
failing. Option A is incorrect because Class I shock involves <15% blood loss with
minimal clinical signs and normal vital signs. Option B is incorrect because Class II
shock involves 15-30% blood loss with tachycardia (100-120 beats/min) but normal
blood pressure due to compensatory vasoconstriction. Option D is incorrect because
Class IV shock involves >40% blood loss with profound hypotension, bradycardia (in
terminal stages), and imminent death.
Question 4
During the primary survey, a trauma patient is found to have a Glasgow Coma Scale
(GCS) score of 8 (E2, V2, M4). Which action is the priority for the trauma nurse?
A. Complete the secondary survey to identify all injuries
B. Prepare the patient for emergent intubation to protect the airway
C. Obtain a detailed history from the patient
D. Perform a focused neurological examination including pupillary response
Correct Answer: B
Rationale: Option B is correct because a GCS score of 8 or less indicates a severe
traumatic brain injury with a high risk of airway compromise due to loss of protective
airway reflexes. According to ATLS and TNCC guidelines, patients with a GCS ≤8 require
, emergent intubation to protect the airway, prevent hypoxia, and control ventilation.
Option A is incorrect because the secondary survey should not be performed until the
primary survey is complete and life-threatening conditions are addressed; airway
protection takes precedence. Option C is incorrect because a patient with a GCS of 8
cannot provide a reliable history, and attempting to do so delays critical interventions.
Option D is incorrect because while pupillary assessment is important, it does not take
precedence over airway protection in a patient with a GCS of 8.
Question 5
A trauma patient arrives with a stab wound to the right upper quadrant of the abdomen.
During the primary survey, the nurse notes that the patient is hypotensive, tachycardic,
and has a rigid, distended abdomen. Which phase of the primary survey is most directly
compromised, and what is the immediate nursing intervention?
A. Airway; insert an oropharyngeal airway
B. Breathing; apply a non-rebreather mask
C. Circulation; initiate two large-bore IVs and administer crystalloid fluids
D. Disability; assess the Glasgow Coma Scale
Correct Answer: C
Rationale: Option C is correct because the patient's presentation (hypotension,
tachycardia, rigid and distended abdomen following penetrating abdominal trauma)
indicates hemorrhagic shock due to intra-abdominal bleeding, which is a circulation
problem. The immediate intervention is to establish two large-bore IV lines (14- or
16-gauge) and initiate fluid resuscitation with crystalloids, followed by blood products
as indicated. Option A is incorrect because there is no indication of airway compromise
in this scenario. Option B is incorrect because while oxygen should be administered, the
primary life threat is circulatory collapse from hemorrhage, not respiratory failure.
Option D is incorrect because although disability assessment is part of the primary
survey, it does not address the immediate threat of exsanguination.
