TNCC final exam test 2024/2025
open book updated with complete
solution
SECTION 1: PRIMARY SURVEY & INITIAL ASSESSMENT
Question 1
What does the mnemonic ABCDE stand for in trauma care?
A) Assessment, Breathing, Care, Decision-making, Evaluation
B) Airway, Breathing, Circulation, Disability, Exposure
C) Airway, Breathing, Circulation, Disability, Environment
D) Assessment, Breathing, Circulation, Diagnosis, Evaluation
Correct Answer: B
,Rationale: ABCDE is the systematic approach to trauma assessment: Airway assessment
with cervical spine stabilization is first, followed by Breathing (ventilation and
oxygenation), Circulation (hemorrhage control and perfusion), Disability (neurological
status), and Exposure (full body examination with temperature control). This sequence
ensures life threats are identified and treated in order of priority .
Question 2
What is the leading cause of preventable death for the trauma patient in the
prehospital environment?
A) Airway compromise
B) Ineffective ventilation
C) Secondary head injury
D) Uncontrolled external hemorrhage
Correct Answer: D
Rationale: Uncontrolled external hemorrhage is the leading cause of preventable death
after injury in the prehospital environment. Assessment to identify uncontrolled external
hemorrhage is key to the initial assessment process, beginning with the general
impression .
Question 3
A trauma patient is restless and repeatedly asking "Where am I?" Vital signs upon
arrival: BP 100/60 mm Hg, HR 96 beats/min, RR 24 breaths/min. Skin is cool and
,dry. Current vital signs: BP 104/84 mm Hg, HR 108 beats/min, RR 28 breaths/min.
The patient is demonstrating signs and symptoms of which stage of shock?
A) Compensated
B) Progressive
C) Irreversible
D) Decompensated
Correct Answer: A
Rationale: Compensated shock is characterized by tachycardia, narrowing pulse pressure,
cool extremities, and anxiety or restlessness. The body maintains near-normal blood
pressure through compensatory mechanisms (increased heart rate, vasoconstriction).
Narrowing pulse pressure (from 40 to 20 mm Hg) is an early sign of decompensation .
Question 4
Why is a measure of serum lactate obtained in the initial assessment of the trauma
patient?
A) To measure oxygenation and ventilation
B) To quantify the base deficit for the adequacy of cellular perfusion
C) To gauge end-organ perfusion and tissue hypoxia
D) To determine the underlying cause of shock
Correct Answer: C
Rationale: Serum lactate is a marker of end-organ perfusion and tissue hypoxia. Elevated
lactate indicates inadequate oxygen delivery to tissues due to hypoperfusion. It helps guide
resuscitation efforts and predict outcomes .
, Question 5
During the primary survey of an unconscious patient with multi-system trauma,
the nurse notes snoring respirations. Which priority nursing intervention should
be performed next?
A) Open the airway with the head-tilt/chin lift maneuver
B) Auscultate bilateral breath sounds to assess ventilatory status
C) Assist respirations using a bag-valve-mask (BVM)
D) Insert an oropharyngeal airway if there is no gag reflex
Correct Answer: D
Rationale: Snoring respirations indicate partial airway obstruction from the tongue. If the
patient is unconscious and has no gag reflex, an oropharyngeal airway should be inserted
to maintain airway patency. The jaw-thrust maneuver (not head-tilt/chin lift) is used when
cervical spine injury is suspected .
Question 6
What is the appropriate technique for palpating the pelvis for stability?
A) Apply gentle pressure over the iliac crests, downward and laterally
B) Apply gentle pressure over the iliac crests, downward and medially
C) Apply firm pressure over the iliac crests, downward and laterally
D) Apply firm pressure over the iliac crests, downward and medially
Correct Answer: B
open book updated with complete
solution
SECTION 1: PRIMARY SURVEY & INITIAL ASSESSMENT
Question 1
What does the mnemonic ABCDE stand for in trauma care?
A) Assessment, Breathing, Care, Decision-making, Evaluation
B) Airway, Breathing, Circulation, Disability, Exposure
C) Airway, Breathing, Circulation, Disability, Environment
D) Assessment, Breathing, Circulation, Diagnosis, Evaluation
Correct Answer: B
,Rationale: ABCDE is the systematic approach to trauma assessment: Airway assessment
with cervical spine stabilization is first, followed by Breathing (ventilation and
oxygenation), Circulation (hemorrhage control and perfusion), Disability (neurological
status), and Exposure (full body examination with temperature control). This sequence
ensures life threats are identified and treated in order of priority .
Question 2
What is the leading cause of preventable death for the trauma patient in the
prehospital environment?
A) Airway compromise
B) Ineffective ventilation
C) Secondary head injury
D) Uncontrolled external hemorrhage
Correct Answer: D
Rationale: Uncontrolled external hemorrhage is the leading cause of preventable death
after injury in the prehospital environment. Assessment to identify uncontrolled external
hemorrhage is key to the initial assessment process, beginning with the general
impression .
Question 3
A trauma patient is restless and repeatedly asking "Where am I?" Vital signs upon
arrival: BP 100/60 mm Hg, HR 96 beats/min, RR 24 breaths/min. Skin is cool and
,dry. Current vital signs: BP 104/84 mm Hg, HR 108 beats/min, RR 28 breaths/min.
The patient is demonstrating signs and symptoms of which stage of shock?
A) Compensated
B) Progressive
C) Irreversible
D) Decompensated
Correct Answer: A
Rationale: Compensated shock is characterized by tachycardia, narrowing pulse pressure,
cool extremities, and anxiety or restlessness. The body maintains near-normal blood
pressure through compensatory mechanisms (increased heart rate, vasoconstriction).
Narrowing pulse pressure (from 40 to 20 mm Hg) is an early sign of decompensation .
Question 4
Why is a measure of serum lactate obtained in the initial assessment of the trauma
patient?
A) To measure oxygenation and ventilation
B) To quantify the base deficit for the adequacy of cellular perfusion
C) To gauge end-organ perfusion and tissue hypoxia
D) To determine the underlying cause of shock
Correct Answer: C
Rationale: Serum lactate is a marker of end-organ perfusion and tissue hypoxia. Elevated
lactate indicates inadequate oxygen delivery to tissues due to hypoperfusion. It helps guide
resuscitation efforts and predict outcomes .
, Question 5
During the primary survey of an unconscious patient with multi-system trauma,
the nurse notes snoring respirations. Which priority nursing intervention should
be performed next?
A) Open the airway with the head-tilt/chin lift maneuver
B) Auscultate bilateral breath sounds to assess ventilatory status
C) Assist respirations using a bag-valve-mask (BVM)
D) Insert an oropharyngeal airway if there is no gag reflex
Correct Answer: D
Rationale: Snoring respirations indicate partial airway obstruction from the tongue. If the
patient is unconscious and has no gag reflex, an oropharyngeal airway should be inserted
to maintain airway patency. The jaw-thrust maneuver (not head-tilt/chin lift) is used when
cervical spine injury is suspected .
Question 6
What is the appropriate technique for palpating the pelvis for stability?
A) Apply gentle pressure over the iliac crests, downward and laterally
B) Apply gentle pressure over the iliac crests, downward and medially
C) Apply firm pressure over the iliac crests, downward and laterally
D) Apply firm pressure over the iliac crests, downward and medially
Correct Answer: B
