TNCC Written Exam EXAM with Questions and
Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Trauma Nursing Process and Systematic Assessment
2. Neurological Trauma and Traumatic Brain Injury
3. Maxillofacial and Ocular Trauma
4. Thoracic and Pulmonary Trauma
5. Abdominal and Retroperitoneal Trauma
6. Musculoskeletal and Vascular Trauma
7. Integumentary and Burn Trauma
8. Pediatric, Geriatric, and Pregnant Trauma Patients
9. Shock, Hemorrhage, and Fluid Resuscitation
10. Psychosocial Aspects of Trauma and Ethical/Legal Considerations
1. A patient arrives after a motorcycle crash with an open femur fracture, multiple abrasions, and a
deformed wrist. During the primary survey, the patient is agitated and tachypneic. Which initial
intervention is most critical for hemodynamic stabilization?
A. Applying a tourniquet to the femur fracture to control occult bleeding.
B. Initiating two large-bore IVs for rapid fluid resuscitation with warmed isotonic
crystalloids.
, C. Performing a complete neurovascular assessment of the affected extremities.
D. Administering high-dose opioid analgesics to manage pain and decrease respiratory drive.
Answer: B
CORRECT ANSWER : B
Rationale: In the primary survey, stabilization of circulation is prioritized to treat potential
hypovolemic shock. Option A is incorrect as a tourniquet is for life-threatening hemorrhage.
Option C is secondary to circulation, and Option D is contraindicated until hemodynamic
stability is achieved due to respiratory depressive effects.
2. During the primary survey of a trauma patient, you identify a tension pneumothorax. What is the
most appropriate immediate action?
A. Obtaining a portable chest X-ray to confirm the diagnosis.
B. Performing immediate needle thoracostomy followed by chest tube placement.
C. Intubating the patient to manage potential airway compromise.
D. Administering 100% oxygen via a non-rebreather mask while observing for improvement.
Answer: B
CORRECT ANSWER : B
Rationale: A tension pneumothorax is a clinical diagnosis requiring immediate decompression to
prevent cardiovascular collapse. Option A delays life-saving treatment, Option C does not
address the thoracic pressure, and Option D is insufficient to reverse the hemodynamic
compromise.
3. A patient presents with a blunt chest injury and exhibits signs of cardiac tamponade (Beck's
triad). Which finding would the nurse expect to assess?
A. Hyper-resonance to percussion on the affected side.
B. Muffled heart sounds, hypotension, and jugular venous distention.
C. Tracheal deviation toward the side of the injury.
D. Diminished breath sounds on the affected side.
Answer: B
, CORRECT ANSWER : B
Rationale: Beck’s triad (hypotension, JVD, and muffled heart sounds) is the classic clinical
presentation of cardiac tamponade. Options A, C, and D are characteristic of a tension
pneumothorax, not cardiac tamponade.
4. A 28-year-old female in the third trimester of pregnancy is brought in after a motor vehicle
collision. She is complaining of abdominal pain and vaginal bleeding. What is the priority
concern?
A. Assessing the fetus for distress via electronic monitoring.
B. Assessing the mother for signs of placental abruption and hemodynamic stability.
C. Administering tocolytic agents to prevent preterm labor.
D. Performing a sterile vaginal exam to determine cervical dilation.
Answer: B
CORRECT ANSWER : B
Rationale: In trauma, the mother's survival is the prerequisite for fetal survival; placental
abruption is a life-threatening complication of blunt abdominal trauma. Option A is secondary to
maternal stability, Option C may mask signs of shock, and Option D is contraindicated due to
risk of provoking hemorrhage.
5. A patient with a traumatic brain injury (TBI) and a GCS of 7 is being managed in the trauma
bay. The patient’s pupils become unequal and non-reactive. What is the most likely cause?
A. A simple concussion causing temporary autonomic dysregulation.
B. Rising intracranial pressure leading to uncal herniation.
C. Secondary brain injury due to hypoxemia.
D. Direct ocular nerve trauma from a facial fracture.
Answer: B
CORRECT ANSWER : B
Rationale: Ipsilateral pupil dilation and loss of reactivity are classic signs of uncal herniation
due to increased intracranial pressure (ICP). Option A is not associated with GCS 7 or pupil
changes, Option C would likely cause bilateral changes, and Option D is less common than
herniation in a TBI patient.
, 6. A trauma patient has a suspected spinal cord injury at the level of T4. The patient develops
bradycardia, hypotension, and warm, dry skin. How should the nurse interpret this?
A. Hypovolemic shock due to occult internal hemorrhage.
B. Neurogenic shock due to loss of sympathetic tone.
C. Septic shock from a secondary infection.
D. Cardiogenic shock from myocardial contusion.
Answer: B
CORRECT ANSWER : B
Rationale: Neurogenic shock is characterized by hypotension, bradycardia, and warm
extremities due to the loss of sympathetic nervous system outflow. Option A would present with
tachycardia, Option C is unlikely in the immediate trauma phase, and Option D would typically
present with different clinical markers.
7. A patient presents with severe facial trauma. During the airway assessment, the patient is unable
to maintain an airway due to extensive blood and debris. What is the preferred method for airway
management?
A. Nasotracheal intubation.
B. Surgical cricothyrotomy.
C. Oropharyngeal airway and bag-valve-mask ventilation.
D. Laryngeal mask airway (LMA).
Answer: B
CORRECT ANSWER : B
Rationale: In patients with severe facial trauma where the airway is obstructed and cannot be
maintained, a surgical airway is the gold standard. Options A, C, and D are often ineffective or
contraindicated in severe facial trauma due to anatomical disruption.
8. When assessing an abdominal trauma patient, the nurse identifies a "Grey Turner sign." What
does this indicate?
A. Rupture of the spleen.
B. Retroperitoneal hemorrhage.
Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Trauma Nursing Process and Systematic Assessment
2. Neurological Trauma and Traumatic Brain Injury
3. Maxillofacial and Ocular Trauma
4. Thoracic and Pulmonary Trauma
5. Abdominal and Retroperitoneal Trauma
6. Musculoskeletal and Vascular Trauma
7. Integumentary and Burn Trauma
8. Pediatric, Geriatric, and Pregnant Trauma Patients
9. Shock, Hemorrhage, and Fluid Resuscitation
10. Psychosocial Aspects of Trauma and Ethical/Legal Considerations
1. A patient arrives after a motorcycle crash with an open femur fracture, multiple abrasions, and a
deformed wrist. During the primary survey, the patient is agitated and tachypneic. Which initial
intervention is most critical for hemodynamic stabilization?
A. Applying a tourniquet to the femur fracture to control occult bleeding.
B. Initiating two large-bore IVs for rapid fluid resuscitation with warmed isotonic
crystalloids.
, C. Performing a complete neurovascular assessment of the affected extremities.
D. Administering high-dose opioid analgesics to manage pain and decrease respiratory drive.
Answer: B
CORRECT ANSWER : B
Rationale: In the primary survey, stabilization of circulation is prioritized to treat potential
hypovolemic shock. Option A is incorrect as a tourniquet is for life-threatening hemorrhage.
Option C is secondary to circulation, and Option D is contraindicated until hemodynamic
stability is achieved due to respiratory depressive effects.
2. During the primary survey of a trauma patient, you identify a tension pneumothorax. What is the
most appropriate immediate action?
A. Obtaining a portable chest X-ray to confirm the diagnosis.
B. Performing immediate needle thoracostomy followed by chest tube placement.
C. Intubating the patient to manage potential airway compromise.
D. Administering 100% oxygen via a non-rebreather mask while observing for improvement.
Answer: B
CORRECT ANSWER : B
Rationale: A tension pneumothorax is a clinical diagnosis requiring immediate decompression to
prevent cardiovascular collapse. Option A delays life-saving treatment, Option C does not
address the thoracic pressure, and Option D is insufficient to reverse the hemodynamic
compromise.
3. A patient presents with a blunt chest injury and exhibits signs of cardiac tamponade (Beck's
triad). Which finding would the nurse expect to assess?
A. Hyper-resonance to percussion on the affected side.
B. Muffled heart sounds, hypotension, and jugular venous distention.
C. Tracheal deviation toward the side of the injury.
D. Diminished breath sounds on the affected side.
Answer: B
, CORRECT ANSWER : B
Rationale: Beck’s triad (hypotension, JVD, and muffled heart sounds) is the classic clinical
presentation of cardiac tamponade. Options A, C, and D are characteristic of a tension
pneumothorax, not cardiac tamponade.
4. A 28-year-old female in the third trimester of pregnancy is brought in after a motor vehicle
collision. She is complaining of abdominal pain and vaginal bleeding. What is the priority
concern?
A. Assessing the fetus for distress via electronic monitoring.
B. Assessing the mother for signs of placental abruption and hemodynamic stability.
C. Administering tocolytic agents to prevent preterm labor.
D. Performing a sterile vaginal exam to determine cervical dilation.
Answer: B
CORRECT ANSWER : B
Rationale: In trauma, the mother's survival is the prerequisite for fetal survival; placental
abruption is a life-threatening complication of blunt abdominal trauma. Option A is secondary to
maternal stability, Option C may mask signs of shock, and Option D is contraindicated due to
risk of provoking hemorrhage.
5. A patient with a traumatic brain injury (TBI) and a GCS of 7 is being managed in the trauma
bay. The patient’s pupils become unequal and non-reactive. What is the most likely cause?
A. A simple concussion causing temporary autonomic dysregulation.
B. Rising intracranial pressure leading to uncal herniation.
C. Secondary brain injury due to hypoxemia.
D. Direct ocular nerve trauma from a facial fracture.
Answer: B
CORRECT ANSWER : B
Rationale: Ipsilateral pupil dilation and loss of reactivity are classic signs of uncal herniation
due to increased intracranial pressure (ICP). Option A is not associated with GCS 7 or pupil
changes, Option C would likely cause bilateral changes, and Option D is less common than
herniation in a TBI patient.
, 6. A trauma patient has a suspected spinal cord injury at the level of T4. The patient develops
bradycardia, hypotension, and warm, dry skin. How should the nurse interpret this?
A. Hypovolemic shock due to occult internal hemorrhage.
B. Neurogenic shock due to loss of sympathetic tone.
C. Septic shock from a secondary infection.
D. Cardiogenic shock from myocardial contusion.
Answer: B
CORRECT ANSWER : B
Rationale: Neurogenic shock is characterized by hypotension, bradycardia, and warm
extremities due to the loss of sympathetic nervous system outflow. Option A would present with
tachycardia, Option C is unlikely in the immediate trauma phase, and Option D would typically
present with different clinical markers.
7. A patient presents with severe facial trauma. During the airway assessment, the patient is unable
to maintain an airway due to extensive blood and debris. What is the preferred method for airway
management?
A. Nasotracheal intubation.
B. Surgical cricothyrotomy.
C. Oropharyngeal airway and bag-valve-mask ventilation.
D. Laryngeal mask airway (LMA).
Answer: B
CORRECT ANSWER : B
Rationale: In patients with severe facial trauma where the airway is obstructed and cannot be
maintained, a surgical airway is the gold standard. Options A, C, and D are often ineffective or
contraindicated in severe facial trauma due to anatomical disruption.
8. When assessing an abdominal trauma patient, the nurse identifies a "Grey Turner sign." What
does this indicate?
A. Rupture of the spleen.
B. Retroperitoneal hemorrhage.
