TNCC TEST PREP A LATEST 2022 EXAM
with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Initial Assessment and Triage
2. Airway and Ventilation Management
3. Circulation and Hemorrhage Control
4. Neurological Assessment and Traumatic Brain Injury
5. Thoracic and Abdominal Trauma
6. Musculoskeletal and Integumentary Trauma
7. Shock States and Fluid Resuscitation
8. Special Populations: Pediatric, Geriatric, and Pregnant Trauma Patients
9. Psychosocial Aspects of Trauma Care
1. A 34-year-old patient arrives via EMS after a high-speed motorcycle crash. Upon
assessment, the patient is agitated, has absent breath sounds on the right side, and a deviated
trachea to the left. Which of the following is the most appropriate initial intervention?
A. Perform a rapid sequence intubation (RSI) to secure the airway.
B. Perform immediate needle thoracocentesis in the second intercostal space at the mid-
clavicular line.
C. Obtain a portable chest X-ray to confirm the suspected tension pneumothorax.
, D. Initiate a 2-liter bolus of warmed isotonic crystalloid fluid.
Answer: B
CORRECT ANSWER : B
Rationale: The patient exhibits classic signs of a tension pneumothorax, which is a clinical
diagnosis requiring immediate decompression, not diagnostic imaging. Option B is the life-
saving intervention. Options A and C delay definitive treatment of a lethal condition, and Option
D does not address the underlying thoracic pressure.
2. A trauma patient presents with a blunt abdominal injury. The patient is tachycardic,
tachypneic, and hypotensive. After a FAST exam reveals free fluid in the RUQ, the patient’s BP
drops to 70/40 mmHg. What is the priority management strategy?
A. Administer a sedative to prevent patient movement.
B. Prepare for an immediate transfer to the operating room for laparotomy.
C. Order a CT scan of the abdomen to identify the specific organ laceration.
D. Maintain the patient in a Trendelenburg position to improve cerebral perfusion.
Answer: B
CORRECT ANSWER : B
Rationale: The patient is hemodynamically unstable with evidence of intraperitoneal
hemorrhage. Immediate surgical exploration (laparotomy) is the definitive treatment. Option C
wastes critical time, Option A is contraindicated in unstable shock, and Option D is ineffective
for hemorrhagic shock.
3. During the primary assessment of a patient with a suspected spinal cord injury, you note
that the patient has warm, dry skin, bradycardia, and hypotension. What is the most likely
etiology?
A. Hypovolemic shock.
B. Neurogenic shock.
C. Cardiogenic shock.
D. Septic shock.
Answer: B
, CORRECT ANSWER : B
Rationale: Neurogenic shock occurs due to loss of sympathetic tone, resulting in vasodilation
(warm skin) and loss of tachycardia response (bradycardia). Hypovolemic shock (A) typically
presents with cool, clammy skin and tachycardia, while C and D are inconsistent with the classic
spinal cord injury presentation.
4. A patient sustained a chemical burn to the eyes after an industrial accident. What is the
priority nursing action?
A. Apply a sterile patch to both eyes to prevent infection.
B. Irrigate the eyes with isotonic saline or water for at least 30 minutes.
C. Instill a topical anesthetic to reduce the patient's pain.
D. Check visual acuity using a Snellen chart.
Answer: B
CORRECT ANSWER : B
Rationale: Copious irrigation is the only way to minimize permanent damage from chemical
exposure by removing the offending agent. Patching (A) traps the chemical, anesthetic (C) masks
symptoms but does not treat the injury, and visual acuity (D) is a secondary concern.
5. A 72-year-old patient falls from a standing height and presents with a hip fracture. Why
is it critical to reassess this patient more frequently than a younger patient?
A. Older patients are more prone to infections.
B. Older patients have less physiological reserve and may decompensate rapidly.
C. Older patients are more likely to have cognitive deficits.
D. Older patients always require higher doses of pain medication.
Answer: B
CORRECT ANSWER : B
Rationale: Aging leads to diminished functional and physiological reserve, making older adults
highly susceptible to rapid decline after trauma. While A and C may be true, B describes the
primary clinical risk requiring vigilant reassessment. Option D is incorrect; older patients often
require lower doses due to altered metabolism.
, 6. Which assessment finding in a patient with a pelvic fracture is most concerning for life-
threatening hemorrhage?
A. Ecchymosis over the pubic bone.
B. Narrowing pulse pressure and persistent tachycardia.
C. Pain on palpation of the iliac crest.
D. Inability to void.
Answer: B
CORRECT ANSWER : B
Rationale: Pelvic fractures can lead to massive retroperitoneal hemorrhage. Narrowing pulse
pressure is an early clinical indicator of compensatory shock. Options A, C, and D are expected
signs of injury but do not signal imminent circulatory collapse as clearly as hemodynamic
changes.
7. A patient with a traumatic brain injury (TBI) is noted to have a Glasgow Coma Scale
(GCS) score drop from 14 to 9. What is the first priority?
A. Administer mannitol to reduce intracranial pressure.
B. Reassess the airway and consider definitive airway management.
C. Hyperventilate the patient to achieve a $pCO_2$ of 25 mmHg.
D. Elevate the head of the bed to 45 degrees.
Answer: B
CORRECT ANSWER : B
Rationale: A GCS of 8 or less generally indicates the need for intubation to protect the airway; a
rapid decline to 9 necessitates immediate airway assessment. Options A and D are interventions,
but airway security takes precedence. Hyperventilation (C) is now used cautiously and not as an
initial, unmonitored maneuver.
8. You are managing a patient with a flail chest injury. What is the most critical
complication to monitor for?
A. Pain-related hypertension.
B. Underlying pulmonary contusion leading to respiratory failure.
with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Initial Assessment and Triage
2. Airway and Ventilation Management
3. Circulation and Hemorrhage Control
4. Neurological Assessment and Traumatic Brain Injury
5. Thoracic and Abdominal Trauma
6. Musculoskeletal and Integumentary Trauma
7. Shock States and Fluid Resuscitation
8. Special Populations: Pediatric, Geriatric, and Pregnant Trauma Patients
9. Psychosocial Aspects of Trauma Care
1. A 34-year-old patient arrives via EMS after a high-speed motorcycle crash. Upon
assessment, the patient is agitated, has absent breath sounds on the right side, and a deviated
trachea to the left. Which of the following is the most appropriate initial intervention?
A. Perform a rapid sequence intubation (RSI) to secure the airway.
B. Perform immediate needle thoracocentesis in the second intercostal space at the mid-
clavicular line.
C. Obtain a portable chest X-ray to confirm the suspected tension pneumothorax.
, D. Initiate a 2-liter bolus of warmed isotonic crystalloid fluid.
Answer: B
CORRECT ANSWER : B
Rationale: The patient exhibits classic signs of a tension pneumothorax, which is a clinical
diagnosis requiring immediate decompression, not diagnostic imaging. Option B is the life-
saving intervention. Options A and C delay definitive treatment of a lethal condition, and Option
D does not address the underlying thoracic pressure.
2. A trauma patient presents with a blunt abdominal injury. The patient is tachycardic,
tachypneic, and hypotensive. After a FAST exam reveals free fluid in the RUQ, the patient’s BP
drops to 70/40 mmHg. What is the priority management strategy?
A. Administer a sedative to prevent patient movement.
B. Prepare for an immediate transfer to the operating room for laparotomy.
C. Order a CT scan of the abdomen to identify the specific organ laceration.
D. Maintain the patient in a Trendelenburg position to improve cerebral perfusion.
Answer: B
CORRECT ANSWER : B
Rationale: The patient is hemodynamically unstable with evidence of intraperitoneal
hemorrhage. Immediate surgical exploration (laparotomy) is the definitive treatment. Option C
wastes critical time, Option A is contraindicated in unstable shock, and Option D is ineffective
for hemorrhagic shock.
3. During the primary assessment of a patient with a suspected spinal cord injury, you note
that the patient has warm, dry skin, bradycardia, and hypotension. What is the most likely
etiology?
A. Hypovolemic shock.
B. Neurogenic shock.
C. Cardiogenic shock.
D. Septic shock.
Answer: B
, CORRECT ANSWER : B
Rationale: Neurogenic shock occurs due to loss of sympathetic tone, resulting in vasodilation
(warm skin) and loss of tachycardia response (bradycardia). Hypovolemic shock (A) typically
presents with cool, clammy skin and tachycardia, while C and D are inconsistent with the classic
spinal cord injury presentation.
4. A patient sustained a chemical burn to the eyes after an industrial accident. What is the
priority nursing action?
A. Apply a sterile patch to both eyes to prevent infection.
B. Irrigate the eyes with isotonic saline or water for at least 30 minutes.
C. Instill a topical anesthetic to reduce the patient's pain.
D. Check visual acuity using a Snellen chart.
Answer: B
CORRECT ANSWER : B
Rationale: Copious irrigation is the only way to minimize permanent damage from chemical
exposure by removing the offending agent. Patching (A) traps the chemical, anesthetic (C) masks
symptoms but does not treat the injury, and visual acuity (D) is a secondary concern.
5. A 72-year-old patient falls from a standing height and presents with a hip fracture. Why
is it critical to reassess this patient more frequently than a younger patient?
A. Older patients are more prone to infections.
B. Older patients have less physiological reserve and may decompensate rapidly.
C. Older patients are more likely to have cognitive deficits.
D. Older patients always require higher doses of pain medication.
Answer: B
CORRECT ANSWER : B
Rationale: Aging leads to diminished functional and physiological reserve, making older adults
highly susceptible to rapid decline after trauma. While A and C may be true, B describes the
primary clinical risk requiring vigilant reassessment. Option D is incorrect; older patients often
require lower doses due to altered metabolism.
, 6. Which assessment finding in a patient with a pelvic fracture is most concerning for life-
threatening hemorrhage?
A. Ecchymosis over the pubic bone.
B. Narrowing pulse pressure and persistent tachycardia.
C. Pain on palpation of the iliac crest.
D. Inability to void.
Answer: B
CORRECT ANSWER : B
Rationale: Pelvic fractures can lead to massive retroperitoneal hemorrhage. Narrowing pulse
pressure is an early clinical indicator of compensatory shock. Options A, C, and D are expected
signs of injury but do not signal imminent circulatory collapse as clearly as hemodynamic
changes.
7. A patient with a traumatic brain injury (TBI) is noted to have a Glasgow Coma Scale
(GCS) score drop from 14 to 9. What is the first priority?
A. Administer mannitol to reduce intracranial pressure.
B. Reassess the airway and consider definitive airway management.
C. Hyperventilate the patient to achieve a $pCO_2$ of 25 mmHg.
D. Elevate the head of the bed to 45 degrees.
Answer: B
CORRECT ANSWER : B
Rationale: A GCS of 8 or less generally indicates the need for intubation to protect the airway; a
rapid decline to 9 necessitates immediate airway assessment. Options A and D are interventions,
but airway security takes precedence. Hyperventilation (C) is now used cautiously and not as an
initial, unmonitored maneuver.
8. You are managing a patient with a flail chest injury. What is the most critical
complication to monitor for?
A. Pain-related hypertension.
B. Underlying pulmonary contusion leading to respiratory failure.
