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TNCC FINAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. A trauma patient arrives at the emergency department following a
motor vehicle collision. The nurse is performing the primary survey.
Which of the following is the PRIORITY action during the "Airway"
assessment?
A) Assessing for facial fractures
B) Determining patency and the need for airway intervention
C) Applying a cervical collar
D) Checking for breath sounds
Rationale: The primary survey follows the ABCDE framework. Airway
is the first priority. The nurse must assess airway patency and
determine if the patient can protect their own airway. Any compromise
requires immediate intervention, such as positioning, suctioning, or
advanced airway placement. Cervical spine immobilization is part of
the secondary survey and spinal motion restriction, but airway takes
precedence.
2. A patient is brought in after a fall from 20 feet. During the primary
survey, the patient is agitated, confused, and unable to follow
commands. The nurse notes unequal pupil sizes. Which of the following
is the MOST likely cause of these findings?
A) Hypovolemic shock
B) Increased intracranial pressure (ICP)
,2|P a g e
C) Hypoxia
D) Hypoglycemia
Rationale: Unequal pupils (anisocoria) and altered mental status are
signs of increased intracranial pressure (ICP), often due to a
traumatic brain injury. Herniation syndromes can cause pupillary
changes. While hypoxia, hypovolemic shock, and hypoglycemia can
cause altered mental status, they do not typically cause unequal pupils.
3. A trauma nurse is assessing a patient's breathing during the primary
survey. Which of the following findings is the MOST concerning?
A) Respiratory rate of 20 breaths per minute
B) Absent breath sounds on the left side
C) Oxygen saturation of 92%
D) Use of accessory muscles
Rationale: Absent breath sounds on one side is a critical finding that
may indicate a tension pneumothorax, hemothorax, or mainstem
intubation. This requires immediate intervention (e.g., needle
decompression or chest tube placement). While tachypnea, hypoxia,
and accessory muscle use are concerning, unilateral absent breath
sounds is a more specific and immediately life-threatening indicator.
4. A patient with a suspected spinal cord injury is being immobilized.
Which of the following is the MOST appropriate method for spinal
motion restriction?
A) Maintaining the patient in a supine position with a rigid cervical
collar and long spine board
B) Allowing the patient to sit up if they are comfortable
C) Placing a soft collar only
D) Using sandbags on either side of the head
Rationale: Spinal motion restriction involves maintaining the patient
in a supine position with a rigid cervical collar and a long spine board
,3|P a g e
(or vacuum mattress) to minimize movement of the spine. Soft collars
and sandbags alone do not provide adequate immobilization. The
patient should not be allowed to sit up until spinal clearance is
obtained.
5. The "D" in the primary survey (ABCDE) stands for:
A) Disability (Neurologic Assessment)
B) Deformity
C) Diagnostics
D) Dressing
Rationale: The primary survey follows the ABCDE mnemonic:
Airway, Breathing, Circulation, Disability (Neurologic Assessment),
and Exposure/Environment. Disability includes assessment of level of
consciousness (LOC) using the AVPU scale or Glasgow Coma Scale
(GCS).
6. A patient is brought in after a motor vehicle collision. The patient is
hemodynamically unstable and has a positive Focused Assessment with
Sonography for Trauma (FAST) exam. Which of the following is the
MOST likely diagnosis?
A) Tension pneumothorax
B) Hemorrhagic shock from intra-abdominal bleeding
C) Cardiac tamponade
D) Pelvic fracture
Rationale: A positive FAST exam indicates the presence of free fluid
(blood) in the peritoneal cavity, suggesting intra-abdominal
hemorrhage. This is a common cause of hemorrhagic shock in blunt
trauma patients. While pelvic fractures and tension pneumothorax can
cause shock, a positive FAST exam specifically points to intra-
abdominal bleeding.
, 4|P a g e
7. A trauma patient has a Glasgow Coma Scale (GCS) score of 6. Which
of the following actions should the nurse take FIRST?
A) Perform a detailed neurologic exam.
B) Prepare for intubation and mechanical ventilation.
C) Administer a sedative.
D) Obtain a CT scan of the head.
Rationale: A GCS score of 8 or less is an indication for intubation to
protect the airway and prevent aspiration. A GCS of 6 indicates severe
traumatic brain injury and the patient cannot protect their own
airway. The nurse should prepare for intubation and mechanical
ventilation immediately. A CT scan and neurologic exam can be
performed after airway and breathing are secured.
8. Which of the following is a sign of a tension pneumothorax?
A) Jugular venous distention (JVD)
B) Decreased respiratory rate
C) Diminished breath sounds on the right side with hyperresonance
D) Hypotension with bradycardia
Rationale: A tension pneumothorax is a life-threatening condition
where air accumulates in the pleural space, compressing the heart and
great vessels. Signs include JVD (due to increased intrathoracic
pressure), tracheal deviation, hyperresonance on the affected side, and
severe respiratory distress. Hypotension with tachycardia (not
bradycardia) is also common.
9. A nurse is assessing a patient with a blunt abdominal injury. Which of
the following is the MOST reliable sign of intra-abdominal bleeding?
A) Rebound tenderness
B) Hemodynamic instability
C) Abdominal distension
D) Guarding
TNCC FINAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
1. A trauma patient arrives at the emergency department following a
motor vehicle collision. The nurse is performing the primary survey.
Which of the following is the PRIORITY action during the "Airway"
assessment?
A) Assessing for facial fractures
B) Determining patency and the need for airway intervention
C) Applying a cervical collar
D) Checking for breath sounds
Rationale: The primary survey follows the ABCDE framework. Airway
is the first priority. The nurse must assess airway patency and
determine if the patient can protect their own airway. Any compromise
requires immediate intervention, such as positioning, suctioning, or
advanced airway placement. Cervical spine immobilization is part of
the secondary survey and spinal motion restriction, but airway takes
precedence.
2. A patient is brought in after a fall from 20 feet. During the primary
survey, the patient is agitated, confused, and unable to follow
commands. The nurse notes unequal pupil sizes. Which of the following
is the MOST likely cause of these findings?
A) Hypovolemic shock
B) Increased intracranial pressure (ICP)
,2|P a g e
C) Hypoxia
D) Hypoglycemia
Rationale: Unequal pupils (anisocoria) and altered mental status are
signs of increased intracranial pressure (ICP), often due to a
traumatic brain injury. Herniation syndromes can cause pupillary
changes. While hypoxia, hypovolemic shock, and hypoglycemia can
cause altered mental status, they do not typically cause unequal pupils.
3. A trauma nurse is assessing a patient's breathing during the primary
survey. Which of the following findings is the MOST concerning?
A) Respiratory rate of 20 breaths per minute
B) Absent breath sounds on the left side
C) Oxygen saturation of 92%
D) Use of accessory muscles
Rationale: Absent breath sounds on one side is a critical finding that
may indicate a tension pneumothorax, hemothorax, or mainstem
intubation. This requires immediate intervention (e.g., needle
decompression or chest tube placement). While tachypnea, hypoxia,
and accessory muscle use are concerning, unilateral absent breath
sounds is a more specific and immediately life-threatening indicator.
4. A patient with a suspected spinal cord injury is being immobilized.
Which of the following is the MOST appropriate method for spinal
motion restriction?
A) Maintaining the patient in a supine position with a rigid cervical
collar and long spine board
B) Allowing the patient to sit up if they are comfortable
C) Placing a soft collar only
D) Using sandbags on either side of the head
Rationale: Spinal motion restriction involves maintaining the patient
in a supine position with a rigid cervical collar and a long spine board
,3|P a g e
(or vacuum mattress) to minimize movement of the spine. Soft collars
and sandbags alone do not provide adequate immobilization. The
patient should not be allowed to sit up until spinal clearance is
obtained.
5. The "D" in the primary survey (ABCDE) stands for:
A) Disability (Neurologic Assessment)
B) Deformity
C) Diagnostics
D) Dressing
Rationale: The primary survey follows the ABCDE mnemonic:
Airway, Breathing, Circulation, Disability (Neurologic Assessment),
and Exposure/Environment. Disability includes assessment of level of
consciousness (LOC) using the AVPU scale or Glasgow Coma Scale
(GCS).
6. A patient is brought in after a motor vehicle collision. The patient is
hemodynamically unstable and has a positive Focused Assessment with
Sonography for Trauma (FAST) exam. Which of the following is the
MOST likely diagnosis?
A) Tension pneumothorax
B) Hemorrhagic shock from intra-abdominal bleeding
C) Cardiac tamponade
D) Pelvic fracture
Rationale: A positive FAST exam indicates the presence of free fluid
(blood) in the peritoneal cavity, suggesting intra-abdominal
hemorrhage. This is a common cause of hemorrhagic shock in blunt
trauma patients. While pelvic fractures and tension pneumothorax can
cause shock, a positive FAST exam specifically points to intra-
abdominal bleeding.
, 4|P a g e
7. A trauma patient has a Glasgow Coma Scale (GCS) score of 6. Which
of the following actions should the nurse take FIRST?
A) Perform a detailed neurologic exam.
B) Prepare for intubation and mechanical ventilation.
C) Administer a sedative.
D) Obtain a CT scan of the head.
Rationale: A GCS score of 8 or less is an indication for intubation to
protect the airway and prevent aspiration. A GCS of 6 indicates severe
traumatic brain injury and the patient cannot protect their own
airway. The nurse should prepare for intubation and mechanical
ventilation immediately. A CT scan and neurologic exam can be
performed after airway and breathing are secured.
8. Which of the following is a sign of a tension pneumothorax?
A) Jugular venous distention (JVD)
B) Decreased respiratory rate
C) Diminished breath sounds on the right side with hyperresonance
D) Hypotension with bradycardia
Rationale: A tension pneumothorax is a life-threatening condition
where air accumulates in the pleural space, compressing the heart and
great vessels. Signs include JVD (due to increased intrathoracic
pressure), tracheal deviation, hyperresonance on the affected side, and
severe respiratory distress. Hypotension with tachycardia (not
bradycardia) is also common.
9. A nurse is assessing a patient with a blunt abdominal injury. Which of
the following is the MOST reliable sign of intra-abdominal bleeding?
A) Rebound tenderness
B) Hemodynamic instability
C) Abdominal distension
D) Guarding
