TNCC 9th EDITION EXAM AND STUDY GUIDE /
ACTUAL EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES GRADED A+
LATEST
1. A 32-year-old patient arrives after a motor vehicle collision. He is speaking in
full sentences, has a respiratory rate of 24/min, and oxygen saturation of 91% on
room air. What is the priority intervention?
A. Obtain arterial blood gases
B. Apply supplemental oxygen
C. Insert a nasogastric tube
D. Prepare for endotracheal intubation
Correct Answer: B
Rationale: The patient has a patent airway but shows signs of inadequate
oxygenation. Supplemental oxygen is the immediate priority to optimize oxygen
delivery.
2. Which finding most strongly suggests airway compromise in a trauma patient?
A. Tachypnea
B. Hoarseness
C. Hypotension
D. Diaphoresis
Correct Answer: B
Rationale: Hoarseness may indicate laryngeal edema or injury and is a warning
sign of impending airway obstruction.
,3. During the primary survey, a patient is found to have absent breath sounds on
the left and tracheal deviation to the right. What is the most likely diagnosis?
A. Hemothorax
B. Cardiac tamponade
C. Tension pneumothorax
D. Pulmonary contusion
Correct Answer: C
Rationale: Tracheal deviation with absent breath sounds is classic for tension
pneumothorax, a life-threatening condition requiring immediate decompression.
4. Which intervention should occur first when managing massive external
hemorrhage?
A. Establish IV access
B. Apply direct pressure
C. Administer tranexamic acid
D. Obtain blood samples
Correct Answer: B
Rationale: Uncontrolled external bleeding must be addressed immediately with
direct pressure to prevent exsanguination.
5. A trauma patient has cool, clammy skin and delayed capillary refill. These
findings are most consistent with:
A. Neurogenic shock
B. Cardiogenic shock
C. Hypovolemic shock
D. Septic shock
Correct Answer: C
Rationale: Hypovolemic shock commonly presents with cool, clammy skin due to
peripheral vasoconstriction from volume loss.
,6. What is the primary purpose of the Disability assessment in the primary survey?
A. Identify internal bleeding
B. Determine neurologic status
C. Assess oxygenation
D. Evaluate circulation
Correct Answer: B
Rationale: Disability focuses on neurologic assessment, including level of
consciousness and pupillary response.
7. A patient has a Glasgow Coma Scale score of 7. What is the priority action?
A. Obtain a CT scan
B. Administer mannitol
C. Secure the airway
D. Start anticonvulsants
Correct Answer: C
Rationale: A GCS ≤8 indicates inability to protect the airway, making airway
management the priority.
8. Which finding is most concerning during exposure of a trauma patient?
A. Mild shivering
B. Body temperature of 35°C (95°F)
C. Abrasions on extremities
D. Small ecchymoses
Correct Answer: B
Rationale: Hypothermia worsens coagulopathy and acidosis, contributing to the
trauma triad of death.
, 9. What is the most appropriate initial fluid for adult trauma resuscitation?
A. 5% dextrose in water
B. Normal saline or lactated Ringer’s
C. Albumin
D. Hypertonic saline
Correct Answer: B
Rationale: Isotonic crystalloids are first-line fluids in trauma resuscitation.
10. Which injury is most commonly associated with a “seatbelt sign”?
A. Pelvic fracture
B. Cervical spine injury
C. Abdominal organ injury
D. Thoracic aortic rupture
Correct Answer: C
Rationale: Seatbelt marks across the abdomen are associated with underlying
intra-abdominal injuries.
11. A trauma patient presents with paradoxical chest wall movement. This finding
indicates:
A. Pulmonary contusion
B. Open pneumothorax
C. Flail chest
D. Simple pneumothorax
Correct Answer: C
Rationale: Flail chest occurs when multiple rib fractures cause a free-floating
chest wall segment.
ACTUAL EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES GRADED A+
LATEST
1. A 32-year-old patient arrives after a motor vehicle collision. He is speaking in
full sentences, has a respiratory rate of 24/min, and oxygen saturation of 91% on
room air. What is the priority intervention?
A. Obtain arterial blood gases
B. Apply supplemental oxygen
C. Insert a nasogastric tube
D. Prepare for endotracheal intubation
Correct Answer: B
Rationale: The patient has a patent airway but shows signs of inadequate
oxygenation. Supplemental oxygen is the immediate priority to optimize oxygen
delivery.
2. Which finding most strongly suggests airway compromise in a trauma patient?
A. Tachypnea
B. Hoarseness
C. Hypotension
D. Diaphoresis
Correct Answer: B
Rationale: Hoarseness may indicate laryngeal edema or injury and is a warning
sign of impending airway obstruction.
,3. During the primary survey, a patient is found to have absent breath sounds on
the left and tracheal deviation to the right. What is the most likely diagnosis?
A. Hemothorax
B. Cardiac tamponade
C. Tension pneumothorax
D. Pulmonary contusion
Correct Answer: C
Rationale: Tracheal deviation with absent breath sounds is classic for tension
pneumothorax, a life-threatening condition requiring immediate decompression.
4. Which intervention should occur first when managing massive external
hemorrhage?
A. Establish IV access
B. Apply direct pressure
C. Administer tranexamic acid
D. Obtain blood samples
Correct Answer: B
Rationale: Uncontrolled external bleeding must be addressed immediately with
direct pressure to prevent exsanguination.
5. A trauma patient has cool, clammy skin and delayed capillary refill. These
findings are most consistent with:
A. Neurogenic shock
B. Cardiogenic shock
C. Hypovolemic shock
D. Septic shock
Correct Answer: C
Rationale: Hypovolemic shock commonly presents with cool, clammy skin due to
peripheral vasoconstriction from volume loss.
,6. What is the primary purpose of the Disability assessment in the primary survey?
A. Identify internal bleeding
B. Determine neurologic status
C. Assess oxygenation
D. Evaluate circulation
Correct Answer: B
Rationale: Disability focuses on neurologic assessment, including level of
consciousness and pupillary response.
7. A patient has a Glasgow Coma Scale score of 7. What is the priority action?
A. Obtain a CT scan
B. Administer mannitol
C. Secure the airway
D. Start anticonvulsants
Correct Answer: C
Rationale: A GCS ≤8 indicates inability to protect the airway, making airway
management the priority.
8. Which finding is most concerning during exposure of a trauma patient?
A. Mild shivering
B. Body temperature of 35°C (95°F)
C. Abrasions on extremities
D. Small ecchymoses
Correct Answer: B
Rationale: Hypothermia worsens coagulopathy and acidosis, contributing to the
trauma triad of death.
, 9. What is the most appropriate initial fluid for adult trauma resuscitation?
A. 5% dextrose in water
B. Normal saline or lactated Ringer’s
C. Albumin
D. Hypertonic saline
Correct Answer: B
Rationale: Isotonic crystalloids are first-line fluids in trauma resuscitation.
10. Which injury is most commonly associated with a “seatbelt sign”?
A. Pelvic fracture
B. Cervical spine injury
C. Abdominal organ injury
D. Thoracic aortic rupture
Correct Answer: C
Rationale: Seatbelt marks across the abdomen are associated with underlying
intra-abdominal injuries.
11. A trauma patient presents with paradoxical chest wall movement. This finding
indicates:
A. Pulmonary contusion
B. Open pneumothorax
C. Flail chest
D. Simple pneumothorax
Correct Answer: C
Rationale: Flail chest occurs when multiple rib fractures cause a free-floating
chest wall segment.
