TNCC PRECOURSE STUDY GUIDE PRACTICE EXAM (2026)
Multiple-Choice Questions | Based on ENA TNCC 9th Edition Core Concepts | Verified
Rationales
1. A 6-year-old child is brought in after a fall from a playground slide. The child is
crying and guarding his right arm. Which of the following is a key component of
the pediatric primary survey?
A) Assessing the airway using the "sniffing" position with a towel under the occiput
B) Using a larger endotracheal tube than an adult (size 8.0)
C) Performing a FAST exam before assessing the airway
D) Immediately applying a cervical collar without a backboard
Correct Answer: A
Rationale: In pediatric patients, the airway is assessed with the head in a "sniffing" position
(slightly extended) using a towel under the occiput to align the airway. The trachea is
shorter and more easily kinked. Cervical spine precautions are maintained, but a
backboard may not be needed for isolated extremity injuries.
2. An 82-year-old patient is brought in after a ground-level fall. The patient is on
warfarin for atrial fibrillation. Which of the following is the most concerning injury
in this patient?
A) Distal radius fracture
B) Hip fracture
C) Subdural hematoma
D) Rib fracture
Correct Answer: C
Rationale: Elderly patients on anticoagulants (warfarin, Eliquis, aspirin) are at extremely
high risk for intracranial hemorrhage (subdural or epidural) after even a ground-level fall.
A subdural hematoma can develop slowly and present with confusion, which may be
mistaken for dementia. This requires a head CT.
,3. A pregnant trauma patient at 32 weeks gestation is involved in a motor vehicle
crash. What is the primary concern regarding the fetus?
A) Fetal distress due to maternal hypotension
B) Premature labor
C) Placental abruption
D) All of the above
Correct Answer: D
Rationale: Trauma in pregnancy can cause maternal hypotension (reducing uterine
perfusion), premature labor, and placental abruption (the most common cause of fetal
death after trauma). All of these are significant concerns. The fetus should be monitored
with continuous fetal heart rate monitoring.
4. A patient is brought in after a blast injury from an explosion. Which of the
following injuries is MOST commonly associated with blast lung (primary blast
injury)?
A) Pneumothorax
B) Pulmonary contusion
C) Air embolism
D) All of the above
Correct Answer: D
Rationale: Blast lung (primary blast injury) results from the sudden overpressure wave
damaging the alveolar-capillary membrane. It can cause pneumothorax, hemothorax,
pulmonary contusion, subcutaneous emphysema, and air embolism. Patients may present
with hypoxia, cough, and hemoptysis.
5. A patient with a severe traumatic brain injury has an ICP of 20 mmHg. The
patient is febrile with a temperature of 39°C (102.2°F). What is the priority
intervention?
A) Administer antipyretics (acetaminophen) and use cooling measures
B) Administer mannitol immediately
C) Hyperventilate the patient to a PaCO2 of 30 mmHg
D) Perform a CT scan of the head
,Correct Answer: A
Rationale: Fever increases cerebral metabolic demand and can elevate ICP. The priority is
to control the fever with antipyretics and cooling measures. ICP of 20 mmHg is borderline;
fever control may reduce it without needing more aggressive interventions.
6. A patient is thrown from a motorcycle and has a flail chest. The patient's oxygen
saturation is 89% on a non-rebreather mask. What is the priority intervention?
A) Apply a chest binder
B) Prepare for intubation and positive pressure ventilation
C) Administer IV fluids
D) Perform a chest X-ray
Correct Answer: B
Rationale: Flail chest with hypoxia despite high-flow oxygen indicates respiratory failure.
Positive pressure ventilation (intubation) is required to stabilize the flail segment and
improve oxygenation. Chest binders are no longer recommended.
7. Which of the following is the most reliable indicator of adequate fluid
resuscitation in a burn patient?
A) Heart rate
B) Blood pressure
C) Urine output (0.5–1 mL/kg/hour in adults)
D) Capillary refill
Correct Answer: C
Rationale: Urine output is the most reliable indicator of adequate fluid resuscitation in
burn patients. Adults should have a urine output of 0.5–1 mL/kg/hour. Children should
have 1–2 mL/kg/hour. Heart rate and BP can be affected by pain and other factors.
8. A trauma patient has a suspected esophageal injury from a penetrating neck
wound. Which of the following is a sign?
A) Subcutaneous emphysema
, B) Hematemesis
C) Pain with swallowing
D) All of the above
Correct Answer: D
Rationale: Esophageal injuries present with subcutaneous emphysema, hematemesis,
odynophagia (painful swallowing), and mediastinal air on imaging. This is a surgical
emergency requiring prompt repair.
9. A patient is in cardiac arrest after a traumatic injury. The cardiac rhythm is
asystole. Which of the following should be the priority?
A) Defibrillation
B) Epinephrine
C) Identify and treat reversible causes (e.g., tension pneumothorax, hypovolemia)
D) CPR only
Correct Answer: C
Rationale: Asystole in trauma is often caused by reversible conditions (e.g., tension
pneumothorax, hypovolemia, cardiac tamponade). The priority is to identify and treat
these causes. CPR and epinephrine are important, but addressing the underlying cause is
critical.
10. A patient with a known history of COPD is brought in after a fall. The patient is
on home oxygen and has a baseline oxygen saturation of 88%. What is the
appropriate target oxygen saturation for this patient?
A) 100%
B) 94–98%
C) 88–92%
D) 80–85%
Correct Answer: C
Rationale: Patients with COPD rely on hypoxic drive. Over-oxygenation can lead to
hypercapnia and respiratory failure. The target SpO2 for patients with COPD is 88–92%. In
trauma, this must be balanced against the need for adequate oxygenation.
Multiple-Choice Questions | Based on ENA TNCC 9th Edition Core Concepts | Verified
Rationales
1. A 6-year-old child is brought in after a fall from a playground slide. The child is
crying and guarding his right arm. Which of the following is a key component of
the pediatric primary survey?
A) Assessing the airway using the "sniffing" position with a towel under the occiput
B) Using a larger endotracheal tube than an adult (size 8.0)
C) Performing a FAST exam before assessing the airway
D) Immediately applying a cervical collar without a backboard
Correct Answer: A
Rationale: In pediatric patients, the airway is assessed with the head in a "sniffing" position
(slightly extended) using a towel under the occiput to align the airway. The trachea is
shorter and more easily kinked. Cervical spine precautions are maintained, but a
backboard may not be needed for isolated extremity injuries.
2. An 82-year-old patient is brought in after a ground-level fall. The patient is on
warfarin for atrial fibrillation. Which of the following is the most concerning injury
in this patient?
A) Distal radius fracture
B) Hip fracture
C) Subdural hematoma
D) Rib fracture
Correct Answer: C
Rationale: Elderly patients on anticoagulants (warfarin, Eliquis, aspirin) are at extremely
high risk for intracranial hemorrhage (subdural or epidural) after even a ground-level fall.
A subdural hematoma can develop slowly and present with confusion, which may be
mistaken for dementia. This requires a head CT.
,3. A pregnant trauma patient at 32 weeks gestation is involved in a motor vehicle
crash. What is the primary concern regarding the fetus?
A) Fetal distress due to maternal hypotension
B) Premature labor
C) Placental abruption
D) All of the above
Correct Answer: D
Rationale: Trauma in pregnancy can cause maternal hypotension (reducing uterine
perfusion), premature labor, and placental abruption (the most common cause of fetal
death after trauma). All of these are significant concerns. The fetus should be monitored
with continuous fetal heart rate monitoring.
4. A patient is brought in after a blast injury from an explosion. Which of the
following injuries is MOST commonly associated with blast lung (primary blast
injury)?
A) Pneumothorax
B) Pulmonary contusion
C) Air embolism
D) All of the above
Correct Answer: D
Rationale: Blast lung (primary blast injury) results from the sudden overpressure wave
damaging the alveolar-capillary membrane. It can cause pneumothorax, hemothorax,
pulmonary contusion, subcutaneous emphysema, and air embolism. Patients may present
with hypoxia, cough, and hemoptysis.
5. A patient with a severe traumatic brain injury has an ICP of 20 mmHg. The
patient is febrile with a temperature of 39°C (102.2°F). What is the priority
intervention?
A) Administer antipyretics (acetaminophen) and use cooling measures
B) Administer mannitol immediately
C) Hyperventilate the patient to a PaCO2 of 30 mmHg
D) Perform a CT scan of the head
,Correct Answer: A
Rationale: Fever increases cerebral metabolic demand and can elevate ICP. The priority is
to control the fever with antipyretics and cooling measures. ICP of 20 mmHg is borderline;
fever control may reduce it without needing more aggressive interventions.
6. A patient is thrown from a motorcycle and has a flail chest. The patient's oxygen
saturation is 89% on a non-rebreather mask. What is the priority intervention?
A) Apply a chest binder
B) Prepare for intubation and positive pressure ventilation
C) Administer IV fluids
D) Perform a chest X-ray
Correct Answer: B
Rationale: Flail chest with hypoxia despite high-flow oxygen indicates respiratory failure.
Positive pressure ventilation (intubation) is required to stabilize the flail segment and
improve oxygenation. Chest binders are no longer recommended.
7. Which of the following is the most reliable indicator of adequate fluid
resuscitation in a burn patient?
A) Heart rate
B) Blood pressure
C) Urine output (0.5–1 mL/kg/hour in adults)
D) Capillary refill
Correct Answer: C
Rationale: Urine output is the most reliable indicator of adequate fluid resuscitation in
burn patients. Adults should have a urine output of 0.5–1 mL/kg/hour. Children should
have 1–2 mL/kg/hour. Heart rate and BP can be affected by pain and other factors.
8. A trauma patient has a suspected esophageal injury from a penetrating neck
wound. Which of the following is a sign?
A) Subcutaneous emphysema
, B) Hematemesis
C) Pain with swallowing
D) All of the above
Correct Answer: D
Rationale: Esophageal injuries present with subcutaneous emphysema, hematemesis,
odynophagia (painful swallowing), and mediastinal air on imaging. This is a surgical
emergency requiring prompt repair.
9. A patient is in cardiac arrest after a traumatic injury. The cardiac rhythm is
asystole. Which of the following should be the priority?
A) Defibrillation
B) Epinephrine
C) Identify and treat reversible causes (e.g., tension pneumothorax, hypovolemia)
D) CPR only
Correct Answer: C
Rationale: Asystole in trauma is often caused by reversible conditions (e.g., tension
pneumothorax, hypovolemia, cardiac tamponade). The priority is to identify and treat
these causes. CPR and epinephrine are important, but addressing the underlying cause is
critical.
10. A patient with a known history of COPD is brought in after a fall. The patient is
on home oxygen and has a baseline oxygen saturation of 88%. What is the
appropriate target oxygen saturation for this patient?
A) 100%
B) 94–98%
C) 88–92%
D) 80–85%
Correct Answer: C
Rationale: Patients with COPD rely on hypoxic drive. Over-oxygenation can lead to
hypercapnia and respiratory failure. The target SpO2 for patients with COPD is 88–92%. In
trauma, this must be balanced against the need for adequate oxygenation.
