TNCC PRECOURSE STUDY GUIDE PRACTICE EXAM (2026–2027)
200 Multiple-Choice Questions | Based on ENA TNCC 9th Edition Core Concepts | Verified
Rationales
1. What is the FIRST priority in the trauma nursing assessment?
A) Obtaining a detailed medical history
B) Performing a head-to-toe physical assessment
C) Ensuring a patent airway with cervical spine protection
D) Inserting two large-bore IV catheters
Correct Answer: C
Rationale: The Primary Survey follows the "ABCDE" mnemonic. Airway with cervical spine
immobilization is always the first priority. If the airway is compromised, the patient cannot
survive, regardless of other injuries. History and full assessments come later.
2. The "Golden Hour" in trauma refers to:
A) The first hour after the trauma team is activated
B) The first 60 minutes after injury, during which immediate surgical intervention is most
critical
C) The time it takes to complete the primary survey
D) The first hour of the nursing shift
Correct Answer: B
Rationale: The "Golden Hour" is the critical 60-minute window following traumatic injury
during which prompt surgical or medical intervention can significantly reduce morbidity
and mortality. Time-sensitive interventions are prioritized during this period.
3. Which of the following is a late sign of increased intracranial pressure (ICP) in a
traumatic brain injury patient?
,A) Restlessness
B) Pupil asymmetry
C) Cushing's triad (hypertension, bradycardia, irregular respirations)
D) Headache
Correct Answer: C
Rationale: Cushing's triad (hypertension with a widened pulse pressure, bradycardia, and
irregular respirations) is a late, ominous sign of severely elevated ICP. Headache,
restlessness, and pupil changes can occur earlier, but Cushing's triad indicates impending
herniation.
4. What is the most common cause of preventable death in trauma patients?
A) Traumatic brain injury
B) Uncontrolled hemorrhage
C) Tension pneumothorax
D) Cardiac tamponade
Correct Answer: B
Rationale: Uncontrolled hemorrhage is the leading cause of preventable death in trauma.
Rapid identification and control of bleeding (hemorrhage control) are critical during the
primary survey, particularly in the Circulation "C" assessment.
5. You are assessing a patient with a suspected tension pneumothorax. Which
finding is MOST consistent with this diagnosis?
A) Absent breath sounds bilaterally
B) Tracheal deviation toward the affected side
C) Tracheal deviation away from the affected side
D) Hypotension with bradycardia
Correct Answer: C
Rationale: Tension pneumothorax causes air to accumulate in the pleural space, shifting
the mediastinum to the opposite side (tracheal deviation AWAY from the affected side).
This is a life-threatening emergency requiring immediate needle decompression.
,6. What is the correct fluid resuscitation strategy for a hypotensive trauma patient
with uncontrolled hemorrhage?
A) Aggressive fluid boluses to restore normal blood pressure
B) Permissive hypotension (limited fluid resuscitation) until surgical control of bleeding
is achieved
C) No fluids until the patient reaches the OR
D) Infuse 3 liters of normal saline rapidly
Correct Answer: B
Rationale: Permissive hypotension (also called hypotensive resuscitation) involves limited
fluid administration to maintain a systolic BP of 80–90 mmHg until surgical hemostasis is
achieved. Aggressive fluid resuscitation can "pop the clot" and worsen bleeding.
7. In the primary survey, "Disability" (D) is assessed using which tool?
A) Glasgow Coma Scale (GCS)
B) Mini-Mental State Exam
C) Pain scale
D) Apgar score
Correct Answer: A
Rationale: The "D" in the primary survey (Disability) is assessed using the Glasgow Coma
Scale (GCS) to evaluate the patient's level of consciousness and neurological status. A
rapid GCS is essential for detecting deterioration.
8. What is the appropriate size of an oropharyngeal airway (OPA) for an adult
patient?
A) Measured from the corner of the mouth to the angle of the mandible
B) Measured from the tip of the nose to the earlobe
C) Measured from the center of the mouth to the tragus of the ear
D) Measured from the forehead to the chin
Correct Answer: A
Rationale: An OPA is sized by measuring from the corner of the patient's mouth to the
angle of the mandible (jaw). A correctly sized OPA will hold the tongue forward and
maintain a patent airway without obstructing the epiglottis.
, 9. A patient arrives with a penetrating injury to the chest. You note jugular venous
distension (JVD), muffled heart sounds, and hypotension. This triad is classic for
which condition?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive hemothorax
D) Flail chest
Correct Answer: B
Rationale: Beck's triad (JVD, muffled heart sounds, and hypotension) is the classic
presentation of cardiac tamponade. Blood accumulates in the pericardial sac, compressing
the heart and impairing diastolic filling, leading to decreased cardiac output.
10. What is the preferred imaging modality for the rapid detection of intra-
abdominal hemorrhage in a stable blunt trauma patient?
A) Flat plate X-ray (KUB)
B) Focused Assessment with Sonography for Trauma (FAST)
C) CT scan of the abdomen with contrast
D) Diagnostic peritoneal lavage (DPL)
Correct Answer: C
Rationale: In a stable blunt trauma patient, a CT scan with contrast is the gold standard
for detecting intra-abdominal injuries and hemorrhage. FAST is a screening tool used in
the primary survey, but CT is more definitive in stable patients.
11. In a patient with a suspected pelvic fracture, which of the following is the
MOST immediate life-threatening complication?
A) Neurovascular injury
B) Massive retroperitoneal hemorrhage
C) Bladder rupture
D) Infection
200 Multiple-Choice Questions | Based on ENA TNCC 9th Edition Core Concepts | Verified
Rationales
1. What is the FIRST priority in the trauma nursing assessment?
A) Obtaining a detailed medical history
B) Performing a head-to-toe physical assessment
C) Ensuring a patent airway with cervical spine protection
D) Inserting two large-bore IV catheters
Correct Answer: C
Rationale: The Primary Survey follows the "ABCDE" mnemonic. Airway with cervical spine
immobilization is always the first priority. If the airway is compromised, the patient cannot
survive, regardless of other injuries. History and full assessments come later.
2. The "Golden Hour" in trauma refers to:
A) The first hour after the trauma team is activated
B) The first 60 minutes after injury, during which immediate surgical intervention is most
critical
C) The time it takes to complete the primary survey
D) The first hour of the nursing shift
Correct Answer: B
Rationale: The "Golden Hour" is the critical 60-minute window following traumatic injury
during which prompt surgical or medical intervention can significantly reduce morbidity
and mortality. Time-sensitive interventions are prioritized during this period.
3. Which of the following is a late sign of increased intracranial pressure (ICP) in a
traumatic brain injury patient?
,A) Restlessness
B) Pupil asymmetry
C) Cushing's triad (hypertension, bradycardia, irregular respirations)
D) Headache
Correct Answer: C
Rationale: Cushing's triad (hypertension with a widened pulse pressure, bradycardia, and
irregular respirations) is a late, ominous sign of severely elevated ICP. Headache,
restlessness, and pupil changes can occur earlier, but Cushing's triad indicates impending
herniation.
4. What is the most common cause of preventable death in trauma patients?
A) Traumatic brain injury
B) Uncontrolled hemorrhage
C) Tension pneumothorax
D) Cardiac tamponade
Correct Answer: B
Rationale: Uncontrolled hemorrhage is the leading cause of preventable death in trauma.
Rapid identification and control of bleeding (hemorrhage control) are critical during the
primary survey, particularly in the Circulation "C" assessment.
5. You are assessing a patient with a suspected tension pneumothorax. Which
finding is MOST consistent with this diagnosis?
A) Absent breath sounds bilaterally
B) Tracheal deviation toward the affected side
C) Tracheal deviation away from the affected side
D) Hypotension with bradycardia
Correct Answer: C
Rationale: Tension pneumothorax causes air to accumulate in the pleural space, shifting
the mediastinum to the opposite side (tracheal deviation AWAY from the affected side).
This is a life-threatening emergency requiring immediate needle decompression.
,6. What is the correct fluid resuscitation strategy for a hypotensive trauma patient
with uncontrolled hemorrhage?
A) Aggressive fluid boluses to restore normal blood pressure
B) Permissive hypotension (limited fluid resuscitation) until surgical control of bleeding
is achieved
C) No fluids until the patient reaches the OR
D) Infuse 3 liters of normal saline rapidly
Correct Answer: B
Rationale: Permissive hypotension (also called hypotensive resuscitation) involves limited
fluid administration to maintain a systolic BP of 80–90 mmHg until surgical hemostasis is
achieved. Aggressive fluid resuscitation can "pop the clot" and worsen bleeding.
7. In the primary survey, "Disability" (D) is assessed using which tool?
A) Glasgow Coma Scale (GCS)
B) Mini-Mental State Exam
C) Pain scale
D) Apgar score
Correct Answer: A
Rationale: The "D" in the primary survey (Disability) is assessed using the Glasgow Coma
Scale (GCS) to evaluate the patient's level of consciousness and neurological status. A
rapid GCS is essential for detecting deterioration.
8. What is the appropriate size of an oropharyngeal airway (OPA) for an adult
patient?
A) Measured from the corner of the mouth to the angle of the mandible
B) Measured from the tip of the nose to the earlobe
C) Measured from the center of the mouth to the tragus of the ear
D) Measured from the forehead to the chin
Correct Answer: A
Rationale: An OPA is sized by measuring from the corner of the patient's mouth to the
angle of the mandible (jaw). A correctly sized OPA will hold the tongue forward and
maintain a patent airway without obstructing the epiglottis.
, 9. A patient arrives with a penetrating injury to the chest. You note jugular venous
distension (JVD), muffled heart sounds, and hypotension. This triad is classic for
which condition?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive hemothorax
D) Flail chest
Correct Answer: B
Rationale: Beck's triad (JVD, muffled heart sounds, and hypotension) is the classic
presentation of cardiac tamponade. Blood accumulates in the pericardial sac, compressing
the heart and impairing diastolic filling, leading to decreased cardiac output.
10. What is the preferred imaging modality for the rapid detection of intra-
abdominal hemorrhage in a stable blunt trauma patient?
A) Flat plate X-ray (KUB)
B) Focused Assessment with Sonography for Trauma (FAST)
C) CT scan of the abdomen with contrast
D) Diagnostic peritoneal lavage (DPL)
Correct Answer: C
Rationale: In a stable blunt trauma patient, a CT scan with contrast is the gold standard
for detecting intra-abdominal injuries and hemorrhage. FAST is a screening tool used in
the primary survey, but CT is more definitive in stable patients.
11. In a patient with a suspected pelvic fracture, which of the following is the
MOST immediate life-threatening complication?
A) Neurovascular injury
B) Massive retroperitoneal hemorrhage
C) Bladder rupture
D) Infection
