TNCC 9th Edition–aligned Practice Exam 2
Questions and Answers with Rationales
Latest Versions
Question 1
A trauma patient arrives after a high-speed motor vehicle collision. The patient is
unconscious and has loud snoring respirations. What is the priority concern?
A. Circulatory shock
B. Upper-airway obstruction
C. Abdominal hemorrhage
D. Long-bone fracture
Correct Answer: B. Upper-airway obstruction
Rationale:
Snoring respirations in an unconscious trauma patient strongly suggest partial
upper-airway obstruction caused by loss of airway muscle tone. Airway patency
must be addressed immediately while maintaining appropriate cervical spine
precautions when indicated.
Question 2
A trauma patient has severe bleeding from a deep thigh wound. Direct pressure has
not controlled the hemorrhage. What should the nurse do next?
A. Continue the secondary survey
B. Escalate hemorrhage-control measures according to protocol
C. Obtain a detailed medical history
D. Apply heat to the extremity
Correct Answer: B. Escalate hemorrhage-control measures according to
protocol
Rationale:
Uncontrolled external hemorrhage is an immediate life threat. If initial direct
pressure is unsuccessful, additional appropriate hemorrhage-control measures
,should be implemented promptly rather than delaying treatment for the secondary
survey.
Question 3
Which patient finding is most concerning during the initial trauma assessment?
A. Respiratory rate of 18/min with normal effort
B. Oxygen saturation of 98% with clear speech
C. Stridor with increasing respiratory effort
D. Mild pain in the wrist
Correct Answer: C. Stridor with increasing respiratory effort
Rationale:
Stridor indicates upper-airway narrowing. In a trauma patient, progressive airway
edema, facial injury, neck trauma, or inhalation injury may cause rapidly
worsening obstruction.
Question 4
A patient involved in a motorcycle collision has unilateral absent breath sounds,
severe respiratory distress, and hypotension. Which condition should the nurse
suspect?
A. Cardiac tamponade
B. Tension pneumothorax
C. Simple rib fracture
D. Pulmonary embolism
Correct Answer: B. Tension pneumothorax
Rationale:
The combination of unilateral absent breath sounds, respiratory distress, and
hypotension is highly concerning for tension pneumothorax. Increasing pleural
pressure compromises both ventilation and venous return.
,Question 5
Which finding would be most suggestive of cardiac tamponade after penetrating
chest trauma?
A. Hypotension with jugular venous distention
B. Bilateral wheezing
C. Severe abdominal distention
D. Unilateral leg swelling
Correct Answer: A. Hypotension with jugular venous distention
Rationale:
Cardiac tamponade restricts ventricular filling because blood or fluid accumulates
in the pericardial space. Hypotension and jugular venous distention are important
findings; muffled heart sounds may also occur.
Question 6
A trauma patient is pale, cool, tachycardic, and anxious. Blood pressure is
currently normal. What does this presentation suggest?
A. No evidence of shock
B. Compensated shock
C. Complete circulatory failure
D. Neurogenic shock exclusively
Correct Answer: B. Compensated shock
Rationale:
Early hemorrhagic shock may be compensated by increased sympathetic activity,
producing tachycardia and peripheral vasoconstriction while blood pressure
remains temporarily maintained.
Question 7
A trauma patient with suspected internal hemorrhage becomes increasingly
confused. What does this finding most likely indicate?
, A. Improved perfusion
B. Decreased cerebral perfusion
C. Increased circulating volume
D. Resolution of shock
Correct Answer: B. Decreased cerebral perfusion
Rationale:
Altered mental status can indicate inadequate cerebral blood flow and oxygen
delivery. In a trauma patient with suspected hemorrhage, worsening confusion is a
significant warning sign of deteriorating perfusion.
Question 8
A patient has an open chest wound with air moving through the wound during
respiration. What injury does this describe?
A. Open pneumothorax
B. Cardiac tamponade
C. Hemoperitoneum
D. Pulmonary embolism
Correct Answer: A. Open pneumothorax
Rationale:
An open pneumothorax occurs when a chest-wall defect creates communication
between the atmosphere and pleural space. Air can enter through the wound and
interfere with normal ventilation.
Question 9
A patient with an open chest injury suddenly develops increasing respiratory
distress and hypotension. What complication should the nurse suspect?
A. Tension physiology
B. Simple anxiety
C. Isolated rib pain
D. Mild dehydration
Questions and Answers with Rationales
Latest Versions
Question 1
A trauma patient arrives after a high-speed motor vehicle collision. The patient is
unconscious and has loud snoring respirations. What is the priority concern?
A. Circulatory shock
B. Upper-airway obstruction
C. Abdominal hemorrhage
D. Long-bone fracture
Correct Answer: B. Upper-airway obstruction
Rationale:
Snoring respirations in an unconscious trauma patient strongly suggest partial
upper-airway obstruction caused by loss of airway muscle tone. Airway patency
must be addressed immediately while maintaining appropriate cervical spine
precautions when indicated.
Question 2
A trauma patient has severe bleeding from a deep thigh wound. Direct pressure has
not controlled the hemorrhage. What should the nurse do next?
A. Continue the secondary survey
B. Escalate hemorrhage-control measures according to protocol
C. Obtain a detailed medical history
D. Apply heat to the extremity
Correct Answer: B. Escalate hemorrhage-control measures according to
protocol
Rationale:
Uncontrolled external hemorrhage is an immediate life threat. If initial direct
pressure is unsuccessful, additional appropriate hemorrhage-control measures
,should be implemented promptly rather than delaying treatment for the secondary
survey.
Question 3
Which patient finding is most concerning during the initial trauma assessment?
A. Respiratory rate of 18/min with normal effort
B. Oxygen saturation of 98% with clear speech
C. Stridor with increasing respiratory effort
D. Mild pain in the wrist
Correct Answer: C. Stridor with increasing respiratory effort
Rationale:
Stridor indicates upper-airway narrowing. In a trauma patient, progressive airway
edema, facial injury, neck trauma, or inhalation injury may cause rapidly
worsening obstruction.
Question 4
A patient involved in a motorcycle collision has unilateral absent breath sounds,
severe respiratory distress, and hypotension. Which condition should the nurse
suspect?
A. Cardiac tamponade
B. Tension pneumothorax
C. Simple rib fracture
D. Pulmonary embolism
Correct Answer: B. Tension pneumothorax
Rationale:
The combination of unilateral absent breath sounds, respiratory distress, and
hypotension is highly concerning for tension pneumothorax. Increasing pleural
pressure compromises both ventilation and venous return.
,Question 5
Which finding would be most suggestive of cardiac tamponade after penetrating
chest trauma?
A. Hypotension with jugular venous distention
B. Bilateral wheezing
C. Severe abdominal distention
D. Unilateral leg swelling
Correct Answer: A. Hypotension with jugular venous distention
Rationale:
Cardiac tamponade restricts ventricular filling because blood or fluid accumulates
in the pericardial space. Hypotension and jugular venous distention are important
findings; muffled heart sounds may also occur.
Question 6
A trauma patient is pale, cool, tachycardic, and anxious. Blood pressure is
currently normal. What does this presentation suggest?
A. No evidence of shock
B. Compensated shock
C. Complete circulatory failure
D. Neurogenic shock exclusively
Correct Answer: B. Compensated shock
Rationale:
Early hemorrhagic shock may be compensated by increased sympathetic activity,
producing tachycardia and peripheral vasoconstriction while blood pressure
remains temporarily maintained.
Question 7
A trauma patient with suspected internal hemorrhage becomes increasingly
confused. What does this finding most likely indicate?
, A. Improved perfusion
B. Decreased cerebral perfusion
C. Increased circulating volume
D. Resolution of shock
Correct Answer: B. Decreased cerebral perfusion
Rationale:
Altered mental status can indicate inadequate cerebral blood flow and oxygen
delivery. In a trauma patient with suspected hemorrhage, worsening confusion is a
significant warning sign of deteriorating perfusion.
Question 8
A patient has an open chest wound with air moving through the wound during
respiration. What injury does this describe?
A. Open pneumothorax
B. Cardiac tamponade
C. Hemoperitoneum
D. Pulmonary embolism
Correct Answer: A. Open pneumothorax
Rationale:
An open pneumothorax occurs when a chest-wall defect creates communication
between the atmosphere and pleural space. Air can enter through the wound and
interfere with normal ventilation.
Question 9
A patient with an open chest injury suddenly develops increasing respiratory
distress and hypotension. What complication should the nurse suspect?
A. Tension physiology
B. Simple anxiety
C. Isolated rib pain
D. Mild dehydration
