TNCC 9th Edition Final Exam: 2026/2027 – 100% Questions With
Verified Answers + Rationales
OVERVIEW:
This 80-question TNCC 9th Edition practice set is built for trauma nurse exam
preparation, not the actual ENA exam. It covers the full Trauma Nursing Process:
XABCDE primary survey, hemorrhage control, airway and breathing emergencies,
shock recognition, head, spine, chest, abdominal and extremity trauma, plus special
populations - pediatrics, geriatrics, pregnancy, burns, and disaster teamwork. Correct
answers in bold Green.
1. What is the first priority in TNCC primary survey?
A. Disability
B. X - Exsanguination / Massive hemorrhage control
C. Breathing
D. Circulation
RATIONALE: TNCC 9th uses XABCDE. X is control of exsanguinating external
hemorrhage before airway.
2. A trauma patient has stridor and facial burns. First action?
A. Give oxygen by nasal cannula
B. Prepare for definitive airway - intubation
C. Check blood pressure
D. Insert NG tube
RATIONALE: Stridor indicates upper airway obstruction/edema. Burns suggest
inhalation injury. Early definitive airway is priority.
3. Best assessment for effective breathing?
A. Heart rate
B. Blood pressure
C. Chest rise, respiratory rate, pulse oximetry, breath sounds
D. Level of consciousness
RATIONALE: Breathing assessment includes inspection of chest rise, rate, depth,
SpO2, auscultation, palpation for crepitus.
4. Where to assess for tension pneumothorax?
A. Abdomen
B. Pelvis
C. Tracheal deviation, absent breath sounds, JVD, hypotension, hyperresonance
D. Pupils
RATIONALE: Tension pneumothorax is clinical - hypotension, JVD, tracheal deviation
away, absent breath sounds, hyperresonance.
5. Initial fluid of choice for hemorrhagic shock in TNCC?
A. D5W
B. Albumin
C. Balanced isotonic crystalloids - Lactated Ringers / PlasmaLyte, early blood
D. Dextran
, RATIONALE: TNCC 9th emphasizes balanced crystalloids and early balanced blood
products, permissive hypotension, avoid large crystalloid volume.
6. Signs of compensated shock?
A. Tachycardia, anxious, narrow pulse pressure, delayed cap refill
B. Hypotension, bradycardia
C. Unresponsive
D. Normal vitals
RATIONALE: Compensated shock body maintains BP with tachycardia,
vasoconstriction leading to narrow pulse pressure.
7. Most reliable sign of decompensated shock?
A. Hypotension - systolic <90
B. Tachycardia
C. Diaphoresis
D. Thirst
RATIONALE: Hypotension is late sign indicating failure of compensatory mechanisms.
8. Neurogenic shock presentation?
A. Cool clammy skin, tachycardia
B. Crackles, JVD
C. Warm dry skin, hypotension, bradycardia
D. Hypertension, bradycardia
RATIONALE: Neurogenic shock from spinal cord injury loses sympathetic tone -
vasodilation warm skin, bradycardia, hypotension.
9. Disability - rapid neuro check includes?
A. Blood glucose only
B. GCS, pupils, motor/sensory, AVPU
C. Breath sounds
D. Pelvic stability
RATIONALE: D = Disability - GCS, pupils, gross motor/sensory, AVPU, lateralizing
signs.
10. Unequal pupils after head trauma indicates?
A. Increased intracranial pressure / uncal herniation
B. Hypoglycemia
C. Shock
D. Tension pneumothorax
RATIONALE: Unilateral dilated pupil suggests CN III compression from rising
ICP/herniation. Emergency.
11. Best intervention for increased ICP?
A. Trendelenburg
B. Give hypotonic fluids
C. Hyperventilate to PaCO2 <25
D. Elevate HOB 30 degrees, keep head midline, prevent hyperthermia, control
pain, give hyperosmolar therapy per order
RATIONALE: Prevent secondary brain injury - head midline, HOB 30 deg, avoid
hypercarbia, hyperthermia, maintain normotension and oxygenation.
12. Clear fluid from nose after facial trauma suggests?
A. Normal mucus
Verified Answers + Rationales
OVERVIEW:
This 80-question TNCC 9th Edition practice set is built for trauma nurse exam
preparation, not the actual ENA exam. It covers the full Trauma Nursing Process:
XABCDE primary survey, hemorrhage control, airway and breathing emergencies,
shock recognition, head, spine, chest, abdominal and extremity trauma, plus special
populations - pediatrics, geriatrics, pregnancy, burns, and disaster teamwork. Correct
answers in bold Green.
1. What is the first priority in TNCC primary survey?
A. Disability
B. X - Exsanguination / Massive hemorrhage control
C. Breathing
D. Circulation
RATIONALE: TNCC 9th uses XABCDE. X is control of exsanguinating external
hemorrhage before airway.
2. A trauma patient has stridor and facial burns. First action?
A. Give oxygen by nasal cannula
B. Prepare for definitive airway - intubation
C. Check blood pressure
D. Insert NG tube
RATIONALE: Stridor indicates upper airway obstruction/edema. Burns suggest
inhalation injury. Early definitive airway is priority.
3. Best assessment for effective breathing?
A. Heart rate
B. Blood pressure
C. Chest rise, respiratory rate, pulse oximetry, breath sounds
D. Level of consciousness
RATIONALE: Breathing assessment includes inspection of chest rise, rate, depth,
SpO2, auscultation, palpation for crepitus.
4. Where to assess for tension pneumothorax?
A. Abdomen
B. Pelvis
C. Tracheal deviation, absent breath sounds, JVD, hypotension, hyperresonance
D. Pupils
RATIONALE: Tension pneumothorax is clinical - hypotension, JVD, tracheal deviation
away, absent breath sounds, hyperresonance.
5. Initial fluid of choice for hemorrhagic shock in TNCC?
A. D5W
B. Albumin
C. Balanced isotonic crystalloids - Lactated Ringers / PlasmaLyte, early blood
D. Dextran
, RATIONALE: TNCC 9th emphasizes balanced crystalloids and early balanced blood
products, permissive hypotension, avoid large crystalloid volume.
6. Signs of compensated shock?
A. Tachycardia, anxious, narrow pulse pressure, delayed cap refill
B. Hypotension, bradycardia
C. Unresponsive
D. Normal vitals
RATIONALE: Compensated shock body maintains BP with tachycardia,
vasoconstriction leading to narrow pulse pressure.
7. Most reliable sign of decompensated shock?
A. Hypotension - systolic <90
B. Tachycardia
C. Diaphoresis
D. Thirst
RATIONALE: Hypotension is late sign indicating failure of compensatory mechanisms.
8. Neurogenic shock presentation?
A. Cool clammy skin, tachycardia
B. Crackles, JVD
C. Warm dry skin, hypotension, bradycardia
D. Hypertension, bradycardia
RATIONALE: Neurogenic shock from spinal cord injury loses sympathetic tone -
vasodilation warm skin, bradycardia, hypotension.
9. Disability - rapid neuro check includes?
A. Blood glucose only
B. GCS, pupils, motor/sensory, AVPU
C. Breath sounds
D. Pelvic stability
RATIONALE: D = Disability - GCS, pupils, gross motor/sensory, AVPU, lateralizing
signs.
10. Unequal pupils after head trauma indicates?
A. Increased intracranial pressure / uncal herniation
B. Hypoglycemia
C. Shock
D. Tension pneumothorax
RATIONALE: Unilateral dilated pupil suggests CN III compression from rising
ICP/herniation. Emergency.
11. Best intervention for increased ICP?
A. Trendelenburg
B. Give hypotonic fluids
C. Hyperventilate to PaCO2 <25
D. Elevate HOB 30 degrees, keep head midline, prevent hyperthermia, control
pain, give hyperosmolar therapy per order
RATIONALE: Prevent secondary brain injury - head midline, HOB 30 deg, avoid
hypercarbia, hyperthermia, maintain normotension and oxygenation.
12. Clear fluid from nose after facial trauma suggests?
A. Normal mucus
