TNCC 9th Edition Final Exam: 2026/2027 – 100% Questions With
Verified Answers + Rationales
Introduction:
TNCC 9th Edition 80-question practice set reviews trauma nursing core concepts. It covers
hemorrhage control, airway management, tension pneumothorax, cardiac tamponade, shock
classification, neurogenic versus hypovolemic shock, traumatic brain injury, spinal cord injury,
chest and abdominal trauma, FAST exam, compartment syndrome, rhabdomyolysis, burns with
Parkland formula, and special populations including pediatrics, geriatrics, pregnancy, and
disaster triage, with rationales reinforcing critical thinking and life-saving priorities. Correct
answers in bold Green.
1. According to TNCC 9th, what is the primary purpose of the primary survey?
• A) To identify and immediately treat life-threatening conditions using XABCDE
• B) To obtain a complete medical history and full physical
• C) To perform a detailed secondary survey
• D) To arrange for CT scan and labs
Rationale: Primary survey is to find what kills first and fix it.
2. A 25-year-old with a deep femoral laceration and active bleeding. What is the
first step for hemorrhage control?
• A) Apply tourniquet first in all cases
• B) Apply direct pressure with hemostatic gauze, if uncontrolled then apply
tourniquet
• C) Elevate leg and wait
• D) Apply pressure bandage without direct pressure
Rationale: MARCH - direct pressure is first, tourniquet if fails or for amputation.
3. A trauma patient is unresponsive with loud snoring respirations. This
indicates:
• A) Foreign body obstruction
• B) Complete laryngospasm
• C) Tongue occluding the posterior pharynx
• D) Tension pneumothorax
Rationale: Snoring = soft tissue airway obstruction by tongue.
4. Which assessment finding BEST differentiates tension pneumothorax from a
simple pneumothorax?
• A) Absent breath sounds on one side
• B) Chest pain and dyspnea
• C) Hypotension, jugular vein distension, and tracheal deviation to opposite side
• D) Subcutaneous emphysema
Rationale: Tension causes obstructive shock and mediastinal shift.
5. You place an occlusive dressing for a sucking chest wound. How should you
tape it?
• A) Tape all 4 sides airtight
, • B) Tape 2 sides only
• C) Tape on 3 sides to create a flutter valve allowing air to escape
• D) Do not cover, leave open
Rationale: 3-sided allows exhalation of trapped air, prevents tension. If worsens,
remove dressing.
6. Which vital sign change is an EARLY indicator of compensated hypovolemic
shock?
• A) Rising anxiety/restlessness, tachycardia, tachypnea, narrowed pulse pressure
• B) Systolic BP <70 with bradycardia
• C) Widened pulse pressure and warm skin
• D) Bradypnea and normal heart rate
Rationale: Sympathetic compensation maintains BP early, narrowing pulse pressure.
7. Why is serum lactate measured in the initial assessment of a trauma patient?
• A) To gauge tissue perfusion and detect anaerobic metabolism from tissue
hypoxia
• B) To measure oxygenation and ventilation directly
• C) To assess kidney function
• D) To determine blood type
Rationale: Lactate rises when tissues hypoperfused.
8. The trauma triad of death includes which three conditions?
• A) Tachycardia, hypotension, tachypnea
• B) Hyperthermia, hypertension, bradycardia
• C) Hypothermia, metabolic acidosis, and coagulopathy
• D) Hypoxia, hypercapnia, hypoglycemia
Rationale: Lethal triad feeds itself and leads to death.
9. A patient with a T6 complete spinal cord injury presents with BP 78/50, HR 52,
warm dry skin below injury. This is:
• A) Hypovolemic shock with tachycardia
• B) Neurogenic shock with loss of sympathetic tone causing bradycardia and
vasodilation
• C) Cardiogenic shock
• D) Anaphylactic shock
Rationale: Neurogenic = hypotension + bradycardia + warm skin.
10. The MOST sensitive early indicator of increased intracranial pressure is:
• A) Change in level of consciousness, restlessness, or confusion
• B) Cushing's triad
• C) Fixed dilated pupil
• D) Decerebrate posturing
Rationale: LOC changes occur first; Cushing is late herniation.
11. A 78-year-old on warfarin falls from standing, hits head, complains of
headache and nausea 6 hours later. Tearing of bridging veins most commonly
causes:
• A) Epidural hematoma
• B) Diffuse axonal injury
• C) Skull fracture
Verified Answers + Rationales
Introduction:
TNCC 9th Edition 80-question practice set reviews trauma nursing core concepts. It covers
hemorrhage control, airway management, tension pneumothorax, cardiac tamponade, shock
classification, neurogenic versus hypovolemic shock, traumatic brain injury, spinal cord injury,
chest and abdominal trauma, FAST exam, compartment syndrome, rhabdomyolysis, burns with
Parkland formula, and special populations including pediatrics, geriatrics, pregnancy, and
disaster triage, with rationales reinforcing critical thinking and life-saving priorities. Correct
answers in bold Green.
1. According to TNCC 9th, what is the primary purpose of the primary survey?
• A) To identify and immediately treat life-threatening conditions using XABCDE
• B) To obtain a complete medical history and full physical
• C) To perform a detailed secondary survey
• D) To arrange for CT scan and labs
Rationale: Primary survey is to find what kills first and fix it.
2. A 25-year-old with a deep femoral laceration and active bleeding. What is the
first step for hemorrhage control?
• A) Apply tourniquet first in all cases
• B) Apply direct pressure with hemostatic gauze, if uncontrolled then apply
tourniquet
• C) Elevate leg and wait
• D) Apply pressure bandage without direct pressure
Rationale: MARCH - direct pressure is first, tourniquet if fails or for amputation.
3. A trauma patient is unresponsive with loud snoring respirations. This
indicates:
• A) Foreign body obstruction
• B) Complete laryngospasm
• C) Tongue occluding the posterior pharynx
• D) Tension pneumothorax
Rationale: Snoring = soft tissue airway obstruction by tongue.
4. Which assessment finding BEST differentiates tension pneumothorax from a
simple pneumothorax?
• A) Absent breath sounds on one side
• B) Chest pain and dyspnea
• C) Hypotension, jugular vein distension, and tracheal deviation to opposite side
• D) Subcutaneous emphysema
Rationale: Tension causes obstructive shock and mediastinal shift.
5. You place an occlusive dressing for a sucking chest wound. How should you
tape it?
• A) Tape all 4 sides airtight
, • B) Tape 2 sides only
• C) Tape on 3 sides to create a flutter valve allowing air to escape
• D) Do not cover, leave open
Rationale: 3-sided allows exhalation of trapped air, prevents tension. If worsens,
remove dressing.
6. Which vital sign change is an EARLY indicator of compensated hypovolemic
shock?
• A) Rising anxiety/restlessness, tachycardia, tachypnea, narrowed pulse pressure
• B) Systolic BP <70 with bradycardia
• C) Widened pulse pressure and warm skin
• D) Bradypnea and normal heart rate
Rationale: Sympathetic compensation maintains BP early, narrowing pulse pressure.
7. Why is serum lactate measured in the initial assessment of a trauma patient?
• A) To gauge tissue perfusion and detect anaerobic metabolism from tissue
hypoxia
• B) To measure oxygenation and ventilation directly
• C) To assess kidney function
• D) To determine blood type
Rationale: Lactate rises when tissues hypoperfused.
8. The trauma triad of death includes which three conditions?
• A) Tachycardia, hypotension, tachypnea
• B) Hyperthermia, hypertension, bradycardia
• C) Hypothermia, metabolic acidosis, and coagulopathy
• D) Hypoxia, hypercapnia, hypoglycemia
Rationale: Lethal triad feeds itself and leads to death.
9. A patient with a T6 complete spinal cord injury presents with BP 78/50, HR 52,
warm dry skin below injury. This is:
• A) Hypovolemic shock with tachycardia
• B) Neurogenic shock with loss of sympathetic tone causing bradycardia and
vasodilation
• C) Cardiogenic shock
• D) Anaphylactic shock
Rationale: Neurogenic = hypotension + bradycardia + warm skin.
10. The MOST sensitive early indicator of increased intracranial pressure is:
• A) Change in level of consciousness, restlessness, or confusion
• B) Cushing's triad
• C) Fixed dilated pupil
• D) Decerebrate posturing
Rationale: LOC changes occur first; Cushing is late herniation.
11. A 78-year-old on warfarin falls from standing, hits head, complains of
headache and nausea 6 hours later. Tearing of bridging veins most commonly
causes:
• A) Epidural hematoma
• B) Diffuse axonal injury
• C) Skull fracture
