TNCC FINAL EXAM PREP - 2026/2027
QUESTIONS AND ANSWERS
1. During the primary survey, which of the following is the most immediate priority when
treating a patient with a suspected tension pneumothorax?
A. Obtaining a portable chest X-ray
B. Performing needle thoracostomy
C. Inserting a large-bore chest tube
D. Intubating the patient for ventilatory support
Answer: B
Conceptual Explanation: Immediate decompression via needle thoracostomy is required
for tension pneumothorax to prevent cardiovascular collapse; X-rays should not delay
treatment.
2. A trauma patient presents with a widened mediastinum on chest X-ray and a mechanism
involving high-speed deceleration. Which injury should the nurse suspect first?
A. Tension pneumothorax
B. Blunt aortic injury
,C. Cardiac tamponade
D. Esophageal rupture
Answer: B
Conceptual Explanation: A widened mediastinum is a classic radiographic sign of blunt
aortic injury, often caused by rapid deceleration forces.
3. In the ‘Triad of Death’ for trauma patients, which three physiological states create a self-
sustaining cycle of worsening condition?
A. Hypotension, bradycardia, and bradypnea
B. Tachycardia, hypertension, and tachypnea
C. Hyperthermia, alkalosis, and thrombosis
D. Hypothermia, metabolic acidosis, and coagulopathy
Answer: D
Conceptual Explanation: The lethal triad of trauma includes hypothermia, acidosis, and
coagulopathy, each of which exacerbates the others.
4. When assessing a patient with a traumatic brain injury, which finding is the most sensitive
indicator of increasing intracranial pressure?
A. Decreasing level of consciousness
B. Fixed and dilated pupils
C. Cushing’s triad
, D. Decerebrate posturing
Answer: A
Conceptual Explanation: A change in the level of consciousness is generally the first and
most sensitive sign of neurological deterioration or rising ICP.
5. Which of the following is the preferred site for needle decompression in an adult trauma
patient according to the latest TNCC guidelines?
A. Second intercostal space at the midclavicular line
B. Fifth intercostal space at the anterior axillary line
C. Fourth intercostal space at the midaxillary line
D. Third intercostal space at the midaxillary line
Answer: B
Conceptual Explanation: Current guidelines recommend the 5th intercostal space at the
anterior axillary line as the primary site for adult needle decompression due to thinner
chest walls.
6. A patient with a pelvic fracture remains hypotensive despite initial fluid resuscitation.
What is the priority intervention to stabilize the pelvis?
A. Application of a pelvic binder
B. Immediate surgical internal fixation
C. Log-rolling to check for posterior injuries
QUESTIONS AND ANSWERS
1. During the primary survey, which of the following is the most immediate priority when
treating a patient with a suspected tension pneumothorax?
A. Obtaining a portable chest X-ray
B. Performing needle thoracostomy
C. Inserting a large-bore chest tube
D. Intubating the patient for ventilatory support
Answer: B
Conceptual Explanation: Immediate decompression via needle thoracostomy is required
for tension pneumothorax to prevent cardiovascular collapse; X-rays should not delay
treatment.
2. A trauma patient presents with a widened mediastinum on chest X-ray and a mechanism
involving high-speed deceleration. Which injury should the nurse suspect first?
A. Tension pneumothorax
B. Blunt aortic injury
,C. Cardiac tamponade
D. Esophageal rupture
Answer: B
Conceptual Explanation: A widened mediastinum is a classic radiographic sign of blunt
aortic injury, often caused by rapid deceleration forces.
3. In the ‘Triad of Death’ for trauma patients, which three physiological states create a self-
sustaining cycle of worsening condition?
A. Hypotension, bradycardia, and bradypnea
B. Tachycardia, hypertension, and tachypnea
C. Hyperthermia, alkalosis, and thrombosis
D. Hypothermia, metabolic acidosis, and coagulopathy
Answer: D
Conceptual Explanation: The lethal triad of trauma includes hypothermia, acidosis, and
coagulopathy, each of which exacerbates the others.
4. When assessing a patient with a traumatic brain injury, which finding is the most sensitive
indicator of increasing intracranial pressure?
A. Decreasing level of consciousness
B. Fixed and dilated pupils
C. Cushing’s triad
, D. Decerebrate posturing
Answer: A
Conceptual Explanation: A change in the level of consciousness is generally the first and
most sensitive sign of neurological deterioration or rising ICP.
5. Which of the following is the preferred site for needle decompression in an adult trauma
patient according to the latest TNCC guidelines?
A. Second intercostal space at the midclavicular line
B. Fifth intercostal space at the anterior axillary line
C. Fourth intercostal space at the midaxillary line
D. Third intercostal space at the midaxillary line
Answer: B
Conceptual Explanation: Current guidelines recommend the 5th intercostal space at the
anterior axillary line as the primary site for adult needle decompression due to thinner
chest walls.
6. A patient with a pelvic fracture remains hypotensive despite initial fluid resuscitation.
What is the priority intervention to stabilize the pelvis?
A. Application of a pelvic binder
B. Immediate surgical internal fixation
C. Log-rolling to check for posterior injuries
