TNCC 2026 ADVANCED TRAUMA
NURSING EXAM QUESTIONS AND
ANSWERS
1. A trauma patient presents with a suspected tracheobronchial injury. Which clinical finding
is most indicative of this specific injury during the primary survey?
A. Subcutaneous emphysema of the neck and upper thorax
B. Tracheal deviation away from the affected side
C. Muffled heart sounds and jugular venous distention
D. Massive hemoptysis and persistent air leak after chest tube insertion
Answer: D
Conceptual Explanation: While subcutaneous emphysema is common, a massive
hemoptysis and a large, persistent air leak after tube thoracostomy strongly suggest a
major airway tear rather than a simple pneumothorax.
2. When managing a patient with a traumatic brain injury (TBI), which of the following is the
target range for PaCO2 to prevent secondary brain injury through vasoconstriction?
A. 25-30 mmHg
,B. 45-55 mmHg
C. 35-45 mmHg
D. 20-25 mmHg
Answer: C
Conceptual Explanation: Current trauma guidelines recommend maintaining
normocapnia (35-45 mmHg) to avoid excessive vasoconstriction (hypocapnia) or
vasodilation (hypercapnia) which both worsen secondary TBI.
3. A patient exhibits Cushing’s Triad. Which trio of symptoms are you observing?
A. Bradycardia, hypertension, and irregular respirations
B. Hypertension, tachycardia, and Cheyne-Stokes respirations
C. Hypotension, tachycardia, and tachypnea
D. Bradycardia, hypotension, and narrow pulse pressure
Answer: A
Conceptual Explanation: Cushing’s Triad (bradycardia, hypertension/widened pulse
pressure, and irregular respirations) is a late sign of increased intracranial pressure and
impending herniation.
4. Which intervention is the most appropriate initial treatment for a patient with a suspected
open book pelvic fracture and hemodynamic instability?
A. Immediate internal fixation in the OR
, B. Application of a pelvic binder at the level of the greater trochanters
C. Aggressive fluid resuscitation with 2L of lactated ringers
D. Placement of a urinary catheter to monitor output
Answer: B
Conceptual Explanation: A pelvic binder stabilizes the pelvic ring and reduces pelvic
volume to control venous bleeding. It must be placed at the greater trochanters, not the
iliac crests.
5. In the ‘Lethal Triad’ of trauma, which component directly inhibits the coagulation cascade
and protease activity?
A. Hypothermia
B. Acidosis
C. Hypocalcemia
D. Hyperkalemia
Answer: B
Conceptual Explanation: Acidosis (pH < 7.1) significantly impairs the activity of
coagulation factors. Hypothermia impairs platelet function, but acidosis targets the
protease enzymes of the cascade.
NURSING EXAM QUESTIONS AND
ANSWERS
1. A trauma patient presents with a suspected tracheobronchial injury. Which clinical finding
is most indicative of this specific injury during the primary survey?
A. Subcutaneous emphysema of the neck and upper thorax
B. Tracheal deviation away from the affected side
C. Muffled heart sounds and jugular venous distention
D. Massive hemoptysis and persistent air leak after chest tube insertion
Answer: D
Conceptual Explanation: While subcutaneous emphysema is common, a massive
hemoptysis and a large, persistent air leak after tube thoracostomy strongly suggest a
major airway tear rather than a simple pneumothorax.
2. When managing a patient with a traumatic brain injury (TBI), which of the following is the
target range for PaCO2 to prevent secondary brain injury through vasoconstriction?
A. 25-30 mmHg
,B. 45-55 mmHg
C. 35-45 mmHg
D. 20-25 mmHg
Answer: C
Conceptual Explanation: Current trauma guidelines recommend maintaining
normocapnia (35-45 mmHg) to avoid excessive vasoconstriction (hypocapnia) or
vasodilation (hypercapnia) which both worsen secondary TBI.
3. A patient exhibits Cushing’s Triad. Which trio of symptoms are you observing?
A. Bradycardia, hypertension, and irregular respirations
B. Hypertension, tachycardia, and Cheyne-Stokes respirations
C. Hypotension, tachycardia, and tachypnea
D. Bradycardia, hypotension, and narrow pulse pressure
Answer: A
Conceptual Explanation: Cushing’s Triad (bradycardia, hypertension/widened pulse
pressure, and irregular respirations) is a late sign of increased intracranial pressure and
impending herniation.
4. Which intervention is the most appropriate initial treatment for a patient with a suspected
open book pelvic fracture and hemodynamic instability?
A. Immediate internal fixation in the OR
, B. Application of a pelvic binder at the level of the greater trochanters
C. Aggressive fluid resuscitation with 2L of lactated ringers
D. Placement of a urinary catheter to monitor output
Answer: B
Conceptual Explanation: A pelvic binder stabilizes the pelvic ring and reduces pelvic
volume to control venous bleeding. It must be placed at the greater trochanters, not the
iliac crests.
5. In the ‘Lethal Triad’ of trauma, which component directly inhibits the coagulation cascade
and protease activity?
A. Hypothermia
B. Acidosis
C. Hypocalcemia
D. Hyperkalemia
Answer: B
Conceptual Explanation: Acidosis (pH < 7.1) significantly impairs the activity of
coagulation factors. Hypothermia impairs platelet function, but acidosis targets the
protease enzymes of the cascade.
