TNCC COMPLETE STUDY GUIDE
NEWEST 2026 | TRAUMA NURSING
CORE COURSE EXAM REVIEW |
TNCC 9TH EDITION TEST BANK |
PRACTICE QUESTIONS AND
DETAILED RATIONALES | 2026
EDITION
Question
What is the priority intervention for a patient with a traumatic amputation and
uncontrolled, spurting hemorrhage from the stump?
A) Open the airway using a jaw-thrust maneuver
B) Apply a tourniquet proximal to the injury
C) Start two large-bore intravenous lines
D) Apply direct pressure with a sterile dressing
Expert Rationale: In the 9th Edition TNCC Trauma Nursing Process and the MARCH
algorithm, massive, life-threatening external hemorrhage (Circulation/Exsanguination) is
addressed before airway to prevent exsanguination and cardiac arrest . A tourniquet is the
definitive intervention for uncontrolled extremity hemorrhage when direct pressure fails, as
it stops arterial bleeding immediately . Direct pressure may not control spurting arterial
bleeding, and IV access and airway management are secondary priorities.
Question
A trauma patient is involved in a high-speed motor vehicle collision. The patient has absent
breath sounds on the left side, tracheal deviation to the right, hypotension, and distended
neck veins. What is the most likely diagnosis?
,A) Simple pneumothorax
B) Tension pneumothorax
C) Cardiac tamponade
D) Massive hemothorax
Expert Rationale: This classic presentation of absent breath sounds on the affected side,
tracheal deviation away from the affected side, hypotension, and distended neck veins is
diagnostic for tension pneumothorax . Air accumulates in the pleural space under
pressure, shifting the mediastinum and compressing the vena cava, reducing cardiac
output. Immediate needle decompression is required, followed by chest tube insertion .
Cardiac tamponade presents with muffled heart sounds, not tracheal deviation .
Question
A patient presents with paradoxical chest wall movement on the right side following a fall.
This finding is most consistent with which injury?
A) Pulmonary contusion
B) Tension pneumothorax
C) Flail chest
D) Hemothorax
Expert Rationale: Flail chest occurs when three or more consecutive ribs are fractured in
two or more places, creating a free-floating segment that moves paradoxically—inward
during inspiration and outward during expiration . This paradoxical movement impairs
ventilation and may indicate underlying pulmonary contusion . The other choices do not
typically present with paradoxical movement.
Question
During the primary survey, what is the preferred method for opening the airway in a trauma
patient with a suspected cervical spine injury?
A) Head-tilt, chin-lift maneuver
B) Jaw-thrust maneuver
C) Oropharyngeal airway insertion
D) Nasopharyngeal airway insertion
Expert Rationale: The jaw-thrust maneuver is the recommended technique for opening the
airway in a trauma patient because it lifts the mandible forward without moving the cervical
,spine . The head-tilt, chin-lift is contraindicated in suspected spinal injury. Airway adjuncts
(OPA/NPA) may be used but do not replace manual maneuvers.
Question
A trauma patient involved in a motor vehicle crash has a seatbelt sign (ecchymosis) across
the lower abdomen. Which injury should the nurse suspect?
A) Blunt cardiac injury
B) Bowel or mesenteric injury
C) Diaphragmatic rupture
D) Liver laceration
Expert Rationale: A seatbelt sign (ecchymosis or abrasion across the abdomen) is
associated with a high risk of intra-abdominal injury, particularly to the small bowel and
mesentery due to compression and shearing forces . These injuries may not be
immediately apparent and require careful monitoring. While other injuries can occur, bowel
perforation is a classic concern with this finding.
Question
An adult patient presents with superficial burns to the extremities following a house fire.
The patient is drowsy, confused, and reports a headache with nausea. What is the most
likely cause of these symptoms?
A) Capillary leak syndrome
B) Rhabdomyolysis
C) Carbon monoxide poisoning
D) Hypothermia
Expert Rationale: Headache, nausea, drowsiness, and confusion are classic signs of
carbon monoxide (CO) poisoning, which occurs in enclosed-space fires . CO binds to
hemoglobin with higher affinity than oxygen, causing tissue hypoxia. Capillary leak
syndrome and rhabdomyolysis are complications of burns but do not explain these
neurologic symptoms; hypothermia is less likely in a fire environment.
Question
A patient has been intubated and is being mechanically ventilated after a severe trauma.
The patient has received a balanced resuscitation including multiple blood products.
, Under which circumstance will it be harder for hemoglobin to release oxygen to the
tissues?
A) Decreased body temperature
B) Increased cardiac output
C) Elevated blood pressure
D) Alkalosis
Expert Rationale: Hypothermia shifts the oxyhemoglobin dissociation curve to the left,
increasing hemoglobin's affinity for oxygen and making it harder to release oxygen to
tissues . This impairs tissue oxygenation despite adequate oxygen content in the blood.
Acidosis, not alkalosis, promotes oxygen release . Maintaining normothermia is a key
component of trauma care to prevent coagulopathy and impaired oxygen delivery.
Question
What is the "Golden Hour" in trauma care?
A) The first hour after arrival in the emergency department
B) The critical window for definitive care to improve survival
C) The time required to complete the primary survey
D) The duration for completing all diagnostic imaging
Expert Rationale: The "Golden Hour" refers to the critical window—typically the first hour
post-injury—during which timely, definitive trauma care significantly improves survival
outcomes . Early intervention within this period is statistically linked to better outcomes . It
is not a strict time limit but emphasizes urgency in resuscitation and definitive surgical
intervention.
Question
A trauma patient has a GCS score of 6 (E-1, V-1, M-4). This score is consistent with what
category of traumatic brain injury?
A) Mild traumatic brain injury
B) Moderate traumatic brain injury
C) Severe traumatic brain injury
D) No brain injury
Expert Rationale: A Glasgow Coma Scale (GCS) score of 3–8 indicates severe traumatic
brain injury (TBI) . Scores of 9–12 indicate moderate TBI, and 13–15 indicate mild TBI .
NEWEST 2026 | TRAUMA NURSING
CORE COURSE EXAM REVIEW |
TNCC 9TH EDITION TEST BANK |
PRACTICE QUESTIONS AND
DETAILED RATIONALES | 2026
EDITION
Question
What is the priority intervention for a patient with a traumatic amputation and
uncontrolled, spurting hemorrhage from the stump?
A) Open the airway using a jaw-thrust maneuver
B) Apply a tourniquet proximal to the injury
C) Start two large-bore intravenous lines
D) Apply direct pressure with a sterile dressing
Expert Rationale: In the 9th Edition TNCC Trauma Nursing Process and the MARCH
algorithm, massive, life-threatening external hemorrhage (Circulation/Exsanguination) is
addressed before airway to prevent exsanguination and cardiac arrest . A tourniquet is the
definitive intervention for uncontrolled extremity hemorrhage when direct pressure fails, as
it stops arterial bleeding immediately . Direct pressure may not control spurting arterial
bleeding, and IV access and airway management are secondary priorities.
Question
A trauma patient is involved in a high-speed motor vehicle collision. The patient has absent
breath sounds on the left side, tracheal deviation to the right, hypotension, and distended
neck veins. What is the most likely diagnosis?
,A) Simple pneumothorax
B) Tension pneumothorax
C) Cardiac tamponade
D) Massive hemothorax
Expert Rationale: This classic presentation of absent breath sounds on the affected side,
tracheal deviation away from the affected side, hypotension, and distended neck veins is
diagnostic for tension pneumothorax . Air accumulates in the pleural space under
pressure, shifting the mediastinum and compressing the vena cava, reducing cardiac
output. Immediate needle decompression is required, followed by chest tube insertion .
Cardiac tamponade presents with muffled heart sounds, not tracheal deviation .
Question
A patient presents with paradoxical chest wall movement on the right side following a fall.
This finding is most consistent with which injury?
A) Pulmonary contusion
B) Tension pneumothorax
C) Flail chest
D) Hemothorax
Expert Rationale: Flail chest occurs when three or more consecutive ribs are fractured in
two or more places, creating a free-floating segment that moves paradoxically—inward
during inspiration and outward during expiration . This paradoxical movement impairs
ventilation and may indicate underlying pulmonary contusion . The other choices do not
typically present with paradoxical movement.
Question
During the primary survey, what is the preferred method for opening the airway in a trauma
patient with a suspected cervical spine injury?
A) Head-tilt, chin-lift maneuver
B) Jaw-thrust maneuver
C) Oropharyngeal airway insertion
D) Nasopharyngeal airway insertion
Expert Rationale: The jaw-thrust maneuver is the recommended technique for opening the
airway in a trauma patient because it lifts the mandible forward without moving the cervical
,spine . The head-tilt, chin-lift is contraindicated in suspected spinal injury. Airway adjuncts
(OPA/NPA) may be used but do not replace manual maneuvers.
Question
A trauma patient involved in a motor vehicle crash has a seatbelt sign (ecchymosis) across
the lower abdomen. Which injury should the nurse suspect?
A) Blunt cardiac injury
B) Bowel or mesenteric injury
C) Diaphragmatic rupture
D) Liver laceration
Expert Rationale: A seatbelt sign (ecchymosis or abrasion across the abdomen) is
associated with a high risk of intra-abdominal injury, particularly to the small bowel and
mesentery due to compression and shearing forces . These injuries may not be
immediately apparent and require careful monitoring. While other injuries can occur, bowel
perforation is a classic concern with this finding.
Question
An adult patient presents with superficial burns to the extremities following a house fire.
The patient is drowsy, confused, and reports a headache with nausea. What is the most
likely cause of these symptoms?
A) Capillary leak syndrome
B) Rhabdomyolysis
C) Carbon monoxide poisoning
D) Hypothermia
Expert Rationale: Headache, nausea, drowsiness, and confusion are classic signs of
carbon monoxide (CO) poisoning, which occurs in enclosed-space fires . CO binds to
hemoglobin with higher affinity than oxygen, causing tissue hypoxia. Capillary leak
syndrome and rhabdomyolysis are complications of burns but do not explain these
neurologic symptoms; hypothermia is less likely in a fire environment.
Question
A patient has been intubated and is being mechanically ventilated after a severe trauma.
The patient has received a balanced resuscitation including multiple blood products.
, Under which circumstance will it be harder for hemoglobin to release oxygen to the
tissues?
A) Decreased body temperature
B) Increased cardiac output
C) Elevated blood pressure
D) Alkalosis
Expert Rationale: Hypothermia shifts the oxyhemoglobin dissociation curve to the left,
increasing hemoglobin's affinity for oxygen and making it harder to release oxygen to
tissues . This impairs tissue oxygenation despite adequate oxygen content in the blood.
Acidosis, not alkalosis, promotes oxygen release . Maintaining normothermia is a key
component of trauma care to prevent coagulopathy and impaired oxygen delivery.
Question
What is the "Golden Hour" in trauma care?
A) The first hour after arrival in the emergency department
B) The critical window for definitive care to improve survival
C) The time required to complete the primary survey
D) The duration for completing all diagnostic imaging
Expert Rationale: The "Golden Hour" refers to the critical window—typically the first hour
post-injury—during which timely, definitive trauma care significantly improves survival
outcomes . Early intervention within this period is statistically linked to better outcomes . It
is not a strict time limit but emphasizes urgency in resuscitation and definitive surgical
intervention.
Question
A trauma patient has a GCS score of 6 (E-1, V-1, M-4). This score is consistent with what
category of traumatic brain injury?
A) Mild traumatic brain injury
B) Moderate traumatic brain injury
C) Severe traumatic brain injury
D) No brain injury
Expert Rationale: A Glasgow Coma Scale (GCS) score of 3–8 indicates severe traumatic
brain injury (TBI) . Scores of 9–12 indicate moderate TBI, and 13–15 indicate mild TBI .
