TNCC 9th Edition Final Exam 2026/2027 | 300+ Practice
Questions, Correct Answers & Detailed Rationales
Questions 1–50: Primary Survey, ABCDE & Initial Trauma Assessment
1. A trauma patient arrives after a motor vehicle collision. Which
assessment should the nurse perform first?
A. Assess pupils
B. Evaluate airway patency
C. Obtain a complete medical history
D. Inspect the abdomen
Answer: B
Rationale: Airway assessment is the first priority in the trauma primary
survey. An obstructed airway can rapidly cause hypoxia and death.
2. Which finding most strongly suggests an immediate airway
obstruction?
A. Bradycardia
B. Gurgling respirations
C. Hypertension
D. Abdominal tenderness
Answer: B
Rationale: Gurgling indicates blood, secretions, or other material
obstructing the airway and requires immediate intervention.
3. During the primary survey, which sequence is most appropriate?
A. Disability, airway, breathing, circulation, exposure
B. Airway, breathing, circulation, disability, exposure
C. Breathing, airway, exposure, circulation, disability
,D. Circulation, airway, disability, breathing, exposure
Answer: B
Rationale: The traditional trauma primary survey follows ABCDE:
airway, breathing, circulation, disability, and exposure/environment.
4. A trauma patient has facial trauma and is unable to maintain airway
patency. What is the priority?
A. Insert a nasogastric tube
B. Secure the airway
C. Obtain a urine specimen
D. Perform a secondary survey
Answer: B
Rationale: Failure to maintain the airway is immediately life-
threatening.
5. Which patient is at greatest risk for cervical spine injury?
A. Patient with an isolated forearm laceration
B. Patient involved in a high-speed collision
C. Patient with a superficial hand burn
D. Patient with a minor ankle sprain
Answer: B
Rationale: High-energy mechanisms, including high-speed collisions,
increase the risk of spinal injury.
6. What is the safest initial method for opening the airway when
cervical spine injury is suspected?
A. Head tilt–chin lift
B. Jaw-thrust maneuver
C. Hyperextension of the neck
D. Neck rotation
,Answer: B
Rationale: The jaw-thrust maneuver helps open the airway while
minimizing cervical spine movement.
7. Which finding indicates inadequate oxygenation?
A. SpO₂ of 99%
B. Cyanosis
C. Warm skin
D. Normal respiratory rate
Answer: B
Rationale: Cyanosis can indicate significant hypoxemia and requires
immediate evaluation.
8. A trauma patient has severe respiratory distress and absent breath
sounds on one side. What should the nurse suspect?
A. Tension pneumothorax
B. Simple rib fracture
C. Gastric ulcer
D. Isolated concussion
Answer: A
Rationale: Unilateral absent breath sounds with severe respiratory
compromise can indicate tension pneumothorax, a life-threatening
emergency.
9. Which assessment finding is most concerning for tension
pneumothorax?
A. Mild chest discomfort
B. Severe respiratory distress with hypotension
C. Normal oxygen saturation
D. Isolated abdominal bruising
, Answer: B
Rationale: Tension pneumothorax can impair venous return, causing
hypotension and obstructive shock.
10. Which intervention is expected for a patient with suspected tension
pneumothorax?
A. Immediate decompression
B. Oral fluids
C. Delayed imaging before treatment
D. Trendelenburg positioning only
Answer: A
Rationale: A clinically unstable patient with suspected tension
pneumothorax requires immediate decompression rather than waiting
for definitive imaging.
11. Which finding is most suggestive of a massive hemothorax?
A. Hyperresonance
B. Absent breath sounds with shock
C. Bradycardia without blood loss
D. Isolated headache
Answer: B
Rationale: Massive blood accumulation in the pleural space can cause
respiratory compromise and hemorrhagic shock.
12. What is the primary purpose of the circulation assessment in the
trauma primary survey?
A. Identify chronic hypertension
B. Detect and control life-threatening hemorrhage
C. Determine dietary intake
D. Assess long-term rehabilitation needs
Questions, Correct Answers & Detailed Rationales
Questions 1–50: Primary Survey, ABCDE & Initial Trauma Assessment
1. A trauma patient arrives after a motor vehicle collision. Which
assessment should the nurse perform first?
A. Assess pupils
B. Evaluate airway patency
C. Obtain a complete medical history
D. Inspect the abdomen
Answer: B
Rationale: Airway assessment is the first priority in the trauma primary
survey. An obstructed airway can rapidly cause hypoxia and death.
2. Which finding most strongly suggests an immediate airway
obstruction?
A. Bradycardia
B. Gurgling respirations
C. Hypertension
D. Abdominal tenderness
Answer: B
Rationale: Gurgling indicates blood, secretions, or other material
obstructing the airway and requires immediate intervention.
3. During the primary survey, which sequence is most appropriate?
A. Disability, airway, breathing, circulation, exposure
B. Airway, breathing, circulation, disability, exposure
C. Breathing, airway, exposure, circulation, disability
,D. Circulation, airway, disability, breathing, exposure
Answer: B
Rationale: The traditional trauma primary survey follows ABCDE:
airway, breathing, circulation, disability, and exposure/environment.
4. A trauma patient has facial trauma and is unable to maintain airway
patency. What is the priority?
A. Insert a nasogastric tube
B. Secure the airway
C. Obtain a urine specimen
D. Perform a secondary survey
Answer: B
Rationale: Failure to maintain the airway is immediately life-
threatening.
5. Which patient is at greatest risk for cervical spine injury?
A. Patient with an isolated forearm laceration
B. Patient involved in a high-speed collision
C. Patient with a superficial hand burn
D. Patient with a minor ankle sprain
Answer: B
Rationale: High-energy mechanisms, including high-speed collisions,
increase the risk of spinal injury.
6. What is the safest initial method for opening the airway when
cervical spine injury is suspected?
A. Head tilt–chin lift
B. Jaw-thrust maneuver
C. Hyperextension of the neck
D. Neck rotation
,Answer: B
Rationale: The jaw-thrust maneuver helps open the airway while
minimizing cervical spine movement.
7. Which finding indicates inadequate oxygenation?
A. SpO₂ of 99%
B. Cyanosis
C. Warm skin
D. Normal respiratory rate
Answer: B
Rationale: Cyanosis can indicate significant hypoxemia and requires
immediate evaluation.
8. A trauma patient has severe respiratory distress and absent breath
sounds on one side. What should the nurse suspect?
A. Tension pneumothorax
B. Simple rib fracture
C. Gastric ulcer
D. Isolated concussion
Answer: A
Rationale: Unilateral absent breath sounds with severe respiratory
compromise can indicate tension pneumothorax, a life-threatening
emergency.
9. Which assessment finding is most concerning for tension
pneumothorax?
A. Mild chest discomfort
B. Severe respiratory distress with hypotension
C. Normal oxygen saturation
D. Isolated abdominal bruising
, Answer: B
Rationale: Tension pneumothorax can impair venous return, causing
hypotension and obstructive shock.
10. Which intervention is expected for a patient with suspected tension
pneumothorax?
A. Immediate decompression
B. Oral fluids
C. Delayed imaging before treatment
D. Trendelenburg positioning only
Answer: A
Rationale: A clinically unstable patient with suspected tension
pneumothorax requires immediate decompression rather than waiting
for definitive imaging.
11. Which finding is most suggestive of a massive hemothorax?
A. Hyperresonance
B. Absent breath sounds with shock
C. Bradycardia without blood loss
D. Isolated headache
Answer: B
Rationale: Massive blood accumulation in the pleural space can cause
respiratory compromise and hemorrhagic shock.
12. What is the primary purpose of the circulation assessment in the
trauma primary survey?
A. Identify chronic hypertension
B. Detect and control life-threatening hemorrhage
C. Determine dietary intake
D. Assess long-term rehabilitation needs
