TNCC Final Exam Preparation
Guide (2026/2027): 100
Representative Practice Questions
with Verified Answers for Trauma
Nursing Certification"| Instant
download PDF
1. Primary Survey Priority
Scenario: During the primary survey of a trauma patient, the nurse notes snoring
respirations.
Question: Which priority nursing intervention should be performed next?
A. Open the airway with the head-tilt/chin-lift maneuver
B. Auscultate bilateral breath sounds
C. Assist respirations using a bag-mask device
D. Insert an oropharyngeal airway if there is no gag reflex
Correct Answer: D
Rationale: Snoring respirations indicate airway obstruction from the tongue. In an
unconscious patient, an oropharyngeal airway is indicated to maintain a patent
airway, provided there is no gag reflex. The jaw thrust is used when cervical spine
injury is suspected, but an airway adjunct is needed to actually maintain patency.
2. Shock Recognition
Scenario: A trauma patient is restless and repeatedly asking "Where am I?" Vital
signs upon arrival were BP 100/60 mm Hg, HR 96, RR 24. Current vital signs are BP
104/84 mm Hg, HR 108, RR 28.
Question: The patient is demonstrating signs and symptoms of which stage of
shock?
A. Compensated
B. Progressive
C. Irreversible
D. Decompensated
,Correct Answer: A
Rationale: The patient is demonstrating signs of compensated shock. In compensated
shock, the body's compensatory mechanisms (increased heart rate, increased
respiratory rate, peripheral vasoconstriction) are maintaining blood pressure and
perfusion to vital organs. Restlessness and anxiety are early signs of cerebral
hypoperfusion. The narrow pulse pressure (104/84 = pulse pressure of 20) is also a
hallmark of compensated shock.
3. Neurological Assessment
Question: A patient with a complete spinal cord injury in neurogenic shock will
demonstrate hypotension and which other clinical signs?
A. Bradycardia and ipsilateral absence of motor function
B. Tachycardia and respiratory depression
C. Tachycardia and absent motor function below the level of injury
D. Bradycardia and absent motor function below the level of the injury
Correct Answer: D
Rationale: Neurogenic shock results from loss of sympathetic tone, which causes
vasodilation and unopposed vagal tone. This leads to hypotension and bradycardia
(rather than tachycardia, which is seen in hypovolemic shock). Motor function is absent
below the level of injury due to the spinal cord damage.
4. Thoracic Trauma
Question: Which of the following assessment findings is the most reliable indicator
of a developing tension pneumothorax?
A. Sudden shortness of breath
B. Diminished breath sounds on the affected side
C. Hypoxia with a pulse oximetry reading of 90%
D. Tracheal deviation away from the midline
Correct Answer: D
Rationale: While all options are signs of tension pneumothorax, tracheal deviation to
the contralateral side is a late and highly reliable sign of mediastinal shift due to
pressure buildup in the pleural space, indicating an immediate life-threatening
emergency. This is a classic late finding that signals imminent cardiovascular collapse.
,5. Interfacility Transfer
Scenario: A patient is brought to the emergency department of a rural hospital
following a high-speed MVC. Significant abdominal and pelvic injuries are noted in
the primary survey.
Question: What is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
Correct Answer: A
Rationale: When a patient's needs outweigh the capabilities of the facility, the priority
is to initiate transfer to a higher level of care. The decision to transfer should be made
early, based on the primary survey findings, rather than completing extensive imaging
studies at a facility that cannot provide definitive care.
6. Musculoskeletal Trauma
Scenario: A patient with a lower extremity fracture complains of severe pain and
tightness in his calf, minimally relieved by pain medications.
Question: Which of the following is the priority nursing intervention?
A. Elevating the extremity above the level of the heart
B. Repositioning and applying ice
C. Elevating the extremity to the level of the heart
D. Preparing the patient for ultrasound
Correct Answer: C
Rationale: Severe pain and tightness that is minimally relieved by medication in a
patient with a fracture raises suspicion for compartment syndrome. The priority is to
keep the extremity at the level of the heart (not above, which can impair arterial flow)
and prepare for further evaluation. Elevating above the heart can worsen ischemia.
7. Mechanism of Injury
Question: Which of the following occurs during the third impact of a motor vehicle
crash?
A. The driver of the vehicle collides with the steering wheel
B. The vehicle collides with a tree
C. The aorta is torn at its attachment with the ligamentum arteriosum
D. The airbag deploys and strikes the front seat passenger
, Correct Answer: C
Rationale: The "third impact" refers to the internal organs continuing to move and
tearing at attachment points after the external body has stopped. The aorta is a classic
example—it can shear at the ligamentum arteriosum due to deceleration forces.
8. Pediatric Trauma
Scenario: A 5-year-old child presents to the ED with bruises to the upper arms and
buttocks in various stages of healing and multiple small, clean, round burns to the
back.
Question: Which of the following is the priority nursing intervention?
A. Report your suspicion of the maltreatment in accordance with local regulations
B. Apply ice to the bruises and consult wound care
C. Engage in therapeutic communication to determine the MOI
D. Provide the family with injury prevention resources
Correct Answer: A
Rationale: The pattern of injuries (various stages of healing, clean round burns) is
highly suspicious for non-accidental trauma. The nurse's priority is to report the
suspicion of maltreatment in accordance with local regulations and mandatory
reporting laws.
9. Airway Management with C-Spine Precautions
Scenario: A patient is brought to the emergency department following a motorcycle
crash. The patient is only responsive to pain, has bleeding from the nose, and
multiple abrasions to the face.
Question: What is the priority intervention?
A. Apply a cervical collar
B. Use a jaw thrust to open the airway and look for signs of obstruction
C. Administer high-flow oxygen
D. Obtain a CT scan of the head
Correct Answer: B
Rationale: In a patient with facial trauma and altered mental status, the priority is to
establish a patent airway while maintaining cervical spine precautions. The jaw thrust
is the preferred maneuver when cervical spine injury is suspected. Bleeding from the
nose may indicate a basilar skull fracture or significant facial injury that could
compromise the airway.
Guide (2026/2027): 100
Representative Practice Questions
with Verified Answers for Trauma
Nursing Certification"| Instant
download PDF
1. Primary Survey Priority
Scenario: During the primary survey of a trauma patient, the nurse notes snoring
respirations.
Question: Which priority nursing intervention should be performed next?
A. Open the airway with the head-tilt/chin-lift maneuver
B. Auscultate bilateral breath sounds
C. Assist respirations using a bag-mask device
D. Insert an oropharyngeal airway if there is no gag reflex
Correct Answer: D
Rationale: Snoring respirations indicate airway obstruction from the tongue. In an
unconscious patient, an oropharyngeal airway is indicated to maintain a patent
airway, provided there is no gag reflex. The jaw thrust is used when cervical spine
injury is suspected, but an airway adjunct is needed to actually maintain patency.
2. Shock Recognition
Scenario: A trauma patient is restless and repeatedly asking "Where am I?" Vital
signs upon arrival were BP 100/60 mm Hg, HR 96, RR 24. Current vital signs are BP
104/84 mm Hg, HR 108, RR 28.
Question: The patient is demonstrating signs and symptoms of which stage of
shock?
A. Compensated
B. Progressive
C. Irreversible
D. Decompensated
,Correct Answer: A
Rationale: The patient is demonstrating signs of compensated shock. In compensated
shock, the body's compensatory mechanisms (increased heart rate, increased
respiratory rate, peripheral vasoconstriction) are maintaining blood pressure and
perfusion to vital organs. Restlessness and anxiety are early signs of cerebral
hypoperfusion. The narrow pulse pressure (104/84 = pulse pressure of 20) is also a
hallmark of compensated shock.
3. Neurological Assessment
Question: A patient with a complete spinal cord injury in neurogenic shock will
demonstrate hypotension and which other clinical signs?
A. Bradycardia and ipsilateral absence of motor function
B. Tachycardia and respiratory depression
C. Tachycardia and absent motor function below the level of injury
D. Bradycardia and absent motor function below the level of the injury
Correct Answer: D
Rationale: Neurogenic shock results from loss of sympathetic tone, which causes
vasodilation and unopposed vagal tone. This leads to hypotension and bradycardia
(rather than tachycardia, which is seen in hypovolemic shock). Motor function is absent
below the level of injury due to the spinal cord damage.
4. Thoracic Trauma
Question: Which of the following assessment findings is the most reliable indicator
of a developing tension pneumothorax?
A. Sudden shortness of breath
B. Diminished breath sounds on the affected side
C. Hypoxia with a pulse oximetry reading of 90%
D. Tracheal deviation away from the midline
Correct Answer: D
Rationale: While all options are signs of tension pneumothorax, tracheal deviation to
the contralateral side is a late and highly reliable sign of mediastinal shift due to
pressure buildup in the pleural space, indicating an immediate life-threatening
emergency. This is a classic late finding that signals imminent cardiovascular collapse.
,5. Interfacility Transfer
Scenario: A patient is brought to the emergency department of a rural hospital
following a high-speed MVC. Significant abdominal and pelvic injuries are noted in
the primary survey.
Question: What is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
Correct Answer: A
Rationale: When a patient's needs outweigh the capabilities of the facility, the priority
is to initiate transfer to a higher level of care. The decision to transfer should be made
early, based on the primary survey findings, rather than completing extensive imaging
studies at a facility that cannot provide definitive care.
6. Musculoskeletal Trauma
Scenario: A patient with a lower extremity fracture complains of severe pain and
tightness in his calf, minimally relieved by pain medications.
Question: Which of the following is the priority nursing intervention?
A. Elevating the extremity above the level of the heart
B. Repositioning and applying ice
C. Elevating the extremity to the level of the heart
D. Preparing the patient for ultrasound
Correct Answer: C
Rationale: Severe pain and tightness that is minimally relieved by medication in a
patient with a fracture raises suspicion for compartment syndrome. The priority is to
keep the extremity at the level of the heart (not above, which can impair arterial flow)
and prepare for further evaluation. Elevating above the heart can worsen ischemia.
7. Mechanism of Injury
Question: Which of the following occurs during the third impact of a motor vehicle
crash?
A. The driver of the vehicle collides with the steering wheel
B. The vehicle collides with a tree
C. The aorta is torn at its attachment with the ligamentum arteriosum
D. The airbag deploys and strikes the front seat passenger
, Correct Answer: C
Rationale: The "third impact" refers to the internal organs continuing to move and
tearing at attachment points after the external body has stopped. The aorta is a classic
example—it can shear at the ligamentum arteriosum due to deceleration forces.
8. Pediatric Trauma
Scenario: A 5-year-old child presents to the ED with bruises to the upper arms and
buttocks in various stages of healing and multiple small, clean, round burns to the
back.
Question: Which of the following is the priority nursing intervention?
A. Report your suspicion of the maltreatment in accordance with local regulations
B. Apply ice to the bruises and consult wound care
C. Engage in therapeutic communication to determine the MOI
D. Provide the family with injury prevention resources
Correct Answer: A
Rationale: The pattern of injuries (various stages of healing, clean round burns) is
highly suspicious for non-accidental trauma. The nurse's priority is to report the
suspicion of maltreatment in accordance with local regulations and mandatory
reporting laws.
9. Airway Management with C-Spine Precautions
Scenario: A patient is brought to the emergency department following a motorcycle
crash. The patient is only responsive to pain, has bleeding from the nose, and
multiple abrasions to the face.
Question: What is the priority intervention?
A. Apply a cervical collar
B. Use a jaw thrust to open the airway and look for signs of obstruction
C. Administer high-flow oxygen
D. Obtain a CT scan of the head
Correct Answer: B
Rationale: In a patient with facial trauma and altered mental status, the priority is to
establish a patent airway while maintaining cervical spine precautions. The jaw thrust
is the preferred maneuver when cervical spine injury is suspected. Bleeding from the
nose may indicate a basilar skull fracture or significant facial injury that could
compromise the airway.
