TNCC Written Exam 2026
Questions and Answers
Course
TNCC
1. A trauma patient arrives after a high-speed motor vehicle collision. Which assessment
should the trauma nurse prioritize first?
A. Detailed medical history
B. Airway assessment with cervical spine protection
C. Complete medication reconciliation
D. Full head-to-toe skin assessment
Correct Answer: B. Airway assessment with cervical spine protection
Rationale: In the initial trauma assessment, airway and cervical spine protection are immediate
priorities because airway compromise can rapidly become fatal.
2. Which finding is most concerning for an obstructed airway in a trauma patient?
A. Mild anxiety
B. Hoarse voice with stridor
C. Heart rate of 88/min
D. Warm, dry skin
Correct Answer: B. Hoarse voice with stridor
Rationale: Stridor suggests significant upper-airway obstruction. Hoarseness may indicate
airway edema or injury and requires immediate attention.
3. A trauma patient has decreased breath sounds on the right, severe respiratory distress,
and hypotension after blunt chest trauma. Which condition should the nurse suspect?
A. Simple rib fracture
B. Tension pneumothorax
C. Pulmonary contusion only
D. Stable hemothorax
Correct Answer: B. Tension pneumothorax
Rationale: Tension pneumothorax can cause severe respiratory compromise and obstructive
shock. It requires immediate recognition and emergency decompression.
4. Which assessment finding is most consistent with tension pneumothorax?
,A. Bilateral equal breath sounds
B. Severe respiratory distress with unilateral absent breath sounds
C. Bradycardia with hypertension
D. Increased urine output
Correct Answer: B. Severe respiratory distress with unilateral absent breath sounds
Rationale: Accumulating pleural pressure can collapse the affected lung and impair venous
return, producing respiratory distress and hemodynamic instability.
5. A patient with penetrating chest trauma has a sucking chest wound. What is the priority
intervention?
A. Apply an appropriate occlusive dressing
B. Encourage oral fluids
C. Place the patient flat and leave the wound uncovered
D. Delay treatment until imaging is completed
Correct Answer: A. Apply an appropriate occlusive dressing
Rationale: An open chest wound can allow air to enter the pleural space. A properly applied
occlusive dressing helps limit further air entry while the patient receives definitive trauma care.
6. Which finding is most suggestive of hemorrhagic shock?
A. Bradycardia with warm extremities
B. Tachycardia, hypotension, and altered mental status
C. Hypertension and bounding pulses
D. Increased urine output
Correct Answer: B. Tachycardia, hypotension, and altered mental status
Rationale: Significant blood loss decreases circulating volume and tissue perfusion.
Compensatory tachycardia may progress to hypotension and altered mental status as shock
worsens.
7. A trauma patient has uncontrolled external bleeding from an extremity. What should the
nurse prioritize?
A. Obtain a detailed history first
B. Control the hemorrhage
C. Perform a complete neurologic examination first
D. Wait for laboratory results
Correct Answer: B. Control the hemorrhage
, Rationale: Life-threatening external hemorrhage must be rapidly controlled because continued
blood loss can lead to shock and death.
8. Which finding may indicate internal abdominal bleeding after blunt trauma?
A. Increasing abdominal distention with hypotension
B. Improved peripheral perfusion
C. Increased urine output
D. Decreased abdominal tenderness with stable vital signs
Correct Answer: A. Increasing abdominal distention with hypotension
Rationale: Internal hemorrhage can cause abdominal distention, falling blood pressure,
tachycardia, pallor, and other signs of inadequate circulation.
9. A trauma patient has a Glasgow Coma Scale score of 7. What does this indicate?
A. Mild neurologic impairment
B. Severe impairment of consciousness
C. Normal neurologic status
D. Mild confusion only
Correct Answer: B. Severe impairment of consciousness
Rationale: A GCS score of 8 or less generally indicates severe impairment and raises concern
for inability to protect the airway.
10. Which assessment finding is most concerning for increasing intracranial pressure?
A. Improved level of consciousness
B. Decreasing level of consciousness with unequal pupils
C. Normal pupillary responses
D. Increased urine output
Correct Answer: B. Decreasing level of consciousness with unequal pupils
Rationale: A declining level of consciousness and pupillary changes can indicate worsening
intracranial pathology and increased intracranial pressure.
11. Which intervention is appropriate for a patient with suspected cervical spine injury?
A. Encourage neck movement
B. Maintain spinal alignment and appropriate immobilization
C. Place the patient in a sitting position immediately
D. Perform repeated neck flexion assessments
Correct Answer: B. Maintain spinal alignment and appropriate immobilization
Questions and Answers
Course
TNCC
1. A trauma patient arrives after a high-speed motor vehicle collision. Which assessment
should the trauma nurse prioritize first?
A. Detailed medical history
B. Airway assessment with cervical spine protection
C. Complete medication reconciliation
D. Full head-to-toe skin assessment
Correct Answer: B. Airway assessment with cervical spine protection
Rationale: In the initial trauma assessment, airway and cervical spine protection are immediate
priorities because airway compromise can rapidly become fatal.
2. Which finding is most concerning for an obstructed airway in a trauma patient?
A. Mild anxiety
B. Hoarse voice with stridor
C. Heart rate of 88/min
D. Warm, dry skin
Correct Answer: B. Hoarse voice with stridor
Rationale: Stridor suggests significant upper-airway obstruction. Hoarseness may indicate
airway edema or injury and requires immediate attention.
3. A trauma patient has decreased breath sounds on the right, severe respiratory distress,
and hypotension after blunt chest trauma. Which condition should the nurse suspect?
A. Simple rib fracture
B. Tension pneumothorax
C. Pulmonary contusion only
D. Stable hemothorax
Correct Answer: B. Tension pneumothorax
Rationale: Tension pneumothorax can cause severe respiratory compromise and obstructive
shock. It requires immediate recognition and emergency decompression.
4. Which assessment finding is most consistent with tension pneumothorax?
,A. Bilateral equal breath sounds
B. Severe respiratory distress with unilateral absent breath sounds
C. Bradycardia with hypertension
D. Increased urine output
Correct Answer: B. Severe respiratory distress with unilateral absent breath sounds
Rationale: Accumulating pleural pressure can collapse the affected lung and impair venous
return, producing respiratory distress and hemodynamic instability.
5. A patient with penetrating chest trauma has a sucking chest wound. What is the priority
intervention?
A. Apply an appropriate occlusive dressing
B. Encourage oral fluids
C. Place the patient flat and leave the wound uncovered
D. Delay treatment until imaging is completed
Correct Answer: A. Apply an appropriate occlusive dressing
Rationale: An open chest wound can allow air to enter the pleural space. A properly applied
occlusive dressing helps limit further air entry while the patient receives definitive trauma care.
6. Which finding is most suggestive of hemorrhagic shock?
A. Bradycardia with warm extremities
B. Tachycardia, hypotension, and altered mental status
C. Hypertension and bounding pulses
D. Increased urine output
Correct Answer: B. Tachycardia, hypotension, and altered mental status
Rationale: Significant blood loss decreases circulating volume and tissue perfusion.
Compensatory tachycardia may progress to hypotension and altered mental status as shock
worsens.
7. A trauma patient has uncontrolled external bleeding from an extremity. What should the
nurse prioritize?
A. Obtain a detailed history first
B. Control the hemorrhage
C. Perform a complete neurologic examination first
D. Wait for laboratory results
Correct Answer: B. Control the hemorrhage
, Rationale: Life-threatening external hemorrhage must be rapidly controlled because continued
blood loss can lead to shock and death.
8. Which finding may indicate internal abdominal bleeding after blunt trauma?
A. Increasing abdominal distention with hypotension
B. Improved peripheral perfusion
C. Increased urine output
D. Decreased abdominal tenderness with stable vital signs
Correct Answer: A. Increasing abdominal distention with hypotension
Rationale: Internal hemorrhage can cause abdominal distention, falling blood pressure,
tachycardia, pallor, and other signs of inadequate circulation.
9. A trauma patient has a Glasgow Coma Scale score of 7. What does this indicate?
A. Mild neurologic impairment
B. Severe impairment of consciousness
C. Normal neurologic status
D. Mild confusion only
Correct Answer: B. Severe impairment of consciousness
Rationale: A GCS score of 8 or less generally indicates severe impairment and raises concern
for inability to protect the airway.
10. Which assessment finding is most concerning for increasing intracranial pressure?
A. Improved level of consciousness
B. Decreasing level of consciousness with unequal pupils
C. Normal pupillary responses
D. Increased urine output
Correct Answer: B. Decreasing level of consciousness with unequal pupils
Rationale: A declining level of consciousness and pupillary changes can indicate worsening
intracranial pathology and increased intracranial pressure.
11. Which intervention is appropriate for a patient with suspected cervical spine injury?
A. Encourage neck movement
B. Maintain spinal alignment and appropriate immobilization
C. Place the patient in a sitting position immediately
D. Perform repeated neck flexion assessments
Correct Answer: B. Maintain spinal alignment and appropriate immobilization
