TNCC 8th Edition Exam /Questions and
Answers/Latest Complete Solution
SECTION 1: Trauma Systems, Kinematics & Injury Prevention
Questions 1–13
1. A 22-year-old male is brought to the emergency department after a high-speed motor
vehicle collision. He was the unrestrained driver of a vehicle that struck a stationary object.
Based on the kinematics of trauma, which mechanism is MOST likely responsible for the
patient's closed head injury?
A. Direct impact of the head against the windshield
B. Deceleration forces causing the brain to move within the cranial vault
C. Compression forces transmitted through the cervical spine
D. Shearing forces from the steering wheel impact
Correct Answer: B
Rationale: In a high-speed motor vehicle collision where the vehicle strikes a stationary
object, the primary mechanism of closed head injury is deceleration. When the vehicle suddenly
stops, the brain continues to move forward within the cranial vault due to inertia, then
rebounds against the posterior skull. This coup-contrecoup mechanism is a hallmark of
deceleration injuries in unrestrained occupants. While direct impact (A) can occur, the classic
closed head injury in this scenario is caused by the differential movement of the brain within
the skull. Compression forces through the cervical spine (C) are more associated with axial
loading injuries. Shearing forces from the steering wheel (D) typically cause chest or abdominal
injuries rather than primary closed head injuries.
2. According to the Haddon Matrix, which intervention represents a "pre-event" strategy for
reducing motor vehicle collision injuries?
A. Installing airbags in vehicles
B. Providing rapid extrication training for EMS personnel
C. Establishing trauma center verification standards
D. Implementing rehabilitation programs for crash survivors
Correct Answer: A
, Rationale: The Haddon Matrix organizes injury prevention strategies across three phases
(pre-event, event, and post-event) and three factors (host, agent, and environment). Installing
airbags is a pre-event strategy that reduces the likelihood or severity of injury before the
collision occurs by modifying the agent (vehicle). Rapid extrication training (B) is a post-event
strategy focused on the host. Trauma center verification (C) is a post-event environmental
strategy. Rehabilitation programs (D) are post-event host strategies.
3. A motorcycle rider is ejected after striking a guardrail at 45 mph. Which kinematic principle
BEST explains why ejection significantly increases the risk of multisystem trauma?
A. The patient experiences only rotational forces during ejection
B. Ejection eliminates the protective effect of the motorcycle and exposes the patient to
multiple sequential impacts
C. Ejection primarily causes compression injuries to the lower extremities
D. The motorcycle absorbs all kinetic energy during the collision, sparing the patient
Correct Answer: B
Rationale: Ejection from a motorcycle is associated with a significantly higher risk of severe
and multisystem trauma because the rider loses the protective frame of the motorcycle and is
subjected to multiple impacts with the ground, guardrail, or other objects. This creates
sequential trauma mechanisms including deceleration, direct impact, and possible penetration.
Rotational forces (A) are only one component. Compression injuries to lower extremities (C) are
not the primary concern in ejection. The motorcycle does not absorb all kinetic energy (D);
ejection means the rider must absorb the energy through their own body.
4. The severity of injury from a vertical fall is MOST directly related to which factor?
A. The patient's body mass index
B. The distance fallen and the surface struck
C. The patient's age and pre-existing conditions
D. The time of day the fall occurred
Correct Answer: B
Rationale: According to the kinematics of trauma, the severity of injury from a vertical fall is
primarily determined by the distance fallen (which determines velocity at impact) and the
surface struck (which determines how rapidly deceleration occurs and how energy is
,dissipated). While BMI, age, and pre-existing conditions can influence outcomes, the primary
determinants are distance and surface.
5. During a motor vehicle crash, which "impact" is associated with the tearing of the aorta at
its attachment with the ligamentum arteriosum?
A. First impact
B. Second impact
C. Third impact
D. Fourth impact
Correct Answer: C
Rationale: The third impact occurs when internal structures collide within the body cavity.
The aorta is torn at its attachment with the ligamentum arteriosum during the third impact due
to deceleration forces that cause shearing at this fixed point. The first impact is the vehicle
striking an object, the second impact is the occupant striking the interior of the vehicle, and the
fourth impact is not a standard kinematic term.
6. Which of the following best describes the "across-the-room observation" step in the initial
assessment?
A. A detailed head-to-toe examination performed at the bedside
B. A rapid visual assessment performed at the beginning of the primary survey to assess the
need to reprioritize circulation before airway
C. An assessment performed only after the primary survey is complete
D. A focused neurological examination
Correct Answer: B
Rationale: The across-the-room observation is done at the beginning of the primary survey
to rapidly assess the need to reprioritize circulation before airway or breathing. This is done if
uncontrolled external hemorrhage is identified, reflecting the evolution of the primary survey to
XABCDE where "X" (eXternal hemorrhage control) precedes airway.
7. Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage?
, A. ABCDE
B. MARCH
C. SAMPLE
D. AVPU
Correct Answer: B
Rationale: The MARCH mnemonic stands for Massive hemorrhage, Airway, Respiration,
Circulation, and Head injury/Hypothermia. The MARCH mnemonic recognizes uncontrolled
hemorrhage as the major cause of preventable death after injury. ABCDE is the traditional
primary survey sequence but does not prioritize hemorrhage first. SAMPLE is a history-taking
mnemonic. AVPU is a level of consciousness assessment tool.
8. A trauma nurse is conducting a community education session on injury prevention. Which
statement about the Haddon Matrix is MOST accurate?
A. It categorizes injuries by body system affected
B. It organizes prevention strategies by phase (pre-event, event, post-event) and factor
(host, agent, environment)
C. It is used only for motor vehicle collision prevention
D. It replaces the need for trauma systems development
Correct Answer: B
Rationale: The Haddon Matrix is a framework that organizes injury prevention strategies
across three phases (pre-event, event, and post-event) and three factors (host, agent, and
environment). It is a systematic approach to understanding and preventing injuries and is not
limited to motor vehicle collisions. It complements, rather than replaces, trauma systems
development.
9. A patient is brought in after a blast injury at an industrial site. The patient has ruptured
tympanic membranes and blast lung injury. These findings are classified as which type of blast
injury?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Answers/Latest Complete Solution
SECTION 1: Trauma Systems, Kinematics & Injury Prevention
Questions 1–13
1. A 22-year-old male is brought to the emergency department after a high-speed motor
vehicle collision. He was the unrestrained driver of a vehicle that struck a stationary object.
Based on the kinematics of trauma, which mechanism is MOST likely responsible for the
patient's closed head injury?
A. Direct impact of the head against the windshield
B. Deceleration forces causing the brain to move within the cranial vault
C. Compression forces transmitted through the cervical spine
D. Shearing forces from the steering wheel impact
Correct Answer: B
Rationale: In a high-speed motor vehicle collision where the vehicle strikes a stationary
object, the primary mechanism of closed head injury is deceleration. When the vehicle suddenly
stops, the brain continues to move forward within the cranial vault due to inertia, then
rebounds against the posterior skull. This coup-contrecoup mechanism is a hallmark of
deceleration injuries in unrestrained occupants. While direct impact (A) can occur, the classic
closed head injury in this scenario is caused by the differential movement of the brain within
the skull. Compression forces through the cervical spine (C) are more associated with axial
loading injuries. Shearing forces from the steering wheel (D) typically cause chest or abdominal
injuries rather than primary closed head injuries.
2. According to the Haddon Matrix, which intervention represents a "pre-event" strategy for
reducing motor vehicle collision injuries?
A. Installing airbags in vehicles
B. Providing rapid extrication training for EMS personnel
C. Establishing trauma center verification standards
D. Implementing rehabilitation programs for crash survivors
Correct Answer: A
, Rationale: The Haddon Matrix organizes injury prevention strategies across three phases
(pre-event, event, and post-event) and three factors (host, agent, and environment). Installing
airbags is a pre-event strategy that reduces the likelihood or severity of injury before the
collision occurs by modifying the agent (vehicle). Rapid extrication training (B) is a post-event
strategy focused on the host. Trauma center verification (C) is a post-event environmental
strategy. Rehabilitation programs (D) are post-event host strategies.
3. A motorcycle rider is ejected after striking a guardrail at 45 mph. Which kinematic principle
BEST explains why ejection significantly increases the risk of multisystem trauma?
A. The patient experiences only rotational forces during ejection
B. Ejection eliminates the protective effect of the motorcycle and exposes the patient to
multiple sequential impacts
C. Ejection primarily causes compression injuries to the lower extremities
D. The motorcycle absorbs all kinetic energy during the collision, sparing the patient
Correct Answer: B
Rationale: Ejection from a motorcycle is associated with a significantly higher risk of severe
and multisystem trauma because the rider loses the protective frame of the motorcycle and is
subjected to multiple impacts with the ground, guardrail, or other objects. This creates
sequential trauma mechanisms including deceleration, direct impact, and possible penetration.
Rotational forces (A) are only one component. Compression injuries to lower extremities (C) are
not the primary concern in ejection. The motorcycle does not absorb all kinetic energy (D);
ejection means the rider must absorb the energy through their own body.
4. The severity of injury from a vertical fall is MOST directly related to which factor?
A. The patient's body mass index
B. The distance fallen and the surface struck
C. The patient's age and pre-existing conditions
D. The time of day the fall occurred
Correct Answer: B
Rationale: According to the kinematics of trauma, the severity of injury from a vertical fall is
primarily determined by the distance fallen (which determines velocity at impact) and the
surface struck (which determines how rapidly deceleration occurs and how energy is
,dissipated). While BMI, age, and pre-existing conditions can influence outcomes, the primary
determinants are distance and surface.
5. During a motor vehicle crash, which "impact" is associated with the tearing of the aorta at
its attachment with the ligamentum arteriosum?
A. First impact
B. Second impact
C. Third impact
D. Fourth impact
Correct Answer: C
Rationale: The third impact occurs when internal structures collide within the body cavity.
The aorta is torn at its attachment with the ligamentum arteriosum during the third impact due
to deceleration forces that cause shearing at this fixed point. The first impact is the vehicle
striking an object, the second impact is the occupant striking the interior of the vehicle, and the
fourth impact is not a standard kinematic term.
6. Which of the following best describes the "across-the-room observation" step in the initial
assessment?
A. A detailed head-to-toe examination performed at the bedside
B. A rapid visual assessment performed at the beginning of the primary survey to assess the
need to reprioritize circulation before airway
C. An assessment performed only after the primary survey is complete
D. A focused neurological examination
Correct Answer: B
Rationale: The across-the-room observation is done at the beginning of the primary survey
to rapidly assess the need to reprioritize circulation before airway or breathing. This is done if
uncontrolled external hemorrhage is identified, reflecting the evolution of the primary survey to
XABCDE where "X" (eXternal hemorrhage control) precedes airway.
7. Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage?
, A. ABCDE
B. MARCH
C. SAMPLE
D. AVPU
Correct Answer: B
Rationale: The MARCH mnemonic stands for Massive hemorrhage, Airway, Respiration,
Circulation, and Head injury/Hypothermia. The MARCH mnemonic recognizes uncontrolled
hemorrhage as the major cause of preventable death after injury. ABCDE is the traditional
primary survey sequence but does not prioritize hemorrhage first. SAMPLE is a history-taking
mnemonic. AVPU is a level of consciousness assessment tool.
8. A trauma nurse is conducting a community education session on injury prevention. Which
statement about the Haddon Matrix is MOST accurate?
A. It categorizes injuries by body system affected
B. It organizes prevention strategies by phase (pre-event, event, post-event) and factor
(host, agent, environment)
C. It is used only for motor vehicle collision prevention
D. It replaces the need for trauma systems development
Correct Answer: B
Rationale: The Haddon Matrix is a framework that organizes injury prevention strategies
across three phases (pre-event, event, and post-event) and three factors (host, agent, and
environment). It is a systematic approach to understanding and preventing injuries and is not
limited to motor vehicle collisions. It complements, rather than replaces, trauma systems
development.
9. A patient is brought in after a blast injury at an industrial site. The patient has ruptured
tympanic membranes and blast lung injury. These findings are classified as which type of blast
injury?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
