TNCC final exam test 2026/2027 open
book updated with complete solution
SECTION I: Trauma Nursing Process & Initial Assessment (Questions 1–20)
1. During the primary survey of a trauma patient, which assessment priority
takes precedence according to the ABCDE approach?
A. Breathing and ventilation
B. Airway with cervical spine stabilization
C. Circulation and hemorrhage control
D. Disability and neurological status
Correct Answer: B
Rationale: The TNCC uses the ABCDE approach, with A (Airway with
simultaneous cervical spine stabilization) always assessed first. Without a patent
airway, all subsequent interventions become futile. Cervical spine stabilization is
concurrent because manipulation of an unstable cervical spine during airway
management can cause catastrophic neurological injury. This prioritization is a
foundational principle of the Trauma Nursing Process .
2. A trauma patient arrives with an altered level of consciousness. During the
airway assessment, which finding is the earliest indicator of impending airway
compromise?
A. Overt stridor
B. Snoring respirations
C. Inability to vocalize
D. Paradoxical chest movement
Correct Answer: C
, Rationale: The ability to vocalize clearly indicates a patent airway. Inability to
vocalize is an early, ominous sign of airway obstruction or severe compromise.
Stridor is a late sign of significant obstruction. Snoring may indicate tongue
obstruction but does not necessarily mean immediate compromise. Paradoxical
chest movement indicates flail chest, not airway obstruction .
3. Which of the following are components of the airway assessment during the
primary survey? (Select All That Apply)
A. Assessment for loose teeth
B. Assessment for facial instability
C. Auscultation of epigastrium for gurgling
D. Assessment for tongue obstruction
E. Palpation of tracheal deviation
F. Assessment for inhalation injury signs
Correct Answer: A, B, D, F
Rationale: Airway patency and protection assessment includes: bony
deformity, loose teeth, edema, inhalation injury signs, abnormal sounds, tongue
obstruction, burns, fluids, foreign objects, and vocalization . Tracheal deviation is
assessed during the breathing assessment (B) as it indicates tension
pneumothorax. Epigastric auscultation is performed to verify endotracheal tube
placement after intubation.
4. A patient with severe facial trauma has blood pooling in the posterior
pharynx. Which intervention should the trauma nurse anticipate as the
immediate priority?
A. Insert an oropharyngeal airway
B. Perform suctioning of the airway
C. Prepare for immediate intubation
D. Insert a nasopharyngeal airway
, Correct Answer: B
Rationale: Blood in the posterior pharynx requires suctioning as the
immediate intervention to maintain airway patency. An oropharyngeal airway is
contraindicated if the patient has a gag reflex and does not address the fluid
obstruction. A nasopharyngeal airway is contraindicated with severe facial trauma
due to risk of intracranial placement. Intubation may ultimately be required, but
suctioning to clear the airway must occur first.
5. When performing the primary survey on a trauma patient, which of the
following requires immediate reassessment after any intervention?
A. Vital signs only
B. The entire primary survey
C. Only the system that was intervened upon
D. Pupillary response
Correct Answer: B
Rationale: After any intervention during the primary survey, the entire
primary survey must be reassessed from the beginning. For example, if a chest
tube is placed for a hemothorax, the nurse must reassess airway, breathing,
circulation, disability, and exposure to ensure the intervention was effective and
no new threats have emerged. This cyclical reassessment is a critical component
of the Trauma Nursing Process .
6. During the initial assessment, a trauma patient is noted to have a Glasgow
Coma Scale score of 13. How should the nurse interpret this finding?
A. Normal neurological function
B. Mild neurological impairment
C. Moderate neurological impairment
D. Severe neurological impairment
, Correct Answer: B
Rationale: GCS scores are interpreted as follows: 15 = normal, 13–14 = mild
impairment, 9–12 = moderate impairment, and 3–8 = severe impairment. A GCS
of 13 represents mild neurological impairment and warrants close monitoring and
reassessment. Any decline in GCS during the trauma resuscitation indicates
neurological deterioration and requires immediate intervention .
7. Which of the following are indications for cervical spine immobilization during
trauma care? (Select All That Apply)
A. Any patient with a distracting injury
B. Fall from greater than 3 feet in adults
C. Altered mental status
D. Midline cervical spine tenderness
E. Isolated wrist fracture from a ground-level fall
F. Neurological deficit
Correct Answer: A, B, C, D, F
Rationale: Cervical spine immobilization is indicated with: any distracting
injury, fall from >3 feet in adults (or >2–3 times body height in children), altered
mental status, midline cervical tenderness, neurological deficits, or high-risk
mechanism of injury. An isolated wrist fracture from a ground-level fall does not
meet criteria for spinal immobilization .
8. A trauma patient arrives via private vehicle after a high-speed collision. The
patient is confused and has an obvious deformity of the left femur. What is the
priority nursing intervention?
A. Apply a traction splint to the femur
B. Initiate cervical spine stabilization
book updated with complete solution
SECTION I: Trauma Nursing Process & Initial Assessment (Questions 1–20)
1. During the primary survey of a trauma patient, which assessment priority
takes precedence according to the ABCDE approach?
A. Breathing and ventilation
B. Airway with cervical spine stabilization
C. Circulation and hemorrhage control
D. Disability and neurological status
Correct Answer: B
Rationale: The TNCC uses the ABCDE approach, with A (Airway with
simultaneous cervical spine stabilization) always assessed first. Without a patent
airway, all subsequent interventions become futile. Cervical spine stabilization is
concurrent because manipulation of an unstable cervical spine during airway
management can cause catastrophic neurological injury. This prioritization is a
foundational principle of the Trauma Nursing Process .
2. A trauma patient arrives with an altered level of consciousness. During the
airway assessment, which finding is the earliest indicator of impending airway
compromise?
A. Overt stridor
B. Snoring respirations
C. Inability to vocalize
D. Paradoxical chest movement
Correct Answer: C
, Rationale: The ability to vocalize clearly indicates a patent airway. Inability to
vocalize is an early, ominous sign of airway obstruction or severe compromise.
Stridor is a late sign of significant obstruction. Snoring may indicate tongue
obstruction but does not necessarily mean immediate compromise. Paradoxical
chest movement indicates flail chest, not airway obstruction .
3. Which of the following are components of the airway assessment during the
primary survey? (Select All That Apply)
A. Assessment for loose teeth
B. Assessment for facial instability
C. Auscultation of epigastrium for gurgling
D. Assessment for tongue obstruction
E. Palpation of tracheal deviation
F. Assessment for inhalation injury signs
Correct Answer: A, B, D, F
Rationale: Airway patency and protection assessment includes: bony
deformity, loose teeth, edema, inhalation injury signs, abnormal sounds, tongue
obstruction, burns, fluids, foreign objects, and vocalization . Tracheal deviation is
assessed during the breathing assessment (B) as it indicates tension
pneumothorax. Epigastric auscultation is performed to verify endotracheal tube
placement after intubation.
4. A patient with severe facial trauma has blood pooling in the posterior
pharynx. Which intervention should the trauma nurse anticipate as the
immediate priority?
A. Insert an oropharyngeal airway
B. Perform suctioning of the airway
C. Prepare for immediate intubation
D. Insert a nasopharyngeal airway
, Correct Answer: B
Rationale: Blood in the posterior pharynx requires suctioning as the
immediate intervention to maintain airway patency. An oropharyngeal airway is
contraindicated if the patient has a gag reflex and does not address the fluid
obstruction. A nasopharyngeal airway is contraindicated with severe facial trauma
due to risk of intracranial placement. Intubation may ultimately be required, but
suctioning to clear the airway must occur first.
5. When performing the primary survey on a trauma patient, which of the
following requires immediate reassessment after any intervention?
A. Vital signs only
B. The entire primary survey
C. Only the system that was intervened upon
D. Pupillary response
Correct Answer: B
Rationale: After any intervention during the primary survey, the entire
primary survey must be reassessed from the beginning. For example, if a chest
tube is placed for a hemothorax, the nurse must reassess airway, breathing,
circulation, disability, and exposure to ensure the intervention was effective and
no new threats have emerged. This cyclical reassessment is a critical component
of the Trauma Nursing Process .
6. During the initial assessment, a trauma patient is noted to have a Glasgow
Coma Scale score of 13. How should the nurse interpret this finding?
A. Normal neurological function
B. Mild neurological impairment
C. Moderate neurological impairment
D. Severe neurological impairment
, Correct Answer: B
Rationale: GCS scores are interpreted as follows: 15 = normal, 13–14 = mild
impairment, 9–12 = moderate impairment, and 3–8 = severe impairment. A GCS
of 13 represents mild neurological impairment and warrants close monitoring and
reassessment. Any decline in GCS during the trauma resuscitation indicates
neurological deterioration and requires immediate intervention .
7. Which of the following are indications for cervical spine immobilization during
trauma care? (Select All That Apply)
A. Any patient with a distracting injury
B. Fall from greater than 3 feet in adults
C. Altered mental status
D. Midline cervical spine tenderness
E. Isolated wrist fracture from a ground-level fall
F. Neurological deficit
Correct Answer: A, B, C, D, F
Rationale: Cervical spine immobilization is indicated with: any distracting
injury, fall from >3 feet in adults (or >2–3 times body height in children), altered
mental status, midline cervical tenderness, neurological deficits, or high-risk
mechanism of injury. An isolated wrist fracture from a ground-level fall does not
meet criteria for spinal immobilization .
8. A trauma patient arrives via private vehicle after a high-speed collision. The
patient is confused and has an obvious deformity of the left femur. What is the
priority nursing intervention?
A. Apply a traction splint to the femur
B. Initiate cervical spine stabilization
