TNCC Final Exam Test | 2025/2026 Open Book
Version | Updated with Complete Solution |
Verified and A+ Graded
Section 1: Introduction
This document presents the updated open book version of the Trauma Nursing Core Course
(TNCC) Final Exam, aligned with the 2025/2026 ENA curriculum standards. It includes a
complete set of verified questions and 100% correct answers, designed to reinforce trauma
assessment, critical thinking, and evidence-based interventions in emergency care. Topics
include the trauma nursing process, rapid assessment, airway and breathing, hemorrhagic
shock, neurologic evaluation, multisystem trauma, and team communication. This A+ graded
open book format is ideal for final exam prep, course review, or recertification readiness.
Section 2: Exam Questions and Answers
Format: Open-book, multiple-choice questions
Four answer choices per question (A–D)
Correct answer highlighted in green
Complete solution explanations included for every question
1. What is the primary goal of the primary survey in trauma care?
A) Detailed physical examination
B) Identification of life-threatening conditions
C) Documentation of injuries
D) Patient history collection
B) Identification of life-threatening conditions
(Solution: The primary survey, based on the ABCDE approach, focuses on rapidly
identifying and managing life-threatening conditions such as airway obstruction or
severe hemorrhage to stabilize the patient before proceeding to further assessments.)
2. Which assessment tool is used to evaluate airway patency?
A) Glasgow Coma Scale
B) Look, Listen, Feel approach
C) AVPU scale
D) Pain assessment
B) Look, Listen, Feel approach
(Solution: The Look, Listen, Feel approach involves visually inspecting the airway,
listening for breath sounds, and feeling for air movement to assess patency and detect
obstructions or injury.)
3. What is the first step in managing a compromised airway?
A) Administer oxygen
B) Perform endotracheal intubation
C) Clear the airway of obstructions
D) Initiate chest compressions
, C) Clear the airway of obstructions
(Solution: Clearing obstructions, such as foreign bodies or blood, is the first step to
ensure an open airway, followed by oxygenation or advanced airway management if
needed.)
4. Which sign indicates a tension pneumothorax?
A) Equal breath sounds bilaterally
B) Tracheal deviation to the affected side
C) Increased oxygen saturation
D) Normal jugular vein distension
B) Tracheal deviation to the affected side
(Solution: Tracheal deviation away from the affected side, along with jugular vein
distension and decreased breath sounds, indicates a tension pneumothorax due to
increased intrathoracic pressure.)
5. What is the initial treatment for a tension pneumothorax?
A) Chest tube insertion
B) Needle decompression
C) Positive pressure ventilation
D) Administration of antibiotics
B) Needle decompression
(Solution: Needle decompression is the immediate life-saving intervention to relieve
pressure by inserting a needle into the second intercostal space, midclavicular line,
followed by chest tube placement.)
6. Which type of shock is characterized by severe blood loss?
A) Cardiogenic shock
B) Hypovolemic shock
C) Septic shock
D) Neurogenic shock
B) Hypovolemic shock
(Solution: Hypovolemic shock results from significant blood or fluid loss, leading to
inadequate tissue perfusion, commonly seen in trauma with hemorrhage.)
7. What is the primary indicator of hypovolemic shock?
A) Hypertension
B) Tachycardia
C) Bradypnea
D) Warm extremities
B) Tachycardia
(Solution: Tachycardia is an early compensatory response to maintain cardiac output
as blood volume decreases in hypovolemic shock.)
8. Which fluid is recommended for initial resuscitation in hemorrhagic shock?
A) 5% dextrose in water
B) Normal saline or lactated Ringer’s
C) 5% albumin
D) Hypertonic saline
B) Normal saline or lactated Ringer’s
(Solution: Normal saline or lactated Ringer’s are isotonic crystalloids used initially to
restore intravascular volume in hemorrhagic shock, pending blood product
availability.)
9. What is the purpose of the secondary survey?
A) Rapid identification of life threats
B) Detailed head-to-toe assessment
, C) Immediate surgical intervention
D) Monitoring vital signs only
B) Detailed head-to-toe assessment
(Solution: The secondary survey involves a thorough head-to-toe examination to
identify all injuries after life-threatening conditions are addressed in the primary
survey.)
10. Which spinal precaution is used to immobilize the cervical spine?
A) Log roll technique
B) Cervical collar
C) Backboard only
D) Traction splint
B) Cervical collar
(Solution: A cervical collar stabilizes the cervical spine to prevent further injury
during movement or assessment in suspected spinal trauma.)
11. What is a key component of the neurologic assessment in trauma?
A) Pulse oximetry
B) Glasgow Coma Scale
C) Blood pressure measurement
D) Temperature check
B) Glasgow Coma Scale
(Solution: The Glasgow Coma Scale assesses eye, verbal, and motor responses to
evaluate the level of consciousness and detect neurologic deterioration.)
12. Which finding suggests a basilar skull fracture?
A) Clear nasal discharge
B) Battle’s sign
C) Normal pupil response
D) Absence of bruising
B) Battle’s sign
(Solution: Battle’s sign (bruising behind the ear) indicates a basilar skull fracture due
to blood tracking from the fracture site.)
13. What is the initial step in managing a patient with suspected spinal injury?
A) Perform a CT scan
B) Apply spinal immobilization
C) Administer pain medication
D) Conduct a full neurologic exam
B) Apply spinal immobilization
(Solution: Spinal immobilization with a collar and backboard is the first step to
prevent further spinal cord damage until imaging confirms stability.)
14. Which team role is responsible for coordinating care in a trauma resuscitation?
A) Recorder
B) Team leader
C) Primary nurse
D) Respiratory therapist
B) Team leader
(Solution: The team leader oversees the resuscitation, assigns roles, and ensures
effective communication and prioritization of interventions.)
15. What is the primary cause of death in the first hour of trauma?
A) Infection
B) Uncontrolled hemorrhage
C) Organ failure
Version | Updated with Complete Solution |
Verified and A+ Graded
Section 1: Introduction
This document presents the updated open book version of the Trauma Nursing Core Course
(TNCC) Final Exam, aligned with the 2025/2026 ENA curriculum standards. It includes a
complete set of verified questions and 100% correct answers, designed to reinforce trauma
assessment, critical thinking, and evidence-based interventions in emergency care. Topics
include the trauma nursing process, rapid assessment, airway and breathing, hemorrhagic
shock, neurologic evaluation, multisystem trauma, and team communication. This A+ graded
open book format is ideal for final exam prep, course review, or recertification readiness.
Section 2: Exam Questions and Answers
Format: Open-book, multiple-choice questions
Four answer choices per question (A–D)
Correct answer highlighted in green
Complete solution explanations included for every question
1. What is the primary goal of the primary survey in trauma care?
A) Detailed physical examination
B) Identification of life-threatening conditions
C) Documentation of injuries
D) Patient history collection
B) Identification of life-threatening conditions
(Solution: The primary survey, based on the ABCDE approach, focuses on rapidly
identifying and managing life-threatening conditions such as airway obstruction or
severe hemorrhage to stabilize the patient before proceeding to further assessments.)
2. Which assessment tool is used to evaluate airway patency?
A) Glasgow Coma Scale
B) Look, Listen, Feel approach
C) AVPU scale
D) Pain assessment
B) Look, Listen, Feel approach
(Solution: The Look, Listen, Feel approach involves visually inspecting the airway,
listening for breath sounds, and feeling for air movement to assess patency and detect
obstructions or injury.)
3. What is the first step in managing a compromised airway?
A) Administer oxygen
B) Perform endotracheal intubation
C) Clear the airway of obstructions
D) Initiate chest compressions
, C) Clear the airway of obstructions
(Solution: Clearing obstructions, such as foreign bodies or blood, is the first step to
ensure an open airway, followed by oxygenation or advanced airway management if
needed.)
4. Which sign indicates a tension pneumothorax?
A) Equal breath sounds bilaterally
B) Tracheal deviation to the affected side
C) Increased oxygen saturation
D) Normal jugular vein distension
B) Tracheal deviation to the affected side
(Solution: Tracheal deviation away from the affected side, along with jugular vein
distension and decreased breath sounds, indicates a tension pneumothorax due to
increased intrathoracic pressure.)
5. What is the initial treatment for a tension pneumothorax?
A) Chest tube insertion
B) Needle decompression
C) Positive pressure ventilation
D) Administration of antibiotics
B) Needle decompression
(Solution: Needle decompression is the immediate life-saving intervention to relieve
pressure by inserting a needle into the second intercostal space, midclavicular line,
followed by chest tube placement.)
6. Which type of shock is characterized by severe blood loss?
A) Cardiogenic shock
B) Hypovolemic shock
C) Septic shock
D) Neurogenic shock
B) Hypovolemic shock
(Solution: Hypovolemic shock results from significant blood or fluid loss, leading to
inadequate tissue perfusion, commonly seen in trauma with hemorrhage.)
7. What is the primary indicator of hypovolemic shock?
A) Hypertension
B) Tachycardia
C) Bradypnea
D) Warm extremities
B) Tachycardia
(Solution: Tachycardia is an early compensatory response to maintain cardiac output
as blood volume decreases in hypovolemic shock.)
8. Which fluid is recommended for initial resuscitation in hemorrhagic shock?
A) 5% dextrose in water
B) Normal saline or lactated Ringer’s
C) 5% albumin
D) Hypertonic saline
B) Normal saline or lactated Ringer’s
(Solution: Normal saline or lactated Ringer’s are isotonic crystalloids used initially to
restore intravascular volume in hemorrhagic shock, pending blood product
availability.)
9. What is the purpose of the secondary survey?
A) Rapid identification of life threats
B) Detailed head-to-toe assessment
, C) Immediate surgical intervention
D) Monitoring vital signs only
B) Detailed head-to-toe assessment
(Solution: The secondary survey involves a thorough head-to-toe examination to
identify all injuries after life-threatening conditions are addressed in the primary
survey.)
10. Which spinal precaution is used to immobilize the cervical spine?
A) Log roll technique
B) Cervical collar
C) Backboard only
D) Traction splint
B) Cervical collar
(Solution: A cervical collar stabilizes the cervical spine to prevent further injury
during movement or assessment in suspected spinal trauma.)
11. What is a key component of the neurologic assessment in trauma?
A) Pulse oximetry
B) Glasgow Coma Scale
C) Blood pressure measurement
D) Temperature check
B) Glasgow Coma Scale
(Solution: The Glasgow Coma Scale assesses eye, verbal, and motor responses to
evaluate the level of consciousness and detect neurologic deterioration.)
12. Which finding suggests a basilar skull fracture?
A) Clear nasal discharge
B) Battle’s sign
C) Normal pupil response
D) Absence of bruising
B) Battle’s sign
(Solution: Battle’s sign (bruising behind the ear) indicates a basilar skull fracture due
to blood tracking from the fracture site.)
13. What is the initial step in managing a patient with suspected spinal injury?
A) Perform a CT scan
B) Apply spinal immobilization
C) Administer pain medication
D) Conduct a full neurologic exam
B) Apply spinal immobilization
(Solution: Spinal immobilization with a collar and backboard is the first step to
prevent further spinal cord damage until imaging confirms stability.)
14. Which team role is responsible for coordinating care in a trauma resuscitation?
A) Recorder
B) Team leader
C) Primary nurse
D) Respiratory therapist
B) Team leader
(Solution: The team leader oversees the resuscitation, assigns roles, and ensures
effective communication and prioritization of interventions.)
15. What is the primary cause of death in the first hour of trauma?
A) Infection
B) Uncontrolled hemorrhage
C) Organ failure
