TNCC Final Exam Test 2024/2025 – Open Book
Version with Complete Solution | Updated Edition
Question 1:
During the primary survey of a trauma patient, the nurse notes stridor and labored respirations.
Which of the following interventions should be performed first?
A) Provide supplemental oxygen via non-rebreather mask.
B) Prepare for immediate endotracheal intubation.
C) Insert a nasopharyngeal airway.
D) Obtain an arterial blood gas (ABG) sample.
Correct Answer: B
Rationale: Stridor indicates partial airway obstruction, and immediate endotracheal intubation is
required to secure the airway and prevent complete obstruction, as per TNCC primary survey
guidelines for airway management. Supplemental oxygen (A) is supportive but ineffective if the
airway is compromised. A nasopharyngeal airway (C) is contraindicated in suspected upper
airway obstruction due to risk of worsening trauma. ABG (D) assesses gas exchange but does
not address the immediate threat.
Question 2:
A trauma patient arrives with a Glasgow Coma Scale (GCS) score of 10. What is the priority
action in the Disability phase of the primary survey?
A) Perform a pupillary assessment.
B) Obtain a blood glucose level.
C) Initiate seizure precautions.
D) Administer mannitol IV.
Correct Answer: B
Rationale: Altered mental status in trauma requires immediate blood glucose check to rule out
hypoglycemia, a reversible cause, as emphasized in TNCC ABCDE assessment. Pupillary
assessment (A) follows GCS. Seizure precautions (C) are for active seizures. Mannitol (D) is for
increased ICP but requires diagnosis first.
Question 3:
In the Circulation phase, a patient has a weak, thready radial pulse and cool, clammy skin. What
is the initial intervention?
A) Start two large-bore IVs.
B) Administer a 500 mL fluid bolus.
,C) Apply a pelvic binder.
D) Transfuse packed red blood cells.
Correct Answer: A
Rationale: Signs of shock necessitate immediate vascular access with two large-bore IVs for
fluid resuscitation, per TNCC circulation management. Fluid bolus (B) follows access. Pelvic
binder (C) is for suspected pelvic fracture. Transfusion (D) is for confirmed hemorrhage.
Question 4:
During Exposure in the primary survey, the patient develops hypothermia. What is the best
intervention to prevent further heat loss?
A) Apply warm blankets.
B) Increase room temperature.
C) Administer warmed IV fluids.
D) All of the above.
Correct Answer: D
Rationale: Hypothermia exacerbates coagulopathy; TNCC recommends comprehensive
warming: blankets, room temp, and warmed fluids to maintain normothermia. Single
interventions (A, B, C) are incomplete.
Question 5:
A patient with suspected spinal injury is log-rolled. What is the priority during this maneuver?
A) Maintain in-line cervical stabilization.
B) Assess for posterior injuries.
C) Apply a backboard.
D) Check blood pressure.
Correct Answer: A
Rationale: In-line stabilization prevents secondary injury during log-roll, as per TNCC spinal
precautions. Posterior assessment (B) occurs after. Backboard (C) follows. BP (D) is circulation
phase.
Question 6:
In the secondary survey, what is the purpose of the head-to-toe assessment?
A) Identify all injuries missed in primary survey.
B) Perform vital signs only.
C) Administer pain medication.
D) Prepare for discharge.
, Correct Answer: A
Rationale: Secondary survey systematically identifies non-life-threatening injuries, per TNCC
TNP. Vital signs (B) are adjunct. Pain (C) is ongoing. Discharge (D) is post-care.
Question 7:
Reassessment reveals worsening hypotension in a trauma patient. What should the nurse
prioritize?
A) Repeat primary survey.
B) Obtain labs.
C) Perform CT scan.
D) Consult orthopedics.
Correct Answer: A
Rationale: TNCC emphasizes repeat primary survey for deterioration to identify evolving threats.
Labs (B) and CT (C) follow stabilization. Consultation (D) is secondary.
Question 8:
A patient exhibits tachycardia, tachypnea, and delayed capillary refill. What type of shock is
suspected?
A) Cardiogenic
B) Hypovolemic
C) Neurogenic
D) Obstructive
Correct Answer: B
Rationale: These compensatory signs indicate hypovolemic shock from fluid loss, common in
trauma (TNCC shock module). Cardiogenic (A) has different ECG changes. Neurogenic (C)
lacks tachycardia. Obstructive (D) has JVD.
Question 9:
For hemorrhagic shock, initial fluid resuscitation is with:
A) Crystalloids at 1-2 L bolus.
B) Colloids only.
C) Blood products immediately.
D) Vasopressors first.
Correct Answer: A
Version with Complete Solution | Updated Edition
Question 1:
During the primary survey of a trauma patient, the nurse notes stridor and labored respirations.
Which of the following interventions should be performed first?
A) Provide supplemental oxygen via non-rebreather mask.
B) Prepare for immediate endotracheal intubation.
C) Insert a nasopharyngeal airway.
D) Obtain an arterial blood gas (ABG) sample.
Correct Answer: B
Rationale: Stridor indicates partial airway obstruction, and immediate endotracheal intubation is
required to secure the airway and prevent complete obstruction, as per TNCC primary survey
guidelines for airway management. Supplemental oxygen (A) is supportive but ineffective if the
airway is compromised. A nasopharyngeal airway (C) is contraindicated in suspected upper
airway obstruction due to risk of worsening trauma. ABG (D) assesses gas exchange but does
not address the immediate threat.
Question 2:
A trauma patient arrives with a Glasgow Coma Scale (GCS) score of 10. What is the priority
action in the Disability phase of the primary survey?
A) Perform a pupillary assessment.
B) Obtain a blood glucose level.
C) Initiate seizure precautions.
D) Administer mannitol IV.
Correct Answer: B
Rationale: Altered mental status in trauma requires immediate blood glucose check to rule out
hypoglycemia, a reversible cause, as emphasized in TNCC ABCDE assessment. Pupillary
assessment (A) follows GCS. Seizure precautions (C) are for active seizures. Mannitol (D) is for
increased ICP but requires diagnosis first.
Question 3:
In the Circulation phase, a patient has a weak, thready radial pulse and cool, clammy skin. What
is the initial intervention?
A) Start two large-bore IVs.
B) Administer a 500 mL fluid bolus.
,C) Apply a pelvic binder.
D) Transfuse packed red blood cells.
Correct Answer: A
Rationale: Signs of shock necessitate immediate vascular access with two large-bore IVs for
fluid resuscitation, per TNCC circulation management. Fluid bolus (B) follows access. Pelvic
binder (C) is for suspected pelvic fracture. Transfusion (D) is for confirmed hemorrhage.
Question 4:
During Exposure in the primary survey, the patient develops hypothermia. What is the best
intervention to prevent further heat loss?
A) Apply warm blankets.
B) Increase room temperature.
C) Administer warmed IV fluids.
D) All of the above.
Correct Answer: D
Rationale: Hypothermia exacerbates coagulopathy; TNCC recommends comprehensive
warming: blankets, room temp, and warmed fluids to maintain normothermia. Single
interventions (A, B, C) are incomplete.
Question 5:
A patient with suspected spinal injury is log-rolled. What is the priority during this maneuver?
A) Maintain in-line cervical stabilization.
B) Assess for posterior injuries.
C) Apply a backboard.
D) Check blood pressure.
Correct Answer: A
Rationale: In-line stabilization prevents secondary injury during log-roll, as per TNCC spinal
precautions. Posterior assessment (B) occurs after. Backboard (C) follows. BP (D) is circulation
phase.
Question 6:
In the secondary survey, what is the purpose of the head-to-toe assessment?
A) Identify all injuries missed in primary survey.
B) Perform vital signs only.
C) Administer pain medication.
D) Prepare for discharge.
, Correct Answer: A
Rationale: Secondary survey systematically identifies non-life-threatening injuries, per TNCC
TNP. Vital signs (B) are adjunct. Pain (C) is ongoing. Discharge (D) is post-care.
Question 7:
Reassessment reveals worsening hypotension in a trauma patient. What should the nurse
prioritize?
A) Repeat primary survey.
B) Obtain labs.
C) Perform CT scan.
D) Consult orthopedics.
Correct Answer: A
Rationale: TNCC emphasizes repeat primary survey for deterioration to identify evolving threats.
Labs (B) and CT (C) follow stabilization. Consultation (D) is secondary.
Question 8:
A patient exhibits tachycardia, tachypnea, and delayed capillary refill. What type of shock is
suspected?
A) Cardiogenic
B) Hypovolemic
C) Neurogenic
D) Obstructive
Correct Answer: B
Rationale: These compensatory signs indicate hypovolemic shock from fluid loss, common in
trauma (TNCC shock module). Cardiogenic (A) has different ECG changes. Neurogenic (C)
lacks tachycardia. Obstructive (D) has JVD.
Question 9:
For hemorrhagic shock, initial fluid resuscitation is with:
A) Crystalloids at 1-2 L bolus.
B) Colloids only.
C) Blood products immediately.
D) Vasopressors first.
Correct Answer: A
