TNCC 9th Edition
Trauma Nursing Core Course Study Guide
200 Questions with Correct Answers and Rationales
Section 1: Trauma Nursing Process, Kinematics and Assessment
1. What does the ABCDE mnemonic stand for in the TNCC initial (primary) assessment?
Answer: Airway with cervical spine motion restriction; Breathing and ventilation; Circulation with
hemorrhage control; Disability (neurologic status); Exposure/Environment.
Rationale: The sequence follows the order in which untreated problems kill fastest, so each life
threat is found and treated before moving on.
2. Why are life-threatening problems treated as they are found during the initial assessment instead
of waiting until the assessment is finished?
Answer: Because the trauma team works simultaneously, correcting each threat to life immediately
when it is identified.
Rationale: Delaying treatment of an airway obstruction, tension pneumothorax or major bleed while
completing the survey can lead to preventable death.
3. Why is airway assessed before breathing and circulation?
Answer: An obstructed airway prevents oxygen from reaching the lungs and causes death within
minutes.
Rationale: Breathing and circulation interventions are useless if no oxygen can enter the airway.
4. How is life-threatening external hemorrhage handled in relation to the ABCDE sequence?
Answer: It is controlled immediately with direct pressure, a hemostatic dressing or a tourniquet,
even before or alongside airway management.
Rationale: Massive external bleeding can cause exsanguination faster than most airway problems,
so it is not allowed to wait.
5. What is the 'golden hour' in trauma care?
Answer: The period after injury, ideally the first 60 minutes, in which rapid assessment, resuscitation
and definitive surgical care give the best chance of survival.
Rationale: Early hemorrhage control and rapid transport reduce mortality; the concept stresses
minimizing scene and ED time.
TNCC 9th Edition Study Guide | Page 1
,6. Describe the trimodal distribution of trauma death.
Answer: First peak: seconds to minutes (severe brain, heart, aorta injury). Second peak: minutes to
hours (hemorrhage, hematomas, tension pneumothorax). Third peak: days to weeks (sepsis,
multiple organ failure).
Rationale: The second peak is the one most affected by rapid trauma nursing and resuscitation.
7. What is the leading cause of preventable death after trauma?
Answer: Hemorrhage.
Rationale: Uncontrolled bleeding leads to shock, acidosis, hypothermia and coagulopathy, which are
largely preventable with rapid control and early blood products.
8. State the formula for kinetic energy and what it shows about trauma.
Answer: KE = 1/2 x mass x velocity squared.
Rationale: Because velocity is squared, speed contributes far more to injury severity than mass.
9. What are the three collisions in a motor vehicle crash?
Answer: (1) Vehicle collides with an object; (2) the occupant collides with the vehicle interior; (3) the
internal organs collide with the body wall or each other.
Rationale: Organs can be injured even when there is little external evidence, such as an aortic tear
from sudden deceleration.
10. What injuries are expected with a 'down-and-under' pathway in an unrestrained occupant?
Answer: Knee, femur, acetabulum and posterior hip dislocation injuries.
Rationale: The body slides under the dashboard and the knees absorb the force, transmitting it up
the femur to the hip.
11. What injuries are expected with an 'up-and-over' pathway?
Answer: Head, neck, chest and abdominal injuries, including steering wheel injuries to the chest,
aorta and spleen or liver.
Rationale: The body moves up and over the steering wheel so the head and torso absorb the impact.
12. What injuries are associated with improper lap-belt use?
Answer: Chance fracture of the lumbar spine, bowel and mesenteric injury, pancreatic and bladder
injury; a seat belt sign across the abdomen is a warning.
Rationale: The belt rides above the iliac crests and compresses the abdomen against the spine.
13. What injuries are expected when a person falls from a height and lands on the feet?
Answer: Calcaneus fractures, ankle, tibial plateau, femur or hip fractures, and lumbar compression
fractures.
Rationale: Energy travels up the skeleton from the feet to the spine (Don Juan syndrome).
14. Which factors determine the severity of a penetrating injury?
Answer: The type of weapon, velocity and energy, path or trajectory, cavitation, and the tissue
density of the organs hit.
Rationale: Higher-velocity missiles create temporary cavities that damage tissue far from the actual
track.
TNCC 9th Edition Study Guide | Page 2
, 15. What are the four phases of blast injury?
Answer: Primary (pressure wave: ears, lungs, bowel), secondary (flying debris), tertiary (thrown by
the blast), quaternary (burns, crush, inhalation, other).
Rationale: Knowing the phases helps predict hidden injuries such as blast lung and tympanic
membrane rupture.
16. What is Waddell's triad in a child struck by a vehicle?
Answer: Femur fracture, thoracic or abdominal injury, and head or facial injury.
Rationale: A child's height means the bumper strikes the femur, the hood the torso and the ground
the head.
17. Why is a motorcycle crash with ejection considered high risk?
Answer: The rider can sustain multisystem trauma from impact and sliding, and protective
structures are absent.
Rationale: Mechanism of injury should raise the index of suspicion for head, spine, chest, abdominal
and extremity injury.
18. What is the purpose of the secondary survey, and when is it performed?
Answer: A systematic head-to-toe assessment plus history, performed after the primary survey and
resuscitation efforts are underway and life threats are managed.
Rationale: It finds injuries that were not immediately life threatening and prevents missed injuries.
19. What does the AMPLE history stand for?
Answer: Allergies, Medications, Past medical history/Pregnancy, Last meal, Events leading to the
injury.
Rationale: This provides data needed for anesthesia, drug choices, tetanus decisions and
understanding the mechanism.
20. What is a tertiary survey?
Answer: A repeat head-to-toe examination with review of laboratory tests and imaging, performed
within 24 hours of admission or when the patient is awake.
Rationale: It identifies injuries missed early, particularly in patients who were intubated, sedated or
distracted by other injuries.
Section 2: Airway Management
21. List signs of an obstructed or threatened airway.
Answer: Stridor, gurgling, snoring, hoarseness, drooling, agitation, use of accessory muscles,
inability to speak and facial or neck swelling.
Rationale: Noisy breathing signals partial obstruction; silence in a distressed patient may mean
complete obstruction.
22. What is the first maneuver used to open the airway in a trauma patient with a suspected spinal
injury?
Answer: Jaw-thrust maneuver without head tilt.
Rationale: It opens the airway while keeping the cervical spine in a neutral in-line position.
TNCC 9th Edition Study Guide | Page 3
Trauma Nursing Core Course Study Guide
200 Questions with Correct Answers and Rationales
Section 1: Trauma Nursing Process, Kinematics and Assessment
1. What does the ABCDE mnemonic stand for in the TNCC initial (primary) assessment?
Answer: Airway with cervical spine motion restriction; Breathing and ventilation; Circulation with
hemorrhage control; Disability (neurologic status); Exposure/Environment.
Rationale: The sequence follows the order in which untreated problems kill fastest, so each life
threat is found and treated before moving on.
2. Why are life-threatening problems treated as they are found during the initial assessment instead
of waiting until the assessment is finished?
Answer: Because the trauma team works simultaneously, correcting each threat to life immediately
when it is identified.
Rationale: Delaying treatment of an airway obstruction, tension pneumothorax or major bleed while
completing the survey can lead to preventable death.
3. Why is airway assessed before breathing and circulation?
Answer: An obstructed airway prevents oxygen from reaching the lungs and causes death within
minutes.
Rationale: Breathing and circulation interventions are useless if no oxygen can enter the airway.
4. How is life-threatening external hemorrhage handled in relation to the ABCDE sequence?
Answer: It is controlled immediately with direct pressure, a hemostatic dressing or a tourniquet,
even before or alongside airway management.
Rationale: Massive external bleeding can cause exsanguination faster than most airway problems,
so it is not allowed to wait.
5. What is the 'golden hour' in trauma care?
Answer: The period after injury, ideally the first 60 minutes, in which rapid assessment, resuscitation
and definitive surgical care give the best chance of survival.
Rationale: Early hemorrhage control and rapid transport reduce mortality; the concept stresses
minimizing scene and ED time.
TNCC 9th Edition Study Guide | Page 1
,6. Describe the trimodal distribution of trauma death.
Answer: First peak: seconds to minutes (severe brain, heart, aorta injury). Second peak: minutes to
hours (hemorrhage, hematomas, tension pneumothorax). Third peak: days to weeks (sepsis,
multiple organ failure).
Rationale: The second peak is the one most affected by rapid trauma nursing and resuscitation.
7. What is the leading cause of preventable death after trauma?
Answer: Hemorrhage.
Rationale: Uncontrolled bleeding leads to shock, acidosis, hypothermia and coagulopathy, which are
largely preventable with rapid control and early blood products.
8. State the formula for kinetic energy and what it shows about trauma.
Answer: KE = 1/2 x mass x velocity squared.
Rationale: Because velocity is squared, speed contributes far more to injury severity than mass.
9. What are the three collisions in a motor vehicle crash?
Answer: (1) Vehicle collides with an object; (2) the occupant collides with the vehicle interior; (3) the
internal organs collide with the body wall or each other.
Rationale: Organs can be injured even when there is little external evidence, such as an aortic tear
from sudden deceleration.
10. What injuries are expected with a 'down-and-under' pathway in an unrestrained occupant?
Answer: Knee, femur, acetabulum and posterior hip dislocation injuries.
Rationale: The body slides under the dashboard and the knees absorb the force, transmitting it up
the femur to the hip.
11. What injuries are expected with an 'up-and-over' pathway?
Answer: Head, neck, chest and abdominal injuries, including steering wheel injuries to the chest,
aorta and spleen or liver.
Rationale: The body moves up and over the steering wheel so the head and torso absorb the impact.
12. What injuries are associated with improper lap-belt use?
Answer: Chance fracture of the lumbar spine, bowel and mesenteric injury, pancreatic and bladder
injury; a seat belt sign across the abdomen is a warning.
Rationale: The belt rides above the iliac crests and compresses the abdomen against the spine.
13. What injuries are expected when a person falls from a height and lands on the feet?
Answer: Calcaneus fractures, ankle, tibial plateau, femur or hip fractures, and lumbar compression
fractures.
Rationale: Energy travels up the skeleton from the feet to the spine (Don Juan syndrome).
14. Which factors determine the severity of a penetrating injury?
Answer: The type of weapon, velocity and energy, path or trajectory, cavitation, and the tissue
density of the organs hit.
Rationale: Higher-velocity missiles create temporary cavities that damage tissue far from the actual
track.
TNCC 9th Edition Study Guide | Page 2
, 15. What are the four phases of blast injury?
Answer: Primary (pressure wave: ears, lungs, bowel), secondary (flying debris), tertiary (thrown by
the blast), quaternary (burns, crush, inhalation, other).
Rationale: Knowing the phases helps predict hidden injuries such as blast lung and tympanic
membrane rupture.
16. What is Waddell's triad in a child struck by a vehicle?
Answer: Femur fracture, thoracic or abdominal injury, and head or facial injury.
Rationale: A child's height means the bumper strikes the femur, the hood the torso and the ground
the head.
17. Why is a motorcycle crash with ejection considered high risk?
Answer: The rider can sustain multisystem trauma from impact and sliding, and protective
structures are absent.
Rationale: Mechanism of injury should raise the index of suspicion for head, spine, chest, abdominal
and extremity injury.
18. What is the purpose of the secondary survey, and when is it performed?
Answer: A systematic head-to-toe assessment plus history, performed after the primary survey and
resuscitation efforts are underway and life threats are managed.
Rationale: It finds injuries that were not immediately life threatening and prevents missed injuries.
19. What does the AMPLE history stand for?
Answer: Allergies, Medications, Past medical history/Pregnancy, Last meal, Events leading to the
injury.
Rationale: This provides data needed for anesthesia, drug choices, tetanus decisions and
understanding the mechanism.
20. What is a tertiary survey?
Answer: A repeat head-to-toe examination with review of laboratory tests and imaging, performed
within 24 hours of admission or when the patient is awake.
Rationale: It identifies injuries missed early, particularly in patients who were intubated, sedated or
distracted by other injuries.
Section 2: Airway Management
21. List signs of an obstructed or threatened airway.
Answer: Stridor, gurgling, snoring, hoarseness, drooling, agitation, use of accessory muscles,
inability to speak and facial or neck swelling.
Rationale: Noisy breathing signals partial obstruction; silence in a distressed patient may mean
complete obstruction.
22. What is the first maneuver used to open the airway in a trauma patient with a suspected spinal
injury?
Answer: Jaw-thrust maneuver without head tilt.
Rationale: It opens the airway while keeping the cervical spine in a neutral in-line position.
TNCC 9th Edition Study Guide | Page 3
