TNCC ACTUAL EXAM READINESS VALIDATION: THE ULTIMATE
COMPREHENSIVE TRAUMA NURSING CERTIFICATION
ASSESSMENT WITH EVERY FREQUENTLY MOST TESTED
QUESTION, EXPERT-RATIONALE BREAKDOWNS, 100% VERIFIED
CORRECT ANSWERS, AND PROVEN STRATEGIES TO
GUARANTEE YOUR FIRST-TRY PASS FOR EMERGENCY NURSES
Which of the following mnemonics can help a nurse prioritize care for a trauma
patient with massive uncontrolled hemorrhage?
CORRECT ANS: MARCH
Expert Rationale
The MARCH mnemonic is used in tactical emergency casualty care and trauma
resuscitation to prioritize life-threatening conditions in a specific order. MARCH
stands for Massive hemorrhage control, Airway management, Respirations,
Circulation, and Head injury/Hypothermia prevention. This sequence prioritizes
massive hemorrhage control first because uncontrolled bleeding is the most
immediate threat to life in a trauma patient. The traditional ABCDE approach
places airway first, but in cases of massive uncontrolled hemorrhage,
controlling the bleeding takes precedence because the patient can
exsanguinate before airway interventions are completed. Therefore, MARCH is
the correct mnemonic for prioritizing care in a trauma patient with massive
uncontrolled hemorrhage.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Trauma Systems and Triage
MSC: NCLEX: Safe and Effective Care Environment
You are caring for a patient who was involved in a motor vehicle crash and is 32
weeks pregnant. Findings of your secondary survey include abdominal pain on
palpation, fundal height at the costal margin, and some dark bloody show.
,Varying accelerations and decelerations are noted on cardiotocography. These
findings are most consistent with which of the following?
CORRECT ANS: Placental abruption
Expert Rationale
Placental abruption is the premature separation of the placenta from the uterine
wall before delivery. It is a serious complication of pregnancy that can occur
after blunt abdominal trauma, such as that sustained in a motor vehicle crash.
The classic findings of placental abruption include abdominal pain, uterine
tenderness, dark bloody show, and fetal heart rate abnormalities such as
variable decelerations. The fundal height at the costal margin at 32 weeks
gestation is consistent with normal growth but may also indicate that the uterus
is irritable. The varying accelerations and decelerations on cardiotocography
are concerning for fetal compromise. Therefore, these findings are most
consistent with placental abruption.
DIF: Cognitive Level: Apply (Application)
TOP: Obstetric Trauma
MSC: NCLEX: Physiological Integrity
Which of the following is NOT considered goal-directed therapy for cardiogenic
shock?
CORRECT ANS: Pericardiocentesis
Expert Rationale
Goal-directed therapy for cardiogenic shock focuses on optimizing cardiac
output and tissue perfusion through interventions such as fluid management,
inotropic support, vasopressor therapy, and mechanical circulatory support.
Pericardiocentesis is a procedure used to remove fluid from the pericardial sac
in patients with cardiac tamponade, which is a specific cause of obstructive
shock, not cardiogenic shock. While cardiac tamponade can lead to shock, it is
classified as obstructive shock rather than cardiogenic shock. Therefore,
pericardiocentesis is not considered goal-directed therapy for cardiogenic
shock.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Shock and Trauma
MSC: NCLEX: Physiological Integrity
,A patient is found lying on the floor after falling 13 hours ago. Which of the
following laboratory values is expected with a musculoskeletal complication
associated with this presentation?
CORRECT ANS: Elevated creatinine kinase
Expert Rationale
A patient who has been lying on the floor for 13 hours after a fall is at risk for
rhabdomyolysis, a condition in which damaged skeletal muscle breaks down
rapidly and releases its contents into the bloodstream. One of the key laboratory
findings in rhabdomyolysis is an elevated creatinine kinase (CK) level, which
indicates muscle damage. Other findings may include elevated potassium,
elevated phosphate, and low calcium. Therefore, elevated creatinine kinase is
the expected laboratory value.
DIF: Cognitive Level: Apply (Application)
TOP: Musculoskeletal Complications
MSC: NCLEX: Physiological Integrity
Tearing of the bridging veins is most frequently associated with which brain
injury?
CORRECT ANS: Subdural hematoma
Expert Rationale
Bridging veins are veins that traverse the subdural space and connect the
cerebral cortex to the dural venous sinuses. Tearing of these veins, often due to
acceleration-deceleration forces or rotational injury, leads to bleeding into the
subdural space, resulting in a subdural hematoma. Subdural hematomas are
most commonly associated with tearing of the bridging veins. Epidural
hematomas, by contrast, are typically associated with tearing of the middle
meningeal artery. Therefore, subdural hematoma is the correct answer.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Neurological Trauma
MSC: NCLEX: Physiological Integrity
What bedside monitoring parameters are used to assess for adequacy of
oxygenation and effectiveness of ventilation?
CORRECT ANS: Pulse oximetry and capnography
, Expert Rationale
Pulse oximetry is a non-invasive method of measuring the oxygen saturation of
arterial blood, which reflects the adequacy of oxygenation. Capnography
measures the concentration of carbon dioxide in exhaled breath, which reflects
the effectiveness of ventilation. Together, these two bedside monitoring
parameters provide real-time information about both oxygenation and
ventilation, allowing clinicians to detect and respond to respiratory compromise
promptly. Therefore, pulse oximetry and capnography are the correct answer.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Respiratory Monitoring
MSC: NCLEX: Physiological Integrity
Which of the following is a possible complication of positive-pressure
ventilation?
CORRECT ANS: Worsening pneumothorax
Expert Rationale
Positive-pressure ventilation delivers air into the lungs under pressure, which
can worsen an existing pneumothorax by forcing more air into the pleural space.
This can lead to a tension pneumothorax, which is a life-threatening emergency.
Other complications of positive-pressure ventilation include barotrauma,
volutrauma, decreased cardiac output, and ventilator-associated pneumonia.
Therefore, worsening pneumothorax is a possible complication of positive-
pressure ventilation.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Mechanical Ventilation
MSC: NCLEX: Physiological Integrity
Which of the following assessment findings differentiates a tension
pneumothorax from a simple pneumothorax?
CORRECT ANS: Hypotension that worsens with inspiration
Expert Rationale
A tension pneumothorax occurs when air enters the pleural space and cannot
escape, leading to increasing pressure that compresses the lung and pushes
the mediastinum toward the opposite side. This causes impaired venous return
to the heart, leading to hypotension that worsens with inspiration, also known as
pulsus paradoxus. A simple pneumothorax, by contrast, does not cause
COMPREHENSIVE TRAUMA NURSING CERTIFICATION
ASSESSMENT WITH EVERY FREQUENTLY MOST TESTED
QUESTION, EXPERT-RATIONALE BREAKDOWNS, 100% VERIFIED
CORRECT ANSWERS, AND PROVEN STRATEGIES TO
GUARANTEE YOUR FIRST-TRY PASS FOR EMERGENCY NURSES
Which of the following mnemonics can help a nurse prioritize care for a trauma
patient with massive uncontrolled hemorrhage?
CORRECT ANS: MARCH
Expert Rationale
The MARCH mnemonic is used in tactical emergency casualty care and trauma
resuscitation to prioritize life-threatening conditions in a specific order. MARCH
stands for Massive hemorrhage control, Airway management, Respirations,
Circulation, and Head injury/Hypothermia prevention. This sequence prioritizes
massive hemorrhage control first because uncontrolled bleeding is the most
immediate threat to life in a trauma patient. The traditional ABCDE approach
places airway first, but in cases of massive uncontrolled hemorrhage,
controlling the bleeding takes precedence because the patient can
exsanguinate before airway interventions are completed. Therefore, MARCH is
the correct mnemonic for prioritizing care in a trauma patient with massive
uncontrolled hemorrhage.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Trauma Systems and Triage
MSC: NCLEX: Safe and Effective Care Environment
You are caring for a patient who was involved in a motor vehicle crash and is 32
weeks pregnant. Findings of your secondary survey include abdominal pain on
palpation, fundal height at the costal margin, and some dark bloody show.
,Varying accelerations and decelerations are noted on cardiotocography. These
findings are most consistent with which of the following?
CORRECT ANS: Placental abruption
Expert Rationale
Placental abruption is the premature separation of the placenta from the uterine
wall before delivery. It is a serious complication of pregnancy that can occur
after blunt abdominal trauma, such as that sustained in a motor vehicle crash.
The classic findings of placental abruption include abdominal pain, uterine
tenderness, dark bloody show, and fetal heart rate abnormalities such as
variable decelerations. The fundal height at the costal margin at 32 weeks
gestation is consistent with normal growth but may also indicate that the uterus
is irritable. The varying accelerations and decelerations on cardiotocography
are concerning for fetal compromise. Therefore, these findings are most
consistent with placental abruption.
DIF: Cognitive Level: Apply (Application)
TOP: Obstetric Trauma
MSC: NCLEX: Physiological Integrity
Which of the following is NOT considered goal-directed therapy for cardiogenic
shock?
CORRECT ANS: Pericardiocentesis
Expert Rationale
Goal-directed therapy for cardiogenic shock focuses on optimizing cardiac
output and tissue perfusion through interventions such as fluid management,
inotropic support, vasopressor therapy, and mechanical circulatory support.
Pericardiocentesis is a procedure used to remove fluid from the pericardial sac
in patients with cardiac tamponade, which is a specific cause of obstructive
shock, not cardiogenic shock. While cardiac tamponade can lead to shock, it is
classified as obstructive shock rather than cardiogenic shock. Therefore,
pericardiocentesis is not considered goal-directed therapy for cardiogenic
shock.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Shock and Trauma
MSC: NCLEX: Physiological Integrity
,A patient is found lying on the floor after falling 13 hours ago. Which of the
following laboratory values is expected with a musculoskeletal complication
associated with this presentation?
CORRECT ANS: Elevated creatinine kinase
Expert Rationale
A patient who has been lying on the floor for 13 hours after a fall is at risk for
rhabdomyolysis, a condition in which damaged skeletal muscle breaks down
rapidly and releases its contents into the bloodstream. One of the key laboratory
findings in rhabdomyolysis is an elevated creatinine kinase (CK) level, which
indicates muscle damage. Other findings may include elevated potassium,
elevated phosphate, and low calcium. Therefore, elevated creatinine kinase is
the expected laboratory value.
DIF: Cognitive Level: Apply (Application)
TOP: Musculoskeletal Complications
MSC: NCLEX: Physiological Integrity
Tearing of the bridging veins is most frequently associated with which brain
injury?
CORRECT ANS: Subdural hematoma
Expert Rationale
Bridging veins are veins that traverse the subdural space and connect the
cerebral cortex to the dural venous sinuses. Tearing of these veins, often due to
acceleration-deceleration forces or rotational injury, leads to bleeding into the
subdural space, resulting in a subdural hematoma. Subdural hematomas are
most commonly associated with tearing of the bridging veins. Epidural
hematomas, by contrast, are typically associated with tearing of the middle
meningeal artery. Therefore, subdural hematoma is the correct answer.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Neurological Trauma
MSC: NCLEX: Physiological Integrity
What bedside monitoring parameters are used to assess for adequacy of
oxygenation and effectiveness of ventilation?
CORRECT ANS: Pulse oximetry and capnography
, Expert Rationale
Pulse oximetry is a non-invasive method of measuring the oxygen saturation of
arterial blood, which reflects the adequacy of oxygenation. Capnography
measures the concentration of carbon dioxide in exhaled breath, which reflects
the effectiveness of ventilation. Together, these two bedside monitoring
parameters provide real-time information about both oxygenation and
ventilation, allowing clinicians to detect and respond to respiratory compromise
promptly. Therefore, pulse oximetry and capnography are the correct answer.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Respiratory Monitoring
MSC: NCLEX: Physiological Integrity
Which of the following is a possible complication of positive-pressure
ventilation?
CORRECT ANS: Worsening pneumothorax
Expert Rationale
Positive-pressure ventilation delivers air into the lungs under pressure, which
can worsen an existing pneumothorax by forcing more air into the pleural space.
This can lead to a tension pneumothorax, which is a life-threatening emergency.
Other complications of positive-pressure ventilation include barotrauma,
volutrauma, decreased cardiac output, and ventilator-associated pneumonia.
Therefore, worsening pneumothorax is a possible complication of positive-
pressure ventilation.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Mechanical Ventilation
MSC: NCLEX: Physiological Integrity
Which of the following assessment findings differentiates a tension
pneumothorax from a simple pneumothorax?
CORRECT ANS: Hypotension that worsens with inspiration
Expert Rationale
A tension pneumothorax occurs when air enters the pleural space and cannot
escape, leading to increasing pressure that compresses the lung and pushes
the mediastinum toward the opposite side. This causes impaired venous return
to the heart, leading to hypotension that worsens with inspiration, also known as
pulsus paradoxus. A simple pneumothorax, by contrast, does not cause
