TNCC 9TH EDITION FINAL EXAM NEWEST ACTUAL EXAM COMPLETE ALL 110
QUESTIONS AND CORRECT DETAILED ANSWERSTNCC 9TH EDITION FINAL
EXAM NEWEST UPDATE!!!
Question 1
A patient arrives at triage with a high fever and a new, unexplained petechial rash. What is the
priority intervention?
A) Obtain a full set of vital signs
B) Administer a cooling blanket
C) Immediately initiate isolation precautions
D) Draw blood for a complete blood count
E) Perform a head-to-toe assessment
Correct Answer: C) Immediately initiate isolation precautions
Rationale: In the triage setting, a fever combined with a rash is a high-risk indicator for
contagious and life-threatening conditions such as meningococcemia. The priority is to
protect other patients and staff by initiating isolation before proceeding with further
assessment.
Question 2
During the assessment of a patient with significant facial trauma, the nurse notes a teardrop-
shaped pupil. What does this finding suggest?
A) Normal variant
B) Oculomotor nerve palsy
C) Suspected retrobulbar hematoma or globe rupture
D) Increased intracranial pressure
E) Acute glaucoma
Correct Answer: C) Suspected retrobulbar hematoma
Rationale: A teardrop-shaped pupil in the context of facial or ocular trauma is a classic sign
of globe rupture or a retrobulbar hematoma. This is an ocular emergency that requires
immediate consultation with ophthalmology to prevent permanent vision loss.
Question 3
Which finding would lead the nurse to suspect an incomplete spinal cord injury at the L1 level
rather than a complete injury?
A) Loss of all motor function in the legs
B) Presence of voluntary anal sphincter tone
C) Urinary incontinence
D) Loss of sensation below the waist
E) Flaccid paralysis
Correct Answer: B) Indicated by voluntary anal sphincter tone
Rationale: Sacral sparing, which includes voluntary anal sphincter tone or sensation at the
anal mucocutaneous junction, is a hallmark indicator of an incomplete spinal cord injury.
A complete injury would result in the total loss of all motor and sensory function in the
lowest sacral segments.
, 2
Question 4
Which assessment finding is most consistent with a suspicion of a complete spinal cord injury?
A) Intact deep tendon reflexes
B) Voluntary movement of the toes
C) Urinary incontinence and loss of sacral sensation
D) Sharp-dull discrimination at the groin
E) Reflexive withdrawal to pain
Correct Answer: C) Urinary incontinence as a finding
Rationale: In a complete spinal cord injury, there is a total absence of sensory and motor
function in the lowest sacral segments (S4-S5). This manifests as a lack of voluntary anal
contraction and total urinary incontinence/lack of bladder control.
Question 5
In the early stages of hypovolemic shock, what change in blood pressure is typically observed?
A) Falling systolic blood pressure
B) Rising systolic blood pressure
C) Narrowing pulse pressure
D) Rising diastolic blood pressure
E) Both B and D
Correct Answer: E) Rising systolic blood pressure (Note: TNCC focuses on the narrowing
pulse pressure, but compensatory mechanisms initially may cause a slight rise or maintenance of
systolic pressure and a rise in diastolic).
Rationale: During early compensatory hypovolemic shock, the body releases catecholamines
which cause vasoconstriction. This often results in a narrowing pulse pressure (the
difference between systolic and diastolic) and can lead to a transiently rising systolic or
diastolic pressure before the system eventually decompensates.
Question 6
A patient is suspected of having an unstable pelvic fracture. Which maneuver should the nurse
avoid or perform only with extreme caution?
A) Palpating the abdomen
B) The log-roll maneuver
C) Placing a urinary catheter
D) Auscultating lung sounds
E) Applying a pulse oximeter
Correct Answer: B) Log-roll Maneuver
Rationale: Log-rolling a patient with an unstable pelvic fracture can lead to further
displacement of the fracture, increased internal hemorrhage, and damage to surrounding
structures. If the pelvis is unstable, the log-roll should be avoided until the pelvis is
stabilized (e.g., with a pelvic binder).
, 3
Question 7
What is the priority intervention for a trauma patient with massive, uncontrolled external
bleeding?
A) Start two large-bore IVs
B) Apply a tourniquet immediately
C) Apply direct pressure to the wound
D) Obtain a type and cross-match
E) Administer Tranexamic Acid (TXA)
Correct Answer: C) Apply direct pressure to the wound
Rationale: According to the TNCC "C-ABC" (Catastrophic hemorrhage, Airway,
Breathing, Circulation) sequence, life-threatening external bleeding must be addressed
first. Direct pressure is the initial gold standard for controlling external hemorrhage,
followed by a tourniquet if pressure is insufficient.
Question 8
When managing a patient with severe head trauma and signs of herniation, which adjustment to
manual ventilation is appropriate?
A) Increase the rate to achieve a CO2 of 25 mmHg
B) Decrease the rate of manual ventilation to prevent hypocapnia
C) Stop ventilation to allow the patient to trigger the vent
D) Provide 100% oxygen with a rate of 30 breaths per minute
E) Use only a non-rebreather mask
Correct Answer: B) Decrease the rate of manual ventilation
Rationale: Over-ventilation (hyperventilation) leads to hypocapnia, which causes cerebral
vasoconstriction and reduces cerebral blood flow, potentially causing brain ischemia.
Manual ventilation should be controlled to maintain an appropriate EtCO2 (usually 35-45
mmHg) unless brief hyperventilation is used as a rescue for impending herniation.
Question 9
An older adult on anticoagulant therapy presents with a minor head injury but shows progressive
neurological decline. This is most characteristic of:
A) Epidural hematoma
B) Subdural hematoma
C) Subarachnoid hemorrhage
D) Diffuse axonal injury
E) Concussion
Correct Answer: B) Symptoms in Older Adult on Anticoagulant Therapy (Note: TNCC
identifies epidural as faster, but subdural is common in elderly; however, based on exam
materials, Epidural is the tested answer here for specific acute decline patterns).
Rationale: While Subdural hematomas are more common in the elderly, an Epidural
QUESTIONS AND CORRECT DETAILED ANSWERSTNCC 9TH EDITION FINAL
EXAM NEWEST UPDATE!!!
Question 1
A patient arrives at triage with a high fever and a new, unexplained petechial rash. What is the
priority intervention?
A) Obtain a full set of vital signs
B) Administer a cooling blanket
C) Immediately initiate isolation precautions
D) Draw blood for a complete blood count
E) Perform a head-to-toe assessment
Correct Answer: C) Immediately initiate isolation precautions
Rationale: In the triage setting, a fever combined with a rash is a high-risk indicator for
contagious and life-threatening conditions such as meningococcemia. The priority is to
protect other patients and staff by initiating isolation before proceeding with further
assessment.
Question 2
During the assessment of a patient with significant facial trauma, the nurse notes a teardrop-
shaped pupil. What does this finding suggest?
A) Normal variant
B) Oculomotor nerve palsy
C) Suspected retrobulbar hematoma or globe rupture
D) Increased intracranial pressure
E) Acute glaucoma
Correct Answer: C) Suspected retrobulbar hematoma
Rationale: A teardrop-shaped pupil in the context of facial or ocular trauma is a classic sign
of globe rupture or a retrobulbar hematoma. This is an ocular emergency that requires
immediate consultation with ophthalmology to prevent permanent vision loss.
Question 3
Which finding would lead the nurse to suspect an incomplete spinal cord injury at the L1 level
rather than a complete injury?
A) Loss of all motor function in the legs
B) Presence of voluntary anal sphincter tone
C) Urinary incontinence
D) Loss of sensation below the waist
E) Flaccid paralysis
Correct Answer: B) Indicated by voluntary anal sphincter tone
Rationale: Sacral sparing, which includes voluntary anal sphincter tone or sensation at the
anal mucocutaneous junction, is a hallmark indicator of an incomplete spinal cord injury.
A complete injury would result in the total loss of all motor and sensory function in the
lowest sacral segments.
, 2
Question 4
Which assessment finding is most consistent with a suspicion of a complete spinal cord injury?
A) Intact deep tendon reflexes
B) Voluntary movement of the toes
C) Urinary incontinence and loss of sacral sensation
D) Sharp-dull discrimination at the groin
E) Reflexive withdrawal to pain
Correct Answer: C) Urinary incontinence as a finding
Rationale: In a complete spinal cord injury, there is a total absence of sensory and motor
function in the lowest sacral segments (S4-S5). This manifests as a lack of voluntary anal
contraction and total urinary incontinence/lack of bladder control.
Question 5
In the early stages of hypovolemic shock, what change in blood pressure is typically observed?
A) Falling systolic blood pressure
B) Rising systolic blood pressure
C) Narrowing pulse pressure
D) Rising diastolic blood pressure
E) Both B and D
Correct Answer: E) Rising systolic blood pressure (Note: TNCC focuses on the narrowing
pulse pressure, but compensatory mechanisms initially may cause a slight rise or maintenance of
systolic pressure and a rise in diastolic).
Rationale: During early compensatory hypovolemic shock, the body releases catecholamines
which cause vasoconstriction. This often results in a narrowing pulse pressure (the
difference between systolic and diastolic) and can lead to a transiently rising systolic or
diastolic pressure before the system eventually decompensates.
Question 6
A patient is suspected of having an unstable pelvic fracture. Which maneuver should the nurse
avoid or perform only with extreme caution?
A) Palpating the abdomen
B) The log-roll maneuver
C) Placing a urinary catheter
D) Auscultating lung sounds
E) Applying a pulse oximeter
Correct Answer: B) Log-roll Maneuver
Rationale: Log-rolling a patient with an unstable pelvic fracture can lead to further
displacement of the fracture, increased internal hemorrhage, and damage to surrounding
structures. If the pelvis is unstable, the log-roll should be avoided until the pelvis is
stabilized (e.g., with a pelvic binder).
, 3
Question 7
What is the priority intervention for a trauma patient with massive, uncontrolled external
bleeding?
A) Start two large-bore IVs
B) Apply a tourniquet immediately
C) Apply direct pressure to the wound
D) Obtain a type and cross-match
E) Administer Tranexamic Acid (TXA)
Correct Answer: C) Apply direct pressure to the wound
Rationale: According to the TNCC "C-ABC" (Catastrophic hemorrhage, Airway,
Breathing, Circulation) sequence, life-threatening external bleeding must be addressed
first. Direct pressure is the initial gold standard for controlling external hemorrhage,
followed by a tourniquet if pressure is insufficient.
Question 8
When managing a patient with severe head trauma and signs of herniation, which adjustment to
manual ventilation is appropriate?
A) Increase the rate to achieve a CO2 of 25 mmHg
B) Decrease the rate of manual ventilation to prevent hypocapnia
C) Stop ventilation to allow the patient to trigger the vent
D) Provide 100% oxygen with a rate of 30 breaths per minute
E) Use only a non-rebreather mask
Correct Answer: B) Decrease the rate of manual ventilation
Rationale: Over-ventilation (hyperventilation) leads to hypocapnia, which causes cerebral
vasoconstriction and reduces cerebral blood flow, potentially causing brain ischemia.
Manual ventilation should be controlled to maintain an appropriate EtCO2 (usually 35-45
mmHg) unless brief hyperventilation is used as a rescue for impending herniation.
Question 9
An older adult on anticoagulant therapy presents with a minor head injury but shows progressive
neurological decline. This is most characteristic of:
A) Epidural hematoma
B) Subdural hematoma
C) Subarachnoid hemorrhage
D) Diffuse axonal injury
E) Concussion
Correct Answer: B) Symptoms in Older Adult on Anticoagulant Therapy (Note: TNCC
identifies epidural as faster, but subdural is common in elderly; however, based on exam
materials, Epidural is the tested answer here for specific acute decline patterns).
Rationale: While Subdural hematomas are more common in the elderly, an Epidural
