TNCC 9TH EDITION STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | ADVANCED REVIEW | EXAM
PREPARATION | COMPREHENSIVE PRACTICE EXAM | LATEST
UPDATE 2026/2027
Examiner:
Emergency Nurses Association (ENA)
TABLE OF CONTENTS
1. Initial Trauma Nursing Assessment
2. Primary Survey and Priority Interventions
3. Airway and Ventilatory Management
4. Shock Recognition and Resuscitation
5. Traumatic Brain Injury
6. Spine and Spinal Cord Trauma
7. Thoracic Trauma
8. Abdominal and Pelvic Trauma
9. Musculoskeletal Trauma
10.Burns and Environmental Injuries
11.Pediatric Trauma Considerations
12.Geriatric Trauma Considerations
13.Trauma Team Communication and Documentation
14.Trauma Patient Safety and Professional Judgment
TRAUMA NURSING || PRIMARY SURVEY || SECONDARY SURVEY ||
AIRWAY MANAGEMENT || CERVICAL SPINE PROTECTION ||
HEMORRHAGE CONTROL || SHOCK RECOGNITION || TRAUMATIC
BRAIN INJURY || CHEST TRAUMA || ABDOMINAL TRAUMA || PELVIC
INJURY || SPINAL CORD INJURY || BURN MANAGEMENT ||
PEDIATRIC TRAUMA || GERIATRIC TRAUMA || TRIAGE || RAPID
ASSESSMENT || RESUSCITATION || TEAM COMMUNICATION ||
EVIDENCE-BASED PRACTICE
,QUESTION 1.
An adult patient arrives after a high-speed motor vehicle collision. The patient is
speaking in short sentences, has inspiratory stridor, facial trauma, and rapidly
increasing neck swelling. Which action should receive the highest priority?
A. Prepare for definitive airway management while maintaining cervical spine
protection.
B. Obtain a complete neurological assessment.
C. Insert a urinary catheter to monitor perfusion.
D. Transport immediately for CT imaging.
🔴 Correct Answer: A. Prepare for definitive airway management while
maintaining cervical spine protection.
🔵 Explanation: Airway compromise is the most immediate life-threatening
problem. Progressive neck swelling and stridor suggest impending airway
obstruction that requires rapid intervention while protecting the cervical spine. The
remaining actions are appropriate only after the airway has been secured or
stabilized.
QUESTION 2.
A trauma patient has cool clammy skin, tachycardia, delayed capillary refill, and a
normal systolic blood pressure. Which interpretation best reflects these findings?
A. The patient has entered irreversible shock.
B. The patient may be demonstrating compensated shock despite a normal blood
pressure.
C. The patient has adequate tissue perfusion.
D. The patient is most likely experiencing isolated neurogenic shock.
🔴 Correct Answer: B. The patient may be demonstrating compensated shock
despite a normal blood pressure.
🔵 Explanation: Early compensated shock can present with preserved blood
pressure because compensatory mechanisms maintain perfusion temporarily.
Tachycardia, cool skin, and delayed capillary refill are early indicators of
,inadequate tissue perfusion. The other options either underestimate or misidentify
the patient's condition.
QUESTION 3.
A patient with blunt chest trauma develops severe respiratory distress. Breath
sounds are absent on the left, the trachea appears deviated, and jugular veins are
distended. What is the priority intervention?
A. Obtain a portable chest radiograph.
B. Begin positive-pressure ventilation only.
C. Perform immediate intervention for suspected tension pneumothorax.
D. Delay intervention until arterial blood gases are obtained.
🔴 Correct Answer: C. Perform immediate intervention for suspected tension
pneumothorax.
🔵 Explanation: Tension pneumothorax is a clinical diagnosis requiring
immediate decompression before imaging. Delaying treatment for diagnostic
studies increases the risk of cardiovascular collapse. Positive-pressure ventilation
without relieving the tension may worsen the condition.
QUESTION 4.
Following the primary survey, a trauma patient remains hypotensive despite
appropriate fluid resuscitation. Pelvic instability is identified. Which intervention is
most appropriate?
A. Delay stabilization until CT confirmation.
B. Apply a pelvic stabilization device promptly.
C. Encourage passive range-of-motion exercises.
D. Elevate the head of the bed to 45 degrees.
🔴 Correct Answer: B. Apply a pelvic stabilization device promptly.
🔵 Explanation: Pelvic fractures can produce life-threatening hemorrhage. Early
stabilization helps reduce pelvic volume and bleeding while definitive management
is arranged. Delaying stabilization may increase blood loss and worsen shock.
, QUESTION 5.
During reassessment, a patient with traumatic brain injury suddenly develops
hypertension, bradycardia, and irregular respirations. What should the nurse
suspect?
A. Septic shock
B. Acute myocardial infarction
C. Increased intracranial pressure with possible brain herniation
D. Spinal shock without cranial involvement
🔴 Correct Answer: C. Increased intracranial pressure with possible brain
herniation.
🔵 Explanation: This combination of findings is consistent with Cushing's
response, indicating dangerously elevated intracranial pressure. Immediate
interventions aimed at preventing secondary brain injury are warranted. The other
diagnoses do not typically present with this classic pattern.
QUESTION 6.
A patient with suspected spinal cord injury is hypotensive and bradycardic. No
external hemorrhage is identified. Which mechanism most likely explains these
findings?
A. Cardiogenic shock
B. Obstructive shock
C. Neurogenic shock
D. Hypovolemic shock
🔴 Correct Answer: C. Neurogenic shock.
🔵 Explanation: Neurogenic shock results from loss of sympathetic tone after
spinal cord injury, producing hypotension and relative bradycardia. Hypovolemic
shock generally causes tachycardia. Recognition of the mechanism guides
appropriate management.
QUESTION 7.
QUESTIONS & ANSWERS | ADVANCED REVIEW | EXAM
PREPARATION | COMPREHENSIVE PRACTICE EXAM | LATEST
UPDATE 2026/2027
Examiner:
Emergency Nurses Association (ENA)
TABLE OF CONTENTS
1. Initial Trauma Nursing Assessment
2. Primary Survey and Priority Interventions
3. Airway and Ventilatory Management
4. Shock Recognition and Resuscitation
5. Traumatic Brain Injury
6. Spine and Spinal Cord Trauma
7. Thoracic Trauma
8. Abdominal and Pelvic Trauma
9. Musculoskeletal Trauma
10.Burns and Environmental Injuries
11.Pediatric Trauma Considerations
12.Geriatric Trauma Considerations
13.Trauma Team Communication and Documentation
14.Trauma Patient Safety and Professional Judgment
TRAUMA NURSING || PRIMARY SURVEY || SECONDARY SURVEY ||
AIRWAY MANAGEMENT || CERVICAL SPINE PROTECTION ||
HEMORRHAGE CONTROL || SHOCK RECOGNITION || TRAUMATIC
BRAIN INJURY || CHEST TRAUMA || ABDOMINAL TRAUMA || PELVIC
INJURY || SPINAL CORD INJURY || BURN MANAGEMENT ||
PEDIATRIC TRAUMA || GERIATRIC TRAUMA || TRIAGE || RAPID
ASSESSMENT || RESUSCITATION || TEAM COMMUNICATION ||
EVIDENCE-BASED PRACTICE
,QUESTION 1.
An adult patient arrives after a high-speed motor vehicle collision. The patient is
speaking in short sentences, has inspiratory stridor, facial trauma, and rapidly
increasing neck swelling. Which action should receive the highest priority?
A. Prepare for definitive airway management while maintaining cervical spine
protection.
B. Obtain a complete neurological assessment.
C. Insert a urinary catheter to monitor perfusion.
D. Transport immediately for CT imaging.
🔴 Correct Answer: A. Prepare for definitive airway management while
maintaining cervical spine protection.
🔵 Explanation: Airway compromise is the most immediate life-threatening
problem. Progressive neck swelling and stridor suggest impending airway
obstruction that requires rapid intervention while protecting the cervical spine. The
remaining actions are appropriate only after the airway has been secured or
stabilized.
QUESTION 2.
A trauma patient has cool clammy skin, tachycardia, delayed capillary refill, and a
normal systolic blood pressure. Which interpretation best reflects these findings?
A. The patient has entered irreversible shock.
B. The patient may be demonstrating compensated shock despite a normal blood
pressure.
C. The patient has adequate tissue perfusion.
D. The patient is most likely experiencing isolated neurogenic shock.
🔴 Correct Answer: B. The patient may be demonstrating compensated shock
despite a normal blood pressure.
🔵 Explanation: Early compensated shock can present with preserved blood
pressure because compensatory mechanisms maintain perfusion temporarily.
Tachycardia, cool skin, and delayed capillary refill are early indicators of
,inadequate tissue perfusion. The other options either underestimate or misidentify
the patient's condition.
QUESTION 3.
A patient with blunt chest trauma develops severe respiratory distress. Breath
sounds are absent on the left, the trachea appears deviated, and jugular veins are
distended. What is the priority intervention?
A. Obtain a portable chest radiograph.
B. Begin positive-pressure ventilation only.
C. Perform immediate intervention for suspected tension pneumothorax.
D. Delay intervention until arterial blood gases are obtained.
🔴 Correct Answer: C. Perform immediate intervention for suspected tension
pneumothorax.
🔵 Explanation: Tension pneumothorax is a clinical diagnosis requiring
immediate decompression before imaging. Delaying treatment for diagnostic
studies increases the risk of cardiovascular collapse. Positive-pressure ventilation
without relieving the tension may worsen the condition.
QUESTION 4.
Following the primary survey, a trauma patient remains hypotensive despite
appropriate fluid resuscitation. Pelvic instability is identified. Which intervention is
most appropriate?
A. Delay stabilization until CT confirmation.
B. Apply a pelvic stabilization device promptly.
C. Encourage passive range-of-motion exercises.
D. Elevate the head of the bed to 45 degrees.
🔴 Correct Answer: B. Apply a pelvic stabilization device promptly.
🔵 Explanation: Pelvic fractures can produce life-threatening hemorrhage. Early
stabilization helps reduce pelvic volume and bleeding while definitive management
is arranged. Delaying stabilization may increase blood loss and worsen shock.
, QUESTION 5.
During reassessment, a patient with traumatic brain injury suddenly develops
hypertension, bradycardia, and irregular respirations. What should the nurse
suspect?
A. Septic shock
B. Acute myocardial infarction
C. Increased intracranial pressure with possible brain herniation
D. Spinal shock without cranial involvement
🔴 Correct Answer: C. Increased intracranial pressure with possible brain
herniation.
🔵 Explanation: This combination of findings is consistent with Cushing's
response, indicating dangerously elevated intracranial pressure. Immediate
interventions aimed at preventing secondary brain injury are warranted. The other
diagnoses do not typically present with this classic pattern.
QUESTION 6.
A patient with suspected spinal cord injury is hypotensive and bradycardic. No
external hemorrhage is identified. Which mechanism most likely explains these
findings?
A. Cardiogenic shock
B. Obstructive shock
C. Neurogenic shock
D. Hypovolemic shock
🔴 Correct Answer: C. Neurogenic shock.
🔵 Explanation: Neurogenic shock results from loss of sympathetic tone after
spinal cord injury, producing hypotension and relative bradycardia. Hypovolemic
shock generally causes tachycardia. Recognition of the mechanism guides
appropriate management.
QUESTION 7.
