TNCC 9TH EDITION PRACTICE EXAM: 200 UNIQUE, EXPERT-
VERIFIED MULTIPLE-CHOICE QUESTIONS WITH IN-DEPTH
RATIONALES—COMPREHENSIVELY COVERING
PRIMARY/SECONDARY SURVEYS, HEMORRHAGE CONTROL,
NEUROLOGIC ASSESSMENT, SHOCK STATES, SPECIAL
POPULATIONS, AND CRITICAL CLINICAL CALCULATIONS FOR
GUARANTEED EXAM MASTERY.
1. A trauma patient is found unresponsive with no palpable carotid
pulse. What is the immediate priority action?
A) Apply high-flow oxygen via non-rebreather mask
B) Initiate cardiopulmonary resuscitation (CPR)
C) Establish two large-bore intravenous lines
D) Perform a needle decompression of the chest
Answer: B
Rationale: In a trauma patient, the absence of a pulse indicates cardiac
arrest. The immediate priority is to initiate CPR to restore perfusion,
following the ABCs. Airway and breathing are assessed simultaneously,
but circulation is the immediate life threat here.
2. A patient with a suspected pelvic fracture has a blood pressure of
78/52 mm Hg and a heart rate of 130 bpm. Which IV fluid is most
appropriate for initial resuscitation?
A) 0.9% Sodium Chloride (Normal Saline)
,B) 5% Dextrose in Water (D5W)
C) Lactated Ringer's solution
D) 3% Sodium Chloride (Hypertonic Saline)
Answer: C
Rationale: Lactated Ringer's is the preferred isotonic crystalloid for
trauma resuscitation as it is more physiologic and less likely to cause
hyperchloremic metabolic acidosis compared to normal saline. It is used
for initial volume replacement in hemorrhagic shock.
3. A geriatric patient with a ground-level fall is alert but confused
about the event. What is the most critical element of the secondary
survey?
A) Obtaining a head CT scan
B) Checking for a urinary tract infection
C) Reviewing the patient's medication list
D) Assessing for orthostatic hypotension
Answer: C
Rationale: In older adults, polypharmacy can mimic or exacerbate head
injury symptoms. A thorough medication reconciliation is crucial in the
secondary survey to identify potential causes of confusion (e.g.,
sedatives, anticholinergics) that can impact neurologic assessment.
4. During the primary survey, a patient with a flail chest and
paradoxical movement is in respiratory distress. What is the most
appropriate immediate intervention?
A) Apply a bulky dressing over the flail segment
,B) Intubate the patient and provide positive pressure ventilation
C) Administer nebulized bronchodilators
D) Place the patient in the Trendelenburg position
Answer: B
Rationale: Flail chest with respiratory distress indicates impending
failure. Positive pressure ventilation with intubation provides internal
pneumatic stabilization of the flail segment and supports oxygenation
and ventilation, which is the definitive airway and breathing
management.
5. A pediatric patient is brought in with a burn injury. Which finding
should prompt the nurse to suspect non-accidental trauma?
A) A scald burn on the child's hand
B) A splash burn on the anterior chest
C) A contact burn on the palm of the hand with a clear glove-like
pattern
D) A flame burn to the child's clothing
Answer: C
Rationale: A contact burn with a clear, glove-like pattern on the palm is
highly suspicious for inflicted injury, as it suggests the child was forced
to grab a hot object. Immersion burns (stocking/glove) or burns with
clear demarcation lines are also concerning for abuse.
6. A patient has a Glasgow Coma Scale (GCS) score of 7. What is the
priority nursing action?
A) Administer a dose of naloxone (Narcan)
, B) Prepare for immediate endotracheal intubation
C) Obtain a CT scan of the head
D) Reassess GCS in 15 minutes
Answer: B
Rationale: A GCS of 8 or less is an indication for intubation and
mechanical ventilation to protect the airway, prevent aspiration, and
manage ventilation. This is a critical component of the "Disability"
assessment and airway management.
7. A patient is diagnosed with a spinal cord injury at the C5 level.
What is the priority assessment finding?
A) Loss of motor function in the upper extremities
B) Inability to breathe spontaneously and effectively
C) Absence of deep tendon reflexes
D) Loss of pain and temperature sensation below the injury
Answer: B
Rationale: A C5 injury affects the phrenic nerve, which innervates the
diaphragm. The patient is at high risk for respiratory failure due to
diaphragmatic paralysis. Assessing and supporting breathing is the
priority over sensory or motor deficits.
8. Which of the following is a contraindication to the placement of a
nasogastric (NG) tube in a trauma patient?
A) Facial fractures
B) Decreased bowel sounds
VERIFIED MULTIPLE-CHOICE QUESTIONS WITH IN-DEPTH
RATIONALES—COMPREHENSIVELY COVERING
PRIMARY/SECONDARY SURVEYS, HEMORRHAGE CONTROL,
NEUROLOGIC ASSESSMENT, SHOCK STATES, SPECIAL
POPULATIONS, AND CRITICAL CLINICAL CALCULATIONS FOR
GUARANTEED EXAM MASTERY.
1. A trauma patient is found unresponsive with no palpable carotid
pulse. What is the immediate priority action?
A) Apply high-flow oxygen via non-rebreather mask
B) Initiate cardiopulmonary resuscitation (CPR)
C) Establish two large-bore intravenous lines
D) Perform a needle decompression of the chest
Answer: B
Rationale: In a trauma patient, the absence of a pulse indicates cardiac
arrest. The immediate priority is to initiate CPR to restore perfusion,
following the ABCs. Airway and breathing are assessed simultaneously,
but circulation is the immediate life threat here.
2. A patient with a suspected pelvic fracture has a blood pressure of
78/52 mm Hg and a heart rate of 130 bpm. Which IV fluid is most
appropriate for initial resuscitation?
A) 0.9% Sodium Chloride (Normal Saline)
,B) 5% Dextrose in Water (D5W)
C) Lactated Ringer's solution
D) 3% Sodium Chloride (Hypertonic Saline)
Answer: C
Rationale: Lactated Ringer's is the preferred isotonic crystalloid for
trauma resuscitation as it is more physiologic and less likely to cause
hyperchloremic metabolic acidosis compared to normal saline. It is used
for initial volume replacement in hemorrhagic shock.
3. A geriatric patient with a ground-level fall is alert but confused
about the event. What is the most critical element of the secondary
survey?
A) Obtaining a head CT scan
B) Checking for a urinary tract infection
C) Reviewing the patient's medication list
D) Assessing for orthostatic hypotension
Answer: C
Rationale: In older adults, polypharmacy can mimic or exacerbate head
injury symptoms. A thorough medication reconciliation is crucial in the
secondary survey to identify potential causes of confusion (e.g.,
sedatives, anticholinergics) that can impact neurologic assessment.
4. During the primary survey, a patient with a flail chest and
paradoxical movement is in respiratory distress. What is the most
appropriate immediate intervention?
A) Apply a bulky dressing over the flail segment
,B) Intubate the patient and provide positive pressure ventilation
C) Administer nebulized bronchodilators
D) Place the patient in the Trendelenburg position
Answer: B
Rationale: Flail chest with respiratory distress indicates impending
failure. Positive pressure ventilation with intubation provides internal
pneumatic stabilization of the flail segment and supports oxygenation
and ventilation, which is the definitive airway and breathing
management.
5. A pediatric patient is brought in with a burn injury. Which finding
should prompt the nurse to suspect non-accidental trauma?
A) A scald burn on the child's hand
B) A splash burn on the anterior chest
C) A contact burn on the palm of the hand with a clear glove-like
pattern
D) A flame burn to the child's clothing
Answer: C
Rationale: A contact burn with a clear, glove-like pattern on the palm is
highly suspicious for inflicted injury, as it suggests the child was forced
to grab a hot object. Immersion burns (stocking/glove) or burns with
clear demarcation lines are also concerning for abuse.
6. A patient has a Glasgow Coma Scale (GCS) score of 7. What is the
priority nursing action?
A) Administer a dose of naloxone (Narcan)
, B) Prepare for immediate endotracheal intubation
C) Obtain a CT scan of the head
D) Reassess GCS in 15 minutes
Answer: B
Rationale: A GCS of 8 or less is an indication for intubation and
mechanical ventilation to protect the airway, prevent aspiration, and
manage ventilation. This is a critical component of the "Disability"
assessment and airway management.
7. A patient is diagnosed with a spinal cord injury at the C5 level.
What is the priority assessment finding?
A) Loss of motor function in the upper extremities
B) Inability to breathe spontaneously and effectively
C) Absence of deep tendon reflexes
D) Loss of pain and temperature sensation below the injury
Answer: B
Rationale: A C5 injury affects the phrenic nerve, which innervates the
diaphragm. The patient is at high risk for respiratory failure due to
diaphragmatic paralysis. Assessing and supporting breathing is the
priority over sensory or motor deficits.
8. Which of the following is a contraindication to the placement of a
nasogastric (NG) tube in a trauma patient?
A) Facial fractures
B) Decreased bowel sounds
