TNCC EXAM Questions, Answers, and Rationales
1. An adult patient was brought to the emergency department following a motorcycle crash. On
arrival, the patient is only responsive to pain, has bleeding from the nose, and multiple abrasions
and contusions to the face. What is the priority intervention?
A) Use a bulb syringe to suction out secretions from the mouth
B) Insert a nasopharyngeal airway to maintain an open airway
C) Use a jaw thrust to open the airway and look for signs of obstruction
D) Ask the patient to open their mouth to inspect the airway
Correct answer: C
Rationale: The jaw thrust maneuver opens the airway without moving the cervical spine, which
is crucial in trauma patients where spinal injury is suspected. This technique maintains airway
patency while protecting the cervical spine from further injury, which could worsen neurological
outcomes.
2. An adult pedestrian was struck on the right side by a sport utility vehicle traveling at 40 mph.
The patient is awake and alert and the right leg is shortened. Following initial resuscitation with
fluids, the patient remains hypotensive. What would be the priority intervention?
A) Send blood for type and crossmatch
B) Apply a pelvic binder
C) Prepare the patient for surgery
D) Insert a urinary catheter
Correct answer: B
Rationale: Pelvic fractures can cause major bleeding internally, leading to persistent
hypotension despite fluid resuscitation. Applying a pelvic binder stabilizes the pelvis and reduces
hemorrhage risk by compressing bleeding vessels and limiting further movement that could
exacerbate bleeding.
3. A severely injured patient has been intubated and is being mechanically ventilated. The patient
has received a balanced resuscitation including multiple blood products. Under which
circumstance will it be harder for the hemoglobin to release oxygen to the tissues?
A) Decreased pH
B) Elevated carbon dioxide level
C) Decreased body temperature
D) Increased metabolic demand
Correct answer: C
Rationale: Hypothermia shifts the oxyhemoglobin dissociation curve to the left, meaning
, hemoglobin holds oxygen more tightly and releases it less readily to tissues. This impairs oxygen
delivery at the cellular level, worsening tissue hypoxia despite adequate oxygenation.
4. A patient is thrown against a car during a tornado and presents with obvious bilateral femur
fractures. The patient is pale, alert, disoriented, and has delayed capillary refill. Which of the
following interventions would be most appropriate for this patient based on the disaster triage
principles?
A) Initiate two large-caliber intravenous lines for isotonic crystalloid administration
B) Administer intravenous medications for pain
C) Place the patient in an observation area for care within the next few hours
D) Contact the command center for personnel to notify next of kin
Correct answer: A
Rationale: This patient shows signs of shock such as pallor and delayed capillary refill,
indicating hypoperfusion. Initiating two large-bore IV lines for rapid fluid administration is a
critical priority to restore circulating volume and prevent further decompensation.
5. A patient arrives with a large open chest wound after being assaulted with a machete.
Prehospital providers placed a nonporous dressing over the chest wound and taped it on three
sides. The patient is now showing signs of anxiety, restlessness, severe respiratory distress,
cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate
immediate intervention?
A) Needle decompression
B) Tube thoracostomy
C) Dressing removal
D) Surgical repair
Correct answer: C
Rationale: A three-sided taped dressing can create a one-way valve effect, leading to tension
pneumothorax by trapping air inside the pleural space. Removing the dressing immediately
relieves pressure, improves ventilation, and prevents cardiovascular collapse.
6. A driver involved in a high-speed motor vehicle collision arrives in the emergency
department. The vehicle's air-bag failed to deploy. The patient is drowsy but arousable and
complaining of chest pain with ecchymosis noted to the chest. The patient is tachycardic and
hypotensive with no evidence of uncontrolled bleeding. Cardiac monitor shows premature
ventricular contractions. Which of the following is the most appropriate intervention for this
patient?
A) Rapid fluid boluses
B) Tranexamic acid administration
1. An adult patient was brought to the emergency department following a motorcycle crash. On
arrival, the patient is only responsive to pain, has bleeding from the nose, and multiple abrasions
and contusions to the face. What is the priority intervention?
A) Use a bulb syringe to suction out secretions from the mouth
B) Insert a nasopharyngeal airway to maintain an open airway
C) Use a jaw thrust to open the airway and look for signs of obstruction
D) Ask the patient to open their mouth to inspect the airway
Correct answer: C
Rationale: The jaw thrust maneuver opens the airway without moving the cervical spine, which
is crucial in trauma patients where spinal injury is suspected. This technique maintains airway
patency while protecting the cervical spine from further injury, which could worsen neurological
outcomes.
2. An adult pedestrian was struck on the right side by a sport utility vehicle traveling at 40 mph.
The patient is awake and alert and the right leg is shortened. Following initial resuscitation with
fluids, the patient remains hypotensive. What would be the priority intervention?
A) Send blood for type and crossmatch
B) Apply a pelvic binder
C) Prepare the patient for surgery
D) Insert a urinary catheter
Correct answer: B
Rationale: Pelvic fractures can cause major bleeding internally, leading to persistent
hypotension despite fluid resuscitation. Applying a pelvic binder stabilizes the pelvis and reduces
hemorrhage risk by compressing bleeding vessels and limiting further movement that could
exacerbate bleeding.
3. A severely injured patient has been intubated and is being mechanically ventilated. The patient
has received a balanced resuscitation including multiple blood products. Under which
circumstance will it be harder for the hemoglobin to release oxygen to the tissues?
A) Decreased pH
B) Elevated carbon dioxide level
C) Decreased body temperature
D) Increased metabolic demand
Correct answer: C
Rationale: Hypothermia shifts the oxyhemoglobin dissociation curve to the left, meaning
, hemoglobin holds oxygen more tightly and releases it less readily to tissues. This impairs oxygen
delivery at the cellular level, worsening tissue hypoxia despite adequate oxygenation.
4. A patient is thrown against a car during a tornado and presents with obvious bilateral femur
fractures. The patient is pale, alert, disoriented, and has delayed capillary refill. Which of the
following interventions would be most appropriate for this patient based on the disaster triage
principles?
A) Initiate two large-caliber intravenous lines for isotonic crystalloid administration
B) Administer intravenous medications for pain
C) Place the patient in an observation area for care within the next few hours
D) Contact the command center for personnel to notify next of kin
Correct answer: A
Rationale: This patient shows signs of shock such as pallor and delayed capillary refill,
indicating hypoperfusion. Initiating two large-bore IV lines for rapid fluid administration is a
critical priority to restore circulating volume and prevent further decompensation.
5. A patient arrives with a large open chest wound after being assaulted with a machete.
Prehospital providers placed a nonporous dressing over the chest wound and taped it on three
sides. The patient is now showing signs of anxiety, restlessness, severe respiratory distress,
cyanosis, and decreasing blood pressure. Which of the following is the MOST appropriate
immediate intervention?
A) Needle decompression
B) Tube thoracostomy
C) Dressing removal
D) Surgical repair
Correct answer: C
Rationale: A three-sided taped dressing can create a one-way valve effect, leading to tension
pneumothorax by trapping air inside the pleural space. Removing the dressing immediately
relieves pressure, improves ventilation, and prevents cardiovascular collapse.
6. A driver involved in a high-speed motor vehicle collision arrives in the emergency
department. The vehicle's air-bag failed to deploy. The patient is drowsy but arousable and
complaining of chest pain with ecchymosis noted to the chest. The patient is tachycardic and
hypotensive with no evidence of uncontrolled bleeding. Cardiac monitor shows premature
ventricular contractions. Which of the following is the most appropriate intervention for this
patient?
A) Rapid fluid boluses
B) Tranexamic acid administration
