TNCC EXAM QUESTIONS AND
ANSWERS COMPLETE
*An adult patient who sustained a severe head trauma has been intubated and is being manually
ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has received one
intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm
Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important
intervention to manage the cerebral blood flow? A.Decrease the rate of manual ventilation.
An older adult presents to the emergency department with complaints of dizziness, headache,
and nausea. The patient was involved in a motor vehicle collision 10 days ago. There was no loss
of consciousness and a hematoma is noted to the forehead. The patient is currently on
anticoagulant therapy. What is most likely the cause of their symptoms?
A.Intracerebral hemorrhage
B.Epidural hematoma
C.Diffuse axonal injury
D.Post-concussive syndrome post-concussive syndrome
A patient with a lower extremity fracture complains of severe pain and tightness in his calf,
minimally relieved by pain medications. Which of the following is the priority nursing
intervention?
A.Elevating the leg above the level of the heart
B.Repositioning the leg and applying ice
C.Elevating the leg to the level of the heart
D.Preparing the patient for ultrasound of the leg C.Elevating the leg to the level of the heart
,A patient involved in a high-speed rollover is complaining of increased difficulty breathing.
There is a small penetrating wound to the sixth intercostal space in the left lateral chest. Which
finding is most consistent with an injury to the diaphragm? Bowel sounds heard in the left lower
chest
A ruptured diaphragm is a potentially life-threatening injury. The patient will most likely have
decreased breath sounds on the affected side along with pain, which may radiate to the left
shoulder. However, these signs do not specifically implicate an injury to the diaphragm.
Auscultation of bowel sounds in the chest indicates that abdominal contents have herniated up
into the chest through a defect in the diaphragm.
*A patient has been in the emergency department for several hours waiting to be admitted. They
sustained multiple rib fractures and a femur fracture after a fall. The patient has been awake,
alert, and complaining of leg pain. Their spouse reported that the patient suddenly became
anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and
petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated
with which of the following conditions?
A. Acute lung injury
B. Fat embolism
C. Pneumothorax
D. Pulmonary contusion B. Fat embolism
*Three adults present at different times during a one-hour period with a high fever, fatigue, and
headache. All three patients have a rash which started on their mouth, face, and arms with
progression to the chest and abdomen. They all visited the same grocery store within the last
week. What is the most appropriate intervention from triage for these patients?
A. Move them to a decontamination area
B. Mask the patients and send them to the waiting room
C. Immediately initiate isolation precautions
D. Send them to the waiting room without a mask C. Immediately initiate isolation precautions
The fact that multiple people with different demographics are appearing with similar signs and
symptoms would alert the nurse to a possible biological exposure. These patients should be
placed in isolation to prevent possible spread until further determination can be made.
*A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A
teardrop-shaped left pupil is noted on exam. What type of injury is suspected?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment B.Globe rupture
, *A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would
indicate sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area C.Voluntary anal sphincter tone
While caring for a trauma patient in the emergency department, what finding raises suspicion of
a complete spinal cord injury?
A.Weakness in the lower extremities
B.Urinary incontinence
C.Sacral sparing
D.Spastic paralysis of the legs urinary incontinence
*Which blood pressure finding is associated with early or compensated hypovolemic shock?
B. Rising diastolic
In the compensated stage of shock, the diastolic blood pressure rises causing a narrowed pulse
pressure in a attempt to compensate for compromised circulation. Systolic blood pressure is
usually within a normal range.
Which of the following is true about the log-roll maneuver? It should be avoided with a suspected
spine injury prior to imaging
*A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the
priority intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding C.Apply direct pressure to the wound
Which of the following situations could cause functional grief?
A.Inability to live at home
B.Amputation of a limb
C.Loss of one's self-image
D.Destruction of the patient's car B.Amputation of a limb
???*Using the American College of Surgeons screening guidelines, what assessment finding
would prompt the nurse to prepare a patient for cervical spine imaging?
A.Alert with no neurologic deficits or neck pain
B.Multiple abrasions to the extremities
ANSWERS COMPLETE
*An adult patient who sustained a severe head trauma has been intubated and is being manually
ventilated via a bag-mask device at a rate of 18 breaths/minute. The patient has received one
intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm
Hg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important
intervention to manage the cerebral blood flow? A.Decrease the rate of manual ventilation.
An older adult presents to the emergency department with complaints of dizziness, headache,
and nausea. The patient was involved in a motor vehicle collision 10 days ago. There was no loss
of consciousness and a hematoma is noted to the forehead. The patient is currently on
anticoagulant therapy. What is most likely the cause of their symptoms?
A.Intracerebral hemorrhage
B.Epidural hematoma
C.Diffuse axonal injury
D.Post-concussive syndrome post-concussive syndrome
A patient with a lower extremity fracture complains of severe pain and tightness in his calf,
minimally relieved by pain medications. Which of the following is the priority nursing
intervention?
A.Elevating the leg above the level of the heart
B.Repositioning the leg and applying ice
C.Elevating the leg to the level of the heart
D.Preparing the patient for ultrasound of the leg C.Elevating the leg to the level of the heart
,A patient involved in a high-speed rollover is complaining of increased difficulty breathing.
There is a small penetrating wound to the sixth intercostal space in the left lateral chest. Which
finding is most consistent with an injury to the diaphragm? Bowel sounds heard in the left lower
chest
A ruptured diaphragm is a potentially life-threatening injury. The patient will most likely have
decreased breath sounds on the affected side along with pain, which may radiate to the left
shoulder. However, these signs do not specifically implicate an injury to the diaphragm.
Auscultation of bowel sounds in the chest indicates that abdominal contents have herniated up
into the chest through a defect in the diaphragm.
*A patient has been in the emergency department for several hours waiting to be admitted. They
sustained multiple rib fractures and a femur fracture after a fall. The patient has been awake,
alert, and complaining of leg pain. Their spouse reported that the patient suddenly became
anxious and confused. Upon reassessment, the patient is restless, with respiratory distress and
petechiae to his neck. The patient is exhibiting signs and symptoms most commonly associated
with which of the following conditions?
A. Acute lung injury
B. Fat embolism
C. Pneumothorax
D. Pulmonary contusion B. Fat embolism
*Three adults present at different times during a one-hour period with a high fever, fatigue, and
headache. All three patients have a rash which started on their mouth, face, and arms with
progression to the chest and abdomen. They all visited the same grocery store within the last
week. What is the most appropriate intervention from triage for these patients?
A. Move them to a decontamination area
B. Mask the patients and send them to the waiting room
C. Immediately initiate isolation precautions
D. Send them to the waiting room without a mask C. Immediately initiate isolation precautions
The fact that multiple people with different demographics are appearing with similar signs and
symptoms would alert the nurse to a possible biological exposure. These patients should be
placed in isolation to prevent possible spread until further determination can be made.
*A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A
teardrop-shaped left pupil is noted on exam. What type of injury is suspected?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment B.Globe rupture
, *A patient has been diagnosed with an incomplete spinal cord injury at L1. Which finding would
indicate sacral sparing?
A.Involuntary flexion of the great toe
B.Priapism
C.Voluntary anal sphincter tone
D.Numbness to the perianal area C.Voluntary anal sphincter tone
While caring for a trauma patient in the emergency department, what finding raises suspicion of
a complete spinal cord injury?
A.Weakness in the lower extremities
B.Urinary incontinence
C.Sacral sparing
D.Spastic paralysis of the legs urinary incontinence
*Which blood pressure finding is associated with early or compensated hypovolemic shock?
B. Rising diastolic
In the compensated stage of shock, the diastolic blood pressure rises causing a narrowed pulse
pressure in a attempt to compensate for compromised circulation. Systolic blood pressure is
usually within a normal range.
Which of the following is true about the log-roll maneuver? It should be avoided with a suspected
spine injury prior to imaging
*A patient has uncontrolled bleeding from a wound to his right upper extremity. What is the
priority intervention?
A.Initiate two intravenous access sites
B.Place the patient on supplemental oxygen
C.Apply direct pressure to the wound
D.Use a tourniquet to control the bleeding C.Apply direct pressure to the wound
Which of the following situations could cause functional grief?
A.Inability to live at home
B.Amputation of a limb
C.Loss of one's self-image
D.Destruction of the patient's car B.Amputation of a limb
???*Using the American College of Surgeons screening guidelines, what assessment finding
would prompt the nurse to prepare a patient for cervical spine imaging?
A.Alert with no neurologic deficits or neck pain
B.Multiple abrasions to the extremities
