TNCC Final Exam (2024/2025) - 50 Questions And Questions
1. [Primary Survey]
A patient arrives via EMS after a high-speed MVC. They are confused, with labored breathing at 28/min,
and a radial pulse is faint at 130/min. Your first priority is to:
A. Obtain a full set of vital signs.
B. Apply a cervical collar and log roll.
C. Open the airway with a jaw-thrust and assess for compromise.
D. Start two large-bore IVs for fluid administration.
Correct Answer: C
Rationale: The primary survey follows the ABCDE sequence. Airway (with C-spine protection) is always
the first priority. A jaw-thrust is the indicated maneuver in trauma to protect the cervical spine while
assessing for airway compromise.
TNCC Reference: The systematic ABCDE approach mandates airway assessment and management as the
first step in the primary survey.
2. [Hemorrhage Control]
A 24-year-old male with a stab wound to the right upper thigh has bright red blood pulsating from the
wound. Direct pressure is applied but is ineffective. The next appropriate action is to:
A. Elevate the leg above the level of the heart.
B. Apply a tourniquet proximal to the wound.
C. Apply topical hemostatic gauze and wrap tightly.
D. Prepare for immediate surgical intervention in the trauma bay.
Correct Answer: B
Rationale: For life-threatening extremity hemorrhage uncontrolled by direct pressure, the immediate
next step is application of a commercial tourniquet. This follows the "C" (circulation with hemorrhage
control) priority in the MARCH algorithm.
TNCC Reference: TNCC guidelines prioritize rapid tourniquet application for uncontrolled extremity
hemorrhage as a critical circulation intervention.
3. [Airway]
A 30-year-old unrestrained driver is found unconscious at the scene. GCS is 6 (E1 V2 M3), and the
patient is making gurgling sounds. The most appropriate initial airway intervention is:
A. Insert an oropharyngeal airway and apply high-flow oxygen.
B. Perform nasotracheal suction and place in recovery position.
C. Proceed immediately to rapid sequence intubation.
D. Apply a non-rebreather mask at 15 L/min.
Correct Answer: C
Rationale: A GCS ≤8 indicates inability to protect the airway; rapid sequence intubation (RSI) is indicated
to secure the airway and prevent aspiration.
TNCC Reference: TNCC standard: GCS ≤8 requires definitive airway management via RSI with cervical
spine stabilization.
, 4. [Shock]
A 40-year-old female presents after a fall from height. HR 125, BP 88/50, RR 26, capillary refill 5 seconds.
FAST is positive for free fluid in Morrison’s pouch. The priority intervention is:
A. Obtain CT imaging to grade splenic injury.
B. Initiate massive transfusion protocol and prepare for OR.
C. Administer 2 L of crystalloid fluid rapidly.
D. Insert a urinary catheter and monitor urine output.
Correct Answer: B
Rationale: Hemodynamically unstable with positive FAST indicates hemorrhagic shock requiring
immediate control; MTP activation and OR are priorities over imaging or crystalloid.
TNCC Reference: Unstable + positive FAST = OR for hemorrhage control; MTP is initiated early in severe
shock.
5. [Disability]
A 22-year-old male is being assessed after a motorcycle crash. He opens his eyes to pain, withdraws
from stimulus, and makes incomprehensible sounds. His GCS is:
A. 9
B. 8
C. 7
D. 6
Correct Answer: B
Rationale: Eye opening to pain = 2; verbal incomprehensible = 2; motor withdrawal = 4 → Total GCS = 8.
TNCC Reference: GCS calculation is essential in the Disability assessment of the primary survey.
6. [Exposure]
During the secondary survey, a patient is fully exposed and log-rolled. A 15-cm bruise is noted across the
upper abdomen with a seatbelt sign. The next priority is:
A. Apply warm blankets and move to CT scan.
B. Document the finding and continue assessment.
C. Obtain abdominal CT with contrast.
D. Perform a FAST exam if not already done.
Correct Answer: D
Rationale: Seatbelt sign is a marker for intra-abdominal injury; FAST assesses for free fluid and guides
further imaging or intervention.
TNCC Reference: Seatbelt sign increases risk of bowel/mesenteric injury; FAST is indicated in secondary
survey.
7. [Pediatric Trauma]
A 3-year-old child is brought in after a motor vehicle collision. Weight 14 kg, HR 160, RR 40, BP 70/40.
The estimated blood volume is approximately:
A. 800 mL
B. 1,000 mL
C. 1,120 mL
D. 1,400 mL
1. [Primary Survey]
A patient arrives via EMS after a high-speed MVC. They are confused, with labored breathing at 28/min,
and a radial pulse is faint at 130/min. Your first priority is to:
A. Obtain a full set of vital signs.
B. Apply a cervical collar and log roll.
C. Open the airway with a jaw-thrust and assess for compromise.
D. Start two large-bore IVs for fluid administration.
Correct Answer: C
Rationale: The primary survey follows the ABCDE sequence. Airway (with C-spine protection) is always
the first priority. A jaw-thrust is the indicated maneuver in trauma to protect the cervical spine while
assessing for airway compromise.
TNCC Reference: The systematic ABCDE approach mandates airway assessment and management as the
first step in the primary survey.
2. [Hemorrhage Control]
A 24-year-old male with a stab wound to the right upper thigh has bright red blood pulsating from the
wound. Direct pressure is applied but is ineffective. The next appropriate action is to:
A. Elevate the leg above the level of the heart.
B. Apply a tourniquet proximal to the wound.
C. Apply topical hemostatic gauze and wrap tightly.
D. Prepare for immediate surgical intervention in the trauma bay.
Correct Answer: B
Rationale: For life-threatening extremity hemorrhage uncontrolled by direct pressure, the immediate
next step is application of a commercial tourniquet. This follows the "C" (circulation with hemorrhage
control) priority in the MARCH algorithm.
TNCC Reference: TNCC guidelines prioritize rapid tourniquet application for uncontrolled extremity
hemorrhage as a critical circulation intervention.
3. [Airway]
A 30-year-old unrestrained driver is found unconscious at the scene. GCS is 6 (E1 V2 M3), and the
patient is making gurgling sounds. The most appropriate initial airway intervention is:
A. Insert an oropharyngeal airway and apply high-flow oxygen.
B. Perform nasotracheal suction and place in recovery position.
C. Proceed immediately to rapid sequence intubation.
D. Apply a non-rebreather mask at 15 L/min.
Correct Answer: C
Rationale: A GCS ≤8 indicates inability to protect the airway; rapid sequence intubation (RSI) is indicated
to secure the airway and prevent aspiration.
TNCC Reference: TNCC standard: GCS ≤8 requires definitive airway management via RSI with cervical
spine stabilization.
, 4. [Shock]
A 40-year-old female presents after a fall from height. HR 125, BP 88/50, RR 26, capillary refill 5 seconds.
FAST is positive for free fluid in Morrison’s pouch. The priority intervention is:
A. Obtain CT imaging to grade splenic injury.
B. Initiate massive transfusion protocol and prepare for OR.
C. Administer 2 L of crystalloid fluid rapidly.
D. Insert a urinary catheter and monitor urine output.
Correct Answer: B
Rationale: Hemodynamically unstable with positive FAST indicates hemorrhagic shock requiring
immediate control; MTP activation and OR are priorities over imaging or crystalloid.
TNCC Reference: Unstable + positive FAST = OR for hemorrhage control; MTP is initiated early in severe
shock.
5. [Disability]
A 22-year-old male is being assessed after a motorcycle crash. He opens his eyes to pain, withdraws
from stimulus, and makes incomprehensible sounds. His GCS is:
A. 9
B. 8
C. 7
D. 6
Correct Answer: B
Rationale: Eye opening to pain = 2; verbal incomprehensible = 2; motor withdrawal = 4 → Total GCS = 8.
TNCC Reference: GCS calculation is essential in the Disability assessment of the primary survey.
6. [Exposure]
During the secondary survey, a patient is fully exposed and log-rolled. A 15-cm bruise is noted across the
upper abdomen with a seatbelt sign. The next priority is:
A. Apply warm blankets and move to CT scan.
B. Document the finding and continue assessment.
C. Obtain abdominal CT with contrast.
D. Perform a FAST exam if not already done.
Correct Answer: D
Rationale: Seatbelt sign is a marker for intra-abdominal injury; FAST assesses for free fluid and guides
further imaging or intervention.
TNCC Reference: Seatbelt sign increases risk of bowel/mesenteric injury; FAST is indicated in secondary
survey.
7. [Pediatric Trauma]
A 3-year-old child is brought in after a motor vehicle collision. Weight 14 kg, HR 160, RR 40, BP 70/40.
The estimated blood volume is approximately:
A. 800 mL
B. 1,000 mL
C. 1,120 mL
D. 1,400 mL
