TNCC FINAL EXAM TEST 2026/2027 OPEN BOOK
UPDATED WITH COMPLETE SOLUTION
Why is a measure of serum lactate obtained in the initial assessment of the trauma patient?
A) to measure oxygenation and ventilation
B) to quantify the base deficit for the adequacy of cellular perfusion
C) to gauge end-organ perfusion and tissue hypoxia
D) to determine the underlying cause of shock
Accurate Answer: C
A trauma patient is restless and repeatedly asking "where am I?" vital signs upon arrival were BP
100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital
signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and
symptoms of which stage of shock?
A) compensated
B) Progressive
C) irreversible
D) decompensated
Accurate Answer: A.
An elderly patient with a history of anticoagulant use presents after a fall at home that day. She
denies any loss of consciousness. She has a hematoma to her forehead and complains of
headache, dizziness, and nausea. Which is a most likely cause of her symptoms?
A) epidural hematoma
B) diffuse axonal injury
,C) post-concussive syndrome
D) subdural hematoma
Accurate Answer: D.
EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons
screening guidelines, which assessment finding would prompt the nurse to prepare the patient
for radiologic spine clearance?
A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests of water
D) Smell of alcohol on breath
Accurate Answer: D.
You are treating a 27-year old male in respiratory distress who was involved in a house fire.
Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should
you begin fluid resuscitation?
A) 1000 ml/hr
B) 500 ml/hr
C) 250 ml/hr
D) 125 ml/hr
Accurate Answer: B.
A patient has been in the ED for several hours waiting to be admitted. He sustained multiple rib
fractures and a femur fracture after a fall. He has been awake, alert, and c/o leg pain. His wife
reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless,
with respiratory distress and petechiae to his neck. The patient is exhibiting signs of symptoms
commonly associated with which of the following conditions?
, A) acute lung injury
B) fat embolism
C) PTX
D) pulmonary contusion
Accurate Answer: B.
Which pulse pressure description is an indication of early hypovolemic shock?
A) widened
B) narrowed
C) bounding
D) weak
Accurate Answer: B.
Which of the following considerations is most important when caring for a geriatric trauma
patient?
A) head to to exam
B) medical history
C) incontinence
D) falls
Accurate Answer: B.
Which of the following assessment findings differentiates a tension pneumothorax from a
simple pneumothorax?
A) increased work of breathing
B) unilaterally diminished breath sounds
C) pleuritic chest pain
UPDATED WITH COMPLETE SOLUTION
Why is a measure of serum lactate obtained in the initial assessment of the trauma patient?
A) to measure oxygenation and ventilation
B) to quantify the base deficit for the adequacy of cellular perfusion
C) to gauge end-organ perfusion and tissue hypoxia
D) to determine the underlying cause of shock
Accurate Answer: C
A trauma patient is restless and repeatedly asking "where am I?" vital signs upon arrival were BP
100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital
signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and
symptoms of which stage of shock?
A) compensated
B) Progressive
C) irreversible
D) decompensated
Accurate Answer: A.
An elderly patient with a history of anticoagulant use presents after a fall at home that day. She
denies any loss of consciousness. She has a hematoma to her forehead and complains of
headache, dizziness, and nausea. Which is a most likely cause of her symptoms?
A) epidural hematoma
B) diffuse axonal injury
,C) post-concussive syndrome
D) subdural hematoma
Accurate Answer: D.
EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons
screening guidelines, which assessment finding would prompt the nurse to prepare the patient
for radiologic spine clearance?
A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests of water
D) Smell of alcohol on breath
Accurate Answer: D.
You are treating a 27-year old male in respiratory distress who was involved in a house fire.
Calculating TBSA burned is deferred d/t the need for emergent intubation. At what rate should
you begin fluid resuscitation?
A) 1000 ml/hr
B) 500 ml/hr
C) 250 ml/hr
D) 125 ml/hr
Accurate Answer: B.
A patient has been in the ED for several hours waiting to be admitted. He sustained multiple rib
fractures and a femur fracture after a fall. He has been awake, alert, and c/o leg pain. His wife
reported suddenly becoming anxious and confused. Upon reassessment, the patient is restless,
with respiratory distress and petechiae to his neck. The patient is exhibiting signs of symptoms
commonly associated with which of the following conditions?
, A) acute lung injury
B) fat embolism
C) PTX
D) pulmonary contusion
Accurate Answer: B.
Which pulse pressure description is an indication of early hypovolemic shock?
A) widened
B) narrowed
C) bounding
D) weak
Accurate Answer: B.
Which of the following considerations is most important when caring for a geriatric trauma
patient?
A) head to to exam
B) medical history
C) incontinence
D) falls
Accurate Answer: B.
Which of the following assessment findings differentiates a tension pneumothorax from a
simple pneumothorax?
A) increased work of breathing
B) unilaterally diminished breath sounds
C) pleuritic chest pain
