TNCC 9th Edition Final Exam 2026 | 134 Real Questions with
Correct Answers & Detailed Rationales | Complete TNCC Test
Bank & Study Guide
**.** You are caring for a patient who was thrown from a bike and was not
wearing a helmet. While performing the head-to-toe assessment, you note clear
drainage from the right ear. Which of the following is the most appropriate next
step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. **Notify the physician**
D. Document and continue the exam.
**Correct: C**
**Rationale:** Clear fluid = possible CSF otorrhea from basilar skull fracture.
Never clean/pack/suction. Immediate physician notification for imaging &
neurosurgery.
**.** A patient is brought to a rural ED following high-speed MVC with
significant abdominal and pelvic injuries noted in primary survey. Priority
intervention?
A. **Initiate transfer to a trauma center**
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
,**Correct: A**
**Rationale:** Rural facility lacks immediate OR/interventional radiology for
life-threatening hemorrhage → early transfer is priority.
**3.** Adult fell from second-story roof, confused, open wound near obvious left
lower extremity deformity. Priority intervention?
A. **Initiate cervical spine stabilization**
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen
D. Log roll the patient onto a spine board
**Correct: A**
**Rationale:** High-fall mechanism + altered LOC = presumed C-spine injury
until cleared. Manual inline stabilization is part of primary survey.
**.** Severe head trauma, intubated, manual ventilation 18 breaths/min,
PaCO₂ 30 mm Hg, SpO₂ 92%. Most important intervention to manage cerebral
blood flow?
A. **Decrease the rate of manual ventilation**
B. Initiate another fluid bolus
C. Recheck endotracheal tube placement
D. Increase the amount of oxygen delivered
**Correct: A**
**Rationale:** Hypocapnia (PaCO₂ 30) causes cerebral vasoconstriction → ↓
CBF. Target 35–45 mm Hg in TBI.
, **5.** Rollover MVC with prolonged extrication, swelling/bruising right
proximal thigh, weak pedal pulse, pale/cool/moist skin. Most appropriate initial
intervention?
A. Tourniquet
B. **Application of a pelvic binder**
C. Fluid resuscitation to UO 0.5 mL/kg/h
D. Oxygen to ETCO₂ 30-35 mm Hg
**Correct: B**
**Rationale:** Signs of unstable pelvic fracture with retroperitoneal bleed.
Binder reduces volume & tamponades bleeding.
**6.** Which situation 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
**Correct: B**
**Rationale:** Functional grief = loss of body function or body part (amputation,
paralysis, blindness).
**7.** Most important consideration during initial assessment of older adult with
serious injuries?
A. They are likely to be fearful
B. **Medical history including current medications**
C. Availability of support systems after discharge
D. Accessibility to primary care physician
Correct Answers & Detailed Rationales | Complete TNCC Test
Bank & Study Guide
**.** You are caring for a patient who was thrown from a bike and was not
wearing a helmet. While performing the head-to-toe assessment, you note clear
drainage from the right ear. Which of the following is the most appropriate next
step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. **Notify the physician**
D. Document and continue the exam.
**Correct: C**
**Rationale:** Clear fluid = possible CSF otorrhea from basilar skull fracture.
Never clean/pack/suction. Immediate physician notification for imaging &
neurosurgery.
**.** A patient is brought to a rural ED following high-speed MVC with
significant abdominal and pelvic injuries noted in primary survey. Priority
intervention?
A. **Initiate transfer to a trauma center**
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
,**Correct: A**
**Rationale:** Rural facility lacks immediate OR/interventional radiology for
life-threatening hemorrhage → early transfer is priority.
**3.** Adult fell from second-story roof, confused, open wound near obvious left
lower extremity deformity. Priority intervention?
A. **Initiate cervical spine stabilization**
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen
D. Log roll the patient onto a spine board
**Correct: A**
**Rationale:** High-fall mechanism + altered LOC = presumed C-spine injury
until cleared. Manual inline stabilization is part of primary survey.
**.** Severe head trauma, intubated, manual ventilation 18 breaths/min,
PaCO₂ 30 mm Hg, SpO₂ 92%. Most important intervention to manage cerebral
blood flow?
A. **Decrease the rate of manual ventilation**
B. Initiate another fluid bolus
C. Recheck endotracheal tube placement
D. Increase the amount of oxygen delivered
**Correct: A**
**Rationale:** Hypocapnia (PaCO₂ 30) causes cerebral vasoconstriction → ↓
CBF. Target 35–45 mm Hg in TBI.
, **5.** Rollover MVC with prolonged extrication, swelling/bruising right
proximal thigh, weak pedal pulse, pale/cool/moist skin. Most appropriate initial
intervention?
A. Tourniquet
B. **Application of a pelvic binder**
C. Fluid resuscitation to UO 0.5 mL/kg/h
D. Oxygen to ETCO₂ 30-35 mm Hg
**Correct: B**
**Rationale:** Signs of unstable pelvic fracture with retroperitoneal bleed.
Binder reduces volume & tamponades bleeding.
**6.** Which situation 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
**Correct: B**
**Rationale:** Functional grief = loss of body function or body part (amputation,
paralysis, blindness).
**7.** Most important consideration during initial assessment of older adult with
serious injuries?
A. They are likely to be fearful
B. **Medical history including current medications**
C. Availability of support systems after discharge
D. Accessibility to primary care physician
