TNCC 9th Edition Final Exam 2026 | 75 Real Questions with
Correct Answers & Detailed Rationales | Complete TNCC Test
Bank & Study Guide
### **SECTION 1: Secondary Survey & Re-Evaluation Concepts
(Questions 1–25)**
**1.** What does the “J” stand for at the end of the secondary
survey?
**Correct Answer: Just keep evaluating (VIPP)**
**Rationale:** “J” reminds the trauma nurse to continuously re-
evaluate the patient using the VIPP mnemonic to detect deterioration.
**2.** What does VIPP stand for?
**Correct Answer: Vital signs, Injuries/Interventions, Primary survey,
Pain**
**Rationale:** VIPP is the structured re-evaluation framework
performed repeatedly after the secondary survey.
**3.** During the head-to-toe assessment, where would you find
Grey-Turner’s sign?
**Correct Answer: Flank**
**Rationale:** Grey-Turner’s sign = ecchymosis in the flanks,
indicating retroperitoneal hemorrhage (e.g., pelvic or kidney injury).
**4.** During the head-to-toe assessment, where would you find
Cullen’s sign?
**Correct Answer: Umbilicus**
,**Rationale:** Cullen’s sign = periumbilical ecchymosis, associated
with intraperitoneal hemorrhage (especially pancreatic or liver injury).
**5.** What is sometimes deferred at the end of the head-to-toe
assessment?
**Correct Answer: Inspecting posterior surfaces**
**Rationale:** Log-rolling for posterior inspection may be deferred in
unstable patients until spinal clearance or stabilization.
**6.** Antibiotics, consults, head CT, imaging, law enforcement,
mandatory reporting, psychosocial support, social services, splinting,
tetanus, and wound care are all interventions that you do AFTER and
before WHAT?
**Correct Answer: AFTER head-to-toe, BEFORE J (VIPP)**
**Rationale:** These are tertiary survey / adjunct interventions
performed after the full head-to-toe but before ongoing re-evaluation
(J).
**7.** What three items are obtained during the pertinent history
assessment?
**Correct Answer: Medical records, prehospital report, SAMPLE**
**Rationale:** SAMPLE (Symptoms, Allergies, Medications, Past
history, Last oral intake, Events) plus prehospital report and medical
records complete the history.
**8.** What are examples of nonpharmacologic pain measures? (Must
identify at least one during testing)
**Correct Answer: Distraction, family presence, padding bony
prominences, repositioning, splinting, verbal reassurance**
, **Rationale:** Nonpharmacologic interventions are always attempted
first or in conjunction with medications.
**9.** For whom is capnography highly recommended?
**Correct Answer: All patients**
**Rationale:** TNCC recommends continuous waveform capnography
for all intubated patients and strongly for any patient with altered
mental status or respiratory compromise.
**10.** In Step M of “Get Adjuncts,” what else might be indicated
besides cardiac monitor?
**Correct Answer: EKG**
**Rationale:** 12-lead EKG is performed in Step M (Monitoring &
Labs) for patients with chest trauma, dysrhythmias, or suspected
cardiac injury.
**11.** In Step 16 of “Exposure and Environment,” you must name at
least one of these interventions:
**Correct Answer: Blankets, room temperature increase, warmed
fluids, warming lights**
**Rationale:** Prevent hypothermia in all trauma patients (trauma
triad of death).
**12.** At what point PRIOR TO the head-to-toe is the patient
inspected for obvious injuries?
**Correct Answer: In Step 15 of “Exposure and Environment”**
**Rationale:** Full anterior and posterior exposure occurs before the
detailed head-to-toe secondary survey.
Correct Answers & Detailed Rationales | Complete TNCC Test
Bank & Study Guide
### **SECTION 1: Secondary Survey & Re-Evaluation Concepts
(Questions 1–25)**
**1.** What does the “J” stand for at the end of the secondary
survey?
**Correct Answer: Just keep evaluating (VIPP)**
**Rationale:** “J” reminds the trauma nurse to continuously re-
evaluate the patient using the VIPP mnemonic to detect deterioration.
**2.** What does VIPP stand for?
**Correct Answer: Vital signs, Injuries/Interventions, Primary survey,
Pain**
**Rationale:** VIPP is the structured re-evaluation framework
performed repeatedly after the secondary survey.
**3.** During the head-to-toe assessment, where would you find
Grey-Turner’s sign?
**Correct Answer: Flank**
**Rationale:** Grey-Turner’s sign = ecchymosis in the flanks,
indicating retroperitoneal hemorrhage (e.g., pelvic or kidney injury).
**4.** During the head-to-toe assessment, where would you find
Cullen’s sign?
**Correct Answer: Umbilicus**
,**Rationale:** Cullen’s sign = periumbilical ecchymosis, associated
with intraperitoneal hemorrhage (especially pancreatic or liver injury).
**5.** What is sometimes deferred at the end of the head-to-toe
assessment?
**Correct Answer: Inspecting posterior surfaces**
**Rationale:** Log-rolling for posterior inspection may be deferred in
unstable patients until spinal clearance or stabilization.
**6.** Antibiotics, consults, head CT, imaging, law enforcement,
mandatory reporting, psychosocial support, social services, splinting,
tetanus, and wound care are all interventions that you do AFTER and
before WHAT?
**Correct Answer: AFTER head-to-toe, BEFORE J (VIPP)**
**Rationale:** These are tertiary survey / adjunct interventions
performed after the full head-to-toe but before ongoing re-evaluation
(J).
**7.** What three items are obtained during the pertinent history
assessment?
**Correct Answer: Medical records, prehospital report, SAMPLE**
**Rationale:** SAMPLE (Symptoms, Allergies, Medications, Past
history, Last oral intake, Events) plus prehospital report and medical
records complete the history.
**8.** What are examples of nonpharmacologic pain measures? (Must
identify at least one during testing)
**Correct Answer: Distraction, family presence, padding bony
prominences, repositioning, splinting, verbal reassurance**
, **Rationale:** Nonpharmacologic interventions are always attempted
first or in conjunction with medications.
**9.** For whom is capnography highly recommended?
**Correct Answer: All patients**
**Rationale:** TNCC recommends continuous waveform capnography
for all intubated patients and strongly for any patient with altered
mental status or respiratory compromise.
**10.** In Step M of “Get Adjuncts,” what else might be indicated
besides cardiac monitor?
**Correct Answer: EKG**
**Rationale:** 12-lead EKG is performed in Step M (Monitoring &
Labs) for patients with chest trauma, dysrhythmias, or suspected
cardiac injury.
**11.** In Step 16 of “Exposure and Environment,” you must name at
least one of these interventions:
**Correct Answer: Blankets, room temperature increase, warmed
fluids, warming lights**
**Rationale:** Prevent hypothermia in all trauma patients (trauma
triad of death).
**12.** At what point PRIOR TO the head-to-toe is the patient
inspected for obvious injuries?
**Correct Answer: In Step 15 of “Exposure and Environment”**
**Rationale:** Full anterior and posterior exposure occurs before the
detailed head-to-toe secondary survey.
