TNCC 9th Edition Final Exam Review 2026 – Comprehensive
Trauma Nursing Core Course Study Guide with Questions,
Answers & Rationales for Emergency Nursing Certification
Trauma & Emergency Nursing Comprehensive Exam
1.
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 Answer: C. Notify the physician
Rationale: Clear drainage from the ear after head trauma may indicate cerebrospinal fluid (CSF)
leakage from a basilar skull fracture. The ear should not be packed or manipulated. Immediate
physician notification is required for further evaluation and management.
2.
A patient is brought to the emergency department of a rural hospital following a high-speed
motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary
survey, what is the 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 Answer: A. Initiate transfer to a trauma center
Rationale: Significant abdominal and pelvic injuries require definitive trauma care that may
,exceed rural hospital capabilities. Early transfer to a trauma center improves outcomes and
reduces morbidity and mortality.
3.
An adult who fell from a second story roof is brought to the emergency department by private
vehicle. The patient is confused with unlabored respirations and has strong, palpable radial
pulses. There is an open wound in proximity to an obvious deformity of the left lower extremity.
What is the 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 Answer: A. Initiate cervical spine stabilization
Rationale: Any patient with a significant mechanism of injury (fall from height) must be
assumed to have a cervical spine injury until proven otherwise. Spinal stabilization is the priority
to prevent secondary neurologic injury.
4.
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.
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.
Correct Answer: A. Decrease the rate of manual ventilation.
Rationale: A PaCO₂ of 30 mm Hg indicates hyperventilation, which causes cerebral
vasoconstriction and reduces cerebral blood flow. Decreasing the ventilation rate will normalize
CO₂ and improve cerebral perfusion.
5.
,An adult patient is brought to the emergency department following a vehicle "roll-over" with
prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh and a
weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa)
Correct Answer: B. Application of a pelvic binder
Rationale: Mechanism of injury and proximal thigh findings suggest possible pelvic fracture
with internal hemorrhage. A pelvic binder stabilizes the pelvis and reduces bleeding. This is an
immediate life-saving intervention.
6.
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
Correct Answer: B. Amputation of a limb
Rationale: Functional grief occurs when a person experiences loss of physical function or body
part, such as an amputation. It involves grieving the loss of ability or bodily integrity.
7.
What is the most important consideration during the initial assessment when caring for an older
adult who has sustained serious injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician
Correct Answer: B. Medical history including current medications
Rationale: Older adults often have multiple comorbidities and take medications (e.g.,
anticoagulants, beta-blockers) that significantly impact trauma assessment, bleeding risk, and
treatment decisions.
, 8.
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 Answer: C. Notify the physician
Rationale: Clear drainage following head trauma may indicate a CSF leak from a basilar skull
fracture. The ear should not be irrigated or packed. Immediate medical evaluation is required.
9.
When should the definitive calculation for intravenous fluid resuscitation rate be performed for a
patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment
Correct Answer: B. After removal of clothing
Rationale: Accurate calculation of fluid resuscitation (e.g., using the Parkland formula) requires
precise estimation of total body surface area burned. Clothing must be removed to perform a
thorough assessment.
10.
In a motor vehicle collision, which injury pathway is most likely to increase the patient's
morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover
Trauma Nursing Core Course Study Guide with Questions,
Answers & Rationales for Emergency Nursing Certification
Trauma & Emergency Nursing Comprehensive Exam
1.
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 Answer: C. Notify the physician
Rationale: Clear drainage from the ear after head trauma may indicate cerebrospinal fluid (CSF)
leakage from a basilar skull fracture. The ear should not be packed or manipulated. Immediate
physician notification is required for further evaluation and management.
2.
A patient is brought to the emergency department of a rural hospital following a high-speed
motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary
survey, what is the 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 Answer: A. Initiate transfer to a trauma center
Rationale: Significant abdominal and pelvic injuries require definitive trauma care that may
,exceed rural hospital capabilities. Early transfer to a trauma center improves outcomes and
reduces morbidity and mortality.
3.
An adult who fell from a second story roof is brought to the emergency department by private
vehicle. The patient is confused with unlabored respirations and has strong, palpable radial
pulses. There is an open wound in proximity to an obvious deformity of the left lower extremity.
What is the 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 Answer: A. Initiate cervical spine stabilization
Rationale: Any patient with a significant mechanism of injury (fall from height) must be
assumed to have a cervical spine injury until proven otherwise. Spinal stabilization is the priority
to prevent secondary neurologic injury.
4.
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.
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.
Correct Answer: A. Decrease the rate of manual ventilation.
Rationale: A PaCO₂ of 30 mm Hg indicates hyperventilation, which causes cerebral
vasoconstriction and reduces cerebral blood flow. Decreasing the ventilation rate will normalize
CO₂ and improve cerebral perfusion.
5.
,An adult patient is brought to the emergency department following a vehicle "roll-over" with
prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh and a
weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa)
Correct Answer: B. Application of a pelvic binder
Rationale: Mechanism of injury and proximal thigh findings suggest possible pelvic fracture
with internal hemorrhage. A pelvic binder stabilizes the pelvis and reduces bleeding. This is an
immediate life-saving intervention.
6.
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
Correct Answer: B. Amputation of a limb
Rationale: Functional grief occurs when a person experiences loss of physical function or body
part, such as an amputation. It involves grieving the loss of ability or bodily integrity.
7.
What is the most important consideration during the initial assessment when caring for an older
adult who has sustained serious injuries?
A. They are likely to be fearful in the emergency department
B. Medical history including current medications
C. Availability of support systems after discharge
D. Accessibility to a primary care physician
Correct Answer: B. Medical history including current medications
Rationale: Older adults often have multiple comorbidities and take medications (e.g.,
anticoagulants, beta-blockers) that significantly impact trauma assessment, bleeding risk, and
treatment decisions.
, 8.
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 Answer: C. Notify the physician
Rationale: Clear drainage following head trauma may indicate a CSF leak from a basilar skull
fracture. The ear should not be irrigated or packed. Immediate medical evaluation is required.
9.
When should the definitive calculation for intravenous fluid resuscitation rate be performed for a
patient with burns?
A. As soon as the patient arrives
B. After removal of clothing
C. Only at a burn center
D. During the circulation assessment
Correct Answer: B. After removal of clothing
Rationale: Accurate calculation of fluid resuscitation (e.g., using the Parkland formula) requires
precise estimation of total body surface area burned. Clothing must be removed to perform a
thorough assessment.
10.
In a motor vehicle collision, which injury pathway is most likely to increase the patient's
morbidity and mortality?
A. Rotational
B. Ejection
C. Lateral
D. Rollover
