TNCC 9th Edition Final Actual Exam| A
Review of 500+ Real Past Exam Questions
and Correct Verified Answers With Detailed
Clinical Rationales| Document Replicates the
Actual Exam Format (Newest Version
2026/2027)
1. An older adult presents to the emergency department with com- plaints
of dizziness, headache, and nausea. The patient was involved in a
motor vehicle collision 10 days ago. There was no loss of
consciousness and a hematoma is noted to the forehead. The patient is
currently on anticoagulant therapy. What is most likely the cause of
their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
C. Diffuse axonal injury
D. Post-concussive syndrome: ANS D. Post-concussive syndrome
Rationale: Special Populations\Older Adult
Post-concussive syndrome can occur days to weeks after injury or
trauma. The other three conditions present as a more rapid decline,
especially in patients who are on anticoagulants.
2. Your patient was the unrestrained driver involved in a moderate
speed
motor vehicle collision. Assessment reveals tenderness in the upper
right quadrant, crepitus in the lower right ribs, and ecchymosis around
, the
umbilicus. The nurse is concerned about injury to which organ?
A. Transverse colon
B. Pancreas
C. Liver
D. Spleen: ANS C. Liver
Rationale: Head and Torso Trauma\Abdominal and Pelvic Trauma
Liver injuries are associated with right, lower rib fractures. They also
can present with tenderness, guarding, or rigidity in the right upper
quadrant, along with ecchymosis of the right upper quadrant or around
the umbilicus, known as Cullen's sign
3. A 35-year-old male presents with facial trauma after being struck
in the face with a baseball. A teardrop-shaped left pupil is noted on
exam. What type of injury is suspected?
A. Oculomotor nerve palsy
B. Globe rupture
C. Retrobulbar hematoma
D. Retinal detachment: ANS B. Globe rupture
Rationale: Head and Torso Trauma\Head Trauma
The globe of the eye consists of multiple layers. The sclera is the
white outer layer, while the cornea covers the iris and pupil. When a
full thickness injury occurs to the cornea, sclera, or both, the globe
will rupture, causing the shape of the pupil to become irregular or
teardrop-shaped
4. 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: ANS B. After removal of
clothing
Rationale: Musculoskeletal and Wounds\Burns
Some fluid will be given initially, but an accurate fluid total is based
on percentage of total body surface area which requires a good skin
assessment and is calculated after clothing is removed.
5. A patient with a lower extremity fracture complains of severe pain
and tightness in his calf, minimally relieved by pain medications.
Which of the following is the priority nursing intervention?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg: ANS C. Elevating
the leg to the level of the heart
Rationale: Musculoskeletal and Wounds\Musculoskeletal
This patient is exhibiting signs of possible compartment syndrome
which is a dangerous complication of fractured extremities. The pain
is often out of proportion to the injury and might not respond to pain
medications. Elevate the limb to the level of the heart to decrease
dependent edema but not above the heart, which can cause increased
venous congestion and pressure within the compartment.
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: ANS B. Amputation of a limb
Rationale: Preparation and Ongoing Care\Psychosocial Aspects
Functional grief relates to the loss of body function or body parts such
as amputation of a limb, paralysis, or loss of sight.
7.A patient with a traumatic brain injury has a mean arterial pressure
(MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of
22 mm Hg (2.93 kPa). Which finding is most likely an indication of
the body's response to these findings?
A. Increased respiratory effort
B. Widening pulse pressure
C. Reflex tachycardia
D. Reflex hypotension: ANS B. Widening pulse pressure
Rationale: Head and Torso Trauma\Head Trauma
This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8 kPa)
which is associated with poor outcomes. When the CPP falls below
normal levels, the central nervous system initiates the Cushing
response in an attempt to increase mean arterial pressure and improve
CPP. Cushing response assessment findings include widening pulse
pressure, reflex bradycardia, and irregular, decreased respiratory
effort.
8. A severely injured patient has been intubated and is being
mechanically ventilated. The patient has received a balanced
resuscitation including multiple blood products. Under which
circumstance will it be harder for the hemoglobin to release oxygen
to the tissues?
A. Decreased pH
Review of 500+ Real Past Exam Questions
and Correct Verified Answers With Detailed
Clinical Rationales| Document Replicates the
Actual Exam Format (Newest Version
2026/2027)
1. An older adult presents to the emergency department with com- plaints
of dizziness, headache, and nausea. The patient was involved in a
motor vehicle collision 10 days ago. There was no loss of
consciousness and a hematoma is noted to the forehead. The patient is
currently on anticoagulant therapy. What is most likely the cause of
their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
C. Diffuse axonal injury
D. Post-concussive syndrome: ANS D. Post-concussive syndrome
Rationale: Special Populations\Older Adult
Post-concussive syndrome can occur days to weeks after injury or
trauma. The other three conditions present as a more rapid decline,
especially in patients who are on anticoagulants.
2. Your patient was the unrestrained driver involved in a moderate
speed
motor vehicle collision. Assessment reveals tenderness in the upper
right quadrant, crepitus in the lower right ribs, and ecchymosis around
, the
umbilicus. The nurse is concerned about injury to which organ?
A. Transverse colon
B. Pancreas
C. Liver
D. Spleen: ANS C. Liver
Rationale: Head and Torso Trauma\Abdominal and Pelvic Trauma
Liver injuries are associated with right, lower rib fractures. They also
can present with tenderness, guarding, or rigidity in the right upper
quadrant, along with ecchymosis of the right upper quadrant or around
the umbilicus, known as Cullen's sign
3. A 35-year-old male presents with facial trauma after being struck
in the face with a baseball. A teardrop-shaped left pupil is noted on
exam. What type of injury is suspected?
A. Oculomotor nerve palsy
B. Globe rupture
C. Retrobulbar hematoma
D. Retinal detachment: ANS B. Globe rupture
Rationale: Head and Torso Trauma\Head Trauma
The globe of the eye consists of multiple layers. The sclera is the
white outer layer, while the cornea covers the iris and pupil. When a
full thickness injury occurs to the cornea, sclera, or both, the globe
will rupture, causing the shape of the pupil to become irregular or
teardrop-shaped
4. 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: ANS B. After removal of
clothing
Rationale: Musculoskeletal and Wounds\Burns
Some fluid will be given initially, but an accurate fluid total is based
on percentage of total body surface area which requires a good skin
assessment and is calculated after clothing is removed.
5. A patient with a lower extremity fracture complains of severe pain
and tightness in his calf, minimally relieved by pain medications.
Which of the following is the priority nursing intervention?
A. Elevating the leg above the level of the heart
B. Repositioning the leg and applying ice
C. Elevating the leg to the level of the heart
D. Preparing the patient for ultrasound of the leg: ANS C. Elevating
the leg to the level of the heart
Rationale: Musculoskeletal and Wounds\Musculoskeletal
This patient is exhibiting signs of possible compartment syndrome
which is a dangerous complication of fractured extremities. The pain
is often out of proportion to the injury and might not respond to pain
medications. Elevate the limb to the level of the heart to decrease
dependent edema but not above the heart, which can cause increased
venous congestion and pressure within the compartment.
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: ANS B. Amputation of a limb
Rationale: Preparation and Ongoing Care\Psychosocial Aspects
Functional grief relates to the loss of body function or body parts such
as amputation of a limb, paralysis, or loss of sight.
7.A patient with a traumatic brain injury has a mean arterial pressure
(MAP) of 65 mm Hg (8.66 kPa) and an intracranial pressure (ICP) of
22 mm Hg (2.93 kPa). Which finding is most likely an indication of
the body's response to these findings?
A. Increased respiratory effort
B. Widening pulse pressure
C. Reflex tachycardia
D. Reflex hypotension: ANS B. Widening pulse pressure
Rationale: Head and Torso Trauma\Head Trauma
This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8 kPa)
which is associated with poor outcomes. When the CPP falls below
normal levels, the central nervous system initiates the Cushing
response in an attempt to increase mean arterial pressure and improve
CPP. Cushing response assessment findings include widening pulse
pressure, reflex bradycardia, and irregular, decreased respiratory
effort.
8. A severely injured patient has been intubated and is being
mechanically ventilated. The patient has received a balanced
resuscitation including multiple blood products. Under which
circumstance will it be harder for the hemoglobin to release oxygen
to the tissues?
A. Decreased pH
