TNCC 9th Edition Final Exam Actual Exam 2026/2027: Complete
Exam-Style Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Trauma Nursing Core Concepts & Initial Assessment | Q1 – Q20
Section 2 | Head, Neck & Spinal Trauma | Q21 – Q40
Section 3 | Thoracic & Abdominal Trauma | Q41 – Q60
Section 4 | Musculoskeletal & Burn Trauma | Q61 – Q80
Section 5 | Special Populations, Shock & Transfer Considerations | Q81 – Q100
Instructions: Choose the single best answer. Pass: 80% in 120 minutes.
══════════════════════════════════════
SECTION 1: TRAUMA NURSING CORE CONCEPTS & INITIAL ASSESSMENT Q1 – Q20
══════════════════════════════════════
Question 1 of 100
A 24-year-old unrestrained driver is brought to the ED after a high-speed head-on
collision. The triage nurse notes he is ambulatory at the scene with a systolic BP of 110
mmHg and a respiratory rate of 24. Using the CDC Field Triage Decision Scheme, which
finding most strongly supports transport to a trauma center?
A. He is 24 years old and was involved in a motor vehicle crash
B. His systolic blood pressure is 110 mmHg ✓ CORRECT
C. He was able to ambulate at the scene without assistance
D. His respiratory rate of 24 breaths per minute
Correct Answer: B
Rationale: A systolic blood pressure below 90 mmHg in adults meets Step One
physiologic criteria for transport to the highest-level trauma center, and a pressure of
110 is approaching that threshold closely enough to warrant concern in a
high-mechanism crash. Ambulation at the scene and a mildly elevated respiratory rate
,do not independently override the hemodynamic concern. In practice, triage nurses
often over-rely on patient mobility and miss early shock; a pressure under 120 with a
concerning mechanism should prompt trauma center evaluation.
Question 2 of 100
During the primary survey of a 56-year-old construction worker who fell 20 feet from
scaffolding, the team leader asks you to apply the principles of XABCDE. You note
severe active bleeding from a groin laceration. What is the immediate priority before
addressing the airway?
A. Obtain large-bore IV access and begin crystalloid infusion
B. Apply a tourniquet proximal to the groin wound
C. Apply direct pressure or a hemostatic dressing to control exsanguination ✓
CORRECT
D. Prepare for rapid sequence intubation to protect the airway
Correct Answer: C
Rationale: The "X" in XABCDE stands for exsanguination, and uncontrolled hemorrhage
must be addressed before airway management because the patient will not survive
intubation if they bleed out during the procedure. Tourniquets are ineffective for
proximal groin injuries, and crystalloids do not replace immediate mechanical
hemorrhage control. This sequencing reflects the TNCC emphasis on stopping
life-threatening bleeding as the absolute first step.
Question 3 of 100
A trauma patient arrives via EMS with a Glasgow Coma Scale score of 13, a systolic BP
of 100 mmHg, and a respiratory rate of 30. The charge nurse is assigning acuity using
the Revised Trauma Score. Which component contributes most heavily to lowering this
patient's overall RTS?
,A. The respiratory rate of 30 ✓ CORRECT
B. The systolic blood pressure of 100
C. The Glasgow Coma Scale score of 13
D. The patient's age, which is not yet known
Correct Answer: A
Rationale: In the Revised Trauma Score, the respiratory rate is coded on a steep scale
where rates above 29 receive only 1 point, making it the most heavily weighted
decrement in this patient. A GCS of 13 still codes to 4 points and a systolic of 100
codes to 3 points, so neither drags the total score down as aggressively as the
respiratory value. Age is factored into the Trauma and Injury Severity Score, not the RTS
itself.
Question 4 of 100
You are caring for a 34-year-old motorcyclist who struck a guardrail at 45 mph. He is
alert but complains of chest and abdominal pain. His vital signs are stable. When
obtaining the history, which question best helps the nurse understand the mechanism of
injury and predict injury patterns?
A. "Did you lose consciousness at any point during the crash?"
B. "What speed were you traveling and were you thrown from the motorcycle?" ✓
CORRECT
C. "Do you have any medical problems or take blood thinners?"
D. "Were you wearing a helmet that met Department of Transportation standards?"
Correct Answer: B
Rationale: Understanding the velocity, the rider's relationship to the motorcycle at
impact, and whether ejection occurred directly predicts patterns such as femur
fractures, pelvic injuries, and solid-organ damage from handlebar impact. Loss of
consciousness and helmet use are important but secondary to the physics of the crash
when predicting specific injury patterns. Past medical history matters for overall
management but does not illuminate kinematics.
, Question 5 of 100
A 67-year-old patient on warfarin for atrial fibrillation slips on ice and strikes her head.
She arrives ambulatory and neurologically intact. The triage nurse is considering
whether to activate the trauma team. Which factor is most likely to be under-triaged in
older adults with ground-level falls?
A. The risk of intracranial hemorrhage due to anticoagulation ✓ CORRECT
B. The potential for cervical spine fracture from hyperextension
C. The likelihood of distal radius fracture from landing on outstretched hands
D. The possibility of hip fracture from direct lateral impact
Correct Answer: A
Rationale: Older adults on anticoagulants who sustain even minor head trauma are at
substantial risk for delayed intracranial bleeding, and this population is frequently
under-triaged because they appear well initially. Hip and wrist fractures are common
and usually recognized, while cervical spine injury from simple falls is less common
than intracranial hemorrhage in anticoagulated patients. Trauma centers should have a
low threshold for head CT and trauma team activation in this scenario.
Question 6 of 100
During a mass casualty incident, the triage officer tags a 42-year-old patient yellow after
noting a closed femur fracture and stable vitals. A few minutes later, the patient
becomes confused and his radial pulse weakens. What is the most appropriate action?
A. Re-triage the patient to green and continue monitoring
B. Re-triage the patient to red and move him to immediate treatment ✓ CORRECT
C. Re-triage the patient to black and allocate resources elsewhere
D. Keep the patient yellow because his initial injuries were non-life-threatening
Correct Answer: B
Exam-Style Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Trauma Nursing Core Concepts & Initial Assessment | Q1 – Q20
Section 2 | Head, Neck & Spinal Trauma | Q21 – Q40
Section 3 | Thoracic & Abdominal Trauma | Q41 – Q60
Section 4 | Musculoskeletal & Burn Trauma | Q61 – Q80
Section 5 | Special Populations, Shock & Transfer Considerations | Q81 – Q100
Instructions: Choose the single best answer. Pass: 80% in 120 minutes.
══════════════════════════════════════
SECTION 1: TRAUMA NURSING CORE CONCEPTS & INITIAL ASSESSMENT Q1 – Q20
══════════════════════════════════════
Question 1 of 100
A 24-year-old unrestrained driver is brought to the ED after a high-speed head-on
collision. The triage nurse notes he is ambulatory at the scene with a systolic BP of 110
mmHg and a respiratory rate of 24. Using the CDC Field Triage Decision Scheme, which
finding most strongly supports transport to a trauma center?
A. He is 24 years old and was involved in a motor vehicle crash
B. His systolic blood pressure is 110 mmHg ✓ CORRECT
C. He was able to ambulate at the scene without assistance
D. His respiratory rate of 24 breaths per minute
Correct Answer: B
Rationale: A systolic blood pressure below 90 mmHg in adults meets Step One
physiologic criteria for transport to the highest-level trauma center, and a pressure of
110 is approaching that threshold closely enough to warrant concern in a
high-mechanism crash. Ambulation at the scene and a mildly elevated respiratory rate
,do not independently override the hemodynamic concern. In practice, triage nurses
often over-rely on patient mobility and miss early shock; a pressure under 120 with a
concerning mechanism should prompt trauma center evaluation.
Question 2 of 100
During the primary survey of a 56-year-old construction worker who fell 20 feet from
scaffolding, the team leader asks you to apply the principles of XABCDE. You note
severe active bleeding from a groin laceration. What is the immediate priority before
addressing the airway?
A. Obtain large-bore IV access and begin crystalloid infusion
B. Apply a tourniquet proximal to the groin wound
C. Apply direct pressure or a hemostatic dressing to control exsanguination ✓
CORRECT
D. Prepare for rapid sequence intubation to protect the airway
Correct Answer: C
Rationale: The "X" in XABCDE stands for exsanguination, and uncontrolled hemorrhage
must be addressed before airway management because the patient will not survive
intubation if they bleed out during the procedure. Tourniquets are ineffective for
proximal groin injuries, and crystalloids do not replace immediate mechanical
hemorrhage control. This sequencing reflects the TNCC emphasis on stopping
life-threatening bleeding as the absolute first step.
Question 3 of 100
A trauma patient arrives via EMS with a Glasgow Coma Scale score of 13, a systolic BP
of 100 mmHg, and a respiratory rate of 30. The charge nurse is assigning acuity using
the Revised Trauma Score. Which component contributes most heavily to lowering this
patient's overall RTS?
,A. The respiratory rate of 30 ✓ CORRECT
B. The systolic blood pressure of 100
C. The Glasgow Coma Scale score of 13
D. The patient's age, which is not yet known
Correct Answer: A
Rationale: In the Revised Trauma Score, the respiratory rate is coded on a steep scale
where rates above 29 receive only 1 point, making it the most heavily weighted
decrement in this patient. A GCS of 13 still codes to 4 points and a systolic of 100
codes to 3 points, so neither drags the total score down as aggressively as the
respiratory value. Age is factored into the Trauma and Injury Severity Score, not the RTS
itself.
Question 4 of 100
You are caring for a 34-year-old motorcyclist who struck a guardrail at 45 mph. He is
alert but complains of chest and abdominal pain. His vital signs are stable. When
obtaining the history, which question best helps the nurse understand the mechanism of
injury and predict injury patterns?
A. "Did you lose consciousness at any point during the crash?"
B. "What speed were you traveling and were you thrown from the motorcycle?" ✓
CORRECT
C. "Do you have any medical problems or take blood thinners?"
D. "Were you wearing a helmet that met Department of Transportation standards?"
Correct Answer: B
Rationale: Understanding the velocity, the rider's relationship to the motorcycle at
impact, and whether ejection occurred directly predicts patterns such as femur
fractures, pelvic injuries, and solid-organ damage from handlebar impact. Loss of
consciousness and helmet use are important but secondary to the physics of the crash
when predicting specific injury patterns. Past medical history matters for overall
management but does not illuminate kinematics.
, Question 5 of 100
A 67-year-old patient on warfarin for atrial fibrillation slips on ice and strikes her head.
She arrives ambulatory and neurologically intact. The triage nurse is considering
whether to activate the trauma team. Which factor is most likely to be under-triaged in
older adults with ground-level falls?
A. The risk of intracranial hemorrhage due to anticoagulation ✓ CORRECT
B. The potential for cervical spine fracture from hyperextension
C. The likelihood of distal radius fracture from landing on outstretched hands
D. The possibility of hip fracture from direct lateral impact
Correct Answer: A
Rationale: Older adults on anticoagulants who sustain even minor head trauma are at
substantial risk for delayed intracranial bleeding, and this population is frequently
under-triaged because they appear well initially. Hip and wrist fractures are common
and usually recognized, while cervical spine injury from simple falls is less common
than intracranial hemorrhage in anticoagulated patients. Trauma centers should have a
low threshold for head CT and trauma team activation in this scenario.
Question 6 of 100
During a mass casualty incident, the triage officer tags a 42-year-old patient yellow after
noting a closed femur fracture and stable vitals. A few minutes later, the patient
becomes confused and his radial pulse weakens. What is the most appropriate action?
A. Re-triage the patient to green and continue monitoring
B. Re-triage the patient to red and move him to immediate treatment ✓ CORRECT
C. Re-triage the patient to black and allocate resources elsewhere
D. Keep the patient yellow because his initial injuries were non-life-threatening
Correct Answer: B
