TNCC 9th Edition High-Yield Practice Quiz . Question and
Answers provided in the end. Graded A+ (2026/2027).
Instant Download PDF.
Question 1: The "Diamond of Death"
During a massive transfusion protocol for a patient with severe pelvic fractures, the nurse
notes a widening QRS complex and prolonged QT interval on the cardiac monitor. Which of
the following lab values represents the newest component of the lethal diamond that
explains these findings?
• A. Ionized Calcium < 1.1 mmol/L
• B. Arterial pH < 7.30
• C. Core temperature < 35°C (95°F)
• D. Platelets < 50,000/mm³
Question 2: Trauma Nursing Process (TNP) Prioritization
A 34-year-old patient arrives following a high-speed motor vehicle collision. They are non-
verbal, moaning, and tracking poorly. According to the updated 9th Edition TNP primary
survey, which action must be performed during the D (Disability) phase before moving to
exposure?
• A. Log-roll the patient to inspect the spine.
• B. Check a fingerstick blood glucose level.
• C. Obtain a fast-scan ultrasound.
• D. Calculate the full Injury Severity Score (ISS).
Question 3: Airway Management & Positioning
An obese trauma patient arrives in severe respiratory distress after an industrial crush injury.
To optimize airway patency, chest excursion, and functional residual capacity while
maintaining spinal precautions, the nurse should place the patient in which position?
• A. Supine with a pillow under the head
• B. Left lateral recumbent
• C. Reverse Trendelenburg
• D. Prone with head turned to the side
,Question 4: Oxyhemoglobin Dissociation Curve
A hypothermic trauma patient has an adequate $SpO_2$ reading of 98% on room air, but
arterial blood gas analysis shows severe tissue hypoxia and a worsening lactic acidosis. How
does hypothermia affect hemoglobin's relationship with oxygen?
• A. It causes a right shift, making hemoglobin release oxygen too quickly.
• B. It causes a left shift, increasing hemoglobin's affinity for oxygen and preventing
tissue unloading.
• C. It destroys the hemoglobin molecules, rendering them unable to bind oxygen.
• D. It causes an upward shift, increasing the total oxygen-carrying capacity of the
blood.
Question 5: Neurological / Spinal Prioritization
A patient presents with a suspected cervical spinal cord injury at the C4 level following a
diving accident. Which assessment finding represents the highest risk to life and requires
immediate intervention?
• A. Loss of sensation below the nipple line
• B. Bradycardia and hypotension
• C. Diaphragmatic, shallow breathing with an asymmetric chest rise
• D. Priapism
Question 6: Pelvic Trauma Assessment
During the secondary survey, the nurse is assessing a patient who was compressed between
two vehicles. When evaluating the stability of the pelvis, what is the correct technique
according to current guidelines?
• A. Vigorously rock the iliac crests back and forth to check for crepitus.
• B. Apply gentle downward and medial pressure on the iliac crests once.
• C. Apply hard outward lateral pressure to expand the pelvic ring.
• D. Deeply palpate the pubic symphysis manually.
To keep your review moving at high velocity, here is a massive, comprehensive bank of 25
highly dense, high-yield scenario questions modeled directly after the TNCC 9th Edition
curriculum. They are organized sequentially by core trauma systems to ensure you cover
every major testing block without interruption.
Section 1: Airway, Thoracic, and Ventilatory Trauma
,Question 7
A 26-year-old unrestrained driver arrives with severe anterior chest trauma. The nurse notes
paradoxical chest wall movement on the right side, tachypnea, and severe pain. The
patient's oxygen saturation is dropping despite high-flow oxygen. What is the immediate
pathophysiological consequence of this injury?
• A. Widespread alveolar collapse due to a lack of surfactant production.
• B. Decreased vital capacity and increased work of breathing due to a flail segment.
• C. Increased cardiac output due to compensatory sympathetic thoracic squeezing.
• D. Direct transection of the bronchial tree causing an immediate shift of the trachea.
Question 8
A patient presents with a sucking chest wound from a knife injury. The nurse immediately
applies a non-porous dressing taped on three sides. During reassessment, the patient
develops sudden, severe respiratory distress, hypotension, and absence of breath sounds on
the affected side. What is the nurse's immediate next action?
• A. Apply a second, completely occlusive dressing over the first one.
• B. Lift the untaped edge of the dressing to vent accumulated air.
• C. Prepare for immediate endotracheal intubation.
• D. Request a portable chest X-ray to confirm tube placement.
Question 9
An intubated trauma patient experiences a sudden drop in $SpO_2$ from 98% to 84%, along
with asymmetric chest rise and high peak airway pressure alarms on the ventilator. What is
the first assessment step the nurse should take using the classic mnemonic for intubated
distress?
• A. Check for Displacement of the endotracheal tube by assessing tube depth and
bilateral breath sounds.
• B. Immediately administer a neuromuscular blocking agent to treat ventilator
Opposition.
• C. Obtain an immediate arterial blood gas to check for Bicarbonate deficit.
• D. Increase the positive end-expiratory pressure (PEEP) to fix Equipment failure.
Question 10
, A trauma patient with a massive hemothorax has a chest tube inserted. The nurse notes an
initial output of 1,600 mL of dark red blood upon insertion, followed by a continuous output
of 250 mL/hour over the next two hours. What is the priority nursing intervention?
• A. Clamp the chest tube to prevent further rapid volume loss.
• B. Strip the chest tube tubing vigorously to prevent clot obstruction.
• C. Prepare the patient for immediate surgical intervention (thoracotomy).
• D. Slow down the intravenous fluid administration to reduce intrathoracic pressure.
Question 11
A patient presents with blunt chest trauma following an explosion. On examination, the
nurse notes muffled heart sounds, jugular venous distention (JVD), and a narrowing pulse
pressure with persistent hypotension. Which condition do these findings collectively
indicate?
• A. Tension pneumothorax
• B. Cardiac tamponade
• C. Massive hemothorax
• D. Neurogenic shock
Section 2: Shock and Fluid Resuscitation
Question 12
A 45-year-old trauma patient is in profound hemorrhagic shock. The provider orders massive
fluid resuscitation. According to TNCC 9th Edition guidelines, what is the preferred initial
fluid management strategy to avoid trauma-induced coagulopathy?
• A. Aggressive administration of up to 3 liters of cold Normal Saline ($0.9\%\ NC\ell$)
• B. Early administration of balanced blood products (Packed Red Blood Cells, Fresh
Frozen Plasma, and Platelets) in a 1:1:1 ratio
• C. Large-volume infusion of $5\%$ Dextrose in Water to preserve renal function
• D. Rapid infusion of synthetic starches or dextran solutions to expand intravascular
volume
Question 13
A patient in hemorrhagic shock has received 6 units of packed red blood cells over the last
45 minutes. The nurse notes the patient's ionized calcium level has dropped to 0.95 mmol/L.
What is the physiological mechanism causing this drop?
Answers provided in the end. Graded A+ (2026/2027).
Instant Download PDF.
Question 1: The "Diamond of Death"
During a massive transfusion protocol for a patient with severe pelvic fractures, the nurse
notes a widening QRS complex and prolonged QT interval on the cardiac monitor. Which of
the following lab values represents the newest component of the lethal diamond that
explains these findings?
• A. Ionized Calcium < 1.1 mmol/L
• B. Arterial pH < 7.30
• C. Core temperature < 35°C (95°F)
• D. Platelets < 50,000/mm³
Question 2: Trauma Nursing Process (TNP) Prioritization
A 34-year-old patient arrives following a high-speed motor vehicle collision. They are non-
verbal, moaning, and tracking poorly. According to the updated 9th Edition TNP primary
survey, which action must be performed during the D (Disability) phase before moving to
exposure?
• A. Log-roll the patient to inspect the spine.
• B. Check a fingerstick blood glucose level.
• C. Obtain a fast-scan ultrasound.
• D. Calculate the full Injury Severity Score (ISS).
Question 3: Airway Management & Positioning
An obese trauma patient arrives in severe respiratory distress after an industrial crush injury.
To optimize airway patency, chest excursion, and functional residual capacity while
maintaining spinal precautions, the nurse should place the patient in which position?
• A. Supine with a pillow under the head
• B. Left lateral recumbent
• C. Reverse Trendelenburg
• D. Prone with head turned to the side
,Question 4: Oxyhemoglobin Dissociation Curve
A hypothermic trauma patient has an adequate $SpO_2$ reading of 98% on room air, but
arterial blood gas analysis shows severe tissue hypoxia and a worsening lactic acidosis. How
does hypothermia affect hemoglobin's relationship with oxygen?
• A. It causes a right shift, making hemoglobin release oxygen too quickly.
• B. It causes a left shift, increasing hemoglobin's affinity for oxygen and preventing
tissue unloading.
• C. It destroys the hemoglobin molecules, rendering them unable to bind oxygen.
• D. It causes an upward shift, increasing the total oxygen-carrying capacity of the
blood.
Question 5: Neurological / Spinal Prioritization
A patient presents with a suspected cervical spinal cord injury at the C4 level following a
diving accident. Which assessment finding represents the highest risk to life and requires
immediate intervention?
• A. Loss of sensation below the nipple line
• B. Bradycardia and hypotension
• C. Diaphragmatic, shallow breathing with an asymmetric chest rise
• D. Priapism
Question 6: Pelvic Trauma Assessment
During the secondary survey, the nurse is assessing a patient who was compressed between
two vehicles. When evaluating the stability of the pelvis, what is the correct technique
according to current guidelines?
• A. Vigorously rock the iliac crests back and forth to check for crepitus.
• B. Apply gentle downward and medial pressure on the iliac crests once.
• C. Apply hard outward lateral pressure to expand the pelvic ring.
• D. Deeply palpate the pubic symphysis manually.
To keep your review moving at high velocity, here is a massive, comprehensive bank of 25
highly dense, high-yield scenario questions modeled directly after the TNCC 9th Edition
curriculum. They are organized sequentially by core trauma systems to ensure you cover
every major testing block without interruption.
Section 1: Airway, Thoracic, and Ventilatory Trauma
,Question 7
A 26-year-old unrestrained driver arrives with severe anterior chest trauma. The nurse notes
paradoxical chest wall movement on the right side, tachypnea, and severe pain. The
patient's oxygen saturation is dropping despite high-flow oxygen. What is the immediate
pathophysiological consequence of this injury?
• A. Widespread alveolar collapse due to a lack of surfactant production.
• B. Decreased vital capacity and increased work of breathing due to a flail segment.
• C. Increased cardiac output due to compensatory sympathetic thoracic squeezing.
• D. Direct transection of the bronchial tree causing an immediate shift of the trachea.
Question 8
A patient presents with a sucking chest wound from a knife injury. The nurse immediately
applies a non-porous dressing taped on three sides. During reassessment, the patient
develops sudden, severe respiratory distress, hypotension, and absence of breath sounds on
the affected side. What is the nurse's immediate next action?
• A. Apply a second, completely occlusive dressing over the first one.
• B. Lift the untaped edge of the dressing to vent accumulated air.
• C. Prepare for immediate endotracheal intubation.
• D. Request a portable chest X-ray to confirm tube placement.
Question 9
An intubated trauma patient experiences a sudden drop in $SpO_2$ from 98% to 84%, along
with asymmetric chest rise and high peak airway pressure alarms on the ventilator. What is
the first assessment step the nurse should take using the classic mnemonic for intubated
distress?
• A. Check for Displacement of the endotracheal tube by assessing tube depth and
bilateral breath sounds.
• B. Immediately administer a neuromuscular blocking agent to treat ventilator
Opposition.
• C. Obtain an immediate arterial blood gas to check for Bicarbonate deficit.
• D. Increase the positive end-expiratory pressure (PEEP) to fix Equipment failure.
Question 10
, A trauma patient with a massive hemothorax has a chest tube inserted. The nurse notes an
initial output of 1,600 mL of dark red blood upon insertion, followed by a continuous output
of 250 mL/hour over the next two hours. What is the priority nursing intervention?
• A. Clamp the chest tube to prevent further rapid volume loss.
• B. Strip the chest tube tubing vigorously to prevent clot obstruction.
• C. Prepare the patient for immediate surgical intervention (thoracotomy).
• D. Slow down the intravenous fluid administration to reduce intrathoracic pressure.
Question 11
A patient presents with blunt chest trauma following an explosion. On examination, the
nurse notes muffled heart sounds, jugular venous distention (JVD), and a narrowing pulse
pressure with persistent hypotension. Which condition do these findings collectively
indicate?
• A. Tension pneumothorax
• B. Cardiac tamponade
• C. Massive hemothorax
• D. Neurogenic shock
Section 2: Shock and Fluid Resuscitation
Question 12
A 45-year-old trauma patient is in profound hemorrhagic shock. The provider orders massive
fluid resuscitation. According to TNCC 9th Edition guidelines, what is the preferred initial
fluid management strategy to avoid trauma-induced coagulopathy?
• A. Aggressive administration of up to 3 liters of cold Normal Saline ($0.9\%\ NC\ell$)
• B. Early administration of balanced blood products (Packed Red Blood Cells, Fresh
Frozen Plasma, and Platelets) in a 1:1:1 ratio
• C. Large-volume infusion of $5\%$ Dextrose in Water to preserve renal function
• D. Rapid infusion of synthetic starches or dextran solutions to expand intravascular
volume
Question 13
A patient in hemorrhagic shock has received 6 units of packed red blood cells over the last
45 minutes. The nurse notes the patient's ionized calcium level has dropped to 0.95 mmol/L.
What is the physiological mechanism causing this drop?
