TNCC 9TH EDITION FINAL TEST 2025 QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027
Section One: Questions 1–100
A patient arrives in the emergency department following a high-velocity motor vehicle crash.
Utilizing the Trauma Nursing Process (TNP), which of the following is the first assessment step
performed during the primary survey?
A. Assess for airway patency while protecting the cervical spine
B. Evaluate structural alignment of the pelvis
C. Inspect for external signs of major hemorrhage
D. Assess the patient's level of consciousness via GCS
🟢 C. Inspect for external signs of major hemorrhage
🔴 RATIONALE: The TNP prioritizes "uncontrolled hemorrhage" under the updated MARCH/CABC
paradigm before airway management, as catastrophic bleeding can lead to exsanguination rapidly.
A 42-year-old male is brought to the trauma bay after falling 20 feet from a ladder. He is
unresponsive with snoring respirations. What is the immediate priority intervention for this patient's
airway management?
A. Perform a surgical cricothyroidotomy
B. Insert a nasopharyngeal airway
C. Perform a jaw-thrust maneuver while maintaining manual cervical spine stabilization
D. Insert an oropharyngeal airway without stabilizing the neck
🟢 C. Perform a jaw-thrust maneuver while maintaining manual cervical spine stabilization
🔴 RATIONALE: A jaw-thrust maneuver opens the airway of an unconscious trauma patient
without mobilizing the cervical spine, mitigating the risk of worsening a potential spinal cord injury.
Which of the following parameters provides the most sensitive early clinical indicator of
hemorrhagic shock in an injured pediatric patient?
,A. Decreased systolic blood pressure
B. Narrowing pulse pressure and persistent tachycardia
C. Scleral icterus
D. Decreased skin turgor
🟢 B. Narrowing pulse pressure and persistent tachycardia
🔴 RATIONALE: Pediatric patients can compensate for blood loss effectively by increasing
systemic vascular resistance and heart rate, making a narrowing pulse pressure and persistent
tachycardia critical early warning signs before hypotension occurs.
A trauma patient presents with muffled heart tones, jugular venous distention, and hypotension.
The nurse recognizes these clinical findings as classic signs of which life-threatening condition?
A. Tension pneumothorax
B. Massive hemothorax
C. Cardiac tamponade
D. Neurogenic shock
🟢 C. Cardiac tamponade
🔴 RATIONALE: These three signs comprise Beck's triad, which indicates fluid accumulation in the
pericardial sac, preventing adequate cardiac filling and leading to obstructive shock.
During the secondary survey of a patient with blunt chest trauma, the nurse notes paradoxical
chest wall movement on the right side. Which underlying injury does this clinical presentation
suggest?
A. Flail chest
B. Simple pneumothorax
C. Diaphragmatic rupture
D. Pulmonary contusion
🟢 A. Flail chest
,🔴 RATIONALE: Flail chest occurs when two or more adjacent ribs are fractured in two or more
places, causing the detached segment of the chest wall to move paradoxically (inward during
inspiration, outward during expiration).
A 28-year-old pregnant patient at 32 weeks' gestation arrives after an assault. To prevent supine
hypotensive syndrome during evaluation, how should the nurse position the patient?
A. Placed in a Trendelenburg position
B. Placed in a prone position
C. Placed flat on her back with legs elevated
D. Tilted to the left side or supported with a wedge under the right hip
🟢 D. Tilted to the left side or supported with a wedge under the right hip
🔴 RATIONALE: Displacing the uterus to the left relieves pressure on the inferior vena cava,
optimizing venous return and maintaining adequate cardiac output for both mother and fetus.
A patient sustained a deep laceration to the right thigh with bright red, spurting blood. Direct
pressure has failed to halt the hemorrhage. What is the next most appropriate action?
A. Apply a tourniquet proximal to the injury site
B. Elevate the extremity above the level of the heart
C. Apply a pressure dressing over the damp gauze
D. Pack the wound with plain sterile gauze
🟢 A. Apply a tourniquet proximal to the injury site
🔴 RATIONALE: When direct pressure cannot control life-threatening arterial extremity
hemorrhage, a commercial tourniquet should be applied rapidly and proximally to stem the blood
loss.
A patient presents with a severe traumatic brain injury. The nurse notes an elevated blood pressure
with a widening pulse pressure, bradycardia, and irregular respirations. This constellation of signs
is known as:
, A. Virchow's triad
B. Cushing's triad
C. Beck's triad
D. Horner's syndrome
🟢 B. Cushing's triad
🔴 RATIONALE: Cushing's triad indicates significantly elevated intracranial pressure and
impending brain herniation, requiring immediate neurosurgical and medical intervention.
An adult patient sustains full-thickness burns to the anterior trunk and the entire right arm. Using
the Rule of Nines, what is the estimated Total Body Surface Area (TBSA) burned?
A. 18 percent
B. 27 percent
C. 36 percent
D. 45 percent
🟢 B. 27 percent
🔴 RATIONALE: The anterior trunk accounts for 18 percent of TBSA, and the entire right arm
accounts for 9 percent. Summing these yields 27 percent.
A patient involved in an explosion presents with severe ear pain, tinnitus, and hearing loss. The
nurse recognizes that these symptoms are characteristic of which type of blast injury mechanism?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary
🟢 A. Primary
🔴 RATIONALE: Primary blast injuries result directly from the environmental overpressure wave
generated by the explosion, commonly damaging gas-filled structures like the tympanic membrane.
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027
Section One: Questions 1–100
A patient arrives in the emergency department following a high-velocity motor vehicle crash.
Utilizing the Trauma Nursing Process (TNP), which of the following is the first assessment step
performed during the primary survey?
A. Assess for airway patency while protecting the cervical spine
B. Evaluate structural alignment of the pelvis
C. Inspect for external signs of major hemorrhage
D. Assess the patient's level of consciousness via GCS
🟢 C. Inspect for external signs of major hemorrhage
🔴 RATIONALE: The TNP prioritizes "uncontrolled hemorrhage" under the updated MARCH/CABC
paradigm before airway management, as catastrophic bleeding can lead to exsanguination rapidly.
A 42-year-old male is brought to the trauma bay after falling 20 feet from a ladder. He is
unresponsive with snoring respirations. What is the immediate priority intervention for this patient's
airway management?
A. Perform a surgical cricothyroidotomy
B. Insert a nasopharyngeal airway
C. Perform a jaw-thrust maneuver while maintaining manual cervical spine stabilization
D. Insert an oropharyngeal airway without stabilizing the neck
🟢 C. Perform a jaw-thrust maneuver while maintaining manual cervical spine stabilization
🔴 RATIONALE: A jaw-thrust maneuver opens the airway of an unconscious trauma patient
without mobilizing the cervical spine, mitigating the risk of worsening a potential spinal cord injury.
Which of the following parameters provides the most sensitive early clinical indicator of
hemorrhagic shock in an injured pediatric patient?
,A. Decreased systolic blood pressure
B. Narrowing pulse pressure and persistent tachycardia
C. Scleral icterus
D. Decreased skin turgor
🟢 B. Narrowing pulse pressure and persistent tachycardia
🔴 RATIONALE: Pediatric patients can compensate for blood loss effectively by increasing
systemic vascular resistance and heart rate, making a narrowing pulse pressure and persistent
tachycardia critical early warning signs before hypotension occurs.
A trauma patient presents with muffled heart tones, jugular venous distention, and hypotension.
The nurse recognizes these clinical findings as classic signs of which life-threatening condition?
A. Tension pneumothorax
B. Massive hemothorax
C. Cardiac tamponade
D. Neurogenic shock
🟢 C. Cardiac tamponade
🔴 RATIONALE: These three signs comprise Beck's triad, which indicates fluid accumulation in the
pericardial sac, preventing adequate cardiac filling and leading to obstructive shock.
During the secondary survey of a patient with blunt chest trauma, the nurse notes paradoxical
chest wall movement on the right side. Which underlying injury does this clinical presentation
suggest?
A. Flail chest
B. Simple pneumothorax
C. Diaphragmatic rupture
D. Pulmonary contusion
🟢 A. Flail chest
,🔴 RATIONALE: Flail chest occurs when two or more adjacent ribs are fractured in two or more
places, causing the detached segment of the chest wall to move paradoxically (inward during
inspiration, outward during expiration).
A 28-year-old pregnant patient at 32 weeks' gestation arrives after an assault. To prevent supine
hypotensive syndrome during evaluation, how should the nurse position the patient?
A. Placed in a Trendelenburg position
B. Placed in a prone position
C. Placed flat on her back with legs elevated
D. Tilted to the left side or supported with a wedge under the right hip
🟢 D. Tilted to the left side or supported with a wedge under the right hip
🔴 RATIONALE: Displacing the uterus to the left relieves pressure on the inferior vena cava,
optimizing venous return and maintaining adequate cardiac output for both mother and fetus.
A patient sustained a deep laceration to the right thigh with bright red, spurting blood. Direct
pressure has failed to halt the hemorrhage. What is the next most appropriate action?
A. Apply a tourniquet proximal to the injury site
B. Elevate the extremity above the level of the heart
C. Apply a pressure dressing over the damp gauze
D. Pack the wound with plain sterile gauze
🟢 A. Apply a tourniquet proximal to the injury site
🔴 RATIONALE: When direct pressure cannot control life-threatening arterial extremity
hemorrhage, a commercial tourniquet should be applied rapidly and proximally to stem the blood
loss.
A patient presents with a severe traumatic brain injury. The nurse notes an elevated blood pressure
with a widening pulse pressure, bradycardia, and irregular respirations. This constellation of signs
is known as:
, A. Virchow's triad
B. Cushing's triad
C. Beck's triad
D. Horner's syndrome
🟢 B. Cushing's triad
🔴 RATIONALE: Cushing's triad indicates significantly elevated intracranial pressure and
impending brain herniation, requiring immediate neurosurgical and medical intervention.
An adult patient sustains full-thickness burns to the anterior trunk and the entire right arm. Using
the Rule of Nines, what is the estimated Total Body Surface Area (TBSA) burned?
A. 18 percent
B. 27 percent
C. 36 percent
D. 45 percent
🟢 B. 27 percent
🔴 RATIONALE: The anterior trunk accounts for 18 percent of TBSA, and the entire right arm
accounts for 9 percent. Summing these yields 27 percent.
A patient involved in an explosion presents with severe ear pain, tinnitus, and hearing loss. The
nurse recognizes that these symptoms are characteristic of which type of blast injury mechanism?
A. Primary
B. Secondary
C. Tertiary
D. Quaternary
🟢 A. Primary
🔴 RATIONALE: Primary blast injuries result directly from the environmental overpressure wave
generated by the explosion, commonly damaging gas-filled structures like the tympanic membrane.
