TNCC FINAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST
1. A 25-year-old male presents after a motor vehicle collision. He is alert, oriented,
with a BP of 90/60 mmHg, HR 132 bpm, RR 28/min. Which is the priority
intervention?
A. Administer IV fluids
B. Obtain a detailed history
C. Perform a focused physical exam
D. Apply oxygen via nasal cannula
Answer: A. Administer IV fluids
Rationale: Hypotension and tachycardia indicate shock. Immediate fluid
resuscitation takes priority to maintain perfusion before completing the secondary
assessment.
2. Which finding most accurately indicates adequate tissue perfusion in a trauma
patient?
A. Capillary refill < 2 seconds
B. Urine output of 30 mL/hr
C. SBP > 100 mmHg
D. HR < 100 bpm
Answer: B. Urine output of 30 mL/hr
Rationale: Urine output is a sensitive indicator of renal perfusion and overall
tissue perfusion, especially in trauma patients.
,3. A trauma patient has unequal breath sounds after blunt chest trauma. What is the
most likely cause?
A. Pneumothorax
B. Hemothorax
C. Pulmonary contusion
D. Myocardial contusion
Answer: A. Pneumothorax
Rationale: Unequal or absent breath sounds are classic for pneumothorax;
hemothorax may also reduce breath sounds but usually presents with dullness to
percussion.
4. During the primary survey, the "C" in ABCDE stands for:
A. Catheter placement
B. Circulation with hemorrhage control
C. Cervical spine protection
D. Chest assessment
Answer: B. Circulation with hemorrhage control
Rationale: "C" emphasizes assessing circulation and controlling life-threatening
bleeding, a key step in TNCC primary survey.
5. Which is a sign of increased intracranial pressure (ICP)?
A. Hypotension
B. Bradycardia with hypertension
C. Tachypnea
D. Tachycardia
Answer: B. Bradycardia with hypertension
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
indicates elevated ICP and impending brain herniation.
,6. A patient with a penetrating abdominal injury presents with evisceration. What
is the priority intervention?
A. Cover with a dry sterile dressing
B. Reduce the organs into the abdomen
C. Cover with a moist sterile dressing
D. Apply direct pressure
Answer: C. Cover with a moist sterile dressing
Rationale: Moist sterile dressing prevents contamination and protects exposed
organs. Do not attempt reduction in the field or ED before surgical intervention.
7. Which type of shock is most likely in a patient with a spinal cord injury at T6?
A. Hypovolemic
B. Cardiogenic
C. Neurogenic
D. Septic
Answer: C. Neurogenic
Rationale: Spinal cord injuries can cause loss of sympathetic tone, leading to
hypotension and bradycardia characteristic of neurogenic shock.
8. Which finding suggests tension pneumothorax in a trauma patient?
A. Equal breath sounds, hypotension
B. Tracheal deviation, hypotension, absent breath sounds on one side
C. Bradycardia, hypertension
D. Diffuse crackles in both lungs
Answer: B. Tracheal deviation, hypotension, absent breath sounds on one side
Rationale: Tension pneumothorax causes mediastinal shift (tracheal deviation),
hypotension, and absent breath sounds—requires immediate needle
decompression.
, 9. The most appropriate fluid for initial resuscitation in hemorrhagic shock is:
A. 0.9% normal saline
B. Dextrose 5% in water
C. Lactated Ringer’s solution
D. Albumin 5%
Answer: C. Lactated Ringer’s solution
Rationale: Lactated Ringer’s is isotonic, effective for volume resuscitation, and
preferred in trauma over D5W, which is hypotonic.
10. Which of the following is the most sensitive indicator of airway
compromise?
A. Stridor
B. Drooling
C. Hoarseness
D. Gurgling
Answer: D. Gurgling
Rationale: Gurgling indicates fluid or blood obstructing the airway and requires
immediate suctioning or advanced airway management.
11. A patient presents with a flail chest. What is the priority intervention?
A. Pain control and oxygen therapy
B. Intubation and mechanical ventilation if needed
C. Apply chest binder
D. Immediate thoracotomy
Answer: B. Intubation and mechanical ventilation if needed
Rationale: Flail chest causes paradoxical chest movement and impaired
oxygenation. Airway support may be required while monitoring oxygenation.
ANSWERS WITH RATIONALES GRADED A+
LATEST
1. A 25-year-old male presents after a motor vehicle collision. He is alert, oriented,
with a BP of 90/60 mmHg, HR 132 bpm, RR 28/min. Which is the priority
intervention?
A. Administer IV fluids
B. Obtain a detailed history
C. Perform a focused physical exam
D. Apply oxygen via nasal cannula
Answer: A. Administer IV fluids
Rationale: Hypotension and tachycardia indicate shock. Immediate fluid
resuscitation takes priority to maintain perfusion before completing the secondary
assessment.
2. Which finding most accurately indicates adequate tissue perfusion in a trauma
patient?
A. Capillary refill < 2 seconds
B. Urine output of 30 mL/hr
C. SBP > 100 mmHg
D. HR < 100 bpm
Answer: B. Urine output of 30 mL/hr
Rationale: Urine output is a sensitive indicator of renal perfusion and overall
tissue perfusion, especially in trauma patients.
,3. A trauma patient has unequal breath sounds after blunt chest trauma. What is the
most likely cause?
A. Pneumothorax
B. Hemothorax
C. Pulmonary contusion
D. Myocardial contusion
Answer: A. Pneumothorax
Rationale: Unequal or absent breath sounds are classic for pneumothorax;
hemothorax may also reduce breath sounds but usually presents with dullness to
percussion.
4. During the primary survey, the "C" in ABCDE stands for:
A. Catheter placement
B. Circulation with hemorrhage control
C. Cervical spine protection
D. Chest assessment
Answer: B. Circulation with hemorrhage control
Rationale: "C" emphasizes assessing circulation and controlling life-threatening
bleeding, a key step in TNCC primary survey.
5. Which is a sign of increased intracranial pressure (ICP)?
A. Hypotension
B. Bradycardia with hypertension
C. Tachypnea
D. Tachycardia
Answer: B. Bradycardia with hypertension
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
indicates elevated ICP and impending brain herniation.
,6. A patient with a penetrating abdominal injury presents with evisceration. What
is the priority intervention?
A. Cover with a dry sterile dressing
B. Reduce the organs into the abdomen
C. Cover with a moist sterile dressing
D. Apply direct pressure
Answer: C. Cover with a moist sterile dressing
Rationale: Moist sterile dressing prevents contamination and protects exposed
organs. Do not attempt reduction in the field or ED before surgical intervention.
7. Which type of shock is most likely in a patient with a spinal cord injury at T6?
A. Hypovolemic
B. Cardiogenic
C. Neurogenic
D. Septic
Answer: C. Neurogenic
Rationale: Spinal cord injuries can cause loss of sympathetic tone, leading to
hypotension and bradycardia characteristic of neurogenic shock.
8. Which finding suggests tension pneumothorax in a trauma patient?
A. Equal breath sounds, hypotension
B. Tracheal deviation, hypotension, absent breath sounds on one side
C. Bradycardia, hypertension
D. Diffuse crackles in both lungs
Answer: B. Tracheal deviation, hypotension, absent breath sounds on one side
Rationale: Tension pneumothorax causes mediastinal shift (tracheal deviation),
hypotension, and absent breath sounds—requires immediate needle
decompression.
, 9. The most appropriate fluid for initial resuscitation in hemorrhagic shock is:
A. 0.9% normal saline
B. Dextrose 5% in water
C. Lactated Ringer’s solution
D. Albumin 5%
Answer: C. Lactated Ringer’s solution
Rationale: Lactated Ringer’s is isotonic, effective for volume resuscitation, and
preferred in trauma over D5W, which is hypotonic.
10. Which of the following is the most sensitive indicator of airway
compromise?
A. Stridor
B. Drooling
C. Hoarseness
D. Gurgling
Answer: D. Gurgling
Rationale: Gurgling indicates fluid or blood obstructing the airway and requires
immediate suctioning or advanced airway management.
11. A patient presents with a flail chest. What is the priority intervention?
A. Pain control and oxygen therapy
B. Intubation and mechanical ventilation if needed
C. Apply chest binder
D. Immediate thoracotomy
Answer: B. Intubation and mechanical ventilation if needed
Rationale: Flail chest causes paradoxical chest movement and impaired
oxygenation. Airway support may be required while monitoring oxygenation.
