TNCC Provider Final Actual Exam–
Emergency Nurses Association
(ENA) – 2026/2027 Academic Year –
Verified Questions and Answers for
Professional Trauma Nursing
Candidates
1. You are caring for a patient who was thrown from a bike and was not wearing a
helmet. While performing the head-to-toe assessment, you note clear drainage
from the right ear. Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator
B. Pack the ear with gauze
C. Notify the physician
D. Document and continue the exam
Answer: C. Notify the physician
Rationale: Clear drainage from the ear following head trauma suggests a possible basilar
skull fracture with cerebrospinal fluid (CSF) leak. This requires immediate physician
notification for further evaluation. Do not clean, pack, or insert anything into the ear as
this could introduce infection or cause further injury .
,2. A patient is brought to the emergency department of a rural hospital following
a high-speed motor vehicle collision. When significant abdominal and pelvic
injuries are noted in the primary survey, what is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
Answer: A. Initiate transfer to a trauma center
Rationale: Patients with significant abdominal and pelvic injuries require resources and
surgical capabilities that may not be available at rural facilities. The priority is to initiate
transfer to an appropriate trauma center as soon as possible to ensure definitive care .
3. An adult who fell from a second-story roof is brought to the emergency
department by private vehicle. The patient is confused with unlabored respirations
and has strong, palpable radial pulses. There is an open wound in proximity to an
obvious deformity of the left lower extremity. What is the priority intervention?
A. Initiate cervical spine stabilization
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen
D. Log roll the patient onto a spine board
Answer: A. Initiate cervical spine stabilization
Rationale: The patient's confusion and mechanism of injury (fall from height) indicate
potential cervical spine injury. Cervical spine stabilization is the priority intervention before
,addressing other injuries. The ABCDE approach prioritizes airway with cervical spine
protection first .
4. An adult patient who sustained a severe head trauma has been intubated and is
being manually ventilated via a bag-mask device at a rate of 18 breaths/minute.
The patient has received one intravenous fluid bolus of 500 mL of warmed isotonic
crystalloid solution. The PaCO2 is 30 mm Hg, and the pulse oximetry is 92%. BP is
142/70 mm Hg. What is the most important intervention to manage the cerebral
blood flow?
A. Decrease the rate of manual ventilation
B. Initiate another fluid bolus
C. Recheck endotracheal tube placement
D. Increase the amount of oxygen delivered
Answer: A. Decrease the rate of manual ventilation
Rationale: A PaCO2 of 30 mm Hg indicates hyperventilation, which causes cerebral
vasoconstriction and reduces cerebral blood flow. The target PaCO2 for head-injured
patients is 35-45 mm Hg. Decreasing the ventilation rate will allow PaCO2 to normalize .
5. An adult patient is brought to the emergency department following a vehicle
"roll-over" with prolonged extrication. Assessment reveals swelling and bruising
to the right proximal thigh and a weak pedal pulse. Skin is pale, cool, and moist.
What is the most appropriate initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
, C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg
Answer: B. Application of a pelvic binder
Rationale: The mechanism (roll-over with prolonged extrication), proximal thigh swelling,
and weak distal pulse suggest possible pelvic fracture with retroperitoneal bleeding. A
pelvic binder helps stabilize the pelvis and reduce pelvic volume, which can decrease
hemorrhage. This should be applied early in the resuscitation .
6. A patient arrives with a large metal rod embedded in their left thigh and no
active bleeding. Which intervention is most appropriate for this patient?
A. Remove the rod immediately to assess the wound
B. Cut the rod flush with the skin surface
C. Leave the rod in place and stabilize it
D. Apply a tourniquet above the rod
Answer: C. Leave the rod in place and stabilize it
Rationale: An impaled object should never be removed in the field or emergency
department unless it interferes with airway management or CPR. The object may be
tamponading vascular structures, and removal could precipitate catastrophic hemorrhage.
The object should be stabilized in place .
7. A patient has been diagnosed with an incomplete spinal cord injury at L1. Which
finding would indicate sacral sparing?
Emergency Nurses Association
(ENA) – 2026/2027 Academic Year –
Verified Questions and Answers for
Professional Trauma Nursing
Candidates
1. You are caring for a patient who was thrown from a bike and was not wearing a
helmet. While performing the head-to-toe assessment, you note clear drainage
from the right ear. Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator
B. Pack the ear with gauze
C. Notify the physician
D. Document and continue the exam
Answer: C. Notify the physician
Rationale: Clear drainage from the ear following head trauma suggests a possible basilar
skull fracture with cerebrospinal fluid (CSF) leak. This requires immediate physician
notification for further evaluation. Do not clean, pack, or insert anything into the ear as
this could introduce infection or cause further injury .
,2. A patient is brought to the emergency department of a rural hospital following
a high-speed motor vehicle collision. When significant abdominal and pelvic
injuries are noted in the primary survey, what is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
Answer: A. Initiate transfer to a trauma center
Rationale: Patients with significant abdominal and pelvic injuries require resources and
surgical capabilities that may not be available at rural facilities. The priority is to initiate
transfer to an appropriate trauma center as soon as possible to ensure definitive care .
3. An adult who fell from a second-story roof is brought to the emergency
department by private vehicle. The patient is confused with unlabored respirations
and has strong, palpable radial pulses. There is an open wound in proximity to an
obvious deformity of the left lower extremity. What is the priority intervention?
A. Initiate cervical spine stabilization
B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen
D. Log roll the patient onto a spine board
Answer: A. Initiate cervical spine stabilization
Rationale: The patient's confusion and mechanism of injury (fall from height) indicate
potential cervical spine injury. Cervical spine stabilization is the priority intervention before
,addressing other injuries. The ABCDE approach prioritizes airway with cervical spine
protection first .
4. An adult patient who sustained a severe head trauma has been intubated and is
being manually ventilated via a bag-mask device at a rate of 18 breaths/minute.
The patient has received one intravenous fluid bolus of 500 mL of warmed isotonic
crystalloid solution. The PaCO2 is 30 mm Hg, and the pulse oximetry is 92%. BP is
142/70 mm Hg. What is the most important intervention to manage the cerebral
blood flow?
A. Decrease the rate of manual ventilation
B. Initiate another fluid bolus
C. Recheck endotracheal tube placement
D. Increase the amount of oxygen delivered
Answer: A. Decrease the rate of manual ventilation
Rationale: A PaCO2 of 30 mm Hg indicates hyperventilation, which causes cerebral
vasoconstriction and reduces cerebral blood flow. The target PaCO2 for head-injured
patients is 35-45 mm Hg. Decreasing the ventilation rate will allow PaCO2 to normalize .
5. An adult patient is brought to the emergency department following a vehicle
"roll-over" with prolonged extrication. Assessment reveals swelling and bruising
to the right proximal thigh and a weak pedal pulse. Skin is pale, cool, and moist.
What is the most appropriate initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
, C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg
Answer: B. Application of a pelvic binder
Rationale: The mechanism (roll-over with prolonged extrication), proximal thigh swelling,
and weak distal pulse suggest possible pelvic fracture with retroperitoneal bleeding. A
pelvic binder helps stabilize the pelvis and reduce pelvic volume, which can decrease
hemorrhage. This should be applied early in the resuscitation .
6. A patient arrives with a large metal rod embedded in their left thigh and no
active bleeding. Which intervention is most appropriate for this patient?
A. Remove the rod immediately to assess the wound
B. Cut the rod flush with the skin surface
C. Leave the rod in place and stabilize it
D. Apply a tourniquet above the rod
Answer: C. Leave the rod in place and stabilize it
Rationale: An impaled object should never be removed in the field or emergency
department unless it interferes with airway management or CPR. The object may be
tamponading vascular structures, and removal could precipitate catastrophic hemorrhage.
The object should be stabilized in place .
7. A patient has been diagnosed with an incomplete spinal cord injury at L1. Which
finding would indicate sacral sparing?
