TNCC Exam Test Bank 2 new versions 2026/2027 –
Complete Practice Questions with Rationales &
Answers (9th Edition | Trauma Nursing Core Course)
|Instant pdf download
Covered Topics Include:
- Primary & Secondary Surveys (A-I Trauma Assessment)
- Airway & Definitive Ventilation Management
- Hypovolemic, Shock, & Massive Transfusion Protocols (MTP)
- Neurological & Traumatic Brain Injuries (TBI / GCS / ICP)
- Thoracic, Abdominal, Pelvic, & Orthopedic Trauma
- Burn, Pediatric, Geriatric, & Obstetric Trauma Mechanics
- Damage Control Resuscitation & Damage Control Surgery (DCS)
Section 1: Initial Assessment & Trauma Nursing Process (A–I)
Q1. A trauma patient arrives following a severe rollover motor vehicle collision. The
patient is confused, pale, and has a respiratory rate of 28 breaths/min. What is the
very first step of the Trauma Nursing Process (TNP)?
A) Open the airway using a jaw-thrust maneuver
B) Assess for external uncontrolled hemorrhage
, C) Apply high-flow oxygen via non-rebreather mask
D) Obtain a full set of vital signs
Answer: B
Rationale: Under modern TNCC protocols (incorporating MARCH / C-A-B-C principles),
identifying and controlling across-the-room, life-threatening external hemorrhage precedes
all other assessment steps.
Q2. An intubated trauma patient in the resuscitation bay experiences a sudden drop
in pulse oximetry from 99% to 81% accompanied by high-pressure ventilator alarms.
Using the DOPE mnemonic, what should the nurse assess first?
A) Equipment failure (E)
B) Right mainstem displacement (D)
C) Airway obstruction (O)
D) Tension pneumothorax (P)
Answer: B
Rationale: The DOPE mnemonic stands for Displacement, Obstruction, Pneumothorax, and
Equipment failure. Assessment begins with confirming tube position and depth
(Displacement).
Q3. A pediatric trauma patient presents with snoring respirations after a fall. The
patient has a intact gag reflex. Which airway adjunct is indicated?
A) Oropharyngeal airway (OPA)
B) Nasopharyngeal airway (NPA)
C) Supraglottic airway (LMA)
, D) Endotracheal tube (ETT)
Answer: B
Rationale: An NPA is indicated for patients with a decreased level of consciousness who
retain a gag reflex. OPAs are strictly contraindicated in patients with intact gag reflexes due
to the risk of vomiting and aspiration.
Q4. During the primary survey, a patient presents with stridor, hoarseness, and
subcutaneous emphysema in the neck following blunt neck trauma. What is the
priority intervention?
A) Immediate needle cricothyroidotomy
B) Endotracheal intubation (definitive airway)
C) High-flow oxygen via non-rebreather mask
D) Urgent portable neck X-ray
Answer: B
Rationale: Stridor and hoarseness indicate impending upper airway compromise from direct
airway injury or edema, requiring immediate placement of a definitive airway (ETT) before
complete occlusion occurs.
Q5. When evaluating a patient's breathing (B in the primary survey), the nurse notes
decreased breath sounds on the right side and sub-Q emphysema. What is the
immediate next step?
A) Prepare for immediate chest tube insertion or needle decompression
B) Send the patient to CT scan immediately
C) Administer a beta-agonist nebulizer treatment
, D) Perform a full secondary survey
Answer: A
Rationale: Asymmetric breath sounds combined with subcutaneous emphysema signal a
pneumothorax or tension pneumothorax. Life-threatening breathing problems identified in
the Primary Survey must be intervened upon immediately before moving forward.
Q6. What intervention must be continuously maintained throughout the Primary
Survey for a blunt trauma patient?
A) Manual cervical spine inline stabilization
B) Continuous blood pressure monitoring every 2 minutes
C) Continuous warming via air-blanket
D) Intravenous fluid infusion at 1000 mL/hr
Answer: A
Rationale: Manual inline cervical spine stabilization must be initiated immediately and
maintained continuously until structural spine injury has been ruled out.
Q7. Which parameter measured during the primary survey gives the earliest objective
indication of occult cellular hypoperfusion?
A) Systolic blood pressure
B) Heart rate
C) Serum lactate / Base deficit
D) Urine output
Answer: C
Complete Practice Questions with Rationales &
Answers (9th Edition | Trauma Nursing Core Course)
|Instant pdf download
Covered Topics Include:
- Primary & Secondary Surveys (A-I Trauma Assessment)
- Airway & Definitive Ventilation Management
- Hypovolemic, Shock, & Massive Transfusion Protocols (MTP)
- Neurological & Traumatic Brain Injuries (TBI / GCS / ICP)
- Thoracic, Abdominal, Pelvic, & Orthopedic Trauma
- Burn, Pediatric, Geriatric, & Obstetric Trauma Mechanics
- Damage Control Resuscitation & Damage Control Surgery (DCS)
Section 1: Initial Assessment & Trauma Nursing Process (A–I)
Q1. A trauma patient arrives following a severe rollover motor vehicle collision. The
patient is confused, pale, and has a respiratory rate of 28 breaths/min. What is the
very first step of the Trauma Nursing Process (TNP)?
A) Open the airway using a jaw-thrust maneuver
B) Assess for external uncontrolled hemorrhage
, C) Apply high-flow oxygen via non-rebreather mask
D) Obtain a full set of vital signs
Answer: B
Rationale: Under modern TNCC protocols (incorporating MARCH / C-A-B-C principles),
identifying and controlling across-the-room, life-threatening external hemorrhage precedes
all other assessment steps.
Q2. An intubated trauma patient in the resuscitation bay experiences a sudden drop
in pulse oximetry from 99% to 81% accompanied by high-pressure ventilator alarms.
Using the DOPE mnemonic, what should the nurse assess first?
A) Equipment failure (E)
B) Right mainstem displacement (D)
C) Airway obstruction (O)
D) Tension pneumothorax (P)
Answer: B
Rationale: The DOPE mnemonic stands for Displacement, Obstruction, Pneumothorax, and
Equipment failure. Assessment begins with confirming tube position and depth
(Displacement).
Q3. A pediatric trauma patient presents with snoring respirations after a fall. The
patient has a intact gag reflex. Which airway adjunct is indicated?
A) Oropharyngeal airway (OPA)
B) Nasopharyngeal airway (NPA)
C) Supraglottic airway (LMA)
, D) Endotracheal tube (ETT)
Answer: B
Rationale: An NPA is indicated for patients with a decreased level of consciousness who
retain a gag reflex. OPAs are strictly contraindicated in patients with intact gag reflexes due
to the risk of vomiting and aspiration.
Q4. During the primary survey, a patient presents with stridor, hoarseness, and
subcutaneous emphysema in the neck following blunt neck trauma. What is the
priority intervention?
A) Immediate needle cricothyroidotomy
B) Endotracheal intubation (definitive airway)
C) High-flow oxygen via non-rebreather mask
D) Urgent portable neck X-ray
Answer: B
Rationale: Stridor and hoarseness indicate impending upper airway compromise from direct
airway injury or edema, requiring immediate placement of a definitive airway (ETT) before
complete occlusion occurs.
Q5. When evaluating a patient's breathing (B in the primary survey), the nurse notes
decreased breath sounds on the right side and sub-Q emphysema. What is the
immediate next step?
A) Prepare for immediate chest tube insertion or needle decompression
B) Send the patient to CT scan immediately
C) Administer a beta-agonist nebulizer treatment
, D) Perform a full secondary survey
Answer: A
Rationale: Asymmetric breath sounds combined with subcutaneous emphysema signal a
pneumothorax or tension pneumothorax. Life-threatening breathing problems identified in
the Primary Survey must be intervened upon immediately before moving forward.
Q6. What intervention must be continuously maintained throughout the Primary
Survey for a blunt trauma patient?
A) Manual cervical spine inline stabilization
B) Continuous blood pressure monitoring every 2 minutes
C) Continuous warming via air-blanket
D) Intravenous fluid infusion at 1000 mL/hr
Answer: A
Rationale: Manual inline cervical spine stabilization must be initiated immediately and
maintained continuously until structural spine injury has been ruled out.
Q7. Which parameter measured during the primary survey gives the earliest objective
indication of occult cellular hypoperfusion?
A) Systolic blood pressure
B) Heart rate
C) Serum lactate / Base deficit
D) Urine output
Answer: C
