TNCC 9th Edition Final Exam Questions
and Answers with Rationales Latest
Versions
Question 1
A trauma patient arrives after a high-speed motor vehicle collision. The patient is
restless, has a respiratory rate of 30/min, and has an oxygen saturation of 89% on
room air. What is the nurse's priority action?
A. Obtain a complete health history
B. Apply supplemental oxygen and assess the airway
C. Insert a urinary catheter
D. Obtain a detailed neurologic history
Correct Answer: B. Apply supplemental oxygen and assess the airway
Rationale:
The initial trauma assessment follows the principles of identifying and treating
immediate life threats. Hypoxemia and respiratory distress require immediate
attention. Airway and breathing must be rapidly assessed while providing
appropriate oxygenation. A detailed history and urinary catheterization can occur
after immediate threats are addressed.
Question 2
During the primary survey, a trauma patient suddenly develops absent breath
sounds on the left side, severe respiratory distress, hypotension, and distended neck
veins. Which condition should the nurse suspect?
A. Hemothorax
B. Simple pneumothorax
C. Tension pneumothorax
D. Pulmonary contusion
Correct Answer: C. Tension pneumothorax
,Rationale:
Tension pneumothorax causes increasing intrathoracic pressure, resulting in lung
compression and impaired venous return. Classic findings include severe
respiratory distress, unilateral absent breath sounds, hypotension, and potentially
jugular venous distention. This is an immediately life-threatening condition
requiring rapid intervention.
Question 3
A trauma patient has a Glasgow Coma Scale (GCS) score of 7. Which
interpretation is most appropriate?
A. Mild traumatic brain injury
B. Moderate traumatic brain injury
C. Severe traumatic brain injury
D. Normal neurologic function
Correct Answer: C. Severe traumatic brain injury
Rationale:
A GCS score of 8 or less indicates severe impairment of consciousness and raises
major concerns regarding the patient's ability to protect the airway. A score of 9–
12 is generally considered moderate, while 13–15 represents mild traumatic brain
injury.
Question 4
A patient with blunt chest trauma has paradoxical movement of a section of the
chest wall during inspiration and expiration. Which injury does the nurse suspect?
A. Cardiac tamponade
B. Flail chest
C. Tension pneumothorax
D. Aortic rupture
Correct Answer: B. Flail chest
Rationale:
Flail chest occurs when multiple adjacent ribs are fractured in multiple locations,
,producing a free-floating segment of the chest wall. The affected segment moves
paradoxically—often inward during inspiration and outward during expiration.
Pulmonary contusion frequently accompanies flail chest and can significantly
impair oxygenation.
Question 5
A patient with suspected cervical spine injury requires airway management. Which
technique is preferred when opening the airway?
A. Head-tilt/chin-lift
B. Jaw-thrust maneuver
C. Neck hyperextension
D. Head rotation
Correct Answer: B. Jaw-thrust maneuver
Rationale:
When cervical spine injury is suspected, excessive neck movement should be
avoided. The jaw-thrust maneuver helps open the airway while minimizing
cervical spine movement. Manual cervical stabilization should be maintained as
appropriate.
Question 6
A trauma patient is pale, cool, and diaphoretic. Heart rate is 132/min, blood
pressure is 82/48 mm Hg, and capillary refill is delayed. Which condition is most
likely?
A. Neurogenic shock
B. Hemorrhagic shock
C. Spinal shock
D. Cardiogenic shock
Correct Answer: B. Hemorrhagic shock
Rationale:
Tachycardia, hypotension, cool clammy skin, and delayed capillary refill are
, classic manifestations of inadequate circulating volume, commonly caused by
hemorrhage in trauma. Rapid identification and control of bleeding are critical.
Question 7
Which finding is most concerning for an expanding intracranial injury?
A. Mild headache
B. Increasing level of consciousness
C. Unilateral dilated and nonreactive pupil
D. Heart rate of 88/min
Correct Answer: C. Unilateral dilated and nonreactive pupil
Rationale:
A unilateral dilated, nonreactive pupil can indicate compression of cranial nerve III
and increasing intracranial pressure, potentially associated with cerebral herniation.
This requires immediate recognition and intervention.
Question 8
A trauma patient has an open chest wound that produces a sucking sound during
inspiration. What is the nurse's priority intervention?
A. Remove any visible foreign object
B. Apply an appropriate occlusive dressing
C. Place the patient in Trendelenburg position
D. Encourage deep breathing
Correct Answer: B. Apply an appropriate occlusive dressing
Rationale:
An open pneumothorax allows air to enter the pleural space through the chest wall
defect. Covering the wound with an appropriate occlusive dressing helps limit
further air entry while allowing appropriate management of the pleural injury. The
patient must be closely monitored for development of tension physiology.
and Answers with Rationales Latest
Versions
Question 1
A trauma patient arrives after a high-speed motor vehicle collision. The patient is
restless, has a respiratory rate of 30/min, and has an oxygen saturation of 89% on
room air. What is the nurse's priority action?
A. Obtain a complete health history
B. Apply supplemental oxygen and assess the airway
C. Insert a urinary catheter
D. Obtain a detailed neurologic history
Correct Answer: B. Apply supplemental oxygen and assess the airway
Rationale:
The initial trauma assessment follows the principles of identifying and treating
immediate life threats. Hypoxemia and respiratory distress require immediate
attention. Airway and breathing must be rapidly assessed while providing
appropriate oxygenation. A detailed history and urinary catheterization can occur
after immediate threats are addressed.
Question 2
During the primary survey, a trauma patient suddenly develops absent breath
sounds on the left side, severe respiratory distress, hypotension, and distended neck
veins. Which condition should the nurse suspect?
A. Hemothorax
B. Simple pneumothorax
C. Tension pneumothorax
D. Pulmonary contusion
Correct Answer: C. Tension pneumothorax
,Rationale:
Tension pneumothorax causes increasing intrathoracic pressure, resulting in lung
compression and impaired venous return. Classic findings include severe
respiratory distress, unilateral absent breath sounds, hypotension, and potentially
jugular venous distention. This is an immediately life-threatening condition
requiring rapid intervention.
Question 3
A trauma patient has a Glasgow Coma Scale (GCS) score of 7. Which
interpretation is most appropriate?
A. Mild traumatic brain injury
B. Moderate traumatic brain injury
C. Severe traumatic brain injury
D. Normal neurologic function
Correct Answer: C. Severe traumatic brain injury
Rationale:
A GCS score of 8 or less indicates severe impairment of consciousness and raises
major concerns regarding the patient's ability to protect the airway. A score of 9–
12 is generally considered moderate, while 13–15 represents mild traumatic brain
injury.
Question 4
A patient with blunt chest trauma has paradoxical movement of a section of the
chest wall during inspiration and expiration. Which injury does the nurse suspect?
A. Cardiac tamponade
B. Flail chest
C. Tension pneumothorax
D. Aortic rupture
Correct Answer: B. Flail chest
Rationale:
Flail chest occurs when multiple adjacent ribs are fractured in multiple locations,
,producing a free-floating segment of the chest wall. The affected segment moves
paradoxically—often inward during inspiration and outward during expiration.
Pulmonary contusion frequently accompanies flail chest and can significantly
impair oxygenation.
Question 5
A patient with suspected cervical spine injury requires airway management. Which
technique is preferred when opening the airway?
A. Head-tilt/chin-lift
B. Jaw-thrust maneuver
C. Neck hyperextension
D. Head rotation
Correct Answer: B. Jaw-thrust maneuver
Rationale:
When cervical spine injury is suspected, excessive neck movement should be
avoided. The jaw-thrust maneuver helps open the airway while minimizing
cervical spine movement. Manual cervical stabilization should be maintained as
appropriate.
Question 6
A trauma patient is pale, cool, and diaphoretic. Heart rate is 132/min, blood
pressure is 82/48 mm Hg, and capillary refill is delayed. Which condition is most
likely?
A. Neurogenic shock
B. Hemorrhagic shock
C. Spinal shock
D. Cardiogenic shock
Correct Answer: B. Hemorrhagic shock
Rationale:
Tachycardia, hypotension, cool clammy skin, and delayed capillary refill are
, classic manifestations of inadequate circulating volume, commonly caused by
hemorrhage in trauma. Rapid identification and control of bleeding are critical.
Question 7
Which finding is most concerning for an expanding intracranial injury?
A. Mild headache
B. Increasing level of consciousness
C. Unilateral dilated and nonreactive pupil
D. Heart rate of 88/min
Correct Answer: C. Unilateral dilated and nonreactive pupil
Rationale:
A unilateral dilated, nonreactive pupil can indicate compression of cranial nerve III
and increasing intracranial pressure, potentially associated with cerebral herniation.
This requires immediate recognition and intervention.
Question 8
A trauma patient has an open chest wound that produces a sucking sound during
inspiration. What is the nurse's priority intervention?
A. Remove any visible foreign object
B. Apply an appropriate occlusive dressing
C. Place the patient in Trendelenburg position
D. Encourage deep breathing
Correct Answer: B. Apply an appropriate occlusive dressing
Rationale:
An open pneumothorax allows air to enter the pleural space through the chest wall
defect. Covering the wound with an appropriate occlusive dressing helps limit
further air entry while allowing appropriate management of the pleural injury. The
patient must be closely monitored for development of tension physiology.
