TNCC 9TH EDITION FINAL EXAM – QUESTIONS AND
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1. A 34-year-old male presents to the emergency department following a high-speed motor
vehicle collision. He is unresponsive, breathing shallowly at 8 breaths per minute, and has
asymmetrical chest wall movement with tracheal deviation to the left. Which of the
following is the most immediate life-saving intervention?
A. Needle decompression of the right chest
B. Rapid sequence intubation with a cuffed endotracheal tube
C. Placement of a bilateral chest tube insertion
D. Initiation of aggressive fluid resuscitation with warmed isotonic crystalloids
Answer: A
Needle decompression of the right chest is the most immediate life-saving intervention because
the patient exhibits classic signs of a tension pneumothorax, including tracheal deviation
away from the affected side, absent breath sounds, and respiratory compromise. This must be
performed prior to intubation if positive pressure ventilation would exacerbate the tension
physiology.
2. A trauma patient arrives via EMS following a motorcycle crash. The nurse notes
ecchymosis over the flank areas, known as Grey Turner sign. This physical examination
finding is most indicative of which of the following injuries?
A. Retroperitoneal hemorrhage
B. Splenic laceration
C. Mesenteric ischemia
D. Bladder rupture
Answer: A
Grey Turner sign, characterized by flank ecchymosis, indicates retroperitoneal hemorrhage,
which can result from severe renal, pancreatic, or pelvic vascular injuries. It typically
manifests several hours after the initial trauma event as blood dissects into the retroperitoneal
tissue planes.
3. During the primary survey of an adult female with polytrauma, the nurse identifies an
open fracture of the right femur with active arterial bleeding. What is the immediate
priority action?
A. Apply a commercially manufactured tourniquet proximal to the bleeding site
,B. Irrigate the wound with sterile normal saline and pack with gauze
C. Elevate the affected extremity above the level of the heart
D. Administer a weight-based intravenous analgesic bolus
Answer: A
Applying a tourniquet proximal to the site of severe extremity hemorrhage is the primary
intervention for life-threatening extremity bleeding that cannot be controlled with direct
pressure, effectively occluding arterial blood flow and preventing exsanguination.
4. A 45-year-old construction worker falls 15 feet from scaffolding. He is alert and oriented,
complaining of severe mid-back pain. His lower extremities are cool, and he lacks sensation
below the T10 dermatome. What is the appropriate initial immobilization protocol?
A. Rigid spinal motion restriction using a cervical collar and a flat rigid backboard
B. Immediate removal from the backboard to prevent pressure ulcer formation
C. Log-rolling the patient onto a soft mattress without a cervical collar
D. Encouraging independent ambulation after ruling out gross motor deficits
Answer: A
Rigid spinal motion restriction utilizing a properly fitted cervical collar and a flat rigid
backboard is necessary in the acute phase for patients with a suspected unstable spinal injury,
neurologic deficits, and a reliable mechanism of injury until spinal clearance protocols are
executed.
5. A trauma nurse is performing the secondary survey on a 28-year-old driver involved in a
frontal collision. The steering wheel is bent. The patient complains of shortness of breath
and substernal chest pain. A friction rub is auscultated. Which condition should the nurse
suspect?
A. Myocardial contusion
B. Cardiac tamponade
C. Aortic rupture
D. Esophageal perforation
Answer: A
A myocardial contusion often results from direct blunt anterior chest trauma, such as impact
against a steering wheel. It manifests with substernal chest pain, EKG abnormalities, and
occasionally a friction rub, mimicking an acute myocardial infarction.
6. An elderly pedestrian is struck by a car and brought to the trauma center. Vital signs:
BP 80/50 mm Hg, HR 120 beats/min, RR 26 breaths/min. The patient is confused and pale.
What classification of shock is primarily responsible for these findings?
, A. Hypovolemic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Septic shock
Answer: A
Hypovolemic shock is characterized by inadequate circulating blood volume, leading to
hypotension, tachycardia, tachypnea, and altered mental status resulting from cellular
hypoperfusion and diminished preload following trauma.
7. A 60-year-old male is admitted after an industrial explosion. He has full-thickness burns
to his face, neck, and anterior torso, along with soot in his oropharynx and hoarseness.
What is the most critical immediate concern?
A. Impending upper airway obstruction
B. Fluid volume deficit from evaporative losses
C. Secondary systemic bacterial infection
D. Hypothermia due to loss of skin barrier
Answer: A
Impending upper airway obstruction is the primary and most immediate concern in patients
with facial and neck burns, inhalation injury, and soot in the oropharynx, necessitating early
definitive airway management before edema completely closes the airway.
8. Which of the following assessment findings is most characteristic of cardiac tamponade
resulting from penetrating chest trauma?
A. Beck triad consisting of hypotension, muffled heart sounds, and distended neck veins
B. Hypertension, bounding peripheral pulses, and a wide pulse pressure
C. Tracheal deviation, absent breath sounds, and hyperresonance to percussion
D. Paradoxical chest wall movement with flail segment and severe pain
Answer: A
Beck triad, comprising hypotension, muffled heart sounds, and distended neck veins, is the
classic presentation of cardiac tamponade, caused by blood accumulating in the pericardial
sac and restricting ventricular filling.
9. A 22-year-old female presents after a suicide attempt by ingestion of an unknown
quantity of tricyclic antidepressants. She is somnolent, with a GCS of 10. What is the
primary focus of nursing management during the initial resuscitation phase?
A. Continuous cardiac monitoring for dysrhythmias and wide QRS intervals
B. Immediate administration of oral activated charcoal without airway protection
ANSWERS | VERIFIED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM
PREP | STUDY GUIDE | PRACTICE TEST
1. A 34-year-old male presents to the emergency department following a high-speed motor
vehicle collision. He is unresponsive, breathing shallowly at 8 breaths per minute, and has
asymmetrical chest wall movement with tracheal deviation to the left. Which of the
following is the most immediate life-saving intervention?
A. Needle decompression of the right chest
B. Rapid sequence intubation with a cuffed endotracheal tube
C. Placement of a bilateral chest tube insertion
D. Initiation of aggressive fluid resuscitation with warmed isotonic crystalloids
Answer: A
Needle decompression of the right chest is the most immediate life-saving intervention because
the patient exhibits classic signs of a tension pneumothorax, including tracheal deviation
away from the affected side, absent breath sounds, and respiratory compromise. This must be
performed prior to intubation if positive pressure ventilation would exacerbate the tension
physiology.
2. A trauma patient arrives via EMS following a motorcycle crash. The nurse notes
ecchymosis over the flank areas, known as Grey Turner sign. This physical examination
finding is most indicative of which of the following injuries?
A. Retroperitoneal hemorrhage
B. Splenic laceration
C. Mesenteric ischemia
D. Bladder rupture
Answer: A
Grey Turner sign, characterized by flank ecchymosis, indicates retroperitoneal hemorrhage,
which can result from severe renal, pancreatic, or pelvic vascular injuries. It typically
manifests several hours after the initial trauma event as blood dissects into the retroperitoneal
tissue planes.
3. During the primary survey of an adult female with polytrauma, the nurse identifies an
open fracture of the right femur with active arterial bleeding. What is the immediate
priority action?
A. Apply a commercially manufactured tourniquet proximal to the bleeding site
,B. Irrigate the wound with sterile normal saline and pack with gauze
C. Elevate the affected extremity above the level of the heart
D. Administer a weight-based intravenous analgesic bolus
Answer: A
Applying a tourniquet proximal to the site of severe extremity hemorrhage is the primary
intervention for life-threatening extremity bleeding that cannot be controlled with direct
pressure, effectively occluding arterial blood flow and preventing exsanguination.
4. A 45-year-old construction worker falls 15 feet from scaffolding. He is alert and oriented,
complaining of severe mid-back pain. His lower extremities are cool, and he lacks sensation
below the T10 dermatome. What is the appropriate initial immobilization protocol?
A. Rigid spinal motion restriction using a cervical collar and a flat rigid backboard
B. Immediate removal from the backboard to prevent pressure ulcer formation
C. Log-rolling the patient onto a soft mattress without a cervical collar
D. Encouraging independent ambulation after ruling out gross motor deficits
Answer: A
Rigid spinal motion restriction utilizing a properly fitted cervical collar and a flat rigid
backboard is necessary in the acute phase for patients with a suspected unstable spinal injury,
neurologic deficits, and a reliable mechanism of injury until spinal clearance protocols are
executed.
5. A trauma nurse is performing the secondary survey on a 28-year-old driver involved in a
frontal collision. The steering wheel is bent. The patient complains of shortness of breath
and substernal chest pain. A friction rub is auscultated. Which condition should the nurse
suspect?
A. Myocardial contusion
B. Cardiac tamponade
C. Aortic rupture
D. Esophageal perforation
Answer: A
A myocardial contusion often results from direct blunt anterior chest trauma, such as impact
against a steering wheel. It manifests with substernal chest pain, EKG abnormalities, and
occasionally a friction rub, mimicking an acute myocardial infarction.
6. An elderly pedestrian is struck by a car and brought to the trauma center. Vital signs:
BP 80/50 mm Hg, HR 120 beats/min, RR 26 breaths/min. The patient is confused and pale.
What classification of shock is primarily responsible for these findings?
, A. Hypovolemic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Septic shock
Answer: A
Hypovolemic shock is characterized by inadequate circulating blood volume, leading to
hypotension, tachycardia, tachypnea, and altered mental status resulting from cellular
hypoperfusion and diminished preload following trauma.
7. A 60-year-old male is admitted after an industrial explosion. He has full-thickness burns
to his face, neck, and anterior torso, along with soot in his oropharynx and hoarseness.
What is the most critical immediate concern?
A. Impending upper airway obstruction
B. Fluid volume deficit from evaporative losses
C. Secondary systemic bacterial infection
D. Hypothermia due to loss of skin barrier
Answer: A
Impending upper airway obstruction is the primary and most immediate concern in patients
with facial and neck burns, inhalation injury, and soot in the oropharynx, necessitating early
definitive airway management before edema completely closes the airway.
8. Which of the following assessment findings is most characteristic of cardiac tamponade
resulting from penetrating chest trauma?
A. Beck triad consisting of hypotension, muffled heart sounds, and distended neck veins
B. Hypertension, bounding peripheral pulses, and a wide pulse pressure
C. Tracheal deviation, absent breath sounds, and hyperresonance to percussion
D. Paradoxical chest wall movement with flail segment and severe pain
Answer: A
Beck triad, comprising hypotension, muffled heart sounds, and distended neck veins, is the
classic presentation of cardiac tamponade, caused by blood accumulating in the pericardial
sac and restricting ventricular filling.
9. A 22-year-old female presents after a suicide attempt by ingestion of an unknown
quantity of tricyclic antidepressants. She is somnolent, with a GCS of 10. What is the
primary focus of nursing management during the initial resuscitation phase?
A. Continuous cardiac monitoring for dysrhythmias and wide QRS intervals
B. Immediate administration of oral activated charcoal without airway protection
