TNS EXAM - TRAUMA NURSE SPECIALIST
CERTIFICATION (TNS) TEST BANK 2026/2027
SECTION 1: TRAUMA ASSESSMENT & INITIAL RESUSCITATION
Question 1
A 45-year-old male is brought to the trauma bay after being involved in a motorcycle crash.
He is unresponsive with a GCS of 6. Which of the following is the priority intervention?
A) Obtain a portable chest X-ray
B) Secure the airway
C) Assess for pelvic instability
D) Insert a nasogastric tube
Answer: B) Secure the airway
Rationale: Airway is always the first priority in the primary survey (ABCDE). A GCS of 6
indicates the patient cannot protect their own airway. The inability to maintain a patent
airway is the most immediate life threat. Airway management must occur before any
diagnostic studies or secondary assessments. C-spine precautions must be maintained
during airway manipulation.
Question 2
During the primary survey, a trauma patient has audible stridor, hoarseness, and
subcutaneous emphysema. These findings are most consistent with:
A) Tension pneumothorax
B) Laryngeal or tracheal injury
C) Cardiac tamponade
D) Pulmonary contusion
Answer: B) Laryngeal or tracheal injury
Rationale: Stridor, hoarseness, and subcutaneous emphysema are classic signs of laryngeal
or tracheal injury. These injuries often result from blunt trauma to the anterior neck (e.g.,
clothesline injury, steering wheel impact) or penetrating trauma. These signs indicate airway
compromise and potential impending obstruction. Immediate airway management with
consideration of surgical airway may be necessary. Tension pneumothorax presents with
respiratory distress, absent breath sounds, and hypotension.
Question 3
,A trauma patient has a heart rate of 130 bpm, blood pressure of 88/52 mmHg, respiratory
rate of 28, and SpO₂ of 94% on 15L non-rebreather. Which classification of shock does this
represent?
A) Class I
B) Class II
C) Class III
D) Class IV
Answer: C) Class III
Rationale: Hemorrhagic shock classification:
Class I: Blood loss <15%, HR <100, BP normal, RR 14-20
Class II: Blood loss 15-30%, HR >100, BP normal, RR 20-30
Class III: Blood loss 30-40%, HR >120, BP decreased, RR 30-40
Class IV: Blood loss >40%, HR >140, BP markedly decreased, RR >35
This patient's presentation (HR 130, BP 88/52, RR 28) indicates Class III shock with
approximately 30-40% blood volume loss requiring immediate fluid resuscitation and blood
product administration.
Question 4
In the primary survey, which statement about the "D" assessment (Disability) is correct?
A) Disability assessment includes evaluation of bowel sounds
B) The AVPU scale is used to assess neurological status
C) Disability evaluation includes assessment of pupillary response only
D) Disability assessment should be deferred until after imaging studies
Answer: B) The AVPU scale is used to assess neurological status
Rationale: The Disability assessment (D) in the primary survey includes rapid neurological
evaluation using the AVPU scale (Alert, Verbal, Pain, Unresponsive) and assessment of
pupillary size and response. This provides a baseline for detecting neurological deterioration.
Bowel sounds are assessed in the secondary survey (F - Full set of vitals/Focused adjuncts).
AVPU is a simplified version of GCS used in the primary survey for rapid assessment.
Question 5
A patient presents with a GCS of 14 following a fall from a ladder. The patient is alert,
oriented, and speaking clearly but has a large scalp laceration. Which of the following is the
correct interpretation of this GCS?
A) This patient has a severe head injury
B) GCS of 14 indicates moderate head injury
C) GCS of 14 indicates minor head injury
,D) GCS scoring is invalid with scalp lacerations
Answer: B) GCS of 14 indicates moderate head injury
Rationale: GCS classification:
13-15: Mild head injury
9-12: Moderate head injury
3-8: Severe head injury
A GCS of 14 is considered mild head injury. However, any patient with a GCS <15 following
trauma should be monitored for deterioration. Scalp lacerations do not invalidate GCS
scoring. The patient should have serial neurological assessments to detect changes.
Question 6
During the primary survey, a trauma patient is found to have absent breath sounds on the
left side with hyperresonance to percussion. What is the appropriate next step?
A) Obtain a stat chest X-ray
B) Prepare for needle decompression
C) Administer high-flow oxygen
D) Place a left-sided chest tube
Answer: B) Prepare for needle decompression
Rationale: In the primary survey, if a tension pneumothorax is suspected (absent breath
sounds, hyperresonance, respiratory distress, hypotension), needle decompression should
be performed immediately. Do not delay for X-ray confirmation. Needle decompression is
performed at the 2nd intercostal space, midclavicular line on the affected side. After
decompression, a chest tube should be placed.
Question 7
A 30-year-old male with a stab wound to the chest has a blood pressure of 72/40, heart rate
of 130, distended neck veins, and muffled heart sounds. The most likely diagnosis is:
A) Tension pneumothorax
B) Massive hemothorax
C) Cardiac tamponade
D) Pulmonary contusion
Answer: C) Cardiac tamponade
Rationale: Beck's Triad for cardiac tamponade:
Hypotension
Distended neck veins (JVD)
, Muffled heart sounds
This patient presents with all three classic findings. Cardiac tamponade results from blood
accumulating in the pericardial sac, compressing the heart and impairing diastolic filling.
Emergency pericardiocentesis or thoracotomy may be required. Tension pneumothorax
would present with unilateral absent breath sounds and hyperresonance.
Question 8
A trauma patient arrives with a blood pressure of 80/50, heart rate of 140, and cool, clammy
skin. Two large-bore IVs are inserted and 2L of crystalloid is infused. The blood pressure
increases to 94/62. What is the appropriate next step?
A) Continue crystalloid resuscitation
B) Prepare for surgery
C) Administer vasopressors
D) Transfuse packed red blood cells
Answer: D) Transfuse packed red blood cells
Rationale: This patient is in Class III hemorrhagic shock requiring blood products. The
transient response to crystalloid suggests ongoing hemorrhage. The patient has already
received 2L of crystalloid (damage control resuscitation limit). Further crystalloid
resuscitation should be limited to prevent dilutional coagulopathy. Blood products (PRBCs,
plasma, platelets in a 1:1:1 ratio) should be initiated. Vasopressors are not first-line in
hemorrhagic shock as they mask ongoing bleeding.
Question 9
Which of the following is a contraindication to nasogastric (NG) tube placement in a trauma
patient?
A) GCS of 14
B) Facial fractures
C) Vomiting
D) Abdominal distention
Answer: B) Facial fractures
Rationale: Nasogastric tube placement is contraindicated in patients with suspected or
known facial fractures, particularly midface fractures, basilar skull fractures, or cribriform
plate fractures. In these patients, the NG tube can be inadvertently passed through the
fracture site into the cranial cavity, causing intracranial placement and potential brain injury.
Orogastric tube placement is preferred in these patients.
Question 10
CERTIFICATION (TNS) TEST BANK 2026/2027
SECTION 1: TRAUMA ASSESSMENT & INITIAL RESUSCITATION
Question 1
A 45-year-old male is brought to the trauma bay after being involved in a motorcycle crash.
He is unresponsive with a GCS of 6. Which of the following is the priority intervention?
A) Obtain a portable chest X-ray
B) Secure the airway
C) Assess for pelvic instability
D) Insert a nasogastric tube
Answer: B) Secure the airway
Rationale: Airway is always the first priority in the primary survey (ABCDE). A GCS of 6
indicates the patient cannot protect their own airway. The inability to maintain a patent
airway is the most immediate life threat. Airway management must occur before any
diagnostic studies or secondary assessments. C-spine precautions must be maintained
during airway manipulation.
Question 2
During the primary survey, a trauma patient has audible stridor, hoarseness, and
subcutaneous emphysema. These findings are most consistent with:
A) Tension pneumothorax
B) Laryngeal or tracheal injury
C) Cardiac tamponade
D) Pulmonary contusion
Answer: B) Laryngeal or tracheal injury
Rationale: Stridor, hoarseness, and subcutaneous emphysema are classic signs of laryngeal
or tracheal injury. These injuries often result from blunt trauma to the anterior neck (e.g.,
clothesline injury, steering wheel impact) or penetrating trauma. These signs indicate airway
compromise and potential impending obstruction. Immediate airway management with
consideration of surgical airway may be necessary. Tension pneumothorax presents with
respiratory distress, absent breath sounds, and hypotension.
Question 3
,A trauma patient has a heart rate of 130 bpm, blood pressure of 88/52 mmHg, respiratory
rate of 28, and SpO₂ of 94% on 15L non-rebreather. Which classification of shock does this
represent?
A) Class I
B) Class II
C) Class III
D) Class IV
Answer: C) Class III
Rationale: Hemorrhagic shock classification:
Class I: Blood loss <15%, HR <100, BP normal, RR 14-20
Class II: Blood loss 15-30%, HR >100, BP normal, RR 20-30
Class III: Blood loss 30-40%, HR >120, BP decreased, RR 30-40
Class IV: Blood loss >40%, HR >140, BP markedly decreased, RR >35
This patient's presentation (HR 130, BP 88/52, RR 28) indicates Class III shock with
approximately 30-40% blood volume loss requiring immediate fluid resuscitation and blood
product administration.
Question 4
In the primary survey, which statement about the "D" assessment (Disability) is correct?
A) Disability assessment includes evaluation of bowel sounds
B) The AVPU scale is used to assess neurological status
C) Disability evaluation includes assessment of pupillary response only
D) Disability assessment should be deferred until after imaging studies
Answer: B) The AVPU scale is used to assess neurological status
Rationale: The Disability assessment (D) in the primary survey includes rapid neurological
evaluation using the AVPU scale (Alert, Verbal, Pain, Unresponsive) and assessment of
pupillary size and response. This provides a baseline for detecting neurological deterioration.
Bowel sounds are assessed in the secondary survey (F - Full set of vitals/Focused adjuncts).
AVPU is a simplified version of GCS used in the primary survey for rapid assessment.
Question 5
A patient presents with a GCS of 14 following a fall from a ladder. The patient is alert,
oriented, and speaking clearly but has a large scalp laceration. Which of the following is the
correct interpretation of this GCS?
A) This patient has a severe head injury
B) GCS of 14 indicates moderate head injury
C) GCS of 14 indicates minor head injury
,D) GCS scoring is invalid with scalp lacerations
Answer: B) GCS of 14 indicates moderate head injury
Rationale: GCS classification:
13-15: Mild head injury
9-12: Moderate head injury
3-8: Severe head injury
A GCS of 14 is considered mild head injury. However, any patient with a GCS <15 following
trauma should be monitored for deterioration. Scalp lacerations do not invalidate GCS
scoring. The patient should have serial neurological assessments to detect changes.
Question 6
During the primary survey, a trauma patient is found to have absent breath sounds on the
left side with hyperresonance to percussion. What is the appropriate next step?
A) Obtain a stat chest X-ray
B) Prepare for needle decompression
C) Administer high-flow oxygen
D) Place a left-sided chest tube
Answer: B) Prepare for needle decompression
Rationale: In the primary survey, if a tension pneumothorax is suspected (absent breath
sounds, hyperresonance, respiratory distress, hypotension), needle decompression should
be performed immediately. Do not delay for X-ray confirmation. Needle decompression is
performed at the 2nd intercostal space, midclavicular line on the affected side. After
decompression, a chest tube should be placed.
Question 7
A 30-year-old male with a stab wound to the chest has a blood pressure of 72/40, heart rate
of 130, distended neck veins, and muffled heart sounds. The most likely diagnosis is:
A) Tension pneumothorax
B) Massive hemothorax
C) Cardiac tamponade
D) Pulmonary contusion
Answer: C) Cardiac tamponade
Rationale: Beck's Triad for cardiac tamponade:
Hypotension
Distended neck veins (JVD)
, Muffled heart sounds
This patient presents with all three classic findings. Cardiac tamponade results from blood
accumulating in the pericardial sac, compressing the heart and impairing diastolic filling.
Emergency pericardiocentesis or thoracotomy may be required. Tension pneumothorax
would present with unilateral absent breath sounds and hyperresonance.
Question 8
A trauma patient arrives with a blood pressure of 80/50, heart rate of 140, and cool, clammy
skin. Two large-bore IVs are inserted and 2L of crystalloid is infused. The blood pressure
increases to 94/62. What is the appropriate next step?
A) Continue crystalloid resuscitation
B) Prepare for surgery
C) Administer vasopressors
D) Transfuse packed red blood cells
Answer: D) Transfuse packed red blood cells
Rationale: This patient is in Class III hemorrhagic shock requiring blood products. The
transient response to crystalloid suggests ongoing hemorrhage. The patient has already
received 2L of crystalloid (damage control resuscitation limit). Further crystalloid
resuscitation should be limited to prevent dilutional coagulopathy. Blood products (PRBCs,
plasma, platelets in a 1:1:1 ratio) should be initiated. Vasopressors are not first-line in
hemorrhagic shock as they mask ongoing bleeding.
Question 9
Which of the following is a contraindication to nasogastric (NG) tube placement in a trauma
patient?
A) GCS of 14
B) Facial fractures
C) Vomiting
D) Abdominal distention
Answer: B) Facial fractures
Rationale: Nasogastric tube placement is contraindicated in patients with suspected or
known facial fractures, particularly midface fractures, basilar skull fractures, or cribriform
plate fractures. In these patients, the NG tube can be inadvertently passed through the
fracture site into the cranial cavity, causing intracranial placement and potential brain injury.
Orogastric tube placement is preferred in these patients.
Question 10
