TNCC FINAL EXAM TEST 2023 NEWEST VERSION 2026-2027
COMPLETE OPEN QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+.
An elderly patient with a history of anticoagulant use presents
after a fall at home that day. She denies any loss of
consciousness. She has a hematoma to her forehead and
complains of headache, dizziness, and nausea. Which is the
most likely cause of her symptoms?
a. Epidural hematoma
b. Diffuse axonal injury
c. Post-concussive syndrome
d. Subdural hematoma
✔️ Correct Answer: D
Rationale: Subdural hematoma is most likely in an elderly
patient on anticoagulants who presents with headache,
dizziness, and nausea after a fall. The elderly have increased risk
due to brain atrophy, which stretches bridging veins.
Anticoagulants increase bleeding risk. Epidural hematoma (A) is
typically associated with arterial bleeding and a lucid interval.
Diffuse axonal injury (B) is associated with high-velocity
rotational forces. Post-concussive syndrome (C) occurs after
concussion but is not the acute cause of these symptoms.
EMS brings a patient who fell riding his bicycle. Using the
American College of Surgeons screening guidelines, which
,assessment finding would prompt the nurse to prepare the
patient for radiologic spine clearance?
a. Alert with no neurologic deficits
b. Multiple abrasions to the extremities
c. Multiple requests of water
d. Smell of alcohol on breath
✔️ Correct Answer: D
Rationale: The smell of alcohol on the breath is a distracting
injury or altered mental status that would prompt radiologic
spine clearance per ACS guidelines. An alert patient with no
neurologic deficits (A) may be cleared clinically. Multiple
abrasions (B) are not a distracting injury. Multiple requests for
water (C) may indicate dehydration but not a spine clearance
indicator.
Which of the following occurs during the third impact of a
motor vehicle crash?
a. The driver of the vehicle collides with the steering wheel
b. The vehicle collides with a tree
c. The aorta is torn at its attachment with the ligamentum
arteriosum
d. The airbag deploys and strikes the front seat passenger
✔️ Correct Answer: C
Rationale: The third impact is the internal organ injury that
occurs when the body's organs collide with internal structures.
The aorta being torn at the ligamentum arteriosum is a classic
,third-impact injury. Option A is the second impact (body collides
with vehicle). Option B is the first impact (vehicle collides with
object). Option D is part of the second impact or restraint injury.
A passenger is brought to the emergency department of a rural
hospital following a high-speed MVC. When significant
abdominal and pelvic injuries are noted in the primary survey,
which of the following is the priority intervention?
a. Initiate transfer to a trauma center
b. Provide report to the operating room nurse
c. Obtained imaging studies
d. Place a gastric tube
✔️ Correct Answer: A
Rationale: The priority is to initiate transfer to a trauma center
because the rural hospital cannot provide definitive care for
significant abdominal and pelvic injuries. Stabilization and
transfer are the priorities. Option B is premature. Option C may
delay transfer. Option D is not the priority.
Which of the following injuries is LEAST likely to be promptly
identified?
a. Spleen
b. Lung
c. Bowel
d. Brain
, ✔️ Correct Answer: C
Rationale: Bowel injuries are the least likely to be promptly
identified because they may not present with immediate signs
or symptoms. Spleen (A), lung (B), and brain (D) injuries often
have more immediate and obvious findings such as
hemorrhage, respiratory distress, or neurological changes.
Patients with a crush injury should be monitored for which of
the following conditions?
a. Hypernatremia
b. Hypercalcemia
c. Dysrhythmias
d. Polyuria
✔️ Correct Answer: C
Rationale: Crush injuries can cause rhabdomyolysis, leading to
hyperkalemia, which can cause life-threatening dysrhythmias.
Hypernatremia (A), hypercalcemia (B), and polyuria (D) are not
typical complications of crush injury.
What finding raises suspicion of complete spinal cord injury?
a. Weakness in the lower extremities
b. Priapism
c. Voluntary anal sphincter tone
d. Intact reflexes distal to the injury
✔️ Correct Answer: B
Rationale: Priapism (persistent erection) is a sign of complete
COMPLETE OPEN QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+.
An elderly patient with a history of anticoagulant use presents
after a fall at home that day. She denies any loss of
consciousness. She has a hematoma to her forehead and
complains of headache, dizziness, and nausea. Which is the
most likely cause of her symptoms?
a. Epidural hematoma
b. Diffuse axonal injury
c. Post-concussive syndrome
d. Subdural hematoma
✔️ Correct Answer: D
Rationale: Subdural hematoma is most likely in an elderly
patient on anticoagulants who presents with headache,
dizziness, and nausea after a fall. The elderly have increased risk
due to brain atrophy, which stretches bridging veins.
Anticoagulants increase bleeding risk. Epidural hematoma (A) is
typically associated with arterial bleeding and a lucid interval.
Diffuse axonal injury (B) is associated with high-velocity
rotational forces. Post-concussive syndrome (C) occurs after
concussion but is not the acute cause of these symptoms.
EMS brings a patient who fell riding his bicycle. Using the
American College of Surgeons screening guidelines, which
,assessment finding would prompt the nurse to prepare the
patient for radiologic spine clearance?
a. Alert with no neurologic deficits
b. Multiple abrasions to the extremities
c. Multiple requests of water
d. Smell of alcohol on breath
✔️ Correct Answer: D
Rationale: The smell of alcohol on the breath is a distracting
injury or altered mental status that would prompt radiologic
spine clearance per ACS guidelines. An alert patient with no
neurologic deficits (A) may be cleared clinically. Multiple
abrasions (B) are not a distracting injury. Multiple requests for
water (C) may indicate dehydration but not a spine clearance
indicator.
Which of the following occurs during the third impact of a
motor vehicle crash?
a. The driver of the vehicle collides with the steering wheel
b. The vehicle collides with a tree
c. The aorta is torn at its attachment with the ligamentum
arteriosum
d. The airbag deploys and strikes the front seat passenger
✔️ Correct Answer: C
Rationale: The third impact is the internal organ injury that
occurs when the body's organs collide with internal structures.
The aorta being torn at the ligamentum arteriosum is a classic
,third-impact injury. Option A is the second impact (body collides
with vehicle). Option B is the first impact (vehicle collides with
object). Option D is part of the second impact or restraint injury.
A passenger is brought to the emergency department of a rural
hospital following a high-speed MVC. When significant
abdominal and pelvic injuries are noted in the primary survey,
which of the following is the priority intervention?
a. Initiate transfer to a trauma center
b. Provide report to the operating room nurse
c. Obtained imaging studies
d. Place a gastric tube
✔️ Correct Answer: A
Rationale: The priority is to initiate transfer to a trauma center
because the rural hospital cannot provide definitive care for
significant abdominal and pelvic injuries. Stabilization and
transfer are the priorities. Option B is premature. Option C may
delay transfer. Option D is not the priority.
Which of the following injuries is LEAST likely to be promptly
identified?
a. Spleen
b. Lung
c. Bowel
d. Brain
, ✔️ Correct Answer: C
Rationale: Bowel injuries are the least likely to be promptly
identified because they may not present with immediate signs
or symptoms. Spleen (A), lung (B), and brain (D) injuries often
have more immediate and obvious findings such as
hemorrhage, respiratory distress, or neurological changes.
Patients with a crush injury should be monitored for which of
the following conditions?
a. Hypernatremia
b. Hypercalcemia
c. Dysrhythmias
d. Polyuria
✔️ Correct Answer: C
Rationale: Crush injuries can cause rhabdomyolysis, leading to
hyperkalemia, which can cause life-threatening dysrhythmias.
Hypernatremia (A), hypercalcemia (B), and polyuria (D) are not
typical complications of crush injury.
What finding raises suspicion of complete spinal cord injury?
a. Weakness in the lower extremities
b. Priapism
c. Voluntary anal sphincter tone
d. Intact reflexes distal to the injury
✔️ Correct Answer: B
Rationale: Priapism (persistent erection) is a sign of complete
