TNCC Test Prep: Complete Study Guide with Practice
Questions & Rationales
Based on the TNCC 9th Edition curriculum and provider manual, here is a
comprehensive study guide covering the core components of the Trauma Nursing Core
Course written exam.
A: Airway with Cervical Spine Protection
Key Points:
The airway is the FIRST priority in the primary survey – an obstructed airway can cause
death within minutes
Always assume cervical spine injury in any trauma patient
Use the jaw-thrust maneuver (not head-tilt-chin-lift) to open the airway
Assess for: obstruction by tongue, foreign objects, blood, vomit, edema, burns, loose
teeth
Inspect the mouth for:
Snoring or gurgling sounds (obstructive airway)
Maxillofacial bony deformities
Subcutaneous emphysema
Signs of inhalation injury (singed nasal hairs, carbonaceous sputum)
If airway is not patent:
Suction airway, avoiding gag reflex
Use rigid suction device for blood/vomit
Remove foreign body carefully with forceps
Insert oral airway
Prepare for definitive airway
, B: Breathing and Ventilation
Assess breathing by exposing the chest:
Spontaneous breathing and symmetrical rise and fall
Depth, pattern, and rate of respiration
Accessory muscle use
Skin color (normal, pale, flushed, cyanotic)
Contusions, abrasions, deformities (flail chest)
Open pneumothoraces (sucking chest wounds)
JVD (jugular venous distention)
ET Tube Verification:
Absence of gurgling over epigastrium
Bilateral breath sounds
CO2 verified by CO2 detector or monitor
Definitive airway verification requires:
1. Bilateral breath sounds present
2. No gurgling over epigastrium
3. CO2 detected by device
C: Circulation and Control of Hemorrhage
The major preventable cause of death in trauma patients is uncontrolled
hemorrhage
Components:
1. Inspect for uncontrolled external bleeding
2. Palpate central pulses (carotid, femoral) – rate, rhythm, strength
3. Assess skin color and temperature
4. Cannulate two large-bore IVs; if unable, consider IO access
5. Obtain labs, type and crossmatch
6. Infuse warm isotonic fluids
7. Consider balanced resuscitation
8. Use rapid infusion device if needed
Questions & Rationales
Based on the TNCC 9th Edition curriculum and provider manual, here is a
comprehensive study guide covering the core components of the Trauma Nursing Core
Course written exam.
A: Airway with Cervical Spine Protection
Key Points:
The airway is the FIRST priority in the primary survey – an obstructed airway can cause
death within minutes
Always assume cervical spine injury in any trauma patient
Use the jaw-thrust maneuver (not head-tilt-chin-lift) to open the airway
Assess for: obstruction by tongue, foreign objects, blood, vomit, edema, burns, loose
teeth
Inspect the mouth for:
Snoring or gurgling sounds (obstructive airway)
Maxillofacial bony deformities
Subcutaneous emphysema
Signs of inhalation injury (singed nasal hairs, carbonaceous sputum)
If airway is not patent:
Suction airway, avoiding gag reflex
Use rigid suction device for blood/vomit
Remove foreign body carefully with forceps
Insert oral airway
Prepare for definitive airway
, B: Breathing and Ventilation
Assess breathing by exposing the chest:
Spontaneous breathing and symmetrical rise and fall
Depth, pattern, and rate of respiration
Accessory muscle use
Skin color (normal, pale, flushed, cyanotic)
Contusions, abrasions, deformities (flail chest)
Open pneumothoraces (sucking chest wounds)
JVD (jugular venous distention)
ET Tube Verification:
Absence of gurgling over epigastrium
Bilateral breath sounds
CO2 verified by CO2 detector or monitor
Definitive airway verification requires:
1. Bilateral breath sounds present
2. No gurgling over epigastrium
3. CO2 detected by device
C: Circulation and Control of Hemorrhage
The major preventable cause of death in trauma patients is uncontrolled
hemorrhage
Components:
1. Inspect for uncontrolled external bleeding
2. Palpate central pulses (carotid, femoral) – rate, rhythm, strength
3. Assess skin color and temperature
4. Cannulate two large-bore IVs; if unable, consider IO access
5. Obtain labs, type and crossmatch
6. Infuse warm isotonic fluids
7. Consider balanced resuscitation
8. Use rapid infusion device if needed
