TRAUMA NURSE SPECIALIST (TNS)
CERTIFICATION EXAM PRACTICE |
COMPREHENSIVE STUDY GUIDE — 2026/2027
UPDATE EXAM QUESTIONS 100% WITH CORRECT
ANSWERS AND RATIOALES
Question
A trauma patient arrives after a high-speed motor vehicle collision. The patient is
agitated, has noisy respirations, and is unable to maintain a patent airway. Which
intervention should the trauma nurse prioritize?
A. Obtain a complete neurological history
B. Establish two large-bore IV lines
C. Administer analgesia
D. Open and maintain the airway while protecting the cervical spine
Answer: D. Open and maintain the airway while protecting the cervical spine
Rationale: Airway management is the first priority in the initial trauma
assessment because airway obstruction can rapidly cause hypoxia and cardiac
arrest. In a high-energy mechanism, cervical spine injury must be assumed until
adequately assessed. The nurse should maintain cervical spine precautions while
opening and securing the airway using appropriate trauma techniques.
Circulation, pain management, and detailed history are important but cannot take
precedence over an immediately compromised airway.
Question
A trauma patient has severe external bleeding from the thigh following a
penetrating injury. Direct pressure is being applied but bleeding continues. What
should the nurse anticipate next?
Page 1 of 63
,A. Apply an appropriate tourniquet proximal to the wound
B. Elevate the extremity above the level of the heart
C. Remove the clotting material from the wound
D. Delay intervention until laboratory results are available
Answer: A. Apply an appropriate tourniquet proximal to the wound
Rationale: Life-threatening extremity hemorrhage requires rapid hemorrhage
control. If direct pressure does not adequately control severe bleeding, an
appropriately applied tourniquet is an accepted lifesaving intervention when
indicated. The priority is preventing exsanguination rather than waiting for
laboratory results. Once applied, the tourniquet should be managed according to
trauma protocols, with documentation of the application time and continued
monitoring of the patient.
Question
Which finding in a trauma patient most strongly suggests tension pneumothorax?
A. Bilateral equal breath sounds and mild tachycardia
B. Unilateral absent breath sounds with hypotension and severe respiratory
distress
C. Productive cough with bilateral crackles
D. Mild chest discomfort with normal oxygen saturation
Answer: B. Unilateral absent breath sounds with hypotension and severe
respiratory distress
Rationale: Tension pneumothorax occurs when accumulating air under
pressure compromises lung expansion and progressively impairs venous return to
the heart. Classic concerning findings include severe respiratory distress, unilateral
markedly decreased or absent breath sounds, hypotension, tachycardia, and
potentially distended neck veins or tracheal deviation. It is a clinical emergency,
and treatment should not be unnecessarily delayed for definitive imaging when
the presentation is strongly suggestive.
Question
Page 2 of 63
,A trauma patient has a Glasgow Coma Scale score of 7 after a blunt head injury.
Which concern should receive the highest priority?
A. Nutritional status
B. Urinary elimination
C. Protection of the airway and adequate oxygenation
D. Prevention of constipation
Answer: C. Protection of the airway and adequate oxygenation
Rationale: A markedly depressed level of consciousness increases the risk of
airway obstruction, aspiration, and hypoventilation. A GCS of 8 or less is
commonly treated as an indication for considering definitive airway management
in the appropriate clinical context. In traumatic brain injury, avoiding hypoxemia is
particularly important because inadequate oxygen delivery can worsen secondary
brain injury.
Question
Which assessment finding is most concerning for hemorrhagic shock in a trauma
patient?
A. Warm skin and bounding pulses
B. Bradycardia with hypertension
C. Increased urine output
D. Tachycardia, cool skin, altered mental status, and decreasing urine output
Answer: D. Tachycardia, cool skin, altered mental status, and decreasing urine
output
Rationale: Hemorrhagic shock results from inadequate circulating blood
volume and impaired tissue perfusion. Early findings commonly include
tachycardia, peripheral vasoconstriction, cool or clammy skin, anxiety or altered
mental status, and reduced urine output. Blood pressure can remain relatively
preserved during early compensation, so a normal blood pressure does not
exclude significant hemorrhage.
Page 3 of 63
, Question
A patient with suspected cervical spine trauma requires airway management.
Which technique is preferred initially when opening the airway?
A. Head-tilt/chin-lift without consideration of spinal precautions
B. Jaw-thrust maneuver while maintaining cervical spine alignment
C. Hyperextension of the neck
D. Turning the patient's head laterally
Answer: B. Jaw-thrust maneuver while maintaining cervical spine alignment
Rationale: In a trauma patient with possible cervical spine injury, airway
maneuvers should minimize unnecessary cervical movement. A jaw-thrust can
help open the airway while maintaining spinal alignment. If this does not
adequately establish an airway, the priority remains oxygenation and ventilation,
and other appropriate airway techniques may be necessary while maintaining
spinal precautions as clinically indicated.
Question
A trauma patient develops hypotension and distended neck veins after a
penetrating chest injury. Heart sounds are difficult to hear. Which condition
should the nurse suspect?
A. Cardiac tamponade
B. Simple pneumothorax
C. Pulmonary contusion
D. Flail chest
Answer: A. Cardiac tamponade
Rationale: Cardiac tamponade occurs when blood or fluid accumulates in the
pericardial space and restricts cardiac filling. Hypotension, distended neck veins,
and muffled heart sounds are classically associated with tamponade, although not
all findings are always present. In a trauma setting, penetrating chest injury
substantially raises concern for this life-threatening condition.
Page 4 of 63
CERTIFICATION EXAM PRACTICE |
COMPREHENSIVE STUDY GUIDE — 2026/2027
UPDATE EXAM QUESTIONS 100% WITH CORRECT
ANSWERS AND RATIOALES
Question
A trauma patient arrives after a high-speed motor vehicle collision. The patient is
agitated, has noisy respirations, and is unable to maintain a patent airway. Which
intervention should the trauma nurse prioritize?
A. Obtain a complete neurological history
B. Establish two large-bore IV lines
C. Administer analgesia
D. Open and maintain the airway while protecting the cervical spine
Answer: D. Open and maintain the airway while protecting the cervical spine
Rationale: Airway management is the first priority in the initial trauma
assessment because airway obstruction can rapidly cause hypoxia and cardiac
arrest. In a high-energy mechanism, cervical spine injury must be assumed until
adequately assessed. The nurse should maintain cervical spine precautions while
opening and securing the airway using appropriate trauma techniques.
Circulation, pain management, and detailed history are important but cannot take
precedence over an immediately compromised airway.
Question
A trauma patient has severe external bleeding from the thigh following a
penetrating injury. Direct pressure is being applied but bleeding continues. What
should the nurse anticipate next?
Page 1 of 63
,A. Apply an appropriate tourniquet proximal to the wound
B. Elevate the extremity above the level of the heart
C. Remove the clotting material from the wound
D. Delay intervention until laboratory results are available
Answer: A. Apply an appropriate tourniquet proximal to the wound
Rationale: Life-threatening extremity hemorrhage requires rapid hemorrhage
control. If direct pressure does not adequately control severe bleeding, an
appropriately applied tourniquet is an accepted lifesaving intervention when
indicated. The priority is preventing exsanguination rather than waiting for
laboratory results. Once applied, the tourniquet should be managed according to
trauma protocols, with documentation of the application time and continued
monitoring of the patient.
Question
Which finding in a trauma patient most strongly suggests tension pneumothorax?
A. Bilateral equal breath sounds and mild tachycardia
B. Unilateral absent breath sounds with hypotension and severe respiratory
distress
C. Productive cough with bilateral crackles
D. Mild chest discomfort with normal oxygen saturation
Answer: B. Unilateral absent breath sounds with hypotension and severe
respiratory distress
Rationale: Tension pneumothorax occurs when accumulating air under
pressure compromises lung expansion and progressively impairs venous return to
the heart. Classic concerning findings include severe respiratory distress, unilateral
markedly decreased or absent breath sounds, hypotension, tachycardia, and
potentially distended neck veins or tracheal deviation. It is a clinical emergency,
and treatment should not be unnecessarily delayed for definitive imaging when
the presentation is strongly suggestive.
Question
Page 2 of 63
,A trauma patient has a Glasgow Coma Scale score of 7 after a blunt head injury.
Which concern should receive the highest priority?
A. Nutritional status
B. Urinary elimination
C. Protection of the airway and adequate oxygenation
D. Prevention of constipation
Answer: C. Protection of the airway and adequate oxygenation
Rationale: A markedly depressed level of consciousness increases the risk of
airway obstruction, aspiration, and hypoventilation. A GCS of 8 or less is
commonly treated as an indication for considering definitive airway management
in the appropriate clinical context. In traumatic brain injury, avoiding hypoxemia is
particularly important because inadequate oxygen delivery can worsen secondary
brain injury.
Question
Which assessment finding is most concerning for hemorrhagic shock in a trauma
patient?
A. Warm skin and bounding pulses
B. Bradycardia with hypertension
C. Increased urine output
D. Tachycardia, cool skin, altered mental status, and decreasing urine output
Answer: D. Tachycardia, cool skin, altered mental status, and decreasing urine
output
Rationale: Hemorrhagic shock results from inadequate circulating blood
volume and impaired tissue perfusion. Early findings commonly include
tachycardia, peripheral vasoconstriction, cool or clammy skin, anxiety or altered
mental status, and reduced urine output. Blood pressure can remain relatively
preserved during early compensation, so a normal blood pressure does not
exclude significant hemorrhage.
Page 3 of 63
, Question
A patient with suspected cervical spine trauma requires airway management.
Which technique is preferred initially when opening the airway?
A. Head-tilt/chin-lift without consideration of spinal precautions
B. Jaw-thrust maneuver while maintaining cervical spine alignment
C. Hyperextension of the neck
D. Turning the patient's head laterally
Answer: B. Jaw-thrust maneuver while maintaining cervical spine alignment
Rationale: In a trauma patient with possible cervical spine injury, airway
maneuvers should minimize unnecessary cervical movement. A jaw-thrust can
help open the airway while maintaining spinal alignment. If this does not
adequately establish an airway, the priority remains oxygenation and ventilation,
and other appropriate airway techniques may be necessary while maintaining
spinal precautions as clinically indicated.
Question
A trauma patient develops hypotension and distended neck veins after a
penetrating chest injury. Heart sounds are difficult to hear. Which condition
should the nurse suspect?
A. Cardiac tamponade
B. Simple pneumothorax
C. Pulmonary contusion
D. Flail chest
Answer: A. Cardiac tamponade
Rationale: Cardiac tamponade occurs when blood or fluid accumulates in the
pericardial space and restricts cardiac filling. Hypotension, distended neck veins,
and muffled heart sounds are classically associated with tamponade, although not
all findings are always present. In a trauma setting, penetrating chest injury
substantially raises concern for this life-threatening condition.
Page 4 of 63
