TNCC 9th Edition - Questions and Answers Graded A+ 100%
Complete (Solved 2026/2027) Test Bank
Trauma Nursing Core Course | ENA-Approved Content Alignment
175 Multiple-Choice Questions | Graded A+ | 100% Complete (Solved) | ENA-Approved Content
Section 1: Trauma Nursing Principles and Initial Assessment
(Trauma Systems, Triage, Primary Survey, ABCDE, & Adjuncts) - Q1-Q25
Q1. A trauma patient arrives at the emergency department via EMS. The trauma nurse begins the primary survey.
Which sequence correctly identifies the TNCC 9th Edition primary survey components?
A. Airway, Breathing, Circulation, Disability, Exposure
B. Airway with C-spine protection, Breathing, Circulation with hemorrhage control, Disability, Exposure
[CORRECT]
C. Cervical spine, Airway, Breathing, Circulation, Disability
D. Airway, Breathing, Circulation, Exposure, Disability
Correct Answer: B. Airway with C-spine protection, Breathing, Circulation with hemorrhage control, Disability,
Exposure
Rationale: The TNCC 9th Edition primary survey follows the ABCDE sequence with cervical spine protection integrated into
airway: A (Airway with C-spine protection), B (Breathing and ventilation), C (Circulation with hemorrhage control), D
(Disability - neurologic status), and E (Exposure/Environmental control). The other options either omit C-spine protection or
misorder the components. ENA TNCC emphasizes that hemorrhage control is now explicitly part of C (not just circulation
assessment) to reflect modern trauma resuscitation priorities.
Q2. A patient arrives at a Level III trauma center with a severe traumatic brain injury. The facility does not have
neurosurgical capability. According to trauma system principles, which action is MOST appropriate?
A. Stabilize the patient and transfer to a higher-level trauma center [CORRECT]
B. Perform emergency surgery at the current facility
C. Discharge the patient with instructions
D. Keep the patient for observation indefinitely
Correct Answer: A. Stabilize the patient and transfer to a higher-level trauma center
Rationale: When a facility lacks the resources (such as neurosurgery) needed for a patient's injuries, the patient must be
stabilized and transferred to a higher-level trauma center. Performing surgery without capability, discharging, or indefinite
observation are inappropriate. TNCC emphasizes trauma system integration with appropriate transfer protocols. The referring
facility should stabilize airway, breathing, and circulation, initiate transfer process early, and communicate with the receiving
facility.
Q3. During a mass casualty incident, the triage nurse uses the START algorithm. Which patient should be tagged as
"Immediate" (Red)?
A. A patient who is walking and has a minor laceration
B. A patient who is apneic even after airway repositioning
C. A patient with respiratory rate of 32, capillary refill of 3 seconds, and unable to follow commands [CORRECT]
D. A patient with a femur fracture who can walk
Correct Answer: C. A patient with respiratory rate of 32, capillary refill of 3 seconds, and unable to follow
commands
TNCC 9th Edition Test Bank (2026/2027) | Page 1
,TNCC 9th Edition Test Bank
Rationale: The START algorithm categorizes patients based on ability to walk, respiratory rate, capillary refill, and ability to
follow commands. The "Immediate" (Red) tag is for patients with respiratory rate >30/min, capillary refill >2 seconds, or
inability to follow commands. The walking patient is "Minor" (Green). The apneic patient after airway repositioning is
"Expectant" (Black) if no respirations after airway opening. The femur fracture patient who can walk is "Minor." TNCC
emphasizes rapid triage to maximize survival in mass casualty situations.
Q4. A trauma patient arrives with signs of significant hemorrhage. The nurse assesses that the patient needs
immediate intervention. According to the TNCC 9th Edition, which assessment should be performed during the
primary survey component "C" (Circulation)?
A. Complete blood count
B. Pulse quality, skin color, capillary refill, and active hemorrhage identification [CORRECT]
C. 12-lead ECG
D. Comprehensive neurological examination
Correct Answer: B. Pulse quality, skin color, capillary refill, and active hemorrhage identification
Rationale: During the C (Circulation) component of the primary survey, the nurse assesses pulse quality (central and
peripheral), skin color and temperature, capillary refill, and identifies and controls active hemorrhage. CBC, ECG, and
comprehensive neurological exam are secondary survey or adjunct assessments. TNCC 9th Edition emphasizes early
hemorrhage control during circulation assessment to prevent exsanguination, including use of direct pressure, tourniquets, and
hemostatic agents.
Q5. A trauma nurse is caring for a patient with suspected increased intracranial pressure (ICP). Which finding during
the primary survey D (Disability) component would indicate the MOST urgent need for intervention?
A. Glasgow Coma Scale score of 14
B. Pupils equal and reactive at 3 mm
C. Glasgow Coma Scale score of 8 with unilateral pupil dilation [CORRECT]
D. Patient is awake and oriented
Correct Answer: C. Glasgow Coma Scale score of 8 with unilateral pupil dilation
Rationale: A GCS score of 8 indicates coma requiring airway protection, and unilateral pupil dilation suggests herniation
syndrome from increased ICP. This is a neurosurgical emergency requiring immediate intervention. GCS 14 indicates mild
impairment; pupils 3 mm PERLA is normal. TNCC 9th Edition emphasizes that D (Disability) assessment includes GCS,
pupillary assessment, and gross motor assessment to identify life-threatening neurologic conditions requiring immediate
intervention.
Q6. A trauma patient arrives with severe facial injuries and blood in the airway. The nurse is performing airway
assessment with C-spine protection. Which intervention should be performed FIRST?
A. Immediate orotracheal intubation without suctioning
B. Suction the airway and apply manual inline stabilization [CORRECT]
C. Place a nasal airway and position supine
D. Perform a cricothyroidotomy immediately
Correct Answer: B. Suction the airway and apply manual inline stabilization
Rationale: The first step is to clear the airway of blood and secretions with suctioning while maintaining C-spine stabilization
with manual inline stabilization. Intubation may be needed after suctioning but cannot be done safely with a blood-filled airway.
Nasal airway is contraindicated with suspected facial/basilar skull fractures. Cricothyroidotomy is the surgical airway of last
resort. TNCC 9th Edition emphasizes maintaining C-spine protection throughout airway management.
Q7. A trauma nurse is applying adjuncts to the primary survey. Which adjunct should be placed in a patient with
suspected intra-abdominal hemorrhage and hypotension?
TNCC 9th Edition Test Bank (2026/2027) | Page 2
,TNCC 9th Edition Test Bank
A. 12-lead ECG
B. Focused Assessment with Sonography for Trauma (FAST) exam [CORRECT]
C. CT scan of the abdomen
D. MRI of the abdomen
Correct Answer: B. Focused Assessment with Sonography for Trauma (FAST) exam
Rationale: The FAST exam is a rapid bedside ultrasound that identifies free fluid (blood) in the abdomen, pericardium, or
pleural spaces. It is a primary survey adjunct for unstable patients with suspected internal hemorrhage. 12-lead ECG is useful
but not for hemorrhage identification. CT scan is for stable patients. MRI is inappropriate for trauma due to time and metallic
concerns. TNCC 9th Edition includes FAST as a key adjunct to identify bleeding sources rapidly.
Q8. A trauma patient's family arrives demanding to be present during resuscitation. Which action by the trauma
nurse follows current ENA recommendations?
A. Refuse family presence to maintain order
B. Allow family presence with a designated family support person [CORRECT]
C. Allow family presence only if the patient dies
D. Call security to remove the family
Correct Answer: B. Allow family presence with a designated family support person
Rationale: ENA supports family presence during resuscitation when appropriate, with a designated family support person to
explain procedures and provide emotional support. Refusing family presence, allowing only at death, or calling security
disregards evidence-based practice. TNCC 9th Edition includes family presence as an important component of patient- and
family-centered trauma care, with protocols to assess appropriateness and provide support.
Q9. A trauma nurse is completing a secondary survey using the AMPLE history format. What does the "A" in
AMPLE stand for?
A. Airway
B. Allergies [CORRECT]
C. Assessment
D. Age
Correct Answer: B. Allergies
Rationale: AMPLE stands for Allergies, Medications, Past medical history/operations, Last meal, and Events/Environment
related to the trauma. Airway, Assessment, and Age are not part of AMPLE. TNCC 9th Edition uses AMPLE as the structured
history-taking format during the secondary survey to obtain critical information that influences trauma management decisions.
Q10. A trauma patient arrives with paradoxical movement of the left chest wall during respiration. Which injury
should the nurse suspect, and what is the priority intervention?
A. Simple pneumothorax - observe
B. Flail chest - provide oxygen and positive pressure ventilation [CORRECT]
C. Hemothorax - chest tube insertion
D. Cardiac tamponade - pericardiocentesis
Correct Answer: B. Flail chest - provide oxygen and positive pressure ventilation
Rationale: Paradoxical chest wall movement is the hallmark of flail chest (two or more fractures in two or more adjacent ribs).
The priority intervention is oxygen and positive pressure ventilation (such as CPAP or mechanical ventilation) to splint the chest
internally and improve oxygenation. Simple pneumothorax does not cause paradoxical movement. Hemothorax causes dullness
and decreased breath sounds. Cardiac tamponade causes Beck's triad. TNCC 9th Edition emphasizes that flail chest with
respiratory compromise requires positive pressure ventilation.
TNCC 9th Edition Test Bank (2026/2027) | Page 3
, TNCC 9th Edition Test Bank
Q11. A trauma patient is brought to the emergency department after a high-speed motor vehicle crash. The patient is
talking but confused. The nurse should perform which action FIRST?
A. Obtain a complete blood count
B. Perform the primary survey [CORRECT]
C. Insert a urinary catheter
D. Obtain a CT scan
Correct Answer: B. Perform the primary survey
Rationale: The primary survey (ABCDE) is the first step in trauma assessment to identify and treat life-threatening conditions in
order of priority. CBC, urinary catheter, and CT scan are secondary survey or adjunct interventions that follow the primary
survey. TNCC 9th Edition emphasizes that the primary survey always precedes diagnostic tests unless life-threatening conditions
are identified that require simultaneous intervention.
Q12. A trauma patient has an open pneumothorax (sucking chest wound). Which intervention should the nurse
perform FIRST?
A. Cover the wound with an occlusive dressing taped on three sides [CORRECT]
B. Cover the wound with an occlusive dressing taped on all four sides
C. Insert a chest tube immediately
D. Apply direct pressure
Correct Answer: A. Cover the wound with an occlusive dressing taped on three sides
Rationale: An occlusive dressing taped on three sides allows air to escape during exhalation but prevents air from entering
during inhalation, preventing progression to tension pneumothorax. Taping on all four sides can create tension pneumothorax.
Chest tube insertion follows the occlusive dressing. Direct pressure does not address the airway issue. TNCC 9th Edition
specifies the three-sided occlusive dressing as the initial treatment for open pneumothorax.
Q13. A trauma patient has a GCS score of 7. According to TNCC 9th Edition guidelines, which intervention is
indicated?
A. Observation and frequent neurological checks
B. Definitive airway management [CORRECT]
C. CT scan only
D. Discharge home
Correct Answer: B. Definitive airway management
Rationale: A GCS score of 8 or less indicates coma and the need for definitive airway management (endotracheal intubation or
surgical airway) to protect the airway and ensure adequate ventilation. Observation alone is inadequate. CT scan follows airway
management. Discharge is inappropriate. TNCC 9th Edition establishes that GCS <=8 is an indication for intubation to protect
the airway.
Q14. A trauma patient arrives with suspected pelvic fracture and hypotension. Which intervention should the nurse
anticipate to help control hemorrhage?
A. Foley catheter insertion
B. Application of a pelvic binder [CORRECT]
C. Bilateral chest tubes
D. Central line placement
Correct Answer: B. Application of a pelvic binder
Rationale: A pelvic binder stabilizes pelvic fractures and reduces pelvic volume, which helps control hemorrhage from pelvic
venous bleeding. Foley catheter is contraindicated until urethral injury is ruled out. Chest tubes are for thoracic injuries. Central
line is for vascular access, not hemorrhage control. TNCC 9th Edition recommends pelvic binder application for unstable pelvic
TNCC 9th Edition Test Bank (2026/2027) | Page 4
Complete (Solved 2026/2027) Test Bank
Trauma Nursing Core Course | ENA-Approved Content Alignment
175 Multiple-Choice Questions | Graded A+ | 100% Complete (Solved) | ENA-Approved Content
Section 1: Trauma Nursing Principles and Initial Assessment
(Trauma Systems, Triage, Primary Survey, ABCDE, & Adjuncts) - Q1-Q25
Q1. A trauma patient arrives at the emergency department via EMS. The trauma nurse begins the primary survey.
Which sequence correctly identifies the TNCC 9th Edition primary survey components?
A. Airway, Breathing, Circulation, Disability, Exposure
B. Airway with C-spine protection, Breathing, Circulation with hemorrhage control, Disability, Exposure
[CORRECT]
C. Cervical spine, Airway, Breathing, Circulation, Disability
D. Airway, Breathing, Circulation, Exposure, Disability
Correct Answer: B. Airway with C-spine protection, Breathing, Circulation with hemorrhage control, Disability,
Exposure
Rationale: The TNCC 9th Edition primary survey follows the ABCDE sequence with cervical spine protection integrated into
airway: A (Airway with C-spine protection), B (Breathing and ventilation), C (Circulation with hemorrhage control), D
(Disability - neurologic status), and E (Exposure/Environmental control). The other options either omit C-spine protection or
misorder the components. ENA TNCC emphasizes that hemorrhage control is now explicitly part of C (not just circulation
assessment) to reflect modern trauma resuscitation priorities.
Q2. A patient arrives at a Level III trauma center with a severe traumatic brain injury. The facility does not have
neurosurgical capability. According to trauma system principles, which action is MOST appropriate?
A. Stabilize the patient and transfer to a higher-level trauma center [CORRECT]
B. Perform emergency surgery at the current facility
C. Discharge the patient with instructions
D. Keep the patient for observation indefinitely
Correct Answer: A. Stabilize the patient and transfer to a higher-level trauma center
Rationale: When a facility lacks the resources (such as neurosurgery) needed for a patient's injuries, the patient must be
stabilized and transferred to a higher-level trauma center. Performing surgery without capability, discharging, or indefinite
observation are inappropriate. TNCC emphasizes trauma system integration with appropriate transfer protocols. The referring
facility should stabilize airway, breathing, and circulation, initiate transfer process early, and communicate with the receiving
facility.
Q3. During a mass casualty incident, the triage nurse uses the START algorithm. Which patient should be tagged as
"Immediate" (Red)?
A. A patient who is walking and has a minor laceration
B. A patient who is apneic even after airway repositioning
C. A patient with respiratory rate of 32, capillary refill of 3 seconds, and unable to follow commands [CORRECT]
D. A patient with a femur fracture who can walk
Correct Answer: C. A patient with respiratory rate of 32, capillary refill of 3 seconds, and unable to follow
commands
TNCC 9th Edition Test Bank (2026/2027) | Page 1
,TNCC 9th Edition Test Bank
Rationale: The START algorithm categorizes patients based on ability to walk, respiratory rate, capillary refill, and ability to
follow commands. The "Immediate" (Red) tag is for patients with respiratory rate >30/min, capillary refill >2 seconds, or
inability to follow commands. The walking patient is "Minor" (Green). The apneic patient after airway repositioning is
"Expectant" (Black) if no respirations after airway opening. The femur fracture patient who can walk is "Minor." TNCC
emphasizes rapid triage to maximize survival in mass casualty situations.
Q4. A trauma patient arrives with signs of significant hemorrhage. The nurse assesses that the patient needs
immediate intervention. According to the TNCC 9th Edition, which assessment should be performed during the
primary survey component "C" (Circulation)?
A. Complete blood count
B. Pulse quality, skin color, capillary refill, and active hemorrhage identification [CORRECT]
C. 12-lead ECG
D. Comprehensive neurological examination
Correct Answer: B. Pulse quality, skin color, capillary refill, and active hemorrhage identification
Rationale: During the C (Circulation) component of the primary survey, the nurse assesses pulse quality (central and
peripheral), skin color and temperature, capillary refill, and identifies and controls active hemorrhage. CBC, ECG, and
comprehensive neurological exam are secondary survey or adjunct assessments. TNCC 9th Edition emphasizes early
hemorrhage control during circulation assessment to prevent exsanguination, including use of direct pressure, tourniquets, and
hemostatic agents.
Q5. A trauma nurse is caring for a patient with suspected increased intracranial pressure (ICP). Which finding during
the primary survey D (Disability) component would indicate the MOST urgent need for intervention?
A. Glasgow Coma Scale score of 14
B. Pupils equal and reactive at 3 mm
C. Glasgow Coma Scale score of 8 with unilateral pupil dilation [CORRECT]
D. Patient is awake and oriented
Correct Answer: C. Glasgow Coma Scale score of 8 with unilateral pupil dilation
Rationale: A GCS score of 8 indicates coma requiring airway protection, and unilateral pupil dilation suggests herniation
syndrome from increased ICP. This is a neurosurgical emergency requiring immediate intervention. GCS 14 indicates mild
impairment; pupils 3 mm PERLA is normal. TNCC 9th Edition emphasizes that D (Disability) assessment includes GCS,
pupillary assessment, and gross motor assessment to identify life-threatening neurologic conditions requiring immediate
intervention.
Q6. A trauma patient arrives with severe facial injuries and blood in the airway. The nurse is performing airway
assessment with C-spine protection. Which intervention should be performed FIRST?
A. Immediate orotracheal intubation without suctioning
B. Suction the airway and apply manual inline stabilization [CORRECT]
C. Place a nasal airway and position supine
D. Perform a cricothyroidotomy immediately
Correct Answer: B. Suction the airway and apply manual inline stabilization
Rationale: The first step is to clear the airway of blood and secretions with suctioning while maintaining C-spine stabilization
with manual inline stabilization. Intubation may be needed after suctioning but cannot be done safely with a blood-filled airway.
Nasal airway is contraindicated with suspected facial/basilar skull fractures. Cricothyroidotomy is the surgical airway of last
resort. TNCC 9th Edition emphasizes maintaining C-spine protection throughout airway management.
Q7. A trauma nurse is applying adjuncts to the primary survey. Which adjunct should be placed in a patient with
suspected intra-abdominal hemorrhage and hypotension?
TNCC 9th Edition Test Bank (2026/2027) | Page 2
,TNCC 9th Edition Test Bank
A. 12-lead ECG
B. Focused Assessment with Sonography for Trauma (FAST) exam [CORRECT]
C. CT scan of the abdomen
D. MRI of the abdomen
Correct Answer: B. Focused Assessment with Sonography for Trauma (FAST) exam
Rationale: The FAST exam is a rapid bedside ultrasound that identifies free fluid (blood) in the abdomen, pericardium, or
pleural spaces. It is a primary survey adjunct for unstable patients with suspected internal hemorrhage. 12-lead ECG is useful
but not for hemorrhage identification. CT scan is for stable patients. MRI is inappropriate for trauma due to time and metallic
concerns. TNCC 9th Edition includes FAST as a key adjunct to identify bleeding sources rapidly.
Q8. A trauma patient's family arrives demanding to be present during resuscitation. Which action by the trauma
nurse follows current ENA recommendations?
A. Refuse family presence to maintain order
B. Allow family presence with a designated family support person [CORRECT]
C. Allow family presence only if the patient dies
D. Call security to remove the family
Correct Answer: B. Allow family presence with a designated family support person
Rationale: ENA supports family presence during resuscitation when appropriate, with a designated family support person to
explain procedures and provide emotional support. Refusing family presence, allowing only at death, or calling security
disregards evidence-based practice. TNCC 9th Edition includes family presence as an important component of patient- and
family-centered trauma care, with protocols to assess appropriateness and provide support.
Q9. A trauma nurse is completing a secondary survey using the AMPLE history format. What does the "A" in
AMPLE stand for?
A. Airway
B. Allergies [CORRECT]
C. Assessment
D. Age
Correct Answer: B. Allergies
Rationale: AMPLE stands for Allergies, Medications, Past medical history/operations, Last meal, and Events/Environment
related to the trauma. Airway, Assessment, and Age are not part of AMPLE. TNCC 9th Edition uses AMPLE as the structured
history-taking format during the secondary survey to obtain critical information that influences trauma management decisions.
Q10. A trauma patient arrives with paradoxical movement of the left chest wall during respiration. Which injury
should the nurse suspect, and what is the priority intervention?
A. Simple pneumothorax - observe
B. Flail chest - provide oxygen and positive pressure ventilation [CORRECT]
C. Hemothorax - chest tube insertion
D. Cardiac tamponade - pericardiocentesis
Correct Answer: B. Flail chest - provide oxygen and positive pressure ventilation
Rationale: Paradoxical chest wall movement is the hallmark of flail chest (two or more fractures in two or more adjacent ribs).
The priority intervention is oxygen and positive pressure ventilation (such as CPAP or mechanical ventilation) to splint the chest
internally and improve oxygenation. Simple pneumothorax does not cause paradoxical movement. Hemothorax causes dullness
and decreased breath sounds. Cardiac tamponade causes Beck's triad. TNCC 9th Edition emphasizes that flail chest with
respiratory compromise requires positive pressure ventilation.
TNCC 9th Edition Test Bank (2026/2027) | Page 3
, TNCC 9th Edition Test Bank
Q11. A trauma patient is brought to the emergency department after a high-speed motor vehicle crash. The patient is
talking but confused. The nurse should perform which action FIRST?
A. Obtain a complete blood count
B. Perform the primary survey [CORRECT]
C. Insert a urinary catheter
D. Obtain a CT scan
Correct Answer: B. Perform the primary survey
Rationale: The primary survey (ABCDE) is the first step in trauma assessment to identify and treat life-threatening conditions in
order of priority. CBC, urinary catheter, and CT scan are secondary survey or adjunct interventions that follow the primary
survey. TNCC 9th Edition emphasizes that the primary survey always precedes diagnostic tests unless life-threatening conditions
are identified that require simultaneous intervention.
Q12. A trauma patient has an open pneumothorax (sucking chest wound). Which intervention should the nurse
perform FIRST?
A. Cover the wound with an occlusive dressing taped on three sides [CORRECT]
B. Cover the wound with an occlusive dressing taped on all four sides
C. Insert a chest tube immediately
D. Apply direct pressure
Correct Answer: A. Cover the wound with an occlusive dressing taped on three sides
Rationale: An occlusive dressing taped on three sides allows air to escape during exhalation but prevents air from entering
during inhalation, preventing progression to tension pneumothorax. Taping on all four sides can create tension pneumothorax.
Chest tube insertion follows the occlusive dressing. Direct pressure does not address the airway issue. TNCC 9th Edition
specifies the three-sided occlusive dressing as the initial treatment for open pneumothorax.
Q13. A trauma patient has a GCS score of 7. According to TNCC 9th Edition guidelines, which intervention is
indicated?
A. Observation and frequent neurological checks
B. Definitive airway management [CORRECT]
C. CT scan only
D. Discharge home
Correct Answer: B. Definitive airway management
Rationale: A GCS score of 8 or less indicates coma and the need for definitive airway management (endotracheal intubation or
surgical airway) to protect the airway and ensure adequate ventilation. Observation alone is inadequate. CT scan follows airway
management. Discharge is inappropriate. TNCC 9th Edition establishes that GCS <=8 is an indication for intubation to protect
the airway.
Q14. A trauma patient arrives with suspected pelvic fracture and hypotension. Which intervention should the nurse
anticipate to help control hemorrhage?
A. Foley catheter insertion
B. Application of a pelvic binder [CORRECT]
C. Bilateral chest tubes
D. Central line placement
Correct Answer: B. Application of a pelvic binder
Rationale: A pelvic binder stabilizes pelvic fractures and reduces pelvic volume, which helps control hemorrhage from pelvic
venous bleeding. Foley catheter is contraindicated until urethral injury is ruled out. Chest tubes are for thoracic injuries. Central
line is for vascular access, not hemorrhage control. TNCC 9th Edition recommends pelvic binder application for unstable pelvic
TNCC 9th Edition Test Bank (2026/2027) | Page 4
