TNCC 9TH EDITION RENEWAL COMPREHENSIVE
PRACTICE EXAMINATION 2026/2027 UPDATE.
INTRODUCTION
This comprehensive practice examination is designed for trauma nurses preparing for the
Trauma Nursing Core Course (TNCC) 9th Edition Renewal Exam. The examination covers
all essential domains including the Trauma Nursing Process (TNP) and primary survey
(ABCDEFGHI), airway and cervical spine management, breathing and ventilation,
circulation and hemorrhage control, shock recognition and management, disability and
neurologic evaluation, special populations (pediatrics, geriatrics, pregnancy, obesity), and
professional nursing considerations. Questions are written at the advanced practice level
expected for TNCC renewal certification, emphasizing clinical reasoning, prioritization,
evidence-based trauma care, and the Emergency Nurses Association (ENA) guidelines. This
resource is intended to help candidates assess their readiness, identify knowledge gaps, and
strengthen their preparation for the renewal certification examination.
TABLE OF CONTENTS
1. Trauma Nursing Process & Primary Survey (ABCDEFGHI)
2. Airway & Cervical Spine Management
3. Breathing & Ventilation
4. Circulation & Hemorrhage Control
5. Shock Recognition & Management
6. Disability & Neurologic Evaluation
7. Special Populations (Pediatrics, Geriatrics, Pregnancy, Obesity)
8. Thoracic, Abdominal & Musculoskeletal Injuries
, 9. Comprehensive Scenario-Based Review
SECTION 1 – TRAUMA NURSING PROCESS & PRIMARY SURVEY (ABCDEFGHI)
1. According to the TNCC 9th edition, the primary survey follows which mnemonic?
A) ABCDE
B) MARCH
C) ABCDEFGHI
D) CABDE
Correct Answer: C
Rationale: The TNCC primary survey uses the mnemonic A (Airway with cervical spine
protection), B (Breathing), C (Circulation), D (Disability), E (Exposure), F (Full set of vitals
and family presence), G (Get resuscitation adjuncts), H (History and head-to-toe assessment),
and I (Inspect posterior surfaces).
2. What is the primary goal of the primary survey in trauma care?
A) To identify all injuries
B) To obtain a complete medical history
C) To identify and treat life-threatening conditions
D) To prepare the patient for transfer
Correct Answer: C
Rationale: The primary goal of the primary survey is to rapidly identify and treat life-
threatening conditions in order of priority. A comprehensive history and identification of all
injuries occurs during the secondary survey.
3. During the primary survey, which step occurs simultaneously with airway assessment?
A) Cervical spine immobilization
B) Breathing assessment
C) Circulation assessment
D) Exposure
,Correct Answer: A
Rationale: Cervical spine protection is initiated at the same time as airway assessment to
prevent spinal cord injury in trauma patients.
4. According to the 9th Edition TNP, what is the priority intervention for a patient with an
obvious, massive arterial bleed from the leg?
A) Open the airway
B) Apply a tourniquet
C) Check a pulse
D) Start an IV
Correct Answer: B
Rationale: The 9th Edition prioritizes "C" (Circulation/Exsanguination) before "A" (Airway)
when life-threatening external hemorrhage is present.
5. What is the "Across-the-Room" survey in trauma assessment?
A) A detailed neurologic examination
B) A visual assessment for signs of life-threatening conditions
C) A complete head-to-toe assessment
D) A review of the patient's medical history
Correct Answer: B
Rationale: The "Across-the-Room" survey is part of the initial assessment where the nurse
visually assesses the patient for signs of life-threatening conditions, including gross external
hemorrhage, airway patency, and breathing effort.
6. What does VIPP stand for in the TNCC primary survey?
A) Vital signs, Inspect, Palpate, Percuss
B) Vital signs, IV access, Pain management, Position
C) Vital signs, Inspection, Palpation, Percussion
D) Ventilation, Inspection, Perfusion, Pain
Correct Answer: A
Rationale: VIPP stands for Vital signs, Inspect, Palpate, and Percuss—components of the full
set of vital signs and physical examination during the primary survey.
, 7. What does the "J" stand for at the end of the secondary survey?
A) Joint assessment
B) Just keep evaluating
C) Jugular venous pressure
D) Justice and equity in care
Correct Answer: B
Rationale: In the TNCC primary survey, "J" stands for "Just keep evaluating" (as part of the
ABCDEFGHI mnemonic). This reminds providers that the primary survey is a continuous
process.
8. What is the correct sequence of the Trauma Nursing Process (TNP) according to TNCC
9th Edition?
A) Triage → Primary Survey → Secondary Survey → Reassessment
B) Preparation and Triage → Primary Survey (ABCDE) → Resuscitation Adjuncts → Secondary
Survey (Head-to-Toe) → Reassessment and Ongoing Care
C) Assessment → Intervention → Evaluation → Documentation
D) Primary Survey → Diagnostic Testing → Secondary Survey → Transfer
Correct Answer: B
Rationale: The TNCC 9th Edition emphasizes a standardized approach: Preparation and
Triage, Primary Survey, Resuscitation Adjuncts, Secondary Survey, and Reassessment.
9. A trauma patient is restless and repeatedly asking "where am I?" What does this finding
indicate?
A) The patient is stable and oriented
B) This is a normal response to trauma
C) The patient may be experiencing hypoxia or hypoperfusion
D) The patient needs immediate sedation
Correct Answer: C
Rationale: Restlessness, confusion, and anxiety in a trauma patient are often early signs of
hypoxia or hypoperfusion and should be evaluated during the primary survey.
PRACTICE EXAMINATION 2026/2027 UPDATE.
INTRODUCTION
This comprehensive practice examination is designed for trauma nurses preparing for the
Trauma Nursing Core Course (TNCC) 9th Edition Renewal Exam. The examination covers
all essential domains including the Trauma Nursing Process (TNP) and primary survey
(ABCDEFGHI), airway and cervical spine management, breathing and ventilation,
circulation and hemorrhage control, shock recognition and management, disability and
neurologic evaluation, special populations (pediatrics, geriatrics, pregnancy, obesity), and
professional nursing considerations. Questions are written at the advanced practice level
expected for TNCC renewal certification, emphasizing clinical reasoning, prioritization,
evidence-based trauma care, and the Emergency Nurses Association (ENA) guidelines. This
resource is intended to help candidates assess their readiness, identify knowledge gaps, and
strengthen their preparation for the renewal certification examination.
TABLE OF CONTENTS
1. Trauma Nursing Process & Primary Survey (ABCDEFGHI)
2. Airway & Cervical Spine Management
3. Breathing & Ventilation
4. Circulation & Hemorrhage Control
5. Shock Recognition & Management
6. Disability & Neurologic Evaluation
7. Special Populations (Pediatrics, Geriatrics, Pregnancy, Obesity)
8. Thoracic, Abdominal & Musculoskeletal Injuries
, 9. Comprehensive Scenario-Based Review
SECTION 1 – TRAUMA NURSING PROCESS & PRIMARY SURVEY (ABCDEFGHI)
1. According to the TNCC 9th edition, the primary survey follows which mnemonic?
A) ABCDE
B) MARCH
C) ABCDEFGHI
D) CABDE
Correct Answer: C
Rationale: The TNCC primary survey uses the mnemonic A (Airway with cervical spine
protection), B (Breathing), C (Circulation), D (Disability), E (Exposure), F (Full set of vitals
and family presence), G (Get resuscitation adjuncts), H (History and head-to-toe assessment),
and I (Inspect posterior surfaces).
2. What is the primary goal of the primary survey in trauma care?
A) To identify all injuries
B) To obtain a complete medical history
C) To identify and treat life-threatening conditions
D) To prepare the patient for transfer
Correct Answer: C
Rationale: The primary goal of the primary survey is to rapidly identify and treat life-
threatening conditions in order of priority. A comprehensive history and identification of all
injuries occurs during the secondary survey.
3. During the primary survey, which step occurs simultaneously with airway assessment?
A) Cervical spine immobilization
B) Breathing assessment
C) Circulation assessment
D) Exposure
,Correct Answer: A
Rationale: Cervical spine protection is initiated at the same time as airway assessment to
prevent spinal cord injury in trauma patients.
4. According to the 9th Edition TNP, what is the priority intervention for a patient with an
obvious, massive arterial bleed from the leg?
A) Open the airway
B) Apply a tourniquet
C) Check a pulse
D) Start an IV
Correct Answer: B
Rationale: The 9th Edition prioritizes "C" (Circulation/Exsanguination) before "A" (Airway)
when life-threatening external hemorrhage is present.
5. What is the "Across-the-Room" survey in trauma assessment?
A) A detailed neurologic examination
B) A visual assessment for signs of life-threatening conditions
C) A complete head-to-toe assessment
D) A review of the patient's medical history
Correct Answer: B
Rationale: The "Across-the-Room" survey is part of the initial assessment where the nurse
visually assesses the patient for signs of life-threatening conditions, including gross external
hemorrhage, airway patency, and breathing effort.
6. What does VIPP stand for in the TNCC primary survey?
A) Vital signs, Inspect, Palpate, Percuss
B) Vital signs, IV access, Pain management, Position
C) Vital signs, Inspection, Palpation, Percussion
D) Ventilation, Inspection, Perfusion, Pain
Correct Answer: A
Rationale: VIPP stands for Vital signs, Inspect, Palpate, and Percuss—components of the full
set of vital signs and physical examination during the primary survey.
, 7. What does the "J" stand for at the end of the secondary survey?
A) Joint assessment
B) Just keep evaluating
C) Jugular venous pressure
D) Justice and equity in care
Correct Answer: B
Rationale: In the TNCC primary survey, "J" stands for "Just keep evaluating" (as part of the
ABCDEFGHI mnemonic). This reminds providers that the primary survey is a continuous
process.
8. What is the correct sequence of the Trauma Nursing Process (TNP) according to TNCC
9th Edition?
A) Triage → Primary Survey → Secondary Survey → Reassessment
B) Preparation and Triage → Primary Survey (ABCDE) → Resuscitation Adjuncts → Secondary
Survey (Head-to-Toe) → Reassessment and Ongoing Care
C) Assessment → Intervention → Evaluation → Documentation
D) Primary Survey → Diagnostic Testing → Secondary Survey → Transfer
Correct Answer: B
Rationale: The TNCC 9th Edition emphasizes a standardized approach: Preparation and
Triage, Primary Survey, Resuscitation Adjuncts, Secondary Survey, and Reassessment.
9. A trauma patient is restless and repeatedly asking "where am I?" What does this finding
indicate?
A) The patient is stable and oriented
B) This is a normal response to trauma
C) The patient may be experiencing hypoxia or hypoperfusion
D) The patient needs immediate sedation
Correct Answer: C
Rationale: Restlessness, confusion, and anxiety in a trauma patient are often early signs of
hypoxia or hypoperfusion and should be evaluated during the primary survey.
