TNCC 9th Edition study guide with questions, answers and
rationales and some extra quick notes
Trauma Nursing Exam Study Guide: Questions, Answers, Rationales & Quick Review
Section 1: Multiple-Choice Questions
1. A patient thrown from a bicycle without a helmet has clear drainage from the ear. What is the most
appropriate next step?
A. Clean the ear with a cotton-tipped applicator
B. Pack the ear with gauze
C. Notify the treating clinician
D. Document and continue the examination
Correct answer: C. Notify the treating clinician
Rationale: Clear otorrhea after head trauma may indicate a basilar skull fracture or cerebrospinal fluid leak. Do
not pack or instrument the ear.
2. At a rural hospital, a patient injured in a high-speed MVC has significant abdominal and pelvic
injuries. What is the priority?
A. Initiate transfer to an appropriate trauma center
B. Attempt family notification
C. Obtain additional imaging before arranging care
D. Insert an indwelling urinary catheter
Correct answer: A. Initiate transfer to an appropriate trauma center
Rationale: Arrange timely transfer while continuing immediate stabilization within the facility’s capabilities.
3. A confused adult fell from a second-story roof and has an obvious open lower-extremity injury.
Respirations are unlabored and radial pulses are strong. What is the priority intervention?
A. Initiate cervical spine stabilization / spinal motion restriction
B. Apply a splint before addressing the spine
C. Apply portable oxygen regardless of oxygenation
D. Log-roll immediately onto a spine board
Correct answer: A. Initiate cervical spine stabilization / spinal motion restriction
Rationale: High-energy trauma with confusion requires attention to potential cervical spine injury while the
primary survey continues.
4. A patient with severe traumatic brain injury is being manually ventilated at 18 breaths/min. PaCO ₂ is
30 mm Hg and SpO₂ is 92%. What intervention best addresses cerebral blood flow?
A. Decrease the rate of manual ventilation
B. Give another fluid bolus without reassessment
C. Recheck tube placement as the only intervention
D. Increase oxygen delivery without reassessing ventilation
Correct answer: A. Decrease the rate of manual ventilation
TNCC 9th Edition Study Guide | Page 1
, Rationale: Hypocapnia can cause cerebral vasoconstriction and reduce cerebral blood flow. Avoid inadvertent
hyperventilation unless specifically indicated by an emergency protocol.
5. A patient after a rollover MVC has proximal-thigh bruising and swelling, a weak pedal pulse, and pale,
cool, moist skin. What intervention is most appropriate when pelvic injury is suspected?
A. Apply a tourniquet to the thigh without evidence of external hemorrhage
B. Apply a pelvic binder when indicated
C. Give fluid solely to reach a urine-output target before controlling hemorrhage
D. Use oxygen to maintain ETCO₂ at 30–35 mm Hg
Correct answer: B. Apply a pelvic binder when indicated
Rationale: A suspected unstable pelvic fracture with shock may require pelvic stabilization and rapid
hemorrhage management.
6. Which situation is associated with functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of self-image
D. Destruction of a car
Correct answer: B. Amputation of a limb
Rationale: Functional grief can relate to loss of body function or a body part, such as amputation, paralysis, or
loss of sight.
7. What is an important consideration in the initial assessment of an older adult with serious injuries?
A. Assume they will be fearful in the ED
B. Obtain medical history, including current medications
C. Assess discharge support before primary survey
D. Confirm access to a primary care clinician before stabilization
Correct answer: B. Obtain medical history, including current medications
Rationale: Medication use, comorbidities, and baseline function can affect assessment and treatment. Do not
delay the primary survey to obtain history.
8. When should the definitive burn-fluid calculation be made?
A. Immediately on arrival before assessment
B. After clothing is removed and burn extent can be assessed
C. Only after arrival at a burn center
D. During circulation assessment without estimating burn size
Correct answer: B. After clothing is removed and burn extent can be assessed
Rationale: Initial resuscitation begins as indicated, but a more accurate calculation requires assessment of burn
size and total body surface area.
9. Which motor-vehicle injury pathway is associated with particularly high morbidity and mortality?
A. Rotation
B. Ejection
C. Lateral impact only
D. Rollover only
Correct answer: B. Ejection
Rationale: Ejection from a vehicle is associated with severe injury risk; all mechanisms still require clinical
assessment.
TNCC 9th Edition Study Guide | Page 2
rationales and some extra quick notes
Trauma Nursing Exam Study Guide: Questions, Answers, Rationales & Quick Review
Section 1: Multiple-Choice Questions
1. A patient thrown from a bicycle without a helmet has clear drainage from the ear. What is the most
appropriate next step?
A. Clean the ear with a cotton-tipped applicator
B. Pack the ear with gauze
C. Notify the treating clinician
D. Document and continue the examination
Correct answer: C. Notify the treating clinician
Rationale: Clear otorrhea after head trauma may indicate a basilar skull fracture or cerebrospinal fluid leak. Do
not pack or instrument the ear.
2. At a rural hospital, a patient injured in a high-speed MVC has significant abdominal and pelvic
injuries. What is the priority?
A. Initiate transfer to an appropriate trauma center
B. Attempt family notification
C. Obtain additional imaging before arranging care
D. Insert an indwelling urinary catheter
Correct answer: A. Initiate transfer to an appropriate trauma center
Rationale: Arrange timely transfer while continuing immediate stabilization within the facility’s capabilities.
3. A confused adult fell from a second-story roof and has an obvious open lower-extremity injury.
Respirations are unlabored and radial pulses are strong. What is the priority intervention?
A. Initiate cervical spine stabilization / spinal motion restriction
B. Apply a splint before addressing the spine
C. Apply portable oxygen regardless of oxygenation
D. Log-roll immediately onto a spine board
Correct answer: A. Initiate cervical spine stabilization / spinal motion restriction
Rationale: High-energy trauma with confusion requires attention to potential cervical spine injury while the
primary survey continues.
4. A patient with severe traumatic brain injury is being manually ventilated at 18 breaths/min. PaCO ₂ is
30 mm Hg and SpO₂ is 92%. What intervention best addresses cerebral blood flow?
A. Decrease the rate of manual ventilation
B. Give another fluid bolus without reassessment
C. Recheck tube placement as the only intervention
D. Increase oxygen delivery without reassessing ventilation
Correct answer: A. Decrease the rate of manual ventilation
TNCC 9th Edition Study Guide | Page 1
, Rationale: Hypocapnia can cause cerebral vasoconstriction and reduce cerebral blood flow. Avoid inadvertent
hyperventilation unless specifically indicated by an emergency protocol.
5. A patient after a rollover MVC has proximal-thigh bruising and swelling, a weak pedal pulse, and pale,
cool, moist skin. What intervention is most appropriate when pelvic injury is suspected?
A. Apply a tourniquet to the thigh without evidence of external hemorrhage
B. Apply a pelvic binder when indicated
C. Give fluid solely to reach a urine-output target before controlling hemorrhage
D. Use oxygen to maintain ETCO₂ at 30–35 mm Hg
Correct answer: B. Apply a pelvic binder when indicated
Rationale: A suspected unstable pelvic fracture with shock may require pelvic stabilization and rapid
hemorrhage management.
6. Which situation is associated with functional grief?
A. Inability to live at home
B. Amputation of a limb
C. Loss of self-image
D. Destruction of a car
Correct answer: B. Amputation of a limb
Rationale: Functional grief can relate to loss of body function or a body part, such as amputation, paralysis, or
loss of sight.
7. What is an important consideration in the initial assessment of an older adult with serious injuries?
A. Assume they will be fearful in the ED
B. Obtain medical history, including current medications
C. Assess discharge support before primary survey
D. Confirm access to a primary care clinician before stabilization
Correct answer: B. Obtain medical history, including current medications
Rationale: Medication use, comorbidities, and baseline function can affect assessment and treatment. Do not
delay the primary survey to obtain history.
8. When should the definitive burn-fluid calculation be made?
A. Immediately on arrival before assessment
B. After clothing is removed and burn extent can be assessed
C. Only after arrival at a burn center
D. During circulation assessment without estimating burn size
Correct answer: B. After clothing is removed and burn extent can be assessed
Rationale: Initial resuscitation begins as indicated, but a more accurate calculation requires assessment of burn
size and total body surface area.
9. Which motor-vehicle injury pathway is associated with particularly high morbidity and mortality?
A. Rotation
B. Ejection
C. Lateral impact only
D. Rollover only
Correct answer: B. Ejection
Rationale: Ejection from a vehicle is associated with severe injury risk; all mechanisms still require clinical
assessment.
TNCC 9th Edition Study Guide | Page 2
