TNCC Trauma Nursing Core Course Exam
Questions with Complete Solutions Latest
Update
Initial Assessment - Answer-1. Preparation and Triage
2. Primary Survey
3. Re-evaluation
4. Secondary Survey
5. Re-evaluation Adjuncts
6. Re-evaluation and Post Resuscitation Care
7. Definitive Care or Transport
A (Primary Survey) - Answer-Airway and alertness with simultaneous cervical spinal
stabilization.
Alertness Assessment - Answer-A-Alert
V-Verbal
P-Painful
U-Unresponsive
Airway Assessment - Answer-Inspect: tongue obstruction, loose/missing teeth, foreign
objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous
emphysema
Airway Interventions: - Answer-Suction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
A (AVPU) - Answer-Alert. Will be able to maintain airway once clear.
V (AVPU) - Answer-Verbal. Needs verbal stimuli to respond.
(Airway adjunct may be needed to prevent tongue obstruction)
P (AVPU) - Answer-Painful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
U (AVPU) - Answer-Unresponsive. Does not respond to any stimuli.
, B (Primary Survey) - Answer-Breathing and Ventilation
Breathing and Ventilation Assessment - Answer-Inspect: spontaneous breathing,
symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,
diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),
contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces
(sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space
midclavicular line and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV
pulsations at suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open
pneumothorax, tension pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - Answer-Breathing absent: jaw-thrust maneuver,
oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or
higher. If ineffective: assist with bag-mask and determine need for definitive airway
C (Primary Survey) - Answer-Circulation and Control of Hemorrhage
Circulation and Control of Hemorrhage Assessment - Answer-Inspect: Uncontrolled
external bleeding, skin color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - Answer-Control and treat external
bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial
sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis
and may cause hypothermia. Component therapy, including administering RBC, plasma
and platelets is a balanced approach so that O2 delivery is optimized, acidosis
corrected and coagulopathy prevented.
Questions with Complete Solutions Latest
Update
Initial Assessment - Answer-1. Preparation and Triage
2. Primary Survey
3. Re-evaluation
4. Secondary Survey
5. Re-evaluation Adjuncts
6. Re-evaluation and Post Resuscitation Care
7. Definitive Care or Transport
A (Primary Survey) - Answer-Airway and alertness with simultaneous cervical spinal
stabilization.
Alertness Assessment - Answer-A-Alert
V-Verbal
P-Painful
U-Unresponsive
Airway Assessment - Answer-Inspect: tongue obstruction, loose/missing teeth, foreign
objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury
Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor)
Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous
emphysema
Airway Interventions: - Answer-Suction
Remove foreign body if noted
Jaw thrust maneuver (maintain cspine)
Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag)
Consider definitive airway
A (AVPU) - Answer-Alert. Will be able to maintain airway once clear.
V (AVPU) - Answer-Verbal. Needs verbal stimuli to respond.
(Airway adjunct may be needed to prevent tongue obstruction)
P (AVPU) - Answer-Painful. Responds only to painful stimuli.
(Airway adjunct may be needed while determining need for intubation)
U (AVPU) - Answer-Unresponsive. Does not respond to any stimuli.
, B (Primary Survey) - Answer-Breathing and Ventilation
Breathing and Ventilation Assessment - Answer-Inspect: spontaneous breathing,
symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use,
diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic),
contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces
(sucking chest wound), JVD, tracheal position, signs of inhalation injury
Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space
midclavicular line and bases at the fifth intercostal space anterior axillary line
Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV
pulsations at suprasternal notch or supraclavicular area
Life-threatening pulmonary injuries requiring immediate intervention: open
pneumothorax, tension pneumothorax, flail chest, hemothorax.
Breathing and Ventilation Intervention - Answer-Breathing absent: jaw-thrust maneuver,
oral airway adjunct, assist ventilation with bag-mask device, prepare for definitive airway
Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or
higher. If ineffective: assist with bag-mask and determine need for definitive airway
C (Primary Survey) - Answer-Circulation and Control of Hemorrhage
Circulation and Control of Hemorrhage Assessment - Answer-Inspect: Uncontrolled
external bleeding, skin color
Auscultate: Muffled heart sounds - may indicate pericardial tamponade
Palpate: carotid and/or femoral pulses for rate, rhythm, strength
Circulation and Control of Hemorrhage Interventions - Answer-Control and treat external
bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial
sites, consider use of a tourniquet.
2 large bore IVs, if unable consider IO, obtain labs and crossmatch.
Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L.
**Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis
and may cause hypothermia. Component therapy, including administering RBC, plasma
and platelets is a balanced approach so that O2 delivery is optimized, acidosis
corrected and coagulopathy prevented.
