TNCC 9 TH EDITION FINAL ACTUAL EXAM NEWEST VERSION
2025/2026 QUESTION AND CORRECT DETAILED VERIFIED
ANSWERS FROM VERIFIED SOURCES RATED A GRADE.
An adult patient who sustained a severe head trauma has been
intubated and is being manually ventilated via a bag-mask
device at a rate of 18 breaths/minute. The patient has received
one intravenous fluid bolus of 500 mL of warmed isotonic
crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the
pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most
important intervention to manage the cerebral blood flow? A.
Decrease the rate of manual ventilation
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.
A. Decrease the rate of manual ventilation –ANSWER.
A patient with a traumatic brain injury has a mean arterial
pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial
pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most
likely an indication of the body's response to these findings?
A. Increased respiratory effort
B. Widening pulse pressure
C. Reflex tachycardia
,D. Reflex hypotension
B. Widening pulse pressure –ANSWER.
Rationale: Head and Torso Trauma\Head Trauma
This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8
kPa) which is associated with poor outcomes. When the CPP
falls below normal levels, the central nervous system initiates
the Cushing response in an attempt to increase mean arterial
pressure and improve CPP. Cushing response assessment
findings include widening pulse pressure, reflex bradycardia,
and irregular, decreased respiratory effort.
A patient presents, after a 25-foot fall, with paradoxical chest
wall movement to the right lower chest and complaints of
shortness of breath. What is the priority intervention?
A. Surgical intervention
B. Chest tube insertion
C. Needle decompression
D. Airway and ventilation support D. Airway and ventilation
support –ANSWER.
A trauma patient is being held in the emergency department
because there are no available inpatient beds. The patient
sustained a femur fracture and required multiple blood products.
The patient now has blood oozing from abrasions, IV sites, the
nose, and gums. What condition is most consistent with these
findings? A. Rhabdomyolysis
B. Fat embolism
,C. Disseminated intravascular coagulopathy
D. Multiple organ dysfunctions syndrome
C. Disseminated intravascular coagulopathy -ANSWER
An older adult presents to the emergency department with
complaints of dizziness, headache, and nausea. The patient was
involved in a motor vehicle collision 10 days ago. There was no
loss of consciousness and a hematoma is noted to the forehead.
The patient is currently on anticoagulant therapy. What is most
likely the cause of their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
C. Diffuse axonal injury
D. Post-concussive syndrome
D. Post-concussive syndrome –ANSWER.
Rationale: Special Populations\Older Adult
Post-concussive syndrome can occur days to weeks after injury
or trauma. The other three conditions present as a more rapid
decline, especially in patients who are on anticoagulants.
Your patient was the unrestrained driver involved in a moderate
speed motor vehicle collision. Assessment reveals tenderness
in the upper right quadrant, crepitus in the lower right ribs, and
ecchymosis around the umbilicus. The nurse is concerned
about injury to which organ?
A. Transverse colon
B. Pancreas
, C. Liver
D. Spleen
C. Liver –ANSWER.
Rationale: Head and Torso Trauma\Abdominal and Pelvic
Trauma
Liver injuries are associated with right, lower rib fractures. They
also can present with tenderness, guarding, or rigidity in the
right upper quadrant, along with ecchymosis of the right upper
quadrant or around the umbilicus, known as
Cullen's sign
A 35-year-old male presents with facial trauma after being
struck in the face with a baseball. A teardrop-shaped left pupil
is noted on exam. What type of injury is suspected? A.
Oculomotor nerve palsy
B. Globe rupture
C. Retrobulbar hematoma
D. Retinal detachment
B. Globe rupture –ANSWER.
Rationale: Head and Torso Trauma\Head Trauma
The globe of the eye consists of multiple layers. The sclera is the
white outer layer, while the cornea covers the iris and pupil.
When a full thickness injury occurs to the cornea, sclera, or
both, the globe will rupture, causing the shape of the pupil to
become irregular or teardrop-shaped
2025/2026 QUESTION AND CORRECT DETAILED VERIFIED
ANSWERS FROM VERIFIED SOURCES RATED A GRADE.
An adult patient who sustained a severe head trauma has been
intubated and is being manually ventilated via a bag-mask
device at a rate of 18 breaths/minute. The patient has received
one intravenous fluid bolus of 500 mL of warmed isotonic
crystalloid solution. The PaCO2 is 30 mm Hg (4.0 kPa), and the
pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most
important intervention to manage the cerebral blood flow? A.
Decrease the rate of manual ventilation
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.
A. Decrease the rate of manual ventilation –ANSWER.
A patient with a traumatic brain injury has a mean arterial
pressure (MAP) of 65 mm Hg (8.66 kPa) and an intracranial
pressure (ICP) of 22 mm Hg (2.93 kPa). Which finding is most
likely an indication of the body's response to these findings?
A. Increased respiratory effort
B. Widening pulse pressure
C. Reflex tachycardia
,D. Reflex hypotension
B. Widening pulse pressure –ANSWER.
Rationale: Head and Torso Trauma\Head Trauma
This patient has a CPP (MAP − ICP) of less than 60 mm Hg (8
kPa) which is associated with poor outcomes. When the CPP
falls below normal levels, the central nervous system initiates
the Cushing response in an attempt to increase mean arterial
pressure and improve CPP. Cushing response assessment
findings include widening pulse pressure, reflex bradycardia,
and irregular, decreased respiratory effort.
A patient presents, after a 25-foot fall, with paradoxical chest
wall movement to the right lower chest and complaints of
shortness of breath. What is the priority intervention?
A. Surgical intervention
B. Chest tube insertion
C. Needle decompression
D. Airway and ventilation support D. Airway and ventilation
support –ANSWER.
A trauma patient is being held in the emergency department
because there are no available inpatient beds. The patient
sustained a femur fracture and required multiple blood products.
The patient now has blood oozing from abrasions, IV sites, the
nose, and gums. What condition is most consistent with these
findings? A. Rhabdomyolysis
B. Fat embolism
,C. Disseminated intravascular coagulopathy
D. Multiple organ dysfunctions syndrome
C. Disseminated intravascular coagulopathy -ANSWER
An older adult presents to the emergency department with
complaints of dizziness, headache, and nausea. The patient was
involved in a motor vehicle collision 10 days ago. There was no
loss of consciousness and a hematoma is noted to the forehead.
The patient is currently on anticoagulant therapy. What is most
likely the cause of their symptoms?
A. Intracerebral hemorrhage
B. Epidural hematoma
C. Diffuse axonal injury
D. Post-concussive syndrome
D. Post-concussive syndrome –ANSWER.
Rationale: Special Populations\Older Adult
Post-concussive syndrome can occur days to weeks after injury
or trauma. The other three conditions present as a more rapid
decline, especially in patients who are on anticoagulants.
Your patient was the unrestrained driver involved in a moderate
speed motor vehicle collision. Assessment reveals tenderness
in the upper right quadrant, crepitus in the lower right ribs, and
ecchymosis around the umbilicus. The nurse is concerned
about injury to which organ?
A. Transverse colon
B. Pancreas
, C. Liver
D. Spleen
C. Liver –ANSWER.
Rationale: Head and Torso Trauma\Abdominal and Pelvic
Trauma
Liver injuries are associated with right, lower rib fractures. They
also can present with tenderness, guarding, or rigidity in the
right upper quadrant, along with ecchymosis of the right upper
quadrant or around the umbilicus, known as
Cullen's sign
A 35-year-old male presents with facial trauma after being
struck in the face with a baseball. A teardrop-shaped left pupil
is noted on exam. What type of injury is suspected? A.
Oculomotor nerve palsy
B. Globe rupture
C. Retrobulbar hematoma
D. Retinal detachment
B. Globe rupture –ANSWER.
Rationale: Head and Torso Trauma\Head Trauma
The globe of the eye consists of multiple layers. The sclera is the
white outer layer, while the cornea covers the iris and pupil.
When a full thickness injury occurs to the cornea, sclera, or
both, the globe will rupture, causing the shape of the pupil to
become irregular or teardrop-shaped
