TNCC 9th Edition Final Exam 2025 -
Questions and Answers
1. Why is a measure of serum lactate obtained in the initial assessment of the trauma
patient?
a) To measure oxygenation and ventilation
b) To quantify the base deficit for the adequacy of cellular perfusion
c) To gauge end-organ perfusion and tissue hypoxia
d) To determine the underlying cause of shock
Answer: C
2. A trauma patient is restless and repeatedly asking "Where am I?" Vital signs on arrival:
BP 100/60 mm Hg, HR 96 bpm, RR 24 breaths/min. Current vitals: BP 104/84 mm Hg,
HR 108 bpm, RR 28 breaths/min. This patient is demonstrating signs and symptoms of
which stage of shock?
a) Compensated
b) Progressive
c) Irreversible
d) Decompensated
Answer: A
3. An elderly patient on anticoagulants presents with a fall and hematoma on the forehead,
headache, dizziness, and nausea. What is the most likely cause of symptoms?
a) Epidural hematoma
b) Diffuse axonal injury
c) Post-concussive syndrome
d) Subdural hematoma
Answer: D
4. EMS brings in a bicyclist who fell. According to the American College of Surgeons
screening guidelines, which assessment finding would prompt preparation for radiologic
spine clearance?
a) Alert with no neurologic deficits
b) Multiple abrasions to extremities
c) Multiple requests for water
d) Smell of alcohol on breath
Answer: D
5. What occurs during the third impact of a motor vehicle crash?
a) Driver collides with the steering wheel
, b) Vehicle collides with a tree
c) The aorta is torn at its attachment with the ligamentum arteriosum
d) Airbag deploys and strikes the front seat passenger
Answer: C
6. A patient with bilateral femoral fractures is pale, alert, disoriented, and has delayed
capillary refill. Which intervention is most appropriate based on disaster triage
principles?
a) Initiate two large-caliber IV lines for Ringer's lactate administration
b) Administer Dilaudid for pain control and comfort
c) Place patient in observation area for care within hours
d) Contact command center to notify next of kin
Answer: A
7. Which injury is least likely to be promptly identified in trauma?
a) Spleen
b) Lung
c) Bowel
d) Brain
Answer: C
8. What condition should be closely monitored in patients with crush injuries?
a) Hypernatremia
b) Hypercalcemia
c) Dysrhythmias
d) Polyuria
Answer: C
9. What finding suggests complete spinal cord injury?
a) Weakness in lower extremities
b) Priapism
c) Voluntary anal sphincter tone
d) Intact reflexes distal to injury
Answer: B
10.A patient with complete spinal cord injury in neurogenic shock will exhibit hypotension
and which other clinical signs?
a) Bradycardia and ipsilateral absence of motor function
b) Tachycardia and respiratory depression
c) Tachycardia and absent motor function below injury
d) Bradycardia and absent motor function below injury
Answer: D
, 11.A patient with multiple bruises to various healing stages presents. What is the priority
nursing intervention?
a) Report suspected maltreatment per local regulations
b) Apply ice and consult wound care
c) Engage in therapeutic communication to determine mechanism of injury
d) Provide family with injury prevention resources
Answer: A
12.Which intervention is most appropriate for a patient with severe calf pain after lower
extremity fracture?
a) Elevate extremity above level of heart
b) Reposition and apply ice
c) Elevate extremity to level of heart
d) Prepare for ultrasound
Answer: C
13.Following a fall, a patient has a wrist deformity and is reluctant to move due to pain.
What is the most appropriate intervention?
a) Apply a sling and elevate extremity to level of heart
b) Apply splint and elevate above level of heart
c) Apply sling and elevate above level of heart
d) Apply splint and elevate to level of heart
Answer: B
14.What is a late sign of increased intracranial pressure?
a) Restlessness or drowsiness
b) Nausea and vomiting
c) Decreased respiratory effort
d) Amnesia and anxiety
Answer: C
15.Which mnemonic helps prioritize care for trauma patients with massive uncontrolled
hemorrhage?
a) ABC
b) MARCH
c) AVPU
d) VIPP
Answer: B
16.A passenger is brought to the emergency department of a rural hospital following a
high-speed MVC. Significant abdominal and pelvic injuries are noted in the primary
survey. What is the priority intervention?
Answer: A) Initiate transfer to a trauma center
Questions and Answers
1. Why is a measure of serum lactate obtained in the initial assessment of the trauma
patient?
a) To measure oxygenation and ventilation
b) To quantify the base deficit for the adequacy of cellular perfusion
c) To gauge end-organ perfusion and tissue hypoxia
d) To determine the underlying cause of shock
Answer: C
2. A trauma patient is restless and repeatedly asking "Where am I?" Vital signs on arrival:
BP 100/60 mm Hg, HR 96 bpm, RR 24 breaths/min. Current vitals: BP 104/84 mm Hg,
HR 108 bpm, RR 28 breaths/min. This patient is demonstrating signs and symptoms of
which stage of shock?
a) Compensated
b) Progressive
c) Irreversible
d) Decompensated
Answer: A
3. An elderly patient on anticoagulants presents with a fall and hematoma on the forehead,
headache, dizziness, and nausea. What is the most likely cause of symptoms?
a) Epidural hematoma
b) Diffuse axonal injury
c) Post-concussive syndrome
d) Subdural hematoma
Answer: D
4. EMS brings in a bicyclist who fell. According to the American College of Surgeons
screening guidelines, which assessment finding would prompt preparation for radiologic
spine clearance?
a) Alert with no neurologic deficits
b) Multiple abrasions to extremities
c) Multiple requests for water
d) Smell of alcohol on breath
Answer: D
5. What occurs during the third impact of a motor vehicle crash?
a) Driver collides with the steering wheel
, b) Vehicle collides with a tree
c) The aorta is torn at its attachment with the ligamentum arteriosum
d) Airbag deploys and strikes the front seat passenger
Answer: C
6. A patient with bilateral femoral fractures is pale, alert, disoriented, and has delayed
capillary refill. Which intervention is most appropriate based on disaster triage
principles?
a) Initiate two large-caliber IV lines for Ringer's lactate administration
b) Administer Dilaudid for pain control and comfort
c) Place patient in observation area for care within hours
d) Contact command center to notify next of kin
Answer: A
7. Which injury is least likely to be promptly identified in trauma?
a) Spleen
b) Lung
c) Bowel
d) Brain
Answer: C
8. What condition should be closely monitored in patients with crush injuries?
a) Hypernatremia
b) Hypercalcemia
c) Dysrhythmias
d) Polyuria
Answer: C
9. What finding suggests complete spinal cord injury?
a) Weakness in lower extremities
b) Priapism
c) Voluntary anal sphincter tone
d) Intact reflexes distal to injury
Answer: B
10.A patient with complete spinal cord injury in neurogenic shock will exhibit hypotension
and which other clinical signs?
a) Bradycardia and ipsilateral absence of motor function
b) Tachycardia and respiratory depression
c) Tachycardia and absent motor function below injury
d) Bradycardia and absent motor function below injury
Answer: D
, 11.A patient with multiple bruises to various healing stages presents. What is the priority
nursing intervention?
a) Report suspected maltreatment per local regulations
b) Apply ice and consult wound care
c) Engage in therapeutic communication to determine mechanism of injury
d) Provide family with injury prevention resources
Answer: A
12.Which intervention is most appropriate for a patient with severe calf pain after lower
extremity fracture?
a) Elevate extremity above level of heart
b) Reposition and apply ice
c) Elevate extremity to level of heart
d) Prepare for ultrasound
Answer: C
13.Following a fall, a patient has a wrist deformity and is reluctant to move due to pain.
What is the most appropriate intervention?
a) Apply a sling and elevate extremity to level of heart
b) Apply splint and elevate above level of heart
c) Apply sling and elevate above level of heart
d) Apply splint and elevate to level of heart
Answer: B
14.What is a late sign of increased intracranial pressure?
a) Restlessness or drowsiness
b) Nausea and vomiting
c) Decreased respiratory effort
d) Amnesia and anxiety
Answer: C
15.Which mnemonic helps prioritize care for trauma patients with massive uncontrolled
hemorrhage?
a) ABC
b) MARCH
c) AVPU
d) VIPP
Answer: B
16.A passenger is brought to the emergency department of a rural hospital following a
high-speed MVC. Significant abdominal and pelvic injuries are noted in the primary
survey. What is the priority intervention?
Answer: A) Initiate transfer to a trauma center
