TRAUMA NURSING CORE COURSE (TNCC) – 9TH EDITION (2025) –
COMPREHENSIVE STUDY QUESTIONS AND ANSWERS FOR EXAM PREPARATION
An adult pt who sustained a severe head trauma has been intubated and is being manually ventilated via
bag-mask device at a rate of 18 bpm. The pt has received one IV fluid bolus of 500 mL of warm isotonic
crystalloid solution. The PaCO2 is 30 mmHg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70
mmHg. 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 - (answers)a) decrease the rate of manual ventilation
CO2 is the primary regulator of blood flow to the brain. Aggro manual ventilation results in decreased
PaCO2 levels, which results in vasoconstriction, which then leads to decreased ICP and inadequate
delivery of O2 and glucose to the brain. Bagging should be at a rate of one breath every 6 or 10 seconds
A patient with a chest tube transported to the ICU and fluctuation is noted in the water seal chamber
during inspiration and expiration. What is the best action for the nurse to take?
a) clamp the chest tube
b) return to the ED
c) assist with ventilation via bag-mask device
d) continue to ICU - (answers)d) continue to ICU
fluctuation of the water seal chamber during insp and expr is a normal finding
Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and
crying with increased work of breathing and pale skin. which of the following interventions has the
highest priority?
a) stabilizing the cervical spine
b) applying a nonrebreather mask
,c) establishing IV access
d) preparing for drug-assisted intubation - (answers)a) stabilizing the cervical spine
A retained driver involved in a motor vehicle collision is being brought to the ED with abdominal, pelvic,
and bilateral lower extremity pain. Vital signs are BP 147/78, HR 98 bpm. A FAST exam is negative for
fluid in the abdominal and peritoneal cavities. Which of the following should the nurse anticipate?
a) diagnostic peritoneal lavage
b) angiography
c) non-contrast abdominal CT
d) serial abdominal assessments - (answers)d) serial abdominal assessments
The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities
and reduces the need for more invasive testing. However, a negative FAST exam does not rule out injury,
so serial abdominal assessments should occur. If a CT scan is indicated, it should be done with contrast
A patient arrives with a 3-inch laceration to their forearm from a tree branch. Which of the following
methods will the nurse use to remove small pieces of bark and debris from the wound?
a) low pressure irrigation
b) high pressure irrigation
c) scrubbing with normal saline
d) scrubbing with tap water - (answers)b) high pressure irrigation
low pressure irrigation used for larger wounds
Three adults present at different times during a one-hour period with high fever, fatigue, and headache.
All three patients have a rash which started on their mouth, face, and arms with progression to the chest
and abdomen. They all visited the same grocery store within the last week. What is the most appropriate
intervention from the triage of these patients?
a) move them to a decontamination area
, b) mask the patients and send them to the waiting room
c) immediately initiate isolation precautions
d) send them to the waiting room without a mask - (answers)c) immediately initiate isolation
precautions
The fact that mult people with different demographics are appearing with similar signs and symptoms
would alear the nurse to a possible biological exposure. These patients should be placed in isolation to
prevent the possible spread and further determination can be made.
What is the most important consideration during the initial assessment when caring for an older adult
who has sustained serious injuries?
a) they are likely to be fearful in the ED
b) medical history including current medications
c) availability of support systems after discharge
d) accessibility to a primary care physician - (answers)b) medical history including current medications
An adult patient involved in a motor vehicle collision is brought to the ED of a rural critical access facility.
They complain of neck pain, shortness of breath, and diffuse abdominal pain. The Glasgow Coma Scale is
15. Vital signs are BP 98/71, HR 125 bpm, RR 26 bpm, and SpO2 94% on a high-flow oxygen via non-
rebreather mask. Which of the following is the priority intervention for this patient?
a) expedite transport to the CT scanner
b) prepare the patient for spinal radiographs
c) expedite transfer to the closest trauma center
d) notify the patient's family - (answers)c) expedite transfer to the closest trauma center
While caring for a trauma patient in the ED, what finding raises suspicion of complete spinal cord injury?
a) weakness in the lower extremities
b) urinary incontinence
COMPREHENSIVE STUDY QUESTIONS AND ANSWERS FOR EXAM PREPARATION
An adult pt who sustained a severe head trauma has been intubated and is being manually ventilated via
bag-mask device at a rate of 18 bpm. The pt has received one IV fluid bolus of 500 mL of warm isotonic
crystalloid solution. The PaCO2 is 30 mmHg (4.0 kPa), and the pulse oximetry is 92%. BP is 142/70
mmHg. 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 - (answers)a) decrease the rate of manual ventilation
CO2 is the primary regulator of blood flow to the brain. Aggro manual ventilation results in decreased
PaCO2 levels, which results in vasoconstriction, which then leads to decreased ICP and inadequate
delivery of O2 and glucose to the brain. Bagging should be at a rate of one breath every 6 or 10 seconds
A patient with a chest tube transported to the ICU and fluctuation is noted in the water seal chamber
during inspiration and expiration. What is the best action for the nurse to take?
a) clamp the chest tube
b) return to the ED
c) assist with ventilation via bag-mask device
d) continue to ICU - (answers)d) continue to ICU
fluctuation of the water seal chamber during insp and expr is a normal finding
Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and
crying with increased work of breathing and pale skin. which of the following interventions has the
highest priority?
a) stabilizing the cervical spine
b) applying a nonrebreather mask
,c) establishing IV access
d) preparing for drug-assisted intubation - (answers)a) stabilizing the cervical spine
A retained driver involved in a motor vehicle collision is being brought to the ED with abdominal, pelvic,
and bilateral lower extremity pain. Vital signs are BP 147/78, HR 98 bpm. A FAST exam is negative for
fluid in the abdominal and peritoneal cavities. Which of the following should the nurse anticipate?
a) diagnostic peritoneal lavage
b) angiography
c) non-contrast abdominal CT
d) serial abdominal assessments - (answers)d) serial abdominal assessments
The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities
and reduces the need for more invasive testing. However, a negative FAST exam does not rule out injury,
so serial abdominal assessments should occur. If a CT scan is indicated, it should be done with contrast
A patient arrives with a 3-inch laceration to their forearm from a tree branch. Which of the following
methods will the nurse use to remove small pieces of bark and debris from the wound?
a) low pressure irrigation
b) high pressure irrigation
c) scrubbing with normal saline
d) scrubbing with tap water - (answers)b) high pressure irrigation
low pressure irrigation used for larger wounds
Three adults present at different times during a one-hour period with high fever, fatigue, and headache.
All three patients have a rash which started on their mouth, face, and arms with progression to the chest
and abdomen. They all visited the same grocery store within the last week. What is the most appropriate
intervention from the triage of these patients?
a) move them to a decontamination area
, b) mask the patients and send them to the waiting room
c) immediately initiate isolation precautions
d) send them to the waiting room without a mask - (answers)c) immediately initiate isolation
precautions
The fact that mult people with different demographics are appearing with similar signs and symptoms
would alear the nurse to a possible biological exposure. These patients should be placed in isolation to
prevent the possible spread and further determination can be made.
What is the most important consideration during the initial assessment when caring for an older adult
who has sustained serious injuries?
a) they are likely to be fearful in the ED
b) medical history including current medications
c) availability of support systems after discharge
d) accessibility to a primary care physician - (answers)b) medical history including current medications
An adult patient involved in a motor vehicle collision is brought to the ED of a rural critical access facility.
They complain of neck pain, shortness of breath, and diffuse abdominal pain. The Glasgow Coma Scale is
15. Vital signs are BP 98/71, HR 125 bpm, RR 26 bpm, and SpO2 94% on a high-flow oxygen via non-
rebreather mask. Which of the following is the priority intervention for this patient?
a) expedite transport to the CT scanner
b) prepare the patient for spinal radiographs
c) expedite transfer to the closest trauma center
d) notify the patient's family - (answers)c) expedite transfer to the closest trauma center
While caring for a trauma patient in the ED, what finding raises suspicion of complete spinal cord injury?
a) weakness in the lower extremities
b) urinary incontinence
