TNCC 9TH EDITION EXAM STUDY GUIDE 2026
PRACTICE QUESTIONS AND SOLUTIONS
◉—What does VIPP stand for? Answer: vital signs,
injuries/interventions, primary survey, pain
◉—During the head-to-toe, where would you find Grey-Turner's sign?
Answer: flank
◉—During the head-to-toe, where would you find Cullen's sign?
Answer: umbilicus
◉-What is sometimes deferred at the end of the head-to-toe? Answer:
inspecting posterior
◉-Antibiotics, consults, head CT, imaging, law enforcement, mandatory
reporting, psychosocial support, social services, splinting, tetanus, and
wound care are all interventions that you do AFTER and before WHAT?
Answer: AFTER head-to-toe, BEFORE J (VIPP)
◉-What three items are obtained during the pertinent history
assessment? Answer: Medical records, prehospital report, SAMPLE
,◉-What are examples of nonpharmacologic measures? (must identify at
least one during testing) Answer: Distraction, family presence, padding
bony prominences, repositioning, splinting, verbal reassurance
◉-For whom is capnography highly recommended? Answer: all patients
◉-In step M of "Get Adjuncts", what else might be indicated besides
cardiac monitor? Answer: EKG
◉-In Step 16 of "Exposure and Environment", you must name at least
one of these interventions: Answer: blankets, room temp increase,
warmed fluids, warming lights
◉-To assess circulation, you must do these two main tasks: Answer: 1.
inspect AND palpate skin color, temp, moisture and 2. palpate a pulse
◉-What do you do when alterations are identified in any of the steps in
the primary survery? Answer: intervene as appropriate and reassess
◉-What three assessments must be done if the patient is intubated?
Answer: 1. attach CO2 detector and assess for evidence of exhaled CO2;
2. observe for rise and fall of the chest w/ assisted ventilations; 3.
auscultate over epigastrium for gurgling AND lungs for bilateral breath
sounds
,◉-Four of these must be identified to assess breathing effectiveness:
Answer: Breath sounds, depth/pattern/rate, spontaneous breathing,
subcutaneous emphysema, increased work of breathing, symmetrical
chest rise and fall, tracheal deviation/JVD, open wounds/deformities,
skin color
◉-What can be applied in step 12 of "Circulation and Control of
Hemorrhage" for which credit is given in the LMNOP section? Answer:
cardiac monitor
◉-When should 2 IV sites be established? Answer: During
"Circulation" assessment
◉-If the patient is intubated and you've already assessed ETT placement,
what else needs to be done with the ETT? (step 10) Answer: assess ETT
position by noting the number at teeth/gums AND secure ETT
◉-What should you verbalize after completing all ETT assessments?
Answer: moving patient from assisted ventilation to mechanical
◉-During which part of the primary survey would you anticipate the
need for a chest tube, intubation, decompression of pneumothorax,
oxygen, or BVMs? Answer: "Breathing and Ventilation"
, ◉-Four of these must be identified to assess patency and protection of
the airway: Answer: bony deformity, loose teeth, edema, inhalation
injury, sounds, tongue obstruction, burns, fluids, foreign objects,
vocalization
◉-During which part of the primary survey would there be anticipation
for intubation, insertion of OPA/NPA, removal of any loose teeth or
foreign objects, or suctioning? Answer: Assessing patency and
protection of the airway, Step 7 of
"Alertness and Airway with Simultaneous Cervical Spinal Stabilization"
◉If c-spine stabilization is necessary, what need should be stated?
Answer: the need for a second person to provide manual c-spine
stabilization
◉*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? Answer: A.Decrease the rate of manual ventilation.
◉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
PRACTICE QUESTIONS AND SOLUTIONS
◉—What does VIPP stand for? Answer: vital signs,
injuries/interventions, primary survey, pain
◉—During the head-to-toe, where would you find Grey-Turner's sign?
Answer: flank
◉—During the head-to-toe, where would you find Cullen's sign?
Answer: umbilicus
◉-What is sometimes deferred at the end of the head-to-toe? Answer:
inspecting posterior
◉-Antibiotics, consults, head CT, imaging, law enforcement, mandatory
reporting, psychosocial support, social services, splinting, tetanus, and
wound care are all interventions that you do AFTER and before WHAT?
Answer: AFTER head-to-toe, BEFORE J (VIPP)
◉-What three items are obtained during the pertinent history
assessment? Answer: Medical records, prehospital report, SAMPLE
,◉-What are examples of nonpharmacologic measures? (must identify at
least one during testing) Answer: Distraction, family presence, padding
bony prominences, repositioning, splinting, verbal reassurance
◉-For whom is capnography highly recommended? Answer: all patients
◉-In step M of "Get Adjuncts", what else might be indicated besides
cardiac monitor? Answer: EKG
◉-In Step 16 of "Exposure and Environment", you must name at least
one of these interventions: Answer: blankets, room temp increase,
warmed fluids, warming lights
◉-To assess circulation, you must do these two main tasks: Answer: 1.
inspect AND palpate skin color, temp, moisture and 2. palpate a pulse
◉-What do you do when alterations are identified in any of the steps in
the primary survery? Answer: intervene as appropriate and reassess
◉-What three assessments must be done if the patient is intubated?
Answer: 1. attach CO2 detector and assess for evidence of exhaled CO2;
2. observe for rise and fall of the chest w/ assisted ventilations; 3.
auscultate over epigastrium for gurgling AND lungs for bilateral breath
sounds
,◉-Four of these must be identified to assess breathing effectiveness:
Answer: Breath sounds, depth/pattern/rate, spontaneous breathing,
subcutaneous emphysema, increased work of breathing, symmetrical
chest rise and fall, tracheal deviation/JVD, open wounds/deformities,
skin color
◉-What can be applied in step 12 of "Circulation and Control of
Hemorrhage" for which credit is given in the LMNOP section? Answer:
cardiac monitor
◉-When should 2 IV sites be established? Answer: During
"Circulation" assessment
◉-If the patient is intubated and you've already assessed ETT placement,
what else needs to be done with the ETT? (step 10) Answer: assess ETT
position by noting the number at teeth/gums AND secure ETT
◉-What should you verbalize after completing all ETT assessments?
Answer: moving patient from assisted ventilation to mechanical
◉-During which part of the primary survey would you anticipate the
need for a chest tube, intubation, decompression of pneumothorax,
oxygen, or BVMs? Answer: "Breathing and Ventilation"
, ◉-Four of these must be identified to assess patency and protection of
the airway: Answer: bony deformity, loose teeth, edema, inhalation
injury, sounds, tongue obstruction, burns, fluids, foreign objects,
vocalization
◉-During which part of the primary survey would there be anticipation
for intubation, insertion of OPA/NPA, removal of any loose teeth or
foreign objects, or suctioning? Answer: Assessing patency and
protection of the airway, Step 7 of
"Alertness and Airway with Simultaneous Cervical Spinal Stabilization"
◉If c-spine stabilization is necessary, what need should be stated?
Answer: the need for a second person to provide manual c-spine
stabilization
◉*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? Answer: A.Decrease the rate of manual ventilation.
◉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
