Trauma Nursing Core Course (TNCC) Final Exam – ENA – Academic Year 2026/2027 – 40 practice exam
questions
1. [Primary Survey] A 6-year-old restrained passenger is thrown against the dashboard in a high-
speed MVC. On arrival he is conscious but gasping; respiratory rate is 40/min with asymmetric
chest rise and absent breath sounds on the right. His heart rate is 160/min and BP 70/40 mmHg.
The first action is to: A. Insert a 20-gauge IV catheter and begin fluid resuscitation B. Perform
needle decompression of the right chest C. Administer high-flow oxygen via non-rebreather
mask D. Secure the airway with rapid-sequence intubation
Correct Answer: B Rationale: Asymmetric chest rise, absent breath sounds and shock in a trauma patient
indicate tension pneumothorax, a life-threatening "B" problem requiring immediate needle
decompression before any other intervention. TNCC 2026/2027 emphasises treating recognised tension
during the primary survey without imaging delay. TNCC Reference: 2026/2027 Primary Survey -
immediate life-saving intervention for tension pneumothorax precedes airway manipulation in a
breathing-compromised child.
2. [Hemorrhage Control] A 30-year-old motorcyclist arrives with a mangled left lower extremity.
Bright-red blood spurts despite a CAT tourniquet applied at the scene. The most appropriate
next step is to: A. Release and re-apply the tourniquet 2-3 cm proximally B. Leave the tourniquet
in place and prepare for OR C. Apply a second tourniquet proximal to the first D. Replace the
CAT with a pneumatic tourniquet and inflate to 250 mmHg
Correct Answer: C Rationale: Continued arterial bleeding indicates tourniquet failure; applying a second
tourniquet proximal to the first doubles compressive force and is the 2026/2027 recommended
immediate action. OR preparation proceeds in parallel. TNCC Reference: 2026/2027 MARCH update -
"two is better than one" for persistent junctional/extremity arterial haemorrhage.
3. [Airway] An unconscious 22-year-old driver is found with snoring respirations after an MVC. GCS
is 6 (E1 V2 M3). The most appropriate initial airway manoeuvre is: A. Insert an oropharyngeal
airway and bag-mask ventilate B. Perform a jaw-thrust while maintaining inline stabilisation C.
Suction the oropharynx for 30 seconds D. Apply a cervical collar and await ENT
Correct Answer: B Rationale: Jaw-thrust with spinal motion restriction opens the airway without
instruments and is the first step for any trauma patient with airway compromise per 2026/2027
updates; adjuncts follow once patency is confirmed. TNCC Reference: 2026/2027 Airway algorithm -
jaw-thrust remains the opening manoeuvre of choice in suspected cervical-spine injury.
4. [Shock] A 28-year-old woman at 32 weeks gestation presents after a fall with HR 125, BP 85/50,
RR 26, and a tender uterus. After airway control, the priority is to: A. Perform FAST and initiate
massive transfusion protocol B. Obtain CT abdomen to assess for placental abruption C. Start
oxytocin to augment uterine contractions D. Apply left-lateral tilt 15-30° and initiate fluid
resuscitation
Correct Answer: D Rationale: Left-lateral tilt relieves aortocaval compression and is the immediate
intervention for any hypotensive pregnant trauma patient per 2026/2027 guidelines; FAST and fluid
resuscitation follow. TNCC Reference: 2026/2027 Special Populations - left tilt and volume loading
precede imaging in unstable pregnant patients.
, 5. [Pediatric Trauma] A 3-year-old is ejected from a car seat and arrives with RR 50, HR 180, and
capillary refill 4 s. The estimated blood volume is approximately: A. 800 mL B. 1,000 mL C. 1,200
mL D. 1,500 mL
Correct Answer: C Rationale: Paediatric blood volume = 80 mL/kg × 15 kg ≈ 1,200 mL; this baseline is
essential for calculating permissible hypovolemia and transfusion thresholds in the 2026/2027 paediatric
MARCH protocol. TNCC Reference: 2026/2027 MARCH paediatric card - weight-based blood volume
estimation at triage.
6. [Burns] A 70-kg man has partial-thickness burns to anterior chest/abdomen and both arms.
Using the rule of nines, TBSA is: A. 18 % B. 27 % C. 36 % D. 45 %
Correct Answer: B Rationale: Anterior trunk 18 % + both arms 9 % = 27 %; accurate TBSA dictates
Parkland formula calculations for the 2026/2027 burn resuscitation pathway. TNCC Reference:
2026/2027 Burn module - rule of nines remains standard for adult rapid assessment.
7. [Spinal Trauma] An awake 45-year-old restrained driver complains of mid-back pain after an
MVC. Which finding mandates immediate spinal motion restriction? A. Able to walk but reports
mild tenderness B. GCS 15 with no neurologic deficit C. Tenderness at T8 with paraesthesias
below umbilicus D. Midline cervical pain only
Correct Answer: C Rationale: New neurologic deficit (paraesthesias) with spinal tenderness is a hard sign
for spinal instability per 2026/2027 updates, requiring immediate immobilisation regardless of GCS. Pain
alone (choices A, B, D) is a soft sign. TNCC Reference: 2026/2027 Spine protocol - any new neuro deficit
+ spinal pain = immediate motion restriction.
8. [Environmental Injury] A hiker is found apneic and pulseless in a snowbank. Core temperature is
24 °C. The safest field rewarming method is: A. Warm water immersion at 40 °C B. Forced-air
warming blanket C. Warm humidified oxygen at 42 °C D. Vigorous rubbing with alcohol pads
Correct Answer: C Rationale: Warm humidified oxygen at 42 °C is non-invasive, does not cause after-
drop, and can be initiated immediately during CPR per 2026/2027 hypothermia guidelines. Immersion
(choice A) is impractical in arrest, forced-air (choice B) requires power, and rubbing (choice D) is
ineffective. TNCC Reference: 2026/2027 Environmental - active internal rewarming with warm O₂ is first-
line in arrested hypothermia.
9. [Triage] In a mass-casualty event, a patient with a Glasgow Coma Scale of 3 and no pulse is
tagged: A. Red (Immediate) B. Yellow (Delayed) C. Green (Minor) D. Black (Expectant/Deceased)
Correct Answer: D Rationale: GCS 3 without vital signs in the field is unsalvageable under 2026/2027
disaster triage; resources are allocated to the potentially viable. Tag is black (choice D). TNCC Reference:
2026/2027 Disaster triage - black tag for expectant/deceased in resource-limited settings.
10. [Pharmacology – Trauma] A 22-year-old is intubated for head injury. Which induction agent best
preserves cerebral perfusion pressure? A. Ketamine 2 mg/kg IV B. Etomidate 0.3 mg/kg IV C.
Propofol 2 mg/kg IV D. Midazolam 0.2 mg/kg IV
Correct Answer: B Explanation: Etomidate causes minimal hypotension and preserves CPP; ketamine
(choice A) is now acceptable in brain injury per 2026/2027 updates but etomidate remains preferred
questions
1. [Primary Survey] A 6-year-old restrained passenger is thrown against the dashboard in a high-
speed MVC. On arrival he is conscious but gasping; respiratory rate is 40/min with asymmetric
chest rise and absent breath sounds on the right. His heart rate is 160/min and BP 70/40 mmHg.
The first action is to: A. Insert a 20-gauge IV catheter and begin fluid resuscitation B. Perform
needle decompression of the right chest C. Administer high-flow oxygen via non-rebreather
mask D. Secure the airway with rapid-sequence intubation
Correct Answer: B Rationale: Asymmetric chest rise, absent breath sounds and shock in a trauma patient
indicate tension pneumothorax, a life-threatening "B" problem requiring immediate needle
decompression before any other intervention. TNCC 2026/2027 emphasises treating recognised tension
during the primary survey without imaging delay. TNCC Reference: 2026/2027 Primary Survey -
immediate life-saving intervention for tension pneumothorax precedes airway manipulation in a
breathing-compromised child.
2. [Hemorrhage Control] A 30-year-old motorcyclist arrives with a mangled left lower extremity.
Bright-red blood spurts despite a CAT tourniquet applied at the scene. The most appropriate
next step is to: A. Release and re-apply the tourniquet 2-3 cm proximally B. Leave the tourniquet
in place and prepare for OR C. Apply a second tourniquet proximal to the first D. Replace the
CAT with a pneumatic tourniquet and inflate to 250 mmHg
Correct Answer: C Rationale: Continued arterial bleeding indicates tourniquet failure; applying a second
tourniquet proximal to the first doubles compressive force and is the 2026/2027 recommended
immediate action. OR preparation proceeds in parallel. TNCC Reference: 2026/2027 MARCH update -
"two is better than one" for persistent junctional/extremity arterial haemorrhage.
3. [Airway] An unconscious 22-year-old driver is found with snoring respirations after an MVC. GCS
is 6 (E1 V2 M3). The most appropriate initial airway manoeuvre is: A. Insert an oropharyngeal
airway and bag-mask ventilate B. Perform a jaw-thrust while maintaining inline stabilisation C.
Suction the oropharynx for 30 seconds D. Apply a cervical collar and await ENT
Correct Answer: B Rationale: Jaw-thrust with spinal motion restriction opens the airway without
instruments and is the first step for any trauma patient with airway compromise per 2026/2027
updates; adjuncts follow once patency is confirmed. TNCC Reference: 2026/2027 Airway algorithm -
jaw-thrust remains the opening manoeuvre of choice in suspected cervical-spine injury.
4. [Shock] A 28-year-old woman at 32 weeks gestation presents after a fall with HR 125, BP 85/50,
RR 26, and a tender uterus. After airway control, the priority is to: A. Perform FAST and initiate
massive transfusion protocol B. Obtain CT abdomen to assess for placental abruption C. Start
oxytocin to augment uterine contractions D. Apply left-lateral tilt 15-30° and initiate fluid
resuscitation
Correct Answer: D Rationale: Left-lateral tilt relieves aortocaval compression and is the immediate
intervention for any hypotensive pregnant trauma patient per 2026/2027 guidelines; FAST and fluid
resuscitation follow. TNCC Reference: 2026/2027 Special Populations - left tilt and volume loading
precede imaging in unstable pregnant patients.
, 5. [Pediatric Trauma] A 3-year-old is ejected from a car seat and arrives with RR 50, HR 180, and
capillary refill 4 s. The estimated blood volume is approximately: A. 800 mL B. 1,000 mL C. 1,200
mL D. 1,500 mL
Correct Answer: C Rationale: Paediatric blood volume = 80 mL/kg × 15 kg ≈ 1,200 mL; this baseline is
essential for calculating permissible hypovolemia and transfusion thresholds in the 2026/2027 paediatric
MARCH protocol. TNCC Reference: 2026/2027 MARCH paediatric card - weight-based blood volume
estimation at triage.
6. [Burns] A 70-kg man has partial-thickness burns to anterior chest/abdomen and both arms.
Using the rule of nines, TBSA is: A. 18 % B. 27 % C. 36 % D. 45 %
Correct Answer: B Rationale: Anterior trunk 18 % + both arms 9 % = 27 %; accurate TBSA dictates
Parkland formula calculations for the 2026/2027 burn resuscitation pathway. TNCC Reference:
2026/2027 Burn module - rule of nines remains standard for adult rapid assessment.
7. [Spinal Trauma] An awake 45-year-old restrained driver complains of mid-back pain after an
MVC. Which finding mandates immediate spinal motion restriction? A. Able to walk but reports
mild tenderness B. GCS 15 with no neurologic deficit C. Tenderness at T8 with paraesthesias
below umbilicus D. Midline cervical pain only
Correct Answer: C Rationale: New neurologic deficit (paraesthesias) with spinal tenderness is a hard sign
for spinal instability per 2026/2027 updates, requiring immediate immobilisation regardless of GCS. Pain
alone (choices A, B, D) is a soft sign. TNCC Reference: 2026/2027 Spine protocol - any new neuro deficit
+ spinal pain = immediate motion restriction.
8. [Environmental Injury] A hiker is found apneic and pulseless in a snowbank. Core temperature is
24 °C. The safest field rewarming method is: A. Warm water immersion at 40 °C B. Forced-air
warming blanket C. Warm humidified oxygen at 42 °C D. Vigorous rubbing with alcohol pads
Correct Answer: C Rationale: Warm humidified oxygen at 42 °C is non-invasive, does not cause after-
drop, and can be initiated immediately during CPR per 2026/2027 hypothermia guidelines. Immersion
(choice A) is impractical in arrest, forced-air (choice B) requires power, and rubbing (choice D) is
ineffective. TNCC Reference: 2026/2027 Environmental - active internal rewarming with warm O₂ is first-
line in arrested hypothermia.
9. [Triage] In a mass-casualty event, a patient with a Glasgow Coma Scale of 3 and no pulse is
tagged: A. Red (Immediate) B. Yellow (Delayed) C. Green (Minor) D. Black (Expectant/Deceased)
Correct Answer: D Rationale: GCS 3 without vital signs in the field is unsalvageable under 2026/2027
disaster triage; resources are allocated to the potentially viable. Tag is black (choice D). TNCC Reference:
2026/2027 Disaster triage - black tag for expectant/deceased in resource-limited settings.
10. [Pharmacology – Trauma] A 22-year-old is intubated for head injury. Which induction agent best
preserves cerebral perfusion pressure? A. Ketamine 2 mg/kg IV B. Etomidate 0.3 mg/kg IV C.
Propofol 2 mg/kg IV D. Midazolam 0.2 mg/kg IV
Correct Answer: B Explanation: Etomidate causes minimal hypotension and preserves CPP; ketamine
(choice A) is now acceptable in brain injury per 2026/2027 updates but etomidate remains preferred
