TNCC final exam test 2024/2025 open
book updated with complete solution
SECTION 1: TRAUMA NURSING PROCESS & PRIMARY SURVEY (Questions 1-10)
1. What is the correct sequence of the Trauma Nursing Process (TNP)?
A. Primary survey, Preparation and triage, Secondary survey, Reevaluation, Definitive care
B. Preparation and triage, Primary survey, Reevaluation, Secondary survey, Reevaluation and
post-resuscitation care, Definitive care
C. Primary survey, Secondary survey, Preparation and triage, Reevaluation, Transfer
D. Preparation and triage, Secondary survey, Primary survey, Reevaluation, Discharge
Answer: B
Rationale: The TNP follows a specific sequence: (1) Preparation and Triage, (2) Primary Survey
with resuscitation adjuncts, (3) Reevaluation (consideration of transfer), (4) Secondary Survey
with reevaluation adjuncts, (5) Reevaluation and post-resuscitation care, and (6) Definitive care
or transfer to an appropriate trauma facility.
2. A trauma patient arrives after a motorcycle crash. The nurse completes the across-the-
room observation and notes no signs of uncontrolled external hemorrhage. What is the NEXT
priority action?
A. Assess level of consciousness using AVPU
B. Open the airway using jaw thrust maneuver
C. Assess for adequate breathing and ventilation
D. Apply cervical collar and log roll the patient
Answer: B
Rationale: The primary survey follows a specific sequence: Across-the-room observation →
Airway with cervical spine protection → Breathing → Circulation. After determining no
immediate life-threatening hemorrhage, airway assessment and management with manual in-
line stabilization is the next priority.
3. The across-the-room observation step in the initial assessment provides the opportunity
to:
,A. Assess for uncontrolled internal hemorrhage
B. Accurately triage the patient
C. Reprioritize circulation before airway or breathing
D. Activate the trauma team
Answer: C
Rationale: The across-the-room observation is done at the beginning of the primary survey to
rapidly assess the need to reprioritize circulation before airway or breathing. This is done if
uncontrolled external hemorrhage is identified—because hemorrhage is the leading
preventable cause of death.
4. When should the secondary survey begin?
A. Immediately after the primary survey is complete
B. After life-threatening conditions have been identified and managed
C. Within 5 minutes of patient arrival
D. After all diagnostic imaging is complete
Answer: B
Rationale: The secondary survey should only begin after the primary survey is complete AND all
life-threatening conditions identified during the primary survey have been adequately
managed. Starting the secondary survey prematurely can allow unstable patients to
deteriorate.
5. During the primary survey of an unconscious patient with multi-system trauma, the nurse
notes snoring respirations. What priority nursing intervention should be performed next?
A. Open the airway with the head-tilt/chin lift maneuver
B. Auscultate bilateral breath sounds to assess ventilatory status
C. Assist respirations using a bag-mask device
D. Insert an oropharyngeal airway if there is no gag reflex
Answer: D
Rationale: Snoring respirations indicate partial airway obstruction from the tongue. In an
unconscious patient with no gag reflex, an oropharyngeal airway is the appropriate intervention
to maintain a patent airway while maintaining cervical spine precautions.
,6. When should the decision for definitive care or transfer to an appropriate trauma facility
be made?
A. Before the primary survey is complete
B. During the secondary survey
C. After reevaluation and post-resuscitation care
D. Upon patient arrival to the emergency department
Answer: C
Rationale: The Trauma Nursing Process includes definitive care or transfer as the final step,
which occurs after reevaluation and post-resuscitation care have been completed and the
patient has been stabilized to the extent possible at the current facility.
7. A patient responds only to verbal stimuli. According to the AVPU scale, what is the
appropriate interpretation for airway management?
A. The patient can maintain their own airway without assistance
B. An airway adjunct may be needed to prevent tongue obstruction
C. The patient requires immediate intubation
D. The patient is completely unresponsive and needs airway assessment
Answer: B
Rationale: A patient who responds only to verbal stimuli (V on AVPU) may not be able to
maintain their own airway. An airway adjunct such as a nasopharyngeal or oropharyngeal
airway may be needed to keep the tongue from obstructing the airway while further
assessment is performed.
8. When obtaining a history for an injured patient, understanding the kinematic concepts
associated with the mechanism of injury and energy transfer can initially assist the trauma
provider in:
A. Evaluating and anticipating the types of injury that may be present
B. Deciding whether law enforcement should be notified
C. Determining needed laboratory tests
D. Predicting the need for a surgical procedure
Answer: A
Rationale: Mechanism of injury and energy transfer can assist the provider in evaluating and
anticipating damage. Understanding how energy was transferred to the body helps predict
which injuries are most likely present.
, 9. The major preventable cause of death in the trauma patient is:
A. Airway compromise
B. Ineffective ventilation
C. Secondary head injury
D. Uncontrolled hemorrhage
Answer: D
Rationale: Uncontrolled hemorrhage is the major cause of preventable death after injury, so
assessment to identify uncontrolled hemorrhage is key to the initial assessment process. This is
why the "across-the-room observation" prioritizes identifying external bleeding before airway
assessment in some cases.
10. Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage?
A. ABC
B. MARCH
C. AVPU
D. VIPP
Answer: B
Rationale: MARCH stands for Massive hemorrhage, Airway, Respiratory, Circulation,
Hypothermia/Head injury. This mnemonic is used in tactical combat casualty care and trauma
settings when massive hemorrhage is the immediate priority.
SECTION 2: SHOCK AND HEMODYNAMICS (Questions 11-18)
11. A trauma patient is restless and repeatedly asking "where am I?" Vital signs upon arrival
were BP 110/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry.
Current vital signs are BP 104/84 mm Hg, HR 108 beats/min, RR 28 breaths/min. The patient
is demonstrating signs and symptoms of which stage of shock?
A. Compensated
B. Progressive
C. Irreversible
D. Decompensated
book updated with complete solution
SECTION 1: TRAUMA NURSING PROCESS & PRIMARY SURVEY (Questions 1-10)
1. What is the correct sequence of the Trauma Nursing Process (TNP)?
A. Primary survey, Preparation and triage, Secondary survey, Reevaluation, Definitive care
B. Preparation and triage, Primary survey, Reevaluation, Secondary survey, Reevaluation and
post-resuscitation care, Definitive care
C. Primary survey, Secondary survey, Preparation and triage, Reevaluation, Transfer
D. Preparation and triage, Secondary survey, Primary survey, Reevaluation, Discharge
Answer: B
Rationale: The TNP follows a specific sequence: (1) Preparation and Triage, (2) Primary Survey
with resuscitation adjuncts, (3) Reevaluation (consideration of transfer), (4) Secondary Survey
with reevaluation adjuncts, (5) Reevaluation and post-resuscitation care, and (6) Definitive care
or transfer to an appropriate trauma facility.
2. A trauma patient arrives after a motorcycle crash. The nurse completes the across-the-
room observation and notes no signs of uncontrolled external hemorrhage. What is the NEXT
priority action?
A. Assess level of consciousness using AVPU
B. Open the airway using jaw thrust maneuver
C. Assess for adequate breathing and ventilation
D. Apply cervical collar and log roll the patient
Answer: B
Rationale: The primary survey follows a specific sequence: Across-the-room observation →
Airway with cervical spine protection → Breathing → Circulation. After determining no
immediate life-threatening hemorrhage, airway assessment and management with manual in-
line stabilization is the next priority.
3. The across-the-room observation step in the initial assessment provides the opportunity
to:
,A. Assess for uncontrolled internal hemorrhage
B. Accurately triage the patient
C. Reprioritize circulation before airway or breathing
D. Activate the trauma team
Answer: C
Rationale: The across-the-room observation is done at the beginning of the primary survey to
rapidly assess the need to reprioritize circulation before airway or breathing. This is done if
uncontrolled external hemorrhage is identified—because hemorrhage is the leading
preventable cause of death.
4. When should the secondary survey begin?
A. Immediately after the primary survey is complete
B. After life-threatening conditions have been identified and managed
C. Within 5 minutes of patient arrival
D. After all diagnostic imaging is complete
Answer: B
Rationale: The secondary survey should only begin after the primary survey is complete AND all
life-threatening conditions identified during the primary survey have been adequately
managed. Starting the secondary survey prematurely can allow unstable patients to
deteriorate.
5. During the primary survey of an unconscious patient with multi-system trauma, the nurse
notes snoring respirations. What priority nursing intervention should be performed next?
A. Open the airway with the head-tilt/chin lift maneuver
B. Auscultate bilateral breath sounds to assess ventilatory status
C. Assist respirations using a bag-mask device
D. Insert an oropharyngeal airway if there is no gag reflex
Answer: D
Rationale: Snoring respirations indicate partial airway obstruction from the tongue. In an
unconscious patient with no gag reflex, an oropharyngeal airway is the appropriate intervention
to maintain a patent airway while maintaining cervical spine precautions.
,6. When should the decision for definitive care or transfer to an appropriate trauma facility
be made?
A. Before the primary survey is complete
B. During the secondary survey
C. After reevaluation and post-resuscitation care
D. Upon patient arrival to the emergency department
Answer: C
Rationale: The Trauma Nursing Process includes definitive care or transfer as the final step,
which occurs after reevaluation and post-resuscitation care have been completed and the
patient has been stabilized to the extent possible at the current facility.
7. A patient responds only to verbal stimuli. According to the AVPU scale, what is the
appropriate interpretation for airway management?
A. The patient can maintain their own airway without assistance
B. An airway adjunct may be needed to prevent tongue obstruction
C. The patient requires immediate intubation
D. The patient is completely unresponsive and needs airway assessment
Answer: B
Rationale: A patient who responds only to verbal stimuli (V on AVPU) may not be able to
maintain their own airway. An airway adjunct such as a nasopharyngeal or oropharyngeal
airway may be needed to keep the tongue from obstructing the airway while further
assessment is performed.
8. When obtaining a history for an injured patient, understanding the kinematic concepts
associated with the mechanism of injury and energy transfer can initially assist the trauma
provider in:
A. Evaluating and anticipating the types of injury that may be present
B. Deciding whether law enforcement should be notified
C. Determining needed laboratory tests
D. Predicting the need for a surgical procedure
Answer: A
Rationale: Mechanism of injury and energy transfer can assist the provider in evaluating and
anticipating damage. Understanding how energy was transferred to the body helps predict
which injuries are most likely present.
, 9. The major preventable cause of death in the trauma patient is:
A. Airway compromise
B. Ineffective ventilation
C. Secondary head injury
D. Uncontrolled hemorrhage
Answer: D
Rationale: Uncontrolled hemorrhage is the major cause of preventable death after injury, so
assessment to identify uncontrolled hemorrhage is key to the initial assessment process. This is
why the "across-the-room observation" prioritizes identifying external bleeding before airway
assessment in some cases.
10. Which of the following mnemonics can help the nurse prioritize care for a trauma patient
with massive uncontrolled hemorrhage?
A. ABC
B. MARCH
C. AVPU
D. VIPP
Answer: B
Rationale: MARCH stands for Massive hemorrhage, Airway, Respiratory, Circulation,
Hypothermia/Head injury. This mnemonic is used in tactical combat casualty care and trauma
settings when massive hemorrhage is the immediate priority.
SECTION 2: SHOCK AND HEMODYNAMICS (Questions 11-18)
11. A trauma patient is restless and repeatedly asking "where am I?" Vital signs upon arrival
were BP 110/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry.
Current vital signs are BP 104/84 mm Hg, HR 108 beats/min, RR 28 breaths/min. The patient
is demonstrating signs and symptoms of which stage of shock?
A. Compensated
B. Progressive
C. Irreversible
D. Decompensated
