TNCC 9TH EDITION FINAL EXAM 2026/2027 | 100 Verified
Questions | A+ Graded | Pass Guaranteed - A+ Graded
[Section 1: Primary Survey & Initial Assessment (Q1-16)]
Q1. A trauma nurse begins the primary survey on a multi-system trauma patient. Which
sequence is correct for the primary survey?
A. Airway, Circulation, Breathing, Disability, Exposure
B. Airway, Breathing, Disability, Circulation, Exposure
C. Airway, Breathing, Circulation, Disability, Exposure [CORRECT]
D. Circulation, Airway, Breathing, Disability, Exposure
Rationale: The primary survey follows the ABCDE sequence (Airway, Breathing,
Circulation, Disability, Exposure). Circulation is assessed after breathing, and options A,
B, and D place components out of order.
Correct Answer: C
Q2. A 34-year-old male arrives after a motorcycle crash. He is speaking clearly but has
severe facial injuries. His BP is 88/52, HR 128, RR 32. What is the priority intervention?
A. Obtain a chest X-ray
B. Apply a cervical collar
C. Establish large-bore IV access and administer fluids [CORRECT]
D. Perform a focused neurological exam
Rationale: The patient is hypotensive and tachycardic, indicating hemorrhagic shock
(Circulation priority). While airway and C-spine are important, the immediate life threat is
circulatory collapse requiring fluid resuscitation.
Correct Answer: C
Q3. The TNCC 9th edition emphasizes which modification to the traditional primary
survey approach?
A. CABDE sequence
,B. XABCDE approach [CORRECT]
C. ABCDEF sequence
D. eCAB approach
Rationale: The 9th edition introduces the XABCDE approach, adding an eXtended
primary survey to enhance systematic assessment and identification of all life threats.
Options A, C, and D are not recognized TNCC sequences.
Correct Answer: B
Q4. A trauma patient arrives with gurgling respirations and a Glasgow Coma Scale score
of 7. What is the first priority?
A. Insert an oropharyngeal airway
B. Administer high-flow oxygen via nasal cannula
C. Perform endotracheal intubation [CORRECT]
D. Apply a non-rebreather mask
Rationale: A GCS of 8 or less indicates the need for definitive airway protection. Gurgling
respirations suggest an inability to protect the airway, requiring immediate intubation
rather than basic adjuncts or supplemental oxygen.
Correct Answer: C
Q5. During the secondary survey, which component is assessed?
A. Airway patency
B. Breathing adequacy
C. Head-to-toe physical examination [CORRECT]
D. Hemorrhage control
Rationale: The secondary survey is a comprehensive head-to-toe examination, while the
primary survey addresses immediate life threats (ABCDE). Options A, B, and D are
primary survey components.
Correct Answer: C
,Q6. Four trauma patients arrive simultaneously from a multi-vehicle collision. Which
patient requires the most immediate intervention?
A. 28-year-old with closed femur fracture, BP 130/80, HR 96
B. 45-year-old with chest pain, BP 110/70, HR 88, SpO2 94%
C. 62-year-old with altered mental status, BP 72/48, HR 142, RR 28 [CORRECT]
D. 35-year-old with open forearm fracture, BP 124/76, HR 102
Rationale: This patient exhibits Class IV hemorrhagic shock with hypotension,
tachycardia, and altered mental status, representing the greatest immediate threat to
life. The other patients are hemodynamically stable.
Correct Answer: C
Q7. A trauma patient has been stabilized after the primary survey. Twelve hours later,
the nurse identifies new-onset hypotension and decreased urine output. This finding is
most consistent with:
A. Primary survey failure
B. Secondary survey completion
C. Tertiary survey identification [CORRECT]
D. Primary survey reassessment
Rationale: The tertiary survey is a repeat head-to-toe examination performed within 24
hours to identify injuries missed during initial resuscitation. New hypotension indicates
a missed injury, not a failure of earlier surveys.
Correct Answer: C
Q8. A trauma patient arrives after being ejected from a vehicle during a rollover
collision. Based on mechanism of injury criteria, which level of trauma center activation
is indicated?
A. Level III trauma center
B. Level I trauma center [CORRECT]
C. Level IV trauma center
D. No trauma activation needed
, Rationale: Ejection from a vehicle is a high-energy mechanism that automatically meets
Level I trauma team activation criteria due to the high risk of multisystem injury.
Lower-level centers lack comprehensive specialty coverage.
Correct Answer: B
Q9. A patient presents after a high-speed MVC with steering wheel deformity. During the
secondary survey, the nurse notes seat belt marks across the abdomen. What is the
priority nursing concern?
A. Pelvic fracture
B. Intra-abdominal solid organ injury
C. Intra-abdominal hollow organ injury [CORRECT]
D. Thoracic aortic injury
Rationale: Seat belt signs across the abdomen are highly associated with hollow organ
injuries (small bowel, colon) due to compression and deceleration forces. Steering
wheel deformity suggests anterior chest injury, not aortic injury.
Correct Answer: C
Q10. The AMPLE history obtained during the secondary survey includes which
components?
A. Airway, Mechanism, Pain, Labs, Events
B. Allergies, Medications, Past history, Last meal, Events [CORRECT]
C. Assessment, Motion, Pulse, Lungs, Exposure
D. Airway, Medications, Pain, Labs, Environment
Rationale: AMPLE is a mnemonic for Allergies, Medications, Past history/Pregnancy,
Last meal, and Events related to the injury. Options A, C, and D are incorrect mnemonics.
Correct Answer: B
Q11. During the primary survey, a trauma patient's airway is patent, breathing is
adequate, but radial pulses are weak and thready. After establishing IV access, the next
step is:
A. Complete the secondary survey
Questions | A+ Graded | Pass Guaranteed - A+ Graded
[Section 1: Primary Survey & Initial Assessment (Q1-16)]
Q1. A trauma nurse begins the primary survey on a multi-system trauma patient. Which
sequence is correct for the primary survey?
A. Airway, Circulation, Breathing, Disability, Exposure
B. Airway, Breathing, Disability, Circulation, Exposure
C. Airway, Breathing, Circulation, Disability, Exposure [CORRECT]
D. Circulation, Airway, Breathing, Disability, Exposure
Rationale: The primary survey follows the ABCDE sequence (Airway, Breathing,
Circulation, Disability, Exposure). Circulation is assessed after breathing, and options A,
B, and D place components out of order.
Correct Answer: C
Q2. A 34-year-old male arrives after a motorcycle crash. He is speaking clearly but has
severe facial injuries. His BP is 88/52, HR 128, RR 32. What is the priority intervention?
A. Obtain a chest X-ray
B. Apply a cervical collar
C. Establish large-bore IV access and administer fluids [CORRECT]
D. Perform a focused neurological exam
Rationale: The patient is hypotensive and tachycardic, indicating hemorrhagic shock
(Circulation priority). While airway and C-spine are important, the immediate life threat is
circulatory collapse requiring fluid resuscitation.
Correct Answer: C
Q3. The TNCC 9th edition emphasizes which modification to the traditional primary
survey approach?
A. CABDE sequence
,B. XABCDE approach [CORRECT]
C. ABCDEF sequence
D. eCAB approach
Rationale: The 9th edition introduces the XABCDE approach, adding an eXtended
primary survey to enhance systematic assessment and identification of all life threats.
Options A, C, and D are not recognized TNCC sequences.
Correct Answer: B
Q4. A trauma patient arrives with gurgling respirations and a Glasgow Coma Scale score
of 7. What is the first priority?
A. Insert an oropharyngeal airway
B. Administer high-flow oxygen via nasal cannula
C. Perform endotracheal intubation [CORRECT]
D. Apply a non-rebreather mask
Rationale: A GCS of 8 or less indicates the need for definitive airway protection. Gurgling
respirations suggest an inability to protect the airway, requiring immediate intubation
rather than basic adjuncts or supplemental oxygen.
Correct Answer: C
Q5. During the secondary survey, which component is assessed?
A. Airway patency
B. Breathing adequacy
C. Head-to-toe physical examination [CORRECT]
D. Hemorrhage control
Rationale: The secondary survey is a comprehensive head-to-toe examination, while the
primary survey addresses immediate life threats (ABCDE). Options A, B, and D are
primary survey components.
Correct Answer: C
,Q6. Four trauma patients arrive simultaneously from a multi-vehicle collision. Which
patient requires the most immediate intervention?
A. 28-year-old with closed femur fracture, BP 130/80, HR 96
B. 45-year-old with chest pain, BP 110/70, HR 88, SpO2 94%
C. 62-year-old with altered mental status, BP 72/48, HR 142, RR 28 [CORRECT]
D. 35-year-old with open forearm fracture, BP 124/76, HR 102
Rationale: This patient exhibits Class IV hemorrhagic shock with hypotension,
tachycardia, and altered mental status, representing the greatest immediate threat to
life. The other patients are hemodynamically stable.
Correct Answer: C
Q7. A trauma patient has been stabilized after the primary survey. Twelve hours later,
the nurse identifies new-onset hypotension and decreased urine output. This finding is
most consistent with:
A. Primary survey failure
B. Secondary survey completion
C. Tertiary survey identification [CORRECT]
D. Primary survey reassessment
Rationale: The tertiary survey is a repeat head-to-toe examination performed within 24
hours to identify injuries missed during initial resuscitation. New hypotension indicates
a missed injury, not a failure of earlier surveys.
Correct Answer: C
Q8. A trauma patient arrives after being ejected from a vehicle during a rollover
collision. Based on mechanism of injury criteria, which level of trauma center activation
is indicated?
A. Level III trauma center
B. Level I trauma center [CORRECT]
C. Level IV trauma center
D. No trauma activation needed
, Rationale: Ejection from a vehicle is a high-energy mechanism that automatically meets
Level I trauma team activation criteria due to the high risk of multisystem injury.
Lower-level centers lack comprehensive specialty coverage.
Correct Answer: B
Q9. A patient presents after a high-speed MVC with steering wheel deformity. During the
secondary survey, the nurse notes seat belt marks across the abdomen. What is the
priority nursing concern?
A. Pelvic fracture
B. Intra-abdominal solid organ injury
C. Intra-abdominal hollow organ injury [CORRECT]
D. Thoracic aortic injury
Rationale: Seat belt signs across the abdomen are highly associated with hollow organ
injuries (small bowel, colon) due to compression and deceleration forces. Steering
wheel deformity suggests anterior chest injury, not aortic injury.
Correct Answer: C
Q10. The AMPLE history obtained during the secondary survey includes which
components?
A. Airway, Mechanism, Pain, Labs, Events
B. Allergies, Medications, Past history, Last meal, Events [CORRECT]
C. Assessment, Motion, Pulse, Lungs, Exposure
D. Airway, Medications, Pain, Labs, Environment
Rationale: AMPLE is a mnemonic for Allergies, Medications, Past history/Pregnancy,
Last meal, and Events related to the injury. Options A, C, and D are incorrect mnemonics.
Correct Answer: B
Q11. During the primary survey, a trauma patient's airway is patent, breathing is
adequate, but radial pulses are weak and thready. After establishing IV access, the next
step is:
A. Complete the secondary survey
