TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
TNCC TNCC
9TH ED
Trauma Nursing Core Course — 9th Edition
EMERGENCY NURSES ASSOCIATION
TNCC 9th Edition Final Exam
QUESTIONS WITH CORRECT, DETAILED, VERIFIED ANSWERS | GRADED A+
ORGANIZATION Emergency Nurses COURSE CODE TNCC-9E
Association (ENA)
PROGRAM Trauma Nursing Core ACADEMIC YEAR Update
Course Certification
EXAM TITLE TNCC Final Exam — TOTAL QUESTIONS 130 Questions
Verified Answers
COURSE TITLE Trauma Nursing Core FORMAT Multiple Choice — Select
Course (TNCC), 9th Edition the Single Best Answer
EXAMINATION INSTRUCTIONS
▶ Select the single best answer for each question.
▶ This exam covers primary/secondary trauma assessment, head and torso trauma, musculoskeletal injuries,
burns, shock, special populations, and psychosocial aspects of trauma care.
▶ Scenario-based questions and conceptual applications are all testable content.
▶ Correct answers and rationales appear below each question for review purposes.
Page 1 • TNCC 9th Edition • 2026/2027 Update
, TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
① 🚑 Primary Assessment & Airway Management Questions 1–5
1. You are caring for a patient who was thrown from a bike and was not wearing a
helmet. While performing the head-to-toe assessment, you note clear drainage from the
right ear. Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician.
D. Document and continue the exam.
CORRECT ANSWER C — Notify the physician.
RATIONALE Clear drainage from the ear after head trauma raises suspicion for cerebrospinal fluid (CSF)
leak from a basilar skull fracture. The physician must be notified immediately so further evaluation can
occur; the ear should never be packed or cleaned, as this could introduce infection or increase intracranial
pressure.
2. A patient is brought to the emergency department of a rural hospital following a high-
speed motor vehicle collision. When significant abdominal and pelvic injuries are noted
in the primary survey, what is the priority intervention?
A. Initiate transfer to a trauma center.
B. Attempt family notification.
C. Obtain additional imaging studies.
D. Place an indwelling urinary catheter.
CORRECT ANSWER A — Initiate transfer to a trauma center.
RATIONALE Significant abdominal and pelvic injuries identified at a rural, non-trauma facility require
definitive surgical and critical care resources unavailable locally. Transfer to a trauma center should be
initiated as early as possible, as delays in definitive care are directly linked to increased morbidity and
mortality.
3. An adult who fell from a second story roof is brought to the emergency department by
private vehicle. The patient is confused with unlabored respirations and has strong,
palpable radial pulses. There is an open wound in proximity to an obvious deformity of
the left lower extremity. What is the priority intervention?
A. Initiate cervical spine stabilization.
B. Apply a splint to the lower extremity.
C. Put the patient on portable oxygen.
D. Log roll the patient onto a spine board.
CORRECT ANSWER A — Initiate cervical spine stabilization.
RATIONALE Falls from height carry high risk for cervical spine injury, and confusion raises concern for
head/spinal involvement. Per primary survey priorities, spinal motion restriction takes precedence over
extremity splinting, since an unstabilized spine injury can result in permanent neurological damage.
Page 2 • TNCC 9th Edition • 2026/2027 Update
, TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
4. 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?
A. Decrease the rate of manual ventilation.
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.
CORRECT ANSWER A — Decrease the rate of manual ventilation.
RATIONALE A PaCO2 of 30 mm Hg indicates hyperventilation-induced hypocapnia, which causes cerebral
vasoconstriction and can worsen cerebral ischemia in a brain-injured patient. The ventilation rate of 18
breaths/minute is too high for an adult (target is typically 10/min) and must be decreased to normalize
PaCO2 and protect cerebral blood flow.
5. An adult patient is brought to the emergency department following a vehicle 'roll-over'
with prolonged extrication. Assessment reveals swelling and bruising to the right
proximal thigh and a weak pedal pulse. Skin is pale, cool, and moist. What is the most
appropriate initial intervention?
A. Application of a tourniquet to the affected extremity.
B. Application of a pelvic binder.
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour.
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa).
CORRECT ANSWER B — Application of a pelvic binder.
RATIONALE Findings of proximal thigh swelling/bruising with a weak pedal pulse and signs of shock (pale,
cool, moist skin) after a high-energy mechanism are concerning for occult pelvic fracture with significant
hemorrhage. A pelvic binder should be applied early to stabilize the pelvis and reduce ongoing bleeding
into the pelvic space.
Page 3 • TNCC 9th Edition • 2026/2027 Update
, TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
① 💔 Psychosocial Aspects & Special Populations Questions 6–
19
6. Which of the following situations could cause functional grief?
A. Inability to live at home.
B. Amputation of a limb.
C. Loss of one's self-image.
D. Destruction of the patient's car.
CORRECT ANSWER B — Amputation of a limb.
RATIONALE Functional grief relates specifically to the loss of body function or body parts, such as
amputation of a limb, paralysis, or loss of sight. Loss of one's home, self-image, or property reflects other
categories of loss but not functional grief in the trauma psychosocial framework.
7. 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 emergency department.
B. Medical history including current medications.
C. Availability of support systems after discharge.
D. Accessibility to a primary care physician.
CORRECT ANSWER B — Medical history including current medications.
RATIONALE Older adults often take multiple medications (including anticoagulants) and have
comorbidities that significantly affect injury presentation, bleeding risk, and treatment decisions. Obtaining
an accurate medical history and medication list during the initial assessment is critical to safe, appropriate
trauma care in this population.
8. When should the definitive calculation for intravenous fluid resuscitation rate be
performed for a patient with burns?
A. As soon as the patient arrives.
B. After removal of clothing.
C. Only at a burn center.
D. During the circulation assessment.
CORRECT ANSWER B — After removal of clothing.
RATIONALE Although some fluid is given initially, an accurate fluid resuscitation total depends on
percentage of total body surface area (TBSA) burned. This requires a thorough skin assessment, which
can only be done accurately after the patient's clothing has been fully removed.
9. In a motor vehicle collision, which injury pathway is most likely to increase the
patient's morbidity and mortality?
A. Rotational.
B. Ejection.
Page 4 • TNCC 9th Edition • 2026/2027 Update
TNCC TNCC
9TH ED
Trauma Nursing Core Course — 9th Edition
EMERGENCY NURSES ASSOCIATION
TNCC 9th Edition Final Exam
QUESTIONS WITH CORRECT, DETAILED, VERIFIED ANSWERS | GRADED A+
ORGANIZATION Emergency Nurses COURSE CODE TNCC-9E
Association (ENA)
PROGRAM Trauma Nursing Core ACADEMIC YEAR Update
Course Certification
EXAM TITLE TNCC Final Exam — TOTAL QUESTIONS 130 Questions
Verified Answers
COURSE TITLE Trauma Nursing Core FORMAT Multiple Choice — Select
Course (TNCC), 9th Edition the Single Best Answer
EXAMINATION INSTRUCTIONS
▶ Select the single best answer for each question.
▶ This exam covers primary/secondary trauma assessment, head and torso trauma, musculoskeletal injuries,
burns, shock, special populations, and psychosocial aspects of trauma care.
▶ Scenario-based questions and conceptual applications are all testable content.
▶ Correct answers and rationales appear below each question for review purposes.
Page 1 • TNCC 9th Edition • 2026/2027 Update
, TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
① 🚑 Primary Assessment & Airway Management Questions 1–5
1. You are caring for a patient who was thrown from a bike and was not wearing a
helmet. While performing the head-to-toe assessment, you note clear drainage from the
right ear. Which of the following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician.
D. Document and continue the exam.
CORRECT ANSWER C — Notify the physician.
RATIONALE Clear drainage from the ear after head trauma raises suspicion for cerebrospinal fluid (CSF)
leak from a basilar skull fracture. The physician must be notified immediately so further evaluation can
occur; the ear should never be packed or cleaned, as this could introduce infection or increase intracranial
pressure.
2. A patient is brought to the emergency department of a rural hospital following a high-
speed motor vehicle collision. When significant abdominal and pelvic injuries are noted
in the primary survey, what is the priority intervention?
A. Initiate transfer to a trauma center.
B. Attempt family notification.
C. Obtain additional imaging studies.
D. Place an indwelling urinary catheter.
CORRECT ANSWER A — Initiate transfer to a trauma center.
RATIONALE Significant abdominal and pelvic injuries identified at a rural, non-trauma facility require
definitive surgical and critical care resources unavailable locally. Transfer to a trauma center should be
initiated as early as possible, as delays in definitive care are directly linked to increased morbidity and
mortality.
3. An adult who fell from a second story roof is brought to the emergency department by
private vehicle. The patient is confused with unlabored respirations and has strong,
palpable radial pulses. There is an open wound in proximity to an obvious deformity of
the left lower extremity. What is the priority intervention?
A. Initiate cervical spine stabilization.
B. Apply a splint to the lower extremity.
C. Put the patient on portable oxygen.
D. Log roll the patient onto a spine board.
CORRECT ANSWER A — Initiate cervical spine stabilization.
RATIONALE Falls from height carry high risk for cervical spine injury, and confusion raises concern for
head/spinal involvement. Per primary survey priorities, spinal motion restriction takes precedence over
extremity splinting, since an unstabilized spine injury can result in permanent neurological damage.
Page 2 • TNCC 9th Edition • 2026/2027 Update
, TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
4. 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?
A. Decrease the rate of manual ventilation.
B. Initiate another fluid bolus.
C. Recheck endotracheal tube placement.
D. Increase the amount of oxygen delivered.
CORRECT ANSWER A — Decrease the rate of manual ventilation.
RATIONALE A PaCO2 of 30 mm Hg indicates hyperventilation-induced hypocapnia, which causes cerebral
vasoconstriction and can worsen cerebral ischemia in a brain-injured patient. The ventilation rate of 18
breaths/minute is too high for an adult (target is typically 10/min) and must be decreased to normalize
PaCO2 and protect cerebral blood flow.
5. An adult patient is brought to the emergency department following a vehicle 'roll-over'
with prolonged extrication. Assessment reveals swelling and bruising to the right
proximal thigh and a weak pedal pulse. Skin is pale, cool, and moist. What is the most
appropriate initial intervention?
A. Application of a tourniquet to the affected extremity.
B. Application of a pelvic binder.
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour.
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa).
CORRECT ANSWER B — Application of a pelvic binder.
RATIONALE Findings of proximal thigh swelling/bruising with a weak pedal pulse and signs of shock (pale,
cool, moist skin) after a high-energy mechanism are concerning for occult pelvic fracture with significant
hemorrhage. A pelvic binder should be applied early to stabilize the pelvis and reduce ongoing bleeding
into the pelvic space.
Page 3 • TNCC 9th Edition • 2026/2027 Update
, TNCC 9th Edition Final Exam | Emergency Nurses Association | 2026/2027 Update
① 💔 Psychosocial Aspects & Special Populations Questions 6–
19
6. Which of the following situations could cause functional grief?
A. Inability to live at home.
B. Amputation of a limb.
C. Loss of one's self-image.
D. Destruction of the patient's car.
CORRECT ANSWER B — Amputation of a limb.
RATIONALE Functional grief relates specifically to the loss of body function or body parts, such as
amputation of a limb, paralysis, or loss of sight. Loss of one's home, self-image, or property reflects other
categories of loss but not functional grief in the trauma psychosocial framework.
7. 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 emergency department.
B. Medical history including current medications.
C. Availability of support systems after discharge.
D. Accessibility to a primary care physician.
CORRECT ANSWER B — Medical history including current medications.
RATIONALE Older adults often take multiple medications (including anticoagulants) and have
comorbidities that significantly affect injury presentation, bleeding risk, and treatment decisions. Obtaining
an accurate medical history and medication list during the initial assessment is critical to safe, appropriate
trauma care in this population.
8. When should the definitive calculation for intravenous fluid resuscitation rate be
performed for a patient with burns?
A. As soon as the patient arrives.
B. After removal of clothing.
C. Only at a burn center.
D. During the circulation assessment.
CORRECT ANSWER B — After removal of clothing.
RATIONALE Although some fluid is given initially, an accurate fluid resuscitation total depends on
percentage of total body surface area (TBSA) burned. This requires a thorough skin assessment, which
can only be done accurately after the patient's clothing has been fully removed.
9. In a motor vehicle collision, which injury pathway is most likely to increase the
patient's morbidity and mortality?
A. Rotational.
B. Ejection.
Page 4 • TNCC 9th Edition • 2026/2027 Update
