TNCC Exam 2026/2027With100 Questions
& Answers with Rationales
**1. What is the first priority in the primary survey of a trauma
patient?**
- **Answer:** Airway with cervical spine protection
- **Rationale:** Airway must be secured before all other
interventions. The "A" in ABCDE represents airway with simultaneous
cervical spine immobilization. Without a patent airway, oxygenation
and ventilation cannot occur .
**2. A trauma patient who is talking clearly most likely has:**
- **Answer:** A patent airway
- **Rationale:** Speaking requires air movement through the vocal
cords, indicating an open airway. However, this does not rule out
potential airway compromise from evolving injuries .
**3. Snoring respirations in a trauma patient indicate:**
- **Answer:** Partial airway obstruction
- **Rationale:** Snoring suggests partial obstruction from the
tongue or soft tissues, especially in an unconscious patient. This
requires immediate intervention such as positioning, airway adjuncts,
or suction .
,**4. 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?**
- **Answer:** Insert an oropharyngeal airway if there is no gag reflex
- **Rationale:** Snoring indicates partial airway obstruction from the
tongue. An oropharyngeal airway is appropriate for unconscious
patients without a gag reflex to maintain airway patency .
**5. What is the most appropriate initial airway intervention for an
unconscious trauma patient?**
- **Answer:** Jaw-thrust maneuver
- **Rationale:** The jaw-thrust maneuver opens the airway while
maintaining cervical spine immobilization. The head-tilt chin-lift is
contraindicated in trauma patients with potential cervical spine injury
.
**6. Which AVPU classification indicates a patient who responds only
to painful stimuli?**
- **Answer:** Pain (P)
- **Rationale:** The AVPU scale assesses level of consciousness:
Alert (A), Verbal (V), Pain (P), Unresponsive (U). A "P" response
indicates significant alteration in consciousness requiring immediate
attention .
**7. What is the best position for maintaining an open airway in the
obese patient?**
- **Answer:** Reverse Trendelenburg
,- **Rationale:** The reverse Trendelenburg position benefits both
airway maintenance and work of breathing in obese patients by
reducing abdominal pressure on the diaphragm and improving
ventilation .
**8. What is the appropriate technique for palpating the pelvis for
stability?**
- **Answer:** Apply gentle pressure over the iliac crests, downward
and medially
- **Rationale:** Gentle downward and medial pressure over the iliac
crests assesses pelvic stability without causing further injury. Firm
pressure or lateral compression can destabilize an unstable pelvic
fracture and exacerbate hemorrhage .
**9. Cervical spine immobilization should be maintained until:**
- **Answer:** Spinal injury is ruled out
- **Rationale:** Cervical spine precautions must continue until
radiographic or clinical clearance confirms no injury. Premature
removal can cause devastating neurological damage .
**10. In a patient with severe traumatic brain injury, hypocapnia
causes:**
- **Answer:** Cerebral vasoconstriction
- **Rationale:** Hypocapnia (low CO₂) causes cerebral
vasoconstriction, reducing cerebral blood flow. This can lead to
cerebral ischemia and worsen outcomes in TBI patients .
, ---
## Breathing & Ventilation
**11. Which finding indicates inadequate breathing?**
- **Answer:** SpO₂ 88%
- **Rationale:** Oxygen saturation below 94% indicates inadequate
oxygenation. Normal SpO₂ should be maintained at 94% or higher in
trauma patients .
**12. Tracheal deviation, hypotension, and absent breath sounds
suggest:**
- **Answer:** Tension pneumothorax
- **Rationale:** Tension pneumothorax causes air trapping in the
pleural space, shifting the trachea away from the affected side,
compressing the heart and great vessels (causing hypotension), and
collapsing the lung (absent breath sounds). This is a life-threatening
emergency requiring immediate needle decompression .
**13. What is the priority treatment for tension pneumothorax?**
- **Answer:** Needle decompression
- **Rationale:** Needle decompression (second intercostal space,
midclavicular line) relieves pressure and prevents cardiac arrest. This
is followed by chest tube insertion .
**14. Which intervention is recommended regarding drug-assisted
intubation and rapid sequence intubation?**
& Answers with Rationales
**1. What is the first priority in the primary survey of a trauma
patient?**
- **Answer:** Airway with cervical spine protection
- **Rationale:** Airway must be secured before all other
interventions. The "A" in ABCDE represents airway with simultaneous
cervical spine immobilization. Without a patent airway, oxygenation
and ventilation cannot occur .
**2. A trauma patient who is talking clearly most likely has:**
- **Answer:** A patent airway
- **Rationale:** Speaking requires air movement through the vocal
cords, indicating an open airway. However, this does not rule out
potential airway compromise from evolving injuries .
**3. Snoring respirations in a trauma patient indicate:**
- **Answer:** Partial airway obstruction
- **Rationale:** Snoring suggests partial obstruction from the
tongue or soft tissues, especially in an unconscious patient. This
requires immediate intervention such as positioning, airway adjuncts,
or suction .
,**4. 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?**
- **Answer:** Insert an oropharyngeal airway if there is no gag reflex
- **Rationale:** Snoring indicates partial airway obstruction from the
tongue. An oropharyngeal airway is appropriate for unconscious
patients without a gag reflex to maintain airway patency .
**5. What is the most appropriate initial airway intervention for an
unconscious trauma patient?**
- **Answer:** Jaw-thrust maneuver
- **Rationale:** The jaw-thrust maneuver opens the airway while
maintaining cervical spine immobilization. The head-tilt chin-lift is
contraindicated in trauma patients with potential cervical spine injury
.
**6. Which AVPU classification indicates a patient who responds only
to painful stimuli?**
- **Answer:** Pain (P)
- **Rationale:** The AVPU scale assesses level of consciousness:
Alert (A), Verbal (V), Pain (P), Unresponsive (U). A "P" response
indicates significant alteration in consciousness requiring immediate
attention .
**7. What is the best position for maintaining an open airway in the
obese patient?**
- **Answer:** Reverse Trendelenburg
,- **Rationale:** The reverse Trendelenburg position benefits both
airway maintenance and work of breathing in obese patients by
reducing abdominal pressure on the diaphragm and improving
ventilation .
**8. What is the appropriate technique for palpating the pelvis for
stability?**
- **Answer:** Apply gentle pressure over the iliac crests, downward
and medially
- **Rationale:** Gentle downward and medial pressure over the iliac
crests assesses pelvic stability without causing further injury. Firm
pressure or lateral compression can destabilize an unstable pelvic
fracture and exacerbate hemorrhage .
**9. Cervical spine immobilization should be maintained until:**
- **Answer:** Spinal injury is ruled out
- **Rationale:** Cervical spine precautions must continue until
radiographic or clinical clearance confirms no injury. Premature
removal can cause devastating neurological damage .
**10. In a patient with severe traumatic brain injury, hypocapnia
causes:**
- **Answer:** Cerebral vasoconstriction
- **Rationale:** Hypocapnia (low CO₂) causes cerebral
vasoconstriction, reducing cerebral blood flow. This can lead to
cerebral ischemia and worsen outcomes in TBI patients .
, ---
## Breathing & Ventilation
**11. Which finding indicates inadequate breathing?**
- **Answer:** SpO₂ 88%
- **Rationale:** Oxygen saturation below 94% indicates inadequate
oxygenation. Normal SpO₂ should be maintained at 94% or higher in
trauma patients .
**12. Tracheal deviation, hypotension, and absent breath sounds
suggest:**
- **Answer:** Tension pneumothorax
- **Rationale:** Tension pneumothorax causes air trapping in the
pleural space, shifting the trachea away from the affected side,
compressing the heart and great vessels (causing hypotension), and
collapsing the lung (absent breath sounds). This is a life-threatening
emergency requiring immediate needle decompression .
**13. What is the priority treatment for tension pneumothorax?**
- **Answer:** Needle decompression
- **Rationale:** Needle decompression (second intercostal space,
midclavicular line) relieves pressure and prevents cardiac arrest. This
is followed by chest tube insertion .
**14. Which intervention is recommended regarding drug-assisted
intubation and rapid sequence intubation?**
