TNCC 9TH EDITION FINAL TEST
LATEST 2026/2027 WITH VERIFIED
QUESTIONS AND ANSWERS
1. Primary Survey & Airway Management
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 PaCO₂ is 30 mm Hg, and the pulse oximetry is 92%.
What is the most important intervention to manage 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 level below 35 mm Hg indicates hyperventilation,
which causes cerebral vasoconstriction. This reduces cerebral blood flow
and can worsen ischemia in a patient with a severe head injury. The priority
is to slow the ventilation rate to allow the PaCO₂ to normalize to 35-45 mm
Hg, preserving cerebral perfusion.
2. Recognizing Stages of Shock
A trauma patient is restless and repeatedly asking "where am I?". Vital signs
upon arrival were BP 100/60, HR 96, RR 24. Current vital signs are BP
104/84, HR 108, RR 28. The patient's skin is cool and dry. The patient is
demonstrating signs of which stage of shock?
A. Compensated
B. Progressive
,C. Irreversible
D. Decompensated
Correct Answer: A. Compensated.
Rationale: In compensated shock, the body uses compensatory
mechanisms (like tachycardia and increased respiratory rate) to maintain
blood pressure and perfusion to vital organs. A narrowed pulse pressure
(104/84, a pulse pressure of 20) is an early indicator of cardiovascular
compromise. The patient's restlessness and cool, dry skin also point to early
shock.
3. Tertiary Injury from Blast Trauma
A factory worker is thrown against a concrete wall during an explosion.
Assessment reveals a fractured femur, a liver laceration, and a small
subdural hematoma. Which level of blast trauma most likely caused these
injuries?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: C. Tertiary blast injury.
Rationale: Tertiary blast injuries result from the victim being thrown by the
blast wind and impacting another object, such as a wall or the ground. This
can cause blunt trauma including fractures, internal organ lacerations, and
head injuries.
4. Spinal Cord Injury and Neurogenic Shock
A patient with a complete spinal cord injury (SCI) in neurogenic shock will
demonstrate hypotension and which other clinical signs?
,A. Bradycardia and ipsilateral absence of motor function
B. Tachycardia and respiratory depression
C. Tachycardia and absent motor function below the level of injury
D. Bradycardia and absent motor function below the level of injury
Correct Answer: D. Bradycardia and absent motor function below the level
of injury.
Rationale: Neurogenic shock is caused by a loss of sympathetic tone
following a spinal cord injury. This leads to hypotension and bradycardia,
which is a key differentiator from hypovolemic shock. A complete SCI also
results in a loss of motor and sensory function below the level of the injury.
5. Care of the Geriatric Trauma Patient
Which of the following considerations is most important when caring for a
geriatric trauma patient?
A. Head-to-toe exam
B. Medical history
C. Incontinence
D. Falls
Correct Answer: B. Medical history.
Rationale: Geriatric patients often have multiple comorbidities and take
medications (like anticoagulants) that can significantly impact their
response to trauma and treatment. A thorough history is crucial, as age-
related physiological changes and pre-existing conditions can complicate
assessment and management
6. A patient arrives after a motor vehicle collision with a flail chest
segment. Which finding indicates the need for immediate
endotracheal intubation?
A. Respiratory rate of 28
B. Paradoxical chest wall movement
, C. SpO₂ of 91% on 15 L non-rebreather
D. PaCO₂ of 48 mm Hg
Correct Answer: D. PaCO₂ of 48 mm Hg
Rationale: A rising PaCO₂ (hypercapnia) indicates respiratory fatigue and
inadequate ventilation. Flail chest patients can decompensate quickly;
intubation is indicated for respiratory failure, not just hypoxia.
7. Which of the following is the earliest sign of impending
cardiovascular collapse in a trauma patient?
A. Hypotension
B. Tachycardia
C. Narrowed pulse pressure
D. Cool, clammy skin
Correct Answer: C. Narrowed pulse pressure
Rationale: A narrowed pulse pressure (e.g., 100/80 = PP 20) is an early sign
of decreased stroke volume and systemic vascular resistance compensation,
often appearing before overt hypotension.
8. A 6-year-old child is brought in after a fall from a 2-story window.
Vital signs: HR 140, RR 30, BP 90/60. Which intervention is the
priority?
A. CT head
B. FAST exam
C. IV fluid bolus of 20 mL/kg warmed isotonic crystalloid
D. Chest X-ray
Correct Answer: C. IV fluid bolus of 20 mL/kg warmed isotonic crystalloid
Rationale: In pediatrics, hypotension is a late sign. Tachycardia with
LATEST 2026/2027 WITH VERIFIED
QUESTIONS AND ANSWERS
1. Primary Survey & Airway Management
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 PaCO₂ is 30 mm Hg, and the pulse oximetry is 92%.
What is the most important intervention to manage 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 level below 35 mm Hg indicates hyperventilation,
which causes cerebral vasoconstriction. This reduces cerebral blood flow
and can worsen ischemia in a patient with a severe head injury. The priority
is to slow the ventilation rate to allow the PaCO₂ to normalize to 35-45 mm
Hg, preserving cerebral perfusion.
2. Recognizing Stages of Shock
A trauma patient is restless and repeatedly asking "where am I?". Vital signs
upon arrival were BP 100/60, HR 96, RR 24. Current vital signs are BP
104/84, HR 108, RR 28. The patient's skin is cool and dry. The patient is
demonstrating signs of which stage of shock?
A. Compensated
B. Progressive
,C. Irreversible
D. Decompensated
Correct Answer: A. Compensated.
Rationale: In compensated shock, the body uses compensatory
mechanisms (like tachycardia and increased respiratory rate) to maintain
blood pressure and perfusion to vital organs. A narrowed pulse pressure
(104/84, a pulse pressure of 20) is an early indicator of cardiovascular
compromise. The patient's restlessness and cool, dry skin also point to early
shock.
3. Tertiary Injury from Blast Trauma
A factory worker is thrown against a concrete wall during an explosion.
Assessment reveals a fractured femur, a liver laceration, and a small
subdural hematoma. Which level of blast trauma most likely caused these
injuries?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: C. Tertiary blast injury.
Rationale: Tertiary blast injuries result from the victim being thrown by the
blast wind and impacting another object, such as a wall or the ground. This
can cause blunt trauma including fractures, internal organ lacerations, and
head injuries.
4. Spinal Cord Injury and Neurogenic Shock
A patient with a complete spinal cord injury (SCI) in neurogenic shock will
demonstrate hypotension and which other clinical signs?
,A. Bradycardia and ipsilateral absence of motor function
B. Tachycardia and respiratory depression
C. Tachycardia and absent motor function below the level of injury
D. Bradycardia and absent motor function below the level of injury
Correct Answer: D. Bradycardia and absent motor function below the level
of injury.
Rationale: Neurogenic shock is caused by a loss of sympathetic tone
following a spinal cord injury. This leads to hypotension and bradycardia,
which is a key differentiator from hypovolemic shock. A complete SCI also
results in a loss of motor and sensory function below the level of the injury.
5. Care of the Geriatric Trauma Patient
Which of the following considerations is most important when caring for a
geriatric trauma patient?
A. Head-to-toe exam
B. Medical history
C. Incontinence
D. Falls
Correct Answer: B. Medical history.
Rationale: Geriatric patients often have multiple comorbidities and take
medications (like anticoagulants) that can significantly impact their
response to trauma and treatment. A thorough history is crucial, as age-
related physiological changes and pre-existing conditions can complicate
assessment and management
6. A patient arrives after a motor vehicle collision with a flail chest
segment. Which finding indicates the need for immediate
endotracheal intubation?
A. Respiratory rate of 28
B. Paradoxical chest wall movement
, C. SpO₂ of 91% on 15 L non-rebreather
D. PaCO₂ of 48 mm Hg
Correct Answer: D. PaCO₂ of 48 mm Hg
Rationale: A rising PaCO₂ (hypercapnia) indicates respiratory fatigue and
inadequate ventilation. Flail chest patients can decompensate quickly;
intubation is indicated for respiratory failure, not just hypoxia.
7. Which of the following is the earliest sign of impending
cardiovascular collapse in a trauma patient?
A. Hypotension
B. Tachycardia
C. Narrowed pulse pressure
D. Cool, clammy skin
Correct Answer: C. Narrowed pulse pressure
Rationale: A narrowed pulse pressure (e.g., 100/80 = PP 20) is an early sign
of decreased stroke volume and systemic vascular resistance compensation,
often appearing before overt hypotension.
8. A 6-year-old child is brought in after a fall from a 2-story window.
Vital signs: HR 140, RR 30, BP 90/60. Which intervention is the
priority?
A. CT head
B. FAST exam
C. IV fluid bolus of 20 mL/kg warmed isotonic crystalloid
D. Chest X-ray
Correct Answer: C. IV fluid bolus of 20 mL/kg warmed isotonic crystalloid
Rationale: In pediatrics, hypotension is a late sign. Tachycardia with
