TNCC FINAL EXAM PRACTICE
QUESTIONS 2025/2026 EXAM
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES
Questions 150: Primary Survey & Initial Assessment
1. What does the mnemonic ABCDE stand for in trauma care?
A) Assessment, Breathing, Care, Decisionmaking, Evaluation
B) Airway, Breathing, Circulation, Disability, Exposure
C) Airway, Breathing, Circulation, Disability, Environment
D) Assessment, Breathing, Circulation, Diagnosis, Evaluation
Correct Answer: B
Rationale: ABCDE is the systematic approach to trauma assessment: Airway
assessment with cervical spine stabilization is first, followed by Breathing
(ventilation and oxygenation), Circulation (hemorrhage control and
perfusion), Disability (neurological status), and Exposure (full body
examination with temperature control). This sequence ensures life threats are
identified and treated in order of priority.
,2. What is the leading cause of preventable death for the trauma patient in the
prehospital environment?
A) Airway compromise
B) Ineffective ventilation
C) Secondary head injury
D) Uncontrolled external hemorrhage
Correct Answer: D
Rationale: Uncontrolled external hemorrhage is the leading cause of
preventable death in trauma. Early identification and intervention (direct
pressure, tourniquet application, hemostatic agents) are critical to improve
survival outcomes.
3. Why is a measure of serum lactate obtained in the initial assessment of the
trauma patient?
A) To measure oxygenation and ventilation
B) To quantify the base deficit for the adequacy of cellular perfusion
C) To gauge endorgan perfusion and tissue hypoxia
D) To determine the underlying cause of shock
Correct Answer: C
Rationale: Serum lactate is a marker of endorgan perfusion and tissue
hypoxia. Elevated lactate indicates inadequate oxygen delivery to tissues due
to hypoperfusion. It helps guide resuscitation efforts and predict outcomes.
,4. A trauma patient is restless and repeatedly asking "where am I?" Vital signs
upon arrival: BP 100/60 mmHg, HR 96 beats/min, RR 24 breaths/min. Skin is
cool and dry. Current vital signs: BP 104/84 mmHg, HR 108, RR 28
breaths/min. The patient is demonstrating signs and symptoms of which stage
of shock?
A) Compensated
B) Progressive
C) Irreversible
D) Decompensated
Correct Answer: A
Rationale: Compensated shock is characterized by tachycardia, narrowing
pulse pressure, cool extremities, and anxiety or restlessness. The body
maintains nearnormal blood pressure through compensatory mechanisms
(increased heart rate, vasoconstriction). Narrowing pulse pressure (from 40
to 20 mmHg) is an early sign of decompensation.
5. An elderly patient with a history of anticoagulant use presents after a fall at
home. She denies loss of consciousness. She has a hematoma to her forehead
and complains of headache, dizziness, and nausea. Which is the most likely
cause of her symptoms?
A) Epidural hematoma
B) Diffuse axonal injury
, C) Postconcussive syndrome
D) Subdural hematoma
Correct Answer: D
Rationale: Elderly patients on anticoagulants are at high risk for subdural
hematoma, which can present with a delayed onset of symptoms (headache,
dizziness, nausea, confusion) following seemingly minor head trauma. Unlike
epidural hematomas (which typically have a lucid interval followed by rapid
deterioration), subdural hematomas can have a more insidious presentation.
6. EMS brings a patient who fell riding a bicycle. Using the American College of
Surgeons screening guidelines, which assessment finding would prompt the
nurse to prepare the patient for radiologic spine clearance?
A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests for water
D) Smell of alcohol on breath
Correct Answer: D
Rationale: The smell of alcohol on breath indicates intoxication, which is a
criterion for radiologic spine clearance because the patient's reliability for
neurologic assessment is compromised. Other indications include altered
mental status, neurologic deficit, spinal pain/tenderness, and distracting
injury.
QUESTIONS 2025/2026 EXAM
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES
Questions 150: Primary Survey & Initial Assessment
1. What does the mnemonic ABCDE stand for in trauma care?
A) Assessment, Breathing, Care, Decisionmaking, Evaluation
B) Airway, Breathing, Circulation, Disability, Exposure
C) Airway, Breathing, Circulation, Disability, Environment
D) Assessment, Breathing, Circulation, Diagnosis, Evaluation
Correct Answer: B
Rationale: ABCDE is the systematic approach to trauma assessment: Airway
assessment with cervical spine stabilization is first, followed by Breathing
(ventilation and oxygenation), Circulation (hemorrhage control and
perfusion), Disability (neurological status), and Exposure (full body
examination with temperature control). This sequence ensures life threats are
identified and treated in order of priority.
,2. What is the leading cause of preventable death for the trauma patient in the
prehospital environment?
A) Airway compromise
B) Ineffective ventilation
C) Secondary head injury
D) Uncontrolled external hemorrhage
Correct Answer: D
Rationale: Uncontrolled external hemorrhage is the leading cause of
preventable death in trauma. Early identification and intervention (direct
pressure, tourniquet application, hemostatic agents) are critical to improve
survival outcomes.
3. Why is a measure of serum lactate obtained in the initial assessment of the
trauma patient?
A) To measure oxygenation and ventilation
B) To quantify the base deficit for the adequacy of cellular perfusion
C) To gauge endorgan perfusion and tissue hypoxia
D) To determine the underlying cause of shock
Correct Answer: C
Rationale: Serum lactate is a marker of endorgan perfusion and tissue
hypoxia. Elevated lactate indicates inadequate oxygen delivery to tissues due
to hypoperfusion. It helps guide resuscitation efforts and predict outcomes.
,4. A trauma patient is restless and repeatedly asking "where am I?" Vital signs
upon arrival: BP 100/60 mmHg, HR 96 beats/min, RR 24 breaths/min. Skin is
cool and dry. Current vital signs: BP 104/84 mmHg, HR 108, RR 28
breaths/min. The patient is demonstrating signs and symptoms of which stage
of shock?
A) Compensated
B) Progressive
C) Irreversible
D) Decompensated
Correct Answer: A
Rationale: Compensated shock is characterized by tachycardia, narrowing
pulse pressure, cool extremities, and anxiety or restlessness. The body
maintains nearnormal blood pressure through compensatory mechanisms
(increased heart rate, vasoconstriction). Narrowing pulse pressure (from 40
to 20 mmHg) is an early sign of decompensation.
5. An elderly patient with a history of anticoagulant use presents after a fall at
home. She denies loss of consciousness. She has a hematoma to her forehead
and complains of headache, dizziness, and nausea. Which is the most likely
cause of her symptoms?
A) Epidural hematoma
B) Diffuse axonal injury
, C) Postconcussive syndrome
D) Subdural hematoma
Correct Answer: D
Rationale: Elderly patients on anticoagulants are at high risk for subdural
hematoma, which can present with a delayed onset of symptoms (headache,
dizziness, nausea, confusion) following seemingly minor head trauma. Unlike
epidural hematomas (which typically have a lucid interval followed by rapid
deterioration), subdural hematomas can have a more insidious presentation.
6. EMS brings a patient who fell riding a bicycle. Using the American College of
Surgeons screening guidelines, which assessment finding would prompt the
nurse to prepare the patient for radiologic spine clearance?
A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests for water
D) Smell of alcohol on breath
Correct Answer: D
Rationale: The smell of alcohol on breath indicates intoxication, which is a
criterion for radiologic spine clearance because the patient's reliability for
neurologic assessment is compromised. Other indications include altered
mental status, neurologic deficit, spinal pain/tenderness, and distracting
injury.
