1
TNCC final exam test 2025/2026 open book updated with complete
solution
Questions 1-10: Primary Survey & Airway Management
1. During the primary survey of an unconscious trauma patient, the nurse notes snoring
respirations. What is the priority nursing intervention?
A) Administer supplemental oxygen via non-rebreather mask
B) Insert an oropharyngeal airway if there is no gag reflex
C) Prepare for immediate endotracheal intubation
D) Position the patient in the recovery position
Answer: B) Insert an oropharyngeal airway if there is no gag reflex
Rationale: Snoring respirations indicate partial airway obstruction from the tongue falling back. An
oropharyngeal airway is indicated for unconscious patients without a gag reflex to maintain airway
patency. Nasopharyngeal airways are preferred for conscious patients. Oxygen administration alone
will not correct the obstruction .
2. The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better
visualization during the insertion of which device?
A) Nasogastric tube
B) Endotracheal tube
C) Central venous catheter
D) Chest tube
Answer: B) Endotracheal tube
Rationale: The ramped position elevates the patient's head and shoulders to align the external
auditory meatus with the sternal notch. This positioning improves laryngoscopic visualization during
endotracheal intubation in obese patients by facilitating a direct line of sight to the glottis .
3. What bedside monitoring parameters are used to assess for adequacy of oxygenation and
effectiveness of ventilation?
A) Respiratory rate and capnography
B) Pulse oximetry and capnography
C) Pulse oximetry and respiratory rate
D) Capnography and capnometry
Answer: B) Pulse oximetry and capnography
Rationale: Pulse oximetry (SpO2) measures oxygen saturation and reflects adequacy of oxygenation.
Capnography (ETCO2) measures exhaled carbon dioxide and reflects effectiveness of ventilation.
Together, these provide continuous, non-invasive monitoring of respiratory status .
,2
4. An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored
respirations, and dusky skin. The trauma team administered medications for drug-assisted
intubation but was unsuccessful. What is the most appropriate immediate next step?
A) Attempt a surgical airway
B) Ventilate with a bag-mask device
C) Repeat drug-assisted intubation
D) Insert a supraglottic airway device
Answer: B) Ventilate with a bag-mask device
Rationale: When intubation is unsuccessful, the priority is to maintain oxygenation and ventilation.
Bag-mask ventilation provides temporary support while preparing for a second intubation attempt or
alternative airway management. The patient is already showing signs of hypoxia (dusky skin) .
5. Which of the following is NOT considered goal-directed therapy for cardiogenic shock?
A) Controlled fluid boluses
B) Antidysrhythmic administration
C) Pericardiocentesis
D) Cardiac catheterization
Answer: C) Pericardiocentesis
Rationale: Pericardiocentesis is treatment for cardiac tamponade, not cardiogenic shock. Goal-
directed therapy for cardiogenic shock includes controlled fluid administration, antidysrhythmic
medications, inotropic support, and cardiac catheterization for revascularization .
6. An intubated trauma patient is being transferred to a tertiary care center. After moving the
patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the
following is the priority intervention?
A) Call for a portable chest X-ray stat
B) Confirm endotracheal tube placement
C) Suction the ET tube
D) Increase ventilator rate
Answer: B) Confirm endotracheal tube placement
Rationale: Sudden desaturation during patient movement should prompt immediate verification of
endotracheal tube placement. Movement can cause tube dislodgement or displacement. Assessment
includes auscultation, ETCO2 monitoring, and visualizing chest rise .
7. An adult patient with a knife injury to the neck has an intact airway and is hemodynamically
stable. They complain of difficulty swallowing and speaking. Further assessment is indicated next
for which condition?
A) Damage to the cervical spine
B) An expanding pneumothorax
, 3
C) Laceration of the carotid artery
D) Injury to the thyroid gland
Answer: A) Damage to the cervical spine
Rationale: Difficulty swallowing and speaking following penetrating neck trauma raises concern for
cervical spine injury. Penetrating trauma can cause direct spinal cord injury. Airway protection with
cervical spine precautions is essential .
8. Which of the following accurately describes ventilation principles associated with use of a bag-
mask device for an adult?
A) Compress the bag-mask device at a rate of one breath every 6 seconds
B) Delivers 100% oxygen
C) Squeeze the bag-mask device completely for each breath
D) Maintain oxygen saturation between 92% and 94%
Answer: A) Compress the bag-mask device at a rate of one breath every 6 seconds
Rationale: For an adult, ventilations should be delivered at a rate of 10 breaths per minute (one
breath every 6 seconds). Each breath should be delivered over 1 second, with enough volume to
produce visible chest rise. The bag-mask device with reservoir typically delivers 90-95% oxygen, not
100% .
9. Which of the following values indicates the need for alcohol withdrawal interventions?
A) CIWA-Ar of 36
B) GCS of 13
C) ETCO2 of 48 mm Hg
D) Heart rate of 45 beats/minute
Answer: A) CIWA-Ar of 36
Rationale: A CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol-Revised) score of 36
indicates severe alcohol withdrawal requiring pharmacological intervention. Scores 8-15 indicate
mild withdrawal, and 16+ indicates moderate withdrawal. GCS, ETCO2, and heart rate abnormalities
may have other causes .
10. A trauma patient is restless and repeatedly asking "Where am I?" Vital signs: BP 104/84 mm
Hg, HR 108 beats/min, RR 28 breaths/min, skin cool and dry. The patient is demonstrating signs
and symptoms of which stage of shock?
A) Compensated
B) Progressive
C) Irreversible
D) Neurogenic
Answer: A) Compensated
TNCC final exam test 2025/2026 open book updated with complete
solution
Questions 1-10: Primary Survey & Airway Management
1. During the primary survey of an unconscious trauma patient, the nurse notes snoring
respirations. What is the priority nursing intervention?
A) Administer supplemental oxygen via non-rebreather mask
B) Insert an oropharyngeal airway if there is no gag reflex
C) Prepare for immediate endotracheal intubation
D) Position the patient in the recovery position
Answer: B) Insert an oropharyngeal airway if there is no gag reflex
Rationale: Snoring respirations indicate partial airway obstruction from the tongue falling back. An
oropharyngeal airway is indicated for unconscious patients without a gag reflex to maintain airway
patency. Nasopharyngeal airways are preferred for conscious patients. Oxygen administration alone
will not correct the obstruction .
2. The trauma nurse knows that placing a bariatric patient in a "ramped position" provides better
visualization during the insertion of which device?
A) Nasogastric tube
B) Endotracheal tube
C) Central venous catheter
D) Chest tube
Answer: B) Endotracheal tube
Rationale: The ramped position elevates the patient's head and shoulders to align the external
auditory meatus with the sternal notch. This positioning improves laryngoscopic visualization during
endotracheal intubation in obese patients by facilitating a direct line of sight to the glottis .
3. What bedside monitoring parameters are used to assess for adequacy of oxygenation and
effectiveness of ventilation?
A) Respiratory rate and capnography
B) Pulse oximetry and capnography
C) Pulse oximetry and respiratory rate
D) Capnography and capnometry
Answer: B) Pulse oximetry and capnography
Rationale: Pulse oximetry (SpO2) measures oxygen saturation and reflects adequacy of oxygenation.
Capnography (ETCO2) measures exhaled carbon dioxide and reflects effectiveness of ventilation.
Together, these provide continuous, non-invasive monitoring of respiratory status .
,2
4. An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored
respirations, and dusky skin. The trauma team administered medications for drug-assisted
intubation but was unsuccessful. What is the most appropriate immediate next step?
A) Attempt a surgical airway
B) Ventilate with a bag-mask device
C) Repeat drug-assisted intubation
D) Insert a supraglottic airway device
Answer: B) Ventilate with a bag-mask device
Rationale: When intubation is unsuccessful, the priority is to maintain oxygenation and ventilation.
Bag-mask ventilation provides temporary support while preparing for a second intubation attempt or
alternative airway management. The patient is already showing signs of hypoxia (dusky skin) .
5. Which of the following is NOT considered goal-directed therapy for cardiogenic shock?
A) Controlled fluid boluses
B) Antidysrhythmic administration
C) Pericardiocentesis
D) Cardiac catheterization
Answer: C) Pericardiocentesis
Rationale: Pericardiocentesis is treatment for cardiac tamponade, not cardiogenic shock. Goal-
directed therapy for cardiogenic shock includes controlled fluid administration, antidysrhythmic
medications, inotropic support, and cardiac catheterization for revascularization .
6. An intubated trauma patient is being transferred to a tertiary care center. After moving the
patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the
following is the priority intervention?
A) Call for a portable chest X-ray stat
B) Confirm endotracheal tube placement
C) Suction the ET tube
D) Increase ventilator rate
Answer: B) Confirm endotracheal tube placement
Rationale: Sudden desaturation during patient movement should prompt immediate verification of
endotracheal tube placement. Movement can cause tube dislodgement or displacement. Assessment
includes auscultation, ETCO2 monitoring, and visualizing chest rise .
7. An adult patient with a knife injury to the neck has an intact airway and is hemodynamically
stable. They complain of difficulty swallowing and speaking. Further assessment is indicated next
for which condition?
A) Damage to the cervical spine
B) An expanding pneumothorax
, 3
C) Laceration of the carotid artery
D) Injury to the thyroid gland
Answer: A) Damage to the cervical spine
Rationale: Difficulty swallowing and speaking following penetrating neck trauma raises concern for
cervical spine injury. Penetrating trauma can cause direct spinal cord injury. Airway protection with
cervical spine precautions is essential .
8. Which of the following accurately describes ventilation principles associated with use of a bag-
mask device for an adult?
A) Compress the bag-mask device at a rate of one breath every 6 seconds
B) Delivers 100% oxygen
C) Squeeze the bag-mask device completely for each breath
D) Maintain oxygen saturation between 92% and 94%
Answer: A) Compress the bag-mask device at a rate of one breath every 6 seconds
Rationale: For an adult, ventilations should be delivered at a rate of 10 breaths per minute (one
breath every 6 seconds). Each breath should be delivered over 1 second, with enough volume to
produce visible chest rise. The bag-mask device with reservoir typically delivers 90-95% oxygen, not
100% .
9. Which of the following values indicates the need for alcohol withdrawal interventions?
A) CIWA-Ar of 36
B) GCS of 13
C) ETCO2 of 48 mm Hg
D) Heart rate of 45 beats/minute
Answer: A) CIWA-Ar of 36
Rationale: A CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol-Revised) score of 36
indicates severe alcohol withdrawal requiring pharmacological intervention. Scores 8-15 indicate
mild withdrawal, and 16+ indicates moderate withdrawal. GCS, ETCO2, and heart rate abnormalities
may have other causes .
10. A trauma patient is restless and repeatedly asking "Where am I?" Vital signs: BP 104/84 mm
Hg, HR 108 beats/min, RR 28 breaths/min, skin cool and dry. The patient is demonstrating signs
and symptoms of which stage of shock?
A) Compensated
B) Progressive
C) Irreversible
D) Neurogenic
Answer: A) Compensated
