TNCC final exam test 2026/2027 open book
updated with complete solution
Course
TNCC
1. A trauma patient arrives after a high-speed motor vehicle collision. The patient is confused,
has gurgling respirations, and has visible blood in the mouth. What is the nurse's priority?
A. Obtain a complete health history
B. Establish IV access
C. Clear and manage the airway
D. Obtain a chest x-ray
Answer: C. Clear and manage the airway
Rationale: The immediate priority in trauma assessment is identifying and treating life threats.
Gurgling suggests airway obstruction from blood or secretions. Airway management takes
priority before secondary assessment.
2. During the primary survey, which sequence is most appropriate?
A. History → secondary survey → airway → circulation
B. Airway → breathing → circulation → disability → exposure
C. Circulation → airway → exposure → disability → breathing
D. Exposure → airway → history → circulation
Answer: B. Airway → breathing → circulation → disability → exposure
Rationale: The systematic trauma approach prioritizes immediate life threats. The ABCDE
sequence provides a structured assessment and treatment framework.
3. A trauma patient has facial trauma and is increasingly restless. Which finding is most
concerning for impending airway compromise?
A. Mild facial swelling
B. Hoarse voice and increasing stridor
C. Small superficial abrasion
D. Heart rate of 88/min
,Answer: B. Hoarse voice and increasing stridor
Rationale: Hoarseness and stridor can indicate upper-airway narrowing. Progressive airway
edema can rapidly make airway management more difficult.
4. A patient with suspected cervical spine injury requires airway management. Which principle
is most important?
A. Hyperextend the neck
B. Maintain cervical spine precautions
C. Turn the patient's head toward the injured side
D. Remove all spinal precautions immediately
Answer: B. Maintain cervical spine precautions
Rationale: Trauma patients with possible cervical spine injury require appropriate spinal motion
restriction while airway management is performed.
5. A patient has severe chest trauma, respiratory distress, hypotension, and absent breath
sounds on the right side. Which condition should the nurse suspect?
A. Simple rib fracture
B. Tension pneumothorax
C. Pulmonary contusion only
D. Cardiac tamponade
Answer: B. Tension pneumothorax
Rationale: Respiratory distress, unilateral absent breath sounds, and hemodynamic compromise
are classic findings of tension pneumothorax. This is an immediately life-threatening condition
requiring rapid intervention.
6. A trauma patient has severe dyspnea, hypotension, distended neck veins, and muffled heart
sounds. Which condition is most likely?
A. Cardiac tamponade
B. Simple pneumothorax
C. Hemothorax
D. Pulmonary embolism
, Answer: A. Cardiac tamponade
Rationale: The combination of hypotension, jugular venous distention, and muffled heart
sounds is associated with cardiac tamponade. Trauma-related tamponade can rapidly impair
cardiac filling and cardiac output.
7. A patient with blunt chest trauma has paradoxical movement of a portion of the chest wall.
What injury does this suggest?
A. Flail chest
B. Hemothorax
C. Simple pneumothorax
D. Cardiac tamponade
Answer: A. Flail chest
Rationale: Flail chest occurs when multiple adjacent ribs are fractured in multiple places,
producing an unstable chest-wall segment that can move paradoxically during respiration.
8. A patient with a flail chest becomes increasingly hypoxic. Which intervention is the priority?
A. Encourage vigorous coughing
B. Provide appropriate oxygenation and ventilatory support
C. Place the patient flat
D. Delay treatment until x-ray confirmation
Answer: B. Provide appropriate oxygenation and ventilatory support
Rationale: Hypoxemia is an immediate threat. Respiratory support should not be unnecessarily
delayed while waiting for diagnostic imaging.
9. A trauma patient has a sucking chest wound. Which intervention should the nurse anticipate?
A. Application of an appropriate occlusive chest dressing
B. Packing the wound deeply with gauze
C. Leaving the wound completely uncovered
D. Applying circumferential abdominal pressure
Answer: A. Application of an appropriate occlusive chest dressing
updated with complete solution
Course
TNCC
1. A trauma patient arrives after a high-speed motor vehicle collision. The patient is confused,
has gurgling respirations, and has visible blood in the mouth. What is the nurse's priority?
A. Obtain a complete health history
B. Establish IV access
C. Clear and manage the airway
D. Obtain a chest x-ray
Answer: C. Clear and manage the airway
Rationale: The immediate priority in trauma assessment is identifying and treating life threats.
Gurgling suggests airway obstruction from blood or secretions. Airway management takes
priority before secondary assessment.
2. During the primary survey, which sequence is most appropriate?
A. History → secondary survey → airway → circulation
B. Airway → breathing → circulation → disability → exposure
C. Circulation → airway → exposure → disability → breathing
D. Exposure → airway → history → circulation
Answer: B. Airway → breathing → circulation → disability → exposure
Rationale: The systematic trauma approach prioritizes immediate life threats. The ABCDE
sequence provides a structured assessment and treatment framework.
3. A trauma patient has facial trauma and is increasingly restless. Which finding is most
concerning for impending airway compromise?
A. Mild facial swelling
B. Hoarse voice and increasing stridor
C. Small superficial abrasion
D. Heart rate of 88/min
,Answer: B. Hoarse voice and increasing stridor
Rationale: Hoarseness and stridor can indicate upper-airway narrowing. Progressive airway
edema can rapidly make airway management more difficult.
4. A patient with suspected cervical spine injury requires airway management. Which principle
is most important?
A. Hyperextend the neck
B. Maintain cervical spine precautions
C. Turn the patient's head toward the injured side
D. Remove all spinal precautions immediately
Answer: B. Maintain cervical spine precautions
Rationale: Trauma patients with possible cervical spine injury require appropriate spinal motion
restriction while airway management is performed.
5. A patient has severe chest trauma, respiratory distress, hypotension, and absent breath
sounds on the right side. Which condition should the nurse suspect?
A. Simple rib fracture
B. Tension pneumothorax
C. Pulmonary contusion only
D. Cardiac tamponade
Answer: B. Tension pneumothorax
Rationale: Respiratory distress, unilateral absent breath sounds, and hemodynamic compromise
are classic findings of tension pneumothorax. This is an immediately life-threatening condition
requiring rapid intervention.
6. A trauma patient has severe dyspnea, hypotension, distended neck veins, and muffled heart
sounds. Which condition is most likely?
A. Cardiac tamponade
B. Simple pneumothorax
C. Hemothorax
D. Pulmonary embolism
, Answer: A. Cardiac tamponade
Rationale: The combination of hypotension, jugular venous distention, and muffled heart
sounds is associated with cardiac tamponade. Trauma-related tamponade can rapidly impair
cardiac filling and cardiac output.
7. A patient with blunt chest trauma has paradoxical movement of a portion of the chest wall.
What injury does this suggest?
A. Flail chest
B. Hemothorax
C. Simple pneumothorax
D. Cardiac tamponade
Answer: A. Flail chest
Rationale: Flail chest occurs when multiple adjacent ribs are fractured in multiple places,
producing an unstable chest-wall segment that can move paradoxically during respiration.
8. A patient with a flail chest becomes increasingly hypoxic. Which intervention is the priority?
A. Encourage vigorous coughing
B. Provide appropriate oxygenation and ventilatory support
C. Place the patient flat
D. Delay treatment until x-ray confirmation
Answer: B. Provide appropriate oxygenation and ventilatory support
Rationale: Hypoxemia is an immediate threat. Respiratory support should not be unnecessarily
delayed while waiting for diagnostic imaging.
9. A trauma patient has a sucking chest wound. Which intervention should the nurse anticipate?
A. Application of an appropriate occlusive chest dressing
B. Packing the wound deeply with gauze
C. Leaving the wound completely uncovered
D. Applying circumferential abdominal pressure
Answer: A. Application of an appropriate occlusive chest dressing
