TNCC – Final Test: Trauma Nursing
Mastery 2026-2027
You are caring for a patient who was thrown from a bike and was not wearing a helmet. While
performing the head-to-toe assessment, you note clear drainage from the right ear. Which of the
following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam.
C. Notify the physician
A patient is brought to the emergency department of a rural hospital following a high-speed motor
vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what
is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
A. Initiate transfer to a trauma center
An adult who fell from a second story roof is brought to the emergency department by private vehicle.
The patient is confused with unlabored respirations and has strong, palpable radial pulses. There is an
open wound in proximity to an obvious deformity of the left lower extremity. What is the priority
intervention?
A. Initiate cervical spine stabilization
,B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen.
D. Log roll the patient onto a spine board
A. Initiate cervical spine stabilization
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 patient has received one
intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0
kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to
manage the 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.
A. Decrease the rate of manual ventilation.
An adult patient is brought to the emergency department following a vehicle "roll-over" with
prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh and a
weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa)
B. Application of a pelvic binder
An adult arrives at the emergency department with superficial burns to the extremities following a
house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is the
most likely cause of these symptoms?
A. Capillary leak syndrome
B. Rhabdomyolysis
C. Carbon monoxide poisoning
D. Hypothermia
Using the American College of Surgeons Guidelines for Screening Patients with Suspected Spine Injury,
what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging?
A. Alert with no neurologic deficits or neck pain
B. Multiple abrasions to the extremities
C. Ecchymosis to the flank
D. Responds to verbal stimulation using AVPU
, A 5-month pregnant patient arrives in the emergency department stating she tripped and fell, landing
on her abdomen. Assessment reveals bruising to the abdomen, both arms, and her neck. She states
she does not take any medications and has not had any prenatal care. The nurse suspects the findings
are most likely related to which of the following?
A.Intentional violence
B.Pregnancy-related changes
C.Undiagnosed embolus
D.Iron deficiency
During the primary survey of an unconscious patient with multi-system trauma, the nurse notes
snoring respirations. Which priority nursing intervention should be performed next?
A.Open the airway with the head-tilt/chin-lift maneuver
B.Auscultate bilateral breath sounds
C.Assist respirations using a bag-mask device
D.Insert an oropharyngeal airway if there is no gag reflex
An adult was thrown against a concrete wall during a factory explosion and sustained a femur
fracture, liver laceration, and a small subdural hematoma. These injuries most likely occurred during
what level of blast trauma?
A.Primary
B.Secondary
C.Tertiary
D.Quaternary
A patient presents to the emergency department with a degloving injury involving the entire forearm.
What should the nurse consider when planning care for a patient with this injury?
A.Wound edges can be easily approximated for suturing.
B.Surgical intervention will be needed
C.Extent of tissue damage does not affect potential limb salvage
D.Only soft tissue has been damaged
A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A
teardrop-shaped left pupil is noted on exam. What type of injury is suspected?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment
A driver involved in a high-speed motor vehicle collision arrives in the emergency department. The
vehicle's air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain
with ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of
uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. Which of the
Mastery 2026-2027
You are caring for a patient who was thrown from a bike and was not wearing a helmet. While
performing the head-to-toe assessment, you note clear drainage from the right ear. Which of the
following is the most appropriate next step?
A. Clean the ear with a cotton-tipped applicator.
B. Pack the ear with gauze.
C. Notify the physician
D. Document and continue the exam.
C. Notify the physician
A patient is brought to the emergency department of a rural hospital following a high-speed motor
vehicle collision. When significant abdominal and pelvic injuries are noted in the primary survey, what
is the priority intervention?
A. Initiate transfer to a trauma center
B. Attempt family notification
C. Obtain additional imaging studies
D. Place an indwelling urinary catheter
A. Initiate transfer to a trauma center
An adult who fell from a second story roof is brought to the emergency department by private vehicle.
The patient is confused with unlabored respirations and has strong, palpable radial pulses. There is an
open wound in proximity to an obvious deformity of the left lower extremity. What is the priority
intervention?
A. Initiate cervical spine stabilization
,B. Apply a splint to the lower extremity
C. Put the patient on portable oxygen.
D. Log roll the patient onto a spine board
A. Initiate cervical spine stabilization
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 patient has received one
intravenous fluid bolus of 500 mL of warmed isotonic crystalloid solution. The PaCO2 is 30 mm Hg (4.0
kPa), and the pulse oximetry is 92%. BP is 142/70 mm Hg. What is the most important intervention to
manage the 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.
A. Decrease the rate of manual ventilation.
An adult patient is brought to the emergency department following a vehicle "roll-over" with
prolonged extrication. Assessment reveals swelling and bruising to the right proximal thigh and a
weak pedal pulse. Skin is pale, cool, and moist. What is the most appropriate initial intervention?
A. Application of a tourniquet to the affected extremity
B. Application of a pelvic binder
C. Fluid resuscitation to maintain a urine output of 0.5 mL/kg/hour
D. Oxygen to maintain the ETCO2 between 30-35 mm Hg (3.9-4.6 kPa)
B. Application of a pelvic binder
An adult arrives at the emergency department with superficial burns to the extremities following a
house fire. The patient is reporting a headache with nausea and is drowsy and confused. What is the
most likely cause of these symptoms?
A. Capillary leak syndrome
B. Rhabdomyolysis
C. Carbon monoxide poisoning
D. Hypothermia
Using the American College of Surgeons Guidelines for Screening Patients with Suspected Spine Injury,
what assessment finding would prompt the nurse to prepare a patient for cervical spine imaging?
A. Alert with no neurologic deficits or neck pain
B. Multiple abrasions to the extremities
C. Ecchymosis to the flank
D. Responds to verbal stimulation using AVPU
, A 5-month pregnant patient arrives in the emergency department stating she tripped and fell, landing
on her abdomen. Assessment reveals bruising to the abdomen, both arms, and her neck. She states
she does not take any medications and has not had any prenatal care. The nurse suspects the findings
are most likely related to which of the following?
A.Intentional violence
B.Pregnancy-related changes
C.Undiagnosed embolus
D.Iron deficiency
During the primary survey of an unconscious patient with multi-system trauma, the nurse notes
snoring respirations. Which priority nursing intervention should be performed next?
A.Open the airway with the head-tilt/chin-lift maneuver
B.Auscultate bilateral breath sounds
C.Assist respirations using a bag-mask device
D.Insert an oropharyngeal airway if there is no gag reflex
An adult was thrown against a concrete wall during a factory explosion and sustained a femur
fracture, liver laceration, and a small subdural hematoma. These injuries most likely occurred during
what level of blast trauma?
A.Primary
B.Secondary
C.Tertiary
D.Quaternary
A patient presents to the emergency department with a degloving injury involving the entire forearm.
What should the nurse consider when planning care for a patient with this injury?
A.Wound edges can be easily approximated for suturing.
B.Surgical intervention will be needed
C.Extent of tissue damage does not affect potential limb salvage
D.Only soft tissue has been damaged
A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A
teardrop-shaped left pupil is noted on exam. What type of injury is suspected?
A.Oculomotor nerve palsy
B.Globe rupture
C.Retrobulbar hematoma
D.Retinal detachment
A driver involved in a high-speed motor vehicle collision arrives in the emergency department. The
vehicle's air-bag failed to deploy. The patient is drowsy but arousable and complaining of chest pain
with ecchymosis noted to the chest. The patient is tachycardic and hypotensive with no evidence of
uncontrolled bleeding. Cardiac monitor shows premature ventricular contractions. Which of the
