Trauma Nursing Core Course Certification Exam (Version
3)– Emergency Trauma Nursing Assessment (TNCC EXAM)
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient arrives with a traumatic amputation of the lower leg and life-threatening
bleeding. According to the MARCH mnemonic, which intervention is the absolute priority?
A. Establishing a patent airway via jaw-thrust
B. Administering high-flow oxygen via non-rebreather
C. Applying a tourniquet proximal to the injury
D. Initiating large-bore IV access for fluid resuscitation
Ans: C
Rationale: Massive hemorrhage control is the first step in the MARCH mnemonic to prevent
exsanguination. Life-threatening bleeding must be addressed even before airway management in modern
trauma protocols. Applying a tourniquet is the most effective way to stop arterial bleeding in an
extremity. Neglecting this step leads to rapid hemodynamic collapse and the lethal triad of death. The
nurse should place the tourniquet ‘high and tight’ if the exact source is unclear in a chaotic scene. This
prioritization reflects a shift from the traditional ABC to the MARCH algorithm for improved survival.
Early control of external bleeding significantly reduces the need for massive transfusions later.
,2. During the ‘A’ (Airway and Alertness) portion of the primary survey, which technique is
mandatory for a patient with suspected cervical spine injury?
A. Head-tilt, chin-lift maneuver
B. Blind finger sweep of the oropharynx
C. Jaw-thrust maneuver while maintaining C-spine stabilization
D. Immediate nasopharyngeal airway insertion
Ans: C
Rationale: The jaw-thrust maneuver is the gold standard for opening the airway when a cervical spine
injury is suspected. It minimizes movement of the vertebrae compared to the head-tilt/chin-lift which is
contraindicated in trauma. A second provider should ideally provide manual in-line stabilization during
this process. Maintaining a patent airway is critical as hypoxia can quickly lead to secondary brain injury.
If the airway is obstructed by blood or vomit, suctioning should be performed carefully. The nurse must
also assess for alertness using the AVPU scale during this phase. Consistent spinal protection is a core
competency of TNCC nursing care.
,3. A patient presents with muffled heart sounds, jugular venous distention, and
hypotension. Which condition should the trauma nurse immediately suspect?
A. Cardiac Tamponade
B. Tension Pneumothorax
C. Hypovolemic Shock
D. Massive Hemothorax
Ans: A
Rationale: These three clinical signs are collectively known as Beck’s Triad, which indicates cardiac
tamponade. Tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and
preventing diastolic filling. Hypotension results from decreased cardiac output while venous distention
occurs due to backflow. Muffled heart sounds are caused by the insulating effect of the pericardial fluid.
This is an obstructive shock state that requires immediate needle pericardiocentesis or a pericardial
window. It is often seen in penetrating chest trauma but can occur in blunt injuries. Prompt recognition
by the trauma nurse is life-saving as the condition rapidly deteriorates.
, 4. What is the primary physiological goal of ‘Permissive Hypotension’ in the initial
resuscitation of a trauma patient?
A. To increase renal perfusion and urine output
B. To ensure maximum oxygen delivery to the brain
C. To prevent the dislodgement of formed clots
D. To reduce the risk of intracranial hypertension
Ans: C
Rationale: Permissive hypotension involves maintaining a lower-than-normal blood pressure to avoid
‘popping the clot.’ Aggressive fluid resuscitation can increase pressure enough to dislodge internal
hemostatic plugs. This strategy is typically used until definitive surgical hemorrhage control is achieved.
The target systolic blood pressure is usually around 80-90 mmHg in the absence of head injury. However,
this approach is contraindicated in patients with traumatic brain injury who require higher perfusion
pressures. Fluids should be administered in small boluses rather than continuous high-flow infusions.
Balancing tissue perfusion with the risk of re-bleeding is a critical nursing assessment task.
3)– Emergency Trauma Nursing Assessment (TNCC EXAM)
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient arrives with a traumatic amputation of the lower leg and life-threatening
bleeding. According to the MARCH mnemonic, which intervention is the absolute priority?
A. Establishing a patent airway via jaw-thrust
B. Administering high-flow oxygen via non-rebreather
C. Applying a tourniquet proximal to the injury
D. Initiating large-bore IV access for fluid resuscitation
Ans: C
Rationale: Massive hemorrhage control is the first step in the MARCH mnemonic to prevent
exsanguination. Life-threatening bleeding must be addressed even before airway management in modern
trauma protocols. Applying a tourniquet is the most effective way to stop arterial bleeding in an
extremity. Neglecting this step leads to rapid hemodynamic collapse and the lethal triad of death. The
nurse should place the tourniquet ‘high and tight’ if the exact source is unclear in a chaotic scene. This
prioritization reflects a shift from the traditional ABC to the MARCH algorithm for improved survival.
Early control of external bleeding significantly reduces the need for massive transfusions later.
,2. During the ‘A’ (Airway and Alertness) portion of the primary survey, which technique is
mandatory for a patient with suspected cervical spine injury?
A. Head-tilt, chin-lift maneuver
B. Blind finger sweep of the oropharynx
C. Jaw-thrust maneuver while maintaining C-spine stabilization
D. Immediate nasopharyngeal airway insertion
Ans: C
Rationale: The jaw-thrust maneuver is the gold standard for opening the airway when a cervical spine
injury is suspected. It minimizes movement of the vertebrae compared to the head-tilt/chin-lift which is
contraindicated in trauma. A second provider should ideally provide manual in-line stabilization during
this process. Maintaining a patent airway is critical as hypoxia can quickly lead to secondary brain injury.
If the airway is obstructed by blood or vomit, suctioning should be performed carefully. The nurse must
also assess for alertness using the AVPU scale during this phase. Consistent spinal protection is a core
competency of TNCC nursing care.
,3. A patient presents with muffled heart sounds, jugular venous distention, and
hypotension. Which condition should the trauma nurse immediately suspect?
A. Cardiac Tamponade
B. Tension Pneumothorax
C. Hypovolemic Shock
D. Massive Hemothorax
Ans: A
Rationale: These three clinical signs are collectively known as Beck’s Triad, which indicates cardiac
tamponade. Tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and
preventing diastolic filling. Hypotension results from decreased cardiac output while venous distention
occurs due to backflow. Muffled heart sounds are caused by the insulating effect of the pericardial fluid.
This is an obstructive shock state that requires immediate needle pericardiocentesis or a pericardial
window. It is often seen in penetrating chest trauma but can occur in blunt injuries. Prompt recognition
by the trauma nurse is life-saving as the condition rapidly deteriorates.
, 4. What is the primary physiological goal of ‘Permissive Hypotension’ in the initial
resuscitation of a trauma patient?
A. To increase renal perfusion and urine output
B. To ensure maximum oxygen delivery to the brain
C. To prevent the dislodgement of formed clots
D. To reduce the risk of intracranial hypertension
Ans: C
Rationale: Permissive hypotension involves maintaining a lower-than-normal blood pressure to avoid
‘popping the clot.’ Aggressive fluid resuscitation can increase pressure enough to dislodge internal
hemostatic plugs. This strategy is typically used until definitive surgical hemorrhage control is achieved.
The target systolic blood pressure is usually around 80-90 mmHg in the absence of head injury. However,
this approach is contraindicated in patients with traumatic brain injury who require higher perfusion
pressures. Fluids should be administered in small boluses rather than continuous high-flow infusions.
Balancing tissue perfusion with the risk of re-bleeding is a critical nursing assessment task.
