TNCC Trauma Nursing Core Course Practice Exam | 2026/2027
TNCC TRAUMA NURSING CORE COURSE PRACTICE EXAM
2026/2027 | 75 Questions | Verified Solutions | 100% Correct | Graded A+
Emergency Nurses Association (ENA) TNCC-Aligned Format | NCSBN CJMM Standards
Next Generation NCLEX-Aligned | Scenario-Based Critical Thinking Items
Exam Structure: 75 multiple-choice and scenario-based questions (Standard MC, SATA, Ordered
Response, Matrix/Matching). Total testing time: approximately 90-120 minutes. Passing score: typically
80% required for TNCC course completion and verification card eligibility (60/75 correct). TNCC
verification card valid for 4 years.
Note: This practice exam is high-probability study material based on ENA TNCC 8th/9th Edition
guidelines, ATLS principles, standard trauma nursing textbooks, and commonly tested concepts. The ENA
does not publicly disclose exam item banks. Use as a study guide only. Confirm current exam
requirements directly with ENA (ena.org) or your authorized TNCC course provider.
Trauma Nursing Process
1. The trauma nurse arrives at the scene of a motor vehicle collision. Which action is the
FIRST priority in the scene size-up?
A. Obtain a detailed medical history from the patient
B. Determine the mechanism of injury and assess scene safety
C. Perform a complete head-to-toe assessment
D. Establish IV access and begin fluid resuscitation
Correct Answer: B. Determine the mechanism of injury and assess scene safety
Rationale: Scene safety is the absolute first priority for all responders, including the trauma nurse.
Before any patient contact, the nurse must verify that the scene is safe from ongoing hazards such as
traffic, fire, electrical wires, hazardous materials, or structural instability. Simultaneously, the
mechanism of injury (MOI) should be assessed to anticipate the types and severity of injuries. The MOI
guides triage decisions, resource activation, and preparation for interventions. Scene size-up also
includes determining the number of patients, requesting additional resources, and identifying the need for
extrication. Patient care cannot begin safely until scene safety is confirmed.
2. A trauma patient was the unrestrained driver in a high-speed head-on collision at 70 mph.
The windshield is starred, and the steering column is deformed. Which triage category
should the nurse assign based on the Centers for Disease Control and Prevention (CDC)
Field Triage Criteria?
A. Green (Minor)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant)
Correct Answer: C. Red (Immediate)
Rationale: The CDC Field Triage Criteria use a stepwise algorithm incorporating physiological,
anatomical, mechanism of injury, and special considerations to assign triage categories. A high-speed
head-on collision at 70 mph with steering column deformation and windshield damage indicates
significant kinetic energy transfer, which strongly suggests serious internal injuries. The patient should
1
, TNCC Trauma Nursing Core Course Practice Exam | 2026/2027
be triaged as Red (Immediate), requiring rapid transport to a trauma center. Green (Minor) is for
patients with minor injuries who can wait. Yellow (Delayed) is for patients who can tolerate a short delay
in care. Black (Expectant) is reserved for patients with injuries incompatible with survival given available
resources in mass casualty situations.
3. [SATA] Which findings during the scene size-up indicate the need to activate the trauma
team at a Level I trauma center? (Select all that apply)
A. Fall from greater than 20 feet
B. Penetrating injury to the head, neck, torso, or proximal extremities
C. Glasgow Coma Scale score of 14
D. Vehicle intrusion greater than 12 inches at the patient compartment
E. Heart rate of 88 bpm with no other abnormalities
F. Ejection from the vehicle
Correct Answers: A, B, D, F - Fall from greater than 20 feet; Penetrating injury to the head,
neck, torso, or proximal extremities; Vehicle intrusion greater than 12 inches at the patient
compartment; Ejection from the vehicle
Rationale: Trauma team activation criteria are based on anatomic, physiological, mechanism of injury,
and special consideration factors. Falls greater than 20 feet (two stories) generate significant kinetic
energy and carry a high probability of multisystem injuries. Penetrating injuries to critical zones (head,
neck, torso, proximal extremities) indicate potential for life-threatening hemorrhage or organ damage.
Vehicle intrusion greater than 12 inches correlates with severe patient compartment deformation and
internal injuries. Ejection from a vehicle is associated with a 25-30% mortality rate regardless of vehicle
speed. A GCS of 14, while abnormal, alone may not trigger full team activation depending on institutional
criteria. An isolated heart rate of 88 bpm is within normal limits and does not suggest shock or significant
injury.
4. Which mechanism of injury MOST likely results in deceleration injuries to the thoracic
aorta?
A. Fall from a standing height
B. Penetrating gunshot wound to the abdomen
C. High-speed motor vehicle collision with rapid deceleration
D. Low-speed lateral impact motor vehicle collision
Correct Answer: C. High-speed motor vehicle collision with rapid deceleration
Rationale: Deceleration injuries occur when the body is moving at a high rate of speed and is abruptly
stopped or slowed, causing internal structures to continue moving forward. The thoracic aorta is
particularly vulnerable at the ligamentum arteriosum (distal to the left subclavian artery), where it is
relatively fixed. In rapid deceleration, the mobile aortic arch continues forward while the fixed
descending aorta decelerates, creating a shearing force that can cause aortic transection,
pseudoaneurysm, or intimal tear. This injury is associated with falls from height, high-speed MVCs, and
head-on collisions. Falls from standing height generate insufficient kinetic energy. Penetrating injuries
cause disruption through direct tissue penetration rather than deceleration forces.
5. A patient arrives via EMS following a motorcycle crash. The prehospital report indicates
the patient was thrown 30 feet from the motorcycle and was helmeted. Which is the priority
nursing intervention upon arrival to the emergency department?
A. Obtain a complete set of vital signs including blood pressure
B. Perform the primary survey using the ABCDE approach
C. Obtain a detailed history from EMS about the crash
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, TNCC Trauma Nursing Core Course Practice Exam | 2026/2027
D. Perform a complete head-to-toe secondary survey
Correct Answer: B. Perform the primary survey using the ABCDE approach
Rationale: The primary survey (ABCDE: Airway with C-spine protection, Breathing, Circulation with
hemorrhage control, Disability, Exposure/Environmental control) is always the first intervention upon
arrival of a trauma patient. Its purpose is to rapidly identify and treat immediate life threats. A 30-foot
ejection from a motorcycle, even helmeted, indicates significant kinetic energy transfer with high
probability of multisystem injuries. The primary survey must be completed before any detailed
assessment, history, or secondary survey. While vital signs and EMS history are important, they are
obtained during or immediately after the primary survey. The secondary survey is performed only after
the primary survey is complete and the patient is stabilized.
6. A patient injured in a blast explosion presents with tympanic membrane rupture, lung
contusion, and abdominal bruising. Which blast injury phase accounts for these findings?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: A. Primary blast injury
Rationale: Blast injuries are categorized into four phases. Primary blast injuries are caused exclusively
by the blast overpressure wave affecting air-filled organs, resulting in tympanic membrane rupture (the
most common primary blast injury), pulmonary contusion (blast lung), gastrointestinal perforation, and
traumatic brain injury. The overpressure wave causes the greatest damage at air-tissue interfaces.
Secondary blast injuries result from flying debris and shrapnel causing penetrating trauma. Tertiary
blast injuries occur when the patient is thrown by the blast wind, causing blunt trauma from impact.
Quaternary blast injuries include burns, crush injuries, and inhalation injuries from toxic gases or dust.
7. The triage officer at a mass casualty incident has assessed five patients. Which patient
should be classified as Priority 1 (Red/Immediate)?
A. A conscious patient with a fractured wrist and minor lacerations
B. An unresponsive patient with no palpable pulse or respirations
C. A patient with an open femur fracture, active hemorrhage, and tachycardia
D. A patient with minor abrasions who is ambulatory
Correct Answer: C. A patient with an open femur fracture, active hemorrhage, and
tachycardia
Rationale: In START (Simple Triage and Rapid Treatment) triage, patients are sorted by severity and
urgency of intervention needed. Priority 1 (Red/Immediate) includes patients with life-threatening but
potentially survivable injuries requiring immediate intervention. An open femur fracture with active
hemorrhage and tachycardia (indicating hypovolemic shock) is correctly classified as Red. The patient
with the fractured wrist and minor lacerations is Priority 3 (Green/Minor). The unresponsive patient
without pulse or respirations is assessed for breathing: if not breathing after airway repositioning, this
patient is classified as Priority 4 (Black/Expectant) in a mass casualty situation. The ambulatory patient
with minor abrasions is Priority 3 (Green/Minor).
Initial Assessment and Primary Survey
8. During the primary survey of a trauma patient, the nurse notes tracheal deviation to the
right and absent breath sounds on the left. Which intervention is the priority?
A. Perform needle decompression of the left chest
3
TNCC TRAUMA NURSING CORE COURSE PRACTICE EXAM
2026/2027 | 75 Questions | Verified Solutions | 100% Correct | Graded A+
Emergency Nurses Association (ENA) TNCC-Aligned Format | NCSBN CJMM Standards
Next Generation NCLEX-Aligned | Scenario-Based Critical Thinking Items
Exam Structure: 75 multiple-choice and scenario-based questions (Standard MC, SATA, Ordered
Response, Matrix/Matching). Total testing time: approximately 90-120 minutes. Passing score: typically
80% required for TNCC course completion and verification card eligibility (60/75 correct). TNCC
verification card valid for 4 years.
Note: This practice exam is high-probability study material based on ENA TNCC 8th/9th Edition
guidelines, ATLS principles, standard trauma nursing textbooks, and commonly tested concepts. The ENA
does not publicly disclose exam item banks. Use as a study guide only. Confirm current exam
requirements directly with ENA (ena.org) or your authorized TNCC course provider.
Trauma Nursing Process
1. The trauma nurse arrives at the scene of a motor vehicle collision. Which action is the
FIRST priority in the scene size-up?
A. Obtain a detailed medical history from the patient
B. Determine the mechanism of injury and assess scene safety
C. Perform a complete head-to-toe assessment
D. Establish IV access and begin fluid resuscitation
Correct Answer: B. Determine the mechanism of injury and assess scene safety
Rationale: Scene safety is the absolute first priority for all responders, including the trauma nurse.
Before any patient contact, the nurse must verify that the scene is safe from ongoing hazards such as
traffic, fire, electrical wires, hazardous materials, or structural instability. Simultaneously, the
mechanism of injury (MOI) should be assessed to anticipate the types and severity of injuries. The MOI
guides triage decisions, resource activation, and preparation for interventions. Scene size-up also
includes determining the number of patients, requesting additional resources, and identifying the need for
extrication. Patient care cannot begin safely until scene safety is confirmed.
2. A trauma patient was the unrestrained driver in a high-speed head-on collision at 70 mph.
The windshield is starred, and the steering column is deformed. Which triage category
should the nurse assign based on the Centers for Disease Control and Prevention (CDC)
Field Triage Criteria?
A. Green (Minor)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant)
Correct Answer: C. Red (Immediate)
Rationale: The CDC Field Triage Criteria use a stepwise algorithm incorporating physiological,
anatomical, mechanism of injury, and special considerations to assign triage categories. A high-speed
head-on collision at 70 mph with steering column deformation and windshield damage indicates
significant kinetic energy transfer, which strongly suggests serious internal injuries. The patient should
1
, TNCC Trauma Nursing Core Course Practice Exam | 2026/2027
be triaged as Red (Immediate), requiring rapid transport to a trauma center. Green (Minor) is for
patients with minor injuries who can wait. Yellow (Delayed) is for patients who can tolerate a short delay
in care. Black (Expectant) is reserved for patients with injuries incompatible with survival given available
resources in mass casualty situations.
3. [SATA] Which findings during the scene size-up indicate the need to activate the trauma
team at a Level I trauma center? (Select all that apply)
A. Fall from greater than 20 feet
B. Penetrating injury to the head, neck, torso, or proximal extremities
C. Glasgow Coma Scale score of 14
D. Vehicle intrusion greater than 12 inches at the patient compartment
E. Heart rate of 88 bpm with no other abnormalities
F. Ejection from the vehicle
Correct Answers: A, B, D, F - Fall from greater than 20 feet; Penetrating injury to the head,
neck, torso, or proximal extremities; Vehicle intrusion greater than 12 inches at the patient
compartment; Ejection from the vehicle
Rationale: Trauma team activation criteria are based on anatomic, physiological, mechanism of injury,
and special consideration factors. Falls greater than 20 feet (two stories) generate significant kinetic
energy and carry a high probability of multisystem injuries. Penetrating injuries to critical zones (head,
neck, torso, proximal extremities) indicate potential for life-threatening hemorrhage or organ damage.
Vehicle intrusion greater than 12 inches correlates with severe patient compartment deformation and
internal injuries. Ejection from a vehicle is associated with a 25-30% mortality rate regardless of vehicle
speed. A GCS of 14, while abnormal, alone may not trigger full team activation depending on institutional
criteria. An isolated heart rate of 88 bpm is within normal limits and does not suggest shock or significant
injury.
4. Which mechanism of injury MOST likely results in deceleration injuries to the thoracic
aorta?
A. Fall from a standing height
B. Penetrating gunshot wound to the abdomen
C. High-speed motor vehicle collision with rapid deceleration
D. Low-speed lateral impact motor vehicle collision
Correct Answer: C. High-speed motor vehicle collision with rapid deceleration
Rationale: Deceleration injuries occur when the body is moving at a high rate of speed and is abruptly
stopped or slowed, causing internal structures to continue moving forward. The thoracic aorta is
particularly vulnerable at the ligamentum arteriosum (distal to the left subclavian artery), where it is
relatively fixed. In rapid deceleration, the mobile aortic arch continues forward while the fixed
descending aorta decelerates, creating a shearing force that can cause aortic transection,
pseudoaneurysm, or intimal tear. This injury is associated with falls from height, high-speed MVCs, and
head-on collisions. Falls from standing height generate insufficient kinetic energy. Penetrating injuries
cause disruption through direct tissue penetration rather than deceleration forces.
5. A patient arrives via EMS following a motorcycle crash. The prehospital report indicates
the patient was thrown 30 feet from the motorcycle and was helmeted. Which is the priority
nursing intervention upon arrival to the emergency department?
A. Obtain a complete set of vital signs including blood pressure
B. Perform the primary survey using the ABCDE approach
C. Obtain a detailed history from EMS about the crash
2
, TNCC Trauma Nursing Core Course Practice Exam | 2026/2027
D. Perform a complete head-to-toe secondary survey
Correct Answer: B. Perform the primary survey using the ABCDE approach
Rationale: The primary survey (ABCDE: Airway with C-spine protection, Breathing, Circulation with
hemorrhage control, Disability, Exposure/Environmental control) is always the first intervention upon
arrival of a trauma patient. Its purpose is to rapidly identify and treat immediate life threats. A 30-foot
ejection from a motorcycle, even helmeted, indicates significant kinetic energy transfer with high
probability of multisystem injuries. The primary survey must be completed before any detailed
assessment, history, or secondary survey. While vital signs and EMS history are important, they are
obtained during or immediately after the primary survey. The secondary survey is performed only after
the primary survey is complete and the patient is stabilized.
6. A patient injured in a blast explosion presents with tympanic membrane rupture, lung
contusion, and abdominal bruising. Which blast injury phase accounts for these findings?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: A. Primary blast injury
Rationale: Blast injuries are categorized into four phases. Primary blast injuries are caused exclusively
by the blast overpressure wave affecting air-filled organs, resulting in tympanic membrane rupture (the
most common primary blast injury), pulmonary contusion (blast lung), gastrointestinal perforation, and
traumatic brain injury. The overpressure wave causes the greatest damage at air-tissue interfaces.
Secondary blast injuries result from flying debris and shrapnel causing penetrating trauma. Tertiary
blast injuries occur when the patient is thrown by the blast wind, causing blunt trauma from impact.
Quaternary blast injuries include burns, crush injuries, and inhalation injuries from toxic gases or dust.
7. The triage officer at a mass casualty incident has assessed five patients. Which patient
should be classified as Priority 1 (Red/Immediate)?
A. A conscious patient with a fractured wrist and minor lacerations
B. An unresponsive patient with no palpable pulse or respirations
C. A patient with an open femur fracture, active hemorrhage, and tachycardia
D. A patient with minor abrasions who is ambulatory
Correct Answer: C. A patient with an open femur fracture, active hemorrhage, and
tachycardia
Rationale: In START (Simple Triage and Rapid Treatment) triage, patients are sorted by severity and
urgency of intervention needed. Priority 1 (Red/Immediate) includes patients with life-threatening but
potentially survivable injuries requiring immediate intervention. An open femur fracture with active
hemorrhage and tachycardia (indicating hypovolemic shock) is correctly classified as Red. The patient
with the fractured wrist and minor lacerations is Priority 3 (Green/Minor). The unresponsive patient
without pulse or respirations is assessed for breathing: if not breathing after airway repositioning, this
patient is classified as Priority 4 (Black/Expectant) in a mass casualty situation. The ambulatory patient
with minor abrasions is Priority 3 (Green/Minor).
Initial Assessment and Primary Survey
8. During the primary survey of a trauma patient, the nurse notes tracheal deviation to the
right and absent breath sounds on the left. Which intervention is the priority?
A. Perform needle decompression of the left chest
3
