TNCC 9TH EDITION ACTUAL EXAM 2026 QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES |ALREADY GRADED A+
| GUARANTEED PASS |TNCC 9TH EDITION FINAL LATEST
VERSION 2026 [BRAND NEW!!]
Question 1
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.
Correct answer: C. Notify the physician
Rationale: Clear drainage from the ear after head trauma is suspicious for
cerebrospinal fluid (CSF) leak, indicating a possible basilar skull fracture. Cleaning
or packing the ear can introduce infection. The physician must be notified
immediately for further diagnostic evaluation and management.
Question 2
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
Correct answer: A. Initiate transfer to a trauma center
1|Page
,Rationale: Rural hospitals often lack surgical subspecialists and resources for
major abdominal/pelvic trauma. Early transfer to a trauma center is critical for
definitive surgical management and improved outcomes.
Question 3
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
(Note: The document cuts off here, but based on trauma priorities, the answer is
cervical spine stabilization due to fall from height and altered mental status.)
Correct answer: A. Initiate cervical spine stabilization
Rationale: The patient has a significant mechanism of injury (fall from height) and
altered mental status (confusion). Cervical spine injury is presumed until cleared.
Airway and breathing are intact (unlabored respirations, strong pulses), so spinal
motion restriction is the priority.
Question 4
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.
2|Page
,Correct answer: A. Decrease the rate of manual ventilation
Rationale: PaCO2 is 30 mm Hg (low-normal). Hyperventilation (rate 18/min)
causes cerebral vasoconstriction, reducing cerebral blood flow. Decreasing
ventilation rate will normalize PaCO2 to ~35-40 mm Hg, optimizing cerebral
perfusion.
Question 5
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)
Correct answer: B. Application of a pelvic binder
Rationale: The presentation (swelling/bruising proximal thigh, weak pedal pulse,
pale/cool/moist skin) suggests pelvic fracture with hemorrhage. A pelvic binder
reduces pelvic volume, stabilizes fractures, and decreases bleeding.
Question 6
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
Correct answer: C. Carbon monoxide poisoning
3|Page
, Rationale: Headache, nausea, drowsiness, confusion after a fire are hallmark signs
of carbon monoxide poisoning from smoke inhalation. Burns may be superficial,
but neurologic symptoms indicate CO exposure.
Question 7
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
Correct answer: D. Responds to verbal stimulation using AVPU
Rationale: Any alteration in mental status (e.g., responds to verbal stimuli)
indicates the patient cannot reliably deny neck pain or neurologic deficits, so
cervical spine imaging is indicated per NEXUS criteria.
Question 8
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
Correct answer: A. Intentional violence
4|Page
CORRECT ANSWERS WITH RATIONALES |ALREADY GRADED A+
| GUARANTEED PASS |TNCC 9TH EDITION FINAL LATEST
VERSION 2026 [BRAND NEW!!]
Question 1
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.
Correct answer: C. Notify the physician
Rationale: Clear drainage from the ear after head trauma is suspicious for
cerebrospinal fluid (CSF) leak, indicating a possible basilar skull fracture. Cleaning
or packing the ear can introduce infection. The physician must be notified
immediately for further diagnostic evaluation and management.
Question 2
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
Correct answer: A. Initiate transfer to a trauma center
1|Page
,Rationale: Rural hospitals often lack surgical subspecialists and resources for
major abdominal/pelvic trauma. Early transfer to a trauma center is critical for
definitive surgical management and improved outcomes.
Question 3
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
(Note: The document cuts off here, but based on trauma priorities, the answer is
cervical spine stabilization due to fall from height and altered mental status.)
Correct answer: A. Initiate cervical spine stabilization
Rationale: The patient has a significant mechanism of injury (fall from height) and
altered mental status (confusion). Cervical spine injury is presumed until cleared.
Airway and breathing are intact (unlabored respirations, strong pulses), so spinal
motion restriction is the priority.
Question 4
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.
2|Page
,Correct answer: A. Decrease the rate of manual ventilation
Rationale: PaCO2 is 30 mm Hg (low-normal). Hyperventilation (rate 18/min)
causes cerebral vasoconstriction, reducing cerebral blood flow. Decreasing
ventilation rate will normalize PaCO2 to ~35-40 mm Hg, optimizing cerebral
perfusion.
Question 5
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)
Correct answer: B. Application of a pelvic binder
Rationale: The presentation (swelling/bruising proximal thigh, weak pedal pulse,
pale/cool/moist skin) suggests pelvic fracture with hemorrhage. A pelvic binder
reduces pelvic volume, stabilizes fractures, and decreases bleeding.
Question 6
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
Correct answer: C. Carbon monoxide poisoning
3|Page
, Rationale: Headache, nausea, drowsiness, confusion after a fire are hallmark signs
of carbon monoxide poisoning from smoke inhalation. Burns may be superficial,
but neurologic symptoms indicate CO exposure.
Question 7
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
Correct answer: D. Responds to verbal stimulation using AVPU
Rationale: Any alteration in mental status (e.g., responds to verbal stimuli)
indicates the patient cannot reliably deny neck pain or neurologic deficits, so
cervical spine imaging is indicated per NEXUS criteria.
Question 8
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
Correct answer: A. Intentional violence
4|Page
