TNCC FINAL EXAM 2026/2027 | Trauma Nursing Core
Course Open Book Updated | Complete Solution
Preparation | Verified Q&A | Pass Guaranteed - A+
Graded
Section 1: Primary Survey (ABCDE) & Adjuncts (Q1-12)
Q1. A 34-year-old unrestrained driver is brought to the ED after a high-speed MVC.
He is moaning but not following commands. His airway is patent with gurgling
sounds. What is the nurse's priority action?
A. Obtain a cervical spine x-ray
B. Apply a cervical collar and perform an oropharyngeal suctioning [CORRECT]
C. Insert an oropharyngeal airway and prepare for intubation
D. Obtain a full set of vital signs before any intervention
Rationale: Gurgling indicates pooled secretions/obstruction requiring immediate
suctioning. C-spine protection (B) is simultaneous with airway management per
ATLS/TNCC. Option A delays airway intervention; C is premature without suctioning;
D violates the primary survey sequence. [TNCC 9th Ed: Airway; ATLS 11th Ed: ABCDE]
Correct Answer: B
Q2. A trauma patient presents with absent breath sounds on the right, tracheal
deviation to the left, and distended neck veins. BP is 78/50, HR 128. What is the
immediate intervention?
A. Insert a chest tube on the left side
B. Perform a needle decompression at the 2nd intercostal space, midclavicular line on
the right [CORRECT]
,C. Administer 2 liters of crystalloid fluid bolus
D. Obtain a chest x-ray before intervention
Rationale: This is classic tension pneumothorax—a life threat requiring immediate
needle decompression before imaging or fluid resuscitation. The affected side is right
(absent breath sounds); decompression occurs on the affected side at 2nd ICS MCL.
Chest tube (A) is definitive but not immediate; fluids (C) and imaging (D) delay critical
intervention. [TNCC 9th Ed: Breathing; Tension Pneumothorax]
Correct Answer: B
Q3. During the primary survey, the nurse identifies massive external hemorrhage
from a traumatic leg amputation. What is the correct sequence of interventions?
A. Apply tourniquet, call for blood products, obtain IV access
B. Apply direct pressure, elevate extremity, apply tourniquet if bleeding continues
[CORRECT]
C. Obtain large-bore IV access first, then address the bleeding
D. Apply hemostatic gauze only and wait for the surgeon
Rationale: Massive hemorrhage control is the first step (even before airway in some
protocols). Direct pressure → elevation → tourniquet is the standard escalation.
Tourniquet first (A) may be unnecessary; obtaining IV first (C) delays hemorrhage
control; hemostatic gauze alone (D) is insufficient for massive bleeding. [TNCC 9th
Ed: Circulation; Hemorrhage Control; ATLS 11th Ed: C-ABC]
Correct Answer: B
Q4. A patient with a GCS of 7 (E1, V2, M4) requires definitive airway management.
Which finding is a contraindication to rapid sequence intubation (RSI) with
succinylcholine?
A. History of asthma
B. Hyperkalemia with K+ 6.2 mEq/L [CORRECT]
, C. Penetrating eye injury
D. Cervical spine immobilization in place
Rationale: Succinylcholine is contraindicated in hyperkalemia (>5.5 mEq/L) due to
risk of fatal arrhythmias from additional potassium release. Asthma (A) is not a
contraindication; penetrating eye injury (C) requires caution but not absolute
contraindication; c-spine precautions (D) are managed with in-line stabilization.
[TNCC 9th Ed: Airway; RSI Contraindications]
Correct Answer: B
Q5. A trauma patient has a respiratory rate of 32, SpO2 88% on room air, and absent
breath sounds on the left with dullness to percussion. What is the most likely
diagnosis and immediate management?
A. Tension pneumothorax; needle decompression
B. Hemothorax; large-bore chest tube insertion [CORRECT]
C. Flail chest; intubation and positive pressure ventilation
D. Open pneumothorax; three-sided occlusive dressing
Rationale: Absent breath sounds + dull percussion = hemothorax (blood in pleural
space), requiring chest tube drainage. Tension pneumothorax (A) presents with
hyperresonance and tracheal deviation; flail chest (C) shows paradoxical movement;
open pneumothorax (D) has a visible chest wall defect. [TNCC 9th Ed: Breathing;
Hemothorax Management]
Correct Answer: B
Q6. The nurse is preparing to insert a chest tube for a hemothorax. Where should the
tube be placed?
A. 2nd intercostal space, midclavicular line
B. 4th or 5th intercostal space, anterior axillary line [CORRECT]
Course Open Book Updated | Complete Solution
Preparation | Verified Q&A | Pass Guaranteed - A+
Graded
Section 1: Primary Survey (ABCDE) & Adjuncts (Q1-12)
Q1. A 34-year-old unrestrained driver is brought to the ED after a high-speed MVC.
He is moaning but not following commands. His airway is patent with gurgling
sounds. What is the nurse's priority action?
A. Obtain a cervical spine x-ray
B. Apply a cervical collar and perform an oropharyngeal suctioning [CORRECT]
C. Insert an oropharyngeal airway and prepare for intubation
D. Obtain a full set of vital signs before any intervention
Rationale: Gurgling indicates pooled secretions/obstruction requiring immediate
suctioning. C-spine protection (B) is simultaneous with airway management per
ATLS/TNCC. Option A delays airway intervention; C is premature without suctioning;
D violates the primary survey sequence. [TNCC 9th Ed: Airway; ATLS 11th Ed: ABCDE]
Correct Answer: B
Q2. A trauma patient presents with absent breath sounds on the right, tracheal
deviation to the left, and distended neck veins. BP is 78/50, HR 128. What is the
immediate intervention?
A. Insert a chest tube on the left side
B. Perform a needle decompression at the 2nd intercostal space, midclavicular line on
the right [CORRECT]
,C. Administer 2 liters of crystalloid fluid bolus
D. Obtain a chest x-ray before intervention
Rationale: This is classic tension pneumothorax—a life threat requiring immediate
needle decompression before imaging or fluid resuscitation. The affected side is right
(absent breath sounds); decompression occurs on the affected side at 2nd ICS MCL.
Chest tube (A) is definitive but not immediate; fluids (C) and imaging (D) delay critical
intervention. [TNCC 9th Ed: Breathing; Tension Pneumothorax]
Correct Answer: B
Q3. During the primary survey, the nurse identifies massive external hemorrhage
from a traumatic leg amputation. What is the correct sequence of interventions?
A. Apply tourniquet, call for blood products, obtain IV access
B. Apply direct pressure, elevate extremity, apply tourniquet if bleeding continues
[CORRECT]
C. Obtain large-bore IV access first, then address the bleeding
D. Apply hemostatic gauze only and wait for the surgeon
Rationale: Massive hemorrhage control is the first step (even before airway in some
protocols). Direct pressure → elevation → tourniquet is the standard escalation.
Tourniquet first (A) may be unnecessary; obtaining IV first (C) delays hemorrhage
control; hemostatic gauze alone (D) is insufficient for massive bleeding. [TNCC 9th
Ed: Circulation; Hemorrhage Control; ATLS 11th Ed: C-ABC]
Correct Answer: B
Q4. A patient with a GCS of 7 (E1, V2, M4) requires definitive airway management.
Which finding is a contraindication to rapid sequence intubation (RSI) with
succinylcholine?
A. History of asthma
B. Hyperkalemia with K+ 6.2 mEq/L [CORRECT]
, C. Penetrating eye injury
D. Cervical spine immobilization in place
Rationale: Succinylcholine is contraindicated in hyperkalemia (>5.5 mEq/L) due to
risk of fatal arrhythmias from additional potassium release. Asthma (A) is not a
contraindication; penetrating eye injury (C) requires caution but not absolute
contraindication; c-spine precautions (D) are managed with in-line stabilization.
[TNCC 9th Ed: Airway; RSI Contraindications]
Correct Answer: B
Q5. A trauma patient has a respiratory rate of 32, SpO2 88% on room air, and absent
breath sounds on the left with dullness to percussion. What is the most likely
diagnosis and immediate management?
A. Tension pneumothorax; needle decompression
B. Hemothorax; large-bore chest tube insertion [CORRECT]
C. Flail chest; intubation and positive pressure ventilation
D. Open pneumothorax; three-sided occlusive dressing
Rationale: Absent breath sounds + dull percussion = hemothorax (blood in pleural
space), requiring chest tube drainage. Tension pneumothorax (A) presents with
hyperresonance and tracheal deviation; flail chest (C) shows paradoxical movement;
open pneumothorax (D) has a visible chest wall defect. [TNCC 9th Ed: Breathing;
Hemothorax Management]
Correct Answer: B
Q6. The nurse is preparing to insert a chest tube for a hemothorax. Where should the
tube be placed?
A. 2nd intercostal space, midclavicular line
B. 4th or 5th intercostal space, anterior axillary line [CORRECT]
