TNCC 10TH EDITION PROVIDER CERTIFICATION EXAM
2026/2027 | Trauma Nursing Core Course | ENA | Complete
Q&A | Pass Guaranteed - A+ Graded
Section 1: Trauma Nursing Principles & Initial Assessment
(Primary/Secondary Survey) (Questions 1-15)
Question 1
A 32-year-old male arrives at the trauma center after a high-speed motor vehicle
collision. The trauma nurse begins the primary survey. According to the TNCC 10th
Edition, which sequence correctly represents the primary survey priorities?
A. Circulation, Airway, Breathing, Disability, Exposure (CABDE)
B. Airway with cervical spine protection, Breathing, Circulation, Disability, Exposure
(ABCDE)
C. Exposure, Disability, Circulation, Breathing, Airway (EDCBA)
D. Disability, Airway, Breathing, Circulation, Exposure (DABCE)
Correct Answer: B
Rationale: The TNCC primary survey follows the ABCDE sequence: Airway (with
simultaneous cervical spine protection), Breathing, Circulation, Disability, and
Exposure/Environment. This systematic approach ensures life-threatening conditions
are identified and addressed in order of priority. Option A reflects the old CAB sequence
used in cardiac arrest, not trauma; Option C reverses the priority order; Option D
incorrectly places Disability before Airway.
,Question 2
A trauma patient presents after a fall from a second-story balcony. During the primary
survey, the nurse assesses airway patency. The patient is speaking clearly but has blood
in the oropharynx and gurgling respirations. Which intervention is the priority?
A. Immediately intubate the patient with an endotracheal tube.
B. Suction the oropharynx and insert an oropharyngeal airway if needed.
C. Perform a jaw-thrust maneuver only and reassess.
D. Proceed to the breathing assessment without addressing the airway.
Correct Answer: B
Rationale: Blood and gurgling in the oropharynx indicates a partially obstructed airway
that requires immediate suctioning to clear secretions and maintain patency. An
oropharyngeal airway may be needed if the patient cannot maintain the airway
independently. Option A is premature—suctioning and basic adjuncts should precede
definitive airway unless the patient is apneic or cannot protect the airway; Option C is
insufficient because blood must be cleared; Option D violates the ABCDE sequence.
Question 3
During the primary survey of a trauma patient, the nurse auscultates breath sounds and
finds absent sounds on the left side with tracheal deviation to the right. The patient has
distended neck veins and is hypotensive. Which life-threatening condition should the
nurse suspect?
A. Hemothorax
B. Tension pneumothorax
C. Flail chest
D. Pulmonary contusion
,Correct Answer: B
Rationale: The classic triad of absent breath sounds, tracheal deviation away from the
affected side, and hypotension with distended neck veins (Beck's triad variant) indicates
tension pneumothorax—a life-threatening condition requiring immediate needle
decompression. Option A (hemothorax) presents with dullness to percussion and
decreased breath sounds but not tracheal deviation; Option C (flail chest) presents with
paradoxical chest wall movement; Option D (pulmonary contusion) presents with
crackles and hypoxia but not mediastinal shift.
Question 4
A trauma nurse is performing the secondary survey on a patient who fell from a ladder.
Which component is correctly included in the secondary survey but NOT the primary
survey?
A. Assessment of airway patency
B. Collection of the AMPLE history
C. Evaluation of breathing effort and rate
D. Assessment of circulation and hemorrhage control
Correct Answer: B
Rationale: The AMPLE history (Allergies, Medications, Past medical history, Last meal,
Events/Environment related to the injury) is obtained during the secondary survey after
life-threatening conditions have been addressed in the primary survey. Options A, C, and
D are all components of the primary survey (ABCDE).
Question 5
, A 45-year-old patient is brought in after a motorcycle crash at 65 mph. The trauma
nurse recognizes that the mechanism of injury suggests significant energy transfer.
According to TNCC principles, which statement about mechanism of injury (MOI) is
most accurate?
A. MOI is irrelevant in trauma triage decisions.
B. MOI helps predict the potential for serious injury and guides the index of suspicion
for occult injuries.
C. MOI is only relevant for penetrating trauma, not blunt trauma.
D. A low-energy MOI always rules out serious injury.
Correct Answer: B
Rationale: Mechanism of injury is a critical component of trauma triage and
assessment, helping clinicians anticipate injury patterns and maintain a high index of
suspicion for occult injuries even when initial findings are subtle. High-energy
mechanisms (e.g., high-speed MVC, falls >20 feet) warrant higher-level trauma team
activation. Option A is incorrect because MOI is fundamental to triage; Option C is
incorrect because MOI applies to both blunt and penetrating trauma; Option D is
incorrect because serious injuries can occur with any mechanism.
Question 6
A trauma patient arrives with multiple stab wounds to the chest and abdomen. During
the primary survey, the nurse notes the patient is anxious, tachycardic, and has cool,
clammy skin. Blood pressure is 88/60 mmHg. Which classification of shock is most
likely?
A. Cardiogenic shock
B. Obstructive shock
C. Hemorrhagic shock
D. Neurogenic shock
2026/2027 | Trauma Nursing Core Course | ENA | Complete
Q&A | Pass Guaranteed - A+ Graded
Section 1: Trauma Nursing Principles & Initial Assessment
(Primary/Secondary Survey) (Questions 1-15)
Question 1
A 32-year-old male arrives at the trauma center after a high-speed motor vehicle
collision. The trauma nurse begins the primary survey. According to the TNCC 10th
Edition, which sequence correctly represents the primary survey priorities?
A. Circulation, Airway, Breathing, Disability, Exposure (CABDE)
B. Airway with cervical spine protection, Breathing, Circulation, Disability, Exposure
(ABCDE)
C. Exposure, Disability, Circulation, Breathing, Airway (EDCBA)
D. Disability, Airway, Breathing, Circulation, Exposure (DABCE)
Correct Answer: B
Rationale: The TNCC primary survey follows the ABCDE sequence: Airway (with
simultaneous cervical spine protection), Breathing, Circulation, Disability, and
Exposure/Environment. This systematic approach ensures life-threatening conditions
are identified and addressed in order of priority. Option A reflects the old CAB sequence
used in cardiac arrest, not trauma; Option C reverses the priority order; Option D
incorrectly places Disability before Airway.
,Question 2
A trauma patient presents after a fall from a second-story balcony. During the primary
survey, the nurse assesses airway patency. The patient is speaking clearly but has blood
in the oropharynx and gurgling respirations. Which intervention is the priority?
A. Immediately intubate the patient with an endotracheal tube.
B. Suction the oropharynx and insert an oropharyngeal airway if needed.
C. Perform a jaw-thrust maneuver only and reassess.
D. Proceed to the breathing assessment without addressing the airway.
Correct Answer: B
Rationale: Blood and gurgling in the oropharynx indicates a partially obstructed airway
that requires immediate suctioning to clear secretions and maintain patency. An
oropharyngeal airway may be needed if the patient cannot maintain the airway
independently. Option A is premature—suctioning and basic adjuncts should precede
definitive airway unless the patient is apneic or cannot protect the airway; Option C is
insufficient because blood must be cleared; Option D violates the ABCDE sequence.
Question 3
During the primary survey of a trauma patient, the nurse auscultates breath sounds and
finds absent sounds on the left side with tracheal deviation to the right. The patient has
distended neck veins and is hypotensive. Which life-threatening condition should the
nurse suspect?
A. Hemothorax
B. Tension pneumothorax
C. Flail chest
D. Pulmonary contusion
,Correct Answer: B
Rationale: The classic triad of absent breath sounds, tracheal deviation away from the
affected side, and hypotension with distended neck veins (Beck's triad variant) indicates
tension pneumothorax—a life-threatening condition requiring immediate needle
decompression. Option A (hemothorax) presents with dullness to percussion and
decreased breath sounds but not tracheal deviation; Option C (flail chest) presents with
paradoxical chest wall movement; Option D (pulmonary contusion) presents with
crackles and hypoxia but not mediastinal shift.
Question 4
A trauma nurse is performing the secondary survey on a patient who fell from a ladder.
Which component is correctly included in the secondary survey but NOT the primary
survey?
A. Assessment of airway patency
B. Collection of the AMPLE history
C. Evaluation of breathing effort and rate
D. Assessment of circulation and hemorrhage control
Correct Answer: B
Rationale: The AMPLE history (Allergies, Medications, Past medical history, Last meal,
Events/Environment related to the injury) is obtained during the secondary survey after
life-threatening conditions have been addressed in the primary survey. Options A, C, and
D are all components of the primary survey (ABCDE).
Question 5
, A 45-year-old patient is brought in after a motorcycle crash at 65 mph. The trauma
nurse recognizes that the mechanism of injury suggests significant energy transfer.
According to TNCC principles, which statement about mechanism of injury (MOI) is
most accurate?
A. MOI is irrelevant in trauma triage decisions.
B. MOI helps predict the potential for serious injury and guides the index of suspicion
for occult injuries.
C. MOI is only relevant for penetrating trauma, not blunt trauma.
D. A low-energy MOI always rules out serious injury.
Correct Answer: B
Rationale: Mechanism of injury is a critical component of trauma triage and
assessment, helping clinicians anticipate injury patterns and maintain a high index of
suspicion for occult injuries even when initial findings are subtle. High-energy
mechanisms (e.g., high-speed MVC, falls >20 feet) warrant higher-level trauma team
activation. Option A is incorrect because MOI is fundamental to triage; Option C is
incorrect because MOI applies to both blunt and penetrating trauma; Option D is
incorrect because serious injuries can occur with any mechanism.
Question 6
A trauma patient arrives with multiple stab wounds to the chest and abdomen. During
the primary survey, the nurse notes the patient is anxious, tachycardic, and has cool,
clammy skin. Blood pressure is 88/60 mmHg. Which classification of shock is most
likely?
A. Cardiogenic shock
B. Obstructive shock
C. Hemorrhagic shock
D. Neurogenic shock
