TNCC 9TH EDITION EXAM 500 MCQs QUESTIONS AND
ANSWERS PLUS RATIONALES GRADED A+
1. A patient arrives with a knife injury to the neck, intact airway, and hemodynamic stability but reports
difficulty swallowing and speaking. During the primary survey, further assessment is indicated next for
which condition?
A) Damage to the cervical spine
B) An expanding pneumothorax
C) Laceration of the carotid artery
D) Injury to the thyroid gland
Answer: A
Rationale: Difficulty swallowing and speaking after penetrating neck trauma raises concern for
underlying cervical spine injury, which requires immediate immobilization and further evaluation .
2. A patient arrives by private vehicle with a large gaping wound to the right thigh with significant
bleeding after a saw injury. What is the priority intervention?
A) Elevate the extremity to heart level
B) Initiate direct pressure
C) Apply a tourniquet
D) Cover with sterile saline dressings
Answer: B
Rationale: Direct pressure is the first-line intervention for external hemorrhage control; tourniquets are
used only if direct pressure fails or for massive arterial bleeding .
3. A patient who fell two weeks ago striking their head was diagnosed with a small subdural hematoma
and has been in the ED for 24 hours. The night shift reports the patient is anxious, restless, shaky, and
vomited twice, claiming a child kept entering the room. What is the most likely cause?
A) Increased intracranial pressure
B) Alcohol withdrawal
C) Rhabdomyolysis
D) Pulmonary embolus
Answer: B
1|Page SUCCESS!!!
,Rationale: The symptom constellation—anxiety, restlessness, tremors, vomiting, and perceptual
disturbances—is classic for alcohol withdrawal, not worsening intracranial pathology .
4. A patient involved in an MVC sustained a fracture to the second rib of the anterior left chest. Which
concurrent injury is most commonly associated?
A) Blunt cardiac injury
B) Brachial plexus injury
C) Pneumothorax
D) Hemothorax
Answer: B
Rationale: First and second rib fractures require significant force and are associated with brachial plexus
injury and great vessel injury due to proximity .
5. A patient with a C5 spinal cord injury is being cared for in the ED awaiting trauma center transfer.
What represents the highest priority for ongoing assessment?
A) Maintain adequate respiratory status
B) Administer balanced resuscitation fluid
C) Perform serial neurologic assessments
D) Maintain core temperature
Answer: A
Rationale: C5 injuries affect phrenic nerve function (C3-C5), compromising diaphragmatic breathing;
respiratory failure is the leading cause of death, making airway and breathing the priority.
6. Following a bomb explosion, fragmentation injuries from the bomb or environmental objects are
examples of which phase of injury?
A) Primary
B) Secondary
C) Tertiary
D) Quaternary
Answer: B
Rationale: Secondary blast injuries result from flying debris and projectiles; primary is from overpressure
wave, tertiary from body displacement, and quaternary from burns or toxins .
2|Page SUCCESS!!!
,7. In a patient with severe traumatic brain injury, hypocapnia causes which condition?
A) Respiratory acidosis
B) Metabolic acidosis
C) Neurogenic shock
D) Cerebral vasoconstriction
Answer: D
Rationale: Hypocapnia induces cerebral vasoconstriction, reducing cerebral blood flow and potentially
worsening ischemia; it should be avoided except for brief treatment of herniation .
8. The general impression step in the initial assessment provides the opportunity to do what?
A) Assess for uncontrolled internal hemorrhage
B) Accurately triage the patient
C) Reprioritize circulation before airway or breathing
D) Activate the trauma team
Answer: C
Rationale: The general impression allows the nurse to identify immediate life threats and potentially
reprioritize to C-ABC if uncontrolled hemorrhage is the most immediate threat .
9. A trauma nurse who cared for a child with devastating burns two weeks ago called in sick for a few
days and is now back. Which behavior indicates the nurse is coping well?
A) Talking about taking the emergency nursing certification examination
B) Requesting assignment to the walk-in/ambulatory area
C) Being impatient and snapping at coworkers
D) Thinking about transferring out of the emergency department
Answer: A
Rationale: Positive coping after a difficult case includes professional growth activities like pursuing
certification; avoidance, irritability, or withdrawal suggest maladaptive coping .
10. What is the leading cause of preventable death for the trauma patient in the prehospital environment?
A) Airway compromise
3|Page SUCCESS!!!
, B) Ineffective ventilation
C) Secondary head injury
D) Uncontrolled external hemorrhage
Answer: D
Rationale: Hemorrhage is the leading cause of preventable death after injury, emphasizing the importance
of early bleeding control in the field .
11. Which accurately describes ventilation principles when using a bag-mask device for an adult?
A) Compress at one breath every 6 seconds
B) Delivers 100% oxygen
C) Squeeze the bag completely for each breath
D) Maintain oxygen saturation between 92% and 94%
Answer: A
*Rationale: The recommended bag-mask ventilation rate for an adult is one breath every 5-6 seconds (10-
12 breaths/minute) to avoid overventilation and gastric distention .*
12. What is considered a cornerstone of a high-performance trauma team?
A) Individual goals
B) Use of TeamSTEPPS
C) Identification of a single decision maker
D) Effective communication
Answer: D
Rationale: Effective communication is foundational to all team functions, including closed-loop
communication, shared mental models, and role clarity .
13. While assessing a 13-month-old involved in an MVC, the nurse identifies which finding as a sign of
possible altered mental status?
A) Sunken fontanel
B) Crying, but consolable
C) Spontaneous movement of arms and legs
D) Cooperation with the assessment
4|Page SUCCESS!!!
ANSWERS PLUS RATIONALES GRADED A+
1. A patient arrives with a knife injury to the neck, intact airway, and hemodynamic stability but reports
difficulty swallowing and speaking. During the primary survey, further assessment is indicated next for
which condition?
A) Damage to the cervical spine
B) An expanding pneumothorax
C) Laceration of the carotid artery
D) Injury to the thyroid gland
Answer: A
Rationale: Difficulty swallowing and speaking after penetrating neck trauma raises concern for
underlying cervical spine injury, which requires immediate immobilization and further evaluation .
2. A patient arrives by private vehicle with a large gaping wound to the right thigh with significant
bleeding after a saw injury. What is the priority intervention?
A) Elevate the extremity to heart level
B) Initiate direct pressure
C) Apply a tourniquet
D) Cover with sterile saline dressings
Answer: B
Rationale: Direct pressure is the first-line intervention for external hemorrhage control; tourniquets are
used only if direct pressure fails or for massive arterial bleeding .
3. A patient who fell two weeks ago striking their head was diagnosed with a small subdural hematoma
and has been in the ED for 24 hours. The night shift reports the patient is anxious, restless, shaky, and
vomited twice, claiming a child kept entering the room. What is the most likely cause?
A) Increased intracranial pressure
B) Alcohol withdrawal
C) Rhabdomyolysis
D) Pulmonary embolus
Answer: B
1|Page SUCCESS!!!
,Rationale: The symptom constellation—anxiety, restlessness, tremors, vomiting, and perceptual
disturbances—is classic for alcohol withdrawal, not worsening intracranial pathology .
4. A patient involved in an MVC sustained a fracture to the second rib of the anterior left chest. Which
concurrent injury is most commonly associated?
A) Blunt cardiac injury
B) Brachial plexus injury
C) Pneumothorax
D) Hemothorax
Answer: B
Rationale: First and second rib fractures require significant force and are associated with brachial plexus
injury and great vessel injury due to proximity .
5. A patient with a C5 spinal cord injury is being cared for in the ED awaiting trauma center transfer.
What represents the highest priority for ongoing assessment?
A) Maintain adequate respiratory status
B) Administer balanced resuscitation fluid
C) Perform serial neurologic assessments
D) Maintain core temperature
Answer: A
Rationale: C5 injuries affect phrenic nerve function (C3-C5), compromising diaphragmatic breathing;
respiratory failure is the leading cause of death, making airway and breathing the priority.
6. Following a bomb explosion, fragmentation injuries from the bomb or environmental objects are
examples of which phase of injury?
A) Primary
B) Secondary
C) Tertiary
D) Quaternary
Answer: B
Rationale: Secondary blast injuries result from flying debris and projectiles; primary is from overpressure
wave, tertiary from body displacement, and quaternary from burns or toxins .
2|Page SUCCESS!!!
,7. In a patient with severe traumatic brain injury, hypocapnia causes which condition?
A) Respiratory acidosis
B) Metabolic acidosis
C) Neurogenic shock
D) Cerebral vasoconstriction
Answer: D
Rationale: Hypocapnia induces cerebral vasoconstriction, reducing cerebral blood flow and potentially
worsening ischemia; it should be avoided except for brief treatment of herniation .
8. The general impression step in the initial assessment provides the opportunity to do what?
A) Assess for uncontrolled internal hemorrhage
B) Accurately triage the patient
C) Reprioritize circulation before airway or breathing
D) Activate the trauma team
Answer: C
Rationale: The general impression allows the nurse to identify immediate life threats and potentially
reprioritize to C-ABC if uncontrolled hemorrhage is the most immediate threat .
9. A trauma nurse who cared for a child with devastating burns two weeks ago called in sick for a few
days and is now back. Which behavior indicates the nurse is coping well?
A) Talking about taking the emergency nursing certification examination
B) Requesting assignment to the walk-in/ambulatory area
C) Being impatient and snapping at coworkers
D) Thinking about transferring out of the emergency department
Answer: A
Rationale: Positive coping after a difficult case includes professional growth activities like pursuing
certification; avoidance, irritability, or withdrawal suggest maladaptive coping .
10. What is the leading cause of preventable death for the trauma patient in the prehospital environment?
A) Airway compromise
3|Page SUCCESS!!!
, B) Ineffective ventilation
C) Secondary head injury
D) Uncontrolled external hemorrhage
Answer: D
Rationale: Hemorrhage is the leading cause of preventable death after injury, emphasizing the importance
of early bleeding control in the field .
11. Which accurately describes ventilation principles when using a bag-mask device for an adult?
A) Compress at one breath every 6 seconds
B) Delivers 100% oxygen
C) Squeeze the bag completely for each breath
D) Maintain oxygen saturation between 92% and 94%
Answer: A
*Rationale: The recommended bag-mask ventilation rate for an adult is one breath every 5-6 seconds (10-
12 breaths/minute) to avoid overventilation and gastric distention .*
12. What is considered a cornerstone of a high-performance trauma team?
A) Individual goals
B) Use of TeamSTEPPS
C) Identification of a single decision maker
D) Effective communication
Answer: D
Rationale: Effective communication is foundational to all team functions, including closed-loop
communication, shared mental models, and role clarity .
13. While assessing a 13-month-old involved in an MVC, the nurse identifies which finding as a sign of
possible altered mental status?
A) Sunken fontanel
B) Crying, but consolable
C) Spontaneous movement of arms and legs
D) Cooperation with the assessment
4|Page SUCCESS!!!
