TNCC 9th Edition Updated 2026 | Trauma Nursing Core Course Comprehensive
Study Guide, Practice Exam Questions and Answers, Exam Prep Test Bank, Trauma
Patient Assessment, Emergency Nursing Care, Airway and Breathing Management,
Shock and Hemorrhage Control, Neurological Trauma Evaluation, Trauma Nursing
Process, and Detailed Rationales for Certification Preparation
Question 1: A trauma patient arrives with a suspected basilar skull fracture after a
motor vehicle collision. During the head-to-toe assessment, you note clear
drainage from the patient's left ear. What is the most appropriate nursing action?
A. Clean the ear with a cotton-tipped applicator to improve visualization.
B. Pack the ear with sterile gauze to prevent contamination.
C. Notify the physician immediately and prepare for possible interventions.
D. Document the finding and continue the primary survey.
CORRECT ANSWER: C. Notify the physician immediately and prepare for possible
interventions.
Rationale: Clear drainage from the ear in a trauma patient indicates a cerebrospinal
fluid (CSF) leak, a sign of a basilar skull fracture. The priority is to notify the physician, as
this finding requires prompt evaluation for infection risk (meningitis) and potential need
for prophylactic antibiotics. Documenting the finding is important but should not be the
sole action. It is contraindicated to clean or pack the ear, as this can introduce infection
or increase intracranial pressure .
Question 2: A patient is brought to the emergency department of a rural hospital
following a high-speed motor vehicle collision. The primary survey reveals
significant abdominal and pelvic injuries. What is the priority intervention for this
patient?
A. Obtain a focused assessment with sonography for trauma (FAST) exam.
B. Initiate transfer to a designated trauma center.
C. Place an indwelling urinary catheter to monitor output.
D. Perform a pelvic x-ray to identify the specific fracture pattern.
CORRECT ANSWER: B. Initiate transfer to a designated trauma center.
Rationale: For a patient with significant abdominal and pelvic injuries identified during
the primary survey, the priority is to initiate transfer to a facility capable of providing the
definitive care they require, such as a Level I or II trauma center. A rural hospital may
lack the surgical capabilities and resources to manage these complex injuries. While
other interventions like a FAST exam or urinary catheter might be appropriate, they
should not delay the transfer process .
Question 3: An adult patient who fell from a second-story roof is brought to the ED
by private vehicle. The patient is confused but has unlabored respirations and
,strong radial pulses. An open wound is noted near an obvious deformity of the left
lower extremity. What is the priority intervention?
A. Apply a splint to the lower extremity to stabilize the fracture.
B. Initiate cervical spine stabilization.
C. Put the patient on supplemental oxygen via a non-rebreather mask.
D. Perform a log roll to place the patient on a long spine board.
CORRECT ANSWER: B. Initiate cervical spine stabilization.
Rationale: The patient's altered level of consciousness (confusion) and the mechanism
of injury (fall from >10 feet) necessitate immediate cervical spine stabilization as a high
priority. While extremity injuries are significant, airway protection and spinal
precautions take precedence. The patient is currently breathing adequately, but cervical
spine immobilization is critical to prevent secondary spinal cord injury, and it must be
performed before any other movement like log-rolling .
Question 4: An adult patient with severe head trauma is intubated and being
manually ventilated with a bag-mask device at 18 breaths per minute. The patient
has received a 500 mL bolus of warmed isotonic crystalloid. The PaCO2 is 30 mm
Hg and pulse oximetry is 92%. Blood pressure is 142/70 mm Hg. What is the priority
intervention to manage cerebral blood flow?
A. Decrease the rate of manual ventilation.
B. Initiate a second fluid bolus.
C. Increase the amount of oxygen delivered.
D. Recheck endotracheal tube placement.
CORRECT ANSWER: A. Decrease the rate of manual ventilation.
Rationale: Cerebral blood flow is highly sensitive to PaCO2 levels. A PaCO2 of 30 mm
Hg represents hypocapnia, which causes cerebral vasoconstriction and can reduce
cerebral blood flow, potentially leading to secondary brain ischemia. The patient is
being hyperventilated at a rate of 18 breaths/min. The appropriate action is to slow the
ventilation rate to target a normocapnic PaCO2 of 35-45 mm Hg. While SpO2 of 92% is
slightly low, the more immediate concern is the hypocapnia .
Question 5: A patient involved in a motor vehicle collision presents with respiratory
distress, tachycardia, and hypotension. The patient has muffled heart sounds, and
jugular venous distention is noted. Bedside ultrasound reveals a pericardial
effusion. What is the most likely diagnosis?
A. Tension pneumothorax
B. Massive hemothorax
,C. Cardiac tamponade
D. Myocardial contusion
CORRECT ANSWER: C. Cardiac tamponade
Rationale: The classic triad of Beck's (hypotension, muffled heart sounds, and jugular
venous distention) in a trauma patient suggests cardiac tamponade. This condition
occurs when blood accumulates in the pericardial sac, compressing the heart and
impairing ventricular filling. A positive FAST exam showing pericardial fluid confirms the
diagnosis. Tension pneumothorax presents with absent breath sounds and
hyperresonance, while hemothorax presents with dullness to percussion .
Question 6: A trauma patient is being manually ventilated with a bag-mask device.
The nurse notes increasing resistance to ventilation and the patient's oxygen
saturation drops to 88%. The patient has become hypotensive and tachycardic.
Which finding would differentiate a tension pneumothorax from a simple
pneumothorax in this patient?
A. Tachycardia
B. Unilaterally diminished breath sounds
C. Hypotension
D. Increased work of breathing
CORRECT ANSWER: C. Hypotension
Rationale: A tension pneumothorax is a life-threatening condition where air
accumulates in the pleural space with no outlet, causing increasing pressure that shifts
the mediastinum, compresses the heart and great vessels, and severely impairs venous
return. This leads to profound hypotension and obstructive shock. While tachycardia,
diminished breath sounds, and increased work of breathing are also present,
hypotension is the key finding that differentiates a tension pneumothorax from a simple
pneumothorax .
Question 7: An adult patient arrives with a large metal rod embedded in his left
thigh following a construction accident. There is no active bleeding from the site.
What is the priority nursing action for this patient's wound?
A. Remove the rod immediately to assess the underlying injury.
B. Apply a tourniquet proximal to the embedded object.
C. Stabilize the rod in place and prepare the patient for surgery.
D. Apply a pressure dressing around the rod to control potential bleeding.
CORRECT ANSWER: C. Stabilize the rod in place and prepare the patient for
surgery.
, Rationale: Impaled objects should never be removed in the prehospital or emergency
department setting because the object may be tamponading a vascular injury. Removal
can precipitate sudden, massive hemorrhage. The priority is to stabilize the object in
place to prevent further injury and prepare the patient for surgical removal in the
operating room .
Question 8: A patient who sustained a femur fracture and required massive
transfusion is now showing signs of oozing blood from IV sites, the gums, and
abrasions. Laboratory results reveal prolonged PT and PTT, decreased fibrinogen,
and a low platelet count. What is the most likely underlying condition?
A. Rhabdomyolysis
B. Fat embolism syndrome
C. Disseminated intravascular coagulopathy (DIC)
D. Multiple organ dysfunction syndrome (MODS)
CORRECT ANSWER: C. Disseminated intravascular coagulopathy (DIC)
Rationale: DIC is a complication of massive trauma and tissue injury, often triggered by
the release of tissue factors. The clinical presentation of widespread bleeding from
multiple sites (e.g., IV sites, mucous membranes) along with laboratory findings of
prolonged clotting times, low platelets, and low fibrinogen are classic signs of DIC. It
represents an overactivation of the coagulation cascade leading to consumption of
clotting factors, resulting in both thrombosis and hemorrhage .
Question 9: An older adult patient presents with dizziness, headache, and nausea.
The patient was involved in a motor vehicle collision 10 days ago without loss of
consciousness but has a resolving forehead hematoma. The patient takes warfarin
for atrial fibrillation. What is the most likely diagnosis?
A. Diffuse axonal injury
B. Intracerebral hemorrhage
C. Epidural hematoma
D. Post-concussive syndrome
CORRECT ANSWER: D. Post-concussive syndrome
Rationale: Post-concussive syndrome can present days to weeks after a head injury
with symptoms such as headache, dizziness, nausea, and cognitive disturbances.
While an older patient on anticoagulants is at high risk for intracranial bleeding, the
delayed onset of symptoms (10 days post-injury) makes an acute epidural or subdural
hematoma less likely as these typically present with a more rapid decline. Chronic
subdural hematoma should be considered, but post-concussive syndrome is most
consistent with the gradual symptom presentation .
Study Guide, Practice Exam Questions and Answers, Exam Prep Test Bank, Trauma
Patient Assessment, Emergency Nursing Care, Airway and Breathing Management,
Shock and Hemorrhage Control, Neurological Trauma Evaluation, Trauma Nursing
Process, and Detailed Rationales for Certification Preparation
Question 1: A trauma patient arrives with a suspected basilar skull fracture after a
motor vehicle collision. During the head-to-toe assessment, you note clear
drainage from the patient's left ear. What is the most appropriate nursing action?
A. Clean the ear with a cotton-tipped applicator to improve visualization.
B. Pack the ear with sterile gauze to prevent contamination.
C. Notify the physician immediately and prepare for possible interventions.
D. Document the finding and continue the primary survey.
CORRECT ANSWER: C. Notify the physician immediately and prepare for possible
interventions.
Rationale: Clear drainage from the ear in a trauma patient indicates a cerebrospinal
fluid (CSF) leak, a sign of a basilar skull fracture. The priority is to notify the physician, as
this finding requires prompt evaluation for infection risk (meningitis) and potential need
for prophylactic antibiotics. Documenting the finding is important but should not be the
sole action. It is contraindicated to clean or pack the ear, as this can introduce infection
or increase intracranial pressure .
Question 2: A patient is brought to the emergency department of a rural hospital
following a high-speed motor vehicle collision. The primary survey reveals
significant abdominal and pelvic injuries. What is the priority intervention for this
patient?
A. Obtain a focused assessment with sonography for trauma (FAST) exam.
B. Initiate transfer to a designated trauma center.
C. Place an indwelling urinary catheter to monitor output.
D. Perform a pelvic x-ray to identify the specific fracture pattern.
CORRECT ANSWER: B. Initiate transfer to a designated trauma center.
Rationale: For a patient with significant abdominal and pelvic injuries identified during
the primary survey, the priority is to initiate transfer to a facility capable of providing the
definitive care they require, such as a Level I or II trauma center. A rural hospital may
lack the surgical capabilities and resources to manage these complex injuries. While
other interventions like a FAST exam or urinary catheter might be appropriate, they
should not delay the transfer process .
Question 3: An adult patient who fell from a second-story roof is brought to the ED
by private vehicle. The patient is confused but has unlabored respirations and
,strong radial pulses. An open wound is noted near an obvious deformity of the left
lower extremity. What is the priority intervention?
A. Apply a splint to the lower extremity to stabilize the fracture.
B. Initiate cervical spine stabilization.
C. Put the patient on supplemental oxygen via a non-rebreather mask.
D. Perform a log roll to place the patient on a long spine board.
CORRECT ANSWER: B. Initiate cervical spine stabilization.
Rationale: The patient's altered level of consciousness (confusion) and the mechanism
of injury (fall from >10 feet) necessitate immediate cervical spine stabilization as a high
priority. While extremity injuries are significant, airway protection and spinal
precautions take precedence. The patient is currently breathing adequately, but cervical
spine immobilization is critical to prevent secondary spinal cord injury, and it must be
performed before any other movement like log-rolling .
Question 4: An adult patient with severe head trauma is intubated and being
manually ventilated with a bag-mask device at 18 breaths per minute. The patient
has received a 500 mL bolus of warmed isotonic crystalloid. The PaCO2 is 30 mm
Hg and pulse oximetry is 92%. Blood pressure is 142/70 mm Hg. What is the priority
intervention to manage cerebral blood flow?
A. Decrease the rate of manual ventilation.
B. Initiate a second fluid bolus.
C. Increase the amount of oxygen delivered.
D. Recheck endotracheal tube placement.
CORRECT ANSWER: A. Decrease the rate of manual ventilation.
Rationale: Cerebral blood flow is highly sensitive to PaCO2 levels. A PaCO2 of 30 mm
Hg represents hypocapnia, which causes cerebral vasoconstriction and can reduce
cerebral blood flow, potentially leading to secondary brain ischemia. The patient is
being hyperventilated at a rate of 18 breaths/min. The appropriate action is to slow the
ventilation rate to target a normocapnic PaCO2 of 35-45 mm Hg. While SpO2 of 92% is
slightly low, the more immediate concern is the hypocapnia .
Question 5: A patient involved in a motor vehicle collision presents with respiratory
distress, tachycardia, and hypotension. The patient has muffled heart sounds, and
jugular venous distention is noted. Bedside ultrasound reveals a pericardial
effusion. What is the most likely diagnosis?
A. Tension pneumothorax
B. Massive hemothorax
,C. Cardiac tamponade
D. Myocardial contusion
CORRECT ANSWER: C. Cardiac tamponade
Rationale: The classic triad of Beck's (hypotension, muffled heart sounds, and jugular
venous distention) in a trauma patient suggests cardiac tamponade. This condition
occurs when blood accumulates in the pericardial sac, compressing the heart and
impairing ventricular filling. A positive FAST exam showing pericardial fluid confirms the
diagnosis. Tension pneumothorax presents with absent breath sounds and
hyperresonance, while hemothorax presents with dullness to percussion .
Question 6: A trauma patient is being manually ventilated with a bag-mask device.
The nurse notes increasing resistance to ventilation and the patient's oxygen
saturation drops to 88%. The patient has become hypotensive and tachycardic.
Which finding would differentiate a tension pneumothorax from a simple
pneumothorax in this patient?
A. Tachycardia
B. Unilaterally diminished breath sounds
C. Hypotension
D. Increased work of breathing
CORRECT ANSWER: C. Hypotension
Rationale: A tension pneumothorax is a life-threatening condition where air
accumulates in the pleural space with no outlet, causing increasing pressure that shifts
the mediastinum, compresses the heart and great vessels, and severely impairs venous
return. This leads to profound hypotension and obstructive shock. While tachycardia,
diminished breath sounds, and increased work of breathing are also present,
hypotension is the key finding that differentiates a tension pneumothorax from a simple
pneumothorax .
Question 7: An adult patient arrives with a large metal rod embedded in his left
thigh following a construction accident. There is no active bleeding from the site.
What is the priority nursing action for this patient's wound?
A. Remove the rod immediately to assess the underlying injury.
B. Apply a tourniquet proximal to the embedded object.
C. Stabilize the rod in place and prepare the patient for surgery.
D. Apply a pressure dressing around the rod to control potential bleeding.
CORRECT ANSWER: C. Stabilize the rod in place and prepare the patient for
surgery.
, Rationale: Impaled objects should never be removed in the prehospital or emergency
department setting because the object may be tamponading a vascular injury. Removal
can precipitate sudden, massive hemorrhage. The priority is to stabilize the object in
place to prevent further injury and prepare the patient for surgical removal in the
operating room .
Question 8: A patient who sustained a femur fracture and required massive
transfusion is now showing signs of oozing blood from IV sites, the gums, and
abrasions. Laboratory results reveal prolonged PT and PTT, decreased fibrinogen,
and a low platelet count. What is the most likely underlying condition?
A. Rhabdomyolysis
B. Fat embolism syndrome
C. Disseminated intravascular coagulopathy (DIC)
D. Multiple organ dysfunction syndrome (MODS)
CORRECT ANSWER: C. Disseminated intravascular coagulopathy (DIC)
Rationale: DIC is a complication of massive trauma and tissue injury, often triggered by
the release of tissue factors. The clinical presentation of widespread bleeding from
multiple sites (e.g., IV sites, mucous membranes) along with laboratory findings of
prolonged clotting times, low platelets, and low fibrinogen are classic signs of DIC. It
represents an overactivation of the coagulation cascade leading to consumption of
clotting factors, resulting in both thrombosis and hemorrhage .
Question 9: An older adult patient presents with dizziness, headache, and nausea.
The patient was involved in a motor vehicle collision 10 days ago without loss of
consciousness but has a resolving forehead hematoma. The patient takes warfarin
for atrial fibrillation. What is the most likely diagnosis?
A. Diffuse axonal injury
B. Intracerebral hemorrhage
C. Epidural hematoma
D. Post-concussive syndrome
CORRECT ANSWER: D. Post-concussive syndrome
Rationale: Post-concussive syndrome can present days to weeks after a head injury
with symptoms such as headache, dizziness, nausea, and cognitive disturbances.
While an older patient on anticoagulants is at high risk for intracranial bleeding, the
delayed onset of symptoms (10 days post-injury) makes an acute epidural or subdural
hematoma less likely as these typically present with a more rapid decline. Chronic
subdural hematoma should be considered, but post-concussive syndrome is most
consistent with the gradual symptom presentation .
