TNCC – Trauma Nursing Core Course (by ENA) | QUESTIONS AND ANSWERS |
2025/2026| LATEST UPDATE
1. The first action when a trauma patient arrives to the ED is:
A. Obtain a full past medical history
B. Perform a rapid primary survey (airway, breathing, circulation) (CORRECT)
C. Order CT scans
D. Start prophylactic antibiotics
Rationale:
Initial trauma care prioritizes rapid assessment of life threats using the primary survey (ABC).
This identifies and treats immediate threats (e.g., compromised airway, massive hemorrhage)
before detailed history or imaging. Early interventions during the primary survey reduce
mortality and guide need for rapid diagnostics.
2. Which sign most reliably indicates inadequate perfusion in a child after
trauma?
A. Decreased blood pressure
B. Tachycardia and delayed capillary refill (CORRECT)
C. Warm, flushed skin
D. Elevated urine output
Rationale:
Children maintain blood pressure until late shock, so tachycardia and delayed capillary refill
are earlier and more reliable indicators of poor perfusion. Recognizing these signs prompts rapid
fluid resuscitation and evaluation for hemorrhage or other causes of shock.
3. A trauma patient has snoring respirations and a suspected cervical spine
injury. The best immediate airway maneuver is:
A. Head-tilt, chin-lift
B. Jaw-thrust with manual cervical stabilization (CORRECT)
C. Insert a nasopharyngeal airway without precautions
D. Hyperextend the neck
,Rationale:
When cervical spine injury is possible, jaw-thrust opens the airway while minimizing neck
movement. Head-tilt/chin-lift risks spinal displacement. Nasopharyngeal airways are
contraindicated with basal skull fractures; any airway adjunct must be used judiciously.
4. Massive external hemorrhage from a femoral artery laceration should be
controlled initially by:
A. Elevation and cold pack
B. Tourniquet only as a last resort
C. Direct pressure, then tourniquet if bleeding persists (CORRECT)
D. IV vasopressors
Rationale:
Direct pressure is first-line for external hemorrhage. If bleeding cannot be controlled quickly or
is life-threatening, apply a tourniquet proximal to wound — tourniquets save lives and are
indicated when direct pressure fails. Rapid hemorrhage control precedes definitive vascular
repair.
5. During the primary survey you detect single, unequal breath sounds and
hypotension after blunt chest trauma. The immediate concern is:
A. Pneumonia
B. Tension pneumothorax (CORRECT)
C. Pulmonary contusion only
D. Simple rib fracture
Rationale:
Tension pneumothorax presents with hypotension, decreased/absent breath sounds on one side,
and potential tracheal shift. It’s an emergency requiring immediate decompression (needle or
finger) before imaging. Delay can rapidly lead to cardiovascular collapse.
6. In trauma resuscitation, the recommended initial IV fluid bolus for a
hypotensive pediatric patient is:
A. 5 mL/kg D5W
B. 20 mL/kg isotonic crystalloid (CORRECT)
C. 1 mL/kg albumin
D. 40 mL/kg blood
,Rationale:
The standard pediatric bolus for hypovolemia/shock is 20 mL/kg of isotonic crystalloid (NS or
LR) delivered rapidly. This restores intravascular volume while reassessing for ongoing
bleeding. Blood is considered early if hemorrhagic shock or massive transfusion criteria are met.
7. Which component is essential in the secondary survey?
A. Immediate CT of the head for everyone
B. Complete head-to-toe exam including tertiary history (AMPLE) (CORRECT)
C. Routine intubation of stable patients
D. Prophylactic antibiotics for all wounds
Rationale:
The secondary survey is a thorough head-to-toe assessment plus focused history (AMPLE:
Allergies, Meds, Past medical, Last meal, Events). It identifies injuries missed in the primary
survey and informs diagnostic testing and management priorities.
8. A patient with blunt abdominal trauma is hemodynamically unstable. The
most appropriate next step is:
A. Abdominal CT scan with contrast
B. Immediate transfer to operating room for exploratory laparotomy (CORRECT)
C. Observe in ED for 24 hours
D. Give PO fluids
Rationale:
In unstable patients with suspected intra-abdominal hemorrhage, surgical exploration is
indicated rather than CT, which delays definitive control. Rapid operative intervention to control
bleeding improves survival in exsanguinating abdominal injuries.
9. Which ECG rhythm requires immediate defibrillation in a trauma patient?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation (CORRECT)
D. Sinus tachycardia
Rationale:
Ventricular fibrillation is a shockable rhythm — immediate defibrillation improves chances of
, ROSC. Asystole and PEA are non-shockable and require high-quality CPR and identification of
reversible causes.
10. A penetrating neck wound with expanding hematoma and airway
compromise should be managed by:
A. Packing the wound and delay airway intervention
B. Immediate airway control in the operating room or by experienced provider
(CORRECT)
C. CT angiography first
D. Observation only
Rationale:
An expanding neck hematoma threatens the airway; prompt airway control (often in OR with
surgical backup) is critical. Imaging can be done after airway is secured if the patient is stable;
delays risk complete airway loss.
11. Which finding suggests thoracic aortic injury after deceleration trauma?
A. Isolated rib fracture
B. Bradycardia only
C. Widened mediastinum on chest x-ray and upper extremity hypotension (CORRECT)
D. Clear chest x-ray
Rationale:
Deceleration injuries (e.g., MVC) can tear the aorta. Widened mediastinum on chest x-ray and
differential BP between extremities raise suspicion; confirmatory CT angiography is needed in
stable patients, but unstable patients require emergent intervention.
12. A long-bone fracture with a warm, swollen, painful limb and pain out of
proportion suggests:
A. Simple bruise
B. Compartment syndrome (CORRECT)
C. Uncomplicated fracture only
D. Superficial infection
Rationale:
Compartment syndrome presents with severe pain, tense swelling, and often pain with passive
2025/2026| LATEST UPDATE
1. The first action when a trauma patient arrives to the ED is:
A. Obtain a full past medical history
B. Perform a rapid primary survey (airway, breathing, circulation) (CORRECT)
C. Order CT scans
D. Start prophylactic antibiotics
Rationale:
Initial trauma care prioritizes rapid assessment of life threats using the primary survey (ABC).
This identifies and treats immediate threats (e.g., compromised airway, massive hemorrhage)
before detailed history or imaging. Early interventions during the primary survey reduce
mortality and guide need for rapid diagnostics.
2. Which sign most reliably indicates inadequate perfusion in a child after
trauma?
A. Decreased blood pressure
B. Tachycardia and delayed capillary refill (CORRECT)
C. Warm, flushed skin
D. Elevated urine output
Rationale:
Children maintain blood pressure until late shock, so tachycardia and delayed capillary refill
are earlier and more reliable indicators of poor perfusion. Recognizing these signs prompts rapid
fluid resuscitation and evaluation for hemorrhage or other causes of shock.
3. A trauma patient has snoring respirations and a suspected cervical spine
injury. The best immediate airway maneuver is:
A. Head-tilt, chin-lift
B. Jaw-thrust with manual cervical stabilization (CORRECT)
C. Insert a nasopharyngeal airway without precautions
D. Hyperextend the neck
,Rationale:
When cervical spine injury is possible, jaw-thrust opens the airway while minimizing neck
movement. Head-tilt/chin-lift risks spinal displacement. Nasopharyngeal airways are
contraindicated with basal skull fractures; any airway adjunct must be used judiciously.
4. Massive external hemorrhage from a femoral artery laceration should be
controlled initially by:
A. Elevation and cold pack
B. Tourniquet only as a last resort
C. Direct pressure, then tourniquet if bleeding persists (CORRECT)
D. IV vasopressors
Rationale:
Direct pressure is first-line for external hemorrhage. If bleeding cannot be controlled quickly or
is life-threatening, apply a tourniquet proximal to wound — tourniquets save lives and are
indicated when direct pressure fails. Rapid hemorrhage control precedes definitive vascular
repair.
5. During the primary survey you detect single, unequal breath sounds and
hypotension after blunt chest trauma. The immediate concern is:
A. Pneumonia
B. Tension pneumothorax (CORRECT)
C. Pulmonary contusion only
D. Simple rib fracture
Rationale:
Tension pneumothorax presents with hypotension, decreased/absent breath sounds on one side,
and potential tracheal shift. It’s an emergency requiring immediate decompression (needle or
finger) before imaging. Delay can rapidly lead to cardiovascular collapse.
6. In trauma resuscitation, the recommended initial IV fluid bolus for a
hypotensive pediatric patient is:
A. 5 mL/kg D5W
B. 20 mL/kg isotonic crystalloid (CORRECT)
C. 1 mL/kg albumin
D. 40 mL/kg blood
,Rationale:
The standard pediatric bolus for hypovolemia/shock is 20 mL/kg of isotonic crystalloid (NS or
LR) delivered rapidly. This restores intravascular volume while reassessing for ongoing
bleeding. Blood is considered early if hemorrhagic shock or massive transfusion criteria are met.
7. Which component is essential in the secondary survey?
A. Immediate CT of the head for everyone
B. Complete head-to-toe exam including tertiary history (AMPLE) (CORRECT)
C. Routine intubation of stable patients
D. Prophylactic antibiotics for all wounds
Rationale:
The secondary survey is a thorough head-to-toe assessment plus focused history (AMPLE:
Allergies, Meds, Past medical, Last meal, Events). It identifies injuries missed in the primary
survey and informs diagnostic testing and management priorities.
8. A patient with blunt abdominal trauma is hemodynamically unstable. The
most appropriate next step is:
A. Abdominal CT scan with contrast
B. Immediate transfer to operating room for exploratory laparotomy (CORRECT)
C. Observe in ED for 24 hours
D. Give PO fluids
Rationale:
In unstable patients with suspected intra-abdominal hemorrhage, surgical exploration is
indicated rather than CT, which delays definitive control. Rapid operative intervention to control
bleeding improves survival in exsanguinating abdominal injuries.
9. Which ECG rhythm requires immediate defibrillation in a trauma patient?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation (CORRECT)
D. Sinus tachycardia
Rationale:
Ventricular fibrillation is a shockable rhythm — immediate defibrillation improves chances of
, ROSC. Asystole and PEA are non-shockable and require high-quality CPR and identification of
reversible causes.
10. A penetrating neck wound with expanding hematoma and airway
compromise should be managed by:
A. Packing the wound and delay airway intervention
B. Immediate airway control in the operating room or by experienced provider
(CORRECT)
C. CT angiography first
D. Observation only
Rationale:
An expanding neck hematoma threatens the airway; prompt airway control (often in OR with
surgical backup) is critical. Imaging can be done after airway is secured if the patient is stable;
delays risk complete airway loss.
11. Which finding suggests thoracic aortic injury after deceleration trauma?
A. Isolated rib fracture
B. Bradycardia only
C. Widened mediastinum on chest x-ray and upper extremity hypotension (CORRECT)
D. Clear chest x-ray
Rationale:
Deceleration injuries (e.g., MVC) can tear the aorta. Widened mediastinum on chest x-ray and
differential BP between extremities raise suspicion; confirmatory CT angiography is needed in
stable patients, but unstable patients require emergent intervention.
12. A long-bone fracture with a warm, swollen, painful limb and pain out of
proportion suggests:
A. Simple bruise
B. Compartment syndrome (CORRECT)
C. Uncomplicated fracture only
D. Superficial infection
Rationale:
Compartment syndrome presents with severe pain, tense swelling, and often pain with passive
