TNCC Exam 2026/2027 — Trauma Nursing Core Course
TNCC (TRAUMA NURSING CORE COURSE) EXAM | 2026/2027
75 Questions | Already Graded A+ | 100% Verified
Instructions: Select the single best answer for each question. Correct answers are highlighted in bold cyan with clinical
rationales. Each question is worth 1 point. This exam aligns with ENA TNCC guidelines and ATLS principles.
Section I: Trauma Assessment & Primary/Secondary Survey
Q1. A 34-year-old male arrives via EMS after a high-speed motorcycle collision. He is unresponsive with shallow
respirations. What is the FIRST action the trauma nurse should take according to the primary survey?
A. Obtain a full set of vital signs B. Perform a head-to-toe secondary survey
C. Initiate cervical spine immobilization and open D. Obtain intravenous access and draw laboratory
the airway specimens
Correct Answer: C
Rationale: The primary survey follows the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure).
Cervical spine immobilization and airway management are the absolute first priority. Vital signs, secondary survey, and
IV access occur after the airway is secured.
Q2. During the primary survey of a trauma patient, the nurse assesses bilateral breath sounds and finds absent
breath sounds on the left side with tracheal deviation to the right. Which intervention is MOST critical?
A. Perform needle decompression at the left second B. Administer 100% oxygen via non-rebreather mask
intercostal space
C. Initiate a two-large-bore IV fluid bolus D. Prepare for immediate chest X-ray
Correct Answer: A
Rationale: Absent breath sounds with tracheal deviation indicate a tension pneumothorax, a life-threatening condition
requiring immediate needle decompression (ATLS standard). This is a clinical diagnosis not requiring radiographic
confirmation.
Q3. Which component of the primary survey evaluates the patient's neurological status using the AVPU scale?
A. Airway assessment B. Breathing assessment C. Circulation assessment D. Disability assessment
Correct Answer: D
Rationale: The disability assessment in the primary survey evaluates neurological function using the AVPU scale
(Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive) or the Glasgow Coma Scale (GCS).
Q4. A trauma nurse is performing the secondary survey on a stable patient. Which statement BEST describes the
purpose of the secondary survey?
A. It identifies and treats immediately life-threatening B. It is a comprehensive head-to-toe assessment to
conditions identify all injuries
C. It involves only radiographic and laboratory D. It is performed before the primary survey to
evaluation establish baseline
Correct Answer: B
Rationale: The secondary survey is a systematic head-to-toe assessment performed only after the primary survey is
complete and the patient is hemodynamically stable. Life-threatening conditions are addressed in the primary survey.
1
, TNCC Exam 2026/2027 — Trauma Nursing Core Course
Q5. A patient presents with a GCS score of 8 after a fall from a two-story building. How should this patient's level
of consciousness be classified using the AVPU scale?
A. Alert B. Responds to verbal C. Responds to painful D. Unresponsive
stimuli stimuli
Correct Answer: C
Rationale: A GCS of 8 suggests the patient responds only to painful stimuli, not consistently to voice commands. Per
TNCC classification, a GCS of 8 or below warrants definitive airway management (intubation) as the patient cannot
protect their airway.
Q6. During the primary survey, the trauma nurse identifies a pulsating hematoma in the right groin of a patient
who sustained a penetrating injury. Which classification of hemorrhage does this represent?
A. Class I hemorrhage B. Class II hemorrhage C. Class III hemorrhage D. Class IV hemorrhage
Correct Answer: D
Rationale: A pulsating hematoma with penetrating trauma suggests active arterial bleeding. Class IV hemorrhage
involves blood loss exceeding 40% of blood volume (>2000 mL), causing significant tachycardia, hypotension, and
altered mental status.
Q7. The AMPLE mnemonic is used during the trauma assessment to gather which type of information?
A. Physical examination B. Patient history related C. Vital signs and D. Radiographic
findings to the injury event hemodynamic parameters interpretation criteria
Correct Answer: B
Rationale: AMPLE stands for Allergies, Medications, Past medical history, Last meal, and Events/environment of the
injury. It is the standard mnemonic used during the secondary survey to obtain relevant patient history.
Q8. A trauma patient presents with cool, diaphoretic skin; capillary refill of 4 seconds; and a heart rate of 120
bpm. Which stage of shock is MOST likely present?
A. Compensated shock B. Decompensated shock C. Irreversible shock D. Neurogenic shock
Correct Answer: A
Rationale: Cool, diaphoretic skin, delayed capillary refill (>2 seconds), and tachycardia are classic signs of
compensated (hypovolemic) shock. The body maintains blood pressure through vasoconstriction and tachycardia, but
tissue perfusion is inadequate.
Q9. When performing the E (Exposure) component of the primary survey, what is the critical concurrent nursing
action?
A. Obtain a full set of vital B. Initiate warming C. Perform a detailed D. Administer prophylactic
signs measures to prevent neurological assessment antibiotics
hypothermia
Correct Answer: B
Rationale: The Exposure/Environment component requires fully exposing the patient to identify all injuries while
simultaneously preventing hypothermia. Hypothermia is one of the lethal triad (hypothermia, acidosis, coagulopathy) in
trauma.
2
, TNCC Exam 2026/2027 — Trauma Nursing Core Course
Q10. Which assessment finding during the primary survey would prompt the trauma nurse to re-evaluate the
airway immediately?
A. Blood pressure of 90/60 B. Heart rate of 110 bpm C. GCS score decreasing D. Abdominal distension
mmHg from 14 to 8 on palpation
Correct Answer: C
Rationale: A rapidly declining GCS (from 14 to 8) indicates worsening neurological status. A GCS of 8 or below
indicates the patient cannot protect their airway, requiring immediate re-evaluation and preparation for intubation.
Section II: Airway & Ventilation Management
Q11. A trauma patient with suspected cervical spine injury requires intubation. Which technique is preferred for
securing the airway while maintaining spinal alignment?
A. Blind nasotracheal intubation B. Rapid sequence intubation (RSI) with manual in-
line stabilization
C. Fiber-optic bronchoscopy-guided intubation D. Bag-valve-mask ventilation for 5 minutes before
intubation
Correct Answer: B
Rationale: RSI with manual in-line stabilization (MILS) is the preferred method for trauma patients with suspected
cervical spine injury. MILS maintains neutral cervical positioning without extending the neck.
Q12. A patient with massive facial trauma arrives with blood and debris in the oropharynx. The nurse is unable to
clear the airway with suctioning and a jaw thrust maneuver. Which intervention is the NEXT priority?
A. Perform needle B. Attempt oral intubation C. Place an oropharyngeal D. Perform a surgical
cricothyrotomy with a laryngoscope airway (OPA) and cricothyrotomy
ventilate
Correct Answer: A
Rationale: When the airway cannot be secured by basic means due to massive facial trauma, the CICV (Cannot
Intubate, Cannot Ventilate) scenario requires an emergency surgical airway. Needle cricothyrotomy is the fastest first-
line option.
Q13. Which device is contraindicated in a patient with a suspected basilar skull fracture?
A. Supraglottic airway (i- B. Endotracheal tube via C. Nasopharyngeal D. Bag-valve-mask device
gel) oral route airway (NPA)
Correct Answer: C
Rationale: An NPA is contraindicated in patients with suspected basilar skull fractures (raccoon eyes, Battle sign, CSF
rhinorrhea) because insertion may pass through the fracture into the cranial vault, causing direct brain injury.
Q14. A trauma patient is mechanically ventilated after intubation. The nurse notices subcutaneous emphysema
around the neck and chest, and high peak airway pressures. Which complication should be suspected?
A. Pulmonary embolism B. Tension pneumothorax C. Tracheobronchial D. Acute respiratory
injury distress syndrome
Correct Answer: C
Rationale: Subcutaneous emphysema tracking to the neck with high peak airway pressures after intubation is highly
suggestive of tracheobronchial injury. Immediate bronchoscopy and surgical consultation are indicated.
3
TNCC (TRAUMA NURSING CORE COURSE) EXAM | 2026/2027
75 Questions | Already Graded A+ | 100% Verified
Instructions: Select the single best answer for each question. Correct answers are highlighted in bold cyan with clinical
rationales. Each question is worth 1 point. This exam aligns with ENA TNCC guidelines and ATLS principles.
Section I: Trauma Assessment & Primary/Secondary Survey
Q1. A 34-year-old male arrives via EMS after a high-speed motorcycle collision. He is unresponsive with shallow
respirations. What is the FIRST action the trauma nurse should take according to the primary survey?
A. Obtain a full set of vital signs B. Perform a head-to-toe secondary survey
C. Initiate cervical spine immobilization and open D. Obtain intravenous access and draw laboratory
the airway specimens
Correct Answer: C
Rationale: The primary survey follows the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure).
Cervical spine immobilization and airway management are the absolute first priority. Vital signs, secondary survey, and
IV access occur after the airway is secured.
Q2. During the primary survey of a trauma patient, the nurse assesses bilateral breath sounds and finds absent
breath sounds on the left side with tracheal deviation to the right. Which intervention is MOST critical?
A. Perform needle decompression at the left second B. Administer 100% oxygen via non-rebreather mask
intercostal space
C. Initiate a two-large-bore IV fluid bolus D. Prepare for immediate chest X-ray
Correct Answer: A
Rationale: Absent breath sounds with tracheal deviation indicate a tension pneumothorax, a life-threatening condition
requiring immediate needle decompression (ATLS standard). This is a clinical diagnosis not requiring radiographic
confirmation.
Q3. Which component of the primary survey evaluates the patient's neurological status using the AVPU scale?
A. Airway assessment B. Breathing assessment C. Circulation assessment D. Disability assessment
Correct Answer: D
Rationale: The disability assessment in the primary survey evaluates neurological function using the AVPU scale
(Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive) or the Glasgow Coma Scale (GCS).
Q4. A trauma nurse is performing the secondary survey on a stable patient. Which statement BEST describes the
purpose of the secondary survey?
A. It identifies and treats immediately life-threatening B. It is a comprehensive head-to-toe assessment to
conditions identify all injuries
C. It involves only radiographic and laboratory D. It is performed before the primary survey to
evaluation establish baseline
Correct Answer: B
Rationale: The secondary survey is a systematic head-to-toe assessment performed only after the primary survey is
complete and the patient is hemodynamically stable. Life-threatening conditions are addressed in the primary survey.
1
, TNCC Exam 2026/2027 — Trauma Nursing Core Course
Q5. A patient presents with a GCS score of 8 after a fall from a two-story building. How should this patient's level
of consciousness be classified using the AVPU scale?
A. Alert B. Responds to verbal C. Responds to painful D. Unresponsive
stimuli stimuli
Correct Answer: C
Rationale: A GCS of 8 suggests the patient responds only to painful stimuli, not consistently to voice commands. Per
TNCC classification, a GCS of 8 or below warrants definitive airway management (intubation) as the patient cannot
protect their airway.
Q6. During the primary survey, the trauma nurse identifies a pulsating hematoma in the right groin of a patient
who sustained a penetrating injury. Which classification of hemorrhage does this represent?
A. Class I hemorrhage B. Class II hemorrhage C. Class III hemorrhage D. Class IV hemorrhage
Correct Answer: D
Rationale: A pulsating hematoma with penetrating trauma suggests active arterial bleeding. Class IV hemorrhage
involves blood loss exceeding 40% of blood volume (>2000 mL), causing significant tachycardia, hypotension, and
altered mental status.
Q7. The AMPLE mnemonic is used during the trauma assessment to gather which type of information?
A. Physical examination B. Patient history related C. Vital signs and D. Radiographic
findings to the injury event hemodynamic parameters interpretation criteria
Correct Answer: B
Rationale: AMPLE stands for Allergies, Medications, Past medical history, Last meal, and Events/environment of the
injury. It is the standard mnemonic used during the secondary survey to obtain relevant patient history.
Q8. A trauma patient presents with cool, diaphoretic skin; capillary refill of 4 seconds; and a heart rate of 120
bpm. Which stage of shock is MOST likely present?
A. Compensated shock B. Decompensated shock C. Irreversible shock D. Neurogenic shock
Correct Answer: A
Rationale: Cool, diaphoretic skin, delayed capillary refill (>2 seconds), and tachycardia are classic signs of
compensated (hypovolemic) shock. The body maintains blood pressure through vasoconstriction and tachycardia, but
tissue perfusion is inadequate.
Q9. When performing the E (Exposure) component of the primary survey, what is the critical concurrent nursing
action?
A. Obtain a full set of vital B. Initiate warming C. Perform a detailed D. Administer prophylactic
signs measures to prevent neurological assessment antibiotics
hypothermia
Correct Answer: B
Rationale: The Exposure/Environment component requires fully exposing the patient to identify all injuries while
simultaneously preventing hypothermia. Hypothermia is one of the lethal triad (hypothermia, acidosis, coagulopathy) in
trauma.
2
, TNCC Exam 2026/2027 — Trauma Nursing Core Course
Q10. Which assessment finding during the primary survey would prompt the trauma nurse to re-evaluate the
airway immediately?
A. Blood pressure of 90/60 B. Heart rate of 110 bpm C. GCS score decreasing D. Abdominal distension
mmHg from 14 to 8 on palpation
Correct Answer: C
Rationale: A rapidly declining GCS (from 14 to 8) indicates worsening neurological status. A GCS of 8 or below
indicates the patient cannot protect their airway, requiring immediate re-evaluation and preparation for intubation.
Section II: Airway & Ventilation Management
Q11. A trauma patient with suspected cervical spine injury requires intubation. Which technique is preferred for
securing the airway while maintaining spinal alignment?
A. Blind nasotracheal intubation B. Rapid sequence intubation (RSI) with manual in-
line stabilization
C. Fiber-optic bronchoscopy-guided intubation D. Bag-valve-mask ventilation for 5 minutes before
intubation
Correct Answer: B
Rationale: RSI with manual in-line stabilization (MILS) is the preferred method for trauma patients with suspected
cervical spine injury. MILS maintains neutral cervical positioning without extending the neck.
Q12. A patient with massive facial trauma arrives with blood and debris in the oropharynx. The nurse is unable to
clear the airway with suctioning and a jaw thrust maneuver. Which intervention is the NEXT priority?
A. Perform needle B. Attempt oral intubation C. Place an oropharyngeal D. Perform a surgical
cricothyrotomy with a laryngoscope airway (OPA) and cricothyrotomy
ventilate
Correct Answer: A
Rationale: When the airway cannot be secured by basic means due to massive facial trauma, the CICV (Cannot
Intubate, Cannot Ventilate) scenario requires an emergency surgical airway. Needle cricothyrotomy is the fastest first-
line option.
Q13. Which device is contraindicated in a patient with a suspected basilar skull fracture?
A. Supraglottic airway (i- B. Endotracheal tube via C. Nasopharyngeal D. Bag-valve-mask device
gel) oral route airway (NPA)
Correct Answer: C
Rationale: An NPA is contraindicated in patients with suspected basilar skull fractures (raccoon eyes, Battle sign, CSF
rhinorrhea) because insertion may pass through the fracture into the cranial vault, causing direct brain injury.
Q14. A trauma patient is mechanically ventilated after intubation. The nurse notices subcutaneous emphysema
around the neck and chest, and high peak airway pressures. Which complication should be suspected?
A. Pulmonary embolism B. Tension pneumothorax C. Tracheobronchial D. Acute respiratory
injury distress syndrome
Correct Answer: C
Rationale: Subcutaneous emphysema tracking to the neck with high peak airway pressures after intubation is highly
suggestive of tracheobronchial injury. Immediate bronchoscopy and surgical consultation are indicated.
3
