TNCC FINAL EXAM TEST 2025/2026 OPEN BOOK UPDATED WITH COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) ALREADY GRADED A+

TNCC FINAL EXAM TEST 2025/2026 OPEN BOOK UPDATED WITH COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) ALREADY GRADED A+ 1. Which is true regarding occult hemorrhage? A. Patient may be pale/diaphoretic with normal external bleeding but internal bleeding ongoing; maintain high suspicion B. Occult hemorrhage always obvious on external exam C. No monitoring required if vitals stable initially D. Only present in elderly patients Answer: A Rationale: Internal bleeding may not be externally visible; ongoing monitoring and reassessment are critical even when initial vitals appear stable. 2. A patient presents with major burn and singed nasal hairs and carbonaceous sputum—this suggests: A. Inhalation injury; early airway protection recommended B. No airway concern if oxygen saturation normal C. Only superficial injury to face; no action required D. Bronchodilator therapy only Answer: A Rationale: Signs of inhalation injury portend airway edema—consider early intubation to secure airway. 3. Which is immediate management for unstable pelvic fracture with suspected arterial bleeding? A. Pelvic binder and urgent interventional radiology embolization or surgical packing B. Simple analgesia only C. CT angiography while unstable D. Trendelenburg position to increase abdominal pressure Answer: A Rationale: Pelvic binders reduce pelvic volume; IR embolization or surgical control is definitive for arterial pelvic bleeding. - 2 - 4. For blunt neck trauma with expanding hematoma and airway compromise, the safest initial airway approach is: A. Awake fiberoptic intubation if expertise available, otherwise rapid sequence with surgical airway backup B. Nasotracheal intubation routinely C. Delay airway until CT complete D. Inferior alveolar nerve block first Answer: A Rationale: Awake fiberoptic may preserve airway control; if not possible, RSI with surgical airway backup is prudent. Nasal intubation contraindicated in basilar skull or facial fractures. 5. In trauma, what does a positive Trendelenburg test indicate? A. This test is not used in acute trauma assessment for shock B. Venous insufficiency specific to trauma C. Abdominal compartment syndrome D. Hip instability in pelvic trauma Answer: A Rationale: Trendelenburg test relates to venous valve function in legs, not an acute trauma assessment for shock. 6. A trauma patient presents hypoxic with high airway pressures on ventilator and sudden hypoxia. Suspect: A. Tension pneumothorax—perform immediate decompression B. Pulmonary embolism only C. Chest tube removal unnecessary D. Endotracheal tube obstruction only Answer: A Rationale: Sudden increased airway pressures with hypoxia on ventilated patient should prompt assessment for tension pneumothorax; decompress emergently if suspected. 7. Which is best immediate action for a patient with evisceration following penetrating abdominal trauma? A. Cover protruding organs with sterile, moist dressings and rapid transport to OR B. Replace organs and suture skin closed at bedside C. Leave organs exposed to air to dry and then pack D. Apply tight abdominal binder to push organs back in Answer: A Rationale: Eviscerated organs must be kept moist and protected; do not replace into cavity; urgent surgery required. - 3 - 8. A patient with facial burns and soot in mouth has stridor and progressive hoarseness—next step: A. Prepare for early intubation before airway edema worsens B. Treat with inhaled bronchodilators only C. Observe; intubate only if stops breathing D. Perform immediate tracheostomy in ED without attempt at intubation Answer: A Rationale: Progressive airway signs after inhalation injury predict imminent loss of airway—secure airway early. 9. Which of the following is NOT a component of the primary survey (ABCDE)? A. Exposure/Environment (E) B. Breathing (B) C. Diabetes control (D) D. Circulation (C) Answer: C Rationale: In primary survey, D = Disability (neurologic status), not Diabetes; diabetes control is not primary survey component. 10. For an amputated extremity brought with patient, what is correct handling? A. Wrap in sterile moist gauze, place in sealed bag, keep cool on ice (do not place directly on ice) B. Put amputated part directly on ice without protection C. Put amputated part in alcohol for sterilization D. Discard amputated part if 1 hour old Answer: A Rationale: Protect tissue from contamination and cold injury; use sealed bag in cool environment, not direct ice contact. 11. Indication for immediate thoracotomy in ED includes: A. Penetrating chest trauma with witnessed loss of vital signs in ED and signs of life within minutes B. All chest trauma regardless of vitals C. Stable patient with small pneumothorax on x-ray D. Isolated rib fractures only Answer: A Rationale: Emergency department thoracotomy reserved for select penetrating chest trauma with recent signs of life and arrest—otherwise not indicated. 12. In trauma patient with suspected long-bone fractures, prophylactic measure for fat embolism prevention includes: A. Early immobilization and stabilization of long-bone fractures B. Immediate ambulation and exercise C. No immobilization to allow swelling