2026
TNCC Trauma Nursing Care Course
Comprehensive Exam Preparation and
Practice Review Guide 2026
You are treating a 27-year-old male in respiratory distress who was involved in a house fire.
Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate
should you begin fluid resuscitation?
A) 1000 mL/hr
B) 500 mL/hr
C) 250 mL/hr
D) 125 mL/hr
Correct Answer: B) 500 mL/hr
Rationale:
In adult burn patients when TBSA is not yet calculated, an initial rate of 500 mL/hr of isotonic
crystalloid (such as lactated Ringer’s) is recommended until formal calculations can be
performed. Higher rates may cause fluid overload, while lower rates may lead to inadequate
perfusion.
A patient has been in the ED for several hours waiting to be admitted after sustaining multiple
rib fractures and a femur fracture. He suddenly becomes anxious and confused, with respiratory
distress and petechiae noted on his neck. These findings are most consistent with which
condition?
A) Acute lung injury
B) Fat embolism
C) Pneumothorax
D) Pulmonary contusion
Correct Answer: B) Fat embolism
Rationale:
Fat embolism syndrome is classically associated with long bone fractures and presents with
respiratory distress, neurologic changes, and petechiae. The other conditions do not typically
produce petechial rash and acute mental status changes together.
,2026
Which pulse pressure description is an indication of early hypovolemic shock?
A) Widened
B) Narrowed
C) Bounding
D) Weak
Correct Answer: B) Narrowed
Rationale:
Early hypovolemic shock causes vasoconstriction, leading to a narrowed pulse pressure.
Widened or bounding pulses are not typical early findings.
Which consideration is most important when caring for a geriatric trauma patient?
A) Head-to-toe exam
B) Medical history
C) Incontinence
D) Falls
Correct Answer: B) Medical history
Rationale:
Older adults often have multiple comorbidities and take medications such as anticoagulants that
significantly affect trauma outcomes. These factors may alter presentation and management
priorities.
Which assessment finding differentiates a tension pneumothorax from a simple pneumothorax?
A) Increased work of breathing
B) Unilaterally diminished breath sounds
C) Pleuritic chest pain
D) Hypotension that worsens with inspiration
Correct Answer: D) Hypotension that worsens with inspiration
Rationale:
Tension pneumothorax causes obstructive shock due to compression of the heart and great
vessels, leading to hypotension that worsens with inspiration. The other findings may be present
in both conditions.
The nurse is calculating fluid resuscitation for a 120-kg male with partial-thickness burns to both
upper extremities and superficial burns to the anterior chest. Using the modified Lund and
, 2026
Browder chart, how much IV fluid should be given in the first 8 hours?
A) 2280 mL
B) 3840 mL
C) 4560 mL
D) 7680 mL
Correct Answer: A) 2280 mL
Rationale:
Using the Parkland formula (2 mL × kg × %TBSA):
120 kg × 2 mL × 19% = 4560 mL in 24 hours.
Half of this (2280 mL) is given in the first 8 hours. Other options represent incorrect
calculations.
Which of the following is a component of the trauma triad of death?
A) Acidosis
B) Hyperthermia
C) Hemorrhage
D) Sepsis
Correct Answer: A) Acidosis
Rationale:
The trauma triad of death consists of hypothermia, metabolic acidosis, and coagulopathy.
Hyperthermia, hemorrhage, and sepsis are not components of the triad.
A 56-year-old male involved in a motor vehicle crash presents to a rural ED with hypotension,
tachycardia, tachypnea, and abdominal pain. What is the priority intervention?
A) Expedite transport to the CT scanner
B) Prepare for spinal radiographs
C) Expedite transfer to the closest trauma center
D) Notify the patient’s family
Correct Answer: C) Expedite transfer to the closest trauma center
Rationale:
This patient is unstable and requires resources beyond a rural facility’s capability. Rapid transfer
to a trauma center takes priority over diagnostics or family notification.
TNCC Trauma Nursing Care Course
Comprehensive Exam Preparation and
Practice Review Guide 2026
You are treating a 27-year-old male in respiratory distress who was involved in a house fire.
Calculating TBSA burned is deferred due to the need for emergent intubation. At what rate
should you begin fluid resuscitation?
A) 1000 mL/hr
B) 500 mL/hr
C) 250 mL/hr
D) 125 mL/hr
Correct Answer: B) 500 mL/hr
Rationale:
In adult burn patients when TBSA is not yet calculated, an initial rate of 500 mL/hr of isotonic
crystalloid (such as lactated Ringer’s) is recommended until formal calculations can be
performed. Higher rates may cause fluid overload, while lower rates may lead to inadequate
perfusion.
A patient has been in the ED for several hours waiting to be admitted after sustaining multiple
rib fractures and a femur fracture. He suddenly becomes anxious and confused, with respiratory
distress and petechiae noted on his neck. These findings are most consistent with which
condition?
A) Acute lung injury
B) Fat embolism
C) Pneumothorax
D) Pulmonary contusion
Correct Answer: B) Fat embolism
Rationale:
Fat embolism syndrome is classically associated with long bone fractures and presents with
respiratory distress, neurologic changes, and petechiae. The other conditions do not typically
produce petechial rash and acute mental status changes together.
,2026
Which pulse pressure description is an indication of early hypovolemic shock?
A) Widened
B) Narrowed
C) Bounding
D) Weak
Correct Answer: B) Narrowed
Rationale:
Early hypovolemic shock causes vasoconstriction, leading to a narrowed pulse pressure.
Widened or bounding pulses are not typical early findings.
Which consideration is most important when caring for a geriatric trauma patient?
A) Head-to-toe exam
B) Medical history
C) Incontinence
D) Falls
Correct Answer: B) Medical history
Rationale:
Older adults often have multiple comorbidities and take medications such as anticoagulants that
significantly affect trauma outcomes. These factors may alter presentation and management
priorities.
Which assessment finding differentiates a tension pneumothorax from a simple pneumothorax?
A) Increased work of breathing
B) Unilaterally diminished breath sounds
C) Pleuritic chest pain
D) Hypotension that worsens with inspiration
Correct Answer: D) Hypotension that worsens with inspiration
Rationale:
Tension pneumothorax causes obstructive shock due to compression of the heart and great
vessels, leading to hypotension that worsens with inspiration. The other findings may be present
in both conditions.
The nurse is calculating fluid resuscitation for a 120-kg male with partial-thickness burns to both
upper extremities and superficial burns to the anterior chest. Using the modified Lund and
, 2026
Browder chart, how much IV fluid should be given in the first 8 hours?
A) 2280 mL
B) 3840 mL
C) 4560 mL
D) 7680 mL
Correct Answer: A) 2280 mL
Rationale:
Using the Parkland formula (2 mL × kg × %TBSA):
120 kg × 2 mL × 19% = 4560 mL in 24 hours.
Half of this (2280 mL) is given in the first 8 hours. Other options represent incorrect
calculations.
Which of the following is a component of the trauma triad of death?
A) Acidosis
B) Hyperthermia
C) Hemorrhage
D) Sepsis
Correct Answer: A) Acidosis
Rationale:
The trauma triad of death consists of hypothermia, metabolic acidosis, and coagulopathy.
Hyperthermia, hemorrhage, and sepsis are not components of the triad.
A 56-year-old male involved in a motor vehicle crash presents to a rural ED with hypotension,
tachycardia, tachypnea, and abdominal pain. What is the priority intervention?
A) Expedite transport to the CT scanner
B) Prepare for spinal radiographs
C) Expedite transfer to the closest trauma center
D) Notify the patient’s family
Correct Answer: C) Expedite transfer to the closest trauma center
Rationale:
This patient is unstable and requires resources beyond a rural facility’s capability. Rapid transfer
to a trauma center takes priority over diagnostics or family notification.
