TNCC 9th Edition Updated 2026 | Trauma Nursing Core
Course Comprehensive Study Guide, Practice Exam
Questions and Answers, Exam Prep Test Bank, Trauma
Assessment Frameworks, Emergency Nursing Care, Rapid
Patient Evaluation, Injury Management Principles, Critical
Thinking Strategies, and Detailed Rationales for
Certification Preparation
Question 1: What is the primary goal of a trauma system? A. To reduce hospital costs
B. To provide optimal care from injury to discharge C. To ensure all patients go to Level I
centers D. To train paramedics CORRECT ANSWER: B. To provide optimal care from
injury to discharge Rationale: A trauma system coordinates care from the scene to
rehabilitation to ensure optimal outcomes.
Question 2: Which triage criterion automatically qualifies a patient for highest
priority? A. Closed femur fracture B. Respiratory rate of 24 C. Penetrating injury to head,
neck, torso D. Systolic BP of 110 CORRECT ANSWER: C. Penetrating injury to head,
neck, torso Rationale: Penetrating injuries to critical areas are high-priority triage
criteria per CDC guidelines.
Question 3: What Glasgow Coma Scale (GCS) score indicates severe brain injury in
triage? A. 13 or less B. 12 or less C. 10 or less D. 8 or less CORRECT ANSWER: D. 8 or
less Rationale: A GCS of 8 or less is a criterion for highest priority triage and indicates
severe TBI.
Question 4: Which vital sign abnormality meets criteria for highest priority triage in
adults? A. RR of 22 B. HR of 110 C. SBP of 85 mmHg D. Temp of 36.0 C CORRECT
ANSWER: C. SBP of 85 mmHg Rationale: SBP less than 90 mmHg is a physiologic
criterion for highest priority trauma triage.
Question 5: What is the defining characteristic of a Level I trauma center? A.
Provides definitive care for most injured patients B. Has 24/7 coverage by all surgical
subspecialties and research C. Stabilizes patients before transfer to a higher level D.
Only handles pediatric trauma CORRECT ANSWER: B. Has 24/7 coverage by all
surgical subspecialties and research Rationale: Level I centers provide
comprehensive care, have all subspecialties available, and lead in research/education.
Question 6: What is the first step in the primary survey? A. Breathing B. Circulation C.
Disability D. Airway maintenance with c-spine restriction CORRECT ANSWER: D.
Airway maintenance with c-spine restriction Rationale: The primary survey follows
the ABCDE sequence, starting with Airway.
Question 7: Which maneuver is preferred to open the airway in a trauma patient? A.
Head tilt-chin lift B. Jaw thrust C. Neck hyperextension D. Cricoid pressure CORRECT
,ANSWER: B. Jaw thrust Rationale: The jaw thrust minimizes cervical spine movement
while opening the airway.
Question 8: What is the primary indication for an oropharyngeal airway (OPA)? A.
Conscious patient with gag reflex B. Unconscious patient without a gag reflex C. Patient
with facial trauma D. Patient with a cervical spine injury CORRECT ANSWER: B.
Unconscious patient without a gag reflex Rationale: An OPA is used in unconscious
patients lacking a gag reflex to prevent airway obstruction by the tongue.
Question 9: When is a nasopharyngeal airway (NPA) contraindicated? A. Patient has
a gag reflex B. Patient has suspected basilar skull fracture C. Patient is conscious D.
Patient has a cervical spine injury CORRECT ANSWER: B. Patient has suspected
basilar skull fracture Rationale: NPA insertion is contraindicated in suspected basilar
skull fractures due to the risk of intracranial placement.
Question 10: What is the definitive airway of choice in a trauma patient? A.
Laryngeal mask airway B. Endotracheal intubation with c-spine control C. Esophageal
tracer device D. Nasotracheal intubation CORRECT ANSWER: B. Endotracheal
intubation with c-spine control Rationale: A cuffed tube in the trachea with c-spine
restriction is the definitive airway.
Question 11: What is the surgical airway of choice in an emergency? A.
Tracheostomy B. Cricothyroidotomy C. Bronchoscopy D. Laryngotomy CORRECT
ANSWER: B. Cricothyroidotomy Rationale: Cricothyroidotomy is the preferred surgical
airway in emergencies due to its superficial location and ease of access.
Question 12: What is the primary purpose of a rigid cervical collar? A. To completely
immobilize the cervical spine B. To restrict cervical spine movement C. To clear the
cervical spine D. To treat cervical spine fractures CORRECT ANSWER: B. To restrict
cervical spine movement Rationale: Collars restrict but do not completely eliminate c-
spine motion; they are an adjunct to immobilization.
Question 13: Which finding requires immediate intervention during the breathing
assessment? A. RR of 18 B. SpO2 of 96% C. Tracheal deviation D. Symmetrical chest
expansion CORRECT ANSWER: C. Tracheal deviation D. Symmetrical chest expansion
CORRECT ANSWER: C. Tracheal deviation Rationale: Tracheal deviation is a late sign
of tension pneumothorax and requires immediate decompression.
Question 14: What is the immediate treatment for a tension pneumothorax? A.
Needle decompression or finger thoracostomy B. Endotracheal intubation C.
Pericardiocentesis D. Chest tube insertion CORRECT ANSWER: A. Needle
decompression or finger thoracostomy Rationale: Tension pneumothorax requires
immediate decompression before chest tube placement.
Question 15: How is an open pneumothorax initially managed? A. Apply a three-
sided occlusive dressing B. Insert a chest tube immediately C. Intubate the patient D.
Apply a completely sealed dressing CORRECT ANSWER: A. Apply a three-sided
, occlusive dressing Rationale: A three-sided dressing acts as a flutter valve, allowing air
to escape but not enter.
Question 16: What is the hallmark sign of a flail chest? A. Absent breath sounds on
one side B. Paradoxical chest wall movement C. Subcutaneous emphysema D. Tracheal
deviation CORRECT ANSWER: B. Paradoxical chest wall movement Rationale: Flail
chest occurs when multiple ribs fracture in multiple places, causing paradoxical
movement.
Question 17: What is the most common cause of shock in trauma patients? A.
Cardiogenic B. Hypovolemic C. Neurogenic D. Septic CORRECT ANSWER: B.
Hypovolemic Rationale: Hemorrhage leading to hypovolemic shock is the most
common cause of shock in trauma.
Question 18: What is the first step in controlling external hemorrhage? A. Apply a
tourniquet B. Apply direct pressure C. Elevate the extremity D. Apply hemostatic agents
CORRECT ANSWER: B. Apply direct pressure Rationale: Direct pressure is the first
and most effective method to control external bleeding.
Question 19: When is a tourniquet indicated? A. For all extremity bleeding B. When
direct pressure fails to control life-threatening extremity hemorrhage C. For venous
bleeding D. For bleeding from the neck CORRECT ANSWER: B. When direct pressure
fails to control life-threatening extremity hemorrhage Rationale: Tourniquets are
used for life-threatening extremity bleeding unresponsive to direct pressure.
Question 20: What is the primary treatment for a pelvic fracture with hemodynamic
instability? A. Immediate surgical fixation B. Application of a pelvic binder C.
Intravenous fluid bolus D. Angiographic embolization CORRECT ANSWER: B.
Application of a pelvic binder Rationale: A pelvic binder reduces pelvic volume and
stabilizes clots, controlling hemorrhage.
Question 21: In Class II hemorrhagic shock, what is the expected heart rate? A. <
100 bpm B. 100-120 bpm C. 120-140 bpm D. > 140 bpm CORRECT ANSWER: B. 100-
120 bpm Rationale: Class II shock involves 15-30% blood loss, with tachycardia (100-
120 bpm) and narrowed pulse pressure.
Question 22: What is the expected urine output in an adult with Class III shock? A. >
30 mL/hr B. 20-30 mL/hr C. 5-15 mL/hr D. Negligible CORRECT ANSWER: C. 5-15 mL/hr
Rationale: Class III shock (30-40% blood loss) results in significantly decreased urine
output (5-15 mL/hr).
Question 23: What is the initial fluid resuscitation for a trauma patient in
hemorrhagic shock? A. 1-2 L of 0.9% normal saline B. 10 mL/kg of D5W C. Immediate
administration of blood products D. 3 L of Lactated Ringer's CORRECT ANSWER: C.
Immediate administration of blood products Rationale: Current guidelines
emphasize early blood product administration (1:1:1 ratio) over large volume
crystalloids.
Course Comprehensive Study Guide, Practice Exam
Questions and Answers, Exam Prep Test Bank, Trauma
Assessment Frameworks, Emergency Nursing Care, Rapid
Patient Evaluation, Injury Management Principles, Critical
Thinking Strategies, and Detailed Rationales for
Certification Preparation
Question 1: What is the primary goal of a trauma system? A. To reduce hospital costs
B. To provide optimal care from injury to discharge C. To ensure all patients go to Level I
centers D. To train paramedics CORRECT ANSWER: B. To provide optimal care from
injury to discharge Rationale: A trauma system coordinates care from the scene to
rehabilitation to ensure optimal outcomes.
Question 2: Which triage criterion automatically qualifies a patient for highest
priority? A. Closed femur fracture B. Respiratory rate of 24 C. Penetrating injury to head,
neck, torso D. Systolic BP of 110 CORRECT ANSWER: C. Penetrating injury to head,
neck, torso Rationale: Penetrating injuries to critical areas are high-priority triage
criteria per CDC guidelines.
Question 3: What Glasgow Coma Scale (GCS) score indicates severe brain injury in
triage? A. 13 or less B. 12 or less C. 10 or less D. 8 or less CORRECT ANSWER: D. 8 or
less Rationale: A GCS of 8 or less is a criterion for highest priority triage and indicates
severe TBI.
Question 4: Which vital sign abnormality meets criteria for highest priority triage in
adults? A. RR of 22 B. HR of 110 C. SBP of 85 mmHg D. Temp of 36.0 C CORRECT
ANSWER: C. SBP of 85 mmHg Rationale: SBP less than 90 mmHg is a physiologic
criterion for highest priority trauma triage.
Question 5: What is the defining characteristic of a Level I trauma center? A.
Provides definitive care for most injured patients B. Has 24/7 coverage by all surgical
subspecialties and research C. Stabilizes patients before transfer to a higher level D.
Only handles pediatric trauma CORRECT ANSWER: B. Has 24/7 coverage by all
surgical subspecialties and research Rationale: Level I centers provide
comprehensive care, have all subspecialties available, and lead in research/education.
Question 6: What is the first step in the primary survey? A. Breathing B. Circulation C.
Disability D. Airway maintenance with c-spine restriction CORRECT ANSWER: D.
Airway maintenance with c-spine restriction Rationale: The primary survey follows
the ABCDE sequence, starting with Airway.
Question 7: Which maneuver is preferred to open the airway in a trauma patient? A.
Head tilt-chin lift B. Jaw thrust C. Neck hyperextension D. Cricoid pressure CORRECT
,ANSWER: B. Jaw thrust Rationale: The jaw thrust minimizes cervical spine movement
while opening the airway.
Question 8: What is the primary indication for an oropharyngeal airway (OPA)? A.
Conscious patient with gag reflex B. Unconscious patient without a gag reflex C. Patient
with facial trauma D. Patient with a cervical spine injury CORRECT ANSWER: B.
Unconscious patient without a gag reflex Rationale: An OPA is used in unconscious
patients lacking a gag reflex to prevent airway obstruction by the tongue.
Question 9: When is a nasopharyngeal airway (NPA) contraindicated? A. Patient has
a gag reflex B. Patient has suspected basilar skull fracture C. Patient is conscious D.
Patient has a cervical spine injury CORRECT ANSWER: B. Patient has suspected
basilar skull fracture Rationale: NPA insertion is contraindicated in suspected basilar
skull fractures due to the risk of intracranial placement.
Question 10: What is the definitive airway of choice in a trauma patient? A.
Laryngeal mask airway B. Endotracheal intubation with c-spine control C. Esophageal
tracer device D. Nasotracheal intubation CORRECT ANSWER: B. Endotracheal
intubation with c-spine control Rationale: A cuffed tube in the trachea with c-spine
restriction is the definitive airway.
Question 11: What is the surgical airway of choice in an emergency? A.
Tracheostomy B. Cricothyroidotomy C. Bronchoscopy D. Laryngotomy CORRECT
ANSWER: B. Cricothyroidotomy Rationale: Cricothyroidotomy is the preferred surgical
airway in emergencies due to its superficial location and ease of access.
Question 12: What is the primary purpose of a rigid cervical collar? A. To completely
immobilize the cervical spine B. To restrict cervical spine movement C. To clear the
cervical spine D. To treat cervical spine fractures CORRECT ANSWER: B. To restrict
cervical spine movement Rationale: Collars restrict but do not completely eliminate c-
spine motion; they are an adjunct to immobilization.
Question 13: Which finding requires immediate intervention during the breathing
assessment? A. RR of 18 B. SpO2 of 96% C. Tracheal deviation D. Symmetrical chest
expansion CORRECT ANSWER: C. Tracheal deviation D. Symmetrical chest expansion
CORRECT ANSWER: C. Tracheal deviation Rationale: Tracheal deviation is a late sign
of tension pneumothorax and requires immediate decompression.
Question 14: What is the immediate treatment for a tension pneumothorax? A.
Needle decompression or finger thoracostomy B. Endotracheal intubation C.
Pericardiocentesis D. Chest tube insertion CORRECT ANSWER: A. Needle
decompression or finger thoracostomy Rationale: Tension pneumothorax requires
immediate decompression before chest tube placement.
Question 15: How is an open pneumothorax initially managed? A. Apply a three-
sided occlusive dressing B. Insert a chest tube immediately C. Intubate the patient D.
Apply a completely sealed dressing CORRECT ANSWER: A. Apply a three-sided
, occlusive dressing Rationale: A three-sided dressing acts as a flutter valve, allowing air
to escape but not enter.
Question 16: What is the hallmark sign of a flail chest? A. Absent breath sounds on
one side B. Paradoxical chest wall movement C. Subcutaneous emphysema D. Tracheal
deviation CORRECT ANSWER: B. Paradoxical chest wall movement Rationale: Flail
chest occurs when multiple ribs fracture in multiple places, causing paradoxical
movement.
Question 17: What is the most common cause of shock in trauma patients? A.
Cardiogenic B. Hypovolemic C. Neurogenic D. Septic CORRECT ANSWER: B.
Hypovolemic Rationale: Hemorrhage leading to hypovolemic shock is the most
common cause of shock in trauma.
Question 18: What is the first step in controlling external hemorrhage? A. Apply a
tourniquet B. Apply direct pressure C. Elevate the extremity D. Apply hemostatic agents
CORRECT ANSWER: B. Apply direct pressure Rationale: Direct pressure is the first
and most effective method to control external bleeding.
Question 19: When is a tourniquet indicated? A. For all extremity bleeding B. When
direct pressure fails to control life-threatening extremity hemorrhage C. For venous
bleeding D. For bleeding from the neck CORRECT ANSWER: B. When direct pressure
fails to control life-threatening extremity hemorrhage Rationale: Tourniquets are
used for life-threatening extremity bleeding unresponsive to direct pressure.
Question 20: What is the primary treatment for a pelvic fracture with hemodynamic
instability? A. Immediate surgical fixation B. Application of a pelvic binder C.
Intravenous fluid bolus D. Angiographic embolization CORRECT ANSWER: B.
Application of a pelvic binder Rationale: A pelvic binder reduces pelvic volume and
stabilizes clots, controlling hemorrhage.
Question 21: In Class II hemorrhagic shock, what is the expected heart rate? A. <
100 bpm B. 100-120 bpm C. 120-140 bpm D. > 140 bpm CORRECT ANSWER: B. 100-
120 bpm Rationale: Class II shock involves 15-30% blood loss, with tachycardia (100-
120 bpm) and narrowed pulse pressure.
Question 22: What is the expected urine output in an adult with Class III shock? A. >
30 mL/hr B. 20-30 mL/hr C. 5-15 mL/hr D. Negligible CORRECT ANSWER: C. 5-15 mL/hr
Rationale: Class III shock (30-40% blood loss) results in significantly decreased urine
output (5-15 mL/hr).
Question 23: What is the initial fluid resuscitation for a trauma patient in
hemorrhagic shock? A. 1-2 L of 0.9% normal saline B. 10 mL/kg of D5W C. Immediate
administration of blood products D. 3 L of Lactated Ringer's CORRECT ANSWER: C.
Immediate administration of blood products Rationale: Current guidelines
emphasize early blood product administration (1:1:1 ratio) over large volume
crystalloids.
