Page 1 of 149
TNCC Notes for Written Exam Latest Update 2025
What is the Mnemonic for the Secondary Assessment?
.....ANSWER.....F = Full set of VS/Focused adjuncts (includes
cardiac monitor, urinary catheter, and gastric tube)/Family
presence
G = Give comfort measures (verbal reassurance, touch, and
pharmacologic and nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds?
.....ANSWER.....Auscultate the lungs bilaterally at the second
intercostal space midclavicular line and at the fifth intercostal
space at the anterior axillary line.
What are the late signs of breathing compromise?
.....ANSWER.....- Tracheal deviation
,Page 2 of 149
- JVD
What are signs of ineffective breathing? .....ANSWER.....- AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and
expiration
- Use of accessory muscles or abdominal muscles or both or
diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask
device, as indicated
- Anticipate definitive airway management to support
ventilation.
,Page 3 of 149
Upon initial assessment, what type of oxygen should be used for
a pt breathing effectively? .....ANSWER.....A tight-fitting
nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective
circulation? .....ANSWER.....- Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an
appropriate rate
What are signs of ineffective circulation? .....ANSWER.....-
Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
, Page 4 of 149
What are the interventions for Effective/Ineffective Circulation?
.....ANSWER.....- Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an
isotonic crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of
blood
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
TNCC Notes for Written Exam Latest Update 2025
What is the Mnemonic for the Secondary Assessment?
.....ANSWER.....F = Full set of VS/Focused adjuncts (includes
cardiac monitor, urinary catheter, and gastric tube)/Family
presence
G = Give comfort measures (verbal reassurance, touch, and
pharmacologic and nonpharmacologic management of pain).
H = Hx and Head-to-toe assessment
I = Inspect posterior surfaces
Where do you listen to auscultate breath sounds?
.....ANSWER.....Auscultate the lungs bilaterally at the second
intercostal space midclavicular line and at the fifth intercostal
space at the anterior axillary line.
What are the late signs of breathing compromise?
.....ANSWER.....- Tracheal deviation
,Page 2 of 149
- JVD
What are signs of ineffective breathing? .....ANSWER.....- AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and
expiration
- Use of accessory muscles or abdominal muscles or both or
diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask
device, as indicated
- Anticipate definitive airway management to support
ventilation.
,Page 3 of 149
Upon initial assessment, what type of oxygen should be used for
a pt breathing effectively? .....ANSWER.....A tight-fitting
nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective
circulation? .....ANSWER.....- Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an
appropriate rate
What are signs of ineffective circulation? .....ANSWER.....-
Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
, Page 4 of 149
What are the interventions for Effective/Ineffective Circulation?
.....ANSWER.....- Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an
isotonic crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of
blood
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
