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TNCC FINAL EXAM 2025 /202 6 Edition
(Open Book) VERSION 1 QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
- What is the first priority in the primary survey of a trauma patient? A. Breathing B. Airway with cervical spine protection C. Circulation D. Disability Airway must be assessed and secured first to ensure oxygenation and prevent hypoxia, while maintaining cervical spine precautions in trauma.
- During the primary survey, which assessment finding requires immediate intervention? A. Open tibial fracture B. Stridor and hoarseness
C. Painful abdomen D. Bruising on the chest Stridor indicates an airway obstruction, which is life-threatening and must be managed immediately.
- What is the correct sequence of the primary survey? A. Circulation, Airway, Breathing, Disability, Exposure B. Airway, Breathing, Circulation, Disability, Exposure C. Breathing, Airway, Circulation, Disability, Exposure D. Airway, Circulation, Breathing, Disability, Exposure The primary survey follows the ABCDE format to prioritize life-threatening issues.
- Which method is best for assessing a patient’s airway? A. Listen for bowel sounds B. Inspect for foreign bodies, listen for sounds, feel for airflow C. Check skin turgor D. Observe chest expansion This is the correct approach to assessing airway patency and potential obstructions.
- In a trauma patient with altered mental status and no gag reflex, what airway intervention is most appropriate?
- What sign indicates a possible tension pneumothorax? A. Bradycardia B. Bilateral breath sounds C. Tracheal deviation D. Flat neck veins Tracheal deviation away from the affected side is a classic sign of tension pneumothorax.
- What is the purpose of exposing a trauma patient during the primary survey? A. To warm the patient B. To inspect for hidden injuries C. To change clothing D. To auscultate bowel sounds Exposure helps reveal injuries that may not be visible otherwise. 10.A trauma patient’s BP is 90/50, HR is 132 bpm. What is the most likely cause? A. Stroke B. Hypovolemic shock C. Sepsis D. Pain response Hypotension with tachycardia in trauma suggests blood loss and hypovolemia.
11.What lab value is most concerning in a trauma patient? A. Hematocrit 42% B. Sodium 139 mmol/L C. Lactate 5.2 mmol/L D. Potassium 3.8 mmol/L Elevated lactate indicates poor tissue perfusion and possible shock. 12.A trauma patient is moaning and withdrawing from pain. What is their GCS motor score? A. 5 B. 4 C. 5 D. 3 Withdrawal from pain = motor response of 5 on GCS. 13.A GCS of 8 indicates: A. Alert and oriented B. Minor brain injury C. Severe brain injury D. Normal status GCS ≤8 indicates a need for airway protection and possibly intubation.
17.What should the nurse do first if the trauma patient has absent breath sounds on one side? A. Prepare for MRI B. Insert IV C. Notify provider and prepare for needle decompression D. Elevate the head Absent unilateral breath sounds may indicate pneumothorax; immediate decompression is needed. 18.In trauma care, which intervention is done last? A. Airway assessment B. IV fluid resuscitation C. Secondary survey D. Cervical spine stabilization The secondary survey is a head-to-toe exam done after life threats are addressed. 19.What is the primary concern for a patient with chest trauma and paradoxical chest movement? A. Infection B. Internal bleeding
C. Ineffective ventilation D. Pain Paradoxical movement suggests flail chest, impairing ventilation. 20.Which assessment indicates adequate perfusion? A. Cap refill > 4 sec B. Warm skin and brisk capillary refill C. Cold extremities D. Weak pulses Warm, well-perfused extremities indicate good perfusion. 21.What intervention should be prioritized for an open pneumothorax? A. Intubation B. Chest tube placement C. Application of a 3-sided occlusive dressing D. High-flow oxygen only A 3-sided occlusive dressing prevents air from being sucked into the pleural space during inhalation. 22.The "golden hour" in trauma care refers to: A. The first hour of surgery B. The critical first hour after injury
A. Airway assessment B. Head-to-toe physical exam C. Needle decompression D. C-spine stabilization The secondary survey involves a full-body examination and history. 26.What is the first sign of shock? A. Bradycardia B. Hypotension C. Tachycardia D. Cyanosis Tachycardia is an early compensatory mechanism in shock. 27.What finding indicates neurogenic shock? A. Tachycardia and hypertension B. Hypotension and bradycardia C. Fever and rash D. Hypertension and bounding pulses Neurogenic shock results from loss of sympathetic tone. 28.In trauma care, what does SAMPLE stand for?
A. Systolic, Airway, Medications, Past History, Location, Events B. Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events leading up C. Systolic BP, Auscultation, Mobility, Pain, Lungs, Exposure D. Signs, Airway, Muscle use, Pressure, Liver, Ejection SAMPLE is used for obtaining patient history during the secondary survey. 29.Which of the following is most appropriate to assess disability? A. Pupil size only B. Glasgow Coma Scale (GCS) C. Blood glucose D. Reflex testing The GCS is a standardized tool to assess neurologic function. 30.In a blunt abdominal trauma patient, what finding is most concerning? A. Hematuria B. Abdominal distension and hypotension C. Guarding D. Pain Distension and hypotension may indicate internal bleeding. 31.Which intervention prevents hypothermia in trauma patients?
A. Kidney contusion B. Intra-abdominal bleeding C. Gastric ulcer D. Splinting These signs suggest hemorrhage requiring urgent imaging/intervention. 35.What injury is associated with Kehr's sign? A. Liver laceration B. Splenic rupture C. Rib fracture D. Bladder rupture Kehr’s sign (left shoulder pain) is referred pain from splenic irritation. 36.Which fracture is most concerning for hemorrhagic shock? A. Femur B. Wrist C. Pelvis D. Clavicle Pelvic fractures can cause massive blood loss due to vascular injury. 37.A trauma patient has chest bruising, muffled heart sounds, and distended neck veins. What is suspected?
A. Hemothorax B. Cardiac tamponade C. Pneumonia D. Pulmonary embolism These are classic signs of Beck’s triad for cardiac tamponade. 38.A tension pneumothorax requires which immediate action? A. Endotracheal intubation B. Chest X-ray C. Needle decompression D. Foley catheter placement This is a life-saving emergency procedure done before imaging. 39.Which spinal cord injury level causes diaphragmatic paralysis? A. C B. T C. C3–C D. L “C3, 4, 5 keeps the diaphragm alive” – injury here impairs respiration. 40.What does the “D” in ABCDE stand for?
A. Adequate perfusion B. Bradycardia C. Poor peripheral perfusion D. Hypervolemia Diminished peripheral pulses reflect reduced cardiac output and poor perfusion. 44.A trauma patient’s BP is dropping despite fluids. Next step? A. Administer diuretics B. Activate massive transfusion protocol C. Intubate D. Provide glucose Massive transfusion is needed for ongoing hemorrhage unresponsive to fluids. 45.When should reassessment of vital signs be performed? A. Once during secondary survey B. After discharge C. Continuously or frequently D. Before primary survey Frequent reassessment ensures patient stability during interventions. 46.What is the hallmark of spinal shock?
A. Hyperreflexia B. Flaccid paralysis and loss of reflexes C. Increased muscle tone D. Pupil dilation Spinal shock results in a temporary loss of reflex function below the injury. 47.What is the most sensitive indicator of early shock? A. Hypotension B. Cold skin C. Altered mental status D. Tachypnea Cerebral perfusion is compromised early, leading to changes in mental status. 48.Which finding requires urgent surgical intervention? A. Isolated femur fracture B. Decreased breath sounds C. Peritoneal signs with hypotension D. Open tibia fracture Signs of peritonitis and hypotension suggest intra-abdominal bleeding. 49.The best way to prevent hypothermia during transport is to:
A. Ask the patient B. Use the MIST report from EMS C. Wait until conscious D. Skip history EMS provides vital prehospital information in the MIST format. 53.Which of the following is most life-threatening? A. Femur fracture B. Airway obstruction C. Dislocated shoulder D. Ankle fracture Airway obstruction causes rapid deterioration and death if not treated. 54.A trauma patient has blood at the urinary meatus. Next step? A. Insert Foley B. Clean area C. Do not catheterize – get urology consult D. Give antibiotics Blood at the meatus suggests urethral injury; avoid catheterization until ruled out. 55.What best confirms endotracheal tube placement?
A. Bilateral breath sounds B. Capnography (CO2 detection) C. Fogging in the tube D. Chest rise Capnography provides continuous confirmation of correct tube placement. 56.A trauma patient with a scalp wound is alert but vomits. What do you suspect? A. Infection B. Concussion or TBI C. Stroke D. Dehydration Vomiting after head trauma is a sign of increased intracranial pressure. 57.A flail chest is defined as: A. Pain on inspiration B. 3 or more ribs fractured in 2 or more places C. Bruised lung D. Shallow breathing Flail chest causes paradoxical movement and impaired ventilation. 58.Which population is most susceptible to hypothermia in trauma?
