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TNCC FINAL EXAM 2025 /202 6 Edition
(Open Book) VERSION 2 QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
1. What is the first priority in the primary survey of a trauma patient? A. Disability B. Airway with cervical spine protection C. Breathing D. Exposure ** Rationale: The primary survey follows the ABCDE mnemonic. Airway with cervical spine protection is always assessed first to ensure the patient can oxygenate and ventilate effectively without risk of spinal injury. 2. Which of the following assessment findings indicates a potential tension pneumothorax? A. Bradycardia and hypotension B. Tracheal deviation and absent breath sounds on one side C. Equal breath sounds and JVD
D. Midline trachea with wheezing ** Rationale: Tracheal deviation away from the affected side and absent breath sounds suggest air is trapped, compressing the lung and mediastinum—classic signs of a tension pneumothorax.
3. During the primary survey, what should be done immediately if external bleeding is noted? A. Administer IV fluids B. Apply direct pressure to the site C. Begin CPR D. Start blood transfusion ** Rationale: Life-threatening bleeding is addressed in the "C" of ABCs— circulation—and direct pressure is the first and most effective intervention. 4. What is the appropriate intervention for a trauma patient with a Glasgow Coma Scale (GCS) score of 6? A. Prepare for intubation and advanced airway management B. Monitor vitals every hour C. Provide high-flow oxygen via mask D. Reassess in 15 minutes ** Rationale: A GCS ≤ 8 indicates a severe head injury and potential loss of airway protection—intubation is warranted. 5. Which of the following injuries requires immediate surgical intervention? A. Open tibial fracture B. Stable pelvic fracture C. Pericardial tamponade
B. Hypertonic saline C. Isotonic crystalloid (normal saline or lactated Ringer’s) D. Colloid (albumin) ** Rationale: Isotonic crystalloids are first-line fluids in trauma resuscitation to restore intravascular volume.
9. What is the most reliable early sign of hypovolemic shock in a trauma patient? A. Hypotension B. Loss of consciousness C. Tachycardia D. Pale skin ** Rationale: Tachycardia is a compensatory response and often the first sign of hypovolemia before blood pressure drops. 10. A patient with blunt abdominal trauma is hypotensive and unresponsive. What is the priority diagnostic test? A. CT scan of the abdomen B. Focused Assessment with Sonography for Trauma (FAST) C. Urinalysis D. MRI ** Rationale: A FAST exam is a rapid bedside ultrasound to detect free fluid in the abdomen, essential for unstable patients. 11. Which sign is most indicative of increased intracranial pressure (ICP)? A. Tachycardia and hypertension
B. Widening pulse pressure and bradycardia C. Hypotension and bradypnea D. Miosis and hyperthermia ** Rationale: Cushing's triad—widening pulse pressure, bradycardia, and irregular respirations—is a hallmark of increased ICP.
12. What is the most appropriate site for intraosseous (IO) access in a pediatric trauma patient? A. Distal femur B. Sternum C. Proximal tibia D. Distal ulna ** Rationale: The proximal tibia is the most common and safest site for IO access in children due to ease of landmarking and minimal complications. 13. What is the proper nursing action if a patient with a chest tube suddenly has no drainage and no breath sounds on the affected side? A. Increase IV fluids B. Clamp the chest tube C. Notify the provider and prepare for reinsertion D. Elevate the head of bed ** Rationale: Sudden cessation of drainage and absent breath sounds may indicate dislodgement or obstruction—requires provider intervention immediately. 14. Which medication is most appropriate to administer first in a trauma patient with a head injury and seizures?
B. Pericardial tamponade C. Massive hemorrhage D. Spinal cord injury ** Rationale: Pelvic fractures can cause significant vascular disruption, leading to life-threatening hemorrhage.
18. In a trauma code, what does “MTP” stand for? A. Manual Trauma Pressure B. Mechanical Transport Protocol C. Massive Transfusion Protocol D. Minimum Trauma Protocol ** Rationale: The Massive Transfusion Protocol guides the rapid delivery of blood products to address hemorrhagic shock. 19. When managing a facial trauma patient with gurgling respirations, the first nursing action is: A. Check pulse oximetry B. Apply oxygen via mask C. Suction the airway D. Assess for facial fractures ** Rationale: Gurgling indicates airway obstruction from secretions or blood— suctioning is the immediate intervention to clear the airway. 20. What spinal level controls the diaphragm and breathing? A. T2–T B. C3–C C. L1–L
D. T12–L
** Rationale: “C3, 4, 5 keeps the diaphragm alive.” These spinal nerves are essential for diaphragm function and spontaneous breathing.
21. What is the best indicator of adequate fluid resuscitation? A. Pink skin B. Capillary refill under 3 seconds C. Urine output >0.5 mL/kg/hr D. Clear lungs ** Rationale: Adequate urine output is a reliable indicator of end-organ perfusion and effective volume resuscitation. 22. What type of shock is caused by a spinal cord injury? A. Cardiogenic B. Hypovolemic C. Neurogenic D. Obstructive ** Rationale: Neurogenic shock results from loss of sympathetic tone following spinal cord injury, leading to hypotension and bradycardia. 23. The 'secondary survey' begins after: A. Cervical spine is cleared B. IV access is obtained C. Primary survey is completed and life-threatening conditions are addressed D. The patient is sedated
27. What is the first step when a patient presents with an impaled object? A. Remove the object B. Cut around the object C. Stabilize the object in place D. Pack the wound ** Rationale: Never remove an impaled object in the field. It should be stabilized to prevent further injury until surgical removal is possible. 28. A patient develops paradoxical chest movement after blunt trauma. This suggests: A. Pneumothorax B. Pulmonary embolism C. Flail chest D. Asthma ** Rationale: Flail chest results from multiple rib fractures causing part of the chest wall to move independently, leading to paradoxical motion. 29. Which of the following would most likely indicate early hemorrhagic shock? A. Cool, moist skin B. Coma C. Bradypnea D. Narrowed pulse pressure ** Rationale: Narrowed pulse pressure is an early sign of shock, showing reduced stroke volume and vasoconstriction. 30. Which electrolyte imbalance is most concerning in crush injuries? A. Hypocalcemia
B. Hypernatremia C. Hyperkalemia D. Hypokalemia ** Rationale: Cell lysis from crush injuries releases potassium into the bloodstream, risking life-threatening hyperkalemia. Would you like questions 31– 60 next? You said: 31 - 60 ChatGPT said: Here are questions 31– 60 of the TNCC Final Exam 2024/2025 Practice Test with bolded correct answers and italicized rationales :
31. Which injury requires immediate needle decompression? A. Hemothorax B. Tension pneumothorax C. Simple rib fracture D. Flail chest ** Rationale: A tension pneumothorax is a life-threatening condition that requires immediate needle decompression to release trapped air and restore normal intrathoracic pressure. 32. What is the correct location for needle decompression in an adult? A. 5th intercostal space, midaxillary line
B. Use jaw-thrust maneuver C. Hyperextend the neck D. Apply traction ** Rationale: The jaw-thrust maneuver is used to open the airway while minimizing cervical spine movement.
36. What condition is most likely if bowel sounds are heard in the chest after a motor vehicle crash? A. Hemothorax B. Diaphragmatic rupture C. Tension pneumothorax D. Flail chest ** Rationale: A diaphragmatic rupture allows abdominal contents to enter the chest cavity, producing bowel sounds on auscultation. 37. Which sign is most associated with a basilar skull fracture? A. Increased ICP B. Bradycardia C. Otorrhea of cerebrospinal fluid D. Constricted pupils ** Rationale: CSF drainage from the ear (otorrhea) is a classic sign of a basilar skull fracture. 38. What is the most reliable indicator of brain perfusion? A. Eye movement B. Level of consciousness
C. Blood pressure D. Pupillary reaction ** Rationale: Changes in level of consciousness are the earliest and most sensitive indicator of cerebral perfusion.
39. Which symptom most strongly suggests compartment syndrome? A. Warm, pink extremity B. Strong distal pulses C. Pain out of proportion to injury D. Decreased capillary refill ** Rationale: Severe pain unrelieved by medication and out of proportion to injury is a hallmark sign of compartment syndrome. 40. A patient with periorbital ecchymosis and Battle's sign likely has: A. Orbital fracture B. Basilar skull fracture C. Temporal bone fracture D. Mandibular fracture ** Rationale: Battle’s sign (bruising behind the ear) and raccoon eyes (periorbital bruising) are indicative of a basilar skull fracture. 41. Which part of the primary survey is “Disability” focused on? A. Head-to-toe inspection B. Circulatory collapse C. Neurologic status D. Airway obstruction
45. What does a seatbelt sign across the abdomen increase risk for? A. Pneumothorax B. Hollow organ injury C. Spinal fracture D. Rib fracture ** Rationale: Seatbelt injuries often involve blunt trauma to the abdomen, increasing the risk of hollow organ rupture (e.g., bowel). 46. A trauma patient becomes confused, restless, and hypotensive. What is the most likely cause? A. Brain injury B. Hypoxia or hypoperfusion C. Seizure D. Drug overdose ** Rationale: Restlessness and confusion are early signs of cerebral hypoxia or poor perfusion, often from shock. 47. What is the proper position for a patient with a suspected pelvic fracture? A. Prone B. Supine with pelvic binder C. High Fowler’s D. Lateral recovery ** Rationale: Supine position with a pelvic binder stabilizes the pelvis and reduces bleeding.
48. A child presents after a high-speed accident. What finding requires immediate intervention? A. Mild contusions B. Unequal pupils C. Bruised knees D. Normal breath sounds ** Rationale: Unequal pupils can signal increased ICP or a brain herniation—this requires urgent intervention. 49. What is the best fluid for resuscitating a pediatric trauma patient? A. Isotonic crystalloid (NS or LR) B. D5W C. Colloid D. Hypertonic saline ** Rationale: Isotonic crystalloids are used in initial trauma fluid resuscitation for both adults and children. 50. What does AVPU stand for in the disability assessment? A. Awake, Vomiting, Pain, Unresponsive B. Alert, Verbal, Pain, Unresponsive C. Alert, Visual, Palpate, Unconscious D. Airway, Vital Signs, Pupil, Unresponsive ** Rationale: AVPU is a rapid neurological assessment: Alert, responds to Verbal, responds to Pain, Unresponsive.
C. Imaging window D. Surgery decision time ** Rationale: The first 10 minutes are critical for assessment, stabilization, and initiating transport to definitive care.
55. A trauma patient has unequal chest rise and tracheal deviation. What is the priority? A. Insert chest tube B. Needle decompression C. Oxygen by mask D. Obtain a chest x-ray ** Rationale: Tracheal deviation and unequal chest rise suggest tension pneumothorax—needle decompression is the immediate intervention. 56. Which tool is best for spinal motion restriction in a suspected cervical injury? A. Bed sheet B. Rigid cervical collar and long spine board C. Pillows D. Manual traction ** Rationale: A rigid cervical collar and long spine board provide effective immobilization until injury is ruled out. 57. In the SAMPLE history, what does “P” stand for? A. Past diet B. Past medical history C. Pulse
D. Prehospital time ** Rationale: SAMPLE is a mnemonic for patient history: Symptoms, Allergies, Medications, Past medical history, Last meal, Events.
58. What does the presence of subcutaneous emphysema suggest? A. Fractured clavicle B. Air leak in the respiratory tract C. Rib sprain D. Abdominal gas ** Rationale: Air leaking from the lung or airway can migrate under the skin, causing a crackling sensation—subcutaneous emphysema. 59. What is a priority nursing action for a trauma patient with signs of hypothermia? A. Lower the room temperature B. Administer cold IV fluids C. Apply warm blankets and warmed fluids D. Reassess in 30 minutes ** Rationale: Preventing and reversing hypothermia is critical in trauma care to avoid coagulopathy and worsening shock. 60. What is the most appropriate triage level for a patient with a sucking chest wound? A. Green (minor) B. Red (immediate) C. Yellow (delayed) D. Black (deceased)
