TNCC 8th Edition Questions and
Answers 100% Pass
What are the greatest risks for transport? ✔✔Loss of airway patency, displaced obstructive tubes
lines or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration
in patient status change in vital signs or level of consciousness, injury to the patient and/or team
members
According to newtons law which of these two force is greater: size or force? ✔✔Neither. For
each force there is an equal and opposite reaction.
What is the relationship between mass and velocity to kinetic energy? ✔✔Kinetic energy is
equal to 1/2 the mass multiplied the square of its velocity therefore when mass is doubled so is
the net energy, however, when velocity is doubled energy is quadrupled.
What is tension? ✔✔stretching force by pulling at opposite ends
What is compression? ✔✔Crushing by squeezing together
What is bending? ✔✔Loading about an axis. Bending causes compression on the side the person
is bending toward intention to the opposite side
What is shearing? ✔✔Damage by tearing or bending by exerting faucet different parts in
opposite directions at the same time.
What is torsion? ✔✔Torsion forces twist ends in opposite directions.
What is combined loading? ✔✔Any combination of tension compression torsion bending and/or
shear.
What are the four types of trauma related injuries? ✔✔Blunt, penetrating, thermal, or blast.
What are contributing factors to injuries related to blunt traumas? ✔✔The point of impact on the
patient’s body, the type of surface that is hit, the tissues ability to resist (bone versus soft tissue,
air-filled versus solid organs), and the trajectory of force.
What are the seven patterns of pathway injuries related to motor vehicle accidents? ✔✔Up and
over, down and under, lateral, rotational, rear, roll over, and ejection.
TNCC final exam test 2022 open book
already graded A
Why is a measure of serum lactate obtained in the initial assessment of the trauma patient?
Answer: c ✔✔a) to measure oxygenation and ventilation
b) to quantify the base deficit for the adequacy of cellular perfusion
c) *to gauge end-organ perfusion and tissue hypoxia **
d) to determine the underlying cause of shock
A trauma patient is restless and repeatedly asking “where am I?” vital signs upon arrival were BP
100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and dry. Current vital
signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and
symptoms of which stage of shock?
Answer: A ✔✔A) compensated **
B) Progressive
C) irreversible
D) decompensated
An elderly patient with a history of anticoagulant use presents after a fall at home that day. she
denies any loss of consciousness. She has a hematoma to her forehead and complains of
headache, dizziness, and nausea. Which is a most likely cause of her symptoms?
Answer: D ✔✔A) epidural hematoma
B) diffuse axonal injury
C) post-concussive syndrome
D) subdural hematoma ***
EMS brings a patient who fell riding his bicycle. Using the American College of Surgeons
screening guidelines, which assessment finding would prompt the nurse to prepare the patient for
radiologic spine clearance?
Answer: D ✔✔A) Alert with no neurologic deficits
B) Multiple abrasions to the extremities
C) Multiple requests of water
D) Smell of alcohol on breath ***
Which of the following occurs during the third impact of a motor vehicle crash?
Answer: C ✔✔A) The driver of the vehicle collides with the steering wheel
B) the vehicle collides with a tree
C) the aorta is torn at its attachment with the ligamentum arteriosum
D) the airbag deploys and strikes the front seat passenger ***
A passenger is brought to the emergency department of a rural hospital following a high-speed
MVC. When significant abdominal and pelvic injuries are noted in the primary survey, which of
the following is the priority interventions?
Answer: A ✔✔A) initiate transfer to a trauma center **
B) provide report to the operating room nurse
C) Obtained imaging studies
D) Place a gastric tube
Which of the following injuries is LEAST likely to be promptly identified?
TNCC 8th Edition Questions and
Answers Passed with 100%
The trauma nurse knows that placing a bariatric patient in a “ramped position” provides better
visualization during the insertion of which device? ✔✔endotracheal tube
Tearing of the bridging veins is most frequently associated with which brain injury? ✔✔subdural
hematoma
A patient is found lying on the floor after falling 13 hours ago. Which of the following laboratory
values is expected with a musculoskeletal complication associated with this presentation?
✔✔Elevated creatine kinase
A patient is brought to the emergency department of a rural hospital following a high-speed
motor vehicle collision. When significant abdominal and pelvic injuries are noted in the primary
survey, which of the following is the priority intervention? ✔✔Initiate transfer to a trauma center
Which of the following injuries is LEAST likely to be promptly identified? ✔✔bowel
Which of the following patients warrants referral to a burn center? ✔✔A 52-year-old diabetic
male with a partial-thickness burn to the left lower leg
A patient has been in the emergency department for several hours waiting to be admitted. He
sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and
complaining of leg pain. His wife reported that he suddenly became anxious and confused. Upon
reassessment, the patient is restless, with respiratory distress and petechiae to his neck. The
patient is exhibiting signs and symptoms most commonly associated with which of the follow
conditions? ✔✔fat embolism
A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her
hand due to pain. Which of the following is the most appropriate intervention? ✔✔Apply a splint
and elevate the extremity ABOVE the level of the heart
A 56-year-old male patient involved in a motor vehicle crash is brought to the emergency
department of a rural critical assess facility. He complaints of neck pain, shortness of breath, and
diffuse abdominal pain. His Glasgow Coma Score is 15. His vital signs are as follows: BP 98/71
mm Hg, HR 125 beats/minute, RR 26 breaths/minute, SpO2 94% on high-flow oxygen via nonrebreather mask. Which of the follow is the priority intervention for this patient? ✔✔Expedite
transfer to the closest trauma center
TNCC EXAM QUESTIONS AND
ANSWERS (2022/2023) (VERIFIED
SOLUTIONS)
Initial Assessment ✔✔1. Preparation and Triage
- Primary Survery (ABCDE) with resuscitation adjuncts (F,G)
- Reevaluation (consideration of transfer)
- Secondary Survey (HI) with reevaluation adjuncts
- Reevaluation and post resuscitation care
- Definitive care of transfer to an appropriate trauma nurse
ABCDEFGHI ✔✔1. A- airway and Alertness with simultaneous cervical spinal stabilization - B- breathing and Ventilation
- circulation and control of hemorrhage
- D – disability (neurologic status)
- F – full set of vitals and Family presence
- G – Get resuscitation adjuncts
L- Lab results (arterial gases, blood type and crossmatch)
M- monitor for continuous cardiac rhythm and rate assessment
N- naso or orogastric tube consideration
O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02)
monitoring and capnopgraphy
H- History and head to toe assessment
I- Inspect posterior surfaces
When should PPE be placed: ✔✔Before the arrival of the pt
Safe Care: ✔✔Pt is at hospital in the right amount of time, right care, right trauma facility, right
resources
Major cause of preventable death: ✔✔Uncontrolled Hemorrhage
If uncontrolled hemorrhage .. ✔✔reorganize care to C-ABC
Airway and AVPU: ✔✔Used at the beginning of the initial assessment
- A Alert. If the pt is alert he or she will be able to maintain his or her airway once it is clear.
- V responds to verbal stimuli responds to pain. If the patient needs verbal stimulation to
respond, an airway adjunct may be needed to keep the tongue from obstructing the airway. - P responds to pain. If the pt. responds only to pain, he or she may not be able to maintain his
or her airway adjunct may need to be placed while further assessment is made to determine the
need for intubation. - U Unresponsive. If the pt. is unresponsive, announce it loudly to the team and direct someone
to chk in the pt is pulseless while assessing if the cause of the problem is the airway.
While assessing airway the patient is alert and responds to verbal stimuli you should.. ✔✔ask pt
to pen his or her mouth
While assessing airway pt is unable to open mouth, responds only to pain, or is unresponsive you
should.. ✔✔jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspected
csi, the jaw thrust procedure should be done by two providers. One provider can maintain c-spine
and the other can perform the jaw thrust maneuver.
Inspect the mouth for: ✔✔1. The tongue obstructing the airway - loose or missing teeth
- foreign objects
- blood, vomit, or secretions’
TNCC 8th edition Questions and
Answers with Verified Solutions
The major cause of preventable death after injury ✔✔Uncontrolled hemorrhage
The best measure of the adequacy of cellular perfusion and helps to predict the outcome of
resuscitation ✔✔Base deficit
Examples of primary blast injuries ✔✔Blast lung, ruptured tympanic membrane, TBI, abdominal
hemorrhage
Examples of secondary blast injuries ✔✔Wounds from debris and bomb fragments
Examples of tertiary blast injuries ✔✔Blunt or penetrating trauma from the body being thrown
by the blast
Examples of quaternary blast injuries ✔✔Injuries or illness related to explosion: burns, toxic
injury from chemicals
Examples of quinary blast injuries ✔✔Injuries associated with exposure to hazardous materials
from the components of the blast
Questions to ask for airway assessment (need 4) ✔✔Is the tongue obstructing?
Are there any foreign objects?
Is there any edema?
Are there loose or missing teeth?
Is there snoring, gurgling, or stridor?
Is there bony deformity?
Is there blood, vomit, or secretions?
Questions to ask during breathing assessment. (Need 4) ✔✔Is there symmetrical chest rise?
Is there spontaneous breathing?
Is there tracheal deviation or JVD?
What is their skin color?
Are there open wounds or deformities in the chest?
What’s the depth, pattern, and rate of respirations?
Is there increased work of breathing?
TNCC Written Exam Questions and
Answers Graded A+
What is the best measure of the adequacy of cellular perfusion and helps predict the outcome of
resuscitation? ✔✔Base deficit used in conjunction with serum lactate
Will hypocapnia cause vasoconstriction or vasodilation, especially in the cerebral vasculature?
✔✔Vasoconstriction
What results from tissue hypo perfusion and oxygen deficit? ✔✔Metabolic acidosis
What type of shock results in generalized vasodilation? ✔✔Neurogenic shock
Spinal cord injuries at C3-C5 causes loss of what nerves function, resulting in what? ✔✔Phrenic
nerve; paralyzed diaphragm and inability to breath
Extremity elevation AT the level of the heart is beneficial for what type of injury?
✔✔Compartment Syndrome
What is a high risk of frostbite? ✔✔Thrombus formation
What two medications can be administered to maintain perfusion after a frostbite injury along
with rewarming? ✔✔Tissue plasminogen activator or non steroidal anti-inflammatory
medication (NSAIDS)
An rise in diastolic blood pressures is a sign of increasing what? ✔✔Peripheral resistance
What position will benefit the airway and work of breathing for the bariatric patient? ✔✔Reverse
Trendelenburg
Which phase of a blast results from flying debris, projectiles, and bomb fragments causing
lacerations or penetrating injuries? ✔✔Secondary Phase
What phase of a blast results from any explosion-related illness or injury including
hyperglycemia, hypertension, angina, asthma, COPD, or sepsis? ✔✔Quaternary Phase
What phase of a blast results from individuals being thrown by the blast and impacting walls,
ground, or any hard object? ✔✔Tertiary Phase
TNCC Test prep 8th Edition Questions
and Answers 100% Pass
A 56 y/o M involved in a MVC is brought to the ED. He complains of neck pain, SOB, and
diffuse abdominal pain. His GCS is 15, VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow
O2 via NRB mask. Which is the priority intervention for this patient? ✔✔Expedite transfer to the
closest trauma center
Which of the following considerations is the most important when caring for a geriatric trauma
pt? ✔✔a pertinent medical hx is crucial
Following a review of recent drills and a real disaster event, a hospital has identified deficiencies
and is taking steps to minimize the impact of a future disaster . Which phase of the disaster life
cycle does this describe? ✔✔Mitigation
EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs
screening guidelines, which assessment finding would prompt the RN to prepare the pt for a
radiologic spine clearance? ✔✔smell of alcohol on breath
What is the effect of hypothermia on the oxyhemoglobin dissociation curve? ✔✔hemoglobin
does not readily release O2 for use by the tissues
Which of the following is a component of the trauma triad of death? ✔✔acidosis
EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits
urinary incontinence and priapism. These assessment findings are most consistent with which of
the following types of spinal cord injury? ✔✔Complete
Which of the following is an expected finding in a pt with a tube thoracstomy connected to a
chest drainage system? ✔✔flucuation in the water seal chamber
During the primary survey of an unconscious pt with multi-system trauma, the nurse notes
snoring respirations. What priority nursing interventions should be preformed next? ✔✔insert an
oropharyngeal airway if there is no gag reflex
A 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardropshaped left pupil is noted on exam. What type of injury is suspected? ✔✔globe rupture
TNCC 8th Edition Provider Exam Latest
Update with Verified Solutions
EMS brings a patient who fell while riding his bicycle. Using the American College of Surgeons
screening guidelines, which assessment finding would prompt the nurse to prepare the patient for
radiologic spine clearance? ✔✔Alert with no neurological deficits
The trauma nurse knows that placing a bariatric patient in a “ramped position” provides better
visualization during the insertion of which device? ✔✔Endotracheal tube
A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A
teardrop-shaped left pupil is noted on exam. What type of injury is suspected? ✔✔Globe rupture
Caregivers carry a 2-year-old into the emergency department who fell out of a second-story
window. The patient is awake and crying with increased work of breathing and pale skin. Which
of the following interventions has the highest priority? ✔✔Padding the upper back while
stabilizing the cervical spine
Which of the following injuries is LEAST likely to be promptly identified? ✔✔Bowel
A 49-year-old restrained driver involved in a motor vehicle collision presents to the trauma
center complaining of abdominal, pelvic, and bilateral lower extremity pain. Vital signs are
stable. The nurse can anticipate all of these after a negative FAST exam EXCEPT which of the
following? ✔✔Diagnostic peritoneal lavage
Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? ✔✔To
gauge end-organ perfusion and tissue hypoxia
During the primary survey of an unconscious patient with multi-system trauma, the nurse notes
snoring respirations. Which priority nursing intervention should be performed next? ✔✔Insert an
oropharyngeal airway if there is no gag reflex
Which of the following assessment findings differentiates a tension pneumothorax from a simple
pneumothorax? ✔✔Hypotension that worsens with inspiration (pulsus paradoxus)
What is the effect of hypothermia on the oxyhemoglobin dissociation curve? ✔✔Hemoglobin
does not readily release oxygen for use by the tissues (Left shift)
A trauma patient is en route to a rural emergency department. Radiology notifies the charge
nurse that the computed tomography (CT) scanner will be out of service for several hours. The
TNCC Exam 8th edition study questions
with complete solutions
1.What is the effect of hypothermia on the oxyhemoglobin dissociation curve ✔✔Hemoglobin
does not readily release oxygen for use by the tissues A shift to the left occurs in an environment
of low metabolic demand (hypothermia, hypocapnia, alkalosis), increasing hemoglobin’s affinity
for oxygen.
EMS arrives with the intoxicated driver of a car involved in a motor vehicle crash. EMS reports
significant damage to the driver’s side of the car. The patient is asking to have the cervical collar
removed. When it is appropriate to remove the cervical collar? ✔✔After a physical examination
if the patient has no radiologic abnormalities on CT A CT is recommended for spinal clearance
in an impaired patient.
The nurse is caring for a 120 kg male brought in after a warehouse fire and is calculating the
patient’s fluid resuscitation needs. He has painful red blistering to the entire surface of both upper
extremities and superficial burns to the anterior chest. Using the modified Lund and Browder
chart to calculate the total body surface area burned, how much IV fluid would be administered
in the first 8 hours? ✔✔2280 mL Both upper arms = 8%, both lower arms = 6%, and both hands
= 5%, yielding 19 * 2 * 120 = 4560 mL. Half of the total is equal to 2280 mL. Superficial burns
are not included in the TBSA calculation for fluid resuscitation.
Which of the following is an expected finding in a patient with a tube thoracostomy connected to
a chest drainage system ✔✔Fluctuation in the water seal chamber Fluctuation in the water seal
chamber indicates the tube is placed correctly in the pleural space.
.A 35-year-old male presents with facial trauma after being struck in the face with a baseball. A
teardrop-shaped left pupil is noted on exam. What type of injury is suspected? ✔✔Globe rupture
A teardrop-shaped pupil suggests a globe rupture.
.A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension
and which other clinical signs? ✔✔Bradycardia and absent motor function below the level of
injury Patients with a complete spinal cord injury will have absent motor function below the
level of the lesion. They become hypotensive and bradycardic due to loss of autonomic nervous
system function.
Which of the following patients warrants referral to a burn center? ✔✔A 52-year-old diabetic
male with a partial-thickness burn to the left lower leg This patient has a 7% TBSA burn with a
preexisting medical history that could complicate management, prolong recovery, or affect
mortality.
You are caring for a patient who was involved in a motor vehicle crash and is 32 weeks
pregnant. Findings of your secondary survey include abdominal pain on palpation, fundal height
TNCC Notes for Written Exam Latest
Update 100% Pass
What is kinematics? ✔✔A branch of mechanics (energy transfer) that refers to motion and does
not consider the concepts of force and mass of the object or body.
What is Newton’s First Law? ✔✔A body at rest will remain at rest. A body in motion will
remain in motion until acted on by an outside force.
What is the Law of Conservation of Energy? ✔✔Energy can neither be created nor destroyed. It
is only changed from one form to another.
What is Newton’s Second Law? ✔✔Force equals mass multiplied by acceleration of
deceleration.
What is kinetic energy (KE)? ✔✔KE equals 1/2 the mass (M) multiplied by the velocity squared.
What is the Mnemonic for the Initial Assessment? ✔✔A = Airway with simultaneous cervical
spine protection
B = Breathing
C = Circulation
D = Disability (neurologic status)
E = Expose/Environmental controls (remove clothing and keep the patient warm)
What is the Mnemonic for the Secondary Assessment? ✔✔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? ✔✔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? ✔✔- Tracheal deviation
- JVD
What are signs of ineffective breathing? ✔✔- 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.
Upon initial assessment, what type of oxygen should be used for a pt breathing effectively?
✔✔A tight-fitting nonrebreather mask at 12-15 lpm.
What intervention should be done if a pt presents with effective circulation? ✔✔- Insert 2 large
caliber IV’s - Administer warmed isotonic crystalloid solution at an appropriate rate
What are signs of ineffective circulation? ✔✔- Tachycardia - AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds
What are the interventions for Effective/Ineffective Circulation? ✔✔- 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 Questions and Answers with
Verified Solutions
Primary concern when a person cannot stop coughing/clearing their throat following house
fire/smoke? ✔✔Airway/Intubate
Lab evidence of cellular perfusion ✔✔Base Excess (Less than -6 is BAD)
Multiple people are in the ER of different ages who all go to the same church. They all have the
same symptoms. What is the most likely cause? ✔✔Biologic
Suspected shock type with a spinal cord injury ✔✔Distributive Shock (Includes neurogenic)
Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the
cause? ✔✔Herniation
Middle Meningeal Artery ✔✔Epidural Hematoma (results from collection of blood that forms
between dura mater and skull)
Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What
is the cause? ✔✔2nd Impact Syndrome
Bowel sounds heard in the L chest. What is this a symptom of? ✔✔Ruptured diaphragm
Symptoms of ______: include muffled heart sounds and hypotension
✔✔Pericardiocentesis
How should you dress a severed limb? ✔✔Sterile gauze with normal saline THEN put ice on it
Amylase level looks at _ ✔✔Pancreas
What should you do if your patient has hyphema (collection of blood inside the front part of the
eye?) ✔✔Sit HOB up to 30 degrees
Principle that people have to take action after suffering a loss in order to decrease severity,
seriousness, or painfulness ✔✔Mitigation
What organ is most at risk following a gunshot ✔✔Liver
8 year old child with longitudinal thigh lacerations ✔✔Sign of child abuse
Bleeding around belly button ✔✔Cullen’s Sign
What would cause an inaccurate reading from an 02 saturation probe? ✔✔Carboxyhemoglobin
(increase FiO2 to 100%)
General study of forces and their effects on living tissue and the human body ✔✔Biomechanics
Study of energy transfer as it applies to identifying actual or potential injuries ✔✔Kinematics
Refers to the separation of tissue resulting from a sound and/or hydraulic wave force- the effect
is a crushing pressure wave which creates a temporary cavity, followed by a rapid and violent
closing of the cavity. ✔✔Cavitation
This rapid motion can lead to crushing, tearing, and shearing forces on tissue ✔✔Cavitation
Used in OR; does not provide protection against aspiration and not recommended in patients who
have eaten recently. It is a supraglottic airway. ✔✔Laryngeal Mask Airway
Single tube retroglottic device inserted into the esophagus and traps the glottis opening between
an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a
separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It
is a retroglottic airway. ✔✔King Tube
Types of Shock (4) ✔✔Hypovolemic, Obstructive, Cardiogenic, Distributive
Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma.
Decreased circulating volume –> decreased preload. Therapy includes replacing the type of
volume that was lost. ✔✔Hypovolemic Shock
Results from hypo perfusion of tissue due to an obstruction in either the vasculature or heart.
Therapy aimed at relieving the obstruction and improving perfusion. ✔✔Obstructive Shock
Two classic examples of obstructive shock ✔✔Cardiac tamponade and tension pneumothorax
TNCC questions and answers already
passed
When might a patient need an ETT placed? ✔✔Apnea, GCS 8 or less, severe maxillofacial
injuries, evidence of inhalation injuries, altered LOC/inability to protect airway
What is part of the initial team prep for a pregnant patient? ✔✔Call the OB team, get a fetal
heart monitor
What are the earliest signs of shock in a pregnant patient? ✔✔Fetal tachycardia, bradycardia, and
changes in fetal movement
How is supine hypotension syndrome relieved? ✔✔15-degree tilt of the spine board in either
direction, or manual displacement of the uterus
What is a KB test for? ✔✔Kleinhaurt Betke test – detects fetal RBCs in the maternal blood,
indicating hemorrhage of fetal blood through the placenta
What is the normal range for fetal heart tones? ✔✔120-160 beats/minute