TNCC Practice Test

Sample Questions and Answers

Question 1. A 32-year-old patient arrives in the emergency department after a high-speed motor vehicle collision. The patient is responsive but has noisy respirations, facial trauma, and an oxygen saturation of 86% despite supplemental oxygen. According to the systematic trauma assessment approach, what should the nurse prioritize first?

A. Assess the patient’s pain level.

B. Secure and maintain a patent airway while protecting the cervical spine.

C. Obtain a complete health history from family members.

D. Prepare the patient for discharge instructions.

Correct Answer: B. Secure and maintain a patent airway while protecting the cervical spine.

Explanation:
Airway assessment is always the highest priority during the primary survey of a trauma patient because airway compromise can quickly become life-threatening. Patients with facial trauma, noisy respirations, or decreased oxygen saturation may have partial airway obstruction requiring immediate intervention. While managing the airway, cervical spine protection should be maintained until spinal injury has been ruled out. Establishing a patent airway allows adequate oxygen delivery to vital organs and provides the foundation for subsequent assessment of breathing and circulation. Following the systematic trauma assessment process helps nurses recognize and manage life-threatening conditions promptly while ensuring safe and effective patient care.

Question 2. A trauma patient presents with cool, pale skin, rapid breathing, tachycardia, delayed capillary refill, and decreasing blood pressure following significant blood loss. Which condition should the nurse suspect first?

A. Neurogenic shock

B. Hypovolemic shock

C. Septic shock

D. Cardiogenic shock

Correct Answer: B. Hypovolemic shock

Explanation:
Hypovolemic shock is the most common form of shock following traumatic blood loss. As circulating blood volume decreases, the body activates compensatory mechanisms that produce tachycardia, increased respiratory rate, peripheral vasoconstriction, cool clammy skin, delayed capillary refill, and eventually hypotension if bleeding continues. Early recognition allows the healthcare team to initiate rapid hemorrhage control, fluid resuscitation, blood product administration when appropriate, and continuous monitoring. Prompt intervention is essential because untreated hypovolemic shock can rapidly progress to organ failure and death. Nurses play a critical role in recognizing early signs and communicating changes in patient condition.

Question 3. During the secondary survey, a trauma patient reports severe abdominal pain after sustaining blunt abdominal trauma. The abdomen is becoming increasingly rigid and distended. What is the nurse’s most appropriate immediate action?

A. Encourage the patient to walk to relieve discomfort.

B. Recognize the findings as possible internal bleeding and immediately notify the trauma team.

C. Delay further assessment until laboratory results are available.

D. Offer oral fluids to improve circulation.

Correct Answer: B. Recognize the findings as possible internal bleeding and immediately notify the trauma team.

Explanation:
Increasing abdominal pain, distention, and rigidity following blunt trauma are concerning findings that may indicate internal bleeding or injury to abdominal organs. These signs require immediate communication with the trauma team because rapid diagnosis and treatment are essential to prevent deterioration. Delaying intervention may allow continued hemorrhage and increase the risk of shock and organ damage. Nurses should continue monitoring vital signs, assess for additional signs of hemodynamic instability, and prepare the patient for diagnostic imaging or emergency surgical intervention if indicated. Early recognition and prompt communication are essential components of effective trauma nursing care.

Question 4. A trauma patient with a suspected spinal injury is being transferred from the emergency stretcher to a hospital bed. Which transfer technique best helps reduce unnecessary spinal movement during the transfer?

A. Assist the patient to stand and pivot.

B. Use a coordinated log-roll technique with multiple trained team members.

C. Lift only the patient’s upper body first.

D. Allow the patient to reposition independently if awake.

Correct Answer: B. Use a coordinated log-roll technique with multiple trained team members.

Explanation:
Patients with suspected spinal injuries require careful handling to prevent additional damage to the spinal cord or surrounding structures. A coordinated log-roll performed by multiple trained healthcare providers maintains proper spinal alignment while minimizing unnecessary movement during repositioning or transfer. Team communication is essential so each movement occurs simultaneously under the direction of one team leader. Allowing unnecessary twisting, bending, or independent movement before spinal injury has been excluded may worsen neurological injury. Maintaining spinal precautions remains a priority until appropriate imaging and clinical evaluation confirm that immobilization is no longer required.

Question 5. During the initial assessment of a trauma patient, the nurse observes absent breath sounds on one side of the chest, severe respiratory distress, hypotension, and tracheal deviation. Which life-threatening condition should be suspected immediately?

A. Pulmonary embolism

B. Tension pneumothorax

C. Asthma exacerbation

D. Pleural effusion

Correct Answer: B. Tension pneumothorax

Explanation:
Tension pneumothorax is a life-threatening emergency that occurs when air accumulates within the pleural space under pressure, compressing the affected lung and shifting mediastinal structures. Classic findings include severe respiratory distress, unilateral absent breath sounds, hypotension, distended neck veins, and tracheal deviation in advanced cases. Without rapid recognition and emergency decompression, the condition can quickly lead to cardiovascular collapse and cardiac arrest. Nurses must promptly recognize these findings, notify the trauma team immediately, and prepare for emergency intervention while continuing to support airway, breathing, circulation, and continuous patient monitoring according to established trauma care priorities.