TNCC Cheat Sheet 2026

The 30 highest-yield TNCC facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A patient with blunt abdominal trauma has a positive FAST exam but is hemodynamically stable with a blood pressure of 128/78. The appropriate next step is: → CT scan of the abdomen and pelvis with IV contrast for injury grading
2. A trauma nurse has been involved in resuscitating a child who died from injuries. Which response by the charge nurse best supports the staff nurse's well-being? → Offering a brief debriefing session and connecting the nurse with peer support resources
3. When managing elevated intracranial pressure, the nurse should position the trauma patient with the head of bed elevated to what degree? → 15-30 degrees
4. Tranexamic acid (TXA) administration in trauma hemorrhage is most effective when given within what time frame from injury? → 3 hours
5. Which splinting principle is MOST important when immobilizing a fractured extremity? → Splint the joint above and below the fracture site
6. Which of the following conditions should be kept an eye out for in patients who have had crush injuries? → Dysrhthmias
7. Which injury should be suspected in a trauma patient with Kehr's sign (left shoulder pain) following blunt abdominal trauma? → Splenic injury with diaphragmatic irritation
8. A trauma patient's arterial blood gas shows pH 7.28, PaCO2 28 mmHg, HCO3 14 mEq/L, and lactate 6.2 mmol/L. This pattern is most consistent with: → Metabolic acidosis with respiratory compensation
9. Why is a serum lactate measurement used during the trauma patient's initial evaluation? → to measure tissue hypoxia and end-organ perfusion
10. Hypothermia in trauma patients worsens hemorrhage primarily by: → Impairing coagulation enzyme function and platelet aggregation
11. A trauma patient presents with Beck's triad. Which combination of signs does this include? → Hypotension, distended neck veins, muffled heart sounds
12. A patient with an open (compound) fracture of the tibia has bone protruding through the skin. Which action should the nurse avoid? → Pushing the bone back beneath the skin surface
13. Damage control resuscitation in trauma includes all of the following EXCEPT: → Targeting a normal blood pressure of 120/80 mmHg before surgery
14. In a pregnant trauma patient at 28 weeks, fetal monitoring shows late decelerations with decreased variability. This finding indicates: → Uteroplacental insufficiency and fetal distress requiring urgent intervention
15. Which mechanism of injury has the highest association with aortic disruption? → Rapid deceleration from high-speed frontal collision
16. During the primary survey, which life-threatening condition should be identified and treated during the 'C' (Circulation) assessment? → Uncontrolled external hemorrhage
17. A patient who survived a severe motor vehicle collision repeatedly states 'I should have died in that accident.' This statement may indicate: → Survivor's guilt and potential risk for post-traumatic stress disorder
18. Which of the following injuries has the LEAST chance of being found right away? → bowel
19. A patient with penetrating neck trauma in Zone II (angle of mandible to cricoid cartilage) has an expanding hematoma with stridor. The priority is: → Emergent surgical exploration
20. Which decontamination principle is most critical before treating victims of a chemical exposure incident? → All patients must be decontaminated before entering the treatment area
21. When assessing a geriatric trauma patient, which physiological change most increases vulnerability to thoracic injuries? → Chest wall stiffening from calcified costal cartilage and osteoporotic ribs
22. Which burn depth is characterized by painful blisters, moist red appearance, and blanching with pressure? → Superficial partial-thickness (second-degree)
23. When monitoring fluid resuscitation in a burn patient, which parameter best indicates adequate tissue perfusion? → Urine output of 0.5–1 mL/kg/hour
24. A trauma patient presents with subcutaneous emphysema of the neck and upper chest. This finding most likely indicates: → Pneumothorax, tracheal injury, or esophageal rupture
25. According to American Burn Association guidelines, which patient should be referred to a burn center? → Patient with partial-thickness burns greater than 10% TBSA
26. During damage control resuscitation, the 'lethal triad' that must be aggressively corrected includes: → Hypothermia, acidosis, coagulopathy
27. A trauma patient requires rapid fluid resuscitation through a large-bore IV catheter. Which gauge is most appropriate for this situation? → 14-gauge or 16-gauge
28. When communicating with the family of a critically injured trauma patient, which approach is most therapeutic? → Providing honest, timely updates in clear language while demonstrating empathy
29. A trauma patient receiving crystalloid resuscitation develops worsening metabolic acidosis. Which crystalloid is LEAST likely to cause hyperchloremic acidosis? → Lactated Ringer's solution
30. When performing a focused assessment with sonography for trauma (FAST), which area is NOT routinely examined? → Bilateral lung apices