TNCC Trauma Nurse Core Curriculum Exam — Questions and Answers

Question 1: Which of the following is the PRIMARY patient- and family-centered rationale for facilitating Family Presence During Resuscitation (FPDR) when deemed appropriate?

To allow family members to assist the trauma team with non-clinical tasks.
To help family members understand the severity of the situation and begin the coping and grieving process. (Correct answer)
To ensure the family witnesses the quality of care being provided, thereby reducing the risk of litigation.
To satisfy hospital administrators who are focused on improving patient satisfaction scores.

Correct answer: To help family members understand the severity of the situation and begin the coping and grieving process.

The primary rationale for FPDR is to support the psychosocial needs of the family. Being present helps them comprehend the gravity of the injuries, see that everything possible is being done, and facilitates grieving and closure, which are critical aspects of family-centered care. While other options might be secondary outcomes, they are not the main therapeutic goal.

Question 2: A patient involved in a motor vehicle collision reports left upper quadrant abdominal pain that radiates to the tip of the left shoulder. This finding, known as Kehr's sign, is highly suggestive of an injury to which organ?

Stomach
Pancreas
Liver
Spleen (Correct answer)

Correct answer: Spleen

Kehr's sign is referred pain to the left shoulder caused by irritation of the diaphragm from blood, most commonly associated with a splenic injury or rupture. The phrenic nerve, which innervates the diaphragm, shares nerve roots (C3-C5) with the supraclavicular nerves that supply the shoulder area. [1, 2, 10, 16]

Question 3: Which type of intracranial hemorrhage is MOST commonly associated with a lucid interval followed by rapid deterioration?

Epidural hematoma (Correct answer)
Subdural hematoma
Intraparenchymal hemorrhage
Subarachnoid hemorrhage

Correct answer: Epidural hematoma

Epidural hematoma, typically from middle meningeal artery rupture, classically presents with a brief loss of consciousness, a lucid interval, followed by rapid neurological deterioration.

Question 4: A patient with a penetrating injury to the right side of their thoracic spine presents with paralysis and loss of proprioception on the right side, and loss of pain and temperature sensation on the left side below the injury. These findings are characteristic of which spinal cord syndrome?

Cauda Equina Syndrome
Central Cord Syndrome
Anterior Cord Syndrome
Brown-Séquard Syndrome (Correct answer)

Correct answer: Brown-Séquard Syndrome

Brown-Séquard syndrome results from a hemisection (damage to one half) of the spinal cord. [2, 3] This causes ipsilateral (same side) loss of motor function and proprioception/vibration sense, and contralateral (opposite side) loss of pain and temperature sensation below the level of the lesion. [3, 4, 5]

Question 5: In a patient with suspected cervical spine injury requiring intubation, which technique best minimizes cervical spine movement?

Orotracheal intubation with neck extension
Direct laryngoscopy with head tilt-chin lift
Blind nasotracheal intubation with neck flexion
Video laryngoscopy with manual in-line stabilization (Correct answer)

Correct answer: Video laryngoscopy with manual in-line stabilization

Video laryngoscopy combined with manual in-line stabilization provides the best visualization while minimizing cervical spine movement compared to direct laryngoscopy.

Question 6: A patient is brought to the emergency department after being extricated from a structural collapse where their legs were pinned for several hours. To mitigate the systemic effects of crush syndrome upon reperfusion, which intervention is a critical priority?

Immediate administration of intravenous calcium gluconate.
Application of warming blankets to prevent hypothermia.
Administration of a potent diuretic such as furosemide.
Aggressive intravenous fluid resuscitation with an isotonic crystalloid. (Correct answer)

Correct answer: Aggressive intravenous fluid resuscitation with an isotonic crystalloid.

Crush syndrome involves traumatic rhabdomyolysis, where myoglobin, potassium, and other toxins are released from damaged muscle cells into the circulation. [6, 23] This can lead to acute kidney injury and life-threatening hyperkalemia. [6] The highest priority is aggressive fluid resuscitation, ideally started before extrication, to increase renal perfusion, dilute toxins, and help prevent myoglobin deposition in the renal tubules. [6, 20, 26]

Question 7: A trauma patient presents with absent breath sounds on the right, tracheal deviation to the left, severe respiratory distress, and hypotension. What is the immediate, life-saving intervention for this condition?

Perform an immediate needle decompression. (Correct answer)
Obtain a stat portable chest x-ray.
Administer a 1-liter bolus of crystalloid fluid.
Prepare for immediate chest tube insertion.

Correct answer: Perform an immediate needle decompression.

The patient's signs and symptoms are classic for a tension pneumothorax, a life-threatening emergency where air is trapped in the pleural space, causing mediastinal shift and cardiovascular collapse. The immediate intervention is to relieve the pressure by performing a needle decompression. This is a temporizing measure performed before the definitive treatment of a chest tube (tube thoracostomy). [13, 27, 29, 30]

Question 8: A patient triaged with a YELLOW (Delayed) tag at a mass casualty incident would be best described as having which type of injuries?

Serious injuries that are not immediately life-threatening but require treatment. (Correct answer)
Injuries that are so severe that survival is highly unlikely, even with maximal resources.
Minor injuries, such as abrasions and minor lacerations; they are considered the 'walking wounded'.
Life-threatening injuries that are readily correctable with immediate intervention.

Correct answer: Serious injuries that are not immediately life-threatening but require treatment.

The YELLOW (Delayed) category is for patients who have serious injuries (e.g., long bone fractures, significant burns that do not compromise the airway) but are not in immediate danger of death. Their treatment can be delayed while RED (Immediate) patients are stabilized.

Question 9: A patient with a tracheostomy from a previous surgery presents with trauma and respiratory distress. The first step in airway management is:

Suction the tracheostomy tube and assess patency (Correct answer)
Remove the tracheostomy and intubate orally
Perform a cricothyrotomy below the tracheostomy
Place an oropharyngeal airway alongside the tracheostomy

Correct answer: Suction the tracheostomy tube and assess patency

Suctioning and assessing patency of the existing tracheostomy tube is the first step, as obstruction by blood, secretions, or a mucus plug is the most common cause of respiratory distress in tracheostomy patients.

Question 10: Which assessment finding differentiates obstructive shock from hypovolemic shock?

Tachycardia is present in obstructive but not hypovolemic shock
Both present identically and cannot be differentiated clinically
Distended neck veins are present in obstructive shock but flat in hypovolemic shock (Correct answer)
Hypovolemic shock causes bradycardia while obstructive shock causes tachycardia

Correct answer: Distended neck veins are present in obstructive shock but flat in hypovolemic shock

Obstructive shock (cardiac tamponade, tension pneumothorax) presents with distended neck veins from impaired venous return to the heart, while hypovolemic shock presents with flat neck veins from volume depletion.

Question 11: A trauma patient receiving crystalloid resuscitation develops worsening metabolic acidosis. Which crystalloid is LEAST likely to cause hyperchloremic acidosis?

Lactated Ringer's solution (Correct answer)
Half-normal saline (0.45% NaCl)
Normal saline (0.9% NaCl)
Hypertonic saline (3%)

Correct answer: Lactated Ringer's solution

Lactated Ringer's solution has a chloride concentration (109 mEq/L) closer to plasma (98-106 mEq/L) and contains lactate buffer, making it less likely to cause hyperchloremic metabolic acidosis compared to normal saline (154 mEq/L chloride).

Question 12: A patient with a deceleration injury has a widened mediastinum on chest X-ray. This finding is most concerning for:

Rib fractures
Traumatic aortic disruption (Correct answer)
Simple pneumothorax
Pulmonary contusion

Correct answer: Traumatic aortic disruption

A widened mediastinum (>8 cm on supine AP film) after deceleration injury is the classic screening finding for traumatic aortic disruption, requiring urgent CT angiography for definitive evaluation.

Question 13: During the 'Exposure and Environmental Control' phase of the initial assessment, the trauma nurse removes all of the patient's clothing. What is the MOST critical nursing consideration immediately following this action?

Performing a log roll to inspect the posterior surfaces.
Collecting clothing as evidence for law enforcement.
Initiating warming measures to prevent hypothermia. (Correct answer)
Documenting all visible injuries.

Correct answer: Initiating warming measures to prevent hypothermia.

After exposing the patient by removing their clothing, it is critical to immediately initiate warming measures, such as using warm blankets or a forced-air warmer. Trauma patients are at high risk for hypothermia, which can lead to coagulopathy, acidosis, and increased mortality (the 'trauma triad of death'). [1]

Question 14: A patient arrives following a high-speed motor vehicle collision. During the secondary survey, the nurse notes clear fluid draining from the patient's left ear and ecchymosis over the mastoid process. Which type of injury are these findings most indicative of?

Nasal bone fracture
Cervical spine dislocation
Mandibular fracture
Basilar skull fracture (Correct answer)

Correct answer: Basilar skull fracture

Clear fluid drainage from the ear (CSF otorrhea) and bruising behind the ear over the mastoid process (Battle's sign) are classic clinical signs of a basilar skull fracture. These signs indicate a fracture at the base of the skull, which can tear the underlying dura mater, allowing cerebrospinal fluid to leak.

Question 15: A patient with a closed femur fracture is at risk for significant hemorrhage. The estimated blood loss from a single femur fracture is approximately:

1,000-1,500 mL (Correct answer)
200-500 mL
500-750 mL
2,500-3,000 mL

Correct answer: 1,000-1,500 mL

A closed femur fracture can result in 1,000-1,500 mL of blood loss into the thigh compartment, representing a significant source of hemorrhagic shock.

Question 16: In a patient rescued from a fire involving burning synthetic materials who remains hemodynamically unstable despite 100% oxygen therapy, the trauma nurse should suspect:

Concurrent cyanide poisoning in addition to carbon monoxide toxicity (Correct answer)
Isolated thermal burns causing distributive shock
Cherry-red skin discoloration indicating CO poisoning only
Nicotine toxicity from burning tobacco products

Correct answer: Concurrent cyanide poisoning in addition to carbon monoxide toxicity

Combustion of synthetic materials and plastics releases hydrogen cyanide; persistent instability unresponsive to oxygen therapy suggests combined CO and cyanide poisoning.

Question 17: When monitoring fluid resuscitation in a burn patient, which parameter best indicates adequate tissue perfusion?

Urine output of 0.5–1 mL/kg/hour (Correct answer)
Resolution of facial and periorbital edema
Heart rate decreasing to below 100 beats per minute
Reduction of pain score to below 3 out of 10

Correct answer: Urine output of 0.5–1 mL/kg/hour

Urine output of 0.5–1 mL/kg/hour reflects adequate renal perfusion and is the primary endpoint for titrating fluid resuscitation in burn patients.

Question 18: Which sign indicates complete airway obstruction in a conscious trauma patient?

Inability to speak, cough, or breathe with universal choking sign (Correct answer)
Audible wheezing on expiration
Inspiratory stridor
Ability to speak in short sentences

Correct answer: Inability to speak, cough, or breathe with universal choking sign

Complete airway obstruction presents with inability to speak, cough, or breathe. The universal choking sign (hands clutching the throat) is characteristic. Any vocalization indicates partial, not complete, obstruction.

Question 19: A patient with Class III hemorrhagic shock (30-40% blood volume loss) would be expected to present with which combination of findings?

Tachycardia 120-140, hypotension, tachypnea 30-40, confused and anxious (Correct answer)
Obtunded, pulse barely palpable, agonal respirations
Tachycardia 100-120, normal blood pressure, slightly anxious
Normal vital signs and mild anxiety

Correct answer: Tachycardia 120-140, hypotension, tachypnea 30-40, confused and anxious

Class III hemorrhage (1,500-2,000 mL, 30-40% blood volume) presents with significant tachycardia, the first measurable drop in systolic blood pressure, marked tachypnea, and confusion.

Question 20: Point-of-care viscoelastic testing (TEG/ROTEM) during trauma resuscitation is used to:

Replace standard coagulation studies entirely
Determine blood type for transfusion
Measure hemoglobin and hematocrit levels
Guide goal-directed component therapy by assessing clot formation, strength, and breakdown in real-time (Correct answer)

Correct answer: Guide goal-directed component therapy by assessing clot formation, strength, and breakdown in real-time

TEG (thromboelastography) and ROTEM (rotational thromboelastometry) provide real-time viscoelastic analysis of clot formation, strength, and fibrinolysis, enabling targeted blood component therapy.

Question 21: Which vasopressor is preferred as a first-line agent for trauma patients who remain hypotensive despite adequate volume resuscitation?

Dopamine
Phenylephrine
Norepinephrine (Correct answer)
Epinephrine

Correct answer: Norepinephrine

Norepinephrine is the preferred first-line vasopressor in trauma-related shock (after adequate volume resuscitation) due to its balanced alpha-1 and beta-1 effects, providing vasoconstriction and inotropy.

Question 22: The trauma patient's vital signs were 100/60 mm Hg, 96 beats per minute, and 24 breaths per minute when they arrived. The patient is agitated and asks "where am I?" frequently. She has dry, cold skin. The patient's vital signs are 104/84 mm Hg, 108 bpm, and 28 breaths per minute. Which stage of shock is the patient exhibiting symptoms and signs of?

irreversible
decompensated
gradual
compensated (Correct answer)

Correct answer: compensated

The patient's initial vital signs show a narrow pulse pressure, increased heart rate, and increased respiratory rate, which worsen over time. Agitation and dry, cold skin are also classic signs of sympathetic nervous system activation. These indicate that the body's compensatory mechanisms, such as vasoconstriction and increased heart rate, are actively working to maintain blood pressure and vital organ perfusion despite ongoing hypoperfusion, characteristic of compensated shock.

Question 23: A trauma patient is being assessed using the ABCDE approach. During the 'E' (Exposure) phase, the nurse should:

Apply ECG leads and pulse oximetry
Expose only the extremities for vascular assessment
Completely undress the patient while preventing hypothermia (Correct answer)
Evaluate only the area of obvious injury

Correct answer: Completely undress the patient while preventing hypothermia

'E' (Exposure/Environmental control) requires completely undressing the patient to identify all injuries while simultaneously implementing measures to prevent hypothermia.

Question 24: Spinal shock is characterized by:

Chronic pain syndrome following spinal cord injury
Cardiovascular collapse from spinal cord transection
Permanent loss of all neurological function below the injury
Temporary loss of reflexes, motor function, and sensation below the injury level (Correct answer)

Correct answer: Temporary loss of reflexes, motor function, and sensation below the injury level

Spinal shock is the temporary, physiological suppression of all spinal cord function (reflexes, motor, sensory, autonomic) below the injury level, which may last hours to weeks.

Question 25: What method is employed to get the history of a patient who comes in after being sexually assaulted?

inverse trendelenberg helps with breathing and airway maintenance.
discussing registering for the Emergency Nursing Certification Exam
When documenting information, utilize direct quotes. (Correct answer)
apply direct pressure. Direct pressure is the first stage. Use a torniquet in the second step.

Correct answer: When documenting information, utilize direct quotes.

When obtaining a history from a patient who has experienced sexual assault, it is crucial to document their statements using direct quotes. This practice ensures accuracy, preserves the patient's own words, and avoids misinterpretation or bias, which is vital for both legal proceedings and medical care.

Question 26: A patient with a T10 complete spinal cord injury is most likely to experience which bladder dysfunction?

Lower motor neuron (flaccid/areflexic) bladder
No bladder dysfunction at this level
Upper motor neuron (spastic/reflex) bladder (Correct answer)
Normal voluntary bladder control

Correct answer: Upper motor neuron (spastic/reflex) bladder

Injuries above the conus medullaris (L1-L2) produce an upper motor neuron bladder — the sacral micturition reflex arc (S2-S4) is intact but disconnected from voluntary control, resulting in a spastic, reflex bladder.

Question 27: Which reassessment finding during trauma care warrants an immediate return to the primary survey?

Patient reports increasing pain at the fracture site
IV fluid bag requires replacement
Patient requests pain medication
Oxygen saturation drops from 98% to 85% (Correct answer)

Correct answer: Oxygen saturation drops from 98% to 85%

A significant drop in oxygen saturation from 98% to 85% indicates a potential airway or breathing compromise, requiring immediate return to the primary survey to reassess ABCDEs.

Question 28: A trauma patient has a Glasgow Coma Scale (GCS) score of 7. According to TNCC guidelines, what is the priority intervention related to this finding during the 'Disability' assessment?

Obtaining a non-contrast head CT scan.
Administering mannitol for increased intracranial pressure.
Preparing for a definitive airway. (Correct answer)
Checking for pupillary response.

Correct answer: Preparing for a definitive airway.

A GCS score of 8 or less indicates a severe head injury and the patient's inability to protect their own airway. Therefore, the priority intervention is to secure a definitive airway, such as through intubation. While a CT scan and pupillary assessment are crucial, protecting the airway is the most immediate life-saving priority. [2, 10]

Question 29: Diagnostic peritoneal lavage (DPL) is considered positive for significant intra-abdominal hemorrhage when the red blood cell count exceeds:

500,000/mm³
10,000/mm³
100,000/mm³ (Correct answer)
50,000/mm³

Correct answer: 100,000/mm³

A DPL is positive for blunt trauma when the RBC count in the lavage fluid exceeds 100,000/mm³ (for penetrating trauma, the threshold is lower at 10,000-20,000/mm³).

Question 30: A construction worker sustains a crush injury to his right hand from a hydraulic press. After 4 hours, the hand is markedly swollen with severe pain on passive finger extension. Compartment pressure measures 42 mmHg with a diastolic blood pressure of 70 mmHg. The appropriate intervention is:

Compression bandage to reduce swelling
Elevation and ice with reassessment in 2 hours
IV pain medication only
Emergent fasciotomy (Correct answer)

Correct answer: Emergent fasciotomy

The delta pressure (diastolic BP minus compartment pressure) is 28 mmHg, which is below the 30 mmHg threshold, indicating compartment syndrome requiring emergent fasciotomy.

Question 31: Which finding on a secondary survey is most indicative of a ruptured diaphragm?

Bowel sounds heard in the chest on auscultation (Correct answer)
Distended neck veins
Subcutaneous emphysema over the chest
Bilateral wheezing

Correct answer: Bowel sounds heard in the chest on auscultation

Bowel sounds auscultated in the chest cavity indicate herniation of abdominal contents through a diaphragmatic rupture.

Question 32: A trauma patient has oxygen saturation of 85% despite bag-valve-mask ventilation with 100% oxygen. Breath sounds are absent on the left with tracheal deviation to the right. The immediate intervention is:

Left chest tube insertion
Emergent intubation
Needle decompression at the left 2nd intercostal space, midclavicular line (Correct answer)
Increase the respiratory rate of bag-valve-mask ventilation

Correct answer: Needle decompression at the left 2nd intercostal space, midclavicular line

Absent breath sounds, tracheal deviation away from the affected side, and hypoxemia indicate tension pneumothorax requiring immediate needle decompression.

Question 33: The concept of 'permissive hypotension' is a strategy used in the initial management of certain trauma patients. In which of the following patient populations is this approach generally contraindicated?

Patients with a severe traumatic brain injury (TBI) (Correct answer)
Patients with suspected uncontrolled internal hemorrhage
Patients with extremity fractures and a palpable radial pulse
Patients with penetrating torso trauma

Correct answer: Patients with a severe traumatic brain injury (TBI)

Permissive hypotension, or hypotensive resuscitation, aims to maintain a blood pressure just high enough for vital organ perfusion without dislodging newly formed clots at the site of injury. However, this strategy is contraindicated in patients with traumatic brain injury (TBI) because maintaining adequate cerebral perfusion pressure (CPP) is critical to prevent secondary brain injury. A lower systemic blood pressure would compromise CPP.

Question 34: A patient arrives after a motor vehicle crash with significant maxillofacial trauma, making oral intubation difficult. The patient is apneic. If endotracheal intubation attempts are unsuccessful, what is the next appropriate step in securing an airway?

Ventilate with a bag-valve-mask until an anesthesiologist arrives.
Perform a blind nasotracheal intubation.
Wait for the patient's breathing to resume spontaneously.
Insert a supraglottic airway device. (Correct answer)

Correct answer: Insert a supraglottic airway device.

In a 'can't intubate, can't oxygenate' scenario, or when intubation is unsuccessful, placing a rescue airway such as a supraglottic airway (e.g., LMA, King LT) is a critical next step. These devices can often be placed quickly and provide effective ventilation until a definitive surgical airway can be established if needed. Blind nasotracheal intubation is contraindicated in patients with significant facial trauma.

Question 35: Which adjunct to the primary survey is performed to assess for free fluid in the abdomen?

Diagnostic peritoneal lavage (DPL)
Abdominal X-ray
Focused Assessment with Sonography for Trauma (FAST) (Correct answer)
Digital rectal examination

Correct answer: Focused Assessment with Sonography for Trauma (FAST)

The FAST exam is a bedside ultrasound adjunct to the primary survey used to rapidly detect free fluid (blood) in the peritoneal, pericardial, and pleural spaces.

Question 36: Which airway adjunct is most appropriate as a temporizing measure for an unconscious trauma patient with intact gag reflex?

Oropharyngeal airway (OPA)
Nasopharyngeal airway (NPA) (Correct answer)
Laryngeal mask airway (LMA)
Endotracheal tube

Correct answer: Nasopharyngeal airway (NPA)

A nasopharyngeal airway is better tolerated in patients with an intact gag reflex compared to an oropharyngeal airway, which would stimulate gagging and vomiting.

Question 37: During the primary survey (ABCDE) of a trauma patient who was a driver in a head-on collision and is complaining of neck pain and an inability to move their legs, what is the most critical assessment component under 'D' for Disability?

Removing the cervical collar to assess for tracheal deviation.
Checking for a positive Babinski reflex.
Performing a Glasgow Coma Scale (GCS) score, assessing pupils, and determining a gross motor and sensory level. (Correct answer)
Obtaining a detailed history of the event from paramedics.

Correct answer: Performing a Glasgow Coma Scale (GCS) score, assessing pupils, and determining a gross motor and sensory level.

In a trauma patient with a suspected spinal cord injury, the 'D' (Disability) portion of the primary survey goes beyond just GCS and pupils. [19] It must include a rapid, gross assessment of motor function (e.g., can you move your hands/feet?) and sensory level (e.g., where can you feel me touching you?) to establish a baseline neurologic deficit early in the resuscitation. [7, 23]

Question 38: A trauma patient in hemorrhagic shock has received 4 units of PRBCs and remains hypotensive with a heart rate of 140. The next priority in the massive transfusion protocol is:

Administer vasopressors as the primary intervention
Continue balanced transfusion with plasma and platelets in a 1:1:1 ratio with PRBCs (Correct answer)
Stop all transfusion and obtain a CT scan
Switch to crystalloid-only resuscitation

Correct answer: Continue balanced transfusion with plasma and platelets in a 1:1:1 ratio with PRBCs

Current evidence supports a balanced 1:1:1 ratio of PRBCs to plasma to platelets during massive transfusion to address both oxygen-carrying capacity and coagulopathy simultaneously.

Question 39: A patient with penetrating neck trauma in Zone II (angle of mandible to cricoid cartilage) has an expanding hematoma with stridor. The priority is:

Observation with serial examinations
Emergent surgical exploration (Correct answer)
Apply direct pressure and await specialist consultation
CT angiography of the neck

Correct answer: Emergent surgical exploration

An expanding hematoma with stridor in Zone II indicates vascular injury with impending airway compromise, requiring emergent surgical exploration.

Question 40: An 82-year-old male on a beta-blocker for hypertension fell down a flight of stairs. His initial blood pressure is 110/70 mmHg, and his heart rate is 78 bpm. He has a fractured femur. Which of the following is the most accurate interpretation of this patient's vital signs?

The patient's blood pressure indicates he is hemodynamically stable.
The heart rate is low due to a potential cervical spine injury.
The vital signs are within normal limits and not concerning.
The patient is likely in compensated shock, and the beta-blocker is masking tachycardia. (Correct answer)

Correct answer: The patient is likely in compensated shock, and the beta-blocker is masking tachycardia.

Geriatric patients often have a blunted physiological response to trauma, and pre-existing conditions like hypertension mean a blood pressure of 110/70 mmHg may represent relative hypotension. Beta-blockers prevent the expected tachycardic response to hypovolemia. A 'normal' heart rate and blood pressure in this context can be misleading and may represent occult hypoperfusion or compensated shock.

Question 41: A patient with left lower rib fractures (ribs 9-12) should be evaluated for injury to which organ?

Gallbladder
Right kidney
Liver
Spleen (Correct answer)

Correct answer: Spleen

Left lower rib fractures (ribs 9-12) overlie the spleen, and direct fracture fragments or transmitted force significantly increases the risk of splenic injury.

Question 42: During a mass casualty incident, the trauma nurse's FIRST priority upon arriving at the scene is:

Establishing a triage area and beginning triage (Correct answer)
Calling for additional ambulances
Beginning treatment of the most critically injured patient
Setting up a treatment area with IV supplies

Correct answer: Establishing a triage area and beginning triage

The first priority in an MCI is to establish a triage area and begin rapidly triaging patients to categorize the scope of injuries and direct limited resources appropriately.

Question 43: Which burn depth is characterized by painful blisters, moist red appearance, and blanching with pressure?

Deep partial-thickness (second-degree)
Superficial partial-thickness (second-degree) (Correct answer)
Superficial (first-degree)
Full-thickness (third-degree)

Correct answer: Superficial partial-thickness (second-degree)

Superficial partial-thickness burns extend into the papillary dermis, presenting with intact blisters, moist red or pink wound beds, significant pain (nerve endings intact), and blanching with pressure.

Question 44: A trauma patient's spouse arrives in the emergency department, yelling at the triage nurse and demanding to see the patient, who is currently undergoing active resuscitation. What is the trauma nurse's most therapeutic initial action?

Approach the spouse calmly, acknowledge their distress, and explain that the team is doing everything possible, promising to provide an update shortly. (Correct answer)
Firmly tell the spouse that they cannot see the patient right now and must wait for a doctor.
Ask security to escort the spouse to the waiting room to prevent disruption.
Immediately bring the spouse to the patient's bedside regardless of the ongoing interventions.

Correct answer: Approach the spouse calmly, acknowledge their distress, and explain that the team is doing everything possible, promising to provide an update shortly.

The most appropriate initial action is to use crisis intervention and therapeutic communication. Acknowledging the spouse's fear and distress validates their feelings. Providing a brief, honest explanation of the situation (without violating patient privacy) and establishing a plan for communication can help de-escalate the situation and build trust. The other options are either escalating, unsafe, or dismissive.

Question 45: The Monroe-Kellie doctrine states that the total volume of the intracranial compartment is fixed. The three components are:

Gray matter, white matter, and ventricles
Cerebrum, cerebellum, and brainstem
Blood, bone, and cerebrospinal fluid
Brain tissue, cerebrospinal fluid, and blood (Correct answer)

Correct answer: Brain tissue, cerebrospinal fluid, and blood

The Monroe-Kellie doctrine states that the rigid skull contains brain tissue (80%), cerebrospinal fluid (10%), and blood (10%), and an increase in one must be compensated by a decrease in another.

Question 46: During the primary survey of a trauma patient, which assessment is completed first after an initial 'across-the-room' observation identifies no uncontrolled external hemorrhage?

Airway and alertness with cervical spine stabilization (Correct answer)
Circulation and control of bleeding
Disability and neurologic status
Breathing and ventilation

Correct answer: Airway and alertness with cervical spine stabilization

The TNCC systematic approach to the primary survey follows the <C>ABCDE mnemonic. If the 'across-the-room' observation reveals no catastrophic external hemorrhage (<C>), the next step is to assess Airway and Alertness while maintaining cervical spine stabilization. [3, 10, 14]

Question 47: A trauma patient requires a surgical airway. The anatomical landmark for cricothyrotomy is the membrane between the:

Thyroid cartilage and cricoid cartilage (Correct answer)
Hyoid bone and thyroid cartilage
First and second tracheal rings
Cricoid cartilage and first tracheal ring

Correct answer: Thyroid cartilage and cricoid cartilage

An emergency cricothyrotomy is performed through the cricothyroid membrane, located between the inferior border of the thyroid cartilage and the superior border of the cricoid cartilage.

Question 48: Which of the following is a definitive indication for endotracheal intubation in an adult trauma patient?

A respiratory rate of 24 breaths per minute
An oxygen saturation of 95% on room air
The presence of a simple rib fracture
A Glasgow Coma Scale (GCS) score of 7 (Correct answer)

Correct answer: A Glasgow Coma Scale (GCS) score of 7

A Glasgow Coma Scale (GCS) score of 8 or less is a widely accepted indication for establishing a definitive airway. Patients with such a low GCS are considered unable to protect their own airway from aspiration, increasing the risk of significant morbidity and mortality.

Question 49: A patient with chemical burns from a strong acid should receive which immediate decontamination treatment?

Application of a neutralizing alkaline agent to the skin
Copious water irrigation for a minimum of 15–30 minutes (Correct answer)
Application of baking soda paste to neutralize the acid
Dry brushing to mechanically remove the chemical

Correct answer: Copious water irrigation for a minimum of 15–30 minutes

Copious water irrigation is the standard immediate treatment for chemical burns; neutralizing agents can cause exothermic reactions and worsen the injury.

Question 50: According to American Burn Association guidelines, which patient should be referred to a burn center?

Patient with partial-thickness burns greater than 10% TBSA (Correct answer)
Adult with superficial burns covering 5% TBSA
Patient with minor chemical exposure and no blistering
Adult with a sunburn and localized pain

Correct answer: Patient with partial-thickness burns greater than 10% TBSA

The American Burn Association criteria for burn center referral include partial-thickness burns exceeding 10% TBSA due to the complexity of care required.

Question 51: Tranexamic acid (TXA) administration in trauma hemorrhage is most effective when given within what time frame from injury?

24 hours
3 hours (Correct answer)
12 hours
6 hours

Correct answer: 3 hours

The CRASH-2 trial demonstrated that TXA reduces mortality from hemorrhage when administered within 3 hours of injury. Administration after 3 hours may increase mortality.

Question 52: A patient presents with a traumatic amputation of their left hand. A coworker has brought the amputated part. Which method is correct for preserving the part for potential replantation?

Clean the hand with an antiseptic solution and keep it at room temperature.
Place the hand directly into a container of ice.
Wrap the hand in saline-moistened gauze, place in a sealed bag, and put the bag on ice water. (Correct answer)
Submerge the hand in a container of sterile normal saline.

Correct answer: Wrap the hand in saline-moistened gauze, place in a sealed bag, and put the bag on ice water.

The proper method for preserving an amputated part is to wrap it in saline-moistened gauze, place it in a watertight bag, and then place that bag in a container with ice and water. [1, 17, 24, 28] This cools the tissue to slow metabolism and ischemia without causing direct freezing injury (frostbite), which would occur with direct contact with ice. [1, 17]

TNCC Trauma Nurse Core Curriculum Exam

The TNCC written exam certifies trauma nursing knowledge, covering initial assessment, airway management, shock, and injury-specific care using the Trauma Nursing Process.

Questions

120 min

Time Limit

80%

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Sources & references

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ena.org — Test delivery, eligibility, passing score, renewal, retake policy, score validity · verified Oct 2026