TNCC Trauma Nurse Core Curriculum Exam — Questions and Answers

Question 1: A hospital is preparing for a surge of 200 patients from a mass casualty incident. Which strategy best manages this surge capacity?

Limiting treatment to Red-tagged patients only
Treating all patients in the emergency department only
Activating discharge protocols, opening auxiliary treatment spaces, and calling in off-duty staff (Correct answer)
Diverting all patients to other facilities

Correct answer: Activating discharge protocols, opening auxiliary treatment spaces, and calling in off-duty staff

Surge capacity management requires a multi-pronged approach: rapidly discharging stable inpatients, opening overflow treatment areas, and activating callback systems for additional staff.

Question 2: Which type of disaster agent causes delayed symptom onset of hours to days, making initial triage particularly challenging?

Blast injuries from explosives
Chemical agents such as chlorine gas
Structural collapse with crush injuries
Biological agents such as anthrax (Correct answer)

Correct answer: Biological agents such as anthrax

Biological agents often have incubation periods of hours to days, meaning exposed individuals may appear asymptomatic during initial triage and present later with severe illness.

Question 3: Is there a safe pharmaceutical substitute for opioids in the treatment of rib fracture pain in patients who are anticoagulated?

blocks of intercostal nerves For patients who are anticoagulated, continuous intercostal nerve blocks can offer safe and efficient pain management since they employ long-acting anesthetics. (Correct answer)
typical vital indicators during pregnancy Due to peripheral resistance, the resting heart rate rises by 10–20 beats during pregnancy, with a minor drop in systolic blood pressure and a large drop in diastolic blood pressure. A foetal heart rate of 120 to 160 is typical.
Breathe out at a rate of 10 to 12 times each minute. Help ventilations at 10 to 12 breaths per minute or one every 5 to 6 seconds if ventilation is not working.
fundamental shortfall When combined with serum lactate, base deficits function as an endpoint test of the sufficiency of cellular perfusion and aid in the prediction of the resuscitation's outcome.

Correct answer: blocks of intercostal nerves For patients who are anticoagulated, continuous intercostal nerve blocks can offer safe and efficient pain management since they employ long-acting anesthetics.

For anticoagulated patients with rib fractures, intercostal nerve blocks offer a safe and effective pain management alternative to systemic opioids. These blocks provide targeted pain relief by directly anesthetizing the affected nerves with long-acting anesthetics, minimizing systemic side effects and reducing the risk of bleeding complications associated with other invasive procedures.

Question 4: A trauma patient presents with subcutaneous emphysema of the neck and upper chest. This finding most likely indicates:

Pneumothorax, tracheal injury, or esophageal rupture (Correct answer)
Esophageal rupture only
Superficial soft tissue infection
Arterial air embolism

Correct answer: Pneumothorax, tracheal injury, or esophageal rupture

Subcutaneous emphysema in the neck and upper chest indicates air leaking into soft tissues, most commonly from pneumothorax, tracheobronchial injury, or less commonly esophageal perforation.

Question 5: Which type of shock is characterized by decreased cardiac output due to impaired myocardial contractility following blunt chest trauma?

Distributive shock
Hypovolemic shock
Cardiogenic shock (Correct answer)
Obstructive shock

Correct answer: Cardiogenic shock

Cardiogenic shock from blunt cardiac injury (myocardial contusion) results in decreased contractility and reduced cardiac output despite adequate intravascular volume.

Question 6: A 34-year-old male arrives after a motorcycle crash with a deformed left femur, a heart rate of 130 beats/min, blood pressure of 88/52 mmHg, and cool, clammy skin. After initiating two large-bore IVs, which fluid is most appropriate for initial resuscitation of this patient in suspected hemorrhagic shock?

5% Dextrose in water (D5W)
0.9% Sodium Chloride
Lactated Ringer's solution (Correct answer)
Hetastarch (6% Hydroxyethyl Starch)

Correct answer: Lactated Ringer's solution

Lactated Ringer's is an isotonic crystalloid solution that is the preferred initial fluid for resuscitation in hemorrhagic shock according to TNCC guidelines. It most closely resembles the body's plasma composition and helps to buffer the metabolic acidosis often seen in shock states. While 0.9% NaCl is also an isotonic crystalloid, large volumes can lead to hyperchloremic metabolic acidosis. D5W is hypotonic and not suitable for volume resuscitation. Colloids like Hetastarch are generally not recommended for initial resuscitation due to potential adverse effects on coagulation and renal function.

Question 7: Which type of intracranial hemorrhage is MOST commonly associated with a lucid interval followed by rapid deterioration?

Subdural hematoma
Epidural hematoma (Correct answer)
Subarachnoid hemorrhage
Intraparenchymal 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 8: Which of the following confirms correct endotracheal tube placement most reliably?

Visualization of chest rise with ventilation
Continuous waveform capnography (ETCO2) (Correct answer)
Condensation in the endotracheal tube
Auscultation of bilateral breath sounds

Correct answer: Continuous waveform capnography (ETCO2)

Continuous waveform capnography providing end-tidal CO2 detection is the gold standard for confirming and continuously monitoring correct endotracheal tube placement.

Question 9: 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 extremity fractures and a palpable radial pulse
Patients with penetrating torso trauma
Patients with a severe traumatic brain injury (TBI) (Correct answer)
Patients with suspected uncontrolled internal hemorrhage

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 10: A patient arrives after a penetrating wound to the central chest. The nurse assesses hypotension, distended jugular veins, and muffled heart sounds. These findings, known as Beck's Triad, are the classic signs of which life-threatening condition?

Aortic dissection
Tension pneumothorax
Pulmonary contusion
Pericardial (cardiac) tamponade (Correct answer)

Correct answer: Pericardial (cardiac) tamponade

Beck's Triad consists of hypotension, jugular venous distention, and muffled heart sounds. This triad is the classic presentation for acute pericardial (cardiac) tamponade, where fluid accumulation in the pericardial sac compresses the heart, impairing its ability to pump blood effectively. [3, 6, 7, 9]

Question 11: Which mechanism of injury is most associated with a Jefferson fracture (C1 burst fracture)?

Hyperflexion of the cervical spine
Lateral bending of the neck
Axial loading (compression) force to the top of the head (Correct answer)
Hyperextension with rotation

Correct answer: Axial loading (compression) force to the top of the head

A Jefferson fracture results from axial loading transmitted through the occipital condyles to the C1 lateral masses, causing the ring of C1 to burst outward. Common mechanisms include diving into shallow water or objects falling onto the head.

Question 12: 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:

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

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 13: A trauma nurse is caring for an intubated and ventilated patient. A sudden drop in the end-tidal CO2 (ETCO2) reading to a near-zero value is observed. What is the most likely cause?

Hypoventilation
Increased cardiac output
Dislodged endotracheal tube (Correct answer)
Malignant hyperthermia

Correct answer: Dislodged endotracheal tube

A sudden and significant drop in the ETCO2 reading to near zero in an intubated patient is a critical alarm, most commonly indicating that the endotracheal tube is no longer in the trachea (e.g., esophageal intubation or displacement). This constitutes a complete loss of ventilation and requires immediate assessment and intervention. Other causes, such as a massive pulmonary embolism or cardiac arrest, can also cause a drop, but tube displacement is the most immediate and correctable cause to rule out.

Question 14: What is the primary purpose of applying a pelvic binder to a patient with a suspected unstable pelvic fracture during the initial trauma assessment?

To prevent the development of a fat embolism.
To decrease pelvic volume and provide tamponade for hemorrhage. (Correct answer)
To provide definitive anatomical reduction of the fracture.
To ensure complete immobilization of the lumbar spine.

Correct answer: To decrease pelvic volume and provide tamponade for hemorrhage.

The primary purpose of a pelvic binder is to provide temporary stabilization by applying circumferential pressure. [30] This action reduces the volume of the pelvic ring, which limits potential space for bleeding and creates a tamponade effect on venous and bony sources of hemorrhage, thereby improving hemodynamic stability. [11, 14, 21] It is a temporary measure, not a definitive fracture reduction.

Question 15: Which burn assessment difference is most important in pediatric patients compared to adults?

The Rule of Nines is modified because a child's head represents a proportionally larger BSA (Correct answer)
Burn depth is easier to assess in children
Burns are less painful in children
Children require less fluid resuscitation per kilogram

Correct answer: The Rule of Nines is modified because a child's head represents a proportionally larger BSA

The standard Rule of Nines is inaccurate for children because a child's head is proportionally larger (up to 18% BSA in infants versus 9% in adults). The Lund-Browder chart provides age-adjusted calculations.

Question 16: A patient with a casted right tibial fracture develops severe, deep pain that is unrelieved by opioids. The toes are cool to the touch and swollen, and the patient reports numbness. Which of the following is the priority nursing action?

Elevate the affected limb on two pillows to reduce swelling.
Apply a warm pack to the foot to improve circulation.
Immediately notify the provider and prepare for cast removal. (Correct answer)
Administer the next scheduled dose of anxiolytic medication.

Correct answer: Immediately notify the provider and prepare for cast removal.

The patient is exhibiting classic signs of acute compartment syndrome, a limb-threatening emergency caused by increased pressure within a fascial compartment. [2, 9, 15] Pain out of proportion to the injury is the earliest and most sensitive sign. [2, 15, 22] The priority is to relieve the external pressure immediately by notifying the provider for cast removal or bivalving, and preparing for a potential fasciotomy. Elevating the limb can worsen ischemia by decreasing arterial inflow. [25]

Question 17: Which intervention best promotes psychological resilience in a trauma patient during the acute hospitalization?

Giving the patient as much control and choice as possible within their care (Correct answer)
Avoiding discussion of the traumatic event entirely
Administering sedation to prevent emotional distress
Restricting all visitors to minimize stimulation

Correct answer: Giving the patient as much control and choice as possible within their care

Restoring a sense of control and agency — through choices about their care, scheduling, and environment — promotes psychological resilience and reduces the sense of helplessness that contributes to traumatic stress.

Question 18: A patient with left lower rib fractures (ribs 9-12) should be evaluated for injury to which organ?

Liver
Spleen (Correct answer)
Gallbladder
Right kidney

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 19: What is the primary risk of hyperventilating a patient with traumatic brain injury?

Respiratory alkalosis causing seizures
Oxygen toxicity to pulmonary tissue
Cerebral vasoconstriction leading to secondary brain ischemia (Correct answer)
Increased intrathoracic pressure reducing venous return

Correct answer: Cerebral vasoconstriction leading to secondary brain ischemia

Hyperventilation causes hypocapnia, which leads to cerebral vasoconstriction, reducing cerebral blood flow and potentially worsening secondary brain injury.

Question 20: In a patient with combined blast injury and thermal burns, what assessment takes priority after the airway is secured?

Assessing for blast lung injury (pulmonary barotrauma) as a life-threatening cause of hypoxia (Correct answer)
Calculating total TBSA burned using the Rule of Nines
Beginning Parkland formula fluid calculations
Applying topical antimicrobial agents to burn wounds

Correct answer: Assessing for blast lung injury (pulmonary barotrauma) as a life-threatening cause of hypoxia

Blast lung injury causes pulmonary barotrauma with pneumothorax or parenchymal hemorrhage and is immediately life-threatening, taking priority over burn surface area assessment.

Question 21: A trauma nurse is assessing the effectiveness of fluid resuscitation for a patient in hypovolemic shock. Which of the following is the most reliable indicator of improved tissue perfusion?

A decrease in the serum lactate level (Correct answer)
A heart rate less than 100 beats/min
A urine output of exactly 30 mL/hr
Normalization of blood pressure to 120/80 mmHg

Correct answer: A decrease in the serum lactate level

While blood pressure, heart rate, and urine output are important parameters, a decreasing serum lactate level is a more direct and reliable indicator of improved end-organ tissue perfusion. Lactate is a byproduct of anaerobic metabolism, which occurs when tissues are not adequately oxygenated. A falling lactate level signifies a shift back to aerobic metabolism and the resolution of shock at the cellular level.

Question 22: The concept of 'reverse triage' in disaster management refers to:

Treating the least injured patients first
Reassigning triage tags from Red to Black
Discharging current inpatients to create capacity for incoming casualties (Correct answer)
Triaging patients in reverse alphabetical order

Correct answer: Discharging current inpatients to create capacity for incoming casualties

Reverse triage involves evaluating current hospital inpatients and rapidly discharging those who can safely leave to free beds, staff, and resources for incoming disaster casualties.

Question 23: 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?

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

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

Expose only the extremities for vascular assessment
Completely undress the patient while preventing hypothermia (Correct answer)
Apply ECG leads and pulse oximetry
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 25: Tracheobronchial injury following blunt chest trauma should be suspected when:

Oxygen saturation normalizes after supplemental oxygen alone
The patient has isolated rib fractures with no pneumothorax
A chest tube has been placed but there is a persistent large air leak and the lung fails to re-expand (Correct answer)
A chest tube has been placed and the patient's respiratory status improves immediately

Correct answer: A chest tube has been placed but there is a persistent large air leak and the lung fails to re-expand

A persistent large air leak through the chest tube with failure of the lung to re-expand despite adequate drainage suggests a tracheobronchial disruption — air is entering the pleural space faster than the chest tube can evacuate it.

Question 26: A trauma patient with a penetrating chest wound is receiving a massive transfusion. The nurse should be most concerned about the 'lethal triad' of trauma, which consists of which of the following combinations?

Hypothermia, Hyperkalemia, and Acidosis
Coagulopathy, Alkalosis, and Hyperthermia
Acidosis, Coagulopathy, and Hypocalcemia
Hypothermia, Acidosis, and Coagulopathy (Correct answer)

Correct answer: Hypothermia, Acidosis, and Coagulopathy

The 'lethal triad' of trauma-induced coagulopathy, hypothermia, and acidosis is a critical concept in trauma resuscitation. Uncontrolled hemorrhage leads to coagulopathy, aggressive fluid resuscitation with cold fluids contributes to hypothermia, and poor tissue perfusion results in metabolic acidosis. These three factors create a vicious cycle that significantly increases mortality.

Question 27: Damage control resuscitation in trauma includes all of the following EXCEPT:

Targeting a normal blood pressure of 120/80 mmHg before surgery (Correct answer)
Permissive hypotension until surgical hemorrhage control
Minimizing crystalloid use and early blood product administration
Aggressive rewarming and correction of acidosis

Correct answer: Targeting a normal blood pressure of 120/80 mmHg before surgery

Damage control resuscitation intentionally accepts a lower-than-normal blood pressure (permissive hypotension with SBP 80-90 mmHg) until surgical hemorrhage control is achieved, rather than targeting normotension.

Question 28: A patient with a lower extremity fracture reports that his painkillers only somewhat reduce his extreme calf tightness and pain. Which nursing intervention is the most important among the following?

bringing the extremities up to the heart's level (Correct answer)
moving and using ice
lifting the limb up above the heart's level
Getting ready for an ultrasound

Correct answer: bringing the extremities up to the heart's level

The symptoms of extreme calf tightness and pain, poorly relieved by analgesics, following a lower extremity fracture are highly suggestive of compartment syndrome. Elevating the affected limb above heart level is contraindicated as it can further reduce arterial perfusion and worsen ischemia. Therefore, maintaining the extremity at or slightly below heart level helps optimize blood flow to the compromised tissues, pending definitive surgical intervention.

Question 29: Which airway adjunct is most appropriate as a temporizing measure for an unconscious trauma patient with intact gag reflex?

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

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 30: When using the Rule of Nines to estimate total body surface area (TBSA) burned in an adult, what percentage is assigned to the entire head and neck?

18%
1%
9% (Correct answer)
4.5%

Correct answer: 9%

In adults, the Rule of Nines assigns 9% of total body surface area to the head and neck combined.

Question 31: Which clinical finding is most characteristic of a full-thickness (third-degree) burn wound?

Erythema with intact epidermis and pain without blistering
Moist, blistered surface with extreme pain to light touch
Intact epidermis with subepidermal blistering and moderate pain
Dry, leathery, insensate wound with white, brown, or charred appearance (Correct answer)

Correct answer: Dry, leathery, insensate wound with white, brown, or charred appearance

Full-thickness burns destroy all dermal layers including nerve endings, producing a dry, leathery, insensate wound that is painless due to complete nerve destruction.

Question 32: During the primary survey, which life-threatening condition should be identified and treated during the 'C' (Circulation) assessment?

Cervical spine instability
Altered level of consciousness
Uncontrolled external hemorrhage (Correct answer)
Tension pneumothorax

Correct answer: Uncontrolled external hemorrhage

The 'C' component of the primary survey focuses on circulation and hemorrhage control, including identifying and controlling life-threatening external bleeding and assessing for signs of shock.

Question 33: An open pneumothorax (sucking chest wound) should be immediately treated by:

Applying a three-sided occlusive dressing taped on three sides (Correct answer)
Leaving the wound open to air to prevent tension pneumothorax
Inserting a chest tube through the wound
Covering the wound completely with an airtight dressing taped on all four sides

Correct answer: Applying a three-sided occlusive dressing taped on three sides

A three-sided occlusive dressing creates a flutter-valve effect: it seals the wound during inspiration (preventing air entry) and allows air to escape during expiration (preventing tension pneumothorax development).

Question 34: A trauma patient arrives with injuries from a motorcycle collision. Using the AMPLE history mnemonic, the 'E' represents:

Examination findings
Emergency contacts
Expected outcome
Events and environment related to the injury (Correct answer)

Correct answer: Events and environment related to the injury

In the AMPLE history, 'E' stands for Events/Environment related to the injury — the mechanism of injury, protective equipment used, environmental factors, and pre-hospital treatment.

Question 35: Why is tetanus prophylaxis a standard component of burn wound management?

Tetanus toxin is commonly found in smoke and combustion products
Burn wounds create a necrotic, anaerobic environment ideal for Clostridium tetani proliferation (Correct answer)
Major burns cause immediate systemic immunosuppression requiring prophylaxis
All trauma patients receive tetanus regardless of wound type

Correct answer: Burn wounds create a necrotic, anaerobic environment ideal for Clostridium tetani proliferation

Devitalized burn tissue creates an anaerobic, protein-rich environment that is ideal for Clostridium tetani growth, making tetanus prophylaxis essential.

Question 36: Which splinting principle is MOST important when immobilizing a fractured extremity?

Splint the joint above and below the fracture site (Correct answer)
Splint over clothing to save time
Straighten all angulated fractures before splinting
Apply the splint as tightly as possible to prevent any movement

Correct answer: Splint the joint above and below the fracture site

Proper splinting requires immobilizing the joint above and the joint below the fracture site to prevent movement at the fracture and reduce pain, bleeding, and further injury.

Question 37: The base deficit on an arterial blood gas is a useful marker in trauma because it indicates:

Adequate fluid resuscitation has been achieved
The severity of tissue oxygen debt and anaerobic metabolism (Correct answer)
The amount of bicarbonate administered during resuscitation
The degree of respiratory failure

Correct answer: The severity of tissue oxygen debt and anaerobic metabolism

Base deficit reflects the degree of metabolic acidosis from tissue hypoperfusion and anaerobic metabolism, serving as a surrogate marker for the severity and duration of shock.

Question 38: What is the cause of hypocapnia in a patient with a severe traumatic brain injury?

Breathe out at a rate of 10 to 12 times each minute. Help ventilations at 10 to 12 breaths per minute or one every 5 to 6 seconds if ventilation is not working.
shifts in mental state Older, aware babies or toddlers may not obey orders and are typically wary of strangers.
cerebral vasoconstriction Vasoconstriction will result from hypocapnia or low carbon dioxide levels, particularly in the cerebral vasculature. (Correct answer)
sustain a healthy respiratory state Phrenic nerve function loss from C3 to C5 injuries can paralyze the diaphram and impair breathing.

Correct answer: cerebral vasoconstriction Vasoconstriction will result from hypocapnia or low carbon dioxide levels, particularly in the cerebral vasculature.

Hypocapnia, or low carbon dioxide levels in the blood, causes cerebral vasoconstriction, meaning the blood vessels in the brain narrow. This reduction in cerebral blood flow can decrease intracranial pressure, which might be a temporary therapeutic goal in severe traumatic brain injury, but prolonged or severe vasoconstriction can lead to cerebral ischemia.

Question 39: The trauma nurse should maintain a high index of suspicion for fat embolism syndrome (FES) in a patient with which of the following injuries, especially 24-72 hours after the event?

A penetrating abdominal injury requiring laparotomy.
Bilateral femur fractures and a pelvic fracture. (Correct answer)
A severe closed head injury with loss of consciousness.
A flail chest with multiple rib fractures.

Correct answer: Bilateral femur fractures and a pelvic fracture.

Fat embolism syndrome (FES) is most commonly associated with fractures of the long bones (like the femur) and the pelvis. [5, 8, 13, 18] These bones contain large amounts of fatty marrow that can be released into the bloodstream upon fracture. The classic triad of respiratory distress, neurologic changes, and a petechial rash typically manifests 24 to 72 hours post-injury. [8, 13, 29]

Question 40: 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?

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

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 41: A patient with a cervical spine injury at C4 presents with hypotension and bradycardia but warm, dry skin. This presentation is consistent with:

Septic shock
Hemorrhagic shock
Neurogenic shock (Correct answer)
Cardiogenic shock

Correct answer: Neurogenic shock

Neurogenic shock from high cervical spinal cord injury presents with hypotension, bradycardia, and warm/dry skin due to loss of sympathetic tone below the injury level.

Question 42: A patient with chemical burns from a strong acid should receive which immediate decontamination treatment?

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

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 43: When initiating mechanical ventilation for a trauma patient with suspected Acute Respiratory Distress Syndrome (ARDS), which strategy is most appropriate to prevent further lung injury?

Low respiratory rates and high tidal volumes.
Low tidal volumes and high PEEP. (Correct answer)
High tidal volumes and high respiratory rates.
High FiO2 and minimal PEEP.

Correct answer: Low tidal volumes and high PEEP.

For patients with or at risk for ARDS, a lung-protective ventilation strategy is recommended. This involves using low tidal volumes (e.g., 4-6 mL/kg of ideal body weight) to prevent volutrauma, and appropriate levels of Positive End-Expiratory Pressure (PEEP) to prevent atelectrauma by keeping alveoli open. The goal is to maintain adequate oxygenation while minimizing ventilator-induced lung injury.

Question 44: When assessing a patient with suspected rhabdomyolysis after prolonged entrapment, which urine finding is most characteristic?

Dark brown or tea-colored urine (Correct answer)
Bright red urine with visible clots
Cloudy, foul-smelling urine
Clear, pale yellow urine

Correct answer: Dark brown or tea-colored urine

Rhabdomyolysis causes myoglobin release into the bloodstream, which is filtered by the kidneys, producing characteristic dark brown or tea-colored urine (myoglobinuria).

Question 45: A patient with a C5 spinal cord injury would be expected to retain which motor function?

Finger flexion and intrinsic hand muscles
Triceps function and elbow extension
Wrist extension
Biceps function and shoulder movement (Correct answer)

Correct answer: Biceps function and shoulder movement

C5 innervates the deltoid and biceps muscles, allowing shoulder abduction/flexion and elbow flexion. Wrist extension (C6), triceps (C7), and hand intrinsics (T1) are lost.

Question 46: A patient with a T10 complete spinal cord injury is most likely to experience which bladder dysfunction?

Upper motor neuron (spastic/reflex) bladder (Correct answer)
Lower motor neuron (flaccid/areflexic) bladder
No bladder dysfunction at this level
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 47: 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?

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

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

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

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

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

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 50: Using the Parkland formula, how much Lactated Ringer's should be administered in the first 8 hours after injury for a 70 kg patient with 30% TBSA burns?

2,100 mL
6,300 mL
4,200 mL (Correct answer)
8,400 mL

Correct answer: 4,200 mL

The Parkland formula (4 mL × kg × %TBSA) gives 8,400 mL total; half is given in the first 8 hours from time of injury, equaling 4,200 mL.

Question 51: During the resuscitation of a patient with hemorrhagic shock, a balanced approach using a 1:1:1 ratio of blood products is often initiated. This ratio refers to the administration of:

1 unit of packed red blood cells, 1 unit of fresh frozen plasma, and 1 unit of platelets. (Correct answer)
1 unit of packed red blood cells, 1 unit of albumin, and 1 unit of platelets.
1 unit of packed red blood cells, 1 unit of fresh frozen plasma, and 1 unit of cryoprecipitate.
1 unit of whole blood, 1 liter of crystalloid, and 1 unit of platelets.

Correct answer: 1 unit of packed red blood cells, 1 unit of fresh frozen plasma, and 1 unit of platelets.

Balanced resuscitation, often guided by a massive transfusion protocol (MTP), advocates for a 1:1:1 ratio of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets. This approach aims to mimic whole blood to more effectively treat the coagulopathy associated with massive hemorrhage by replacing not just oxygen-carrying capacity (RBCs) but also clotting factors (FFP) and platelets.

Question 52: Electrical burns are often more severe than they appear externally because:

The skin is a poor conductor and limits surface injury
Delayed symptom onset masks the true depth
Current travels through the body causing extensive internal tissue destruction along its path (Correct answer)
Exit wounds are always larger than entry wounds

Correct answer: Current travels through the body causing extensive internal tissue destruction along its path

Electrical burns cause extensive internal tissue destruction along the current path through the body, while external entry and exit wounds may appear deceptively small.

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.

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