TNCC Trauma Nurse Core Curriculum Exam — Questions and Answers

Question 1: When managing a patient with a flail chest segment, which ventilation strategy is most appropriate?

Positive pressure ventilation if respiratory failure develops (Correct answer)
Immediate intubation regardless of respiratory status
Encouraging deep breathing without analgesics to prevent sedation
Mechanical stabilization by taping the flail segment externally

Correct answer: Positive pressure ventilation if respiratory failure develops

Positive pressure ventilation provides internal pneumatic stabilization of the flail segment when respiratory failure develops. Adequate pain control is essential for non-intubated patients.

Question 2: A trauma patient requires a surgical airway. The anatomical landmark for cricothyrotomy is the membrane between the:

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

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

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

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 4: A patient with a suspected unstable cervical spine fracture has vomited. To manage the airway while protecting the spine, the nurse should:

Logroll the patient to a lateral position while maintaining spinal alignment, then suction (Correct answer)
Turn the patient's head to the side while keeping the body supine
Perform a finger sweep without repositioning the patient
Sit the patient upright for better airway drainage

Correct answer: Logroll the patient to a lateral position while maintaining spinal alignment, then suction

The patient should be logrolled as a unit to a lateral position to allow vomitus to drain by gravity, while maintaining strict spinal alignment to prevent secondary cord injury.

Question 5: 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 whole blood, 1 liter of crystalloid, and 1 unit of platelets.
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.

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 6: 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 7: 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 flail chest with multiple rib fractures.
A penetrating abdominal injury requiring laparotomy.
Bilateral femur fractures and a pelvic fracture. (Correct answer)
A severe closed head injury with loss of consciousness.

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

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

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 9: Which decontamination principle is most critical before treating victims of a chemical exposure incident?

Only symptomatic patients require decontamination
Decontamination is unnecessary if the chemical agent is unknown
All patients must be decontaminated before entering the treatment area (Correct answer)
Decontamination should occur after initial stabilization inside the hospital

Correct answer: All patients must be decontaminated before entering the treatment area

All potentially contaminated patients MUST be decontaminated before entering the treatment area to prevent secondary contamination of healthcare workers and the facility.

Question 10: 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?

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

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

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

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 12: A patient is brought to the emergency department after an assault with a knife impaled in the lateral aspect of their neck, Zone II. The patient is conscious, and the airway is patent. What is the priority nursing intervention?

Prepare for immediate removal of the knife to assess the wound.
Perform a detailed neurologic exam of all four extremities.
Obtain a stat portable chest x-ray to rule out pneumothorax.
Apply a bulky dressing to stabilize the object in place. (Correct answer)

Correct answer: Apply a bulky dressing to stabilize the object in place.

The standard of care for an impaled object is to stabilize it in place and not remove it in the pre-operative setting. Removal can dislodge a clot that is tamponading a major vascular injury, leading to catastrophic hemorrhage. A bulky dressing secures the object, preventing further movement and tissue damage during transport and evaluation.

Question 13: 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 heart rate less than 100 beats/min
Normalization of blood pressure to 120/80 mmHg
A urine output of exactly 30 mL/hr
A decrease in the serum lactate level (Correct answer)

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 14: 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 15: A bariatric trauma patient (BMI 52) requires a pelvic X-ray. The nurse should anticipate which challenge?

Standard X-ray will be equivalent to normal-weight patients
Pelvic injuries are less likely in obese patients
No imaging is needed since clinical exam is more reliable in obese patients
Imaging may be suboptimal due to body habitus; CT may be needed for adequate visualization (Correct answer)

Correct answer: Imaging may be suboptimal due to body habitus; CT may be needed for adequate visualization

Obesity significantly degrades plain radiograph quality due to increased tissue density attenuating the X-ray beam, often necessitating CT for adequate evaluation of potential injuries.

Question 16: Which triage category is assigned to a walking trauma patient in the Emergency Severity Index (ESI)?

It depends on vital signs, mechanism of injury, and resource needs (Correct answer)
ESI Level 1 — Resuscitation
ESI Level 2 — Emergent
ESI Level 3 — Urgent

Correct answer: It depends on vital signs, mechanism of injury, and resource needs

Unlike field triage systems, ESI does not automatically assign a level based on the ability to walk. ESI considers acuity, expected resource needs, vital signs, and clinical presentation to assign one of five levels.

Question 17: 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 and the patient's respiratory status improves immediately
A chest tube has been placed but there is a persistent large air leak and the lung fails to re-expand (Correct answer)

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 18: Which organ is most commonly injured in blunt abdominal trauma?

Pancreas
Liver
Kidney
Spleen (Correct answer)

Correct answer: Spleen

The spleen is the most commonly injured abdominal organ in blunt trauma due to its relatively fixed position, vascular nature, and location beneath the left lower ribs.

Question 19: When managing elevated intracranial pressure, the nurse should position the trauma patient with the head of bed elevated to what degree?

90 degrees (sitting upright)
45-60 degrees
15-30 degrees (Correct answer)
Flat (0 degrees)

Correct answer: 15-30 degrees

Head of bed elevation to 30 degrees promotes venous drainage from the brain via gravity, helping to reduce intracranial pressure while maintaining adequate cerebral perfusion.

Question 20: Which clinical finding is most specific for esophageal perforation following penetrating neck or chest trauma?

Hemoptysis
Left-sided pleural effusion
Tachycardia
Mediastinal air on chest X-ray (pneumomediastinum) (Correct answer)

Correct answer: Mediastinal air on chest X-ray (pneumomediastinum)

Pneumomediastinum (air in the mediastinum) visible on chest X-ray is the most specific radiographic finding for esophageal perforation, as swallowed air and gas-producing bacteria escape into the mediastinal space.

Question 21: During the secondary survey, the nurse palpates a palpable step-off deformity in the thoracolumbar spine. This finding suggests:

Normal anatomical variation
Muscle spasm only
Vertebral fracture with possible posterior element disruption (Correct answer)
Ligamentous sprain without bony injury

Correct answer: Vertebral fracture with possible posterior element disruption

A step-off deformity (one spinous process displaced anteriorly or posteriorly relative to adjacent processes) indicates a vertebral fracture-dislocation with disruption of the posterior spinal elements, suggesting an unstable injury.

Question 22: A patient with high-voltage electrical burns develops dark, cola-colored urine. What is the correct initial management?

Restrict IV fluids to prevent worsening acute kidney injury
Administer diuretics to concentrate and clear the urine
Increase urine output to 1–2 mL/kg/hour and consider urinary alkalinization with sodium bicarbonate (Correct answer)
Begin emergent dialysis immediately upon detection

Correct answer: Increase urine output to 1–2 mL/kg/hour and consider urinary alkalinization with sodium bicarbonate

Myoglobin released from electrically destroyed muscle is nephrotoxic; increasing urine flow flushes tubules and alkalinizing the urine with bicarbonate prevents myoglobin precipitation in renal tubules.

Question 23: A trauma patient becomes increasingly agitated, is pulling at IV lines, and is attempting to leave the emergency department against medical advice. The nurse should first:

Apply physical restraints immediately
Sedate the patient with IV medications
Use verbal de-escalation techniques to establish rapport and identify the cause of agitation (Correct answer)
Call security to physically restrain the patient

Correct answer: Use verbal de-escalation techniques to establish rapport and identify the cause of agitation

Verbal de-escalation should always be attempted first for agitated patients, as agitation may be caused by pain, hypoxia, TBI, substance withdrawal, or psychological distress — each requiring different management.

Question 24: 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?

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

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 25: A patient with blunt chest trauma develops progressive respiratory distress over 24-48 hours with bilateral diffuse infiltrates on chest X-ray. This presentation is most consistent with:

Pulmonary contusion progressing to ARDS (Correct answer)
Bilateral simple pneumothorax
Delayed hemothorax
Aspiration pneumonia

Correct answer: Pulmonary contusion progressing to ARDS

Pulmonary contusion is a common blunt thoracic injury that typically worsens over 24-48 hours and can progress to acute respiratory distress syndrome (ARDS) with bilateral infiltrates.

Question 26: When assessing a patient with suspected rhabdomyolysis after prolonged entrapment, which urine finding is most characteristic?

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

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 27: 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?

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

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 28: A trauma patient with a significant inhalation injury, facial burns, and carbonaceous sputum is becoming increasingly agitated and hoarse. Oxygen saturation is currently 92% on a non-rebreather mask. Which of the following is the most appropriate immediate action?

Apply a continuous positive airway pressure (CPAP) mask.
Prepare for and facilitate early endotracheal intubation. (Correct answer)
Continue to monitor the patient's respiratory status closely.
Administer a sedative to calm the patient's agitation.

Correct answer: Prepare for and facilitate early endotracheal intubation.

This patient shows signs of impending airway compromise due to inhalation injury and associated edema. Hoarseness, agitation (a sign of hypoxia), and facial burns are critical indicators. A definitive airway via endotracheal intubation should be established proactively before complete obstruction occurs, which can happen rapidly.

Question 29: An obese patient (BMI 45) involved in an MVC requires intubation. Which airway challenge should the nurse anticipate?

Rapid oxygen desaturation during apnea, difficult bag-mask ventilation, and challenging laryngoscopy (Correct answer)
Longer safe apnea time due to greater oxygen reserves
No significant difference from normal-weight patients
Easier intubation due to larger oral opening

Correct answer: Rapid oxygen desaturation during apnea, difficult bag-mask ventilation, and challenging laryngoscopy

Obese patients have reduced functional residual capacity, increased oxygen consumption, redundant upper airway tissue, and challenging body habitus, leading to rapid desaturation and difficult airway management.

Question 30: 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.
Documenting all visible injuries.
Initiating warming measures to prevent hypothermia. (Correct answer)

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

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

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

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 33: Which assessment finding differentiates obstructive shock from hypovolemic shock?

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

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 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?

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

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

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

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 36: A patient with bilateral lower extremity fractures is at highest risk for which systemic complication?

Tetanus
Fat embolism syndrome (Correct answer)
Wound infection
Urinary tract infection

Correct answer: Fat embolism syndrome

Fat embolism syndrome occurs when fat globules from bone marrow enter the bloodstream after long bone fractures, potentially causing respiratory distress, neurological changes, and petechial rash.

Question 37: A patient with an open (compound) fracture of the tibia has bone protruding through the skin. Which action should the nurse avoid?

Administering IV antibiotics within one hour
Pushing the bone back beneath the skin surface (Correct answer)
Assessing distal neurovascular status
Covering the wound with a moist sterile dressing

Correct answer: Pushing the bone back beneath the skin surface

Exposed bone should never be pushed back into the wound, as this introduces skin flora and environmental contaminants into the deep tissues and bone, increasing the risk of osteomyelitis.

Question 38: Spinal shock is characterized by:

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

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 39: Which of the following confirms correct endotracheal tube placement most reliably?

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

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

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

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 41: Compassion fatigue in trauma nurses is best described as:

Annoyance with difficult patients
Physical exhaustion from long shifts
Disinterest in professional development
Emotional and physical exhaustion resulting from the cumulative impact of caring for trauma patients (Correct answer)

Correct answer: Emotional and physical exhaustion resulting from the cumulative impact of caring for trauma patients

Compassion fatigue is the emotional and physical cost of caring for traumatized patients over time, resulting in diminished ability to empathize, emotional exhaustion, and decreased job satisfaction.

Question 42: Hypothermia in trauma patients worsens hemorrhage primarily by:

Increasing heart rate and cardiac workload
Reducing pain perception and masking injury
Causing vasodilation and increased blood flow
Impairing coagulation enzyme function and platelet aggregation (Correct answer)

Correct answer: Impairing coagulation enzyme function and platelet aggregation

Hypothermia impairs the enzymatic reactions of the coagulation cascade and reduces platelet adhesion and aggregation, significantly worsening hemorrhage.

Question 43: 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?

gradual
irreversible
decompensated
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 44: A patient with blunt chest trauma from a steering wheel impact is noted to have a segment of their right chest wall that retracts inward during inspiration and bulges outward during expiration. This physical finding is the most definitive sign of which injury?

Tension pneumothorax
Massive hemothorax
Flail chest (Correct answer)
Simple rib fractures

Correct answer: Flail chest

Flail chest is defined by fractures of three or more adjacent ribs in two or more places, creating a free-floating segment. This segment moves independently and opposite to the rest of the chest wall during respiration, a sign known as paradoxical motion, which is the hallmark clinical finding of the injury. [11, 12, 17, 18]

Question 45: You are the triage nurse in the emergency department during a mass casualty incident (MCI). A victim is able to walk to the designated 'green' area. According to the Simple Triage and Rapid Treatment (START) method, what is the next immediate action for this patient?

Assign them to the 'delayed' (yellow) category for reassessment.
Assign them to the 'minor' (green) category and have them await further instruction. (Correct answer)
Immediately transport them to a non-trauma hospital.
Perform a detailed head-to-toe assessment.

Correct answer: Assign them to the 'minor' (green) category and have them await further instruction.

In the START triage system, any victim who is able to walk is categorized as 'minor' or 'green'. These individuals are considered the 'walking wounded' and are the lowest priority for immediate individual assessment, allowing responders to focus on more critically injured patients. [17, 18]

Question 46: A trauma patient is being assessed using the ABCDE approach. During the 'E' (Exposure) phase, the nurse should:

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

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 47: A patient presents after an assault with Battle's sign and hemotympanum. These findings are most consistent with:

Nasal bone fracture
Orbital blowout fracture
Mandibular dislocation
Basilar skull fracture of the posterior fossa (Correct answer)

Correct answer: Basilar skull fracture of the posterior fossa

Battle's sign (mastoid ecchymosis) and hemotympanum (blood behind the tympanic membrane) are classic indicators of a basilar skull fracture involving the temporal bone/posterior fossa.

Question 48: Bp is 94/62, HR 92 in patients 30 weeks pregnant. with a 124 bpm fetal heart rate Why and if this is normal?

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.
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.
Reorder breathing and airway to come before circulation. Before the initial survey, across-the-room monitoring is conducted to quickly determine whether, in the event of uncontrollably excessive bleeding, breathing or airway should take precedence over circulation.
typical vital signs 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. (Correct answer)

Correct answer: typical vital signs 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.

During pregnancy, physiological changes include an increase in maternal heart rate by 10-20 bpm and a decrease in blood pressure, particularly diastolic, due to reduced peripheral vascular resistance. A fetal heart rate of 124 bpm falls within the normal range of 120-160 bpm. Therefore, the presented vital signs are considered typical and normal for a 30-week pregnant patient.

Question 49: Which mechanism of injury is most associated with a Jefferson fracture (C1 burst fracture)?

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

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 50: A patient involved in a fight was struck in the anterior neck. The nurse assesses hoarseness, neck tenderness, and palpable subcutaneous emphysema. Which of the following is the MOST critical and immediate concern for this patient?

Esophageal perforation
Cervical spine fracture
Impending airway compromise (Correct answer)
Carotid artery dissection

Correct answer: Impending airway compromise

The combination of hoarseness (dysphonia), subcutaneous emphysema, and tenderness over the larynx are cardinal signs of a laryngeal or tracheal injury. These injuries can lead to rapid swelling and edema, causing a life-threatening loss of the airway. Securing the airway is the highest priority.

Question 51: The 'Golden Hour' concept in trauma care emphasizes:

The primary survey must take no longer than one hour
Definitive care for critically injured patients should begin within the first hour to improve survival (Correct answer)
Pain medication must be administered within one hour
All imaging must be completed within one hour

Correct answer: Definitive care for critically injured patients should begin within the first hour to improve survival

The Golden Hour concept, attributed to Dr. R Adams Cowley, emphasizes that critically injured trauma patients have the best outcomes when definitive care (typically surgery) begins within the first hour after injury.

Question 52: A burn wound that is moist, blistered, and extremely painful with a red or pink base is classified as which type?

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

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

Superficial partial-thickness burns involve the epidermis and superficial dermis, presenting with blisters, moisture, and intense pain due to exposed nerve endings.

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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120 min

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