TNCC Trauma Nursing Core Course Exam — Questions and Answers

Question 1: The ASIA Impairment Scale grade 'B' indicates which level of spinal cord injury?

Normal: motor and sensory function intact
Incomplete: motor function preserved with more than half of key muscles graded < 3/5
Incomplete: sensory but no motor function preserved below the neurological level (Correct answer)
Complete injury: no motor or sensory function below injury level

Correct answer: Incomplete: sensory but no motor function preserved below the neurological level

ASIA grade B is sensory incomplete: sensory function is preserved below the neurological level but no motor function is present below that level.

Question 2: What should a TNCC Course Director do if a participant exhibits unsafe behavior during a skill station evaluation?

Automatically pass the participant and address behavior post-course
Document the unsafe practice and the participant does not pass that station (Correct answer)
Allow a peer participant to coach them through the station
Ignore it if the participant eventually performs the skill correctly

Correct answer: Document the unsafe practice and the participant does not pass that station

Unsafe behaviors during skill evaluation are documented and result in the participant not passing that station, upholding patient safety standards.

Question 3: A trauma nurse assesses a gunshot wound patient and notes the entrance wound is small and the exit wound is large. This pattern indicates:

A ricochet injury occurred
Low-velocity weapon was used
High-velocity weapon caused cavitation and greater tissue damage (Correct answer)
The bullet fragmented inside the body

Correct answer: High-velocity weapon caused cavitation and greater tissue damage

High-velocity projectiles create cavitation, resulting in a large irregular exit wound and significant internal tissue destruction.

Question 4: Which Glasgow Coma Scale (GCS) modification is used when assessing verbal response in pre-verbal infants in pediatric trauma?

A pediatric GCS replaces coos/babble with age-appropriate speech (Correct answer)
Standard adult GCS verbal score is used unchanged
Verbal component is omitted and total scored out of 10
Verbal response is replaced by grimace response

Correct answer: A pediatric GCS replaces coos/babble with age-appropriate speech

A modified pediatric GCS replaces verbal responses with age-appropriate criteria such as cooing, babbling, and crying to account for developmental language ability.

Question 5: Which organ is most commonly injured in blunt abdominal trauma?

Kidney
Spleen (Correct answer)
Small bowel
Liver

Correct answer: Spleen

The spleen is the most commonly injured solid organ in blunt abdominal trauma due to its fragility, vascularity, and subcostal location.

Question 6: Which mechanism of injury is most commonly associated with a flail chest?

Crush injury causing sternal fracture
Penetrating stab wound to the chest
Deceleration injury causing rib avulsion
High-velocity blunt force causing three or more consecutive rib fractures in two or more places (Correct answer)

Correct answer: High-velocity blunt force causing three or more consecutive rib fractures in two or more places

Flail chest results from at least three consecutive ribs fractured in two or more places, creating a free-floating segment that moves paradoxically with respiration.

Question 7: What is the relationship between theory and practice in Abdominal Trauma?

They are completely separate
Practice is unnecessary if you know theory
Theory provides the foundation; practice applies it to real situations (Correct answer)
Theory is unnecessary

Correct answer: Theory provides the foundation; practice applies it to real situations

Theory provides the conceptual foundation and principles, while practice involves applying those concepts to real-world situations. Both are essential for competence.

Question 8: A trauma patient presents with facial cyanosis, petechiae of the upper body, and bilateral subconjunctival hemorrhages after being pinned under a heavy object. What injury should be suspected?

Traumatic asphyxia from prolonged thoracic compression causing retrograde venous hypertension (Correct answer)
Traumatic aortic transection from rapid deceleration
Penetrating injury to the superior vena cava
Blast lung from primary overpressure wave

Correct answer: Traumatic asphyxia from prolonged thoracic compression causing retrograde venous hypertension

Traumatic asphyxia results from sustained compressive force on the thorax suddenly raising intrathoracic pressure and forcing blood retrograde into the head and neck venous system.

Question 9: Which lab finding is the earliest indicator of significant intra-abdominal hemorrhage in a hemodynamically stable patient?

Elevated serum creatinine
Decreased serum albumin
Elevated serum lactate (Correct answer)
Elevated alkaline phosphatase

Correct answer: Elevated serum lactate

Elevated serum lactate reflects anaerobic metabolism from inadequate tissue perfusion and is an early marker of occult hemorrhagic shock before hemodynamic instability becomes apparent.

Question 10: A TNCC course is being held at a community hospital. Who is responsible for ensuring the course meets ENA standards?

The designated TNCC Course Director (Correct answer)
The hospital's chief nursing officer
The local ENA chapter president
Each individual TNCC Verifier independently

Correct answer: The designated TNCC Course Director

The Course Director bears overall accountability for ensuring the TNCC course is conducted in accordance with ENA standards and guidelines.

Question 11: In pediatric trauma patients, the narrowest portion of the airway is located at the:

Vocal cords
Carina
Subglottic region at the cricoid cartilage (Correct answer)
Oropharynx

Correct answer: Subglottic region at the cricoid cartilage

In children, the subglottic region at the cricoid cartilage is the narrowest airway point, unlike adults where the glottis is narrowest.

Question 12: What is the correct initial management for an open pneumothorax (sucking chest wound)?

Endotracheal intubation as the only intervention
Immediate chest tube insertion directly at the wound site
Application of an occlusive dressing sealed on three sides (Correct answer)
Complete occlusion of the wound with an airtight dressing

Correct answer: Application of an occlusive dressing sealed on three sides

A three-sided occlusive dressing allows air to escape on exhalation while preventing entrainment on inhalation, avoiding conversion to a tension pneumothorax.

Question 13: Which assessment finding best differentiates neurogenic shock from hypovolemic shock in a spinal cord injury patient?

Tachycardia with cool, clammy skin in neurogenic shock
Decreased urine output in hypovolemic shock only
Bradycardia with warm, dry skin in neurogenic shock (Correct answer)
MAP less than 65 mmHg in both conditions

Correct answer: Bradycardia with warm, dry skin in neurogenic shock

Neurogenic shock causes paradoxical bradycardia with vasodilation (warm, dry skin) due to loss of sympathetic tone, unlike the tachycardia and vasoconstriction of hypovolemic shock.

Question 14: What key components are part of the secondary trauma assessment?

Airway and breathing evaluation
Comprehensive physical examination and patient history (Correct answer)
Immediate interventions like CPR
Only focusing on visible injuries

Correct answer: Comprehensive physical examination and patient history

Following the primary survey and stabilization of life-threatening conditions, the secondary trauma assessment involves a more detailed and comprehensive evaluation. This includes a head-to-toe physical examination, a thorough patient history (AMPLE history), and diagnostic studies, aiming to identify all injuries and medical conditions that may impact care.

Question 15: Which injury is characterized by paradoxical chest wall movement during respiration?

Tension pneumothorax
Flail chest (Correct answer)
Pulmonary contusion
Open pneumothorax

Correct answer: Flail chest

Flail chest occurs when three or more consecutive ribs are fractured in two or more places, creating a free-floating segment that moves opposite to the rest of the chest wall.

Question 16: A patient presents with loss of pain and temperature sensation below T6 on one side, and loss of motor function and proprioception on the opposite side below T6. This pattern describes:

Brown-Séquard syndrome (Correct answer)
Anterior cord syndrome
Central cord syndrome
Posterior cord syndrome

Correct answer: Brown-Séquard syndrome

Brown-Séquard syndrome results from hemisection of the spinal cord, causing ipsilateral motor/proprioception loss and contralateral pain/temperature loss.

Question 17: The 'D' in the ABCDE primary survey specifically refers to:

Drainage from injuries
Drugs and allergies
Dressings and wound care
Disability: neurological status (Correct answer)

Correct answer: Disability: neurological status

Disability in the primary survey refers to a rapid neurological assessment including GCS, pupils, and gross motor function.

Question 18: During the secondary survey of a trauma patient, you note cerebrospinal fluid rhinorrhea. The nurse should:

Pack the nares with gauze to prevent fluid loss and infection
Test the fluid with a urine dipstick to confirm CSF
Allow drainage freely, do NOT pack, and notify the physician (Correct answer)
Perform a nasal trumpet insertion for airway management

Correct answer: Allow drainage freely, do NOT pack, and notify the physician

CSF rhinorrhea should never be obstructed; free drainage reduces infection risk and packing can increase ICP; physician notification is mandatory.

Question 19: The 'lethal triad' of trauma (hypothermia, acidosis, coagulopathy) is most directly perpetuated by which resuscitation practice?

Using vasopressors to maintain blood pressure
Applying external warming blankets during resuscitation
Transfusing packed red blood cells early
Infusing large volumes of room-temperature crystalloid (Correct answer)

Correct answer: Infusing large volumes of room-temperature crystalloid

Large-volume crystalloid resuscitation worsens the lethal triad by diluting clotting factors (worsening coagulopathy), cooling the patient (hypothermia), and not correcting the metabolic acidosis.

Question 20: For a patient with alkali (lye) chemical burns, irrigation with water should be performed for at least:

5 minutes
10 minutes
30 minutes or longer (Correct answer)
20 minutes

Correct answer: 30 minutes or longer

Alkali burns require prolonged irrigation (30 minutes or more) because alkalis cause liquefactive necrosis and penetrate tissue more deeply than acids.

Question 21: What is the primary purpose of professional certification in Shock Recognition?

To increase salary automatically
To replace practical experience
To validate competency and knowledge in the field (Correct answer)
To meet legal requirements only

Correct answer: To validate competency and knowledge in the field

Certification validates that a professional has met established standards of knowledge and competency in Shock Recognition.

Question 22: Which waveform capnography finding most reliably confirms endotracheal tube placement in the trachea?

Bilateral breath sounds on auscultation
SpO2 >95% after intubation
Persistent rectangular CO2 waveform over multiple breaths (Correct answer)
Chest rise visible with ventilation

Correct answer: Persistent rectangular CO2 waveform over multiple breaths

A consistent rectangular capnography waveform across multiple ventilations is the gold standard for confirming tracheal intubation.

Question 23: SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) is more common in children than adults because of:

Denser pediatric bone resisting fracture while cord stretches
Greater ligamentous laxity and cartilaginous vertebral bodies allowing cord injury without bony fracture (Correct answer)
Smaller spinal canal diameter compressing the cord more easily
Higher pediatric blood pressure reducing cord perfusion tolerance

Correct answer: Greater ligamentous laxity and cartilaginous vertebral bodies allowing cord injury without bony fracture

The greater ligamentous laxity and cartilaginous nature of pediatric vertebrae allow the spinal column to distract and injure the cord without producing visible fractures on plain films.

Question 24: Which topical agent is contraindicated in burn patients with sulfonamide allergy?

Bacitracin ointment
Mafenide acetate (Sulfamylon)
Silver sulfadiazine (Silvadene) (Correct answer)
Petroleum gauze

Correct answer: Silver sulfadiazine (Silvadene)

Silver sulfadiazine contains a sulfonamide component and is contraindicated in patients with sulfa drug allergies.

Question 25: Succinylcholine is CONTRAINDICATED in which trauma scenario?

Isolated closed head injury within 2 hours of onset
Acute blunt abdominal trauma needing rapid intubation
Cervical spine injury requiring emergent airway
Patient with crush injury and hyperkalemia 72 hours post-trauma (Correct answer)

Correct answer: Patient with crush injury and hyperkalemia 72 hours post-trauma

Succinylcholine causes potassium efflux from muscle cells; in patients with crush injury, burns, or prolonged immobilization, pre-existing hyperkalemia can worsen to lethal levels.

Question 26: In the TNCC shock index, which value indicates significant hemodynamic instability?

Shock index > 0.5
Shock index > 1.5
Shock index > 1.0 (Correct answer)
Shock index > 2.0

Correct answer: Shock index > 1.0

A shock index (HR ÷ systolic BP) greater than 1.0 indicates significant hemodynamic compromise and predicts the need for massive transfusion.

Question 27: When assessing a trauma patient's airway, which finding MOST urgently requires immediate intervention?

Stridor at rest with accessory muscle use (Correct answer)
Tongue lacerations without airway obstruction
Mild hoarseness with intact phonation
History of difficult intubation in a conscious patient

Correct answer: Stridor at rest with accessory muscle use

Stridor at rest combined with accessory muscle use signals near-complete airway obstruction requiring immediate definitive management.

Question 28: Which assessment finding BEST indicates that a trauma patient's shock is being adequately resuscitated?

Heart rate decreases to 100 bpm
Urine output of 0.5–1 mL/kg/hr is established (Correct answer)
Skin color improves to pink
Systolic BP returns to 120 mmHg

Correct answer: Urine output of 0.5–1 mL/kg/hr is established

Adequate urine output (0.5–1 mL/kg/hr) reflects restored renal perfusion and is a reliable endpoint for resuscitation.

Question 29: Which coagulopathy triad, commonly seen in severe hemorrhagic shock, worsens outcomes and must be aggressively reversed?

Hyperglycemia, acidosis, and hyponatremia
Hypothermia, acidosis, and coagulopathy (Correct answer)
Hypertension, alkalosis, and thrombocytosis
Hypothermia, hypocalcemia, and hyperkalemia

Correct answer: Hypothermia, acidosis, and coagulopathy

The lethal triad of hypothermia, acidosis, and coagulopathy creates a self-reinforcing cycle that dramatically increases mortality in trauma patients.

Question 30: The TNCC course was originally developed to address which recognized gap in trauma care?

Absence of a standardized trauma nursing education program (Correct answer)
Inadequate prehospital emergency protocols
Lack of advanced surgical training for nurses
Shortage of trauma surgeons in rural hospitals

Correct answer: Absence of a standardized trauma nursing education program

TNCC was created to fill the gap left by the absence of a nationally standardized educational program for trauma nurses.

Question 31: In a pediatric trauma patient, which of the following is a LATE sign of hemorrhagic shock?

Hypotension (Correct answer)
Tachycardia
Increased capillary refill time
Irritability

Correct answer: Hypotension

Children have robust compensatory mechanisms and can maintain normal blood pressure until 25–30% of blood volume is lost, making hypotension a late and ominous sign.

Question 32: A patient with blunt abdominal trauma has a positive FAST exam showing free fluid in the hepatorenal space. Which structure is most commonly injured with right upper quadrant fluid on FAST?

Ascending colon
Spleen
Liver (Correct answer)
Right kidney

Correct answer: Liver

The hepatorenal space (Morrison's pouch) collects fluid from liver injuries, making the liver the most commonly injured organ when fluid is seen in that location.

Question 33: In TNCC terminology, what does the 'E' in the mnemonic 'ABCDE' primary survey stand for?

Exposure and environmental control (Correct answer)
Endotracheal intubation
Evaluation
Extremity assessment

Correct answer: Exposure and environmental control

In the primary survey, 'E' stands for Exposure and Environmental Control, ensuring the patient is fully assessed while preventing hypothermia.

Question 34: Which neurological finding in a trauma patient warrants immediate neurosurgical consultation for possible epidural hematoma?

Persistent anterograde amnesia with stable vitals
Progressive confusion with no loss of consciousness
Gradual onset headache over 24 hours with vomiting
Brief loss of consciousness followed by a lucid interval then rapid deterioration (Correct answer)

Correct answer: Brief loss of consciousness followed by a lucid interval then rapid deterioration

The classic lucid interval followed by rapid neurological deterioration is the hallmark presentation of an epidural hematoma from middle meningeal artery rupture.

Question 35: Why is continuing education important in Shock Recognition?

It is not important after certification
To network only
To stay current with evolving standards and practices (Correct answer)
Only for re-certification requirements

Correct answer: To stay current with evolving standards and practices

Continuing education keeps professionals updated with the latest developments, standards, and best practices in their field.

Question 36: Which continuing education element is required alongside passing the written TNCC exam for certification?

Completion of an advanced cardiac life support course
Successful demonstration of required psychomotor skills (Correct answer)
Publication of a trauma nursing case study
A supervised clinical practicum of 40 hours

Correct answer: Successful demonstration of required psychomotor skills

In addition to the cognitive written examination, candidates must successfully pass psychomotor skills stations to receive TNCC certification.

Question 37: During the reevaluation phase of the initial assessment, the trauma nurse notes a declining GCS from 13 to 9 over 20 minutes. The priority action is:

Document and notify the physician at the end of the assessment
Repeat the primary survey and prepare for potential airway intervention (Correct answer)
Administer sedation to reduce agitation
Obtain a stat CT scan before reassessing the airway

Correct answer: Repeat the primary survey and prepare for potential airway intervention

A declining GCS indicates neurological deterioration; the nurse must repeat the primary survey and anticipate definitive airway management.

Question 38: A patient involved in a high-speed crash presents with left flank pain and gross hematuria. CT shows a Grade III renal laceration. What is the typical management?

Immediate urologic stent placement
Nonoperative management with close monitoring (Correct answer)
Emergent angioembolization always required
Immediate surgical nephrectomy

Correct answer: Nonoperative management with close monitoring

Grade I–III renal lacerations in hemodynamically stable patients are typically managed nonoperatively with serial imaging and monitoring.

Question 39: Obstructive shock from tension pneumothorax is BEST distinguished from other shock types by the presence of:

Distended neck veins and muffled heart sounds
Tachycardia and hypotension
Diaphoresis and altered mental status
Absent breath sounds and tracheal deviation (Correct answer)

Correct answer: Absent breath sounds and tracheal deviation

Absent or diminished breath sounds with tracheal deviation away from the affected side are hallmark signs of tension pneumothorax causing obstructive shock.

Question 40: Which finding during secondary survey of the head and neck suggests a basilar skull fracture?

Frontal hematoma with laceration
Scalp avulsion with active bleeding
Battle's sign (ecchymosis over mastoid) and raccoon eyes (Correct answer)
Midface tenderness and instability

Correct answer: Battle's sign (ecchymosis over mastoid) and raccoon eyes

Battle's sign and raccoon eyes are classic delayed signs of basilar skull fracture indicating bleeding into tissue planes.

Question 41: Which finding would MOST strongly suggest cardiac tamponade as the cause of shock in a penetrating chest trauma patient?

Subcutaneous emphysema over the chest wall
Diffuse ST elevation on ECG
Absent breath sounds with tracheal deviation
Paradoxical pulse (pulsus paradoxus) greater than 10 mmHg (Correct answer)

Correct answer: Paradoxical pulse (pulsus paradoxus) greater than 10 mmHg

Pulsus paradoxus greater than 10 mmHg — exaggerated drop in systolic BP during inspiration — is a hallmark of cardiac tamponade due to pericardial compression.

Question 42: In a trauma patient with a Glasgow Coma Scale (GCS) score of 8, which airway management approach is generally indicated?

Definitive airway via endotracheal intubation (Correct answer)
Nasal cannula oxygen and monitoring
Simple repositioning and oral airway adjunct
Supraglottic airway as the sole long-term device

Correct answer: Definitive airway via endotracheal intubation

A GCS ≤8 indicates inability to protect the airway, making definitive airway management via endotracheal intubation the standard of care.

Question 43: Which component of the TNCC course is considered the foundation for all trauma nursing interventions?

The trauma nursing process (Correct answer)
Definitive care planning
Pharmacological pain management
Wound closure techniques

Correct answer: The trauma nursing process

The trauma nursing process provides the structured, systematic framework upon which all TNCC interventions are built.

Question 44: In a child with blunt abdominal trauma, which organ is most commonly injured, and why is it at greater risk compared to adults?

Spleen, because the pediatric spleen is proportionally larger and the rib cage is more pliable (Correct answer)
Kidney, because pediatric kidneys are not yet encased in perirenal fat
Liver, because children have a proportionally smaller thoracic cage offering less protection
Pancreas, because children have a thinner abdominal wall

Correct answer: Spleen, because the pediatric spleen is proportionally larger and the rib cage is more pliable

The spleen is the most commonly injured solid organ in pediatric abdominal trauma because it is relatively larger and the flexible rib cage provides less protection than in adults.

Question 45: What is the relationship between theory and practice in Burn Management?

They are completely separate
Theory is unnecessary
Theory provides the foundation; practice applies it to real situations (Correct answer)
Practice is unnecessary if you know theory

Correct answer: Theory provides the foundation; practice applies it to real situations

Theory provides the conceptual foundation and principles, while practice involves applying those concepts to real-world situations. Both are essential for competence.

Question 46: How should you manage time during a timed test?

Divide total time by questions and pace yourself, spending less on easy ones (Correct answer)
Only work on hard questions
Rush through the entire test
Spend equal time on every question

Correct answer: Divide total time by questions and pace yourself, spending less on easy ones

Calculate time per question, spend less on easy questions to bank time for harder ones, and check your pace periodically.

Question 47: When performing the abdominal assessment in the TNCC primary survey, auscultation is performed before palpation because:

Palpation may stimulate bowel sounds and falsely alter auscultation findings (Correct answer)
Auscultation is less painful for the patient if done first
TNCC protocol requires percussion before palpation
Palpation can cause a vasovagal response altering heart rate auscultation

Correct answer: Palpation may stimulate bowel sounds and falsely alter auscultation findings

Palpation can artificially stimulate or suppress bowel sounds, so auscultation must precede palpation to obtain accurate bowel sound assessment.

Question 48: The 'sniffing position' optimizes airway alignment for direct laryngoscopy by:

Flexing the lower cervical spine and extending the atlanto-occipital joint (Correct answer)
Placing the head in neutral position without any elevation
Flexing the cervical spine with the neck on a flat surface
Hyperextending the entire cervical spine maximally

Correct answer: Flexing the lower cervical spine and extending the atlanto-occipital joint

The sniffing position aligns the oral, pharyngeal, and laryngeal axes by flexing the lower cervical spine (head on pillow) and extending the atlanto-occipital joint.

Question 49: A trauma patient is confused, agitated, and combative after a head injury. Before attributing this behavior to TBI alone, the nurse should first:

Administer IV sedation to protect the patient from self-injury
Apply physical restraints and reassess GCS
Rule out hypoxia, hypoglycemia, and hypotension as contributing causes (Correct answer)
Obtain a psychiatric consultation for agitation management

Correct answer: Rule out hypoxia, hypoglycemia, and hypotension as contributing causes

Hypoxia, hypoglycemia, and hypotension can all cause acute confusion and agitation, and must be excluded before attributing altered mental status solely to TBI.

Question 50: In the TNCC framework, 'adjuncts to the primary survey' include which of the following?

Complete blood count and metabolic panel review
ECG monitoring, pulse oximetry, and urinary catheter insertion (Correct answer)
Head-to-toe skin inspection
Family history and allergy documentation

Correct answer: ECG monitoring, pulse oximetry, and urinary catheter insertion

Adjuncts to the primary survey include monitoring devices (ECG, SpO2) and interventions such as urinary catheterization to gather additional physiologic data.

TNCC Trauma Nursing Core Course Exam

The TNCC written exam, administered by the Emergency Nurses Association (ENA), is a 50-question closed-book multiple-choice test with a 2-hour time limit and a passing score of 80% (40/50). It covers the trauma nursing process including primary and secondary survey, airway management, shock recognition, head and neurological trauma, thoracic and abdominal trauma, musculoskeletal injuries, burn management, pediatric and special population trauma, and professional issues in trauma nursing. Candidates must also pass a hands-on Trauma Nursing Process psychomotor skills station.

Questions

120 min

Time Limit

80%

To Pass

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