Download ATLS Practice Test: Trauma Management Scenarios and Solutions and more Exams Nursing in PDF only on Docsity!
complete solutions.
ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/ mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: - ANSWER re-examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: - ANSWER complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - ANSWER Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is to: - ANSWER secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? - ANSWER An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: - ANSWER increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER urinary output of 0. mL/kg/hr
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The diagnosis of shock must include: - ANSWER evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: - ANSWER direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - ANSWER cerebral vasoconstriction with diminished perfusion
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: - ANSWER perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? - ANSWER Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - ANSWER administer supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: - ANSWER 9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: - ANSWER perform needle or finger decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate management during the primary survey? - ANSWER respiratory rate of 40 breaths per minute
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Which one of the following is the most effective method for initially treating frostbite? - ANSWER moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? - ANSWER surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: - ANSWER suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: - ANSWER repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: - ANSWER call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - ANSWER tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - ANSWER Aspiration of bone marrow confirms appropriate positioning of the needle.
complete solutions.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: - ANSWER avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: - ANSWER cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? - ANSWER development of peritonitis on physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? - ANSWER Log rolling using 4 people is a safe approach to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected c- spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: - ANSWER restrict cervical motion and establish a definitive airway
When applying the Rule of Nines to infants: - ANSWER The head is proportionally larger in infants than in adults.
A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: - ANSWER placement of a pelvic binder
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B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - ANSWER D. Transfusion reaction
Skin antiseptic - ANSWER -Ethanol 70% is an effective skin antiseptic
-Acetic acid can be used to treat Gram- skin infections
-Salicylic acid is used to treat certain skin yeast infections
Class IV hemorrhage indicates what % blood loss - ANSWER 55%
How does shivering affect body temperature - ANSWER Increases body temperature
Class III hemorrhage indicates what % of blood loss - ANSWER 35%
Management of a stable patient with kidney contusion - ANSWER Observation
Associated with hypovolemic shock - ANSWER -Inadequate tissue perfusion with resultant tissue hypoxia
-Blood shunting to vital organs
-Decreased circulating blood volume and decreased venous return
-Low cardiac output
-Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia
-Patients become orthostatic with losses between 20 and 40%
-Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins
The most effective method of monitoring the success of resuscitation during CPR? - ANSWER Reactivity of pupils to light
Used to ensure correct placement of endotracheal tube - ANSWER -Ultrasound
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-Bilateral breath sounds
-Sustained end-tidal CO
Total body surface area involved in a burn in an adult to the anterior chest and abdomen - ANSWER 18%
What is often caused by carotid massage? - ANSWER Bradycardia
Step in a patient diagnosed with tension pneumothorax - ANSWER 1. Needle decompression/ thoracotomy
- Chest tube
True statements regarding diaphragmatic injuries - ANSWER -Blunt diaphragmatic injuries are usually associated with skeletal trauma
-Penetrating diaphragmatic injuries may be missed
-Repair of traumatic diaphragmatic injuries usually does not require prosthetic material
First priority in the treatment of an unconscious patient - ANSWER Checking the pulse
A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient?
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
D. Hemothorax - ANSWER C. Intracranial hemorrhage
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Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia
A. Bag and mask
B. LMA
C. Endotracheal intubation
D. Jet ventilation - ANSWER A. Bag and mask
What is the next step in the assessment of a traumatic patient after airway is established? - ANSWER Breathing
Blood group that is considered a universal donor - ANSWER O
A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - ANSWER Brainstem injury
Which of the following is the least preferred method of administering IV fluids?
A. Cubital veins
B. Cephalic veins
C. Subclavian veins
D. Saphenous vein - ANSWER Subclavian veins
Dermatome level for nipple sensation
Dermatome level for umbilicus - ANSWER T
T
At which temperature would a hypothermic patient stop shivering? - ANSWER 88 degrees F
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What is the energy recommendation for the first defibrillation in an adult (*) - ANSWER 300 J
Pharmacologic effects of Morphine - ANSWER Behavioral changes
Analgesia
Respiratory depression
NOT diarrhea
A patient with which condition should be triaged to receive medical attention first?
A. Choking
B. Dizziness
C. Leg cramp
D. Vomiting - ANSWER A. Choking
For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock?
A. 750 mL of saline uniformly
B. 1 liter of saline
C. 20 mL/kg of 0.45% NaCl with 5% glucose
D. 10 to 20 mL/kg of Ringers lactate - ANSWER D. 10 to 20 mL/kg of Ringers lactate
A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment?
A. Tetanus toxoid
B. Cover the wound
C. Airway
D. Obtain blood work - ANSWER C. Airway
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A. Left main bronchus
B. Carina
C. Right main bronchus
D. Esophagus - ANSWER C. Right main bronchus
Skin finding characteristic of second-degree burns - ANSWER Blisters
Which is true regarding cervical spine fractures?
A. Seen most commonly in elderly females
B. Athletic activities are the most common cause
C. Falls are the most common cause
D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours - ANSWER D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours
In which patients can an oropharyngeal airway be used? - ANSWER Non-gag reflex
If a trauma patient has clear fluid draining from the nose the provider should do which of the following?
A. Tilt the head back
B. Apply pressure
C. Collect the fluid
D. Insert nasal tampons - ANSWER C. Collect the fluid
What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop permanent brain damage?
A. 10 minutes
B. 5 minutes
C. 2 minutes
D. 20 minutes - ANSWER B. 5 minutes
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The laryngeal mask airway is contraindicated in patients with what condition?
A. Spine injury
B. Head trauma
C. Giving birth
D. Propensity to aspirate - ANSWER D. Propensity to aspirate
A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed?
A. Abdominal ultrasound
B. Laparotomy
C. KUB
D. Diagnostic peritoneal lavage - ANSWER A. Abdominal ultrasound
Why is tracheostomy generally not performed at the first cartilage ring
A. The trachea is too narrow
B. A high chance of subglottic stenosis
C. A high chance of tracheo-innominate artery fistula
D. Inability to access the area - ANSWER B. A high chance of subglottic stenosis
What does a carotid pulse indicate?
A. A functioning pump for blood flow
B. The circulating blood volume is reaching end organs
C. Diastolic blood pressure
D. None of the above - ANSWER B. The circulating blood volume is reaching end organs
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During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: - ANSWER Lidocaine
Atropine
Naloxone
Epinephrine
Prior to tracheobronchial suctioning, the patient should receive:
A. 5cc normal saline lavage
B. Be placed on NPO status
C. 100% oxygen prior to suctioning
D. Versed 1 mg/mL - ANSWER C. 100% oxygen prior to suctioning
In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level?
- ANSWER Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line
Indications for a CT scan of the head in trauma patients - ANSWER -Glasgow coma scale score of less than 14
-Evidence of basilar skull fracture
-Amnesia lasting more than 30 minutes
Most common Emergency Medical Services pediatric calls - ANSWER -Seizures
-Respiratory problems
-Trauma
Treatments utilized in a patient with head trauma and raised intracranial pressure - ANSWER -Elevation of the head
-Sedation
-Use of diuretics
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NOT fluid restriction
How deep should the provider depress the patient's sternum during CPR in adults? - ANSWER 2 to 3 inches
First parameter to change in patient's with hypovolemic shock?
A. Systolic blood pressure
B. Pulse rate
C. Respiratory rate
D. Skin vasoconstriction - ANSWER B. Pulse rate
A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation? - ANSWER Set PaCO2 between 30-
A young motorcycle driver is thrown against a concrete bridge and sustains severe trauma about the face, with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE?
A. Cervical spine evaluation takes precedence over facial injuries
B. LeFort fractures rarely cause severe hemorrhage
C. Nasotracheal intubation must be done urgently to prevent airway obstruction
D. Plain radiographs are preferred to CT in emergencies - ANSWER A. Cervical spine evaluation takes precedence over facial injuries
Which US industry has the highest accidental death rate?
A. Construction
B. Agriculture
C. Manufacturing
D. Transportation - ANSWER B. Agriculture
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How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)?
A. Delayed
B. Immediate
C. Minor
D. Critical - ANSWER B. Immediate
Appropriate site for insertion of a subclavian line - ANSWER -One centimeter inferior to the junctions of the middle and medial third of the clavicle
-One fingerbreadth lateral to the angle of the clavicle
-Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line
In head trauma, the majority of patients with post-traumatic CSF otorrhea:
A. Need surgery
B. Should be started on antibiotics
C. Heal spontaneously
D. Develop meningitis - ANSWER C. Heal spontaneously
Uncal herniation - ANSWER PE: Biot breathing, dilated and fixed pupil (out and down)
Nerves affected: 3rd, 4th, parasympathetic input
Laryngeal mask is usually seated over the which structure?
A. Tonsils
B. Esophagus
C. Vallecula
D. Pyriform fossa - ANSWER D. Pyriform fossa
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Patterns of injury seen in spinal cord trauma - ANSWER -Central cord syndrome
-Anterior cord syndrome
-Brown-Sequard syndrome
Should be avoided in patient with suspected nasal fracture - ANSWER Nasal intubation
What is the best way to evaluate a cardiac contusion?
A. CT scan of the chest
B. Echocardiogram
C. ECG monitoring x 24 hours
D. Cardiac enzymes - ANSWER C. ECG monitoring x 24 hours
Cerebral contusions - ANSWER May happen opposite to the point of impact
An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient?
A. Assess vital signs
B. Stabilize cervical spine
C. Assess airway
D. Start IV fluids - ANSWER C. Assess airway
Normal adult respiratory rate - ANSWER 12-20 breaths per minute
Scapular fracture - ANSWER -Usually requires a tremendous force to fracture
-May be uneasily visible on plain xray
-Treatment requires prolonged immobilization
-Usually associated with other chest injuries
