ATLS 10th Edition Post Test 4 Actual Questions with Answers (2024 / 2025), Exams of Nursing

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ATLS POST TEST 4

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1. 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 122/84 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: Select one: a. reexamine the chest b. perform an aortogram c. obtain a CT scan of the chest d. obtain arterial blood gas analyses e. perform transesophageal echocardiography Ans; A) Reexamine the chest

2. 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: Select one: a. angiography b. compartment pressures c. retrograde urethrogram d. Doppler ultrasound studies e. complete spine x-ray series Ans; E) Complete spine x-ray series
3. Which of the following is true regarding the initial resuscitation of a trauma patient? Select one: a. A patient that presents with a torso gunshot wound and is hypotensive should receive crystalloid fluid resuscitation until the blood pressure is normal b. Evidence of improved perfusion after fluid resuscitation could include im- provement in Glasgow coma scale score on reevaluation c. Massive transfusion is defined as transfusion of more than >10 of packed red blood cells and plasma in 24 hours d. When tranexamic acid is administered by pre-hospital providers a second

dose is required within 24 hours e. Fluid resuscitation is far more important than bleeding control in trauma patients Ans; B. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation

4. In managing a patient with a severe traumatic brain injury, the most impor- tant initial step is to: Select one: a. Secure the airway b. obtain a c-spine film c. support the circulation d. control scalp hemorrhage e. determine the GCS score Feedback Your answer is corr: a. Secure the airway
5. 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? Select one: a. His pulse pressure will be widened. b. His urinary output will be at the lower limits of normal.

c. He will have tachycardia, but no change in his systolic blood pressure. d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L e. His systolic blood pressure will be maintained with an elevated diastolic pressure. Ans; D. An ABG would demonstrate a base deficit between -6 and -10 mEq/L

6. The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: Select one: a. reducing the need for blood transfusion b. resulting in an elevated hematocrit c. complicating the management of closed head injury d. reducing the volume of crystalloid required for resuscitation e. increasing the volume of blood loss to produce maternal hypotension Ans; E. increasing the volume of blood loss to produce maternal hypotension
7. The best assessment of fluid resuscitation of the adult burn patient is: Select one: a. Urine output of 0.5 mL/kg/hr b. normalization of blood pressure c. normalization of the heart rate

d. measuring a normal central venous pressure e. providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid: a. Urine output of 0.5 mL/kg/hr

8. The diagnosis of shock must include: Select one: a. hypoxemia

b. acidosis c. hypotension d. increased vascular resistance e. evidence of inadequate organ perfusion Ans; E. evidence of inadequate organ perfusion

9. 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: Select one: a. application of a tourniquet b. direct pressure on the wound c. packing the wound with gauze d. direct pressure on the femoral artery at the groin e. debridement of devitalized tissue Ans; B. direct pressure on the wound
10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosis b. metabolic acidosis

c. cerebral vasoconstriction with diminished perfusion d. neurogenic pulmonary edema e. shift of the oxyhemoglobin dissociation curve Ans; C. cerebral vasoconstriction with diminished perfusion

11. 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: Select one: a. obtain contrast angiography b. transfer to a higher level trauma center c. perform an exploratory laparotomy d. infuse additional crystalloid fluids e. Obtain transesophageal echocardiography Ans; C. perform an exploratory laparotomy
12. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Select one: a. The fetus is in jeopardy only with major maternal abdominal trauma. b. Leakage of amniotic fluid is an indication for hospital admission. c. Indications for peritoneal lavage are different from those in the nonpregnant patient. d. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient.

Ans; B. Leakage of amniotic fluid is an indication for hospital admission.

13. The first maneuver to improve oxygenation after chest injury is to: Select one: a. intubate the patient b.

10 / 17 assess arterial blood gases c. administer supplemental oxygen d. ascertain the need for a chest tube e. obtain a chest x-ray Ans; C. administer supplemental oxygen

14. 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: Select one: a: 2 b: 4 c: 6 d: 9 e: 12 Ans; D: 9
15. Which one of the following findings in an adult is most likely to require immediate management during the primary survey? Select one: a. distended abdomen b. Glasgow Coma Scale score of 11 c. temperature of 36.5°C (97.8°F) d. deformity of the right thigh

11 / 17 e. respiratory rate of 40 breaths per minute Ans; E. respiratory rate of 40 breaths per minute

16. A 20-year-old woman that is 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: Select one:

12 / 17 a. perform tracheal intubation b. insert an oropharyngeal airway c. perform needle or finger decompression of the right chest d. manually displace the gravid uterus to the left side of the abdomen e. initiate 2, large-caliber peripheral IV lines and crystalloid infusion Ans; C. perform needle or finger decompression of the right chest

17. An important, immediate step in the management of an open pneumotho- rax is: Select one: a. endotracheal intubation b. operation to close the wound c. placing a chest tube through the chest wound d. placement of an occlusive dressing over the wound secured on three sides e. initiation of 2, large-caliber IVs and infusing crystalloid solution Ans; D. placement of an occlusive dressing over the wound secured on three sides
18. Which of the following is a contraindication for tetanus toxoid administra- tion? Select one: a. history of neurological reaction or severe hypersensitivity to the product b. Local side effects

13 / 17 c. muscular spasms d. pregnancy e. all of the above: a. history of neurological reaction or severe hypersensitivity to the product

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19. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival to the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? Select one: a. tachycardia b. pulse volume c. breath sounds d. pulse pressure e. jugular venous pressure Ans; C. breath sounds
20. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: Select one: a. The trachea is relatively short. b. The distance from the lips to the larynx is relatively short. c. The use of cuffed endotracheal tubes eliminates this issue. d. The mainstem bronchi are less angulated in their relation to the trachea. e. So little friction exists between the endotracheal tube and the wall of the trachea.: a. The trachea is relatively short.

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21. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full sur- gical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initi- ated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per

16 / 17 minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to Select one: a. perform diagnostic peritoneal lavage b. obtain a CT of the chest c. perform an angiography d. urgently transfer the patient to the operating room e. immediately transfer the patient to a trauma center Ans; D. urgently transfer the patient to the operating room

22. A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to Select one: a. perform a surgical cricothyroidotomy b. attempt nasotracheal intubation c. ventilate him with a bag-mask device until c-spine injury can be excluded d. restrict cervical motion and attempt orotracheal intubation using 2 people e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit a. perform a surgical cricothyroidotomy

17 / 17 b. attempt nasotracheal intubation c. ventilate him with a bag-mask device until c-spine injury can be excluded d. restrict cervical motion and attempt orotracheal intubation using 2 people

e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit Ans; D. restrict cervical motion and attempt orotracheal intubation using 2 people

23. A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? Select one: a. Vasoactive medications have no role in this patient's management. b. The hypotension should be managed with volume resuscitation alone. c. Flexion and extension views of the c-spine should be performed early. d. Abdominal visceral injuries can be excluded as a cause of hypotension. e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expect- ed. Ans; E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected
24. Which one of the following is the most effective method for initially treating frostbite? Select one: a. moist heat b. early amputation c. padding and elevation d.

vasodilators and heparin e. topical application of silver sulfadiazine: a. moist heat

25. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival to the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, a pulse cannot be palpated below the right femoral artery

and the muscles of the lower extremity are firm and hard. During the man- agement of this patient, which of the following is most likely to improve the chances for limb salvage? Select one: a. applying skeletal traction b. administering anticoagulant drugs c. administering thrombolytic therapy d. surgical consultation for right lower extremity fasciotomy e. transferring the patient to the trauma center 120 km away Ans; D. surgical consultation for right lower extremity fasciotomy

26. 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: Select one: a. request a CT scan b. insert a gastric tube c. suction the oropharynx d. obtain a lateral cervical spine x-ray e. ventilate the patient with a bag-mask Ans; C. suction the oropharynx
27. A 22-year-old man sustains a gunshot wound to the left chest and is trans-

ported 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:

Select one: a. clamp the chest tube b. cancel the patient's transfer c. perform an emergency department thoracotomy d. repeat the primary survey and proceed with transfer e. delay the transfer until the referring doctor can contact a thoracic surgeon Ans; D. repeat the primary survey and proceed with transfer

28. 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: Select one: a. intubate the patient b. perform diagnostic peritoneal lavage or FAST c. insert a left chest tube d. call the receiving hospital and speak to the surgeon on call e. discuss the advisability of transfer with the patient's family Ans; D. call the receiving hospital and speak to the surgeon on call

29. Hemorrhage of 20% of the patient's blood volume is associated usually with: Select one: a. oliguria b.

confusion c. hypotension d. tachycardia e. blood transfusion requirement Ans; D. tachycardia

30. Which one of the following statements concerning intraosseous infusion is TRUE? Select one: a. Only crystalloid solutions may be safely infused through the needle. b. Aspiration of bone marrow confirms appropriate positioning of the needle. c. Intraosseous infusion is the preferred route for volume resuscitation in small children. d. Intraosseous infusion may be utilized indefinitely. e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. Ans; B. Aspiration of bone marrow confirms appropriate positioning of the needle.
31. A young female sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6, 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: Select one: a.

avoid hypotension b. administer an osmotic diuretic c. aggressively treat systemic hypertension d. reduce metabolic requirements of the brain