ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS, Exams of Nursing

Download ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS and more Exams Nursing in PDF only on Docsity! ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS ATLS 2022 ATLS Posttest 2022 QUESTIONS AND ANSWERS 1. The primary indication for transferring a patient to a higher level trauma center is: unavailability of a surgeon or operating room staff. multiple system injuries, including severe head injury. resource limitations as determined by the transferring doctor. resource limitations as determined by the hospital administration. widened mediastinum on chest x-ray following blunt thoracic trauma. 2. teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to: obtain a lateral cervical spine x-ray. insert a central venous pressure line. administer 2 liters of crystalloid solution. perform endotracheal intubation and ventilation. apply the PASG and inflate the leg compartments. 3. Contraindication to nasogastric intubation is the presence of a: gastric perforation. diaphragmatic rupture. open depressed skull fracture. fracture of the cervical spine. fracture of the cribriform plate. 4. Which one of the following statements regarding patients with thoracic spine injuries is ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS TRUE? Log-rolling may be destabilizing to fractures from T-12 to L-1. Adequate immobilization can be accomplished with the scoop stretcher. Spinal cord injury below T-10 usually spares bowel and bladder function. Hyperflexion fractures in the upper thoracic spine are inherently unstable. These patients rarely present with spinal shock in association with cord injury. 5. young man sustains a ritle wound to the mid- abdomen. He is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate step is to perform: a celiotomy. an abdominal CT scan. diagnostic laparoscopy. abdominal ultrasonography. a diagnostic peritoneal lavage. 6. young woman sustains a severe head injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being 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: administer an osmotic diuretic. prevent secondary brain injury. aggressively treat systemic hypertension. reduce metabolic requirements of the brain. distinguish between intracranial hematoma and cerebral edema. 7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by: 9. 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in this child: is most likely a central cord syndrome. must be diagnosed by magnetic resonance imaging. a subdural hematoma. an epidural hematoma. a transected lumbar spinal cord. a transected cervical spinal cord. hemorrhage into the chest or abdomen. 8. 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS performed, and 2 liters of Ringer's lactate solution are infused through 2 large-caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% 02). The most appropriate next step in managing this patient is: Young children are less tolerant of expanding intracranial mass lesions than adults. 21. 5-year-old boy is struck by an automobile and brought to the emergency department. He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is: percutaneous femoral vein cannulation cutdown on the saphenous vein at the ankle. intraosseous catheter placement in the proximal tibia. percutaneous peripheral veins in the upper extremities. Children suffer spinal cord injury without x- ray abnormality more commonly than adults. An infant with a traumatic brain injury may become hypotensive from cerebral edema. Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone intravenously. Children have more focal mass lesions as a result of traumatic brain injury when compared to adults . increased maternal renal blood flow. 23. Cardiac tamponade after trauma: is seldom life-threatening. can be excluded by an upright, AP chest x- ray. can be confused with a tension pneumothorax. causes a fall in systolic pressure of > 15 mm Hg with expiration. most commonly occurs after blunt injury to the anterior chest wall. 24. 30-year-old man sustains a severely comminuted, open distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve: immediate angiography. tamponade of the wound with a pressure dressing. wound exploration and removal of bony fragments. realignment of the fracture segments with a traction splint. fasciotomy of all four compartments in the ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS lower extremity. 25. 24-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the emergency department reveals a flail segment of the patient's thorax. Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask, and initiation of Ringer' s lactate solution. The patient exhibits progressive confusion, cyanosis, and tachypnea. Management at this time should consist of: intravenous sedation. external stabilization of the chest wall. increasing the F102 in the inspired gas. intercostal nerve blocks for pain relief. endotracheal intubation and mechanical ventilation. 26. 23-year-old man is brought immediately to the emergency department from the hospital' s parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconscious and has no detectable blood pressure. Optimal immedi'ate management is to: perform diagnostic peritoneal lavage. initiate infusion of packed red blood cells. insert a nasogastric tube and urinary catheter. transfer the patient to the operating room, while initiating fluid therapy. initiate fluid therapy to return his blood pressure to normotensive 27. 25-year-old woman is brought to the emergency department after a motor vehicle crash. She was initially lucid at the scene and then developed a dilated pupil and contralateral extremity weakness. In t.he emergency department, she is unconscious and has a GCS score of 6. The initial management step for this patient should be to: obtain a CT scan of the head. administer decadron 20 mg IV. perform endotracheal intubation. initiate an W line and administer Mannitol 1 g/kg. perform an emergency linar hole on the side of the dilated pupil. 28. Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to: treat the most severely injured patients first. establish a field triage area directed by a doctor. rapidly transport all patients to the nearest appropriate hospital. treat the greatest number of patients in the shortest period of time. ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS produce the greatest number of survivors based on available resources. 29. Which one of the following statements is FALSE concerning Rh isoimmunization in the pregnant trauma patient? It occurs in blunt or penetrating abdominal trauma. Minor degrees of fetomaternal hemorrhage produce it. A negative Kleihauer-Betke test excludes Rh isoimmunization. This is not a problem in the traumatized Rh-positive pregnant patient. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage. 30. 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on collision. In the emergency department, she is talking and has marked facial edema and crepitus. The highest priority should be given to: lateral, c-spine x- ray. upper airway protection. carotid pulse assessment. management of blood loss. determination of associated Injuries. 31. Early central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a: patient with a splenic laceration. patient with an inhalation injury. 6-year-old child with a pelvic fracture. patient with a severe cardiac contusion. 24-year-old man with a massive hemothorax. 32. 32-year-old man is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the emergency department, he has no apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is unsuccessful. Examination of his mouth reveals a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial management of his airway should consist of: inserting an oropharyngeal airvvay. inserting a nasopharyngeal airway. performing a surgical cricothyroidotomy. performing fiberoptic-guided nasotracheal intubation. performing orotracheal intubation after obtaining a lateral c- spine x-ray. 33. 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS c. Myocardial contusion. d. Hypothermia. e. Abdominal hemorrhage. 2. A 22 year old male presents following a motorcycle crash. He complains of the inability to move or feel his legs. His blood pressure is 80/50 mm Hg, heart rate is 70, respiratory rate is 18. GCS is 15. Oxygen is 99%on 2L nasal prongs. Chest X- ray, pelvic X-ray, FAST are normal. Extremities are normal. His management should be: a. 2L of IV crystalloid and two units of pRBSs. b. 2L of IV crystalloid, manitol and IV steroids. c. 1 unit of albumin and compression stockings. d. Vassopressors and laprotomy. e. 2L of crystalloid and vassopressors if BPdoes not respond. 3. Which of the following signs is least reliable for diagnosing esophageal intubation? a. Symmetrical chest wall movement. b. End-tidal CO2. c. Bilateral breath sounds. d. Oxygen saturation. e. Chest X-ray demonstrating the ETT tip positioned above the carnia. 4. A 6 months old infant, being held in her mother's arms, is ejected on impact from a vehicle that is struck head-on by an oncoming car travelling at 64 kph. The infant arrives in the ER with multiple facial injuries, is lethargic, and in severe respiratory distress. Respiratory support is not effective using a bag mask device. And her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. The most appropriate procedure to perform next is: a. Administer hellox and epinephrine. b. Perform nasotracheal intubation. c. Perform surgical cricothyriodotomy. d. Repeat orotracheal intubation. e. Perform needle cricothyroidtomy with jet insufflations. 5. 28 year old male is brought to ER. He was involved in fight, in which he was beaten with a wooden stick. His chest 8. A 35 year old female sustains multiple shows multiple severe bruises. Airway injuries in a motor vehicle crash and is is clear, respiratory rate is 22, heart rate transported to a small hospital in full is 126, and systolic blood pressure is 90 spinal protection. She has a GCS of 4 mm Hg. Which of the following should and is being mechanically ventilated. be performed during the primary Intravenous access is established and survey? warmed crystalloid is infused. She remains hemodynamically normal and a. GCS. full spinal protection in maintained. ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS b. Tetanus toxoid administration. Preparations are made to transfer her to c. Cervical spine X-ray. another facility for definitive d. Blood alcohol level. neurosurgical care. Prior to transport, e. Rectal exam. which of the following tests or treatments is mandatory? 6. Which one of the following injuries is a. FAST exam. addressed in the secondary survey? b. Chest X-ray. ??? c. Lateral cervical spine X-ray.??? a. Forearm fracture. d. Administration of b. Mid-thigh amputation. methiprednisolone. c. Open fracture with bleeding. e. CT of abdomen. d. Unstable pelvic fracture. e. Bilateral femur fractures with 9. A 23 year old male is stabbed below the obvious deformity. right nipple. He is alert, and his oxygen is 98%. Chest tube was placed for 7. Which one of the following statements treatment of hemopnueunthorax. BP is true regarding access in pediatric 90/60 mm Hg after 1L of crystalloid resuscitation? solution. What is the next step in treatment? a. Intraosseous access should only be considered after five percutaneous a. Place a left-sided chest tube. attempts. b. Re-examine the chest. b. Cut-down at the ankle is the preferred c. Inscert central venous catheter. initial access technique. d. Perform CT scan of the abdomen c. Internal jugular cannulation is the next and pelvis. preferred option when percutaneous e. Prepare for urgent throacotomy. venous access fails. d. Intraosseouscannulation should be the 10. A 22 year old male is assaulted in a bar. first choice for access. A semi-rigid cervical coller is applied, e. Blood transfusion can be delivered and he is immobilized on a spine board. through intraosseous access. On initial exam, VS are normal, GCS is 15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury? a. Presence of hemotympanum. b. Blood alcohol concentration of 0.16%. c. Presence of an isolated 10 cm scalp laceration. d. Presence of a mandibuler fracture. e. History of assult. 11. A 23 year old construction worker is brought to ER after falling more than 9 meters. VS: HR is 140, BP is 90/60, and RR is 36. He is complaining bitterly of lower abdominal and lower limb pain, and his obvious deformity of both lower legs with bilateral open tibial fractures. Which of the following statements concerning the patient is true? ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS a. Pelvic injury can be ruled out based on the mechanism of injury. b. Blood loss from the lower limbs is the most likely cause of hypotension. c. X-ray of the chest and pelvis are important adjacent in his initial assessment. d. Spinal cord injury is most likely cause of his hypotension. e. Aortic injury is the most likely cause of his tachycardia. 12. A 25 year old female in the third trimester of pregnancy is brought to ER following a high-speed motor vehicle crash. She is conscious and immobilized on long spine board. RR is 24, HR is 120, and BP is 70/50. Labs show a PaCO2 of 40 mm Hg. Which one of the following statements concerning this patient is true? a. Fetal assessment should take priority. b. Log rolling the patient to the right will decompress the vena cava. c. Rh-immunoglubulin therapy should be immediately administered. d. The patient has likely impending respiratory failure. e. Vasopressors should be given to the patient. 13. A 30 year old male is stabbed in the right chest. On arrival to ER, he is very short of breath. HR is 120 and BP is 80/50 mm Hg. His neck veins are flat. There is no diminished air entry on the right side, and there is dullness posteriorly on percussion. These findings are most consistent with: a. Tension pneumothorax. b. Pericardial tamponade. c. Hypovolemia from liver injury. d. Hemothorax. e. Spinal cord injury. 14. A specific aspect of the treatment of thermal injuries is: a. Chemical burns require the immediate removal of clothing. b. Patients who sustain thermal injury are at lower risk of hypothermia. c. Patients with circumferential burns need prompt fasciotomies. d. Electrical burns are associated with extensive skin necrosis (from entry point to exit). e. The Parkland formula should be used to determine adequacy of resuscitation. 15. A 15 year old male is brought to ER after being involved in a motor vehicle crash. He is unconscious and was intubated at the scene by EMS. On ER, O2 is 92%, HR is 96 and BP is 150/85 mm Hg. Breath sounds are decreased on the left side of the thorax. The next step is: a. Immediate needle cricothyroidotomy. b. Immediate needle thoracocentesis. ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS d. Early amputation to prevent septic complications. e. Massage of the affected area. 27. Signs and symptoms of airway compromise include all of the following except: a. Change in voice. b. Stridor. c. Decreased pulse pressure. d. Dyspnea and agitation. e. Tachypnea. 28. Which one of the following statements is true regarding a pregnant patient who presents following blunt trauma? a. Early gastric decompression is important. b. A hemoglobin level of 10 g/dl indicates recent blood loss. c. The central venous pressure response to volume resuscitation is blunted in pregnant patients. d. A lap belt is the best form of restraint due to the size of the gravid uterus. e. A PaCO2 of 40 mm Hg provides reassurance about the adequacy of respiratory function. 29. A 30 year old is brought to ER after being injured in a motor vehicle crash. BP is 90/60 and HR is 122. She responds to the rapid infusion of 1 liter of crystalloid solution with a rise in her BP to 118/ 88 and a decrease in her HR to 90. Her BP then suddenly decreases to 96/66. The least likely cause of her hemodynamic change is: a. Traumatic brain injury. b. Ongoing blood loss. c. Blunt cardiac injury. d. Inadequate resuscitation. e. Tension pneumothorax. 30. Limb-threatening extremity injuries: a. Require a tourniquet. b. Are characterized by the presence of ischemic or crushed tissue. c. Should be definitively managed by application of a traction splint. d. Are rarely present without an open wound. e. Indicates a different order of priorities for the patient's initial assessment and resuscitation. 31. A 29 year old female arrives in ER after being involved in a motor vehicle crash. She is 30 weeks pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the following statements best describes the risk of injury? a. The deployment of the airbag increases the risk of fetal loss. b. The use of seatbelts is associated with increased risk of maternal death. c. The mechanism of injury suggests the need for emergency C- section due to the risk of ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS impending abruption placenta. d. The risk of premature fetal delivery and death is reduced by the use of restraints. e. The deployment of the airbag increases the risk of maternal abdominal injury. 32. Supraglottic airway devices: a. Are equivalent to endotracheal intubation. b. Require neck extension for proper placement. c. Are preferable to endotracheal intubation in a patient who cannot lie flat. d. Are of value as part of a difficult or failed intubation plan. e. Provide one form of definitive airway. 33. A 70 year old male suffers blunt chest trauma after being struck by a car. On ER, GCS is 15, BP is 145/90, HR is 72, RR is 24 and O2 saturation on 5L is 91%. Chest X-ray shows multiple rib fractures. ECG shows normal sinus rhythm with no conduction abnormalities. Management should include: a. Placement of a 22-french, right- sided chest tube. b. Serial troponins and cardiac monitoring. c. Thoracic splinting, taping, and immobilization. d. Monitored IV analgesia. e. Bronchoscopy to exclude tracheobronchial injury. 34. A 15 year old male presenting after a motorcycle crash. Initial exam reveals normal VS. There is a large bruise over his epigastrium that extends to left flank. He has no other appearent injuries. A CT of abdomen shows ruptured spleen surrounded by a large hematoma and fluis in the pelvis. The next step in this patient's management is: a. Splenic artery immobilization. b. Pneumococcal vaccine. c. Transfer to pediatrician. d. Urgent laparotomy. e. Surgical consultation. 35. A 30 year old male presents with a stab wound to the abdomen. BP is 85/60, HR is 130, RR is 25 and GCS is 14. Neck veins are flat, and chest exam is clear with bilateral breath sounds. Optimal resuscitation should include: a. Transfusion of fresh frozen plasma and platelets. b. 500 mL of hypertonic saline and transfusion of pRBSs. c. Resuscitation with crystalloid and pRBCs until base excess is normal. d. Preparation for laparotmy while initiating fluid resuscitation. e. Fluid resuscitation and angioemobolization. ATLS POST TEST (2 VERSIONS) 2023 QUESTIONS AND ANSWERS 36. Initial resuscitation in adult trauma patients should: a. Be with 1-2 liters of crystalloid, monitoring the patient's response. b. Use crystalloid to normalize BP. c. Use permissive hypotension in patients with head injury. d. Be with anon-blood colloid solution. e. Be a minimum of 2 L of crystalloid in all trauma patients prior to administering blood. 37. A 25 year old male is brought to ER following a bar fight. He has an altered level of consciousness, opens his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following concerning this patient is correct? a. Mandatory intubation to protect his airway is required. b. His GCS suggests a severe head injury. c. His level of consciousness can be solely attributed to elevated blood alcohol. d. CT is an important part of neurological exam. e. Hyperoxia should be avoided. 38. Which one of the following statements regarding genitourinary injuries is true? a. Urethral injuries are associated with pelvic fractures. b. All patients with microscopic hematuria require evaluation of the genitourinary tract. c. Patients with gross hematuria and shock will have a major renal injury as the source of hemorrhage. d. Intraperitoneal bladder injuries are usually managed definitively with a urinary catheter. e. Urinary catheters should be placed in all patients with pelvic fractures during the primary survey. 39. Which one of the following physical findings does not suggest spinal cord injury as the cause of hypotension? a. Priapism. b. Bradycardia. c. Distended neck veins. d. Diaphragmatic breathing. e. Ability to flex forearms but inability to extend them. 40. Cardiac temponade: a. Is definitively managed by needle pericardiocentesis. b. Is most common with blunt thoracic trauma and anterior rib fractures. c. Is easily diagnosed by discovery of Beck's triad in the ER. d. Is indicated by Kussmaul breathing. e. Requires surgical intervention.