ATLS Post Test 2023 QUESTIONS AND ANSWERS, Exams of Nursing

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ATLS TEST 1/40 QUESTIONS AND ANSWERS/ LATEST

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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 chestb. perform an aortogramc. obtain a CT scan of the chestd. obtain arterial blood gas analysese. perform transesophageal echocardiography Correct ans - A) Reexamine 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: Select one: a. angiography b. compartment pressuresc. retrograde urethrogramd. Doppler ultrasound studiese. complete spine x-ray series Correct ans - e) Complete spine x-rayseries Which of the following is true regarding the initial resuscitation of a traumapatient? Select one:a.

WITHCOMPLETE SOLUTION 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 improvement 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 traumapatients Correct ans - b. 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 mostimportant initial step is to: Select one: a. Secure the airwayb. obtain a c-spine filmc. support the circulationd. control scalp hemorrhagee. determine the GCS score Feedback Your answer is corr Correct ans - a. Secure the airway A previously healthy, 70-kg (154-pound) man suffers an estimated acuteblood 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.

WITHCOMPLETE SOLUTION An ABG would demonstrate a base deficit between - 6 and - 10 mEq/Le. His systolic blood pressure will be maintained with an elevated diastolic pressure. Correct ans - d. An ABG would demonstrate a base deficit between - 6 and - 10 mEq/L 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 transfusionb. resulting in an elevated hematocritc. complicating the management of closed head injuryd. reducing the volume of crystalloid required for resuscitatione. increasing the volume of blood loss to produce maternal hypotension Correct ans

• e. increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is:Select one: a. Urine output of 0.5 mL/kg/hrb. normalization of blood pressurec. normalization of the heart rated. measuring a normal central venous pressuree. providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid Correct ans
• a. Urine output of 0.5 mL/kg/hr The diagnosis of shock must include: Select one: a. hypoxemia b. acidosisc. hypotensiond.

WITHCOMPLETE SOLUTION increased vascular resistancee. evidence of inadequate organ perfusion Correct ans - e. 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: Select one: a. application of a tourniquetb. direct pressure on the woundc. packing the wound with gauzed. direct pressure on the femoral artery at the groine. debridement of devitalized tissue Correct ans - b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosisb. metabolic acidosisc. cerebral vasoconstriction with diminished perfusiond. neurogenic pulmonary edemae. shift of the oxyhemoglobin dissociation curve Correct ans - c. 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: Select one: a. obtain contrast angiographyb.

WITHCOMPLETE SOLUTION transfer to a higher level trauma centerc. perform an exploratory laparotomyd. infuse additional crystalloid fluidse. Obtain transesophageal echocardiography Correct ans - c. perform an exploratory laparotomy 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 nonpregnantpatient. d. With penetrating trauma, injury to the mother's abdominal hollow viscus ismore common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient. Correct ans - b. Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is to:Select one: a. intubate the patientb. assess arterial blood gasesc. administer supplemental oxygend. ascertain the need for a chest tubee. obtain a chest x-ray Correct ans - c. 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

WITHCOMPLETE SOLUTION 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 Correct ans - d: 9 Which one of the following findings in an adult is most likely to require immediate management during the primary survey? Select one: a. distended abdomenb. Glasgow Coma Scale score of 11c. temperature of 36.5°C (97.8°F)d. deformity of the right thighe. respiratory rate of 40 breaths per minute Correct ans - e. respiratory rate of 40 breaths per minute 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: a. perform tracheal intubationb. insert an oropharyngeal airwayc. perform needle or finger decompression of the right chestd. manually displace the gravid uterus to the left side of the abdomene. initiate 2, large-caliber peripheral IV lines and crystalloid infusion Correct ans

• c. perform needle or finger decompression of the right chest An important, immediate step in the management of an open pneumothoraxis: Select one:

WITHCOMPLETE SOLUTION a. endotracheal intubationb. operation to close the woundc. placing a chest tube through the chest woundd. placement of an occlusive dressing over the wound secured on three sidese. initiation of 2, large-caliber IVs and infusing crystalloid solution Correct ans - d. placement of an occlusive dressing over the wound secured on three sides Which of the following is a contraindication for tetanus toxoid administration?Select one: a. history of neurological reaction or severe hypersensitivity to the productb. Local side effectsc. muscular spasmsd. pregnancye. all of the above Correct ans - a. history of neurological reaction or severe hypersensitivity to the product 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 volumec. breath soundsd. pulse pressuree. jugular venous pressure Correct ans - c. breath sounds

WITHCOMPLETE SOLUTION 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 thetrachea. Correct ans - a. The trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during analtercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated 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 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 lavageb. obtain a CT of the chestc. perform an angiographyd. urgently transfer the patient to the operating roome. immediately transfer the patient to a trauma center Correct ans - d. urgently transfer the patient to the operating room 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 cricothyroidotomyb.

WITHCOMPLETE SOLUTION attempt nasotracheal intubationc. ventilate him with a bag-mask device until c-spine injury can be excludedd. restrict cervical motion and attempt orotracheal intubation using 2 peoplee. ventilate the patient with a bag-mask device until his beard can be shavedfor better mask fit a. perform a surgical cricothyroidotomyb. attempt nasotracheal intubationc. ventilate him with a bag-mask device until c-spine injury can be excludedd. restrict cervical motion and attempt orotracheal intubation using 2 peoplee. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit Correct ans - d. restrict cervical motion and attempt orotracheal intubation using 2 people 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 expected. Correct ans - e. Flaccidity of the lower extremities and loss of deep tendon reflexes areexpected Which one of the following is the most effective method for initially treatingfrostbite? Select one:a. moist heatb.

WITHCOMPLETE SOLUTION early amputationc. padding and elevationd. vasodilators and heparine. topical application of silver sulfadiazine Correct ans - a. 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 to the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, a pulse cannot be palpated below theright 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? Select one: a. applying skeletal tractionb. administering anticoagulant drugsc. administering thrombolytic therapyd. surgical consultation for right lower extremity fasciotomye. transferring the patient to the trauma center 120 km away Correct ans

• d. 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 stepafter providing supplemental oxygen and elevating his jaw is to: Select one: a. request a CT scanb. insert a gastric tubec. suction the oropharynxd. obtain a lateral cervical spine x-raye. ventilate the patient with a bag-mask Correct ans - c.

WITHCOMPLETE SOLUTION 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 mLof 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 tubeb. cancel the patient's transferc. perform an emergency department thoracotomyd. repeat the primary survey and proceed with transfere. delay the transfer until the referring doctor can contact a thoracic surgeonCorrect ans - d. 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: Select one: a. intubate the patientb. perform diagnostic peritoneal lavage or FASTc. insert a left chest tubed. call the receiving hospital and speak to the surgeon on calle. discuss the advisability of transfer with the patient's family Correct ans

• d. call the receiving hospital and speak to the surgeon on call

WITHCOMPLETE SOLUTION 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 Correct ans - d. tachycardia Which one of the following statements concerning intraosseous infusion isTRUE? 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 smallchildren. d. Intraosseous infusion may be utilized indefinitely.e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. Correct ans - b. Aspiration of bone marrow confirms appropriate positioning of the needle. 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 hypotensionb. administer an osmotic diureticc. aggressively treat systemic hypertensiond. reduce metabolic requirements of the brain

WITHCOMPLETE SOLUTION e. distinguish between intracranial hematoma and cerebral edema Correct ans - a. avoid hypotension A 33-year-old female 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

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: Select one: a. hemorrhagic shockb. cardiac tamponadec. massive hemothoraxd. tension pneumothoraxe. diaphragmatic rupture Correct ans - b. 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)? Select one: a. a serum amylase of 200b. a leukocyte count of 14,000c. evidence of retroperitoneal hematoma on CT scand. development of peritonitis on physical exame. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hoursCorrect ans - d. 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

WITHCOMPLETE SOLUTION and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? Select one: a. Neurogenic shock is likely to developb. Imaging of her complete spine is required prior to transfer to a trauma centerc. Given the injury level knee extension would be expectedd. log rolling using 4 people is a safe approach to limit spinal motion whenmoving her e. Presence of bulbocarvenous reflex indicates a better prognosis Correct ans - d. log rolling using 4 people is a safe approach to limit spinal motion whenmoving 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 isto: Select one: a. apply cervical tractionb. perform immediate tracheostomyc. insert bilateral thoracostomy tubesd. maintain 100% oxygen and obtain immediate c-spine x-rayse. restrict cervical motion and establish a definitive airway Correct ans - e. restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants:Select one: a. It is not reliable.b. The body is proportionally larger in infants than in adults.c. The head is proportionally larger in infants than in adults.d. The legs are proportionally larger in infants than in adults.

WITHCOMPLETE SOLUTION e. The arms are proportionally larger in infants than in adults. Correct ans

• c. 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: Select one: a. placement of a pelvic binderb. transfer to a trauma centerc. pelvic x-rayd. insert urinary cathetere. repeat examination of pelvis Correct ans - a. placement of a pelvic binder Which situation requires Rh immunoglobulin administration to an injuredfemale? Select one: a. negative pregnancy test, Rh negative, and has torso traumab. positive pregnancy test, Rh positive, and has torso traumac. positive pregnancy test, Rh negative, and has torso traumad. positive pregnancy test, Rh positive, and has an isolated wrist fracturee. positive pregnancy test, Rh negative, and has an isolated wrist fracture Correct ans
  • c. positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The nextmanagement step for this patient is to: Select one:

WITHCOMPLETE SOLUTION a. perform a thoracoscopyb. perform an arch aortogramc. insert a second left chest tubed. prepare for an exploratory thoracotomye. perform a chest CT Correct ans - d. prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the followingstatements is TRUE about this patient? Select one: a. A flail chest is probable.b. A symptomatic blunt cardiac injury is expected.c. A pulmonary contusion may be present in the absence of rib fractures.d. Transection of the thoracic aorta is more likely than in an adult patient.e. Rib fractures are commonly found in children with this mechanism of injury. Correct ans

• c. A pulmonary contusion may be present in the absence of rib fractures