ATLS Post Test 2024 WITH QUESTIONS AND ANSWERS GRADED A+, Exams of Nursing

Download ATLS Post Test 2024 WITH QUESTIONS AND ANSWERS GRADED A+ and more Exams Nursing in PDF only on Docsity! ATLS Post Test 2024 WITH QUESTIONS AND ANSWERS GRADED A+ 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. Pneumothorax Pneumomediastinum Massive hemothorax Diaphragmatic rupture Subcutaneous emphysema 11. 18-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash. Prehospital persormel report that he was thrown 15 meters (50 feet) off his bfice. He has a history of hypotension prior to arrival in the emergency department, but is now awake, alert, and conversational. Which of the following statements is TRUE? perform diagnostic peritoneal lavage or abdominal ultrasound. Cerebral perfiision is intacto Intravascular volume status is normal. The patient has sensitive vasomotor reflexes. Intraabdominal visceral injuries are unlikely. defmitive treatment in managing this patient is to: The patient probably has an acute epidural hematoma. 12. crosstable, lateral x-ray of the cervical spine: must precede endotracheal intubation. excludes serious cervical spine injury. is an essential part of the primary survey. is not necessary for unconscious patients with penetrating cervical injuries. is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. 13. During resuscitation, which one of the following is the most reliable as a guide to volume replacement? Pulse rate Hematocrit Blood pressure Urinary output Jugular venous pressure 14. Which one of the following is the recommended method for initially treating frostbite? Vasodilators Anticoagulants Warm (40°C) water Padding and elevation Topical application of silvasulphadiazine 15. young man sustains a gunshot wound to the abdomen and is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The administer 0-negative blood. apply extemal warming devices. control internal hemorrhage operatively. apply the pneumatic antishock garment. infuse large volumes of intravenous crystalloid solution. 16. To establish a diagnosis of shock: systolic blood pressure must be below 90 mm Hg. the presence of a closed head injury should be excluded. acidosis should be present by arterial blood \gas analysis. the patient must fail to respond to intravenous fluid infu.sion. clinical evidence of inadequate organ perfusion must be present. 17. Absence of breath sounds and dullness to percussion over the left hemithorax are fmdings best explained by: left hemothorax. cardiac contusion. left simple pneumothorax. left diaphragmatic rupture. right tension pneumothorax. 18. 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following EXCEPT: air splints. bolstering devices. a long spine board. a scoop-style stretcher. a semirigid cervical collar. 19. During an altercation, a 32-year-old man sustains a gunshot wound to the right upper hemithorax, above the nipple line with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, closed tube thoracostomy is celiotomy. diagnostic peritoneal lavage. 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. 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 palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty. Initially, his ventilations are easily assisted with a bag¬valve device. It becomes more difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to89 % . The most appropriate next step is to: obtain a chest x-ray. decrease the tidal volume. auscultate the patient's chest. increase the rate of assisted ventilations. perform needle decompression of the left chest. 34. 42-year-old man is trapped from the waist down beneath his overtumed tractor for several hours before medical assistance arrives. He is awake and alert until just before arriving in the emergency department. He is now unconscious and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his lower extremities. On examination in the emergency department, no movement of his lower extremities is detected, even in response to painful stimuli. The most likely cause for this fmding is: an epidural hematoma. a pelvic fracture. central cord syndrome. intracerebral hemorrhage. bilateral compartment syndrome. 35. An electrician is electrocuted by a downed power line after a thunderstorm. He apparently made contact with the wire at the level of the right mid thigh. In the emergency department, his vital signs are normal and no dysrhythmia is noted on ECG. On examination, there is an exit wound 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. 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? 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 open fracture. c. Prevention of further soft tissue injury. d. Control of hemorrhage. e. Improve long-term function. 18. A 40 year old obese patient with GCS of 8 requires a CT. before transfer to CT you should: a. Give more sedative drugs. b. Insert a multilumen esophageal airway. c. Insert a definitive airway. d. Request a lateral cervical spine film. e. Insert a nasogastric tube. 19. Lateral cervical spine films: a. Must be performed in the primary survey. b. Can exclude any significant spinal injury. c. Should be combined with clinical exam, AP and odontoid, CT. d. Are indicated in all trauma patients. e. Require the following films: oblique views, AP, odontoid and flexion- extension views prior to spinal clearance in trauma patients. 20. A 30 year old male is brought to ER after falling 6 m. Flail chest on the right, tachypneic and normal breath sounds. No hyperresonance or dullness. On oxygen by face mask.ABG are: PaO2 of 45, PaCO2 of 28 and pH of 7.47. Abnormalities in the patient's blood gases is due to: a. Hypoventilation. b. Hypovolemia. c. Small pneumothorax. d. Pulmonary contusion. e. Flail chest. 21. An 82 year old male falls down five stairs and presents to the ER. All are true statements regarding his condition compared to a younger patient with similar mechanism, except: a. He is more likely to have had contracted circulatory volume prior to his injury. b. His risk of cervical spine injury is increased due to degeneration, stenosis, and loss of disk compressibility. c. Intracranial hemorrhage will become sympotmatic more quickly. d. His risk of occult fractures is increased. e. His risk of bleeding may be increased. 22. The most specific test to evaluate for injuries of solid abdominal organs is: a. Abdominal X-ray. b. Abdominal U/S. c. DPL d. Frequent abdominal examination e. CT of abdomen and pelvis. 23. A 14 year old female is brought to ER after falling from a horse. She is immobolizedon a long spine board with a hard collar and blocks, cervical spine X-rays: a. Will show cervical spine injury in more than 20% of these patients. b. Will exclude cervical spine injury if no abnormalities are found on the X- rays. c. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. d. Should be performed before addressing potential breathing or circulatory problems. e. May show atlanto-occipital dislocation if the power's ratio is < 1. 24. The most important consequences of inadequate organ perfusion is: a. Multiple organ failure. b. Decreased base deficit. c. Acute gloumerulnephritis. d. Increased ATP production. e. Vasodilatation. 25. Hypertension following a head injury: a. Should be treated to reduce ICP. b. May indicate imminent herniation from critically high ICP. c. Indicates pre-existing hypertension. d. Mandates prompt administration of mannitol. e. Should prompt burr hole drainage of potential subdural hematomas. 26. Initial treatment of frostbite injuries involves: a. Application of dry heat. b. Rapid rewarming of the body part in circulating WARM water. c. Debridement of hemorrhagic blisters. 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: 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. 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. First group ATLS questions.. 1- triage concept : save more lives with available resources 2- a patient with gun shot , BP 70/0 , Chest tube drained 120 ml , chest sounds normal. next step? - Laboratomy 3- persistent pneumothorax after placing chest tube. Diagnosis? - Tracheobronchial injury 4- which of the following is not part of the initial assessment? - determining incomplete,or complete neurological deficit 5- echomosys in prenium , blood in mayatus ,what will you do? - retrograde urethrogram 6- Class II shock: - normal BP 7- patient with minimal trauma to chest and tenderness,ABCDE are good, how to manage? - pain medication 8- old patient on B-blocker and Coumadin (warfarin), decreased BP, normal pulse, which of the following is true? - excessive fluids cause cardiopulmonary failure. 9- indication for intubation?