ATLS Post Test 4 Latest Versions 260 Questions and Answers 2025, Exams of Nursing

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ATLS Post Test 4 Latest Versions 260 Questions and Answers 2025

re-examine the chest A 22 - year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His BP is initially 80/ mm Hg. After 2 liters of crystalloid solution his BP increases to 122/84. His heart rate is now 100 BPM and his RR is 28 breaths per minute. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left 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 _____________________ _. complete spine x-rays 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 __________ _. secure the airway In managing the head-injured patient, the most important initial step is to _______________________________________________ _. his systolic pressure will be decreased with a narrowed pulse pressure A previously healthy, 70 kg man suffers an estimated acute blood loss of 2 liters. How will this affect his blood pressure? increasing the volume of blood loss to produce maternal hypotension The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by ________ _. adequate urinary output The best assessment of fluid resuscitation of the adult burn patient is _. evidence of inadequate organ perfusion The diagnosis of shock must include _. direct pressure on the wound 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 ________ (application of a tourniquet vs. direct pressure on the wound). cerebral vasoconstriction with diminished perfusion For the patient with severe TBI, profound hypocarbia should be avoided to prevent __________. exploratory laparotomy A 25 - year-old man is brought to a hospital after being involved in a MVA. CT shows an aortic injury and splenic laceration with free abdominal fluid. His BP falls to 70 mm Hg after CT. The next step is __________________ _. leakage of amniotic fluid Abdominal trauma in a pregnant patient --> is an indication for hospital admission. administer supplemental oxygen What is the first maneuver to improve oxygenation after chest injury? 9 (eyes = 2, verbal = 2, motor = 5) A 25 - year old man, injured in a MVA, is admitted to the emergency department. His pupils react sluggishly and his eyes open to painful stimuli. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to painful stimulus; however, his left hand reaches purposefully toward the painful stimulus. Both legs are stiffly extended. His GCS score is ________________________________ _. RR of 40 BPM Which one of the following findings in an adult is most likely to require immediate management during the primary survey: distended abdomen, GCS score of 11, deforming of the right thigh, RR of 40 BPM. placement of an occlusive dressing over the wound The most important, immediate step in the management of an open pneumothorax is _________. history of neurological reaction or severe hypersensitivity to the product The following are contraindications for tetanus toxoid administration: history of neurological reaction or severe hypersensitivity to the product, local side effects, muscular spasms, pregnancy, or all of the above.

breath sounds A 56 - year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department, he is diaphoretic and complaining of chest pain. His BP is 60/40 mm Hg and his RR is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? the trachea is relatively short Bronchial intubation of the right or left mainstem bronchus can easily occur during infant ET intubation because _. urgently transfer the patient to the operating room 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 surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid solution are infused through 2 large-caliber IVs. His blood pressure is now 60/0 mm Hg. Heart rate is 160 bpm, and RR is 14 breaths per minute (ventilated with 100% O2). 1500 cc of blood has drained from the right chest. The most appropriate next step in managing this patient is to _. attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine 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 _______________ _. flaccidity of the lower extremities and loss of deep tendon reflexes are expected A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His BP 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? moist heat What is the most effective method for initially treating frostbite?

suction the oropharynx 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 __ _. repeat the primary survey and proceed with the transfer A 22 - year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital at which surgical capabilities are not available. In the emergency dept, 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 BP decreases to 80/68 and his HR increases to 136 beats per minute. The next step should be to _. call the receiving hospital and speak to the surgeon on call 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 CXR with fractures of left ribs 2 - 4, but no pneumothorax. After infusing 2 liters of crystalloid solution, bis BP is 110/74, his heart rate is 100 bpm, and his RR is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decided to transfer this patient to a facility capable of providing a higher level of care. The facility is 80 miles away. Before transfer, you should first _. tachycardia Hemorrhage of 20% of the patient's blood volume is usually a/w _. aspiration of bone marrow confirms appropriate positioning of the needle Which one of the following statements concerning intraosseous infusion is TRUE?

avoid hypotension 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 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 ____. maintaining a SBP around 90 mm Hg during the early stages of treatment, prior to surgical control (crystalloid use is limited or nonexistent as blood products are transfused in fixed ratios -- this strategy should NOT be used in patients with CNS injury, in which hypotension is a/w adverse outcomes) What is permissive hypotension? cardiac tamponade 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 bpm BP is 90/70, RR 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 non- tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: free intraperitoneal air demonstrated on follow-up A hemodynamically normal 10-year-old girl is admitted to the PICU for observation after a Grade III (moderately

CT severe) splenic injury has been confirmed by CT. Which of the following mandates prompt celiotomy (laparotomy)? anterior cord syndrome A 40 - year-old woman restrained driver is transported to the emergency department in full spinal immobilization. She is hemodynamically normal and found to be paraplegic at the level of T10. Neurologic examination also determines there is loss of pain and temperature sensation with preservation of proprioception and vibration. These findings are consistent with the diagnosis of _. injury to the CERVICAL or UPPER THORACIC SPINAL CORD (T6 and above) can cause IMPAIRMENT OF THE DESCENDING SYMPATHETIC PATHWAYS -

• the loss of vasomotor tone causes vasodilation of visceral and peripheral blood vessels, pooling of blood, and consequently, hypotension; the loss of sympathetic innervation to the heart can cause bradycardia (or at least the inability to mount a tachycardic response to hypovolemia) What is neurogenic shock? judicious use of vasopressors may be required after moderate volume replacement, atropine may be used to How do we treat neurogenic shock?

counteract hemodynamically significant bradycardia flaccidity (loss of muscle tone) and loss of reflexes that occur immediately after spinal cord injury What is spinal shock? respiratory failure, intercostal muscles OR diaphragm (eg injury to C3-C5) When a patient's spine is injured, the primary concern should be potential _____________________________________ _. Hypoventilation can occur from paralysis of the _.

perceive pain When a patient's spine is injured, the primary concern should be potential respiratory failure 2/2 paralysis of the intercostal muscles or diaphragm. In addition, inability to _________ can mask a potentially serious injury elsewhere in the body, such as the usual signs of acute abdominal or pelvic pain a/w pelvic fracture. spinal cord Spinal cord injury: Frequently, there is a discrepancy between the bony and neurological levels of injury because the spinal nerves enter the spinal canal through the foramina and ascend or descend inside the spinal canal before actually entering the _. thoracic injury, cervical injury Spinal cord injury can be categorized as either: incomplete or complete paraplegia (________) vs. incomplete or complete quadriplegia ( ________________________ ). paraplegia only affects the body from the chest or waist down What's the difference between paraplegia and quadriplegia? upper extremities, lower extremities Central cord syndrome is characterized by a disproportionately greater loss of motor strength in the ________ than in the _____________ with varying degrees of sensory loss. central cord syndrome = disproportionately greater loss of motor strength in the upper extremities than in the lower extremities with varying degrees of sensory loss; syringomyelia = syrinx expands and damages anterior white commissure of spinothalamic tract --> b/l symmetric loss of pain and temp sensation in How is central cord syndrome different from syringomyelia?

CAPE-LIKE distribution after a hyperextension injury in a patient with pre-existing cervical canal stenosis (mechanism is commonly that of a forward fall resulting in facial impact, especially in the elderly with underlying spinal stenosis after suffering a ground-level fall) How does central cord syndrome (disproportionately greater loss of motor strength in the upper extremities than in the lower extremities with varying degrees of sensory loss) occur? injury to the motor and sensory pathways in the anterior part of the cord --> characterized by paraplegia and a b/l loss of pain and temperature sensation BUT position, vibration, and deep pressure are still intact) How does anterior cord syndrome present? anterior cord syndrome Which spinal cord syndrome has the poorest prognosis of the incomplete injuries? ipsilateral MOTOR loss and loss of POSITION sense + contralateral loss of PAIN and TEMPERATURE sensation beginning one to two levels below the level of injury Brown-Sequard syndrome results from hemisection of the cord, usually due to a penetrating trauma. How does it present? penetrating trauma What usually causes Brown-Sequard syndrome?

4.5%, 4.5%, 18%, 18%, 4.5%, 4.5%,

9%, 9% (the palmar surface, including the fingers, of the patient's hand represents approximately 1% of the patient's body surface) The rule of nines is a practical guide for determining the extent of a burn/evaluating the severity of a burn. What is the percent of the face, back of the head, abdomen/chest, back, front of arms, back of arms, front of legs, back of legs?

a pulmonary contusion may be present in the absence of rib fractures A 6 - year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 20 mph. Which one of the following statements is true: a flail chest is probable, a symptomatic cardiac contusion is expected, a pulmonary contusion may be present in the absence of rib fractures, transection of the thoracic aorta is more liekly than in an adult patient, OR rib fractures are commonly found in children with this mechanism of injury. 1 liter, 20 mL/kg Hemorrhagic shock and initial fluid therapy: the usual initial dose of fluid is ______________________________________ for adults and for pediatric patients weighing less than 40 kg. balancing the goal of organ perfusion/tissue oxygenation with the avoidance of rebleeding by accepting a lower-than-normal BP (aka permissive hypotension) What is "balanced resuscitation?" 3, 4 Early resuscitation with blood and blood products must be considered in patients with evidence of class ___ and ___ hemorrhage. blood loss is 31 - 40%, pulse > 120, BP is decreased, cap refill is 3 - 4 s, and RR is 30 - 40 What is class 3 hemorrhage? 1 mL/kg/hr (although for children under 1 year of age, 2 mL/kg/hr should be maintained) Adequate volume resuscitation should produce a urinary output of approximately 0.5 mL/kg/hr in adults, whereas is adequate urinary output for pediatric patients. transient responders, nonresponders Hemorrhagic shock: Patient response to fluids can be: rapid, transient, or minimal/no response. Patients who are ______ or _________________________ require pRBCs, plasma, and platelets as an early part of their resuscitation. hemothorax (this blood generally has only low levels Autotransfusion: Consider collection of shed blood for autotransfusion in patients with massive _.

of coagulation factors, so plasma and platelets may still be needed)

10 units of pRBCs within the first 24 hours of admission or more than 4 units in 1 hours What is the definition of massive transfusion? decompressing the pneumothorax with a chest tube A simple pneumothorax can be converted to a tension pneumothorax when a patient is intubated and positive pressure ventilation is provided before

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. Foley, FAST exam, x-rays, gastric tubes What are the primary survey adjuncts? allergies, meds, past medical history, last meal, events/environment related to the injury (eg blunt trauma vs penetrating trauma vs thermal injury, environmental hazards, etc.) To collect a history, use the acronym AMPLE: mechanism (and time) of injury, injuries found/suspected, symptoms and signs, treatment initiated What does MIST stand for? Supplementary O2 _______ must be administered to all severely injured trauma patients. cuffed tube placed in the trachea, inflated below the vocal cords, connected to oxygen What is the definition of a definitive airway? hoarseness (dysphonia), subcutaneous emphysema, palpable fracture What is the triad of clinical signs indicating laryngeal trauma? hypoxia, hypercarbia Airway: agitation suggests ________; obtunded suggests _. hypoxic Abusive and belligerent patients may in fact be; do not assume intoxication.

capnography (ETCO2) _______ is the best way to confirm advanced airway placement. movement of CO2 through the respiratory system What is the capnography waveform a graphical representation of? C-spine injury, limited neck flexion/extension, significant facial trauma, limited mouth opening (less than 3 fingers), obesity What things suggest a difficult airway? look externally (small mouth opening, facial trauma), evaluate using 3 - 3 - 2 rule, Mallampati, obstruction, neck mobility LEMON for intubation = distance between upper and lower incisors, distance between hyoid bone and chin, thyromental distance (distance from chin to top of thyroid cartilage, ie "thyroid notch") What is the 3 - 3 - 2 rule? chin-lift, jaw-thrust, 2 team members (one passes ETT while second manually restricts cervical spinal motion) Two ways to ensure continued oxygenation while restricting cervical spinal motion: cricothyroidotomy If ETT fails, try an LMA (or other extraglottic airway) as a bridge to a definitive airway. If this fails, --> _. 0.3 mg/kg Drug-assisted intubation --> an use etomidate as an induction drug. Can also use midazolam. it does not negatively affect blood pressure or intracranial pressure, it can depress adrenal function What are the good things about using etomidate for induction? What's the problem with using it? 5 minutes or less Onset of SCh = less than 1 minute. What is the duration? 1 - 1.5 mg/kg What is the dose of SCh used for intubation? 12 Surgical cricothyroidotomy is not recommended for children under

________________________________________ years of age. 90 SpO2 of 100% = PaO2 of ____. 60 SpO2 of 90% = PaO2 of ____. 30 SpO2 of 60% = PaO2 of ____. 27 SpO2 of 50% = PaO2 of ____. 8 Needle decompression at 5th intercostal space, midaxillary line. Use _________________________________________ cm needle. 28 - 32 french Use french chest tube for hemothorax. tachycardia In most cases, _ is the earliest measurable circulatory sign of shock. cool to the touch, tachycardic Any injured patient who is ________ and should be considered to be in hemorrhagic shock until proven otherwise. blunt cardiac injury, cardiac tamponade, MI, cocaine What are some causes of cardiogenic shock? subcutaneous emphysema What is a potential clinical finding a/w tension pneumothorax besides absent unilateral breath sounds, asymmetric chest rise, hyper- resonance to percussion, and tracheal shift? preterminal event, patient will die within minutes/blood transfusion is required (> 40% blood loss) Class 4 hemorrhagic shock = 31 - 40% (requires blood products) Class 3 hemorrhagic shock = % blood loss.

15 - 30% (possible need for blood products) Class 2 hemorrhagic shock = % blood loss. less than 15% Class 1 hemorrhagic shock = % blood loss. class 3 At what stage of hemorrhagic shock is urine output affected? in unconscious patients, gastric distension increases the risk of aspiration of gastric contents Why do we use a gastric tube for decompression in the trauma patient? at least 18G What qualifies as a large-bore IV? length (double the length --> cuts the flow in half) Radius of catheter = Poseuille's Law --> the rate of flow is proportional to the 4th power of the radius and inversely related to its ___________________ _. 1 L Trauma (hemorrhagic shock) patient --> administer an initial, warmed bolus of isotonic fluid for adults. GIVE BLOOD if still hypotensive after 1 L of crystalloid. balancing the goal of organ perfusion and tissue oxygenation with the avoidance of rebleeding by accepting lower-than- normal BP (do not use the concept of permissive hypotension if the patient has TBI) What is permissive hypotension? 0.5 mg/kg/h What is normal urine output in an adult? 1 mg/kg/h What is normal urine output in a child?