ATLS POST TEST EXAM LATEST 2024-2025 Update 100 CORRECT QUESTIONS AND VERIFIED ANSWERS GRA, Exams of Nursing

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ATLS POST TEST EXAM (LATEST 2024/

2025 Update) 100% CORRECT QUESTIONS

AND VERIFIED ANSWERS| GRADED A+

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 2 liters of crystalloid solution 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. 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: a) reexamine the chest. b) perform an aortogram. c) obtain a CT scan of the chest. d) obtain arterial blood gas analyses - CORRECT---a) reexamine the chest Which one of the following physical findings suggests a cause of hypotension other than spinal cord injury? a) priapism. b) bradycardia. c) diaphragmatic breathing. d) presence of deep tendon reflexes. - CORRECT---d) presence of deep tendonreflexes. 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: a) compartment pressures b) retrograde urethrogram c) Doppler-ultrasound studies d) complete spine x-ray series - CORRECT---d) complete spine x-ray series In managing the head-injured client, the most important initial step is to: a) obtain c-spine film. b) secure the airway. c) support the circulation. d) control scalp hemorrhage. - CORRECT---b) secure the airway.

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 client? 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) His systolic blood pressure will be decreased with a narrowed pulse pressure. - CORRECT---d) His systolic blood pressure will be decreased with a narrowed pulsepressure. The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: a) reducing the need for blood transfusion. b) increasing the risk of pulmonary edema. c) increasing the volume of blood loss to produce maternal hypotension. d) complicating the mangement of closed head injury. - CORRECT---c) increasing thevolume of blood loss to produce maternal hypotension. The best assessment of fluid resuscitation of the burn client is: a) adequate urinary output. b) reversal of systemic acidosis. c) normalization of the heart rate. d) a normal central venous pressure. - CORRECT---a) adequate urinary output. The diagnosis of shock must include: a) increased vascular resistance. b) evidence of inadequate organ perfusion. c) acidosis. d) hypoxemia. - CORRECT---b) 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: 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. - CORRECT---b) direct pressure onthe wound. For the client with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:

a) respiratory acidosis. b) metabolic acidosis. c) cerebral vasoconstriction with diminished perfusion. d) neurogenic pulmonary edema. - CORRECT---c) cerebral vasoconstriction withdiminished perfusion. A 25 - year-old man is brought to a hospital with a general surgeon after being involved in a motor vehicle crash. Computed tomography 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: a) contrast angiography. b) transfer to a higher level trauma center. c) exploratory laparotomy. d) infuse additional crystalloids. - CORRECT---c) exploratory laparotomy. Which one of the following statements regarding abdominal trauma in the pregnantclient is TRUE? a) The fetus is in jeopardy only with major 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 client. d) Penetration of an abdominal hollow viscus is more common in late than in early pregnancy. - CORRECT---b) Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is: a) intubate the client. b) assess arterial blood gases. c) administer supplemental oxygen. d) ascertain the need for a chest tube. - CORRECT---c) administer supplementaloxygen. 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 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: a) 2 b) 4 c) 6 d) 9 - CORRECT---d) 9

A 20-year-old woman, at 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: a) perform tracheal intubation. b) perform needle decompression of the right chest. c) manually displace the gravid uterus to the left side of the abdomen. d) insert an oropharyngeal airway. - CORRECT---b) perform needle decompression of the right chest. Which one of the following findings in an adult is most likely to require immediate management during the primary survey? a) Distended abdomen. b) Glasgow Coma Scale Score of 11. c) Temperature of 36.5°C (97.8°F). d) Respiratory rate of 40 breaths per minute. - CORRECT---d) Respiratory rate of 40 breaths per minute. The most important, immediate step in the management of an open pneumothorax is: 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. - CORRECT---d) placement of anocclusive dressing over the wound. The following are contraindications for tetanus toxoid administration: a) History of neurological reaction or severe hypersensitivity to the product. b) Local side effects. c) Muscular spasms. d) Pregnancy. - CORRECT---a) History of neurological reaction or severehypersensitivity 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 in 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? a) Tachycardia. b) Pulse volume. c) Breath sounds. d) Pulse pressure. - CORRECT---c) Breath sounds.

Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: a) the trachea is relatively short. b) the distance from the lips to the larynx is relatively short. c) the use of tubes without cuffs allows the tube to slip distally. d) the mainstream bronchi are less angulated in their relation to the trachea. - CORRECT---a) the trachea is relatively short. 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 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). 1500cc of blood has drained from the right chest. The most appropriate next step in managing this client is to: a) perform FAST. b) obtain a CT of the chest. c) immediately transfer the client to a trauma center. d) urgently transfer the client to the operating room. - CORRECT---d) urgently transfer the client 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: a) perform a surgical cricothyroidotomy. b) attempt nasotracheal intubation. c) attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine. d) ventilate him with a bag-mask device until c-spine injury can be excluded. - CORRECT---c) attempt orotracheal intubation using 2 people and inline stabilization ofthe cervical spine. A client 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 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? a) Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. b) Vasoactive medications have no role in this client's management. c) The hypotension should be managed with volume resuscitation alone.

d) Flexion and extension views of the c-spine should be performed early. - CORRECT---a) Flaccidity of the lower extremities and loss of deep tendon reflexes areexpected. Which one of the following is the most effective method for initially treating frostbite? a) Moist heat. b) Early amputation. c) Padding and elevation. d) Vasodilators and heparin. - CORRECT---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 in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessel and the muscles of the lower extremity are firm and hard. During the management of this client, which of the following is most likely to improve the chances for limb salvage? a) Applying skeletal traction. b) Administering anticoagulant drugs. c) Administering thrombolytic therapy. d) Perform right lower extremity fasciotomy. - CORRECT---d) Perform right lowerextremity fasciotomy. A client 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: a) request a CT scan. b) insert a gastric tube. c) suction the oropharynx. d) obtain a lateral cervical spine x-ray. - CORRECT---c) suction the oropharynx. 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 department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the client in transfer. Just before the client 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: a) clamp the chest tube. b) cancel the client's transfer. c) perform an emergency department thoracotomy.

d) repeat the primary survey and proceed with transfer. - CORRECT---d) repeat theprimary survey and proceed with transfer. An elderly man is severely burned in a house fire. On arrival his BP is 100/60, HR of 120, and O2 of 90%. In addition to providing supplmental oxygen, you decide to resuscitate his fluids. He weighs 80kg, has 40% of his total body area burned. What is the total amount of fluid this client needs and how much will you give in the first 8 hours? a) 10,000 total, 2,000 in first 8 hours b) 6,400 total, 3,200 in first 8 hours c) 12,800 total, 6,400 in first 8 hours d) 12,800 total, 3,200 in first 8 hours - CORRECT---c) 12,800 total, 6,400 in first 8 hours A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small hospital with limited resources. 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 infusing 2 liters of crystalloid solution, his blood pressure is 110/ 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 client to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: a) intubate the client. b) call the receiving hospital and speak to the surgeon on call. c) perform diagnostic peritoneal lavage or FAST. d) discuss the advisability of transfer with the client's family. - CORRECT---b) call the receiving hospital and speak to the surgeon on call. Hemorrhage of 20% of the client's blood volume is associated usually with: a) oliguria. b) confusion. c) hypotension. d) tachycardia. - CORRECT---d) tachycardia. What blood volumes must be lost to meet criteria for the four stages of shock? - CORRECT---Stage 1: <20% Stage 2: 20 - 30% Stage 3: 30 - 40% Stage 4: >40% 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 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: a) avoid hypotension. b) administer an osmotic diuretic. c) aggressively treat systemic hypertension. d) reduce metabolic requirements of the brain. - CORRECT---a) avoid hypotension. 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 following statements is TRUE? a) A flail chest is probable. b) A symptomatic cardiac contusion is expected. c) Transection of the thoracic aorta is more likely than in an adult client. d) A pulmonary contusion may be present in the absence of rib fractures. - CORRECT---d) A pulmonary contusion may be present in the absence of rib fractures. All of the following are indicators of inhalation injury, EXCEPT: a) singeing of the eyebrows and nasal vibrissae. b) carboxyhemoglobin level >4%. c) carbon deposits in the mouth or nose, and carbonaceous sputum. d) hoarseness. - CORRECT---b) carboxyhemoglobin level >4%. A 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 definitive treatment in managing this client is to: a) administer Onegative blood. b) apply external warming devices. c) control internal hemorrhage operatively. d) apply a pneumatic antishock garment (PASG). - CORRECT---c) control internalhemorrhage operatively. Regarding shock in the child, which of the following is FALSE: a) Vital signs are agerelated b) Children have greater physiologic reserves than do adults c) Tachycardia is the primary physiologic response to hypovolemia. d) The absolute volume of blood loss required to produce shock is the same as in adults

• CORRECT---d) The absolute volume of blood loss required to produce shock is the same as in adults A 33yearold 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 182 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 thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 81/53 mm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: a) perform external fixation of the pelvis. b) obtain abdominal and pelvic CT scans. c) perform arterial embolization of the pelvic vessels. d) perform diagnostic peritoneal lavage or FAST. - CORRECT---d) perform diagnosticperitoneal lavage or FAST. A 42yearold 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 bagmask device. It becomes more difficult to ventilate the client over the next 5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89% with decreased breath sounds over the left chest. The most appropriate next step is to: a) obtain a chest xray. b) decrease the tidal volume. c) increase the rate of assisted ventilations. d) perform needle decompression of the left chest. - CORRECT---d) perform needledecompression of the left chest. A young man sustains a rifle wound to the midabdomen. He is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate, step is to perform: a) a laparotomy. b) diagnostic laparoscopy. c) abdominal ultrasonography. d) a diagnostic peritoneal lavage. - CORRECT---a) a laparotomy. The primary indication for transferring a client to a higher level trauma center is: a) unavailability of a surgeon or operating room staff. b) multiple system injuries, including severe head injury. c) resource limitations as determined by the transferring doctor. d) resource limitations as determined by the hospital administration. - CORRECT--- c)resource limitations as determined by the transferring doctor. A 42yearold man is trapped from the waist down beneath his overturned 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 client 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 finding is: a) an epidural hematoma. b) a pelvic fracture. c) central cord syndrome. d) bilateral compartment syndrome. - CORRECT---d) bilateral compartment syndrome. A 30yearold 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: a) immediate angiography. b) wound exploration and removal of bony fragments. c) realignment of the fracture segments with a traction splint. d) fasciotomy of all four compartments in the lower extremity. - CORRECT--- d)fasciotomy of all four compartments in the lower extremity. An 18yearold, unhelmeted motorcyclist is brought by ambulance to the emergency department following a crash. He had decreased level of consciousness at the scene, but then was alert and conversational during transportation. Now his GCS is only 11. Which of the following statements is TRUE? a) Cerebral perfusion is intact. b) Intravascular volume status is normal. c) The client probably has an acute epidural hematoma. d) Intraabdominal visceral injuries are unlikely. - CORRECT---c) The client probably has an acute epidural hematoma. During an altercation, a 36yearold man sustains a gunshot wound above the nipple line on the right, with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital without surgical services. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of Ringer's lactate solution are infused via 2 largecaliber 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 client is: a) laparotomy.

b) diagnostic peritoneal lavage. c) arterial blood gas determination. d) administer packed red blood cells. - CORRECT---d) administer packed red bloodcells. A 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 immediate management is to: a) perform diagnostic peritoneal lavage. b) initiate infusion of packed red blood cells. c) insert a nasogastric tube and urinary catheter. d) transfer the client to the operating room, while initiating fluid therapy. - CORRECT- --d) transfer the client to the operating room, while initiating fluid therapy. A teenaged bicycle rider is hit by a truck traveling at high 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 client is to: a) obtain a lateral cervical spine xray. b) administer 2 liters of crystalloid solution. c) insert a central venous pressure line. d) perform endotracheal intubation and ventilation. - CORRECT---d) performendotracheal intubation and ventilation. An 8yearold boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24houraday operating room capabilities. The most appropriate management of this client would be to: a) type and crossmatch for blood. b) request consultation of a pediatrician. c) transfer the client to a trauma center. d) admit the client to the intensive care unit. - CORRECT---c) transfer the client to a trauma center. Which of the following statements regarding injury to the central nervous system in children is TRUE? a) Children suffer spinal cord injury without xray abnormality more commonly than adults.

b) An infant with a traumatic brain injury may become hypotensive from cerebral edema. c) Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone intravenously. d) Children have more focal mass lesions as a result of traumatic brain injury when compared to adults. - CORRECT---a) Children suffer spinal cord injury without xray abnormality more commonly than adults. A 17yearold 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 client may include the use of all the following EXCEPT: a) air splints. b) bolstering devices. c) a scoopstyle stretcher. d) a semirigid cervical collar. - CORRECT---a) air splints. Twentyseven clients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to: a) treat the most severely injured clients first. b) establish a field triage area directed by a doctor. c) produce the greatest number of survivors based on available resources. d) treat the greatest number of clients in the shortest period of time. - CORRECT---c) produce the greatest number of survivors based on available resources. 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 on the bottom of the right foot. His urine is positive for blood by dipstick but no RBCs are seen microscopically. Initial management should include: a) immediate angiography. b) aggressive fluid infusion. c) intravenous pyelography. d) debridement of necrotic muscle. - CORRECT---b) aggressive fluid infusion. A 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:

a) administer an osmotic diuretic. b) prevent secondary brain injury. c) aggressively treat systemic hypertension. d) distinguish between intracranial hematoma and cerebral edema. - CORRECT--- d)distinguish between intracranial hematoma and cerebral edema. To establish a diagnosis of shock: a) systolic blood pressure must be below 90 mm Hg. b) the presence of a closed head injury should be excluded. c) acidosis should be present by arterial blood gas analysis. d) clinical evidence of inadequate organ perfusion must be present. - CORRECT--- d)clinical evidence of inadequate organ perfusion must be present. A 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: a) inserting an oropharyngeal airway. b) inserting a nasopharyngeal airway. c) performing a surgical cricothyroidotomy. d) performing fiberoptic-guided nasotracheal intubation. - CORRECT---c) performing asurgical cricothyroidotomy. A 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 the emergency department, she is unconscious and has a GCS score of 6. The initial management step for this client should be to: a) obtain a CT scan of the head. b) administer decadron 20 mg IV. c) perform endotracheal intubation. d) administer mannitol 1 g/kg IV. - CORRECT---c) perform endotracheal intubation. A contraindication to nasogastric intubation is the presence of a: a) gastric perforation. b) fracture of the cribriform plate. c) open depressed skull fracture. d) fracture of the cervical spine. - CORRECT---b) fracture of the cribriform plate. An 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 xrays do not show a fracture or dislocation. A spinal cord injury in this child: a) is most likely a central cord syndrome. b) must be diagnosed by magnetic resonance imaging. c) can be excluded by obtaining a CT of the entire spine. d) may exist in the absence of objective findings on xray studies. - CORRECT---d) mayexist in the absence of objective findings on xray studies. Immediate chest tube insertion is indicated for which of the following conditions? a) Pneumothorax b) Pneumomediastinum c) Massive hemothorax d) Diaphragmatic rupture - CORRECT---c) Massive hemothorax Cardiac tamponade after trauma: a) is seldom lifethreatening. b) can be excluded by an upright, AP chest xray. c) can be confused with a tension pneumothorax. d) causes a fall in systolic pressure of >15 mm Hg with expiration. - CORRECT---c) canbe confused with a tension pneumothorax. What are the three aspects of Beck's Triad for cardiac tamponade? - CORRECT---Elevated JVD Hypotension Distant heart sounds What is the most rapid way to diagnose cardiac tamponade? - CORRECT--- eFASTultrasound exam A 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: a) hemorrhage into the chest or abdomen. b) an epidural hematoma. c) a transected lumbar spinal cord. d) a basilar skull fracture. - CORRECT---a) hemorrhage into the chest or abdomen. What is the most likely cause of shock in the trauma client? - CORRECT---Hemorrhage WHAT IS THE MOST LIKELY CAUSE OF SHOCK IN THE TRAUMA CLIENT? - CORRECT---HEMORRHAGE

All of the following signs on the chest xray of a blunt injury victim may suggest aortic rupture EXCEPT: a) mediastinal emphysema. b) presence of a "pleural cap." c) obliteration of the aortic knob. d) deviation of the trachea to the right. - CORRECT---a) mediastinal emphysema. A crosstable lateral xray of the cervical spine: a) must precede endotracheal intubation. b) excludes serious cervical spine injury. c) is an essential part of the primary survey. d) is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. - CORRECT---d) is unacceptable unless 7 cervical vertebrae and the C- 7 toT- 1 relationship are visualized. Following immediate traumatic resuscitation, which one of the following is the most reliable as a guide to volume replacement? a) heart rate b) hematocrit c) blood pressure d) urinary output - CORRECT---d) urinary output A 24yearold woman passenger in an automobile strikes the wind screen with her face during a headon collision. In the emergency department, she is talking and has marked facial edema and crepitus. The highest priority should be given to: a) lateral cspine xray. b) upper airway protection. c) carotid pulse assessment. d) management of blood loss. - CORRECT---b) upper airway protection. During the third trimester of pregnancy, all of the following changes occur normally, EXCEPT a: a) decrease in PaCO2. b) decrease in leukocyte count. c) reduced gastric emptying rate. d) diminished residual lung volume. - CORRECT---b) decrease in leukocyte count. In managing the headinjured client, the most important initial step is to: a) secure the airway.

b) obtain cspine film. c) support the circulation. d) control scalp hemorrhage. - CORRECT---a) secure the airway. A trauma client presents to your emergency department with inspiratory stridor and a suspected cspine injury. Oxygen saturation is 88% on highflow oxygen via a nonrebreathing mask. The most appropriate next step is to: a) apply cervical traction. b) perform immediate tracheostomy. c) insert bilateral thoracostomy tubes. d) maintain inline immobilization and establish a definitive airway. - CORRECT--- d)maintain inline immobilization and establish a definitive airway. When applying the Rule of Nines to infants: 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. - CORRECT---c) the head isproportionally larger in infants than in adults. A 60 year old man sustains a stab wound to the right posterior flank. Witnesses state the weapon was a small knife. His heart rate is 90 beats per minute, blood pressure is 128/72 mm Hg, and respiratory rate is 24 breaths per minute. The most appropriate action to take at this time is to: a) perform a colonoscopy. b) perform a barium enema. c) perform an intravenous pyelogram. d) perform serial physical examinations. - CORRECT---d) perform serial physicalexaminations. The following are criteria for transfer to a burn center, EXCEPT for: a) Partialthickness and fullthickness burns on greater than 10% of the BSA b) Any fullthickness burn c) Partialthickness and fullthickness burns involving the face, hands, feet, genitalia, perineum, and skin overlying major joints d) Elevated central venous pressure - CORRECT---d) Elevated central venous pressure Systolic blood pressure starts to decrease in which class of hemorrhage? a) Class 1 b) Class 2 c) Class 3

d) Class 4 - CORRECT---c) Class 3 For the client with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: a) respiratory alkalosis. b) metabolic acidosis. c) cerebral vasoconstriction with diminished perfusion. d) neurogenic pulmonary edema. - CORRECT---c) cerebral vasoconstriction withdiminished perfusion. A 33yearold woman is involved in a headon 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 15. 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: a) hemorrhagic shock. b) cardiac tamponade. c) massive hemothorax. d) tension pneumothorax. - CORRECT---b) cardiac tamponade. A hemodynamically normal 10yearold girl is admitted to the Pediatric Intensive Care Unit (PICU) for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt laparotomy? a) A serum amylase of 200. b) A leukocyte count of 14,000. c) Extraperitoneal bladder rupture. d) Free intraperitoneal air demonstrated on followup CT. - CORRECT---d) Freeintraperitoneal air demonstrated on followup CT. 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 that there is loss of pain and temperature sensation with preservation of proprioception and vibration. These findings are consistent with the diagnosis of: a) central cord syndrome. b) anterior cord syndrome. c) complete cord syndrome. d) Brown-Sequard's syndrome. - CORRECT---b) anterior cord syndrome.

A 38 year old woman is stabbed in the back by a 4-inch knife. Her blood pressure is 120/78. She has motor weakness in her left leg and loss of sensation to pain and temperature in her right side below the navel. What spinal cord syndrome is she suffering? a) central cord syndrome. b) anterior cord syndrome. c) complete cord syndrome. d) Brown-Sequard's syndrome. - CORRECT---d) Brown-Sequard's syndrome. A trauma client 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 is to: a) apply cervical traction. b) perform immediate tracheostomy. c) maintain 100% oxygen and obtain immediate c-spine x-rays. d) maintain inline immobilization and establish a definitive airway. - CORRECT--- d)maintain inline immobilization and establish a definitive airway. Healthy young male in a motor vehicle crash is brought to the emergency department with a blood pressure of 84/60, pulse 123, GCS 10. The client moans when his pelvisis palpated. After initiating fluid resuscitation, the next step in management is: a) Placement of a pelvic binder b) Transfer to a trauma center c) Pelvic x-ray d) Insert urinary catheter - CORRECT---a) Placement of a pelvic binder 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 emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 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 next management step for this client is: a) perform a thoracoscopy. b) perform an arch aortogram. c) insert a second left chest tube. d) prepare for an exploratory thoracotomy. - CORRECT---d) prepare for an exploratorythoracotomy. Early central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a: a) client with a splenic laceration.

b) client with an inhalation injury. c) 6 year old child with a pelvic fracture. d) client with a severe cardiac contusion. - CORRECT---d) client with a severe cardiac contusion. A 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 client's thorax. Primary resuscitation includes highflow oxygen administration via a nonrebreathing mask, and initiation of Ringer's lactate solution. The client exhibits progressive confusion, pain, and tachypnea. Management at this time should consist of: a) intravenous sedation. b) external stabilization of the chest wall. c) increasing the FIO2 in the inspired gas. d) intercostal nerve blocks for pain relief. - CORRECT---d) intercostal nerve blocks forpain relief. Which one of the following statements regarding clients with thoracic spine injuries is TRUE? a) Logrolling may be destabilizing to fractures from T12 to L1. b) Adequate immobilization can be accomplished with the scoop stretcher. c) Spinal cord injury below T10 usually spares bowel and bladder function. d) Hyperflexion fractures in the upper thoracic spine are inherently unstable. - CORRECT---d) Hyperflexion fractures in the upper thoracic spine are inherently unstable. The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head injury and determine that the client is unable to protect his airway. In the emergency department, the client demonstrates decorticate posturing bilaterally. He is being ventilated with a bagvalve device, but his breath sounds are absent in the left hemithorax. His blood pressure is 160/88 mm Hg, heart rate is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%. The next step in assessing and managing this client should be to: a) determine the arterial blood gases. b) obtain a lateral cervical spine xray. c) assess placement of the endotracheal tube. d) perform needle decompression of the left chest. - CORRECT---c) assess placement ofthe endotracheal tube. The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in: a) placental abruption.

b) fetal hypoxia and distress. c) fetal/maternal dysrhythmia. d) improved uterine blood flow. - CORRECT---b) fetal hypoxia and distress. Which one of the following statements concerning intraosseous infusion is TRUE? 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) Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. - CORRECT---b) Aspiration of bone marrow confirms appropriate positioning of the needle. Which one of the following situations requires Rh immunoglobulin administration to an injured woman? a) Negative pregnancy test, Rh negative, and torso trauma. b) Positive pregnancy test, Rh positive, and has torso trauma. c) Positive pregnancy test, Rh negative, and has torso trauma. d) Positive pregnancy test, Rh positive, and has an isolated wrist fracture. - CORRECT---c) Positive pregnancy test, Rh negative, and has torso trauma. 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: a) complete spine xray series. b) compartment pressures. c) retrograde urethrogram. d) dopplerultrasound studies. - CORRECT---a) complete spine xray series. A 23 year old man sustains three 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 largecaliber 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% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this client is to: a) perform FAST. b) obtain a CT of the chest. c) perform an angiography.

d) urgently transfer the client to the operating room. - CORRECT---d) urgently transfer the client to the operating room. All of the following are true of the Mallampati classification, EXCEPT: a) Class IV is the easiest intubation, while Class I is the most difficult. b) It helps assess for difficult intubations. c) It is part of the LEMON assessment. d) It comprises a visual assessment of the distance from the tongue base to the roof of the mouth, and therefore the amount of space in which there is to work. - CORRECT--- a)Class IV is the easiest intubation, while Class I is the most difficult. A 29yearold female arrives in the emergency department 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 caesarean section due to the risk of impending abruptio placentae. d) The risk of premature fetal delivery and death is reduced by the use of restraints. - CORRECT---d) The risk of premature fetal delivery and death is reduced by the use of restraints. Cardiac tamponade: 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 emergency department d) requires surgical intervention and drainage - CORRECT---d) requires surgical intervention and drainage A 14yearold female is brought to the emergency department after falling from a horse. She is immobilized on a long spine board with a hard collar and blocks. Cervical spine xrays: a) will show cervical spine injury in more than 20% of these clients. b) will exclude cervical spine injury if no abnormalities are found on the xrays. 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. - CORRECT---b) will exclude cervical spine injury if no abnormalities are found on the xrays. The most specific test to evaluate for injuries of solid abdominal organs is:

a) abdominal xrays b) abdominal ultrasonography c) CT of abdomen and pelvis d) frequent abdominal examinations - CORRECT---c) CT of abdomen and pelvis A 40yearold obese client with a Glasgow Coma Scale score of 8 and deteriorating respiratory status requires a CT Scan. Before transfer to the scanner, 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. - CORRECT---c) insert a definitive airway. A 25 year old female in the third trimester of pregnancy is brought to the emergency department following a highspeed motor vehicle crash. She is conscious and immobilized on a long spine board. Her respiratory rate is 24, heart rate is 120, and blood pressure is 70/50. The laboratory results show a PaCO2 of 40 mm Hg. Which one of the following statements concerning this client is true? a) Fetal assessment should take priority. b) Logrolling the client to the right will decompress the vena cava. c) Rhimmunoglobulin therapy should be immediately administered. d) The client likely has impending cardiorespiratory failure. - CORRECT---d) Theclient likely has impending cardiorespiratory failure. The most important consequence of inadequate organ perfusion is: a) multiple organ failure b) decreased base deficit c) acute glomerulonephritis d) increased cellular adenosine triphosphate (ATP) production - CORRECT---a) multipleorgan failure Hypertension following a head injury: a) should be treated to reduce intracranial pressure b) may indicate imminent herniation from critically high intracranial pressure c) indicates preexisting hypertension d) mandates prompt administration of mannitol - CORRECT---b) may indicate imminentherniation from critically high intracranial pressure 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. - CORRECT---b) rapid rewarming ofthe body part in circulating warm water. Which of the following signs is least reliable for diagnosing esophageal intubation? a) symmetrical chest wall movement b) endtidal CO2 c) bilateral breath sounds d) oxygen saturation - CORRECT---d) oxygen saturation A 6monthold infant, being held in her mother's arms, is ejected on impact from a vehicle that is struck headon by an oncoming car traveling at 64 kph (40 mph). The infant arrives in the emergency department with multiple facial injuries, is lethargic, and is in severe respiratory distress. Respiratory support is not effective using a bagmask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. The most appropriate procedure to perform next is: a) administer heliox and racemic epinephrine b) perform needle cricothyroidotomy with jet insufflation c) repeat orotracheal intubation d) perform surgical cricothyroidotomy - CORRECT---b) perform needle cricothyroidotomywith jet insufflation Which one of the following injuries is addressed in the secondary survey? a) forearm fracture b) midthigh amputation c) open fracture with bleeding d) unstable pelvic fracture - CORRECT---a) forearm fracture A 30yearold male is stabbed in the right chest. On arrival in the emergency department, he is very short of breath. His heart rate is 120 and blood pressure is 80/50 mm Hg. His neck veins are flat. On auscultation of the chest, there is 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 - CORRECT---d) hemothorax A specific aspect of the treatment of thermal injuries is: a) chemical burns require the immediate removal of clothing. b) clients who sustain thermal injury are at lower risk for hypothermia.

c) clients with circumferential truncal burns need prompt fasciotomies. d) electrical burns are associated with extensive skin necrosis. - CORRECT--- a)chemical burns require the immediate removal of clothing. Which one of the following statements is true? a) Elevated intracranial pressure will not affect cerebral perfusion. b) Cerebrospinal fluid cannot be displaced from the cranial vault. c) Cerebral blood flow is increased when the PacO2 is below 30 mm Hg. d) Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. - CORRECT---d) Autoregulation of cerebral blood flownormally occurs between mean arterial pressures of 50 to 150 mm Hg. Initial resuscitation in adult trauma clients should: a) be with 2 liters of crystalloid, monitoring the client's response. b) use crystalloid to normalize blood pressure. c) use permissive hypotension in clients with head injury. d) be with a nonblood colloid solution. - CORRECT---a) be with 2 liters of crystalloid,monitoring the client's response. A 25yearold male is brought to the emergency department 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 statements concerning this client is true? a) Mandatory intubation to protect his airway is required. b) His Glasgow Coma Scale suggests a severe head injury. c) His level of consciousness can be solely attributed to elevated blood alcohol. d) CT Scanning is an important part of neurological assessment. - CORRECT---d) CTScanning is an important part of neurological assessment. Which one of the following statements is true regarding access in pediatric resuscitation? a) Intraosseous access should only be considered after five percutaneous attempts. b) Cutdown at the ankle is the preferred initial access technique. c) Internal jugular cannulation is the next preferred option when percutaneous venous access fails. d) Blood transfusion can be effectively delivered through intraosseous access. - CORRECT---d) Blood transfusion can be effectively delivered through intraosseousaccess. A 35 year old female sustains multiple injuries in a motor vehicle crash and is transported to a small hospital in full spinal protection. She has a GCS score of 4 and is being mechanically ventilated. Intravenous access is established and warmed

crystalloid is infused. She remains hemodynamically normal and full spinal protection is maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tests or treatments is mandatory? a) FAST exam b) Chest xray c) lateral cervical spine xray d) administration of methylprednisolone - CORRECT---b) Chest xray A 22 year old male is assaulted in a bar. A semirigid cervical collar is applied, and he is immobilized on a spine board. On initial examination, his vital signs are normal, and his Glasgow Coma Scale score is 15. Which of the following is an indication for CT in this client with possible minor traumatic brain injury? a) presence of hemotympanum b) blood alcohol concentration of 0.16% (160 mg/100 ml) c) presence of an isolated 10 cm scalp laceration d) presence of a mandibular fracture - CORRECT---a) presence of hemotympanum Supraglottic airway devices: a) are equivalent to endotracheal intubation. b) require neck extension for proper placement. c) are preferable to endotracheal intubation in a client who cannot lie flat. d) are of value as part of a difficult or failed intubation plan. - CORRECT---d) are of valueas part of a difficult or failed intubation plan. A 70 year old male suffers blunt chest trauma after being struck by a car. On presentation, his Glasgow Coma Scale score is 15, blood pressure is 145/90 mm Hg, heart rate is 72, respiratory rate is 24, and oxygen saturation on 5 L is 91%. Chest xray demonstrates multiple rightsided rib fractures. ECG demonstrates normal sinus rhythm with no conduction abnormalities. Management should include: a) placement of a 22French, rightsided chest tube. b) serial troponins and cardiac monitoring. c) thoracic splinting, taping, and immobilization. d) monitored analgesia. - CORRECT---d) monitored analgesia. A 15 year old male presents following a motorcycle crash. Initial examination reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in this client's management is: a) splenic artery embolization.