ATLS POST-TEST EXAM QUESTIONS AND CORRECT ANSWERS GRADED A+ LATEST 2024-2025, Exams of Nursing

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ATLS POST-TEST EXAM QUESTIONS AND CORRECT

ANSWERS GRADED A+ LATEST 2024- 2025

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 - ANSWER: 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. - ANSWER: d) presence of deep tendon reflexes. 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 - ANSWER: d) complete spine x-ray series In managing the head-injured patient, the most important initial step is to: a. obtain c-spine film. b. secure the airway. c. support the circulation. d. control scalp hemorrhage. - ANSWER: b) secure the airway.

b. reversal of systemic acidosis. c. normalization of the heart rate. d. a normal central venous pressure. - ANSWER: a) adequate urinary output. The diagnosis of shock must include: a. increased vascular resistance. b. evidence of inadequate organ perfusion. c. acidosis. d. hypoxemia. - ANSWER: 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. - ANSWER: b) direct pressure on the wound.

For the patient 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. - ANSWER: c) cerebral vasoconstriction with diminished 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. - ANSWER: c) exploratory laparotomy. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?

c. 6 d. 9 - ANSWER: 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. - ANSWER: 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. - ANSWER: 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. - ANSWER: d) placement of an occlusive 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. - ANSWER: a) History of neurological reaction or severe hypersensitivity to the product. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival 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

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 patient is to: a. perform FAST. b. obtain a CT of the chest. c. immediately transfer the patient to a trauma center. d. urgently transfer the patient to the operating room. - ANSWER: d) urgently transfer the patient to the operating room. A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS Score of

6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: 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. - ANSWER: c) attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine.

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 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 patient'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. - ANSWER: a) Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. 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. - ANSWER: 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

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 patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: a. clamp the chest tube. b. cancel the patient's transfer. c. perform an emergency department thoracotomy. d. repeat the primary survey and proceed with transfer. - ANSWER: d) repeat the primary 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 patient 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 - ANSWER: 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 patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: a. intubate the patient. 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 patient's family. - ANSWER: b) call the receiving hospital and speak to the surgeon on call. All of the following suggest urethral injury in a male, EXCEPT: a. scrotal hematoma. b. blood in the rectal lumen. c. blood at the external urethral meatus.

a. lateral compression forces, resulting in open book pelvic fractures. b. anterior-posterior compression, resulting in shifting of the iliac bones vertically. c. vertical displacement of the hemipelvis, typically resulting in disruption of the sacrospinous ligaments. d. direct blows to the iliac crest of the pelvis, resulting in sacral fractures. - ANSWER: c) vertical displacement of the hemipelvis, typically resulting in disruption of the sacrospinous ligaments. 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 patient's management is: a. splenic artery embolization. b. surgical consultation. c. transfer to a pediatrician. d. urgent laparotomy. - ANSWER: b) surgical consultation. A 30yearold female is brought to the emergency department after being injured in a motor vehicle crash. Her initial blood pressure is 90/60 mm Hg, and her heart rate is 122 beats per minute. She responds to the rapid infusion of 1 liter of crystalloid Solution with

a rise in her blood pressure to 118/88 mm Hg and a decrease in her heart rate to 90 beats per minute. Her pressure then suddenly decreases to 96/66 mm Hg. The least likely cause of her hemodynamic change is: a. traumatic brain injury. b. ongoing blood loss. c. blunt cardiac injury. d. inadequate resuscitation. - ANSWER: b) ongoing blood loss. Limbthreatening extremity injuries: a. require a tourniquet. b. are characterized by the presence of ischemic or crushed tissue. c. should be definitively managed by application of a traction splint. d. are rarely present without an open wound. - ANSWER: b) are characterized by the presence of ischemic or crushed tissue. The first priority in the management of a long bone fracture is: a. reduction of pain. b. prevention of infection in case of an open fracture. c. prevention of further soft tissue injury. d. control of hemorrhage. - ANSWER: d) control of hemorrhage.

A 27 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, and Glasgow Coma Scale score is 15. Oxygen Saturation is 99% on 21 nasal prongs. Chest xray, pelvic Xray, and FAST are normal. Extremities are normal. His management should be: a. 2 L of IV crystalloid and two units of pRBCs (packed red blood cells). b. 2 L of IV crystalloid, mannitol, and IV steroids. c. 1 unit of albumin and compression stockings. d. 2 L of crystalloid and vasopressors if BP does not respond. - ANSWER: d) 2 L of crystalloid and vasopressors if BP does not respond. 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 - ANSWER: c) distended neck veins Hemorrhage of 20% of the patient's blood volume is associated usually with:

a. oliguria. b. confusion. c. hypotension. d. tachycardia. - ANSWER: d) tachycardia. What blood volumes must be lost to meet criteria for the four stages of shock? - ANSWER: 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. - ANSWER: a) avoid hypotension.