ATLS PRE TEST EXAM 2024, Exams of Nursing

Download ATLS PRE TEST EXAM 2024 and more Exams Nursing in PDF only on Docsity! 1 | P a g e ATLS PRE TEST EXAM 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS BY EXPERTS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+ |NEWEST |LATEST UPDATE |GUARANTEED PASS Which best describes shock? A) Decreased Glasgow Coma Scale (GCS) B) Flushed, dry, hot skin combined with bradycardia C) Generalized inadequate tissue perfusion D) Low blood pressure combined with tachycardia C) Generalized inadequate tissue perfusion Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action? A) Apply a tourniquet B) Apply direct pressure C) Initiate rapid transport D) Restore blood volume B) Apply direct pressure Hypotension of unknown etiology in a trauma patient should be assumed to result from which of the following? A) Blood loss B) Cardiac tamponade C) Spinal injury D) Tension pneumothorax A) Blood loss Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting? 2 | P a g e A) Abdomen B) Blood pressure C) Neurologic status D) Skin D) Skin The body initially compensates for blood loss through activation of which of the following? A) Parasympathetic nervous system B) Reticular activating system C) Spinal reflex arcs D) Sympathetic nervous system D) Sympathetic nervous system Medication used by trauma patients for pre-existing conditions may cause which of the following? A) Herbal preparations may enhance blood clotting B) Anti-inflammatory agents may enhance blood clotting C) Beta blockers may prevent tachycardia with blood loss D) Calcium channel blockers may slow the onset of shock C) Beta blockers may prevent tachycardia with blood loss The target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is which of the following? A) 60 - 70mm Hg B) 80 - 90 mm Hg C) 100 - 110 mm Hg D) 120 - 130 mm Hg B) 80 - 90 mm Hg Which best explains the mechanism by which gas exchange is impaired in pulmonary contusion? A) Blood in the alveoli B) Collapse of the alveoli C) Compression of the lung tissue D) Partial occlusion of the bronchi A) Blood in the alveoli Which of the following is a key finding that differentiates cardiac tamponade from tension pneumothorax? A) Distended jugular veins B) Equal breath sounds 5 | P a g e C. Density of the tissues involved D. Surface area of the impact involved B. Velocity of the bodies involved In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because: A. The protein molecules in crystalloid solutions act as volume expanders B. These fluids draw interstitial fluid into the vascular space to enhance volume C. These solutions will stay in the vascular space longer than water solutions, such as D5W D. Their pH enhance oxygen delivery to the tissues C. These solutions will stay in the vascular space longer than water solutions, such as D5W With respect to the distance of a fall, which of the following is a guideline for determining a critical fall? A. 3 times the height of the patient B. 2 times the height of the patient C. 5 times the height of the patient D. 1 ½ times the height of the patient A. 3 times the height of the patient The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the __________ phase. A. Tertiary phase B. Quaternary phase C. Secondary phase D. Primary phase D. Primary phase During the primary survey and management of a trauma patient, the E in ABCDE stands for _________? A. Edema B. Eyes & ears C. Expose/Environment D. Electrical therapy C. Expose/Environment The time in which surgical intervention can make a difference in patient outcome is the __________? A. Golden period B. Golden time C. Golden era D. Golden minutes 6 | P a g e A. Golden period (hour) In the absence of extenuating circumstances, the maximum amount of time it should take to identify and manage immediate threats to life, prepare the patient for transport and begin transport is _________? A. 5 minutes B. 10 minutes C. 15 minutes D. 30 minutes B. 10 minutes In which of the following situations is the use of a short spinal immobilization device indicated? A. 28 year old male, unrestrained driver in a frontal impact crash. Awake, asks repeatedly what happened, complains of a headache, has a hematoma on his forehead. BP 122/84, HR 92, VR 20. B. 40 year old female who was pushed down a flight of stairs and is lying prone on the landing between two flights of stairs, complaining of back pain. BP 118/78, HR 100, VR 20. C. 17 year old female, restrained driver in a frontal impact crash. Awake, pale and diaphoretic, complains of upper right quadrant abdominal pain. BP 100/70, HR 108, VR 20. D. None of the above D. None of the above Your patient is a 32 year old man, restrained driver of a vehicle that has been involved in a frontal impact with a concrete bridge abutment. The patient is awake, but has difficulty answering questions due to shortness of breath. His ventilatory rate is 30 per minute. Of the following choices, when is the first time the patient's breath sounds should be checked? A. As soon as he is removed from the vehicle B. Prior to being removed from the vehicle C. As soon as he is immobilized on a long backboard D. Enroute to the trauma center B. Prior to being removed from the vehicle Which of the following represents adequate spontaneous ventilation in an adult? A. Tidal volume 100 mL, ventilatory rate 40/minute B. Tidal volume 500 mL, ventilatory rate 8/minute C. Tidal volume 300 mL, ventilatory rate 16/minute D. Tidal volume 600 mL, ventilatory rate 12/minute D. Tidal volume 600 mL, ventilatory rate 12/minute Which of the following is 100% accurate in verifying endotracheal tube placement? A. Pulse oximetry 7 | P a g e B. End-tidal capnometry C. Syringe aspiration D. None of the above D. None of the above....(added info by ang: to verify you need breath sounds, condensation in the tube and a confirmatory CXR) When utilizing percutaneous transtracheal ventilation, the correct ration of lung inflation to lung inflation time, in seconds, is: A. 1:4 B. 1:5 C. 1:2 D. 2:2 A. 1:4 Which of the following is a possible complication of using a manually triggered oxygen powered device for ventilation? A. Gastric distention B. Pneumothorax C. Inability to feel lung compliance D. All of the above D. All of the above Which of the following procedures is considered an essential airway skill? A. Needle cricothyroidotomy B. Endotracheal intubation C. Insertion of an oropharyngeal airway D. Retrograde endotracheal intubation C. Insertion of an oropharyngeal airway Pericardial tamponade is most likely to occur in which of the following situations? A. Stab wound to the chest B. Fall from a height C. Frontal impact vehicle crash D. Gunshot wound to the chest A. Stab wound to the chest Which of the following is the preferred site for needle decompression of a tension pneumothorax? A. 4th intercostal space, midclavicular line, just over the top of the 5th rib B. 4th intercostal space, midclavicular line, just below the 4th rib 10 | P a g e Which of the following assessment techniques is least useful in the prehospital assessment of the patient with suspected intraabdominal trauma? A. Palpation B. Auscultation C. Inspection D. Scene assessment B. Auscultation Pregnant trauma patients should be placed on the left side because: A. This prevents seizures due to eclampsia B. This prevents abruption of the placenta C. This prevents compression of the vena cava D. This is the best way to auscultate fetal heart tones C. This prevents compression of the vena cava Survival of the fetus in a trauma situation is most dependent upon which of the following factors? A. Gestational age of the fetus B. Prenatal care C. Immediate cesarean section D. Good resuscitation of the mother D. Good resuscitation of the mother A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to which area of the brain? A. Frontal and occipital B. Occipital C. Parietal D. Frontal B. Occipital (probably too low velocity for Coup & Contre Coup) In the context of the caring for an adult patient with traumatic brain injury who is deteriorating and exhibiting signs of herniation, hyperventilation means ventilating with a BVM and 100% oxygen at a rate of: A. 12 to 16 per minute B. 32 to 40 per minute C. 8 to 12 per minute D. 20 per minute 11 | P a g e D. 20-hyperventilate to temp decrease ICP In the United State, which of the following mechanisms most frequently causes spinal cord injury in adults? A. Shallow water diving B. Vehicle crashes C. Falls D. Pedestrian struck by a vehicle B. Vehicle crashes Which of the following presentation indicate spinal cord injury? A. Complete loss of sensory and motor function below the site of injury B. Weakness and parethesia in the upper extremities, but normal function in the lower extremities C. Complete loss of function on one side of the body and loss of pain and temperature sensation on the opposite side D. All of the above D. All of the above Of the following, which is the earliest indication of compartment syndrome? A. Paralysis of the affected muscles B. Loss of pulses C. Loss of feeling in the web space between the thumb and index finger or between the first and second toes D. Tense swelling of the involved area D. Tense swelling of the involved area A traction splint may be used for which of the following injuries? A. Knee dislocation B. Pelvic fractures C. Femur fractures D. All of the above C. Femur fractures Which of the following descriptions meets the criteria for transport to a facility with a burn unit? A. A 49 year old female with a partial thickness burn from her elbow to her shoulder B. A 25 year old male with an electrical burn across his chest C. A 9 year old make with superficial burns on the backs of both legs D. A 32 year old female with a partial thickness burn about twice the size of her hand on her back B. A 25 year old male with an electrical burn across his chest 12 | P a g e The preferred method of dressing burns in the prehospital setting is: A. Dry sterile dressing B. Moist sterile dressing C. Wet dressings D. Petroleum gauze A. Dry sterile dressing In assessing the hypothermic patient in the prehospital setting, the most reliable indicator of the severity of hypothermia is: A. Rectal temperature B. Oral temperature C. Heart rate < 60 D. Presence or absence of shivering A. Rectal temperature In the normal child, which general statement is most accurate in comparison with the adult patient? A. Blood pressure is higher, hear rate is higher, and ventilatory rate is higher B. Blood pressure is lower, heart rate is lower, and ventilatory rate is higher C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher D. Blood pressure is lower, heart rate is higher, and ventilatory rate is lowe C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher A patient who withdraws from painful stimuli, opens eyes on verbal command, and cannot speak because of intubation has a Glasgow Coma Scale of which of the following: A. 8 B. 8T C. 7 D. 7T B. 8T (E-3, V-T, M-4) The earliest site for intraosseous infusion is: A. Anterior tibia, just above the tibial tuberosity B. Anterior fibula C. Anterior tibia, just below the tibial tuberosity D. Posterior fibula C. Anterior tibia, just below the tibial tuberosity 15 | P a g e B) Ejection from vehicle C) Lateral compression D) Up and over B) Ejection from vehicle Bilateral femur fractures are most often associated with which type of motorcycle crash? A) Angular impact B) Bike-road impact C) Head-on impact D) Rear impact C) Head-on impact Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting? A) 5% dextrose in water B) 7.5% hypertonic saline C) Hetastarch D) Lactated Ringer's D) Lactated Ringer's Which is the most common cause of upper airway obstruction in the trauma patient? A) Blood B) Teeth C) Tongue D) Vomitus C) Tongue Which is the preferred adjunct device for verifying placement of an endotracheal tube in a patient with a perfusing rhythm? A) End-tidal CO2 monitoring (capnography) B) Esophageal detector device C) Pulse oximeter D) Stethoscope A) End-tidal CO2 monitoring (capnography) Which is the most important reason to maintain an open airway in the trauma patient? A) Prevents aspiration and pneumonia B) Prevents hypoxemia and hypercarbia C) Prevents snoring respirations D) Prevents the tongue from blocking the pharynx 16 | P a g e B) Prevents hypoxemia and hypercarbia Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which of the following? A) Dual lumen airway B) Endotracheal intubation C) Laryngeal mask airway D) Oropharyngeal airway D) Oropharyngeal airway Your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening the airway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. Which of the following is the most appropriate next intervention? A) Apply a non-rebreather mask B) Begin ventilation with a BVM C) Insert an endotracheal tube D) Perform a needle decompression B) Begin ventilation with a BVM When something crashes in secondary survey, you... GO BACK TO PRIAMRY SURVEY If the question says you do not have capabilities, you will most likely PREPARE FOR AND DO NOT DELAY TRANSPORT How much blood can femur lose 2L What is always going to be the shock type to pick Hemorrhagic What are the classes of hemorrhagic shock 0-15% is class 1 15-30 is class 2 30-40% is class 3 >40% is class 4 What is the EARLIEST predictor of shock at what class 17 | P a g e Narrowed pulse pressure in class 2 What will be base deficit for class 2 shock? -2 to -6 meQ What will be the deficit for class 4? -10 or less When will urine output start to decrease in shock? Class 3 and 4 When does BP start to fall in shock Class 3 What is GCS? E-4 V-5 M-6 Eye spont 4 To command 3 To pain 2 None 1 Verbal spont is 5 Verbal confused is 4 Inappropriate 3 Garbling is 2 None is 1 Motor spont is 6 Localize pain is 5 Withdrawal pain is 4 Decorticating (flexion) is 3 Decebrate (extension) is 2 None is 1 Two main reasons to think about why GCS goes down? TBI Hemorrhagic shock Why do you want to put in chest tube before needle decompression? SIMPLE PTX can turn into TENSION PTX 20 | P a g e If there is ANY motor or sensory function below level of injury, constitutes as incomplete injury and should be documented appropriately T/F: Stridor is LATE finding of airway damage in burn pt? TRUE Initial management of burn? DRY dressing. NOT moist! Transfer indications for burn? Partial thickness >40% BSA What is dark urine reflective of in burn pt? RHABDO What do you constantly need to replenish burn pt? Cellular losses 2/2 inflammation What is GOAL urine output in burn? 3-50mL per hour, BEST assessment of hydration What do you need to monitor for with rewarming in hypothermia ARRYTHMIA MCC of cardiac arrest in kids? HYPOXIA If you fail an IV in a kid what is next step? IO What is crystalloid infusion unit for kids 20/kg Two MCC of geriatric injuries? FALL, MVC A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: re-examine the chest 21 | P a g e 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: complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation. In managing a patient with a severe traumatic brain injury, the most important initial step is to: 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 patient? An ABG would demonstrate a base deficit between -6 and -10 mEq/L. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is: urinary output of 0.5 mL/kg/hr The diagnosis of shock must include: 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: direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Leakage of amniotic fluid is an indication for hospital admission. 22 | P a g e The first maneuver to improve oxygenation after chest injury is: administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: 9 A 20-year-old woman who is 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: perform needle or finger 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? respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: 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 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: 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, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: urgently transfer the patient to the operating room 25 | P a g e positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the 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 patient is: prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? A pulmonary contusion may be present in the absence of rib fractures. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: - Re-examine the chest - Perform an aortogram - Obtain a CT scan of the chest - Obtain ABG analysis - Transesophageal echocardiography 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: - complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? - A patient with a torso gunshot wound and hypotension should receive crystalloid fluid resuscitation until the blood pressure is normal - Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation - Massive transfusion is defined as transfusion of more than 10 units of packed red blood cells and plasma within 24 hours - When tranexamic acid is administered by pre-hospital providers, a second dose is required within 24 hours - Fluid resuscitation is far more important than bleeding control in trauma patient In managing a patient with a severe traumatic brain injury, the most important initial step is to: - Secure the airway 26 | P a g e 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 patient? - His pulse pressure will be widened. - His urinary output will be at the lower limits of normal. xxx - He will have tachycardia, but no change in his systolic blood pressure. - An ABG would demonstrate a base deficit between -6 and -10 mEq/L. - His systolic blood pressure will be maintained with an elevated diastolic pressure. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: - increasing the volume of blood loss to produce maternal hypotension. The best assessment of fluid resuscitation of the adult burn patient is: - urinary output of 0.5 mL/kg/hr The diagnosis of shock must include: - 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: - direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - respiratory acidosis xxx - metabolic acidosis - Cerebral vasoconstriction with diminished perfusion - neurogenic pulmonary edema - shift of the oxyhemoglobin dissociation curve After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: - perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? - The fetus is in jeopardy only with major abdominal trauma. - Leakage of amniotic fluid is an indication for hospital admission. - Indications for peritoneal lavage are different from those in the nonpregnant patient. - With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. - The secondary survey follows a different pattern from that of the nonpregnant patient. 27 | P a g e The first maneuver to improve oxygenation after chest injury is: - Administer supplemental oxygen - intubate the patient - assess arterial blood gases - ascertain the need for a chest tube - obtain a chest x-ray A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: 9 A 20-year-old woman who is 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: - perform needle or finger 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? - distended abdomen - Glasgow Coma Scale score of 11 - temperature of 36.5°C (97.8°F) - deforming of the right thigh - respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: - placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: - history of neurological reaction or severe hypersensitivity to the product - local side effects - muscular spasms - pregnancy - all of the above xxx 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? - breath sounds 30 | P a g e - avoid hypotension - administer an osmotic diuretic xxx - aggressively treat systemic hypertension - reduce metabolic requirements of the brain - distinguish between intracranial hematoma and cerebral edema 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 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: - Cardiac tamponade A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? - a serum amylase of 200 - a leukocyte count of 14,000 - evidence of retroperitoneal hematoma on CT scan - development of peritonitis on physical exam - a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? - Neurogenic shock is likely to develop. - Imaging of her complete spine is required prior to transfer to a trauma center. - Given the injury level knee extension would be expected. - Log rolling using 4 people is a safe approach to restrict spinal motion when moving her. Presence of bulbocarvenous reflex indicates a better prognosis. A trauma patient presents to your emergency department with inspiratory stridor and a suspected c- spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: - restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants... - The head is proportionally larger in infants than in adults. A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: 31 | P a g e - placement of a pelvic binder - transfer to a trauma center - pelvic x-ray - insert urinary catheter - repeat examination of pelvis Which one of the following situations requires Rh immunoglobulin administration to an injured woman? - negative pregnancy test, Rh negative, and has torso trauma - positive pregnancy test, Rh positive, and has torso trauma - positive pregnancy test, Rh negative, and has torso trauma - positive pregnancy test, Rh positive, and has an isolated wrist fracture - positive pregnancy test, Rh negative, and has an isolated wrist fracture 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 patient is: - prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? - 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 likely than in an adult patient. - Rib fractures are commonly found in children with this mechanism of injury. When something crashes in secondary survey, you... GO BACK TO PRIAMRY SURVEY If the question says you do not have capabilities, you will most likely PREPARE FOR AND DO NOT DELAY TRANSPORT How much blood can femur lose 2L What is always going to be the shock type to pick Hemorrhagic What are the classes of hemorrhagic shock 0-15% is class 1 15-30 is class 2 32 | P a g e 30-40% is class 3 >40% is class 4 What is the EARLIEST predictor of shock at what class Narrowed pulse pressure in class 2 What will be base deficit for class 2 shock? -2 to -6 meQ What will be the deficit for class 4? -10 or less When will urine output start to decrease in shock? Class 3 and 4 When does BP start to fall in shock Class 3 What is GCS? E-4 V-5 M-6 Eye spont 4 To command 3 To pain 2 None 1 Verbal spont is 5 Verbal confused is 4 Inappropriate 3 Garbling is 2 None is 1 Motor spont is 6 Localize pain is 5 Withdrawal pain is 4 Decorticating (flexion) is 3 Decebrate (extension) is 2 None is 1 Two main reasons to think about why GCS goes down? TBI Hemorrhagic shock 35 | P a g e What is bulbovesicular reflex indicative of? NOT qualify as sacral sparing. If there is ANY motor or sensory function below level of injury, constitutes as incomplete injury and should be documented appropriately T/F: Stridor is LATE finding of airway damage in burn pt? TRUE Initial management of burn? DRY dressing. NOT moist! Transfer indications for burn? Partial thickness >40% BSA A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: Select one: a. reexamine the chest b. perform an aortogram c. obtain a CT scan of the chest d. obtain arterial blood gas analyses e. perform transesophageal echocardiography A) Reexamine the chest A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: Select one: a. angiography b. compartment pressures c. retrograde urethrogram 36 | P a g e d. Doppler ultrasound studies e. complete spine x-ray series e) Complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? Select one: a. A patient that presents with a torso gunshot wound and is hypotensive should receive crystalloid fluid resuscitation until the blood pressure is normal b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation c. Massive transfusion is defined as transfusion of more than >10 of packed red blood cells and plasma in 24 hours d. When tranexamic acid is administered by pre-hospital providers a second dose is required within 24 hours e. Fluid resuscitation is far more important than bleeding control in trauma patients b. Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation In managing a patient with a severe traumatic brain injury, the most important initial step is to: Select one: a. Secure the airway b. obtain a c-spine film c. support the circulation d. control scalp hemorrhage e. determine the GCS score Feedback Your answer is corr a. Secure the airway 37 | P a g e 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 patient? Select one: a. His pulse pressure will be widened. b. His urinary output will be at the lower limits of normal. c. He will have tachycardia, but no change in his systolic blood pressure. d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L e. His systolic blood pressure will be maintained with an elevated diastolic pressure. d. An ABG would demonstrate a base deficit between -6 and -10 mEq/L The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: Select one: a. reducing the need for blood transfusion b. resulting in an elevated hematocrit c. complicating the management of closed head injury d. reducing the volume of crystalloid required for resuscitation e. increasing the volume of blood loss to produce maternal hypotension e. increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the adult burn patient is: Select one: a. Urine output of 0.5 mL/kg/hr b. normalization of blood pressure c. normalization of the heart rate d. measuring a normal central venous pressure e. providing 4 mL/kg/percent body burn/24 hours of crystalloid fluid 40 | P a g e assess arterial blood gases c. administer supplemental oxygen d. ascertain the need for a chest tube e. obtain a chest x-ray c. administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: Select one: a: 2 b: 4 c: 6 d: 9 e: 12 d: 9 Which one of the following findings in an adult is most likely to require immediate management during the primary survey? Select one: a. distended abdomen b. Glasgow Coma Scale score of 11 c. temperature of 36.5°C (97.8°F) d. deformity of the right thigh e. respiratory rate of 40 breaths per minute e. respiratory rate of 40 breaths per minute A 20-year-old woman that is 32 weeks gestation , is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: Select one: a. perform tracheal intubation 41 | P a g e b. insert an oropharyngeal airway c. perform needle or finger decompression of the right chest d. manually displace the gravid uterus to the left side of the abdomen e. initiate 2, large-caliber peripheral IV lines and crystalloid infusion c. perform needle or finger decompression of the right chest An important, immediate step in the management of an open pneumothorax is: Select one: 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 secured on three sides e. initiation of 2, large-caliber IVs and infusing crystalloid solution d. placement of an occlusive dressing over the wound secured on three sides Which of the following is a contraindication for tetanus toxoid administration? Select one: a. history of neurological reaction or severe hypersensitivity to the product b. Local side effects c. muscular spasms d. pregnancy e. all of the above a. history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival to the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following 42 | P a g e best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? Select one: a. tachycardia b. pulse volume c. breath sounds d. pulse pressure e. jugular venous pressure c. breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: Select one: a. The trachea is relatively short. b. The distance from the lips to the larynx is relatively short. c. The use of cuffed endotracheal tubes eliminates this issue. d. The mainstem bronchi are less angulated in their relation to the trachea. e. So little friction exists between the endotracheal tube and the wall of the trachea. 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, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to Select one: a. perform diagnostic peritoneal lavage b. obtain a CT of the chest c. 45 | P a g e 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: Select one: a. request a CT scan b. insert a gastric tube c. suction the oropharynx d. obtain a lateral cervical spine x-ray e. ventilate the patient with a bag-mask 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; no surgical capabilities are 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: Select one: 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 e. delay the transfer until the referring doctor can contact a thoracic surgeon d. repeat the primary survey and proceed with transfer A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: Select one: a. 46 | P a g e intubate the patient b. perform diagnostic peritoneal lavage or FAST c. insert a left chest tube d. call the receiving hospital and speak to the surgeon on call e. discuss the advisability of transfer with the patient's family d. call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: Select one: a. oliguria b. confusion c. hypotension d. tachycardia e. blood transfusion requirement d. tachycardia Which one of the following statements concerning intraosseous infusion is TRUE? Select one: a. Only crystalloid solutions may be safely infused through the needle. b. Aspiration of bone marrow confirms appropriate positioning of the needle. c. Intraosseous infusion is the preferred route for volume resuscitation in small children. d. Intraosseous infusion may be utilized indefinitely. e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. b. Aspiration of bone marrow confirms appropriate positioning of the needle. A young female sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6, blood pressure is 140/90 mm Hg, and her heart rate is 80 beats per minute. 47 | P a g e She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: Select one: a. avoid hypotension b. administer an osmotic diuretic c. aggressively treat systemic hypertension d. reduce metabolic requirements of the brain e. distinguish between intracranial hematoma and cerebral edema a. avoid hypotension A 33-year-old female is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 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: Select one: a. hemorrhagic shock b. cardiac tamponade c. massive hemothorax d. tension pneumothorax e. diaphragmatic rupture b. cardiac tamponade A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? Select one: a. a serum amylase of 200 b. 50 | P a g e c. positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is to: Select one: a. perform a thoracoscopy b. perform an arch aortogram c. insert a second left chest tube d. prepare for an exploratory thoracotomy e. perform a chest CT d. prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? Select one: a. A flail chest is probable. b. A symptomatic blunt cardiac injury is expected. c. A pulmonary contusion may be present in the absence of rib fractures. d. Transection of the thoracic aorta is more likely than in an adult patient. e. Rib fractures are commonly found in children with this mechanism of injury. c. A pulmonary contusion may be present in the absence of rib fractures What is dark urine reflective of in burn pt? RHABDO 51 | P a g e What do you constantly need to replenish burn pt? Cellular losses 2/2 inflammation What is GOAL urine output in burn? 3-50mL per hour, BEST assessment of hydration What do you need to monitor for with rewarming in hypothermia ARRYTHMIA MCC of cardiac arrest in kids? HYPOXIA If you fail an IV in a kid what is next step? IO What is crystalloid infusion unit for kids 20/kg Two MCC of geriatric injuries? FALL, MVC indpendent variable the experimental factor that is manipulated; the variable whose affect is being studied Control In an experiment, the standard that is used for comparison A chemist made the table below to record some atomic properties of four elements.Based on the information in the table, which conclusion about the chemical reactivity of these elements is valid? Fluorine is the most reactive because it has 7 electrons in the outer shell. Based on these drawings, which element is the least reactive? Neon, because it has two energy levels with eight elections 52 | P a g e Four students were asked to name the parts of an atom that determine the atom's identity and chemical properties. The students' responses are shown in the table below. Student 2 A chemist is identifying the elements present in a sample of seawater. What characteristic of an elements atom always determines the element's identity? The number of protons A scientist performs tests on a a sample of an element. The element is a shiny solid that conducts electricity and heat. the scientist is able to bend and flatten the sample when pressure is applied to it. Based on this information, the element COULD NOT be a member of which group on the periodic table? group 18 A compound secreted by honeybees to paralyze intruders in their hive is known as 2-heptanone. The formula for this compound is shown. CH3 C4 H8 COCH3 How many atoms of each element are in one molecule of 2-heptanone? 1/1 7 carbon atoms, 14 hydrogen atoms, and 1 oxygen atom Which statement best describes evidence that a chemical reaction occurs as a cake bakes? The cake rises as gas bubbles form in the baking cake. The diagram shows a model of an atom. The model has four different symbols on it. Each symbol represents a different role for one of the particles within the atom.In this model, which particle determines the reactivity of this atom? particle z 55 | P a g e The spectral classes of four stars are shown in comparison with a Hertzsprung-Russell diagram. Based on the information, which star is most like the sun? star 3 A student viewed the moon through binoculars one week after a new moon. Which image shows the phase of the moon that the student observed? Moon J In November 2013 an object orbiting the sun seemed to disappear behind the sun. When a satellite did not detect the object, astronomers thought that the object had been destroyed when it passed close to the sun. However, when another satellite detected a small, bright object with a fan-shaped tail, astronomers proposed that the object was not destroyed.What type of object were astronomers most likely observing? A comet Which statement best describes a galaxy? A system of billions of stars, gas, and dust held together by gravity A teacher asks students to make a model of a transform plate boundary. The students use blocks to represent tectonic plates and slide the blocks past each other in the directions of the arrows as shown. Which event can the students best demonstrate with their model? An earthquake 56 | P a g e The satellite image below shows a portion of the Namib Desert in Africa. This is an ancient,sandy desert with dunes that can be up to 305 m tall. The Namib Desert extends inland from the Atlantic Ocean between 80 km and 200 km and receives only 5 mm to 76 mm of rain each year. A satellite picture of this same area taken weeks before shows that the shape and location of some sand dunes have changed. Which of these most likely caused the changes in the dunes? Blowing wind A mid-ocean ridge is located at the boundary of two tectonic plates. Which diagram correctly models the relative plate motion on each side of a mid-ocean ridge? Plates B In 2011, Typhoon Nesat struck the Philippines and caused widespread flooding. After hitting the Philippines, Typhoon Nesat was predicted to hit the large city of Hanoi, Vietnam. If Typhoon Nesat had continued along the same path, which development would most likely have reduced its strength before it hit Hanoi? Cool water moving into the sea east of Hanoi The blades of a wind turbine are at rest until the movement of air causes the blades to spin. Which energy transformation happens when the blades are spinning as shown? Mechanical to electrical 57 | P a g e A cook heats a meal in a microwave oven. What energy transformations occur between the microwave oven and the meal? Electrical energy, electromagnetic energy, thermal energy A river area is shown on the topographic map. Four riverbank areas are labeled on the map. Which two riverbanks are the steepest? X and Y Many processes occur in the digestive system. Which process is best classified as a physical change? 1/1 Teeth grinding an almond into smaller pieces in the mouth When people run long distances, their muscles require increased amounts of oxygen. Which system is responsible for CARRYING this oxygen to the muscles? 0/1 Circulatory Both primary and secondary succession begin with pioneer species that-- modify the area and allow larger and more complex organisms to appear NASA's space shuttle program was active from 1981 until 2011. The photograph shows rockets carrying a space shuttle off the launchpad. The rockets were used to escape Earth's gravity. Which of these correctly compares the masses of different objects in the universe? A star has less mass than a galaxy and more mass than a planet. Four students were asked to create a graph representing a typical predatory-prey relationship. Which graph shows a situation in which the number of predators in a population depends on the number of prey? Graph J 60 | P a g e If a purebred tall pea plant is crossed with a purebred short pea plant, then all the offspring will be tall. Samantha is testing the movement of molecules into and out of a cell. She hypothesizes that if she places a drop of salt water on a plant cell, the cell will shrivel. What materials should she use to test her hypothesis? Microscope, slide, and pipette Mutualism, commensalism, and parasitism are the three types of symbiotic relationships. Suppose all the buildings and trees in an area are black. Which color moth would have a better rate of survival? Black The variable that is manipulated (or changed on purpose) by the experimenter is called the Independent variable In a germinating seed, the downward growth of roots is the plant's responses to gravity Both a chloroplast and a vacuole are enclosed by membranes, but the two organelles serve different functions. Which of the following best describes the terms chloroplast and vacuole? A chloroplast transforms light energy, and a vacuole stores water and other substances. Plant cells have a larger _____________than animal cells. This structure is used to store water. vacuole Which of the following represents the correct order for the levels of organization of plants and animals (least to greatest)? cell, tissue, organ, organ system, organism A group of organs performing a similar function is called organ system The heart pumps blood to the lungs, allowing the blood to become oxygenated and then carrying the oxygen to the cells within the body. This describes a key interaction between what two body systems? circulatory and respiratory systems The scientific name of an organism comes from its genus and species Which food web best represents the flow of energy in these feeding relationships? Use the following information to answer the question. 61 | P a g e Choice A Based on the model, which consumers would receive the greatest amount of energy captured by the producers in their food chains? Ring-tailed oppossums How do the industrial, agricultural, and residential activities of humans most likely affect the groundwater in the area? Pollutants from the activities percolate through the soil and enter the water table. Which ecosystem would be most likely to survive if a disease killed the grasses? The forest ecosystem, because most the animals can eat other organisms. Some students take care of a vegetable garden. When it is time to plant in the spring, the students leave part of the garden empty in order to observe ecological succession. Which of these will most likely occur first? Growth of weeds and grasses Based on the dichotomous key, in what order should the insect be classified? Use the following dichotomous key. Coleoptera 62 | P a g e Which table best shows some functions of the circulatory, respiratory, digestive, and endocrine systems. Choice D Which of the following best explains this difference? Use the following information. These species are very similar, but the Hood mockingbird has a longer beak than the other three species. Which of the following best explains this difference? The Hood mockingbird's longer beak is an adaptation to the food available in the bird's habitat. The function of the plant cell structure shown in the enlargement is to-- use energy from sunlight to make sugar What statement was developed most directly from these conclusions and is part of the modern cell theory? Living things are composed of cells.