ATLS TEST 1/40 QUESTIONS AND ANSWERS/ LATEST WITH COMPLETE SOLUTION, Exams of Nursing

Download ATLS TEST 1/40 QUESTIONS AND ANSWERS/ LATEST WITH COMPLETE SOLUTION and more Exams Nursing in PDF only on Docsity! ATLS TEST 1/40 QUESTIONS AND ANSWERS/ LATEST WITH COMPLETE SOLUTION 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 Correct ans - 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 d. Doppler ultrasound studies e. complete spine x-ray series Correct ans - 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 Correct ans - 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. direct pressure on the femoral artery at the groin e. debridement of devitalized tissue Correct ans - b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosis b. metabolic acidosis c. cerebral vasoconstriction with diminished perfusion d. neurogenic pulmonary edema e. shift of the oxyhemoglobin dissociation curve Correct ans - c. 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: Select one: a. obtain contrast angiography b. transfer to a higher level trauma center c. perform an exploratory laparotomy d. infuse additional crystalloid fluids e. Obtain transesophageal echocardiography Correct ans - c. perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Select one: a. The fetus is in jeopardy only with major maternal 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 patient. d. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient. Correct ans - b. Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is to: Select one: a. intubate the patient b. assess arterial blood gases c. administer supplemental oxygen d. ascertain the need for a chest tube e. obtain a chest x-ray Correct ans - 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: e: 12 Correct ans - 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 Correct ans - 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 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 Correct ans - 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 Correct ans - d. placement of an occlusive dressing over the wound secured on three sides restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. 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? Select one: a. Vasoactive medications have no role in this patient's management. b. The hypotension should be managed with volume resuscitation alone. c. Flexion and extension views of the c-spine should be performed early. d. Abdominal visceral injuries can be excluded as a cause of hypotension. e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Correct ans - e. 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? Select one: a. moist heat b. early amputation c. padding and elevation d. vasodilators and heparin e. topical application of silver sulfadiazine Correct ans - 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 to the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, a pulse cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? Select one: a. applying skeletal traction b. administering anticoagulant drugs c. administering thrombolytic therapy d. surgical consultation for right lower extremity fasciotomy e. transferring the patient to the trauma center 120 km away Correct ans - d. surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: 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 Correct ans - 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 Correct ans - 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. 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 Correct ans - 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 Correct ans - d. tachycardia a. Neurogenic shock is likely to develop b. Imaging of her complete spine is required prior to transfer to a trauma center c. Given the injury level knee extension would be expected d. log rolling using 4 people is a safe approach to limit spinal motion when moving her e. Presence of bulbocarvenous reflex indicates a better prognosis Correct ans - d. log rolling using 4 people is a safe approach to limit spinal motion when moving her 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: Select one: a. apply cervical traction b. perform immediate tracheostomy c. insert bilateral thoracostomy tubes d. maintain 100% oxygen and obtain immediate c-spine x-rays e. restrict cervical motion and establish a definitive airway Correct ans - e. restrict cervical motion and establish a definitive airway When applying the Rule of Nines to infants: Select one: 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. e. The arms are proportionally larger in infants than in adults. Correct ans - c. 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: Select one: a. placement of a pelvic binder b. transfer to a trauma center c. pelvic x-ray d. insert urinary catheter e. repeat examination of pelvis Correct ans - a. placement of a pelvic binder Which situation requires Rh immunoglobulin administration to an injured female? Select one: a. negative pregnancy test, Rh negative, and has 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 e. positive pregnancy test, Rh negative, and has an isolated wrist fracture Correct ans - 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 Correct ans - 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. Correct ans - c. A pulmonary contusion may be present in the absence of rib fractures