ATLS Test 1 Questions with Complete Solution Latest Update, Exams of Nursing

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ATLS Test 1 Questions with

Complete Solution Latest Update

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 answers - a Reexamine the chest correct answerers 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 answers – e Complete spine x-ray series correct answerer – 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 patients. Correct answer - b Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow coma scale score on reevaluation Correct answerer 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 Correct answers a. Secure the airway correct answer 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. Correct answers - d.

An ABG would demonstrate a base deficit between -6 and - mEq/Lcorrect 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 Correct answers - 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 Correct answer - a. Urine output of 0.5 mL/kg/hr correct answerers The diagnosis of shock must include: Select one: a. hypoxemia b. acidosis c. hypotension d. increased vascular resistance e. evidence of inadequate organ perfusion Correct answers - e. Evidence of inadequate organ perfusion correct answerersA 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: Select one: 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 e. debridement of devitalized tissueCorrect answersb. direct pressure on the woundcorrect answerersFor 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 curveCorrect answersc. cerebral vasoconstriction with diminished perfusioncorrect answerersAfter 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 echocardiographyCorrect answersc. perform an exploratory laparotomycorrect answerersWhich 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 answersb. Leakage of amniotic fluid is an indication for hospital

admission.correct answerersThe 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-rayCorrect answersc. administer supplemental oxygencorrect answerersA 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: 12Correct answersd: 9correct answerersWhich 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 minuteCorrect answerse. respiratory rate of 40 breaths per minutecorrect answerersA 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 infusionCorrect answersc. perform needle or finger decompression of the right chestcorrect answerersAn 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 solutionCorrect answersd.

placement of an occlusive dressing over the wound secured on three sidescorrect answerersWhich 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. pregnanc y e. all of the aboveCorrect answersa. history of neurological reaction or severe hypersensitivity to the productcorrect answerersA 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 best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? Select one: a. tachycard ia b. pulse volume c. breath sounds d. pulse pressure e. jugular venous pressureCorrect answersc. breath soundscorrect answerersBronchial 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.Correct answersa. The trachea is relatively short.correct answerersA 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. perform an angiography d. urgently transfer the patient to the operating room e. immediately transfer the patient to a trauma centerCorrect answersd. urgently transfer the patient to the operating roomcorrect answerersA 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 Select one: a. perform a surgical cricothyroidotomy b. attempt nasotracheal intubation c. ventilate him with a bag-mask device until c-spine injury can be excluded d. restrict cervical motion and attempt orotracheal intubation using 2 people e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit a. perform a surgical cricothyroidotomy b.

attempt nasotracheal intubation c. ventilate him with a bag-mask device until c-spine injury can be excluded d. restrict cervical motion and attempt orotracheal intubation using 2 people e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fitCorrect answersd. restrict cervical motion and attempt orotracheal intubation using 2 peoplecorrect answerersA 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 answerse. Flaccidity of the lower extremities and loss of deep tendon reflexes are expectedcorrect answerersWhich 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 sulfadiazineCorrect answersa. moist heatcorrect answerersA 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 awayCorrect answersd. surgical consultation for right lower extremity fasciotomycorrect answerersA 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-maskCorrect answersc. suction the oropharynxcorrect answerersA 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 surgeonCorrect answersd. repeat the primary survey and proceed with transfercorrect answerersA 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 familyCorrect answersd.

call the receiving hospital and speak to the surgeon on callcorrect answerersHemorrhage of 20% of the patient's blood volume is associated usually with: Select one: a. oliguria b. confusio n c. hypotensi on d. tachycardi a e. blood transfusion requirementCorrect answersd. tachycardiacorrect answerersWhich 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.Correct answersb. Aspiration of bone marrow confirms appropriate positioning of the needle.correct answerersA 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. 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 edemaCorrect answersa. avoid hypotensioncorrect answerersA 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 ruptureCorrect answersb. cardiac tamponadecorrect answerersA 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. a leukocyte count of 14,000 c. evidence of retroperitoneal hematoma on CT scan d. development of peritonitis on physical exam e. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hoursCorrect answersd. development of peritonitis on physical examcorrect answerersA 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? Select one:

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 prognosisCorrect answersd. log rolling using 4 people is a safe approach to limit spinal motion when moving hercorrect answerersA 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 airwayCorrect answerse. restrict cervical motion and establish a definitive airwaycorrect answerersWhen 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 answersc. The head is proportionally larger in infants than in adults.correct answerersA 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 pelvisCorrect answersa. placement of a pelvic bindercorrect answerersWhich 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 fractureCorrect answersc. positive pregnancy test, Rh negative, and has torso traumacorrect answerersA 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 CTCorrect answersd. prepare for an exploratory thoracotomycorrect answerersA 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