PHTLS Post Test 9th Exam Questions with Verified Detailed Answers, Exams of Nursing

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PHTLS POST TEST 9

TH

EXAM QUESTIONS WITH VERIFIED

DETAILED ANSWERS ALREADY GRADED A+ LATEST 2024

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1. A 20 - year-old female was ejected from her vehicle during a high speed roll-over motor vehicle collision. She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic blood pressure of 70 mm Hg and pupils that are equal but respond sluggishly to light. After establishing two large bore IV lines, you should titrate the infusion rate to achieve a target blood pressure of at least
   • ANS - 90 mm Hg. 2.A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to which area of the brain?
   • ANS - Occipital (probably too low velocity for Coup & Contre Coup) 3.4A 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:
   • ANS - 8T (E-3, V-T, M-4) .4.A regional resource center with a full spectrum of trauma services from prevention to rehabilitation which serves as the leader in trauma care for a geographical region is – ANS - Level I trauma center A traction splint may be used for which of the following – ANS - Femur fractures A trauma patient who has fallen 20 feet from an apartment balcony is alert with warm, dry, pink skin, with normal capillary refilling time to the lower extremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the following injuries should be suspected?
   • ANS - Spinal cord injury An 18-year-old female was struck by a car and has sustained an apparent left femur fracture. Communication with her is hampered because she only speaks a foreign language. Which finding, by itself, does not mandate immobilization of the cervical spine?
   • ANS- Mechanism of injury An adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from the wound. Direct pressure is not controlling the bleeding. What is the most appropriate next step?

- ANS - Apply a tourniquet and tighten it until bleeding stops Bilateral femur fractures are most often associated with which type of motorcycle crash?

• ANS - Head-on impact Delayed death due to trauma is usually a result of:
• ANS - Biochemical and pathophysiological effects of inadequate initial resuscitation Deterioration of ventilation and oxygenation after inflation of a PASG in a patient who has sustained a high-pressure compression injury of the abdomen, such as a sudden deceleration with the lap belt placed across the abdomen, most likely represents which of the following – ANS- Ruptured diaphragm During the primary survey and management of a trauma patient, the E in ABCDE stands for _________?
• ANS - Expose/Environment During the primary survey of a trauma patient, you note that the patient is agitated and confused, and has multiple injuries from an altercation. Which of the following choices is the most appropriate first treatment? – ANS - Correction of possible hypoxia Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which of the following?
• ANSOropharyngeal airway Hypotension of unknown etiology in a trauma patient should be assumed to result from which of the following?
• ANSBlood loss In an adult patient, blood loss into the tissue from a fractured femur may be as much as which of the following? - ANS1000 2000 mL In assessing the hypothermic patient in the prehospital setting, the most reliable indicator of the severity of hypothermia is:
• ANSRectal temperature 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 _________?
• ANS10 minutes 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:

- ANS

In the elderly trauma patient a high index of suspicion for shock should occur beginning when the systolic blood pressure is less than:

• ANSC. 120 mmHg In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because:
• ANSThese solutions will stay in the vascular space longer than water solutions, such as D5W In the normal child, which general statement is most accurate in comparison with the adult patient?
• ANSBlood pressure is lower, heart rate is higher, and ventilatory rate is higher In the United State, which of the following mechanisms most frequently causes spinal cord injury in adults?
• ANSVehicle crashes In which of the following situations is the use of a short spinal immobilization device indicated?
• ANSNone of the above Medication used by trauma patients for pre-existing conditions may cause which of the following?
• ANSBeta blockers may prevent tachycardia with blood loss Of the following, which is the earliest indication of compartment syndrome?
• ANSTense swelling of the involved area One of the earliest signs of hypovolemic shock - ANSAnxiety Pericardial tamponade is most likely to occur in which of the following situations?
• ANSStab wound to the chest Pregnant trauma patients should be placed on the left side because:
• ANSThis prevents compression of the vena cava Survival of the fetus in a trauma situation is most dependent upon which of the following factors?
• ANSGood resuscitation of the mother The body initially compensates for blood loss through activation of which of the following?
• ANSSympathetic nervous system The displacement of tissue away from the path of a projectile, both temporarily and permanently, is known as:
• ANSCavitation

The earliest site for intraosseous infusion is:

• ANSAnterior tibia, just below the tibial tuberosity The most immediate life threatening condition resulting from injury to solid abdominal organs is which of the following?
• ANSHemorrhage. The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the __________ phase.
• ANSPrimary phase The potential for death or serious injury is greatest in which of the following motor vehicle collisions?
• ANSEjection from vehicle The preferred method of dressing burns in the prehospital setting is:
• ANSDry sterile dressing The premise of PHTLS is that:
• ANSEMTs are capable of sound patient care judgment, given an adequate knowledge base The single most important factor in determining the potential for injury due to energy exchange is: - ANSVelocity of the bodies involved The target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is which of the following?
• ANS80 - 90 mm Hg The time in which surgical intervention can make a difference in patient outcome is the __________?
• ANSGolden period (hour) When utilizing percutaneous transtracheal ventilation, the correct ration of lung inflation to lung inflation time, in seconds, is:
• ANS1: Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting?
• ANSSkin Which best describes shock?
• ANSGeneralized inadequate tissue perfusion Which best explains the mechanism by which gas exchange is impaired in pulmonary contusion?
• ANSBlood in the alveoli

Which is the most common cause of upper airway obstruction in the trauma patient?

• ANSTongue Which is the most important reason to maintain an open airway in the trauma - ANSPrevents hypoxemia and hypercarbia Which is the preferred adjunct device for verifying placement of an endotracheal tube in a patient with a perfusing rhythm?
• ANSEnd-tidal CO2 monitoring (capnography) Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting?
• ANSLactated Ringer's Which of the following assessment techniques is least useful in the prehospital assessment of the patient with suspected intraabdominal trauma?
• ANSAuscultation Which of the following behaviors is the most reliable indication of confusion in the elderly patient - ANSInability to recall his/her name Which of the following characterizes the washout phase of shock?
• ANSSystemic acidosis Which of the following descriptions meets the criteria for transport to a facility with a burn unit?
• ANSA 25 year old male with an electrical burn across his chest Which of the following is 100% accurate in verifying endotracheal tube placement?
• ANSNone of the above Which of the following is a key finding that differentiates cardiac tamponade from tension pneumothorax?
• ANSEqual breath sounds Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagic shock?
• ANSAll of the above Which of the following is a possible complication of using a manually triggered oxygen powered device for ventilation?
• ANSAll of the above Which of the following is NOT a component of the Fick principle? - ANSAdequate number of platelets in the blood

Which of the following is the foundation of effective trauma care?

• ANSThe ability to quickly locate and manage life-threatening and potentially life-threatening injuries Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation?
• ANSBlood and fluid in the alveoli and interstitial spaces of the lung Which of the following is the preferred prehospital wound management for a patient with a 36% body surface area flame burn?
• ANSDry sterile dressings Which of the following is the preferred site for needle decompression of a tension pneumothorax?
• ANS2nd intercostal space, midclavicular line, just over top of the 3rd rib Which of the following patients is not indicated for spinal immobilization?
• ANSPatient with a knife wound to the chest and a GCS of 15 Which of the following presentation indicate spinal cord injury?
• ANSAll of the above Which of the following procedures is considered an essential airway - ANSInsertion of an oropharyngeal airway Which of the following represents adequate spontaneous ventilation in an adult?
• ANSTidal volume 600 mL, ventilatory rate 12/minute Which of the following statements regarding signs of intraabdominal injury is NOT true?
• ANSSubstantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity Which of the following warrants classification of a patient as a critical trauma patient?
• ANSPreexisting major medical problem With respect to the distance of a fall, which of the following is a guideline for determining a critical fall?
• ANS3 times the height of the patient You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury?
• ANSSpeed of the vehicle

Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action?

• ANSApply direct pressure Your patient is a 20 year old male who struck his head on a teammate's knee while diving to catch a football. He was not wearing a helmet. He demonstrates decerebrate posturing and has a GCS score of 4. His heart rate is 58, blood pressure 180/102 and his left pupil is dilated. What is the best ventilation rate to use when managing this patient?
• ANS20 breaths per minute 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?
• ANSPrior to being removed from the vehicle Your patient is a 55 year old male who was struck in the right side of the chest with a piece of steel pipe. He presents with uncooperative behavior, his skin is pale and moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds are decreased on the right side. The trachea is midline and jugular veins are flat while the patient is supine. There is isolated crepitus over the 4th and 5th ribs in the midaxillary line on the patient's right side. Based on the mechanism of injury and the assessment findings, which of the following is the most likely cause of the patient's signs and symptoms?
• ANSHemothorax 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?

• ANSBegin ventilation with a BVM A 20 year old female was ejected from her vehicle during a high speed roll-over motor vehicle collision. She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic blood pressure of 70 mm Hg and pupils that are equal but respond sluggishly to light. After establishing two large bore IV lines, you should titrate the infusion rate to achieve a target blood pressure of at least
• ANS90 mm Hg. A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to which area of the brain?
• ANSOccipital (probably too low velocity for Coup & Contre Coup) 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:
• ANS8T

(E-3, V-T, M-4)

A regional resource center with a full spectrum of trauma services from prevention to rehabilitation which serves as the leader in trauma care for a geographical region is - ANSLevel I trauma center A traction splint may be used for which of the following - ANSFemur fractures A trauma patient who has fallen 20 feet from an apartment balcony is alert with warm, dry, pink skin, with normal capillary refilling time to the lower extremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the following injuries should be suspected?

• ANSSpinal cord injury An 18-year-old female was struck by a car and has sustained an apparent left femur fracture. Communication with her is hampered because she only speaks a foreign language. Which finding, by itself, does not mandate immobilization of the cervical spine?
• ANSMechanism of injury An adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from the wound. Direct pressure is not controlling the bleeding. What is the most appropriate next step?
• ANSApply a tourniquet and tighten it until bleeding stops Bilateral femur fractures are most often associated with which type of motorcycle crash?
• ANSHead-on impact Delayed death due to trauma is usually a result of:
• ANSBiochemical and pathophysiological effects of inadequate initial resuscitation Deterioration of ventilation and oxygenation after inflation of a PASG in a patient who has sustained a high-pressure compression injury of the abdomen, such as a sudden deceleration with the lap belt placed across the abdomen, most likely represents which of the following - ANSRuptured diaphragm During the primary survey and management of a trauma patient, the E in ABCDE stands for _________?
• ANSExpose/Environment During the primary survey of a trauma patient, you note that the patient is agitated and confused, and has multiple injuries from an altercation. Which of the following choices is the most appropriate first treatment? - ANSCorrection of possible hypoxia Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which of the following?

• ANSOropharyngeal airway Hypotension of unknown etiology in a trauma patient should be assumed to result from which of the following?
• ANSBlood loss In an adult patient, blood loss into the tissue from a fractured femur may be as much as which of the following? - ANS1000 2000 mL In assessing the hypothermic patient in the prehospital setting, the most reliable indicator of the severity of hypothermia is:
• ANSRectal temperature 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 _________?
• ANS10 minutes 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:
• ANS In the elderly trauma patient a high index of suspicion for shock should occur beginning when the systolic blood pressure is less than:
• ANSC. 120 mmHg In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because:
• ANSThese solutions will stay in the vascular space longer than water solutions, such as D5W In the normal child, which general statement is most accurate in comparison with the adult patient?
• ANSBlood pressure is lower, heart rate is higher, and ventilatory rate is higher In the United State, which of the following mechanisms most frequently causes spinal cord injury in adults?
• ANSVehicle crashes In which of the following situations is the use of a short spinal immobilization device indicated?
• ANSNone of the above Medication used by trauma patients for pre-existing conditions may cause which of the following?
• ANSBeta blockers may prevent tachycardia with blood loss

Of the following, which is the earliest indication of compartment syndrome?

• ANSTense swelling of the involved area One of the earliest signs of hypovolemic shock - ANSAnxiety Pericardial tamponade is most likely to occur in which of the following situations?
• ANSStab wound to the chest Pregnant trauma patients should be placed on the left side because:
• ANSThis prevents compression of the vena cava Survival of the fetus in a trauma situation is most dependent upon which of the following factors?
• ANSGood resuscitation of the mother The body initially compensates for blood loss through activation of which of the following?
• ANSSympathetic nervous system The displacement of tissue away from the path of a projectile, both temporarily and permanently, is known as:
• ANSCavitation The earliest site for intraosseous infusion is:
• ANSAnterior tibia, just below the tibial tuberosity The most immediate life threatening condition resulting from injury to solid abdominal organs is which of the following?
• ANSHemorrhage. The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the __________ phase.
• ANSPrimary phase The potential for death or serious injury is greatest in which of the following motor vehicle collisions?
• ANSEjection from vehicle The preferred method of dressing burns in the prehospital setting is:
• ANSDry sterile dressing The premise of PHTLS is that:
• ANSEMTs are capable of sound patient care judgment, given an adequate knowledge base The single most important factor in determining the potential for injury due to energy exchange is: - ANSVelocity of the bodies involved

The target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is which of the following?

• ANS80 - 90 mm Hg The time in which surgical intervention can make a difference in patient outcome is the __________?
• ANSGolden period (hour) When utilizing percutaneous transtracheal ventilation, the correct ration of lung inflation to lung inflation time, in seconds, is:
• ANS1: Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting?
• ANSSkin Which best describes shock?
• ANSGeneralized inadequate tissue perfusion Which best explains the mechanism by which gas exchange is impaired in pulmonary contusion?
• ANSBlood in the alveoli Which is the most common cause of upper airway obstruction in the trauma patient?
• ANSTongue Which is the most important reason to maintain an open airway in the trauma - ANSPrevents hypoxemia and hypercarbia Which is the preferred adjunct device for verifying placement of an endotracheal tube in a patient with a perfusing rhythm?
• ANSEnd-tidal CO2 monitoring (capnography) Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting?
• ANSLactated Ringer's Which of the following assessment techniques is least useful in the prehospital assessment of the patient with suspected intraabdominal trauma?
• ANSAuscultation Which of the following behaviors is the most reliable indication of confusion in the elderly patient - ANSInability to recall his/her name Which of the following characterizes the washout phase of shock?
• ANSSystemic acidosis

Which of the following descriptions meets the criteria for transport to a facility with a burn unit?

• ANSA 25 year old male with an electrical burn across his chest Which of the following is 100% accurate in verifying endotracheal tube placement?
• ANSNone of the above Which of the following is a key finding that differentiates cardiac tamponade from tension pneumothorax?
• ANSEqual breath sounds Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagic shock?
• ANSAll of the above Which of the following is a possible complication of using a manually triggered oxygen powered device for ventilation?
• ANSAll of the above Which of the following is NOT a component of the Fick principle? - ANSAdequate number of platelets in the blood Which of the following is the foundation of effective trauma care?
• ANSThe ability to quickly locate and manage life-threatening and potentially life-threatening injuries Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation?
• ANSBlood and fluid in the alveoli and interstitial spaces of the lung Which of the following is the preferred prehospital wound management for a patient with a 36% body surface area flame burn?
• ANSDry sterile dressings Which of the following is the preferred site for needle decompression of a tension pneumothorax?
• ANS2nd intercostal space, midclavicular line, just over top of the 3rd rib Which of the following patients is not indicated for spinal immobilization?
• ANSPatient with a knife wound to the chest and a GCS of 15 Which of the following presentation indicate spinal cord injury?
• ANSAll of the above

Which of the following procedures is considered an essential airway - ANSInsertion of an oropharyngeal airway Which of the following represents adequate spontaneous ventilation in an adult?

• ANSTidal volume 600 mL, ventilatory rate 12/minute Which of the following statements regarding signs of intraabdominal injury is NOT true?
• ANSSubstantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity Which of the following warrants classification of a patient as a critical trauma patient?
• ANSPreexisting major medical problem With respect to the distance of a fall, which of the following is a guideline for determining a critical fall?
• ANS3 times the height of the patient You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury?
• ANSSpeed of the vehicle Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action?
• ANSApply direct pressure Your patient is a 20 year old male who struck his head on a teammate's knee while diving to catch a football. He was not wearing a helmet. He demonstrates decerebrate posturing and has a GCS score of 4. His heart rate is 58, blood pressure 180/102 and his left pupil is dilated. What is the best ventilation rate to use when managing this patient?
• ANS20 breaths per minute 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?
• ANSPrior to being removed from the vehicle Your patient is a 55 year old male who was struck in the right side of the chest with a piece of steel pipe. He presents with uncooperative behavior, his skin is pale and moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds are decreased on the right side. The trachea is midline and jugular veins are flat while the patient is supine. There is isolated crepitus over the 4th and 5th ribs in the midaxillary line on the patient's right side. Based on the mechanism of injury and the assessment findings, which of the following is the most likely cause of the patient's signs and symptoms?
• ANSHemothorax

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?
   • ANSBegin ventilation with a BVM