PHTLS Pre & Post Test, ATLS exam 100% VERIFIED ANSWERS 2024/2025 CORRECT, Exams of Nursing

Download PHTLS Pre & Post Test, ATLS exam 100% VERIFIED ANSWERS 2024/2025 CORRECT and more Exams Nursing in PDF only on Docsity! PHTLS Pre & Post Test, ATLS exam 100% VERIFIED ANSWERS 2024/2025 CORRECT The displacement of tissue away from the path of a projectile, both temporarily and permanently, is known as: A. Conization B. Cavitation C. Crepitation D. Contusion B. Cavitation The single most important factor in determining the potential for injury due to energy exchange is: A. Mass of the bodies involved B. Velocity of the bodies involved 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 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 C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib D. 2nd intercostal space, midclavicular line, just below the 2nd rib C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation? A. Inability to generate negative intrapleural pressure B. Decrease in vital capacity due to collapse of the flail segment C. Increased intrathoracic pressure D. Blood and fluid in the alveoli and interstitial spaces of the lung D. Blood and fluid in the alveoli and interstitial spaces of the lung 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? A. Tension pneumothorax B. Simple pneumothorax C. Pulmonary contusion D. Hemothorax D. Hemothorax 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 injuries? A. Abdominal aortic aneurysm B. Ruptured diaphragm C. Ruptured esophagus D. "Paper bag" syndrome of the lungs B. Ruptured diaphragm Which of the following is NOT a component of the Fick Principle? A. Adequate number of platelets in the blood B. Oxygenation of red blood cells C. Transportation of red blood cells to the tissues of the body D. Off-loading oxygen from the red blood cells to the tissues A. Adequate number of platelets in the blood One of the earliest signs of hypovolemic shock is: A. Hypotension B. Bradycardia C. Anxiety D. Reduced urine output C. Anxiety Which of the following characterizes the washout phase of shock? A. Systemic acidosis B. Localized tissue acidosis C. Edema D. Reduced capillary blood flow A. Systemic acidosis 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? A. Aortic dissection B. Liver laceration C. Fractured pelvis D. Spinal cord injury D. Spinal cord injury Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagic shock? A. Inability of fluids to carry oxygen B. Pulmonary edema C. Increased hemorrhage D. All of the above D. All of the above 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 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 Which of the following behaviors is the most reliable indication of confusion in the elderly trauma patient? A. Inability to recall his/her name B. Inability to recall the day of the week C. Inability to identify his/her present location when out of his/her normal residence D. Focus on repeated retelling of events that occurred years ago A. Inability to recall his/her name In the elderly trauma patient a high index of suspicion for shock should occur beginning when the systolic blood pressure is less than: A. 90 mmHg B. 150 mmHg C. 120 mmHg D. 100 mmHg C. 120 mmHg In an adult patient, blood loss into the tissue from a fractured femur may be as much as which of the following? A. 150 to 500 mL B. 500 to 1000 mL C. 1000 2000 mL D. 2500 to 5000 mL C. 1000 2000 mL 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 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 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? 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 B) Dry sterile dressings The most immediate life threatening condition resulting from injury to solid abdominal organs is which of the following? A) Acute respiratory failure B) Hemorrhage. C) Multiple organ failure. D) Peritonitis B) Hemorrhage. 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? A) Apply a topical hemostatic agent and transport B) Apply a tourniquet and tighten it until bleeding stops C) Elevate the leg and apply pressure to the femoral artery D) Maintain direct pressure and transport immediately B) Apply a tourniquet and tighten it until bleeding stops 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? A) Fracture of the femur B) Inability to communicate C) Mechanism of injury D) Tenderness over the cervical spine C) Mechanism of injury 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 priority? A) Blood glucose determination B) Correction of possible hypoxia C) Full immobilization to a backboard D) Obtain intravenous access B) Correction of possible hypoxia 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 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? What is considered mid TBI? 13-15 T/o secondary management of mild TBI? CT repeat if first is abnormal OR GCS persists at under 15. Serial exams Initial management of TBI? elevate head NS (3%) Indications of transport to higher Level of care with TBI? Worsening GCS, GCS <8. Lesions on CT Above what level can you get neurogenic shock T6 Description of neurogenic shock patient? 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 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 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 spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? 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? moist heat A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses 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? 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: 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: 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: call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: tachycardia Which one of the following statements concerning intraosseous infusion is TRUE? Aspiration of bone marrow confirms appropriate positioning of the needle. A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: avoid hypotension 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)? development of peritonitis on physical exam 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? Log rolling using 4 people is a safe approach to restrict 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: 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: placement of a pelvic binder Which one of the following situations requires Rh immunoglobulin administration to an injured woman? 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.