PHTLS Pre & Post Test, ATLS Exam Questions, Exams of Nursing

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1. 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
2. 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
3. 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 vascu- lar 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
4. 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
5. The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the

2 / 57 B. Cavitation B. Velocity of the bodies involved C. These solutions will stay in the vas- cular space longer than water solu- tions, such as D5W A. 3 times the height of the patient D. Primary phase

3 / 57 phase. A. Tertiary phase B. Quaternary phase C. Secondary phase D. Primary phase

6. 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
7. 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
8. In the absence of extenuating circumstances, the maximum amount of time it should take to identi- fy 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
9. 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 hap-

4 / 57 C. Expose/Environ- ment A. Golden period (hour) B. 10 minutes D. None of the above

5 / 57 pened, 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, com- plains of upper right quadrant abdominal pain. BP 100/70, HR 108, VR 20. D. None of the above

10. Your patient is a 32 year old man, restrained driver of a vehicle that has been involved in a frontal im- pact 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 back- board D. Enroute to the trauma center
11. Which of the following represents adequate sponta- neous 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
12. Which of the following is 100% accurate in verifying endotracheal tube placement? A. Pulse oximetry B. End-tidal capnometry B. Prior to being re- moved from the ve- hicle D. Tidal volume 600 mL, ventilatory rate 12/minute D. None of the above....(added info by ang: to veri-

6 / 57 fy you need breath sounds, condensa-

7 / 57 C. Syringe aspiration D. None of the above

13. When utilizing percutaneous transtracheal ventila- tion, the correct ration of lung inflation to lung infla- tion time, in seconds, is: A. 1: B. 1: C. 1: D. 2:
14. 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
15. 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
16. 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
17. Which of the following is the preferred site for nee- dle decompression of a tension pneumothorax ?

8 / 57 tion in the tube and a confirmatory CXR) A. 1: D. All of the above C. Insertion of an oropharyngeal air- way A. Stab wound to the chest C. 2nd intercostal space, midclavicu-

9 / 57 A. 4th intercostal space, midclavicular line, just over the top of the 5th rib B. 4th intercostal space, midclavicular line, just be- low the 4th rib C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib D. 2nd intercostal space, midclavicular line, just be- low the 2nd rib

18. Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation? A. Inability to generate negative intrapleural pres- sure 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
19. 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 lar line, just over top of the 3rd rib D. Blood and fluid in the alveoli and inter- stitial spaces of the lung D. Hemothorax

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20. 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
21. 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
22. One of the earliest signs of hypovolemic shock is: A. Hypotension B. Bradycardia C. Anxiety D. Reduced urine output
23. Which of the following characterizes the washout phase of shock? A. Systemic acidosis B. Localized tissue acidosis C. Edema D. Reduced capillary blood flow
24. 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 ex-

12 / 57 B. Ruptured di- aphragm A. Adequate num- ber of platelets in the blood C. Anxiety A. Systemic acido- sis D.Spinal cord injury

13 / 57 tremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the follow- ing injuries should be suspected? A. Aortic dissection B. Liver laceration C. Fractured pelvis D. Spinal cord injury

25. Which of the following is a limitation of prehospi- tal 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
26. Which of the following statements regarding signs of intraabdominal injury is NOT true? A. Fresh blood in the abdominal cavity does not cause signs of peritonitis B. A significant amount of blood loss occurs before abdominal distention can be noticed C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity D. Signs and symptoms of shock greater than can be explained by other injuries is a reliable indicator of intraabdominal injury
27. 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 D. All of the above C. Substantial in- traabdominal he- morrhage always causes tender- ness and abdominal rigidity B. Auscultation

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28. 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
29. 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
30. A patient struck in the back of the head with a base- ball bat may sustain a cerebral contusion to which area of the brain? A. Frontal and occipital B. Occipital C. Parietal D. Frontal
31. In the context of the caring for an adult patient with traumatic brain injury who is deteriorating and ex- hibiting 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
32. In the United State, which of the following mecha- nisms most frequently causes spinal cord injury in adults?

16 / 57 C. This prevents compression of the vena cava D. Good resuscita- tion of the mother B. Occipital (probably too low velocity for Coup & Contre Coup) D. 20-hyperventilate to temp decrease ICP B. Vehicle crashes

17 / 57 A. Shallow water diving B. Vehicle crashes C. Falls D. Pedestrian struck by a vehicle

33. 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 extremi- ties, 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
34. 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
35. A traction splint may be used for which of the fol- lowing injuries? A. Knee dislocation B. Pelvic fractures C. Femur fractures D. All of the above
36. Which of the following descriptions meets the crite- ria 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

18 / 57 D. All of the above D. Tense swelling of the involved area C. Femur fractures B. A 25 year old male with an electri- cal burn across his chest

19 / 57 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

37. The preferred method of dressing burns in the pre- hospital setting is: A. Dry sterile dressing B. Moist sterile dressing C. Wet dressings D. Petroleum gauze
38. In assessing the hypothermic patient in the pre- hospital 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
39. 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
40. A patient who withdraws from painful stimuli, opens eyes on verbal command, and cannot speak be- cause of intubation has a Glasgow Coma Scale of which of the following:

20 / 57 A. Dry sterile dress- ing A. Rectal tempera- ture C. Blood pressure is lower, heart rate is higher, and ventila- tory rate is higher B. 8T (E-3, V-T, M-4)

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A. 8

B. 8T

C. 7

D. 7T

41. 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
42. Which of the following behaviors is the most reli- able 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 oc- curred years ago
43. In the elderly trauma patient a high index of sus- picion 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
44. 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. Anterior tibia, just below the tibial tuberosity A. Inability to recall his/her name C. 120 mmHg C. 1000 2000 mL

22 / 57 C. 1000 2000 mL D. 2500 to 5000 mL

45. Delayed death due to trauma is usually a result of: A. Biochemical and pathophysiological effects of inadequate initial resuscitation B. Acute circulatory failure C. Brain injury D. Acute hypoxia
46. 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 a: A. Level IV trauma center B. Level III trauma center C. Level II trauma center D. Level I trauma center
47. Which of the following patients is not indicated for spinal immobilization? A. Intoxicated patient in a MVC B. Patient who fell 8 feet and lost consciousness C. Patient complaining of pain on palpation of the neck D. Patient with a knife wound to the chest and a GCS of 15
48. The premise of PHTLS is that: A. EMTs must treat all trauma patient based on pro- tocols B. EMTs are capable of sound patient care judg- ment, given an adequate knowledge base C. EMTs must work only under on-line medical di- rection when caring for trauma patients A. Biochemical and pathophysio- logical effects of in- adequate initial re- suscitation D. Level I trauma center D. Patient with a knife wound to the chest and a GCS of 15 B. EMTs are capa- ble of sound pa- tient care judgment, given an adequate

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24 / 57 D. EMTs are capable of working independently of medical direction

49. Which of the following warrants classification of a patient as a critical trauma patient? A. An extremity fracture B. Preexisting major medical problem C. Bleeding from the nose D. Deployment of air bags in a motor vehicle crash
50. Which of the following is the foundation of effective trauma care? A. Protocols permitting invasive airway procedures B.The ability to administer large amounts of crystal- loid fluids C. The ability to quickly locate and manage life-threatening and potentially life-threatening in- juries D. Effective spinal immobilization skills
51. 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? A. Circumference of the vehicle B. Diameter of the tree C. Mass of the vehicle D. Speed of the vehicle
52. The potential for death or serious injury is greatest in which of the following motor vehicle collisions? A) Down and under B) Ejection from vehicle C) Lateral compression D) Up and over B. Preexisting major medical problem C. The ability to quickly locate and manage life- threat- ening and potential- ly life- threatening in- juries D. Speed of the ve- hicle B) Ejection from ve- hicle

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53. C) Head-on impact