Trauma Assessment and Management, Exams of Nursing

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ITLS FINAL EXAM NEWEST 2025

ACTUAL EXAM QUESTIONS AND

DETAILED CORRECT ANSWERS | A+

GRADE

Identify at least seven patterns in traumatic cardiac arrest for whom you should withhold resuscitation attempts Correct Answer 1. Blunt trauma with no breathing, pulse, or organized rhythm on ECG on EMA arrival at the scene.

2. Penetrating trauma with no breathing, pulse, pupillary reflexes, spontaneous movement, or organized ECG activity.
3. Any trauma with injuries obviously incompatible with life (ex: decapitation)
4. Any trauma with evidence of significant time lapse since pulselessness, including dependant lividity ("black and blue"), rigor mortis, etc.
5. Cardiopulmonary arrest patients in whom the mechanism of injury does correlate with the condition (if not, initiate standard resuscitation)
6. With medical direction: EMS-witnessed cardiopulmonary arrest and 20 minutes of unsuccessful resuscitation and the patient remains in a "nonshockable" rhythm or PEA (Pulseless electrical activity) at a rate less than 40 beats per minute.
7. With medical direction: when transport time to the hospital is more than 15 minutes and the preceding condition exists

Special consideration should be given to victims of near _______, _______, and _______ in NOT withholding or terminating resuscitation of TCPA Correct Answer drowning, lightning strike, and hypothermia What does "FBAO" stand for? Correct Answer Foreign Body Airway obstruction What are the three most common bloodborne viral illness to which emergency care providers are likely to be exposed in the provision of patient care? Correct Answer Hepatitis B (HBV), Hepatitis C (HCV), and HIV infection. Contamination is through blood only. Vaginal secretion and semen are only a risk through sexual contact. What is "PEP"? Correct Answer Post-exposure prophylaxis: The administration of medications to prevent infection from the agent to which the person was exposed. What should you do to help prevent contamination of airborne and droplet - transmitted diseases? Correct Answer Stay vaccinated and use a mask, gown and goggle, but if possible, put the mask on the patient. Disinfect surfaces after use. What procedure should you follow as a minimum if you are accidentally exposed to an infection? Correct Answer 1. Thoroughly wash exposed area.

2. Notify your DICO Designated Infection Control Officer. They will assess if post-treatment of any kind is needed.

injuries to deformity of the vehicle, interior structures and body structures. Correct Answer Machine collision = Deformed front end Body collision = Spider-web pattern of windshield Organ collision = Coup/contracoup brain, soft-tissue injury (scalp, face, neck), hyperextension/flexion of the cervical spine Machine collision = Deformed front end Body collision = Steering wheel ring fracture, deformity and column displacement Organ collision = Traumatic tattooing of patient's skin Machine collision = Deformity of vehicle Body collision = Dashboard fracture and deformity Organ collision = Facial trauma, coup/contracoup brain, hyperextension/flexion of the cervical spine, pelvis, hip and knee trauma Using the three collisions associated with a MVC, relate at least three lateral-impact collisions to potential patient injuries to deformity of the vehicle, interior structures and body structures. Correct Answer Machine collision = Deformed driver or passenger side Body collision = Degree of door deformity (ex: armrest bent, outward or inward bowing of door) Organ collision = This cannot be predicted by external exam alone. Instead, consider organs beneath areas of external injury:

• Head = Coup/contracoup

• Neck = Ranging from cervical-muscle strain to fracture or subluxation with neurologic deficit
• Upper arm and shoulder = Injuries appear on the side of the impact and are common, as are injuries to the lower extremities
• Thorax/abdomen = Injuries from soft-tissue injuries to flail chest, lung contusion, pneumothorax, hemothorax, or possible traumatic aortic dissection. Injuries include those to solid and hollow organs
• Pelvis/legs = Pelvic, hip or femur fractures. Pelvic injuries may also include dislocation, bladder rupture and urethral injuries Describe potential injuries associated with proper and improper use of seat restraints, headrest and air bags in a head-on collision Correct Answer Proper use of seat restraint = Facial, head or neck injuries such as fractures, dislocations or spinal-cord injuries; Clavicle fractures (at the point where the chest strap crosses) and chest-wall injuries; Internal organ damage Improper use of seat restraint = Abdominal or lumbar spine injury; No restraint could possibly lead to ejection of vehicle Improper use of headrest = (second impact) Hyperextension of the cervical spine Proper use of air bags = Injuries from a second impact after deflation can lead to striking the steering wheel leading to internal injuries (thus, check under the deflated

What are at least six anticipated injuries from a fall? Correct Answer - Fractures of the feet or legs

• Hip and/or pelvic injuries
• Axial loading to the lumbar and cervical spine
• Vertebrae compression fracture
• Vertical deceleration forces to the organs
• Colles fractures of the wrists Identify the two most common forms of penetrating injuries Correct Answer Knife and gun Discuss associated mechanisms of the two most common forms of penetrating injuries and extent of these injuries Correct Answer Knife depends on the anatomic area penetrated, length of the blade, and angle of penetration. Low-energy injury and tissue damage confined to the direct path of the blade. Guns depends on the anatomic area penetrated, on type of weapon, caliber (size of bullet), and distance from which the weapon was fired. High-energy injury and tissue damage usually not confined to the direct path of the bullet. What are the four injury mechanisms involved in blast injuries Correct Answer 1. Primary = Air blast

2. Secondary = Material (shrapnel) propelled by the blast force
3. Tertiary = Body impact with ground or object

4. Quinary = (Delayed type of injury) Hyperinflammatory state from exposure to contaminants (ex: burns, chemical, biological, radiological) Relate how the four injury mechanisms involved in blast injuries relate to patient assessment Correct Answer 1. Primary = Air containing organs injuries (ex: Ears, lungs, gastrointestinal tract) can lead to ruptured tympanic membranes, pneumothorax, parenchymal hemorrhage, aveolar rupture
5. Secondary = May be penetrating or blunt, as well at higher velocities than high powered rifles
6. Tertiary = injuries similar to being ejected from a vehicle or fallen from a height. Injuries depend on what the person impacts
7. Quinary = Dirty bombs (dispersing toxic chemicals, biological agents or radiological agents) What four things can interrupt the patient assessment sequence in the ITLS Primary Survey? Correct Answer - The scene becomes unsafe

• You must treat exsanguinating hemorrhage
• You must treat an airway obstruction
• You must treat cardiac arrest *Respiratory arrest, dyspnea, or bleeding management should be delegated to other team members while you continue assessment of the patient.

What are some of the potential injury patterns for a mechanism of lateral impact (T-bone)? (Name 8) Correct Answer - Contralateral neck sprain

• Cervical-spine fracture
• Lateral flail chest
• Pneumothorax
• Aortic disruption
• Diaphragmatic rupture
• Laceration of liver, kidney or spleen
• Pelvic fracture What are potential injury patterns for a mechanism of ejection? Correct Answer Exposure to all mechanisms (and mortality increased) What are some of the potential injury patterns for a mechanism of Injury of pedestrian vs. car? (Name 4) Correct Answer - Head injury
• Aortic disruption
• Abdominal visceral injuries
• Fracture pelvis and lower extremities What is "index of suspicion"? Correct Answer The medical provider's estimate of a disease or injury being present in a patient. A high index of suspicion means there is a high probability the injury is present. A low index of suspicion means there is a low risk of the injury. In a team setting, when a critical condition has been found on a patient, when and how should it be managed?

Correct Answer Instruct the other members of the emergency medical team to carry out the intervention immediately At least which 9 factors classify as a "Load N Go" patient? Correct Answer 1. Initial assessment reveals:

• Altered mental status
• Abnormal breathing
• Abnormal circulation (shock or uncontrolled bleeding)

2. Signs discovered during the rapid trauma survey of conditions that can rapidly lead to shock:

• Penetrating wounds of the torso
• Abnormal chest exam (flail chest, open wound, tension pneumothorax, hemothorax)
• Tender, distended abdomen
• Pelvic instability
• Bilateral femur fractures

3. Significant mechanism of injury and/or poor general health of patient What does "MCI" stand for? Correct Answer "Multiple Casualty Incident" What does "SMR" stand for? Correct Answer "Spinal Motion Restriction" What does "ETCO2" stand for? Correct Answer "End-Tidal CO2" What is normal ETCO2 range? Correct Answer 35 - 40 mmHg

What are the major anatomic landmarks from the teeth (for placing an endotracheal tube at the correct level for an average adult)? Correct Answer 15 cm - > Teeth to vocal cords 20 cm - > Teeth to sternal notch 25 cm - > Teeth to carina How do you calculate the remaining minutes of oxygen for the three class of oxygen tanks? Correct Answer Cylinder pressure remaining (PSI) - Safe residual pressure (200PSI) X Constant (D=0.16, E=0.28, M=1.37) / L/min = Minutes remaining (flow rate) What is the Glasgow Coma Score for an adult? Correct Answer -------------- EYES

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4 Open 3 To voice 2 To pain 1 No response

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VERBAL

5 Oriented & alert 4 Disoriented 3 Nonsensical-speech 2 Moans, unintelligible

1 No response

MOTOR

6 Follows commands 5 Localizes pain 4 Withdraws to pain 3 Decorticate flexion 2 Decerebrate extension 1 No response Explain the importance of observation as it relates to airway control Correct Answer Continual observation of the patient to anticipate problems is essential to ensure airway control and adequate ventilation. What does "BIAD" stand for? Correct Answer "Blind Insertion Airway Device" What does "RSI" stand for? Correct Answer "Rapid Sequence Intubation" (also referred to as "DAI", Drug- Assisted Intubation) Describe methods to deliver supplemental oxygen to the trauma patient Correct Answer 1. Nasal cannula

2. Simple face mask
3. Nonrebreathing masks
4. Bag-valve-mask By how much can you increase the oxygen percentage delivered during mouth-to-mask breathing by placing a

Advantages = Assists in ventilation Disadvantages = Mask air leakage. Too much force of ventilation could cause gastric inssuflation, too quick ventilation could hyperventilate. What is lung compliance? Correct Answer The "give" or elasticity of the lungs Briefly describe the indications, contraindications, advantages, and disadvantages of the flow-restricted oxygen-powered ventilation devices Correct Answer Indications = Medical Director's advice and patient requires 100% oxygen Contraindications = Can't intubate patient Advantages = Can deliver 100% oxygen, frees up your hands to address other patient's issues Disadvantages = Can cause or worsen pneumothorax Predictors of difficult mask ventilation can be remembered using "BOOTS", what does it stand for? Correct Answer Beards Obesity Older patients Toothlessness Snores or Stridors What is the 6 step process in responding to the difficulty of bag-valve-mask ventilation? Correct Answer 1. Reposition

2. OPA/NPA
3. Two-person bag
4. Consider obstruction

5. BIAD

6. Laryngoscopy and intubation Suction units should always be stored with which other essential tool? Correct Answer Oxygen kit Briefly describe the indications, contraindications, advantages, and disadvantages of the blind insertion airway devices Correct Answer Indications = Can't get an OPA/NPA inserted Contraindications = [None found in book] Advantages = Can insert without having to visualize the larynx, easier and faster to insert than an ET tube Disadvantages = Not as effective as ET tubes in preventing aspiration Briefly describe the indications, contraindications, advantages, and disadvantages of the endotracheal intubation Correct Answer Indications =Jaw thrust lift alone insufficient to keep tongue from blocking airway Contraindications = Gag reflex, SMR making it difficult Advantages = opens airway where tongue or other restrictions made it difficult Disadvantages = Gag reflex, improper insertion could lead air to stomach Briefly describe the indications, contraindications, advantages, and disadvantages of the nasopharyngeal airways Correct Answer Indications = tongue or epiglottis fell against posterior pharyngeal wall Contraindications = [none found in book]

vocal cords into view during ET intubation. This is done by usually pressing the thyroid cartilage backward against the esophagus and then upward and slightly to the patient's right side. Also known as BURP (Back-Up-Right-Pressure) Describe the essential components of an airway kit Correct Answer [P.83, doubt this is on the test. Will confirm after I've taken it] Never suction an adult patient for longer than _______. Correct Answer 15 seconds The NPA is made to go into which nostril side? Correct Answer Right What part of the patient's body can use you as a rough guide to know which width of NPA size you could use? Correct Answer Smallest finger How is the NPA measured? Correct Answer From the nare to the tip of the ear lobe How is the OPA measured? Correct Answer From the corner of the mouth to the lower part of the external ear or the angle of the jaw When ventilating an adult mouth-to-mask, what is the volume formula, ventilation rate and inspiratory phase? Correct Answer 8 - 10 mL/Kg at 8-10 breaths per minute lasting 1.5 to 2 seconds each breath

An ETCO2 less than 25 mmHg can lead to _______ causing oxygen to bind tightly to hemoglobin and not releasing it for use. This leads to tissue hypoxia with a falsely high (even 100%) pulse oximeter reading. Correct Answer alkalosis An ETCO2 more than 50 mmHg can lead to _______ causing oxygen to bind loosely and reduces the amount carried to the cells. This gives a low pulse oximeter reading that does not respond to O2 therapy. Correct Answer acidosis What are 10 conditions to which make a pulse oximeter reading unreliable? Correct Answer 1. Poor peripheral perfusion

2. Hyperventilation
3. Hypoventilation
4. Severe anemia or exsanguinating hemorrhage
5. Hypothermia
6. Excessive patient movement
7. High ambient light
8. Nail polish or dirty fingernail
9. Carbon monoxide poisoning
10. Cynanide poisining What does "SGA" stand for? Correct Answer "Supraglottic Airways" (Also known as BIADs) What does "MAAM" stand for? Correct Answer "Medically Assisted Airway Management"