ATLS Post Test 2025 WITH QUESTIONS AND ANSWERS GRADED A+, Exams of Nursing

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ATLS Post Test 2025 WITH QUESTIONS

AND ANSWERS GRADED A+

1. The primary indication for transferring a patient to a higher-level trauma center is: unavailability of a surgeon or operating room staff. multiple system injuries, including severe head injury. resource limitations as determined by the transferring doctor. resource limitations as determined by the hospital administration. widened mediastinum on chest x-ray following blunt thoracic trauma.
2. teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to: obtain a lateral cervical spine x-ray. insert a central venous pressure line. administer 2 liters of crystalloid solution. perform endotracheal intubation and ventilation. apply the PASG and inflate the leg compartments.
3. Contraindication to nasogastric intubation is the presence of a: gastric perforation. diaphragmatic rupture.

7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by:
8. 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in this child: is most likely a central cord syndrome. must be diagnosed by magnetic resonance imaging. a subdural hematoma. an epidural hematoma. a transected lumbar spinal cord. a transected cervical spinal cord. hemorrhage into the chest or abdomen.
9. 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: perform a urethrogram and cystogram. perform external fixation of the pelvis. obtain abdominal and pelvic CT scans. perform arterial embolization of the pelvic vessels. can be excluded by obtaining a CT of the entire spine. may exist in the absence of objective findings on x-ray studies. is unlikely because of the incomplete calcification of the vertebral bodies.
10. Immediate chest tube insertion is indicated for which of the following conditions?

Pneumothorax Pneumomediastinum Massive hemothorax Diaphragmatic rupture Subcutaneous emphysema

11. 18-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash. Prehospital persormel report that he was thrown 15 meters (50 feet) off his bfice. He has a history of hypotension prior to arrival in the emergency department, but is now awake, alert, and conversational. Which of the following statements is TRUE? perform diagnostic peritoneal lavage or abdominal ultrasound. Cerebral perfiision is intacto Intravascular volume status is normal. The patient has sensitive vasomotor reflexes. Intraabdominal visceral injuries are unlikely. defmitive treatment in managing this patient is to: The patient probably has an acute epidural hematoma.
12. crosstable, lateral x-ray of the cervical spine: must precede endotracheal intubation. excludes serious cervical spine injury. is an essential part of the primary survey. is not necessary for unconscious patients with penetrating cervical injuries. is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are

acidosis should be present by arterial blood \gas analysis. the patient must fail to respond to intravenous fluid infu.sion. clinical evidence of inadequate organ perfusion must be present.

17. Absence of breath sounds and dullness to percussion over the left hemithorax are fmdings best explained by: left hemothorax. cardiac contusion. left simple pneumothorax. left diaphragmatic rupture. right tension pneumothorax.
18. 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following EXCEPT: air splints. bolstering devices. a long spine board. a scoop-style stretcher. a semirigid cervical collar.
19. During an altercation, a 32-year-old man sustains a gunshot wound to the right upper hemithorax, above the nipple line with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, closed tube thoracostomy is celiotomy. diagnostic peritoneal lavage.

arterial blood gas determination. administer packed red blood cells. chest x-ray to confinn tube placement. central venous access via the subclavian or interna1 jugular vein.

22. The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in:
23. Which of the following statements regarding iWhich of the following statements regardingnjury to the central nervous system in children is TRUE? placental abruption. fetal hypoxia and distress. fetal/maternal dysrhythmia. improved uterine blood flow. performed, and 2 liters of Ringer's lactate solution are infused through 2 large-caliber IVs. 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% 02). The most appropriate next step in managing this patient is: Young children are less tolerant of expanding intracranial mass lesions than adults.
24. 5-year-old boy is struck by an automobile and brought to the emergency department. He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is: percutaneous femoral vein cannulation cutdown on the saphenous vein at the ankle. intraosseous catheter placement in the proximal tibia. percutaneous peripheral veins in the upper extremities. Children suffer spinal cord injury without x-ray abnormality more commonly than adults. An infant with a traumatic brain injury may become hypotensive from cerebral edema. Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone intravenously. Children have more focal mass lesions as a result of traumatic brain injury when compared to adults . increased maternal renal blood flow.
25. Cardiac tamponade after trauma: is seldom life-threatening. can be excluded by an upright, AP chest x- ray.

26. 23-year-old man is brought immediately to the emergency department from the hospital' s parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconscious and has no detectable blood pressure. Optimal immedi'ate management is to: perform diagnostic peritoneal lavage. initiate infusion of packed red blood cells. insert a nasogastric tube and urinary catheter. transfer the patient to the operating room, while initiating fluid therapy. initiate fluid therapy to return his blood pressure to normotensive
27. 25-year-old woman is brought to the emergency department after a motor vehicle crash. She was initially lucid at the scene and then developed a dilated pupil and contralateral extremity weakness. In t.he emergency department, she is unconscious and has a GCS score of 6. The initial management step for this patient should be to: obtain a CT scan of the head. administer decadron 20 mg IV. perform endotracheal intubation. initiate an W line and administer Mannitol 1 g/kg. perform an emergency linar hole on the side of the dilated pupil.
28. Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to: treat the most severely injured patients first. establish a field triage area directed by a doctor. rapidly transport all patients to the nearest appropriate hospital. treat the greatest number of patients in the shortest period of time.

produce the greatest number of survivors based on available resources.

29. Which one of the following statements is FALSE concerning Rh isoimmunization in the pregnant trauma patient? It occurs in blunt or penetrating abdominal trauma. Minor degrees of fetomaternal hemorrhage produce it. A negative Kleihauer-Betke test excludes Rh isoimmunization. This is not a problem in the traumatized Rh-positive pregnant patient. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage.
30. 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on collision. In the emergency department, she is talking and has marked facial edema and crepitus. The highest priority should be given to: lateral, c-spine x-ray. upper airway protection. carotid pulse assessment. management of blood loss. determination of associated Injuries.
31. Early central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a: patient with a splenic laceration. patient with an inhalation injury. 6-year-old child with a pelvic fracture. patient with a severe cardiac contusion. 24-year-old man with a massive hemothorax.
32. 32-year-old man is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the emergency department, he has no apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is unsuccessful. Examination of his mouth reveals a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial management of his airway should consist of: inserting an oropharyngeal airvvay.

on the bottom of the right foot. His urine is positive for blood by dip stick but no RBCs are seen microscopically. Initial management should include: immediate angiography. aggressive fluid infusion. intravenous pyleography. debridement of necrotic muscle. admission to the intensive care unit for observation.

36. Which one of the following physical
37. Regarding shock in the child, which of the following is FALSE? Vital signs are age-related. Children have greater physiologic reserves than do adults. Tachycardia is the primary physiologic response to hypovolemia. The absolute volume of blood loss required to produce shock is the same as in adults. An initial fluid bolus for resuscitation should approximate 20 mL/kg of Ringer's lactate.
38. All of the following signs on the chest x-ray of a blunt injury victim may suggest aortic rupture EXCEPT:: mediastinal emphysema. presence of a "pleural cap." obliteration of the aortic knob. deviation of the trachea to the right. depression of the left mainstem bronchus
39. An 8-year-old boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24-hour-a- day operating room capabilities. The most appropriate management of this patient would

findings suggests a cause of hypotension other than spinal cord injury? be to: type and crossmatch for blood. priapism. bradycardia. diaphragmatic breathing. presence of deep tendon reflexes. ability to flex forearms but inability to extend them. request consultation of a pediatrician. transfer the patient to a trauma center. admit the patient to the intensive care unit. prepare the patient for surgery the next day.

1. A 20 year old athlete is involved in motorcycle crash. When he arrives in the ER. He shouts that he cannot move his legs. On physical exam, there are no abnormalities of the chest, abdomen, or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving. The patient's respiratory rate is 23, heart rate 88, and blood pressure is 80/60 mm Hg. He is pale and sweaty. What is most likely cause of his condition? a. Neurogenic shock. b. Cardiac temponade. c. Myocardial contusion. d. Hypothermia. e. Abdominal hemorrhage.

5. 28 year old male is brought to ER. He was involved in fight, in which he was beaten with a wooden stick. His chest 8. A 35 year old female sustains multiple shows multiple severe bruises. Airway injuries in a motor vehicle crash and is is clear, respiratory rate is 22, heart rate transported to a small hospital in full is 126, and systolic blood pressure is 90 spinal protection. She has a GCS of 4 mm Hg. Which of the following should and is being mechanically ventilated. be performed during the primary Intravenous access is established and survey? warmed crystalloid is infused. She remains hemodynamically normal and a. GCS. full spinal protection in maintained. b. Tetanus toxoid administration. Preparations are made to transfer her to c. Cervical spine X-ray. another facility for definitive d. Blood alcohol level. neurosurgical care. Prior to transport, e. Rectal exam. which of the following tests or treatments is mandatory?
6. Which one of the following injuries is a. FAST exam. addressed in the secondary survey? b. Chest X-ray. ??? c. Lateral cervical spine X-ray.??? a. Forearm fracture. d. Administration of b. Mid-thigh amputation. methiprednisolone. c. Open fracture with bleeding. e. CT of abdomen. d. Unstable pelvic fracture. e. Bilateral femur fractures with 9. A 23 year old male is stabbed below the obvious deformity. right nipple. He is alert, and his oxygen is 98%. Chest tube was placed for
7. Which one of the following statements treatment of hemopnueunthorax. BP is true regarding access in pediatric 90/60 mm Hg after 1L of crystalloid resuscitation? solution. What is the next step in treatment? a. Intraosseous access should only be considered after five percutaneous a. Place a left-sided chest tube. attempts. b. Re-examine the chest. b. Cut-down at the ankle is the preferred c. Inscert central venous catheter. initial access technique. d. Perform CT scan of the abdomen c. Internal jugular cannulation is the next and pelvis.

preferred option when percutaneous e. Prepare for urgent throacotomy. venous access fails. d. Intraosseouscannulation should be the 10. A 22 year old male is assaulted in a bar. first choice for access. A semi-rigid cervical coller is applied, e. Blood transfusion can be delivered and he is immobilized on a spine board. through intraosseous access. On initial exam, VS are normal, GCS is

15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury? a. Presence of hemotympanum. b. Blood alcohol concentration of 0.16%. c. Presence of an isolated 10 cm scalp laceration. d. Presence of a mandibuler fracture. e. History of assult.
16. A 23 year old construction worker is brought to ER after falling more than 9 meters. VS: HR is 140, BP is 90/60, and RR is 36. He is complaining bitterly of lower abdominal and lower limb pain, and his obvious deformity of both lower legs with bilateral open tibial fractures. Which of the following statements concerning the patient is true? a. Pelvic injury can be ruled out based on the mechanism of injury. b. Blood loss from the lower limbs is the most likely cause of hypotension. c. X-ray of the chest and pelvis are important adjacent in his initial assessment. d. Spinal cord injury is most likely cause of his hypotension. e. Aortic injury is the most likely cause

immediate removal of clothing. b. Patients who sustain thermal injury are at lower risk of hypothermia. c. Patients with circumferential burns need prompt fasciotomies. d. Electrical burns are associated with extensive skin necrosis (from entry point to exit). e. The Parkland formula should be used to determine adequacy of resuscitation.

15. A 15 year old male is brought to ER after being involved in a motor vehicle crash. He is unconscious and was intubated at the scene by EMS. On ER, O2 is 92%, HR is 96 and BP is 150/ mm Hg. Breath sounds are decreased on the left side of the thorax. The next step is: a. Immediate needle cricothyroidotomy. b. Immediate needle thoracocentesis. c. Chest tube insertion. d. Reassess the position of endotracheal tube. e. Obtain a chest X-ray.
16. Which one of the following statements is true? a. Elevated ICP will not affect cerebral perfusion. b. CSF cannot be displaced from the cranial vault. c. Cerebral blood flow (CBF) is increased when the PaCO2 is below 30 mm Hg. d. AutoregulationCBF normally occurs between cerebral perfusion pressures of 50 to 150. e. Hypotonic fluids should be used to limit brain edema in patients with severe head injury.
17. The first priority in the management of a long bone fracture is: a. Reduction of the pain. b. Prevention of infection in case of an

open fracture. c. Prevention of further soft tissue injury. d. Control of hemorrhage. e. Improve long-term function.

18. A 40 year old obese patient with GCS of 8 requires a CT. before transfer to CT you should: a. Give more sedative drugs. b. Insert a multilumen esophageal airway. c. Insert a definitive airway. d. Request a lateral cervical spine film. e. Insert a nasogastric tube.
19. Lateral cervical spine films: a. Must be performed in the primary survey. b. Can exclude any significant spinal injury. c. Should be combined with clinical exam, AP and odontoid, CT. d. Are indicated in all trauma patients. e. Require the following films: oblique views, AP, odontoid and flexion- extension views prior to spinal clearance in trauma patients.
20. A 30 year old male is brought to ER after falling 6 m. Flail chest on the right, tachypneic and normal breath sounds. No hyperresonance or dullness. On oxygen by face mask.ABG are: PaO2 of 45, PaCO2 of 28 and pH of 7.47. Abnormalities in the patient's blood gases is due to: a. Hypoventilation. b. Hypovolemia. c. Small pneumothorax. d. Pulmonary contusion. e. Flail chest.