ATLS Practice Tests 1,2,3,4 LATEST STUDY GUIDE 100% GRADED, Exams of Nursing

Download ATLS Practice Tests 1,2,3,4 LATEST STUDY GUIDE 100% GRADED and more Exams Nursing in PDF only on Docsity!

ATLS Practice Tests 1,2,3,4 LATEST STUDY GUIDE 100%

GRADED

ATLS Practice Test 1

1. Which one of the following is the recommended method for initially treating frostbite? a. vasodilators b. anticoagulants c. warm (40°C) water d. padding and elevation e. application of heat from a hair dryer
2. A 6yearold 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: a. percutaneous femoral vein cannulation. b. cutdown on the saphenous vein at the ankle. c. intraosseous catheter placement in the proximal tibia. d. percutaneous peripheral veins in the upper extremities. e. central venous access via the subclavian or internal jugular vein. 3. Which one of the following physical findings suggests a cause of hypotension other than spinal cord injury? a. priapism. b. bradycardia. c. diaphragmatic breathing. d. presence of deep tendon reflexes. e. ability to flex forearms but inability to extend them.
3. A young man sustains a gunshot wound to the abdomen and is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to: a. administer Onegative blood. b. apply external warming devices. c. control internal hemorrhage operatively. d. apply a pneumatic antishock garment (PASG). e. infuse large volumes of intravenous crystalloid solution.

8. A young man sustains a rifle wound to the midabdomen. He is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate, step is to perform: a. a laparotomy. b. an abdominal CT scan. c. diagnostic laparoscopy. d. abdominal ultrasonography. e. a diagnostic peritoneal lavage.
9. The primary indication for transferring a patient to a higher level trauma center is: a. unavailability of a surgeon or operating room staff. b. multiple system injuries, including severe head injury. c. resource limitations as determined by the transferring doctor. d. resource limitations as determined by the hospital administration. e. widened mediastinum on chest xray following blunt thoracic trauma.
10. A 42yearold man is trapped from the waist down beneath his overturned tractor for several hours before medical assistance arrives. He is awake and alert until just before arriving in the emergency department. He is now unconscious and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his lower extremities. On examination in the emergency department, no movement of his lower extremities is detected, even in response to painful stimuli. The most likely cause for this finding is: a. an epidural hematoma. b. a pelvic fracture. c. central cord syndrome. d. intracerebral hemorrhage. e. bilateral compartment syndrome.
11. A 30yearold man sustains a severely comminuted, open, distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve: a. immediate angiography. b. tamponade of the wound with a pressure dressing.

c. wound exploration and removal of bony fragments. d. realignment of the fracture segments with a traction splint. e. fasciotomy of all four compartments in the lower extremity.

12. An 18yearold, unhelmeted motorcyclist is brought by ambulance to the emergency department following a crash. He had decreased level of consciousness at the scene, but then was alert and conversational during transportation. Now his GCS is only 11. Which of the following statements is TRUE? a. Cerebral perfusion is intact. b. Intravascular volume status is normal. c. The patient is in a postictal state. d. Intraabdominal visceral injuries are unlikely. e. The patient probably has an acute epidural hematoma.
13. During an altercation, a 36yearold man sustains a gunshot wound above the nipple line on the right, 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 performed, and 2 liters of Ringer's lactate solution are infused via 2 largecaliber 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: a. laparotomy. b. diagnostic peritoneal lavage. c. arterial blood gas determination. d. administer packed red blood cells. e. chest xray to confirm tube placement.
14. Absence of breath sounds and dullness to percussion over the left hemithorax are findings best explained by: a. left hemothorax. b. cardiac contusion c. left simple pneumothorax d. left diaphragmatic rupture e. right tension pneumothorax.

c. Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone intravenously. d. Children have more focal mass lesions as a result of traumatic brain injury when compared to adults. e. Young children are less tolerant of expanding intracranial mass lesions than adults.

19. A 17yearold 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 : a. air splints. b. bolstering devices. c. a long spine board. d. a scoopstyle stretcher. e. a semirigid cervical collar.
20. Twentyseven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to: a. treat the most severely injured patients first. b. establish a field triage area directed by a doctor. c. rapidly transport all patients to the nearest appropriate hospital. d. treat the greatest number of patients in the shortest period of time. e. produce the greatest number of survivors based on available resources.
21. An electrician is electrocuted by a downed power line after a thunderstorm. He apparently made contact with the wire at the level of the right mid thigh. In the emergency department, his vital signs are normal and no dysrhythmia is noted on ECG. On examination, there is an exit wound on the bottom of the right foot. His urine is positive for blood by dipstick but no RBCs are seen microscopically. Initial management should include: a. immediate angiography. b. aggressive fluid infusion. c. intravenous pyelography. d. debridement of necrotic muscle. e. admission to the intensive care unit for observation.

22. A young woman sustains a severe head injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being 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: a. administer an osmotic diuretic. b. prevent secondary brain injury. c. aggressively treat systemic hypertension. d. reduce metabolic requirements of the brain. e. distinguish between intracranial hematoma and cerebral edema.
23. To establish a diagnosis of shock, a. systolic blood pressure must be below 90 mm Hg. b. the presence of a closed head injury should be excluded c. acidosis should be present by arterial blood gas analysis d. the patient must fail to respond to intravenous fluid infusion. e. clinical evidence of inadequate organ perfusion must be present.
24. A 32yearold 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: a. inserting an oropharyngeal airway. b. inserting a nasopharyngeal airway. c. performing a surgical cricothyroidotomy. d. performing fiberopticguided nasotracheal intubation. e. performing orotracheal intubation after obtaining a lateral cspine xray.
25. A 25yearold 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 the emergency department, she is unconscious and has a GCS score of 6. The initial management step for this patient should be to: a. obtain a CT scan of the head. b. administer decadron 20 mg IV.

30. A 22yearold 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: a. a subdural hematoma. b. an epidural hematoma. c. a transected lumbar spinal cord. d. a basilar skull fracture. e. hemorrhage into the chest or abdomen.
31. Which one of the following statements is FALSE concerning Rh isoimmunization in the pregnant trauma patient? a. It occurs in blunt or penetrating abdominal trauma. b. Minor degrees of fetomaternal hemorrhage produce it. c. A negative KleihauerBetke test excludes Rh isoimmunization. d. This is not a problem in the traumatized Rhpositive pregnant patient. e. initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage.
32. All of the following signs on the chest xray of a blunt injury victim may suggest aortic rupture EXCEPT : a. mediastinal emphysema. b. presence of a "pleural cap." c. obliteration of the aortic knob. d. deviation of the trachea to the right. e. depression of the left mainstem bronchus
33. Early central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a: a. patient with a splenic laceration. b. patient with an inhalation injury. c. 6 yearold child with a pelvic fracture. d. patient with a severe cardiac contusion. e. 24 yearold man with a massive hemothorax.
34. A crosstable lateral xray of the cervical spine: a. must precede endotracheal intubation. b. excludes serious cervical spine injury.

c. is an essential part of the primary survey. d. is not necessary for unconscious patients with penetrating cervical injuries. e. is unacceptable unless 7 cervical vertebrae and the C7 to T1 relationship are visualized.

35. A 24yearold man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the emergency department reveals a flail segment of the patient's thorax. Primary resuscitation includes highflow oxygen administration via a nonrebreathing mask, and initiation of Ringer's lactate solution. The patient exhibits progressive confusion, cyanosis, and tachypnea. Management at this time should consist of: a. intravenous sedation. b. external stabilization of the chest wall. c. increasing the FIO 2 in the inspired gas. d. intercostal nerve blocks for pain relief. e. endotracheal intubation and mechanical ventilation.
36. Which one of the following statements regarding patients with thoracic spine injuries is TRUE? a. Logrolling may be destabilizing to fractures from T12 to L1. b. Adequate immobilization can be accomplished with the scoop stretcher. c. Spinal cord injury below T10 usually spares bowel and bladder function. d. Hyperflexion fractures in the upper thoracic spine are inherently unstable. e. These patients rarely present with neurogenic shock in association with cord injury.
37. During resuscitation, which one of the following is the most reliable as a guide to volume replacement? a. heart rate b. hematocrit c. blood pressure d. urinary output e. jugular venous pressure
38. A 24yearold woman passenger in an automobile strikes the wind screen with her face during a headon collision. In the emergency department, she is talking and has marked facial edema and crepitus. The highest priority should be given to: a. lateral cspine xray. b. upper airway protection.

atls.yolasite.com 1

ATLS Practice Test 2

1. A 22yearold man sustains a gunshot wound to the left chest and is transported to a small community hospital at which surgical capabilities are not 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: a. clamp the chest tube. b. cancel the patient's transfer. c. perform an emergency department thoracotomy. d. repeat the primary survey and proceed with transfer. e. delay the transfer until the referring doctor can contact a thoracic surgeon.
2. 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: a. avoid hypotension. b. administer an osmotic diuretic. c. aggressively treat systemic hypertension. d. reduce metabolic requirements of the brain. e. distinguish between intracranial hematoma and cerebral edema.
3. A 6yearold 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? a. A flail chest is probable. b. A symptomatic cardiac contusion is expected. c. A pulmonary contusion may be present in the absence of rib fractures. d. Transection of the thoracic aorta is more likely than in an adult patient. e. Rib fractures are commonly found in children with this mechanism of injury.
4. A 39yearold man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS Score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: a. perform a surgical cricothyroidotomy. b. attempt nasotracheal intubation. c. ventilate him with a bagmask device until cspine injury can be excluded. d. attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine. e. ventilate the patient with a bagmask device until his beard can be shaved for better mask fit.

atls.yolasite.com 2

5. A patient is brought to the emergency department 20 minutes after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long 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? a. Vasoactive medications have no role in this patient's management. b. The hypotension should be managed with volume resuscitation alone. c. Flexion and extension views of the cspine should be performed early. d. Occult abdominal visceral injuries can be excluded as a cause of hypotension. e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
6. The following are contraindications for tetanus toxoid administration: a. History of neurological reaction or severe hypersensitivity to the product. b. Local side effects. c. Muscular spasms. d. Pregnancy. e. All of the above.
7. After being involved in a motor vehicle crash, a 25yearold man is brought to a hospital with a general surgeon on duty. He has a GCS of 13 and complains of abdominal pain. His blood pressure was 80 mm Hg systolic by palpation on arrival at the hospital, but increases to 110/70 mm Hg with the administration of 2 liters of intravenous fluid. His heart rate remains 120 beats per minute. Computed tomography shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: a. contrast angiography. b. transfer to a higher level trauma center. c. exploratory laparotomy. d. transfuse packed red blood cells. e. transesophageal echocardiography.
8. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? a. The fetus is in jeopardy only with major abdominal trauma. b. Leakage of amniotic fluid is an indication for hospital admission. c. Indications for peritoneal lavage are different from those in the nonpregnant patient. d. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient.

atls.yolasite.com 4

13. During the third trimester of pregnancy, all of the following changes occur normally, EXCEPT a: a. decrease in PaCO 2. b. decrease in leukocyte count. c. reduced gastric emptying rate. d. diminished residual lung volume. e. diminished pelvic ligament tension.
14. In managing the headinjured patient, the most important initial step is to: a. secure the airway. b. obtain cspine film. c. support the circulation. d. control scalp hemorrhage. e. determine the GCS Score.
15. A previously healthy, 70kg (154pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? a. His pulse pressure will be widened. b. His urinary output will be at the lower limits of normal. c. He will have tachycardia, but no change in his systolic blood pressure. d. His systolic blood pressure will be decreased with a narrowed pulse pressure. e. His systolic blood pressure will be maintained with an elevated diastolic pressure.
16. The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: a. reducing the need for blood transfusion. b. increasing the risk of pulmonary edema. c. complicating the management of closed head injury. d. reducing the volume of crystalloid required for resuscitation. e. increasing the volume of blood loss to produce maternal hypotension.
17. The first maneuver to improve oxygenation after chest injury is: a. intubate the patient. b. assess arterial blood gases. c. administer supplemental oxygen. d. ascertain the need for a chest tube. e. obtain a chest xray.

atls.yolasite.com 5

18. A 25yearold man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to painful stimuli only. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to painful stimulus; however, his left hand reaches purposefully toward the painful stimulus. Both legs are stiffly extended. His GCS score is: a. 7 b. 8 c. 9 d. 10 e. 11
19. A 20yearold woman, at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: a. perform tracheal intubation. b. insert an oropharyngeal airway. c. perform needle decompression of the right chest. d. manually displace the gravid uterus to the left side of the abdomen. e. initiate 2 largecaliber peripheral IV lines and crystalloid infusion.
20. Which one of the following findings in an adult should prompt immediate management during the primary survey? a. Distended abdomen. b. Glasgow Coma Scale Score of 11. c. Temperature of 36.5°C (97.8°F). d. Heart rate of 120 beats per minute. e. Respiratory rate of 40 breaths per minute.
21. A trauma patient presents to your emergency department with inspiratory stridor and a suspected cspine injury. Oxygen saturation is 88% on highflow oxygen via a nonrebreathing mask. The most appropriate next step is to: a. apply cervical traction. b. perform immediate tracheostomy. c. insert bilateral thoracostomy tubes. d. maintain 100% oxygen and obtain immediate cspine xrays. e. maintain inline immobilization and establish a definitive airway.
22. When applying the Rule of Nines to infants, a. it is not reliable. b. the body is proportionally larger in infants than in adults. c. the head is proportionally larger in infants than in adults. d. the legs are proportionally larger in infants than in adults. e. the arms are proportionally larger in infants than in adults.

atls.yolasite.com 7

28. A 33yearold woman is involved in a headon 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: a. hemorrhagic shock. b. cardiac tamponade. c. massive hemothorax. d. tension pneumothorax. e. diaphragmatic rupture.
29. A hemodynamically normal 10yearold girl is admitted to the Pediatric Intensive Care Unit (PICU) for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt laparotomy? a. A serum amylase of 200. b. A leukocyte count of 14,000. c. Extraperitoneal bladder rupture. d. Free intraperitoneal air demonstrated on followup CT. e. A fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours.
30. A 40yearold woman restrained driver is transported to the emergency department in full spinal immobilization. She is hemodynamically normal and found to be paraplegic at the level of T10. Neurologic examination also determines that there is loss of pain and temperature sensation with preservation of proprioception and vibration. These findings are consistent with the diagnosis of: a. central cord syndrome. b. spinal shock syndrome. c. anterior cord syndrome. d. complete cord syndrome. e. BrownSéquard syndrome.
31. Hemorrhage of 20% of the patient's blood volume is associated usually with: a. oliguria. b. confusion. c. hypotension. d. tachycardia. e. blood transfusion requirement.

atls.yolasite.com 8

32. Which one of the following statements concerning intraosseous infusion is TRUE? a. Only crystalloid solutions may be safely infused through the needle. b. Aspiration of bone marrow confirms appropriate positioning of the needle. c. Intraosseous infusion is the preferred route for volume resuscitation in small children. d. Intraosseous infusion may be utilized indefinitely. e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion.
33. The most important, immediate step in the management of an open pneumothorax is: a. endotracheal intubation. b. operation to close the wound. c. placing a chest tube through the chest wound. d. placement of an occlusive dressing over the wound. e. initiation of 2 largecaliber IVs with crystalloid solution.
34. Which one of the following situations requires Rh immunoglobulin administration to an injured woman? a. Negative pregnancy test, Rh negative, and torso trauma. b. Positive pregnancy test, Rh positive, and has torso trauma. c. Positive pregnancy test, Rh negative, and has torso trauma. d. Positive pregnancy test, Rh positive, and has an isolated wrist fracture. e. Positive pregnancy test, Rh negative, and has an isolated wrist fracture.
35. A 22yearold man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After 2 liters of crystalloid solution 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. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left 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: a. reexamine the chest. b. perform an aortogram. c. obtain a CT scan of the chest. d. obtain arterial blood gas analyses. e. perform transesophageal echocardiography.