ATLS Pretest and Practice Exam 2025–2026 – 180 Verified Questions
and Correct Answers full trauma
Question 1
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 fluid resuscitation with 1 liter of warmed
crystalloid, his blood pressure improves to 110/70 mm Hg. What is the most likely class of
hemorrhagic shock?
A) Class I
B) Class II
C) Class III
D) Class IV
Correct Answer: B) Class II
Rationale: Class II hemorrhagic shock is characterized by blood loss of 15–30% (approximately
750–1500 mL), resulting in tachycardia (heart rate >100), tachypnea, and a narrowed pulse
pressure. The patient's initial hypotension with improvement after 1 liter of crystalloid is
consistent with Class II shock. Class I involves <15% blood loss with minimal vital sign changes.
Class III involves 30–40% blood loss with significant hypotension that does not typically correct
with only 1 liter of fluid. Class IV involves >40% blood loss with profound hypotension
unresponsive to fluid resuscitation.
Question 2
What is the most important consequence of inadequate organ perfusion in a trauma patient?
A) Decreased base deficit
B) Multiple organ failure
C) Metabolic alkalosis
D) Increased urine output
Correct Answer: B) Multiple organ failure
Rationale: Inadequate organ perfusion leads to tissue hypoxia, cellular dysfunction, and
ultimately multiple organ failure if not corrected promptly. Base deficit actually increases
(becomes more negative) in shock, not decreases. Metabolic acidosis, not alkalosis, occurs with
inadequate perfusion. Urine output decreases, not increases, in hypoperfusion states.
Question 3
,Signs and symptoms of airway compromise include all of the following EXCEPT:
A) Change in voice
B) Stridor
C) Decreased pulse pressure
D) Dyspnea and agitation
Correct Answer: C) Decreased pulse pressure
Rationale: Decreased pulse pressure is a sign of hemorrhagic shock or decreased cardiac output,
not specifically airway compromise. Change in voice (hoarseness), stridor (upper airway
obstruction), and dyspnea with agitation are all classic signs of airway compromise.
Question 4
Which of the following is the most common cause of shock in the trauma patient?
A) Cardiogenic shock
B) Neurogenic shock
C) Hemorrhagic shock
D) Septic shock
Correct Answer: C) Hemorrhagic shock
Rationale: Hemorrhagic shock is the most common cause of shock in trauma patients, resulting
from acute blood loss. While cardiogenic, neurogenic, and septic shock can occur in trauma
settings, hemorrhagic shock is by far the most frequent etiology.
Question 5
According to ATLS, what is the first step in the management of shock?
A) Administer vasopressors
B) Identify and control the source of bleeding
C) Obtain a CT scan
D) Place a central venous catheter
Correct Answer: B) Identify and control the source of bleeding
Rationale: The first step in managing shock in a trauma patient is to identify and control the
source of bleeding. This is part of the circulation assessment in the primary survey. Vasopressors
should not be used as a substitute for hemorrhage control. CT scans and central line placement
are secondary interventions.
Question 6
,A patient with a torso gunshot wound and hypotension should receive which of the following?
A) Crystalloid fluid resuscitation until the blood pressure is normal
B) Limited crystalloid resuscitation with early blood product transfusion
C) No fluid resuscitation until surgical intervention
D) Large volume colloid resuscitation only
Correct Answer: B) Limited crystalloid resuscitation with early blood product transfusion
Rationale: In the 10th edition of ATLS, the initial fluid bolus has been decreased from 2L to 1L of
crystalloid. In patients with hemorrhagic shock from penetrating torso trauma, early blood
product transfusion (balanced resuscitation with plasma and platelets) is preferred over
aggressive crystalloid resuscitation, which can worsen outcomes by diluting clotting factors and
causing hypothermia.
Question 7
A patient is brought to the emergency department after falling from the top of an 8-foot ladder.
Which of the following should be the first priority in the initial assessment?
A) Perform a head CT
B) Assess the airway with cervical spine protection
C) Obtain a chest X-ray
D) Check for pelvic fractures
Correct Answer: B) Assess the airway with cervical spine protection
Rationale: The ATLS primary survey follows the ABCDE approach. Airway assessment with
cervical spine protection is always the first priority. Any patient with a significant mechanism of
injury (such as a fall from height) is presumed to have a cervical spine injury until proven
otherwise.
Question 8
Which of the following findings is most concerning for a tension pneumothorax?
A) Decreased breath sounds on the affected side
B) Hypotension with distended neck veins
C) Subcutaneous emphysema
D) Tracheal deviation toward the affected side
Correct Answer: B) Hypotension with distended neck veins
Rationale: Tension pneumothorax is a life-threatening condition characterized by hypotension,
distended neck veins (jugular venous distension), tracheal deviation away from the affected
, side, and absent breath sounds on the affected side. Tracheal deviation is toward the unaffected
side, not the affected side. While decreased breath sounds and subcutaneous emphysema can
be present, the combination of hypotension and JVD is the most concerning classic finding.
Question 9
What is the primary goal of the initial assessment (primary survey) in ATLS?
A) To obtain a complete medical history
B) To identify and treat life-threatening conditions
C) To perform a full physical examination
D) To order all necessary imaging studies
Correct Answer: B) To identify and treat life-threatening conditions
Rationale: The primary goal of the initial assessment in ATLS is to rapidly identify and treat life-
threatening conditions. This is accomplished through the systematic ABCDE approach. Complete
history, full physical examination, and imaging are part of the secondary survey or subsequent
management.
Question 10
A 19-year-old man hiking in the national forest fell 10 feet through a rotten plank. On arrival, he
is awake and talking but complains of neck pain. Which of the following is the most appropriate
initial management?
A) Apply a cervical collar and log-roll the patient
B) Perform a rapid neurological exam before applying a collar
C) Apply a cervical collar and maintain spinal precautions
D) Obtain cervical spine X-rays before any movement
Correct Answer: C) Apply a cervical collar and maintain spinal precautions
Rationale: Any patient with a significant mechanism of injury and complaints of neck pain
should have spinal precautions initiated immediately. A cervical collar should be applied, and
the patient should be log-rolled with in-line stabilization. A neurological exam can be performed
after spinal precautions are in place. Cervical spine imaging should not delay initial assessment
and stabilization.
Question 11
In a severely injured patient, the risk for coagulopathy is high. Which of the following
contributes most significantly to trauma-induced coagulopathy?
and Correct Answers full trauma
Question 1
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 fluid resuscitation with 1 liter of warmed
crystalloid, his blood pressure improves to 110/70 mm Hg. What is the most likely class of
hemorrhagic shock?
A) Class I
B) Class II
C) Class III
D) Class IV
Correct Answer: B) Class II
Rationale: Class II hemorrhagic shock is characterized by blood loss of 15–30% (approximately
750–1500 mL), resulting in tachycardia (heart rate >100), tachypnea, and a narrowed pulse
pressure. The patient's initial hypotension with improvement after 1 liter of crystalloid is
consistent with Class II shock. Class I involves <15% blood loss with minimal vital sign changes.
Class III involves 30–40% blood loss with significant hypotension that does not typically correct
with only 1 liter of fluid. Class IV involves >40% blood loss with profound hypotension
unresponsive to fluid resuscitation.
Question 2
What is the most important consequence of inadequate organ perfusion in a trauma patient?
A) Decreased base deficit
B) Multiple organ failure
C) Metabolic alkalosis
D) Increased urine output
Correct Answer: B) Multiple organ failure
Rationale: Inadequate organ perfusion leads to tissue hypoxia, cellular dysfunction, and
ultimately multiple organ failure if not corrected promptly. Base deficit actually increases
(becomes more negative) in shock, not decreases. Metabolic acidosis, not alkalosis, occurs with
inadequate perfusion. Urine output decreases, not increases, in hypoperfusion states.
Question 3
,Signs and symptoms of airway compromise include all of the following EXCEPT:
A) Change in voice
B) Stridor
C) Decreased pulse pressure
D) Dyspnea and agitation
Correct Answer: C) Decreased pulse pressure
Rationale: Decreased pulse pressure is a sign of hemorrhagic shock or decreased cardiac output,
not specifically airway compromise. Change in voice (hoarseness), stridor (upper airway
obstruction), and dyspnea with agitation are all classic signs of airway compromise.
Question 4
Which of the following is the most common cause of shock in the trauma patient?
A) Cardiogenic shock
B) Neurogenic shock
C) Hemorrhagic shock
D) Septic shock
Correct Answer: C) Hemorrhagic shock
Rationale: Hemorrhagic shock is the most common cause of shock in trauma patients, resulting
from acute blood loss. While cardiogenic, neurogenic, and septic shock can occur in trauma
settings, hemorrhagic shock is by far the most frequent etiology.
Question 5
According to ATLS, what is the first step in the management of shock?
A) Administer vasopressors
B) Identify and control the source of bleeding
C) Obtain a CT scan
D) Place a central venous catheter
Correct Answer: B) Identify and control the source of bleeding
Rationale: The first step in managing shock in a trauma patient is to identify and control the
source of bleeding. This is part of the circulation assessment in the primary survey. Vasopressors
should not be used as a substitute for hemorrhage control. CT scans and central line placement
are secondary interventions.
Question 6
,A patient with a torso gunshot wound and hypotension should receive which of the following?
A) Crystalloid fluid resuscitation until the blood pressure is normal
B) Limited crystalloid resuscitation with early blood product transfusion
C) No fluid resuscitation until surgical intervention
D) Large volume colloid resuscitation only
Correct Answer: B) Limited crystalloid resuscitation with early blood product transfusion
Rationale: In the 10th edition of ATLS, the initial fluid bolus has been decreased from 2L to 1L of
crystalloid. In patients with hemorrhagic shock from penetrating torso trauma, early blood
product transfusion (balanced resuscitation with plasma and platelets) is preferred over
aggressive crystalloid resuscitation, which can worsen outcomes by diluting clotting factors and
causing hypothermia.
Question 7
A patient is brought to the emergency department after falling from the top of an 8-foot ladder.
Which of the following should be the first priority in the initial assessment?
A) Perform a head CT
B) Assess the airway with cervical spine protection
C) Obtain a chest X-ray
D) Check for pelvic fractures
Correct Answer: B) Assess the airway with cervical spine protection
Rationale: The ATLS primary survey follows the ABCDE approach. Airway assessment with
cervical spine protection is always the first priority. Any patient with a significant mechanism of
injury (such as a fall from height) is presumed to have a cervical spine injury until proven
otherwise.
Question 8
Which of the following findings is most concerning for a tension pneumothorax?
A) Decreased breath sounds on the affected side
B) Hypotension with distended neck veins
C) Subcutaneous emphysema
D) Tracheal deviation toward the affected side
Correct Answer: B) Hypotension with distended neck veins
Rationale: Tension pneumothorax is a life-threatening condition characterized by hypotension,
distended neck veins (jugular venous distension), tracheal deviation away from the affected
, side, and absent breath sounds on the affected side. Tracheal deviation is toward the unaffected
side, not the affected side. While decreased breath sounds and subcutaneous emphysema can
be present, the combination of hypotension and JVD is the most concerning classic finding.
Question 9
What is the primary goal of the initial assessment (primary survey) in ATLS?
A) To obtain a complete medical history
B) To identify and treat life-threatening conditions
C) To perform a full physical examination
D) To order all necessary imaging studies
Correct Answer: B) To identify and treat life-threatening conditions
Rationale: The primary goal of the initial assessment in ATLS is to rapidly identify and treat life-
threatening conditions. This is accomplished through the systematic ABCDE approach. Complete
history, full physical examination, and imaging are part of the secondary survey or subsequent
management.
Question 10
A 19-year-old man hiking in the national forest fell 10 feet through a rotten plank. On arrival, he
is awake and talking but complains of neck pain. Which of the following is the most appropriate
initial management?
A) Apply a cervical collar and log-roll the patient
B) Perform a rapid neurological exam before applying a collar
C) Apply a cervical collar and maintain spinal precautions
D) Obtain cervical spine X-rays before any movement
Correct Answer: C) Apply a cervical collar and maintain spinal precautions
Rationale: Any patient with a significant mechanism of injury and complaints of neck pain
should have spinal precautions initiated immediately. A cervical collar should be applied, and
the patient should be log-rolled with in-line stabilization. A neurological exam can be performed
after spinal precautions are in place. Cervical spine imaging should not delay initial assessment
and stabilization.
Question 11
In a severely injured patient, the risk for coagulopathy is high. Which of the following
contributes most significantly to trauma-induced coagulopathy?
