ATCN Pretest Questions and Answers Actual Exam 2026/2027 |
Detailed Rationales | Graded A+ | Pass Guaranteed – A+
Graded
Section 1: Initial Assessment & Triage
Question 1
A 28-year-old male is brought to the emergency department following a high-speed
motor vehicle crash. He is moaning, has gurgling respirations, and blood is visible in his
oropharynx. His respiratory rate is 8/min and SpO₂ is 82% on room air. What is the
priority intervention?
A. Obtain a CT scan of the cervical spine
B. Apply a non-rebreather oxygen mask at 15 L/min
C. Perform rapid sequence intubation with cervical spine protection
D. Insert a nasopharyngeal airway
Correct Answer: C. Perform rapid sequence intubation with cervical spine protection
Rationale: The patient has definitive airway compromise (gurgling, blood in airway,
hypoxia, bradypnea). ATLS mandates airway with cervical spine protection as the first
priority. Supplemental oxygen alone (B) is insufficient, and nasopharyngeal airways (D)
are contraindicated with blood in the airway and altered mental status. CT imaging (A)
is inappropriate in an unstable patient with an unprotected airway.
Question 2
During the primary survey of a multi-trauma patient, the nurse notes the patient is
speaking clearly but has stridor and a seatbelt sign across the anterior neck. What is the
most appropriate next step?
A. Apply high-flow oxygen via non-rebreather mask
B. Perform direct laryngoscopy to evaluate for laryngotracheal injury
C. Place the patient supine and apply a cervical collar
D. Palpate the anterior neck for crepitus
,Correct Answer: B. Perform direct laryngoscopy to evaluate for laryngotracheal injury
Rationale: Hoarseness or stridor combined with anterior neck bruising (seatbelt sign)
raises high suspicion for laryngotracheal injury. Direct visualization of the airway is
required before instrumentation. While oxygen (A) and cervical spine protection (C) are
important, they do not address the immediate threat of airway obstruction from an
occult laryngeal fracture. Palpation alone (D) is insufficient.
Question 3
A trauma patient arrives with a Glasgow Coma Scale (GCS) score of 7, opens eyes to
pain, makes incomprehensible sounds, and withdraws from painful stimuli. What is the
priority nursing action?
A. Prepare for emergent intubation
B. Insert a nasogastric tube for gastric decompression
C. Obtain a non-contrast CT scan of the head
D. Administer mannitol 1 g/kg IV
Correct Answer: A. Prepare for emergent intubation
Rationale: A GCS of 8 or less indicates the patient cannot protect their airway and
requires definitive airway management. This is an ATLS priority before imaging or other
interventions. Nasogastric tube insertion (B) is contraindicated if basilar skull fracture is
suspected. Head CT (C) and mannitol (D) are important but secondary to securing the
airway.
Question 4
The trauma team is performing the primary survey on a patient involved in a fall from
height. Which action is performed during the "Exposure" phase?
A. Insert two large-bore peripheral IVs
B. Apply a cervical collar and maintain manual stabilization
C. Completely undress the patient while preventing hypothermia
D. Assess breath sounds bilaterally
Correct Answer: C. Completely undress the patient while preventing hypothermia
Rationale: The "E" in ABCDE stands for Exposure with environmental control. This
involves fully undressing the patient to identify occult injuries while actively preventing
, hypothermia, which is a key component of the lethal triad. Option A is part of
Circulation. Option B is part of Airway. Option D is part of Breathing.
Question 5
A trauma patient is being log-rolled to examine the posterior surfaces. The nurse should
be aware that log-rolling may be destabilizing for fractures at which level?
A. C1 to C3
B. C4 to C6
C. T12 to L1
D. L4 to L5
Correct Answer: C. T12 to L1
Rationale: Log-rolling can destabilize fractures at the thoracolumbar junction (T12 to L1)
due to the transition from a rigid thoracic spine to a more mobile lumbar spine. While
cervical spine injuries require stabilization, log-rolling specifically poses destabilization
risk at the thoracolumbar junction.
Question 6
A 45-year-old construction worker falls from a scaffolding and arrives alert with stable
vital signs. The trauma nurse is preparing to perform the secondary survey. When
should the secondary survey be initiated?
A. Immediately upon patient arrival
B. Only after the primary survey is completed and resuscitation is underway
C. After all CT imaging has been completed
D. Concurrently with the primary survey in stable patients
Correct Answer: B. Only after the primary survey is completed and resuscitation is
underway
Rationale: The secondary survey is a comprehensive head-to-toe examination
performed only after the primary survey is complete, life-threatening conditions are
addressed, and resuscitation is in progress. It is never performed before the primary
survey, regardless of how stable the patient appears.
Section 2: Airway & Ventilation
Detailed Rationales | Graded A+ | Pass Guaranteed – A+
Graded
Section 1: Initial Assessment & Triage
Question 1
A 28-year-old male is brought to the emergency department following a high-speed
motor vehicle crash. He is moaning, has gurgling respirations, and blood is visible in his
oropharynx. His respiratory rate is 8/min and SpO₂ is 82% on room air. What is the
priority intervention?
A. Obtain a CT scan of the cervical spine
B. Apply a non-rebreather oxygen mask at 15 L/min
C. Perform rapid sequence intubation with cervical spine protection
D. Insert a nasopharyngeal airway
Correct Answer: C. Perform rapid sequence intubation with cervical spine protection
Rationale: The patient has definitive airway compromise (gurgling, blood in airway,
hypoxia, bradypnea). ATLS mandates airway with cervical spine protection as the first
priority. Supplemental oxygen alone (B) is insufficient, and nasopharyngeal airways (D)
are contraindicated with blood in the airway and altered mental status. CT imaging (A)
is inappropriate in an unstable patient with an unprotected airway.
Question 2
During the primary survey of a multi-trauma patient, the nurse notes the patient is
speaking clearly but has stridor and a seatbelt sign across the anterior neck. What is the
most appropriate next step?
A. Apply high-flow oxygen via non-rebreather mask
B. Perform direct laryngoscopy to evaluate for laryngotracheal injury
C. Place the patient supine and apply a cervical collar
D. Palpate the anterior neck for crepitus
,Correct Answer: B. Perform direct laryngoscopy to evaluate for laryngotracheal injury
Rationale: Hoarseness or stridor combined with anterior neck bruising (seatbelt sign)
raises high suspicion for laryngotracheal injury. Direct visualization of the airway is
required before instrumentation. While oxygen (A) and cervical spine protection (C) are
important, they do not address the immediate threat of airway obstruction from an
occult laryngeal fracture. Palpation alone (D) is insufficient.
Question 3
A trauma patient arrives with a Glasgow Coma Scale (GCS) score of 7, opens eyes to
pain, makes incomprehensible sounds, and withdraws from painful stimuli. What is the
priority nursing action?
A. Prepare for emergent intubation
B. Insert a nasogastric tube for gastric decompression
C. Obtain a non-contrast CT scan of the head
D. Administer mannitol 1 g/kg IV
Correct Answer: A. Prepare for emergent intubation
Rationale: A GCS of 8 or less indicates the patient cannot protect their airway and
requires definitive airway management. This is an ATLS priority before imaging or other
interventions. Nasogastric tube insertion (B) is contraindicated if basilar skull fracture is
suspected. Head CT (C) and mannitol (D) are important but secondary to securing the
airway.
Question 4
The trauma team is performing the primary survey on a patient involved in a fall from
height. Which action is performed during the "Exposure" phase?
A. Insert two large-bore peripheral IVs
B. Apply a cervical collar and maintain manual stabilization
C. Completely undress the patient while preventing hypothermia
D. Assess breath sounds bilaterally
Correct Answer: C. Completely undress the patient while preventing hypothermia
Rationale: The "E" in ABCDE stands for Exposure with environmental control. This
involves fully undressing the patient to identify occult injuries while actively preventing
, hypothermia, which is a key component of the lethal triad. Option A is part of
Circulation. Option B is part of Airway. Option D is part of Breathing.
Question 5
A trauma patient is being log-rolled to examine the posterior surfaces. The nurse should
be aware that log-rolling may be destabilizing for fractures at which level?
A. C1 to C3
B. C4 to C6
C. T12 to L1
D. L4 to L5
Correct Answer: C. T12 to L1
Rationale: Log-rolling can destabilize fractures at the thoracolumbar junction (T12 to L1)
due to the transition from a rigid thoracic spine to a more mobile lumbar spine. While
cervical spine injuries require stabilization, log-rolling specifically poses destabilization
risk at the thoracolumbar junction.
Question 6
A 45-year-old construction worker falls from a scaffolding and arrives alert with stable
vital signs. The trauma nurse is preparing to perform the secondary survey. When
should the secondary survey be initiated?
A. Immediately upon patient arrival
B. Only after the primary survey is completed and resuscitation is underway
C. After all CT imaging has been completed
D. Concurrently with the primary survey in stable patients
Correct Answer: B. Only after the primary survey is completed and resuscitation is
underway
Rationale: The secondary survey is a comprehensive head-to-toe examination
performed only after the primary survey is complete, life-threatening conditions are
addressed, and resuscitation is in progress. It is never performed before the primary
survey, regardless of how stable the patient appears.
Section 2: Airway & Ventilation
