Advanced Trauma Care for Nurses (ATCN) Skills
Evaluation – Practice Exam 1: Verified
Questions and Answers | Instant PDF Study
Guide
1. A trauma patient arrives with severe respiratory distress,
absent breath sounds on the right, hypotension, distended
neck veins, and tracheal deviation to the left. What is the
priority intervention?
A. Obtain a portable chest X-ray
B. Administer a 1-L crystalloid bolus
C. Perform immediate needle or finger thoracostomy
D. Prepare the patient for CT scanning
Answer: C. Perform immediate needle or finger thoracostomy
Rationale: The findings are classic for a tension pneumothorax,
a life-threatening condition caused by progressively increasing
intrathoracic pressure. The pressure impairs venous return to
the heart, producing obstructive shock. Diagnosis is primarily
clinical and treatment should not be delayed for imaging in an
unstable patient. Immediate decompression is followed by
placement of a chest tube. A chest X-ray or CT scan would
unnecessarily delay definitive treatment.
,2. During the primary survey, which finding requires the most
immediate intervention?
A. Open tibial fracture with moderate bleeding
B. Blood pressure of 90/60 mmHg
C. Airway obstruction with inability to maintain oxygenation
D. Abdominal tenderness
Answer: C. Airway obstruction with inability to maintain
oxygenation
Rationale: The primary survey follows the priorities of airway,
breathing, circulation, disability, and exposure. An airway
obstruction that prevents adequate oxygenation can rapidly
cause hypoxic brain injury and cardiac arrest. Although
hemorrhage and hypotension are also emergencies, an
immediately compromised airway takes priority when it
prevents effective oxygenation and ventilation.
3. A patient with facial trauma has gurgling respirations and
visible blood in the oropharynx. What should the nurse do
first?
A. Insert a nasopharyngeal airway
B. Suction the airway while maintaining cervical-spine
precautions
,C. Obtain a Glasgow Coma Scale score
D. Administer intravenous analgesia
Answer: B. Suction the airway while maintaining cervical-spine
precautions
Rationale: Blood and secretions can obstruct the airway and
must be removed immediately. Suctioning should be performed
while maintaining manual cervical-spine stabilization because
significant facial trauma may be associated with cervical injury.
A nasopharyngeal airway may be contraindicated in certain
facial and basilar skull injuries. Airway clearance takes priority
over neurological assessment or medication administration.
4. Which patient has the highest priority for immediate
trauma-team intervention?
A. Patient with an isolated closed forearm fracture and stable
vital signs
B. Patient with a scalp laceration and GCS of 15
C. Patient with penetrating chest trauma, severe respiratory
distress, and hypotension
D. Patient with an ankle deformity and severe pain
Answer: C. Patient with penetrating chest trauma, severe
respiratory distress, and hypotension
, Rationale: Severe respiratory distress combined with
hypotension following penetrating chest trauma suggests a
potentially fatal thoracic injury such as tension pneumothorax,
massive hemothorax, or cardiac tamponade. These conditions
can rapidly cause cardiovascular collapse and require
immediate assessment and intervention. Stable orthopedic and
superficial injuries are lower priorities during the primary
survey.
5. A trauma patient has a Glasgow Coma Scale score of 7 and
cannot protect the airway. Which intervention is most
appropriate?
A. Place the patient in a sitting position
B. Administer oral fluids
C. Prepare for definitive airway management with
endotracheal intubation
D. Delay airway intervention until CT results are available
Answer: C. Prepare for definitive airway management with
endotracheal intubation
Rationale: A markedly depressed level of consciousness can
compromise airway protection and ventilation. A patient with a
GCS of 8 or less commonly requires definitive airway
consideration, particularly when protective reflexes are absent
Evaluation – Practice Exam 1: Verified
Questions and Answers | Instant PDF Study
Guide
1. A trauma patient arrives with severe respiratory distress,
absent breath sounds on the right, hypotension, distended
neck veins, and tracheal deviation to the left. What is the
priority intervention?
A. Obtain a portable chest X-ray
B. Administer a 1-L crystalloid bolus
C. Perform immediate needle or finger thoracostomy
D. Prepare the patient for CT scanning
Answer: C. Perform immediate needle or finger thoracostomy
Rationale: The findings are classic for a tension pneumothorax,
a life-threatening condition caused by progressively increasing
intrathoracic pressure. The pressure impairs venous return to
the heart, producing obstructive shock. Diagnosis is primarily
clinical and treatment should not be delayed for imaging in an
unstable patient. Immediate decompression is followed by
placement of a chest tube. A chest X-ray or CT scan would
unnecessarily delay definitive treatment.
,2. During the primary survey, which finding requires the most
immediate intervention?
A. Open tibial fracture with moderate bleeding
B. Blood pressure of 90/60 mmHg
C. Airway obstruction with inability to maintain oxygenation
D. Abdominal tenderness
Answer: C. Airway obstruction with inability to maintain
oxygenation
Rationale: The primary survey follows the priorities of airway,
breathing, circulation, disability, and exposure. An airway
obstruction that prevents adequate oxygenation can rapidly
cause hypoxic brain injury and cardiac arrest. Although
hemorrhage and hypotension are also emergencies, an
immediately compromised airway takes priority when it
prevents effective oxygenation and ventilation.
3. A patient with facial trauma has gurgling respirations and
visible blood in the oropharynx. What should the nurse do
first?
A. Insert a nasopharyngeal airway
B. Suction the airway while maintaining cervical-spine
precautions
,C. Obtain a Glasgow Coma Scale score
D. Administer intravenous analgesia
Answer: B. Suction the airway while maintaining cervical-spine
precautions
Rationale: Blood and secretions can obstruct the airway and
must be removed immediately. Suctioning should be performed
while maintaining manual cervical-spine stabilization because
significant facial trauma may be associated with cervical injury.
A nasopharyngeal airway may be contraindicated in certain
facial and basilar skull injuries. Airway clearance takes priority
over neurological assessment or medication administration.
4. Which patient has the highest priority for immediate
trauma-team intervention?
A. Patient with an isolated closed forearm fracture and stable
vital signs
B. Patient with a scalp laceration and GCS of 15
C. Patient with penetrating chest trauma, severe respiratory
distress, and hypotension
D. Patient with an ankle deformity and severe pain
Answer: C. Patient with penetrating chest trauma, severe
respiratory distress, and hypotension
, Rationale: Severe respiratory distress combined with
hypotension following penetrating chest trauma suggests a
potentially fatal thoracic injury such as tension pneumothorax,
massive hemothorax, or cardiac tamponade. These conditions
can rapidly cause cardiovascular collapse and require
immediate assessment and intervention. Stable orthopedic and
superficial injuries are lower priorities during the primary
survey.
5. A trauma patient has a Glasgow Coma Scale score of 7 and
cannot protect the airway. Which intervention is most
appropriate?
A. Place the patient in a sitting position
B. Administer oral fluids
C. Prepare for definitive airway management with
endotracheal intubation
D. Delay airway intervention until CT results are available
Answer: C. Prepare for definitive airway management with
endotracheal intubation
Rationale: A markedly depressed level of consciousness can
compromise airway protection and ventilation. A patient with a
GCS of 8 or less commonly requires definitive airway
consideration, particularly when protective reflexes are absent
