ADVANCED TRAUMA CARE FOR NURSES (ATCN) COMPLETE
EXAM QUESTIONS AND VERIFIED ANSWERS | 2026–2027
LATEST UPDATE | GUARANTEED PASS | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP | PRACTICE
TEST | CERTIFICATION PREPARATION
1. A trauma patient is brought to the emergency department following a high-speed motor vehicle
collision. The patient is unresponsive and has gurgling respirations. What is the priority nursing
intervention?
A. Assess the patient's heart rate and blood pressure
B. Apply a non-rebreather mask at 15 L/min
C. Open the airway using a jaw-thrust maneuver and suction the oropharynx
D. Immobilize the cervical spine with a rigid collar
Correct Answer: C. Open the airway using a jaw-thrust maneuver and suction the oropharynx
Rationale: In the ATCN primary survey, "A" stands for Airway with simultaneous cervical spine
protection. The presence of gurgling respirations indicates an obstructed airway from secretions or
blood. The jaw-thrust maneuver is the preferred method for opening the airway in a trauma patient
with suspected cervical spine injury as it minimizes cervical motion. Suctioning is the immediate
intervention to clear the airway of blood and secretions to establish a patent airway . Applying a
cervical collar alone does not address airway obstruction. A non-rebreather mask is ineffective with
an obstructed airway, and assessing vital signs occurs after airway and breathing have been
addressed in the primary survey.
2. A 45-year-old male with a suspected tension pneumothorax is in respiratory distress. Which
clinical finding is most consistent with this diagnosis?
A. Diminished breath sounds on the affected side with hyperresonance to percussion
B. Bilateral crackles and jugular venous distention
C. Tracheal deviation toward the affected side
D. Hypotension with a narrow pulse pressure
Correct Answer: A. Diminished breath sounds on the affected side with hyperresonance to
percussion
Rationale: Tension pneumothorax occurs when air accumulates in the pleural space, causing a
mediastinal shift and compression of the contralateral lung and great vessels. Clinical findings include
diminished or absent breath sounds, hyperresonance on percussion, tracheal deviation away from
the affected side, and hypotension . Tracheal deviation is away from, not toward, the affected side.
Bilateral crackles are more consistent with pulmonary edema or contusion. Hypotension with tension
pneumothorax is usually associated with a narrowed pulse pressure, but the hallmark physical exam
finding is the respiratory assessment described in option A.
,3. During the initial assessment of a trauma patient, the FAST (Focused Assessment with
Sonography for Trauma) examination reveals free fluid in the peritoneal cavity. The patient
remains hemodynamically unstable despite fluid resuscitation. What is the most appropriate next
step?
A. Immediate transfer to the operating room for exploratory laparotomy
B. Administration of 2 units of packed red blood cells
C. Computed tomography (CT) scan of the abdomen and pelvis
D. Placement of a nasogastric tube
Correct Answer: A. Immediate transfer to the operating room for exploratory laparotomy
Rationale: In an unstable trauma patient with a positive FAST examination, free fluid in the peritoneal
cavity is highly suggestive of intra-abdominal hemorrhage requiring urgent surgical intervention. This
patient cannot be safely transported to the CT scanner, which would delay definitive care . While
blood product administration is essential, it does not address the source of bleeding. A nasogastric
tube is an adjunct but does not treat the cause of hemodynamic instability. The standard of care for a
hemodynamically unstable patient with a positive FAST is immediate operative exploration.
4. A nurse is preparing to receive a trauma patient. Which of the following activities represents the
principle of "safe care"?
A. Ensuring the patient is transported to the correct facility at the appropriate time
B. Assembling equipment and verifying its function prior to the patient's arrival
C. Wearing appropriate personal protective equipment (PPE) and preparing the room
D. Reviewing the patient's medical history before transport
Correct Answer: A. Ensuring the patient is transported to the correct facility at the appropriate
time
Rationale: In ATCN preparation, "safe care" refers to ensuring the patient is directed to the right
hospital, at the right time, and receives the right care . The concept of "safe practice" involves team
protection, including the use of PPE and preparing equipment prior to patient arrival. While reviewing
the history is important, it is not the definition of the principle of "safe care." This distinction
reinforces the systematic approach to trauma team readiness.
5. A patient with a GCS of 13 presents with abdominal pain and a positive FAST exam. Vital signs
are heart rate 110 bpm, blood pressure 100/70 mmHg, and respiratory rate 22/min. The patient is
not responding to a 1-liter fluid bolus. What is the correct classification of this patient's shock?
A. Class I Hemorrhagic Shock
B. Class II Hemorrhagic Shock
C. Class III Hemorrhagic Shock
D. Class IV Hemorrhagic Shock
Correct Answer: C. Class III Hemorrhagic Shock
Rationale: Class III hemorrhagic shock is characterized by a blood loss of 30–40% (1500–2000 mL),
typically presenting with a heart rate > 120 bpm (though can be 110–120 in some presentations), a
systolic blood pressure < 100 mmHg, tachypnea, and altered mental status. The patient's vital signs
,and failure to respond to initial fluid resuscitation indicate significant ongoing hemorrhage requiring
blood product transfusion . Class II shock shows tachycardia > 100, but normotension. Class I is mild
tachycardia without hypotension. Class IV is severe shock with a systolic BP < 70 and profound mental
status changes.
6. Which of the following is an absolute contraindication to the placement of a nasopharyngeal
airway?
A. Suspected basilar skull fracture
B. Facial trauma with epistaxis
C. Conscious patient with a gag reflex
D. Severe maxillofacial fractures
Correct Answer: A. Suspected basilar skull fracture
Rationale: Nasopharyngeal airways are generally contraindicated in patients with suspected basilar
skull fractures. Placement can inadvertently enter the cranial vault through a fracture, causing
catastrophic injury. Signs of basilar skull fracture include periorbital ecchymosis (raccoon eyes),
retroauricular ecchymosis (Battle's sign), and cerebrospinal fluid (CSF) rhinorrhea or otorrhea . While
facial trauma with epistaxis and maxillofacial fractures require caution, they are not absolute
contraindications. A conscious patient with an intact gag reflex should not have a nasopharyngeal
airway placed as it may stimulate vomiting and aspiration, but this is a relative contraindication
compared to the absolute risk of intracranial placement with a basilar skull fracture.
7. A trauma patient's arterial blood gas reveals a base deficit of -8 mEq/L. What is the most
appropriate interpretation of this finding?
A. Normal perfusion with adequate resuscitation
B. Mild metabolic acidosis indicating fluid responsiveness
C. Moderate metabolic acidosis indicating significant injury and ongoing hemorrhage
D. Severe metabolic acidosis with a high mortality risk
Correct Answer: C. Moderate metabolic acidosis indicating significant injury and ongoing
hemorrhage
Rationale: Base deficit is a measure of metabolic acidosis and reflects the degree of tissue
hypoperfusion. A base deficit of -6 to -9 mEq/L is classified as moderate acidosis and is associated
with significant injury and substantial mortality. It indicates inadequate organ perfusion and ongoing
hemorrhage . Normal base deficit is -2 to +2 mEq/L. Mild base deficit is -3 to -5 mEq/L. Severe base
deficit is -10 or lower, which indicates profound shock and high mortality risk. This finding should
prompt reassessment for ongoing hemorrhage and aggressive resuscitation.
8. A 28-year-old female was involved in a motor vehicle collision and presents with a penetrating
injury to the left chest. She has stridor and an expanding hematoma on the left side of her neck.
What is the priority action?
A. Prepare for immediate operative exploration
B. Obtain a CT angiogram
, C. Apply a pressure dressing to the neck
D. Perform a needle decompression
Correct Answer: A. Prepare for immediate operative exploration
Rationale: Penetrating neck trauma with stridor and an expanding hematoma are signs of an acutely
compromised airway and potential vascular injury. This patient requires immediate operative
exploration to control hemorrhage and secure the airway . Imaging, such as a CT angiogram, would
delay life-saving intervention. Applying pressure to a neck hematoma is contraindicated as it can
compromise the airway. Needle decompression is indicated for tension pneumothorax, not a neck
hematoma. This scenario represents a surgical emergency requiring immediate operating room
availability.
9. A patient is suspected of having cardiac tamponade following a stab wound to the chest. Which
of the following assessment findings is part of Beck's Triad?
A. Muffled heart sounds, hypotension, and narrowing pulse pressure
B. Muffled heart sounds, distended neck veins, and hypotension
C. Distended neck veins, pulsus paradoxus, and hypertension
D. Hypotension, tachycardia, and clear breath sounds
Correct Answer: B. Muffled heart sounds, distended neck veins, and hypotension
Rationale: Beck's Triad is the classic presentation of cardiac tamponade and consists of muffled heart
sounds, distended neck veins (jugular venous distention), and hypotension . This triad results from
compression of the heart by accumulating blood or fluid in the pericardial sac. While pulsus
paradoxus is a sign of cardiac tamponade, it is not part of Beck's Triad. Hypertension is not seen with
tamponade; the pressure is typically low or normal with a narrowed pulse pressure. Clear breath
sounds are expected unless there is another concurrent injury, but this does not differentiate
tamponade.
10. The "G" in the trauma primary survey stands for "Get resuscitation adjuncts". Which of the
following is part of the "M" component of this assessment?
A. Laboratory studies including ABG's and type and crossmatch
B. Continuous cardiac rhythm and rate monitoring
C. Naso/orogastric tube decompression of the stomach
D. Neurological assessment using the GCS
Correct Answer: B. Continuous cardiac rhythm and rate monitoring
Rationale: The "G" or "Get resuscitation adjuncts" portion of the primary survey includes the LMNOP
mnemonic: L for laboratory studies, M for monitor (continuous cardiac monitoring), N for
naso/orogastric tube, O for oxygen and pulse oximetry, and P for pain assessment and management .
Continuous cardiac monitoring allows for the early detection of dysrhythmias that may result from
hypovolemia, hypoxemia, or blunt cardiac injury. Laboratory studies and naso/orogastric tubes are
covered by "L" and "N" respectively. Neurological assessment using GCS is part of the "D" for
Disability.
EXAM QUESTIONS AND VERIFIED ANSWERS | 2026–2027
LATEST UPDATE | GUARANTEED PASS | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP | PRACTICE
TEST | CERTIFICATION PREPARATION
1. A trauma patient is brought to the emergency department following a high-speed motor vehicle
collision. The patient is unresponsive and has gurgling respirations. What is the priority nursing
intervention?
A. Assess the patient's heart rate and blood pressure
B. Apply a non-rebreather mask at 15 L/min
C. Open the airway using a jaw-thrust maneuver and suction the oropharynx
D. Immobilize the cervical spine with a rigid collar
Correct Answer: C. Open the airway using a jaw-thrust maneuver and suction the oropharynx
Rationale: In the ATCN primary survey, "A" stands for Airway with simultaneous cervical spine
protection. The presence of gurgling respirations indicates an obstructed airway from secretions or
blood. The jaw-thrust maneuver is the preferred method for opening the airway in a trauma patient
with suspected cervical spine injury as it minimizes cervical motion. Suctioning is the immediate
intervention to clear the airway of blood and secretions to establish a patent airway . Applying a
cervical collar alone does not address airway obstruction. A non-rebreather mask is ineffective with
an obstructed airway, and assessing vital signs occurs after airway and breathing have been
addressed in the primary survey.
2. A 45-year-old male with a suspected tension pneumothorax is in respiratory distress. Which
clinical finding is most consistent with this diagnosis?
A. Diminished breath sounds on the affected side with hyperresonance to percussion
B. Bilateral crackles and jugular venous distention
C. Tracheal deviation toward the affected side
D. Hypotension with a narrow pulse pressure
Correct Answer: A. Diminished breath sounds on the affected side with hyperresonance to
percussion
Rationale: Tension pneumothorax occurs when air accumulates in the pleural space, causing a
mediastinal shift and compression of the contralateral lung and great vessels. Clinical findings include
diminished or absent breath sounds, hyperresonance on percussion, tracheal deviation away from
the affected side, and hypotension . Tracheal deviation is away from, not toward, the affected side.
Bilateral crackles are more consistent with pulmonary edema or contusion. Hypotension with tension
pneumothorax is usually associated with a narrowed pulse pressure, but the hallmark physical exam
finding is the respiratory assessment described in option A.
,3. During the initial assessment of a trauma patient, the FAST (Focused Assessment with
Sonography for Trauma) examination reveals free fluid in the peritoneal cavity. The patient
remains hemodynamically unstable despite fluid resuscitation. What is the most appropriate next
step?
A. Immediate transfer to the operating room for exploratory laparotomy
B. Administration of 2 units of packed red blood cells
C. Computed tomography (CT) scan of the abdomen and pelvis
D. Placement of a nasogastric tube
Correct Answer: A. Immediate transfer to the operating room for exploratory laparotomy
Rationale: In an unstable trauma patient with a positive FAST examination, free fluid in the peritoneal
cavity is highly suggestive of intra-abdominal hemorrhage requiring urgent surgical intervention. This
patient cannot be safely transported to the CT scanner, which would delay definitive care . While
blood product administration is essential, it does not address the source of bleeding. A nasogastric
tube is an adjunct but does not treat the cause of hemodynamic instability. The standard of care for a
hemodynamically unstable patient with a positive FAST is immediate operative exploration.
4. A nurse is preparing to receive a trauma patient. Which of the following activities represents the
principle of "safe care"?
A. Ensuring the patient is transported to the correct facility at the appropriate time
B. Assembling equipment and verifying its function prior to the patient's arrival
C. Wearing appropriate personal protective equipment (PPE) and preparing the room
D. Reviewing the patient's medical history before transport
Correct Answer: A. Ensuring the patient is transported to the correct facility at the appropriate
time
Rationale: In ATCN preparation, "safe care" refers to ensuring the patient is directed to the right
hospital, at the right time, and receives the right care . The concept of "safe practice" involves team
protection, including the use of PPE and preparing equipment prior to patient arrival. While reviewing
the history is important, it is not the definition of the principle of "safe care." This distinction
reinforces the systematic approach to trauma team readiness.
5. A patient with a GCS of 13 presents with abdominal pain and a positive FAST exam. Vital signs
are heart rate 110 bpm, blood pressure 100/70 mmHg, and respiratory rate 22/min. The patient is
not responding to a 1-liter fluid bolus. What is the correct classification of this patient's shock?
A. Class I Hemorrhagic Shock
B. Class II Hemorrhagic Shock
C. Class III Hemorrhagic Shock
D. Class IV Hemorrhagic Shock
Correct Answer: C. Class III Hemorrhagic Shock
Rationale: Class III hemorrhagic shock is characterized by a blood loss of 30–40% (1500–2000 mL),
typically presenting with a heart rate > 120 bpm (though can be 110–120 in some presentations), a
systolic blood pressure < 100 mmHg, tachypnea, and altered mental status. The patient's vital signs
,and failure to respond to initial fluid resuscitation indicate significant ongoing hemorrhage requiring
blood product transfusion . Class II shock shows tachycardia > 100, but normotension. Class I is mild
tachycardia without hypotension. Class IV is severe shock with a systolic BP < 70 and profound mental
status changes.
6. Which of the following is an absolute contraindication to the placement of a nasopharyngeal
airway?
A. Suspected basilar skull fracture
B. Facial trauma with epistaxis
C. Conscious patient with a gag reflex
D. Severe maxillofacial fractures
Correct Answer: A. Suspected basilar skull fracture
Rationale: Nasopharyngeal airways are generally contraindicated in patients with suspected basilar
skull fractures. Placement can inadvertently enter the cranial vault through a fracture, causing
catastrophic injury. Signs of basilar skull fracture include periorbital ecchymosis (raccoon eyes),
retroauricular ecchymosis (Battle's sign), and cerebrospinal fluid (CSF) rhinorrhea or otorrhea . While
facial trauma with epistaxis and maxillofacial fractures require caution, they are not absolute
contraindications. A conscious patient with an intact gag reflex should not have a nasopharyngeal
airway placed as it may stimulate vomiting and aspiration, but this is a relative contraindication
compared to the absolute risk of intracranial placement with a basilar skull fracture.
7. A trauma patient's arterial blood gas reveals a base deficit of -8 mEq/L. What is the most
appropriate interpretation of this finding?
A. Normal perfusion with adequate resuscitation
B. Mild metabolic acidosis indicating fluid responsiveness
C. Moderate metabolic acidosis indicating significant injury and ongoing hemorrhage
D. Severe metabolic acidosis with a high mortality risk
Correct Answer: C. Moderate metabolic acidosis indicating significant injury and ongoing
hemorrhage
Rationale: Base deficit is a measure of metabolic acidosis and reflects the degree of tissue
hypoperfusion. A base deficit of -6 to -9 mEq/L is classified as moderate acidosis and is associated
with significant injury and substantial mortality. It indicates inadequate organ perfusion and ongoing
hemorrhage . Normal base deficit is -2 to +2 mEq/L. Mild base deficit is -3 to -5 mEq/L. Severe base
deficit is -10 or lower, which indicates profound shock and high mortality risk. This finding should
prompt reassessment for ongoing hemorrhage and aggressive resuscitation.
8. A 28-year-old female was involved in a motor vehicle collision and presents with a penetrating
injury to the left chest. She has stridor and an expanding hematoma on the left side of her neck.
What is the priority action?
A. Prepare for immediate operative exploration
B. Obtain a CT angiogram
, C. Apply a pressure dressing to the neck
D. Perform a needle decompression
Correct Answer: A. Prepare for immediate operative exploration
Rationale: Penetrating neck trauma with stridor and an expanding hematoma are signs of an acutely
compromised airway and potential vascular injury. This patient requires immediate operative
exploration to control hemorrhage and secure the airway . Imaging, such as a CT angiogram, would
delay life-saving intervention. Applying pressure to a neck hematoma is contraindicated as it can
compromise the airway. Needle decompression is indicated for tension pneumothorax, not a neck
hematoma. This scenario represents a surgical emergency requiring immediate operating room
availability.
9. A patient is suspected of having cardiac tamponade following a stab wound to the chest. Which
of the following assessment findings is part of Beck's Triad?
A. Muffled heart sounds, hypotension, and narrowing pulse pressure
B. Muffled heart sounds, distended neck veins, and hypotension
C. Distended neck veins, pulsus paradoxus, and hypertension
D. Hypotension, tachycardia, and clear breath sounds
Correct Answer: B. Muffled heart sounds, distended neck veins, and hypotension
Rationale: Beck's Triad is the classic presentation of cardiac tamponade and consists of muffled heart
sounds, distended neck veins (jugular venous distention), and hypotension . This triad results from
compression of the heart by accumulating blood or fluid in the pericardial sac. While pulsus
paradoxus is a sign of cardiac tamponade, it is not part of Beck's Triad. Hypertension is not seen with
tamponade; the pressure is typically low or normal with a narrowed pulse pressure. Clear breath
sounds are expected unless there is another concurrent injury, but this does not differentiate
tamponade.
10. The "G" in the trauma primary survey stands for "Get resuscitation adjuncts". Which of the
following is part of the "M" component of this assessment?
A. Laboratory studies including ABG's and type and crossmatch
B. Continuous cardiac rhythm and rate monitoring
C. Naso/orogastric tube decompression of the stomach
D. Neurological assessment using the GCS
Correct Answer: B. Continuous cardiac rhythm and rate monitoring
Rationale: The "G" or "Get resuscitation adjuncts" portion of the primary survey includes the LMNOP
mnemonic: L for laboratory studies, M for monitor (continuous cardiac monitoring), N for
naso/orogastric tube, O for oxygen and pulse oximetry, and P for pain assessment and management .
Continuous cardiac monitoring allows for the early detection of dysrhythmias that may result from
hypovolemia, hypoxemia, or blunt cardiac injury. Laboratory studies and naso/orogastric tubes are
covered by "L" and "N" respectively. Neurological assessment using GCS is part of the "D" for
Disability.
