Atcn pretest – questions & answers study guide questions with 100% correct
answers | verified | updated 2024
A 20-year-old woman who is 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: - ansperform needle or finger
decompression of the right chest
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes after
the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood
pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray
reveals a large left hemothorax. A left chest tube is placed with an immediate return of
1600 mL of blood. The next management step for this patient is: - ansprepare for an
exploratory thoracotomy
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 initial fluid resuscitation 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. A tube thoracostomy is performed for
decreased left chest 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: - ansre-examine the
chest
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital no surgical capabilities are 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: - ansrepeat the primary survey and
proceed with transfer
A 23-year-old man sustains 4 stab wounds to the upper right chest du ring an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds
are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does
not reveal intraabdominal injuries. 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% O2). 1500 mL of blood has drained from the right chest. The most appropriate
next step in managing this patient is to: - ansurgently transfer the patient to the
operating room
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and h is eyes open to pressure. He does not
follow commands, but he does moan periodically. His right arm is deformed and does
,not respond to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is: - ans9
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower
extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses
cannot be palpated below the right femoral artery and the muscles of the lower
extremity are firm and hard. During the management of this patient, which of the
following is most likely to improve the chances for limb salvage? - anssurgical
consultation for right lower extremity fasciotomy
A 33-year-old woman is involved in a head-on 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: - anscardiac tamponade
A 39-year-old 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: - ansrestrict cervical motion and attempt orotracheal
intubation using 2 people
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated
in the emergency department. She is hemodynamically normal and found to be
paraplegic at the level of T10. Which of the following are true regarding her evaluation
and management? - ansLog rolling using 4 people is a safe approach to restrict spinal
motion when moving her.
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. Which of the following best differentiates cardiac tamponade
from tension pneumothorax as the cause of his hypotension? - ansbreath sounds
A 6-year-old 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 about this patient? - ansA pulmonary contusion may be present in the absence of
rib fractures.
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small
hospital without surgical capabilities. He has a closed head injury with a GCS score of
13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4,
but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74
,mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per
minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient
to a facility capable of providing a higher level of care. The facility is 128 km (80 miles)
away. Before transfer, you should first: - anscall the receiving hospital and speak to the
surgeon on call
A 7-year-old boy is brought to the emergency department by his parents several
minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of
his medial right thigh. Immediate management of the wound should consist of: -
ansdirect pressure on the wound
A construction worker falls two stories from a building and sustains bilateral calcaneal
fractures. In the emergency department, he is alert, vital signs are normal, and he is
complaining of severe pain in both heels and his lower back. Lower extremity pulses are
strong and there is no other deformity. The suspected diagnosis is most likely to be
confirmed by: - anscomplete spine x-ray series
A healthy young male is brought to the emergency department following a motor vehicle
crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient
moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in
management is: - ansplacement of a pelvic binder
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade
III (moderately severe) splenic injury has been confirmed by computed tomography
(CT). Which of the following mandates prompt celiotomy (laparotomy)? -
ansdevelopment of peritonitis on physical exam
A patient arrives in the emergency department after being beaten about the head and
face with a wooden club. He is comatose and has a palpable depressed skull fracture.
His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his
face and clothing. The most appropriate step after providing supplemental oxygen and
elevating his jaw is to: - anssuction the oropharynx
A patient is brought to the emergency department 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? - ansFlaccidity of the lower extremities and loss of deep tendon reflexes are
expected.
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2
liters. Which one of the following statements applies to this patient? - ansAn ABG would
demonstrate a base deficit between -6 and -10 mEq/L.
A trauma patient presents to your emergency department with inspiratory stridor and a
suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a
, nonrebreathing mask. The most appropriate next step is to: - ansrestrict cervical motion
and establish a definitive airway
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: -
ansavoid hypotension
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital
that has surgery capabilities available.. Computed tomography of the chest and
abdomen 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: - ansperform an
exploratory laparotomy
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - ansThe trachea is relatively short.
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - anscerebral vasoconstriction with diminished perfusion
Hemorrhage of 20% of the patient's blood volume is associated usually with: -
anstachycardia
In managing a patient with a severe traumatic brain injury, the most important initial step
is to: - anssecure the airway
The best assessment of fluid resuscitation of the adult burn patient is: - ansurinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - ansevidence of inadequate organ perfusion
The first maneuver to improve oxygen ation after chest injury is: - ansadminister
supplemental oxygen
The following are contraindications for tetanus toxoid administration: - anshistory of
neurological reaction or severe hypersensitivity to the product
The most important, immediate step in the management of an open pneumothorax is: -
ansplacement of an occlusive dressing over the wound
The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by: - ansincreasing the volume of
blood loss to produce maternal hypotension
answers | verified | updated 2024
A 20-year-old woman who is 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: - ansperform needle or finger
decompression of the right chest
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes after
the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood
pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray
reveals a large left hemothorax. A left chest tube is placed with an immediate return of
1600 mL of blood. The next management step for this patient is: - ansprepare for an
exploratory thoracotomy
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 initial fluid resuscitation 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. A tube thoracostomy is performed for
decreased left chest 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: - ansre-examine the
chest
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital no surgical capabilities are 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: - ansrepeat the primary survey and
proceed with transfer
A 23-year-old man sustains 4 stab wounds to the upper right chest du ring an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds
are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does
not reveal intraabdominal injuries. 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% O2). 1500 mL of blood has drained from the right chest. The most appropriate
next step in managing this patient is to: - ansurgently transfer the patient to the
operating room
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and h is eyes open to pressure. He does not
follow commands, but he does moan periodically. His right arm is deformed and does
,not respond to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is: - ans9
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower
extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses
cannot be palpated below the right femoral artery and the muscles of the lower
extremity are firm and hard. During the management of this patient, which of the
following is most likely to improve the chances for limb salvage? - anssurgical
consultation for right lower extremity fasciotomy
A 33-year-old woman is involved in a head-on 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: - anscardiac tamponade
A 39-year-old 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: - ansrestrict cervical motion and attempt orotracheal
intubation using 2 people
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated
in the emergency department. She is hemodynamically normal and found to be
paraplegic at the level of T10. Which of the following are true regarding her evaluation
and management? - ansLog rolling using 4 people is a safe approach to restrict spinal
motion when moving her.
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. Which of the following best differentiates cardiac tamponade
from tension pneumothorax as the cause of his hypotension? - ansbreath sounds
A 6-year-old 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 about this patient? - ansA pulmonary contusion may be present in the absence of
rib fractures.
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small
hospital without surgical capabilities. He has a closed head injury with a GCS score of
13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4,
but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74
,mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per
minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient
to a facility capable of providing a higher level of care. The facility is 128 km (80 miles)
away. Before transfer, you should first: - anscall the receiving hospital and speak to the
surgeon on call
A 7-year-old boy is brought to the emergency department by his parents several
minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of
his medial right thigh. Immediate management of the wound should consist of: -
ansdirect pressure on the wound
A construction worker falls two stories from a building and sustains bilateral calcaneal
fractures. In the emergency department, he is alert, vital signs are normal, and he is
complaining of severe pain in both heels and his lower back. Lower extremity pulses are
strong and there is no other deformity. The suspected diagnosis is most likely to be
confirmed by: - anscomplete spine x-ray series
A healthy young male is brought to the emergency department following a motor vehicle
crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient
moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in
management is: - ansplacement of a pelvic binder
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade
III (moderately severe) splenic injury has been confirmed by computed tomography
(CT). Which of the following mandates prompt celiotomy (laparotomy)? -
ansdevelopment of peritonitis on physical exam
A patient arrives in the emergency department after being beaten about the head and
face with a wooden club. He is comatose and has a palpable depressed skull fracture.
His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his
face and clothing. The most appropriate step after providing supplemental oxygen and
elevating his jaw is to: - anssuction the oropharynx
A patient is brought to the emergency department 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? - ansFlaccidity of the lower extremities and loss of deep tendon reflexes are
expected.
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2
liters. Which one of the following statements applies to this patient? - ansAn ABG would
demonstrate a base deficit between -6 and -10 mEq/L.
A trauma patient presents to your emergency department with inspiratory stridor and a
suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a
, nonrebreathing mask. The most appropriate next step is to: - ansrestrict cervical motion
and establish a definitive airway
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: -
ansavoid hypotension
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital
that has surgery capabilities available.. Computed tomography of the chest and
abdomen 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: - ansperform an
exploratory laparotomy
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - ansThe trachea is relatively short.
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - anscerebral vasoconstriction with diminished perfusion
Hemorrhage of 20% of the patient's blood volume is associated usually with: -
anstachycardia
In managing a patient with a severe traumatic brain injury, the most important initial step
is to: - anssecure the airway
The best assessment of fluid resuscitation of the adult burn patient is: - ansurinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - ansevidence of inadequate organ perfusion
The first maneuver to improve oxygen ation after chest injury is: - ansadminister
supplemental oxygen
The following are contraindications for tetanus toxoid administration: - anshistory of
neurological reaction or severe hypersensitivity to the product
The most important, immediate step in the management of an open pneumothorax is: -
ansplacement of an occlusive dressing over the wound
The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by: - ansincreasing the volume of
blood loss to produce maternal hypotension
