ATCN Pretest Questions and Answers
2026/2027 Advanced Trauma Care for Nurses
Exam Preparation Guide.
Domain 1: The Primary Survey (ABCDE) & Airway/Ventilation (12 Questions)
1. During the initial assessment of a multisystem trauma patient, which sequence correctly
reflects the ATCN Primary Survey?
• **[CORRECT]** Airway with cervical spine stabilization, Breathing and ventilation, Circulation
with hemorrhage control, Disability (Neurologic status), and Exposure/Environmental control.
• **Rationale:** This systematic ABCDE approach ensures that the most immediate life-threats
are identified and treated in order of lethality. Cervical spine protection must be maintained
simultaneously with airway management.
2. A trauma patient presents with absent breath sounds on the right, tracheal deviation to
the left, and jugular venous distention. What is the immediate priority?
• **[CORRECT]** Perform needle decompression in the 2nd intercostal space, midclavicular line.
• **Rationale:** These are classic clinical signs of a tension pneumothorax. ATCN guidelines
mandate immediate decompression based on clinical diagnosis alone, without waiting for a
chest X-ray, to prevent cardiovascular collapse.
3. A patient rescued from a house fire presents with deep facial burns, singed nasal hairs,
and carbonaceous sputum. The nurse anticipates which intervention?
• **[CORRECT]** Early endotracheal intubation.
• **Rationale:** Carbonaceous sputum and facial burns are specific indicators of inhalation
injury. These findings predict impending airway edema that can rapidly lead to total airway
obstruction; therefore, a definitive airway must be established early.
4. [SELECT ALL THAT APPLY] Which of the following are components of the "Circulation"
phase of the primary survey?
• **[CORRECT]**
• Assessment of skin color, temperature, and moisture.
, • Evaluation of capillary refill and peripheral pulses.
• Identification and control of external exsanguinating hemorrhage.
• Assessment of level of consciousness as an indicator of cerebral perfusion.
• **Rationale:** The Circulation (C) phase focuses on hemodynamic status. This includes
assessing for signs of shock (skin condition, pulse quality) and stopping active bleeding via
direct pressure or tourniquets.
5. [SELECT ALL THAT APPLY] Clinical indicators that suggest the need for a definitive airway
include:
• **[CORRECT]**
• GCS score of 8 or less.
• Purposeful movement only to painful stimuli with inability to protect the airway.
• Massive maxillofacial fractures.
• Stridor or muffled voice.
• **Rationale:** A definitive airway (cuffed tube in the trachea) is required when a patient
cannot maintain airway patency, has a significant risk of aspiration, or requires assisted
ventilation due to neurologic failure (GCS ≤ 8).
6. [CALCULATION] A patient arrives in the trauma bay. He opens his eyes only when the
nurse applies a sternal rub. He localizes to the pain by reaching toward the nurse's hand.
When asked where he is, he shouts "Blue! Tractor! Fire!" (inappropriate words). Calculate
the total GCS.
• **[CORRECT]** 10
• **Rationale:**
• Eye Opening to pain = 2
• Motor Response (Localizing) = 5
• Verbal Response (Inappropriate words) = 3
• Formula: $E(2) + M(5) + V(3) = 10$.
7. A patient with a suspected tension pneumothorax is being prepared for decompression.
Which anatomical landmark is the standard for needle thoracostomy in an adult?
• **[CORRECT]** 2nd intercostal space at the midclavicular line.
• **Rationale:** This site is the traditional ATLS/ATCN recommendation for rapid
decompression of tension pneumothorax to avoid injury to the internal mammary artery and
the heart.
2026/2027 Advanced Trauma Care for Nurses
Exam Preparation Guide.
Domain 1: The Primary Survey (ABCDE) & Airway/Ventilation (12 Questions)
1. During the initial assessment of a multisystem trauma patient, which sequence correctly
reflects the ATCN Primary Survey?
• **[CORRECT]** Airway with cervical spine stabilization, Breathing and ventilation, Circulation
with hemorrhage control, Disability (Neurologic status), and Exposure/Environmental control.
• **Rationale:** This systematic ABCDE approach ensures that the most immediate life-threats
are identified and treated in order of lethality. Cervical spine protection must be maintained
simultaneously with airway management.
2. A trauma patient presents with absent breath sounds on the right, tracheal deviation to
the left, and jugular venous distention. What is the immediate priority?
• **[CORRECT]** Perform needle decompression in the 2nd intercostal space, midclavicular line.
• **Rationale:** These are classic clinical signs of a tension pneumothorax. ATCN guidelines
mandate immediate decompression based on clinical diagnosis alone, without waiting for a
chest X-ray, to prevent cardiovascular collapse.
3. A patient rescued from a house fire presents with deep facial burns, singed nasal hairs,
and carbonaceous sputum. The nurse anticipates which intervention?
• **[CORRECT]** Early endotracheal intubation.
• **Rationale:** Carbonaceous sputum and facial burns are specific indicators of inhalation
injury. These findings predict impending airway edema that can rapidly lead to total airway
obstruction; therefore, a definitive airway must be established early.
4. [SELECT ALL THAT APPLY] Which of the following are components of the "Circulation"
phase of the primary survey?
• **[CORRECT]**
• Assessment of skin color, temperature, and moisture.
, • Evaluation of capillary refill and peripheral pulses.
• Identification and control of external exsanguinating hemorrhage.
• Assessment of level of consciousness as an indicator of cerebral perfusion.
• **Rationale:** The Circulation (C) phase focuses on hemodynamic status. This includes
assessing for signs of shock (skin condition, pulse quality) and stopping active bleeding via
direct pressure or tourniquets.
5. [SELECT ALL THAT APPLY] Clinical indicators that suggest the need for a definitive airway
include:
• **[CORRECT]**
• GCS score of 8 or less.
• Purposeful movement only to painful stimuli with inability to protect the airway.
• Massive maxillofacial fractures.
• Stridor or muffled voice.
• **Rationale:** A definitive airway (cuffed tube in the trachea) is required when a patient
cannot maintain airway patency, has a significant risk of aspiration, or requires assisted
ventilation due to neurologic failure (GCS ≤ 8).
6. [CALCULATION] A patient arrives in the trauma bay. He opens his eyes only when the
nurse applies a sternal rub. He localizes to the pain by reaching toward the nurse's hand.
When asked where he is, he shouts "Blue! Tractor! Fire!" (inappropriate words). Calculate
the total GCS.
• **[CORRECT]** 10
• **Rationale:**
• Eye Opening to pain = 2
• Motor Response (Localizing) = 5
• Verbal Response (Inappropriate words) = 3
• Formula: $E(2) + M(5) + V(3) = 10$.
7. A patient with a suspected tension pneumothorax is being prepared for decompression.
Which anatomical landmark is the standard for needle thoracostomy in an adult?
• **[CORRECT]** 2nd intercostal space at the midclavicular line.
• **Rationale:** This site is the traditional ATLS/ATCN recommendation for rapid
decompression of tension pneumothorax to avoid injury to the internal mammary artery and
the heart.
