PHTLS PRE & POST TEST 10TH EDITION 2026/2027 |
NAEMT Certification Complete Solution | Prehospital
Trauma Life Support | Graded A+ | Pass Guaranteed - A+
Graded
Section 1: Primary & Secondary Survey (XABCDE) (Q1-15)
Q1. A 34-year-old male was ejected from a motorcycle at highway speed. He is
lying supine on the pavement, unresponsive, with obvious deformity to his left
thigh and a large pool of blood beneath him. According to the XABCDE approach,
what is the FIRST intervention?
A. Open the airway with a jaw-thrust maneuver
B. Apply direct pressure to the bleeding left thigh
C. Assess for exsanguinating hemorrhage and apply a tourniquet to the left thigh
D. Check for a carotid pulse
Correct Answer: C. Assess for exsanguinating hemorrhage and apply a tourniquet
to the left thigh [CORRECT]
Rationale: The "X" in XABCDE stands for Exsanguination—life-threatening
hemorrhage control takes absolute priority over airway, breathing, and circulation.
The large blood pool indicates massive bleeding that will cause death in minutes if
not controlled. A tourniquet is indicated for life-threatening extremity hemorrhage.
Option A (airway) is important but secondary to exsanguination. Option B (direct
pressure) is insufficient for massive hemorrhage. Option D (pulse check) delays
critical hemorrhage control.
Q2. A 28-year-old female was struck by a vehicle while crossing the street. She is
conscious, alert, and complaining of severe abdominal pain. Her airway is patent,
respirations are 24/min and labored, and her radial pulse is weak and rapid at
,128 bpm. Her skin is cool, pale, and diaphoretic. Using the XABCDE approach,
what is the NEXT priority after controlling any visible hemorrhage?
A. Administer high-flow oxygen via non-rebreather mask
B. Initiate spinal motion restriction with a cervical collar and backboard
C. Assess and manage her airway
D. Establish two large-bore IV lines and begin fluid resuscitation
Correct Answer: C. Assess and manage her airway [CORRECT]
Rationale: After "X" (exsanguination), the priority is "A" (Airway). Although the
patient is conscious and talking, the ABC sequence must be systematically addressed.
Her airway is currently patent, but the provider must ensure it remains so and be
prepared to intervene if status changes. Option A addresses breathing (B), which
comes after airway assessment. Option B (SMR) is not a priority in the primary survey
and is deferred until life threats are addressed. Option D addresses circulation (C),
which follows airway and breathing.
Q3. A 45-year-old male construction worker fell 20 feet from scaffolding. He is
unconscious, making gurgling sounds, and has snoring respirations. His airway is
obstructed by blood and vomitus. What is the CORRECT sequence of airway
management?
A. Suction the airway, perform jaw-thrust, insert an oropharyngeal airway, and
ventilate with a bag-valve mask
B. Perform a head-tilt chin-lift, insert a nasopharyngeal airway, and administer
oxygen via nasal cannula
C. Insert an oropharyngeal airway first, then suction, then ventilate
D. Immediately intubate the trachea without attempting basic airway maneuvers
Correct Answer: A. Suction the airway, perform jaw-thrust, insert an
oropharyngeal airway, and ventilate with a bag-valve mask [CORRECT]
Rationale: The correct sequence is: suction to clear blood/vomitus (visualize and
clear), jaw-thrust (spinal precautions for trauma), oropharyngeal airway (unconscious
patient with no gag reflex), then BVM ventilation. Option B uses head-tilt chin-lift
(contraindicated with suspected spinal injury) and nasopharyngeal airway
,(contraindicated with facial/skull fractures and basilar skull fracture risk). Option C
attempts airway insertion before clearing secretions, which will obstruct the airway.
Option D skips essential basic maneuvers and risks failed intubation in a hypoxic
patient.
Q4. A 19-year-old male was stabbed in the right chest. He is anxious, with
decreased breath sounds on the right, jugular venous distension, and tracheal
deviation to the left. His blood pressure is 78/50 mmHg, HR 132 bpm, RR 28/min.
What is the MOST likely diagnosis and immediate intervention?
A. Hemothorax; perform needle decompression at the 2nd intercostal space,
midclavicular line
B. Tension pneumothorax; perform needle decompression at the 2nd intercostal
space, midclavicular line
C. Open pneumothorax; apply an occlusive dressing taped on three sides
D. Cardiac tamponade; perform pericardiocentesis
Correct Answer: B. Tension pneumothorax; perform needle decompression at the
2nd intercostal space, midclavicular line [CORRECT]
Rationale: The classic triad of tension pneumothorax is hypotension, JVD, and
tracheal deviation away from the affected side (to the left in this case), combined
with absent/decreased breath sounds on the affected side. This is a prehospital
emergency requiring immediate needle decompression. Option A (hemothorax)
would not cause JVD or tracheal deviation. Option C (open pneumothorax) requires a
visible chest wall defect. Option D (tamponade) causes Beck's triad (hypotension,
JVD, muffled heart sounds) without tracheal deviation or unilateral absent breath
sounds.
Q5. A 56-year-old male was involved in a high-speed motor vehicle collision. He is
unresponsive, with a GCS of 7 (E1, V2, M4). His right pupil is dilated at 6 mm and
nonreactive; the left pupil is 3 mm and reactive. His blood pressure is 190/110
mmHg, HR 52 bpm, RR 10/min and irregular. What is the MOST likely diagnosis?
, A. Spinal shock from cervical spine injury
B. Cushing's triad indicating increased intracranial pressure and impending herniation
C. Hypovolemic shock from internal bleeding
D. Neurogenic shock from high thoracic spinal cord injury
Correct Answer: B. Cushing's triad indicating increased intracranial pressure and
impending herniation [CORRECT]
Rationale: Cushing's triad is hypertension (190/110), bradycardia (52 bpm), and
irregular respirations (10/min, irregular) indicating brainstem compression from
increased ICP. The unilateral dilated, nonreactive pupil (6 mm right) indicates uncal
herniation with oculomotor nerve (CN III) compression. Option A (spinal shock)
causes hypotension, bradycardia, and flaccid paralysis without pupillary changes.
Option C (hypovolemic shock) causes hypotension and tachycardia. Option D
(neurogenic shock) causes hypotension and bradycardia without hypertension or
pupillary changes.
Q6. A 30-year-old female was trapped in a burning vehicle for approximately 10
minutes before extrication. She has partial-thickness burns to her anterior trunk,
entire right arm, and anterior left leg. Using the Rule of Nines, what is the
estimated total body surface area (TBSA) burned?
A. 18%
B. 27%
C. 31.5%
D. 36%
Correct Answer: C. 31.5% [CORRECT]
Rationale: Rule of Nines: Anterior trunk = 18% (9% chest + 9% abdomen), entire
right arm = 9%, anterior left leg = 4.5% (anterior half of 9% leg). Total = 18 + 9 + 4.5
= 31.5%. Option A (18%) counts only the trunk. Option B (27%) counts trunk and arm
but misses the leg. Option D (36%) incorrectly counts the entire leg (9%) instead of
anterior half (4.5%).
NAEMT Certification Complete Solution | Prehospital
Trauma Life Support | Graded A+ | Pass Guaranteed - A+
Graded
Section 1: Primary & Secondary Survey (XABCDE) (Q1-15)
Q1. A 34-year-old male was ejected from a motorcycle at highway speed. He is
lying supine on the pavement, unresponsive, with obvious deformity to his left
thigh and a large pool of blood beneath him. According to the XABCDE approach,
what is the FIRST intervention?
A. Open the airway with a jaw-thrust maneuver
B. Apply direct pressure to the bleeding left thigh
C. Assess for exsanguinating hemorrhage and apply a tourniquet to the left thigh
D. Check for a carotid pulse
Correct Answer: C. Assess for exsanguinating hemorrhage and apply a tourniquet
to the left thigh [CORRECT]
Rationale: The "X" in XABCDE stands for Exsanguination—life-threatening
hemorrhage control takes absolute priority over airway, breathing, and circulation.
The large blood pool indicates massive bleeding that will cause death in minutes if
not controlled. A tourniquet is indicated for life-threatening extremity hemorrhage.
Option A (airway) is important but secondary to exsanguination. Option B (direct
pressure) is insufficient for massive hemorrhage. Option D (pulse check) delays
critical hemorrhage control.
Q2. A 28-year-old female was struck by a vehicle while crossing the street. She is
conscious, alert, and complaining of severe abdominal pain. Her airway is patent,
respirations are 24/min and labored, and her radial pulse is weak and rapid at
,128 bpm. Her skin is cool, pale, and diaphoretic. Using the XABCDE approach,
what is the NEXT priority after controlling any visible hemorrhage?
A. Administer high-flow oxygen via non-rebreather mask
B. Initiate spinal motion restriction with a cervical collar and backboard
C. Assess and manage her airway
D. Establish two large-bore IV lines and begin fluid resuscitation
Correct Answer: C. Assess and manage her airway [CORRECT]
Rationale: After "X" (exsanguination), the priority is "A" (Airway). Although the
patient is conscious and talking, the ABC sequence must be systematically addressed.
Her airway is currently patent, but the provider must ensure it remains so and be
prepared to intervene if status changes. Option A addresses breathing (B), which
comes after airway assessment. Option B (SMR) is not a priority in the primary survey
and is deferred until life threats are addressed. Option D addresses circulation (C),
which follows airway and breathing.
Q3. A 45-year-old male construction worker fell 20 feet from scaffolding. He is
unconscious, making gurgling sounds, and has snoring respirations. His airway is
obstructed by blood and vomitus. What is the CORRECT sequence of airway
management?
A. Suction the airway, perform jaw-thrust, insert an oropharyngeal airway, and
ventilate with a bag-valve mask
B. Perform a head-tilt chin-lift, insert a nasopharyngeal airway, and administer
oxygen via nasal cannula
C. Insert an oropharyngeal airway first, then suction, then ventilate
D. Immediately intubate the trachea without attempting basic airway maneuvers
Correct Answer: A. Suction the airway, perform jaw-thrust, insert an
oropharyngeal airway, and ventilate with a bag-valve mask [CORRECT]
Rationale: The correct sequence is: suction to clear blood/vomitus (visualize and
clear), jaw-thrust (spinal precautions for trauma), oropharyngeal airway (unconscious
patient with no gag reflex), then BVM ventilation. Option B uses head-tilt chin-lift
(contraindicated with suspected spinal injury) and nasopharyngeal airway
,(contraindicated with facial/skull fractures and basilar skull fracture risk). Option C
attempts airway insertion before clearing secretions, which will obstruct the airway.
Option D skips essential basic maneuvers and risks failed intubation in a hypoxic
patient.
Q4. A 19-year-old male was stabbed in the right chest. He is anxious, with
decreased breath sounds on the right, jugular venous distension, and tracheal
deviation to the left. His blood pressure is 78/50 mmHg, HR 132 bpm, RR 28/min.
What is the MOST likely diagnosis and immediate intervention?
A. Hemothorax; perform needle decompression at the 2nd intercostal space,
midclavicular line
B. Tension pneumothorax; perform needle decompression at the 2nd intercostal
space, midclavicular line
C. Open pneumothorax; apply an occlusive dressing taped on three sides
D. Cardiac tamponade; perform pericardiocentesis
Correct Answer: B. Tension pneumothorax; perform needle decompression at the
2nd intercostal space, midclavicular line [CORRECT]
Rationale: The classic triad of tension pneumothorax is hypotension, JVD, and
tracheal deviation away from the affected side (to the left in this case), combined
with absent/decreased breath sounds on the affected side. This is a prehospital
emergency requiring immediate needle decompression. Option A (hemothorax)
would not cause JVD or tracheal deviation. Option C (open pneumothorax) requires a
visible chest wall defect. Option D (tamponade) causes Beck's triad (hypotension,
JVD, muffled heart sounds) without tracheal deviation or unilateral absent breath
sounds.
Q5. A 56-year-old male was involved in a high-speed motor vehicle collision. He is
unresponsive, with a GCS of 7 (E1, V2, M4). His right pupil is dilated at 6 mm and
nonreactive; the left pupil is 3 mm and reactive. His blood pressure is 190/110
mmHg, HR 52 bpm, RR 10/min and irregular. What is the MOST likely diagnosis?
, A. Spinal shock from cervical spine injury
B. Cushing's triad indicating increased intracranial pressure and impending herniation
C. Hypovolemic shock from internal bleeding
D. Neurogenic shock from high thoracic spinal cord injury
Correct Answer: B. Cushing's triad indicating increased intracranial pressure and
impending herniation [CORRECT]
Rationale: Cushing's triad is hypertension (190/110), bradycardia (52 bpm), and
irregular respirations (10/min, irregular) indicating brainstem compression from
increased ICP. The unilateral dilated, nonreactive pupil (6 mm right) indicates uncal
herniation with oculomotor nerve (CN III) compression. Option A (spinal shock)
causes hypotension, bradycardia, and flaccid paralysis without pupillary changes.
Option C (hypovolemic shock) causes hypotension and tachycardia. Option D
(neurogenic shock) causes hypotension and bradycardia without hypertension or
pupillary changes.
Q6. A 30-year-old female was trapped in a burning vehicle for approximately 10
minutes before extrication. She has partial-thickness burns to her anterior trunk,
entire right arm, and anterior left leg. Using the Rule of Nines, what is the
estimated total body surface area (TBSA) burned?
A. 18%
B. 27%
C. 31.5%
D. 36%
Correct Answer: C. 31.5% [CORRECT]
Rationale: Rule of Nines: Anterior trunk = 18% (9% chest + 9% abdomen), entire
right arm = 9%, anterior left leg = 4.5% (anterior half of 9% leg). Total = 18 + 9 + 4.5
= 31.5%. Option A (18%) counts only the trunk. Option B (27%) counts trunk and arm
but misses the leg. Option D (36%) incorrectly counts the entire leg (9%) instead of
anterior half (4.5%).
