ATLS 10th Edition Post Test Advanced
Trauma Life Support Comprehensive
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PRIMARY SURVEY & INITIAL ASSESSMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old unrestrained driver is brought to the ED after a high-speed frontal collision. He
is confused, speaking in short phrases, and has gurgling respirations. His pulse is 128/min,
blood pressure 88/52 mmHg, respiratory rate 32/min, and SpO2 86% on room air. Breath
sounds are diminished bilaterally. What is the most appropriate immediate next step in
management?
A. Obtain a chest X-ray to confirm bilateral pneumothoraces
B. Insert bilateral chest tubes before addressing the airway
C. Perform immediate orotracheal intubation with in-line cervical spine stabilization ✓
CORRECT
D. Administer 2 liters of crystalloid bolus for presumed hemorrhagic shock
Correct Answer: C
Rationale: The primary survey follows the ABCDE sequence, and this patient has a
compromised airway with gurgling respirations, confusion, and hypoxemia — immediate
definitive airway control with orotracheal intubation and in-line cervical spine stabilization is
the priority. Obtaining a chest X-ray or placing chest tubes before securing the airway violates
the ABCDE sequence, as airway obstruction is an immediately life-threatening condition that
must be addressed first. In ATLS, never delay airway management to obtain imaging or
perform other interventions when the airway is compromised.
Question 2 of 50
,A 28-year-old motorcyclist is ejected from his bike and arrives via EMS with a cervical collar
in place. He is alert, speaking clearly, and complains of severe chest pain. His pulse is
110/min, blood pressure 96/64 mmHg, respiratory rate 28/min, and SpO2 90% on 15L
non-rebreather. Breath sounds are absent on the right, and the trachea is deviated to the left.
What is the definitive management?
A. Perform immediate needle decompression at the second intercostal space, midclavicular
line on the right ✓ CORRECT
B. Insert a large-bore IV and administer a 1-liter crystalloid bolus
C. Obtain an emergent chest X-ray to confirm the diagnosis
D. Perform endotracheal intubation and mechanical ventilation
Correct Answer: A
Rationale: This patient presents with classic signs of tension pneumothorax — absent breath
sounds, tracheal deviation away from the affected side, hypotension, and hypoxemia — which
requires immediate needle decompression without waiting for imaging. Administering fluids
or obtaining a chest X-ray wastes critical time when the patient has a tension pneumothorax
causing hemodynamic compromise. Intubation may be needed later but does not address the
immediate life threat of a tension pneumothorax, which can rapidly progress to cardiac arrest
if not decompressed.
Question 3 of 50
A 45-year-old construction worker falls 20 feet from scaffolding and lands on his back. On
arrival, he is moaning but follows commands. His pulse is 132/min, blood pressure 74/48
mmHg, respiratory rate 24/min, and SpO2 94% on 10L O2. There is a large deformity of the
right femur with an open wound, and his abdomen is soft and non-tender. Two large-bore IVs
are established. What is the most appropriate next step?
A. Apply a traction splint to the right femur and obtain a femur X-ray
B. Administer 1 liter of warmed crystalloid and reassess vital signs
C. Initiate massive transfusion protocol and activate the trauma team for hemorrhage control
✓ CORRECT
D. Perform a FAST exam to evaluate for intra-abdominal bleeding
Correct Answer: C
Rationale: This patient is in class IV hemorrhagic shock with hypotension (SBP 74 mmHg)
and tachycardia (132/min) from a likely femoral artery injury in an open femur fracture,
requiring immediate massive transfusion protocol activation and surgical hemorrhage
control. Applying a traction splint or obtaining X-rays are secondary priorities that should not
delay resuscitation and definitive hemorrhage control in a patient with profound shock. While
a FAST exam is useful, it should not delay transfusion and surgical intervention when the
source of bleeding is clinically evident and the patient is unstable.
, Question 4 of 50
A 52-year-old unrestrained passenger is involved in a T-bone collision. On primary survey, she
opens her eyes to painful stimuli, makes incomprehensible sounds, and withdraws her arm
from a painful stimulus. Her pupils are 3 mm bilaterally and reactive. Her pulse is 96/min,
blood pressure 142/88 mmHg, and respiratory rate 18/min. What is her Glasgow Coma Scale
score?
A. 9
B. 10
C. 7 ✓ CORRECT
D. 8
Correct Answer: C
Rationale: The GCS is calculated as Eye opening (2 — opens to pain) + Verbal response (2 —
incomprehensible sounds) + Motor response (3 — withdraws from pain) = 7. A score of 9
would incorrectly assign a higher verbal or motor score, and 8 would miscalculate the motor
response as localizing to pain rather than withdrawing. ATLS emphasizes accurate GCS
calculation in the primary survey because it guides the urgency of neurosurgical consultation
and the need for airway protection in patients with traumatic brain injury.
Question 5 of 50
A 19-year-old pedestrian is struck by a vehicle traveling at 40 mph. He is brought to the
trauma bay with multiple abrasions and a deformed left forearm. His pulse is 88/min, blood
pressure 118/76 mmHg, respiratory rate 16/min, and SpO2 98% on room air. He is alert and
oriented. What is the correct sequence of actions during the primary survey?
A. Obtain a chest X-ray, pelvis X-ray, and left forearm X-ray simultaneously
B. Complete the ABCDE primary survey, then obtain focused imaging as indicated ✓
CORRECT
C. Splint the forearm first, then proceed with the primary survey
D. Administer tetanus prophylaxis and analgesia before further assessment
Correct Answer: B
Rationale: ATLS mandates that the primary survey (ABCDE) be completed in its entirety for
every trauma patient before moving to secondary survey or imaging, even when injuries
appear isolated and the patient appears stable. Obtaining X-rays or splinting extremities
before completing the primary survey risks missing life-threatening injuries such as
pneumothorax, hemothorax, or intra-abdominal bleeding. The forearm deformity, while
visually dramatic, is not immediately life-threatening and should be addressed only after
airway, breathing, circulation, disability, and exposure have been fully assessed.
Question 6 of 50
Trauma Life Support Comprehensive
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PRIMARY SURVEY & INITIAL ASSESSMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old unrestrained driver is brought to the ED after a high-speed frontal collision. He
is confused, speaking in short phrases, and has gurgling respirations. His pulse is 128/min,
blood pressure 88/52 mmHg, respiratory rate 32/min, and SpO2 86% on room air. Breath
sounds are diminished bilaterally. What is the most appropriate immediate next step in
management?
A. Obtain a chest X-ray to confirm bilateral pneumothoraces
B. Insert bilateral chest tubes before addressing the airway
C. Perform immediate orotracheal intubation with in-line cervical spine stabilization ✓
CORRECT
D. Administer 2 liters of crystalloid bolus for presumed hemorrhagic shock
Correct Answer: C
Rationale: The primary survey follows the ABCDE sequence, and this patient has a
compromised airway with gurgling respirations, confusion, and hypoxemia — immediate
definitive airway control with orotracheal intubation and in-line cervical spine stabilization is
the priority. Obtaining a chest X-ray or placing chest tubes before securing the airway violates
the ABCDE sequence, as airway obstruction is an immediately life-threatening condition that
must be addressed first. In ATLS, never delay airway management to obtain imaging or
perform other interventions when the airway is compromised.
Question 2 of 50
,A 28-year-old motorcyclist is ejected from his bike and arrives via EMS with a cervical collar
in place. He is alert, speaking clearly, and complains of severe chest pain. His pulse is
110/min, blood pressure 96/64 mmHg, respiratory rate 28/min, and SpO2 90% on 15L
non-rebreather. Breath sounds are absent on the right, and the trachea is deviated to the left.
What is the definitive management?
A. Perform immediate needle decompression at the second intercostal space, midclavicular
line on the right ✓ CORRECT
B. Insert a large-bore IV and administer a 1-liter crystalloid bolus
C. Obtain an emergent chest X-ray to confirm the diagnosis
D. Perform endotracheal intubation and mechanical ventilation
Correct Answer: A
Rationale: This patient presents with classic signs of tension pneumothorax — absent breath
sounds, tracheal deviation away from the affected side, hypotension, and hypoxemia — which
requires immediate needle decompression without waiting for imaging. Administering fluids
or obtaining a chest X-ray wastes critical time when the patient has a tension pneumothorax
causing hemodynamic compromise. Intubation may be needed later but does not address the
immediate life threat of a tension pneumothorax, which can rapidly progress to cardiac arrest
if not decompressed.
Question 3 of 50
A 45-year-old construction worker falls 20 feet from scaffolding and lands on his back. On
arrival, he is moaning but follows commands. His pulse is 132/min, blood pressure 74/48
mmHg, respiratory rate 24/min, and SpO2 94% on 10L O2. There is a large deformity of the
right femur with an open wound, and his abdomen is soft and non-tender. Two large-bore IVs
are established. What is the most appropriate next step?
A. Apply a traction splint to the right femur and obtain a femur X-ray
B. Administer 1 liter of warmed crystalloid and reassess vital signs
C. Initiate massive transfusion protocol and activate the trauma team for hemorrhage control
✓ CORRECT
D. Perform a FAST exam to evaluate for intra-abdominal bleeding
Correct Answer: C
Rationale: This patient is in class IV hemorrhagic shock with hypotension (SBP 74 mmHg)
and tachycardia (132/min) from a likely femoral artery injury in an open femur fracture,
requiring immediate massive transfusion protocol activation and surgical hemorrhage
control. Applying a traction splint or obtaining X-rays are secondary priorities that should not
delay resuscitation and definitive hemorrhage control in a patient with profound shock. While
a FAST exam is useful, it should not delay transfusion and surgical intervention when the
source of bleeding is clinically evident and the patient is unstable.
, Question 4 of 50
A 52-year-old unrestrained passenger is involved in a T-bone collision. On primary survey, she
opens her eyes to painful stimuli, makes incomprehensible sounds, and withdraws her arm
from a painful stimulus. Her pupils are 3 mm bilaterally and reactive. Her pulse is 96/min,
blood pressure 142/88 mmHg, and respiratory rate 18/min. What is her Glasgow Coma Scale
score?
A. 9
B. 10
C. 7 ✓ CORRECT
D. 8
Correct Answer: C
Rationale: The GCS is calculated as Eye opening (2 — opens to pain) + Verbal response (2 —
incomprehensible sounds) + Motor response (3 — withdraws from pain) = 7. A score of 9
would incorrectly assign a higher verbal or motor score, and 8 would miscalculate the motor
response as localizing to pain rather than withdrawing. ATLS emphasizes accurate GCS
calculation in the primary survey because it guides the urgency of neurosurgical consultation
and the need for airway protection in patients with traumatic brain injury.
Question 5 of 50
A 19-year-old pedestrian is struck by a vehicle traveling at 40 mph. He is brought to the
trauma bay with multiple abrasions and a deformed left forearm. His pulse is 88/min, blood
pressure 118/76 mmHg, respiratory rate 16/min, and SpO2 98% on room air. He is alert and
oriented. What is the correct sequence of actions during the primary survey?
A. Obtain a chest X-ray, pelvis X-ray, and left forearm X-ray simultaneously
B. Complete the ABCDE primary survey, then obtain focused imaging as indicated ✓
CORRECT
C. Splint the forearm first, then proceed with the primary survey
D. Administer tetanus prophylaxis and analgesia before further assessment
Correct Answer: B
Rationale: ATLS mandates that the primary survey (ABCDE) be completed in its entirety for
every trauma patient before moving to secondary survey or imaging, even when injuries
appear isolated and the patient appears stable. Obtaining X-rays or splinting extremities
before completing the primary survey risks missing life-threatening injuries such as
pneumothorax, hemothorax, or intra-abdominal bleeding. The forearm deformity, while
visually dramatic, is not immediately life-threatening and should be addressed only after
airway, breathing, circulation, disability, and exposure have been fully assessed.
Question 6 of 50
