ATLS Pretest and Practice Exam 2025–2026
Questions with Correct Answers & Detailed
Rationales Advanced Trauma Life Support (ATLS)
Comprehensive Review
Question 1
What does a carotid pulse indicate?
• A) A functioning pump for blood flow
• B) The circulating blood volume is reaching end organs
• C) Diastolic blood pressure
• D) None of the above
Answer: B) The circulating blood volume is reaching end organs
Rationale: A carotid pulse indicates that the circulating blood volume is
reaching the brain. It is a reliable sign of adequate perfusion to the end organs.
The presence of a carotid pulse suggests a systolic blood pressure of at least
60 mmHg.
Question 2
What is the first parameter to change in patients with hypovolemic shock?
• A) Systolic blood pressure
• B) Pulse rate
• C) Respiratory rate
• D) Skin vasoconstriction
Answer: B) Pulse rate
Rationale: In hypovolemic shock, tachycardia is one of the earliest
compensatory responses. The pulse rate increases to maintain cardiac output
as stroke volume decreases. Systolic blood pressure may remain normal
initially due to compensatory mechanisms.
,Question 3
How deep should the provider depress the patient's sternum during CPR in
adults?
• A) 1 to 2 inches
• B) 2 to 2.4 inches (5-6 cm)
• C) 3 to 4 inches
• D) At least 4 inches
Answer: B) 2 to 2.4 inches (5-6 cm)
Rationale: According to the American Heart Association (AHA) guidelines, the
recommended depth for chest compressions in adults is at least 2 inches (5
cm) but no more than 2.4 inches (6 cm). Compressions should be delivered at
a rate of 100-120 per minute with complete chest recoil.
Question 4
Which of the following is NOT a clinical component of the Glasgow Coma Scale
(GCS)?
• A) Eye movement
• B) Sensation
• C) Verbal response
• D) Motor response
Answer: B) Sensation
Rationale: The Glasgow Coma Scale consists of three components: Eye
opening (E, 1-4), Verbal response (V, 1-5), and Motor response (M, 1-6).
Sensation is not a component of the GCS. The total score ranges from 3 to 15,
with lower scores indicating more severe brain injury.
,Question 5
A 34-year-old patient with severe head trauma and elevated intracranial
pressures is intubated. Which of the following should be the target for
mechanical ventilation?
• A) Set PaCO2 between 20-25
• B) Set PaCO2 between 30-35
• C) Set PaCO2 between 40-45
• D) Set PaCO2 between 50-55
Answer: B) Set PaCO2 between 30-35
Rationale: In patients with elevated intracranial pressure (ICP), mild
hyperventilation to a PaCO2 of 30-35 mmHg is recommended to reduce
cerebral blood volume and ICP. However, aggressive hyperventilation (PaCO2
<30) should be avoided as it can cause cerebral ischemia.
Question 6
What percentage of blood loss is associated with Class I hemorrhage?
• A) Up to 15%
• B) 20-30%
• C) 30-40%
• D) 40-50%
Answer: A) Up to 15%
Rationale: Class I hemorrhage involves blood loss up to 15% of total blood
volume (approximately 750 mL in a 70 kg adult). Patients are typically
asymptomatic with normal vital signs. No fluid resuscitation is usually
required.
Question 7
Which of the following generally causes hemorrhage associated with pelvic
fractures?
, • A) Obturator artery injury
• B) Superior gluteal artery
• C) Lateral sacral artery injury
• D) Venous bleeding
Answer: D) Venous bleeding
Rationale: Hemorrhage associated with pelvic fractures is most commonly
due to venous bleeding from the presacral venous plexus. Arterial bleeding
from pelvic vessels also occurs but is less common. Venous bleeding can be
difficult to control and may require pelvic packing or angiography.
Question 8
A patient sustains blunt trauma to the back and left leg. Vital signs in the
emergency department show temperature 36°C, BP 120/80 mmHg, heart rate
92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12
sensory level, and decreased rectal tone. Hemoglobin is 14.2 g/dL and
remains stable after one hour. Which of the following tests is best for
diagnosing an intraperitoneal bleed?
• A) Abdominal ultrasound (FAST)
• B) Laparotomy
• C) KUB
• D) Diagnostic peritoneal lavage
Answer: A) Abdominal ultrasound (FAST)
Rationale: In a hemodynamically stable patient with blunt trauma, the
Focused Assessment with Sonography for Trauma (FAST) is the preferred
initial screening test for intraperitoneal bleeding. It is non-invasive, rapid, and
can detect free fluid in the peritoneal cavity. DPL is more invasive and
generally reserved for unstable patients or when FAST is equivocal.
Questions with Correct Answers & Detailed
Rationales Advanced Trauma Life Support (ATLS)
Comprehensive Review
Question 1
What does a carotid pulse indicate?
• A) A functioning pump for blood flow
• B) The circulating blood volume is reaching end organs
• C) Diastolic blood pressure
• D) None of the above
Answer: B) The circulating blood volume is reaching end organs
Rationale: A carotid pulse indicates that the circulating blood volume is
reaching the brain. It is a reliable sign of adequate perfusion to the end organs.
The presence of a carotid pulse suggests a systolic blood pressure of at least
60 mmHg.
Question 2
What is the first parameter to change in patients with hypovolemic shock?
• A) Systolic blood pressure
• B) Pulse rate
• C) Respiratory rate
• D) Skin vasoconstriction
Answer: B) Pulse rate
Rationale: In hypovolemic shock, tachycardia is one of the earliest
compensatory responses. The pulse rate increases to maintain cardiac output
as stroke volume decreases. Systolic blood pressure may remain normal
initially due to compensatory mechanisms.
,Question 3
How deep should the provider depress the patient's sternum during CPR in
adults?
• A) 1 to 2 inches
• B) 2 to 2.4 inches (5-6 cm)
• C) 3 to 4 inches
• D) At least 4 inches
Answer: B) 2 to 2.4 inches (5-6 cm)
Rationale: According to the American Heart Association (AHA) guidelines, the
recommended depth for chest compressions in adults is at least 2 inches (5
cm) but no more than 2.4 inches (6 cm). Compressions should be delivered at
a rate of 100-120 per minute with complete chest recoil.
Question 4
Which of the following is NOT a clinical component of the Glasgow Coma Scale
(GCS)?
• A) Eye movement
• B) Sensation
• C) Verbal response
• D) Motor response
Answer: B) Sensation
Rationale: The Glasgow Coma Scale consists of three components: Eye
opening (E, 1-4), Verbal response (V, 1-5), and Motor response (M, 1-6).
Sensation is not a component of the GCS. The total score ranges from 3 to 15,
with lower scores indicating more severe brain injury.
,Question 5
A 34-year-old patient with severe head trauma and elevated intracranial
pressures is intubated. Which of the following should be the target for
mechanical ventilation?
• A) Set PaCO2 between 20-25
• B) Set PaCO2 between 30-35
• C) Set PaCO2 between 40-45
• D) Set PaCO2 between 50-55
Answer: B) Set PaCO2 between 30-35
Rationale: In patients with elevated intracranial pressure (ICP), mild
hyperventilation to a PaCO2 of 30-35 mmHg is recommended to reduce
cerebral blood volume and ICP. However, aggressive hyperventilation (PaCO2
<30) should be avoided as it can cause cerebral ischemia.
Question 6
What percentage of blood loss is associated with Class I hemorrhage?
• A) Up to 15%
• B) 20-30%
• C) 30-40%
• D) 40-50%
Answer: A) Up to 15%
Rationale: Class I hemorrhage involves blood loss up to 15% of total blood
volume (approximately 750 mL in a 70 kg adult). Patients are typically
asymptomatic with normal vital signs. No fluid resuscitation is usually
required.
Question 7
Which of the following generally causes hemorrhage associated with pelvic
fractures?
, • A) Obturator artery injury
• B) Superior gluteal artery
• C) Lateral sacral artery injury
• D) Venous bleeding
Answer: D) Venous bleeding
Rationale: Hemorrhage associated with pelvic fractures is most commonly
due to venous bleeding from the presacral venous plexus. Arterial bleeding
from pelvic vessels also occurs but is less common. Venous bleeding can be
difficult to control and may require pelvic packing or angiography.
Question 8
A patient sustains blunt trauma to the back and left leg. Vital signs in the
emergency department show temperature 36°C, BP 120/80 mmHg, heart rate
92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12
sensory level, and decreased rectal tone. Hemoglobin is 14.2 g/dL and
remains stable after one hour. Which of the following tests is best for
diagnosing an intraperitoneal bleed?
• A) Abdominal ultrasound (FAST)
• B) Laparotomy
• C) KUB
• D) Diagnostic peritoneal lavage
Answer: A) Abdominal ultrasound (FAST)
Rationale: In a hemodynamically stable patient with blunt trauma, the
Focused Assessment with Sonography for Trauma (FAST) is the preferred
initial screening test for intraperitoneal bleeding. It is non-invasive, rapid, and
can detect free fluid in the peritoneal cavity. DPL is more invasive and
generally reserved for unstable patients or when FAST is equivocal.
