ATLS PRACTICE TEST 2026
ACTUAL EXAM 250 REAL
QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES GRADED A+ (100%
VERIFIED ANSWERS) |
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: - answer-re-
examine the chest
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: - answer-complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
answer-Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial
step is to: - answer-secure the airway
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? - answer-An ABG
would demonstrate a base deficit between -6 and -10 mEq/L.
,The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by: - answer-increasing the volume
of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - answer-urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - answer-evidence of inadequate organ perfusion
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: - answer-
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - answer-cerebral vasoconstriction with diminished perfusion
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: - answer-perform an
exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE? - answer-Leakage of amniotic fluid is an indication for hospital
admission.
The first maneuver to improve oxygenation after chest injury is: - answer-administer
supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his 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: - answer-9
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: - answer-perform needle or finger
decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - answer-respiratory rate of 40 breaths per
minute
The most important, immediate step in the management of an open pneumothorax is: -
answer-placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - answer-history
of neurological reaction or severe hypersensitivity to the product
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? - answer-breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during
infant endotracheal intubation because: - answer-The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during 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: - answer-urgently transfer the patient to the
operating room
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: - answer-restrict cervical motion and attempt orotracheal
intubation using 2 people
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? - answer-Flaccidity of the lower extremities and loss of deep
tendon reflexes are expected.
Which one of the following is the most effective method for initially treating frostbite? -
answer-moist heat
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? - answer-surgical
consultation for right lower extremity fasciotomy
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: - answer-suction the oropharynx
ACTUAL EXAM 250 REAL
QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES GRADED A+ (100%
VERIFIED ANSWERS) |
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: - answer-re-
examine the chest
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: - answer-complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
answer-Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial
step is to: - answer-secure the airway
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? - answer-An ABG
would demonstrate a base deficit between -6 and -10 mEq/L.
,The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by: - answer-increasing the volume
of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - answer-urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - answer-evidence of inadequate organ perfusion
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: - answer-
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - answer-cerebral vasoconstriction with diminished perfusion
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: - answer-perform an
exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE? - answer-Leakage of amniotic fluid is an indication for hospital
admission.
The first maneuver to improve oxygenation after chest injury is: - answer-administer
supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his 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: - answer-9
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: - answer-perform needle or finger
decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - answer-respiratory rate of 40 breaths per
minute
The most important, immediate step in the management of an open pneumothorax is: -
answer-placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - answer-history
of neurological reaction or severe hypersensitivity to the product
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? - answer-breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during
infant endotracheal intubation because: - answer-The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during 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: - answer-urgently transfer the patient to the
operating room
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: - answer-restrict cervical motion and attempt orotracheal
intubation using 2 people
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? - answer-Flaccidity of the lower extremities and loss of deep
tendon reflexes are expected.
Which one of the following is the most effective method for initially treating frostbite? -
answer-moist heat
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? - answer-surgical
consultation for right lower extremity fasciotomy
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: - answer-suction the oropharynx
