ATLS PRACTICE TEST 2024-2025 ACTUAL EXAM
250 REAL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (100% VERIFIED
ANSWERS)
1. 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 thorac
2. ostomy 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:: re-examine the chest
3. 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:: complete spine x-ray series
4. Which of the following is true regarding the initial resuscitation of a trauma
patient?: Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma
Scale score on reevaluation.
5. In managing a patient with a severe traumatic brain injury, the most impor-
tant initial step is to:: secure the airway
6. 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?: An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
7. The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by:: increasing the volume of blood
loss to produce maternal hypotension
,8. The best assessment of fluid resuscitation of the adult burn patient is:: urinary
output of 0.5 mL/kg/hr
9. The diagnosis of shock must include:: evidence of inadequate organ perfusion
10. 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:: direct pressure on the wound
,11. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:: cerebral vasoconstriction with diminished perfusion
12. 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:: perform an exploratory laparotomy
13. Which one of the following statements regarding abdominal trauma in the
pregnant patient is TRUE?: Leakage of amniotic fluid is an indication for hospital admission.
14. The first maneuver to improve oxygenation after chest injury is:: administer
supplemental oxygen
15. 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:: 9
16. 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:: perform needle or finger decompression of the right chest
17. Which one of the following findings in an adult is most likely to require
immediate management during the primary survey?: respiratory rate of 40 breaths per
minute
18. The most important, immediate step in the management of an open pneu-
mothorax is:: placement of an occlusive dressing over the wound
19. The following are contraindications for tetanus toxoid administration:: history
of neurological reaction or severe hypersensitivity to the product
, 20. 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?: breath sounds
21. Bronchial intubation of the right or left mainstem bronchus can easily occur
during infant endotracheal intubation because:: The trachea is relatively short.
22. 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 sur-
gical capabilities. His wounds are all above the nipple. He is endotracheally
intubated, closed tube thoracostomy is performed, fluid resuscitation is initi-
ated 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:: urgently transfer the patient to the operating room
23. 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:: restrict cervical motion and attempt orotracheal
intubation using 2 people
24. 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?: Flaccidity of the lower extremities
and loss of deep tendon reflexes are expected.
25. Which one of the following is the most effective method for initially treating
frostbite?: moist heat
250 REAL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (100% VERIFIED
ANSWERS)
1. 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 thorac
2. ostomy 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:: re-examine the chest
3. 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:: complete spine x-ray series
4. Which of the following is true regarding the initial resuscitation of a trauma
patient?: Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma
Scale score on reevaluation.
5. In managing a patient with a severe traumatic brain injury, the most impor-
tant initial step is to:: secure the airway
6. 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?: An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
7. The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by:: increasing the volume of blood
loss to produce maternal hypotension
,8. The best assessment of fluid resuscitation of the adult burn patient is:: urinary
output of 0.5 mL/kg/hr
9. The diagnosis of shock must include:: evidence of inadequate organ perfusion
10. 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:: direct pressure on the wound
,11. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:: cerebral vasoconstriction with diminished perfusion
12. 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:: perform an exploratory laparotomy
13. Which one of the following statements regarding abdominal trauma in the
pregnant patient is TRUE?: Leakage of amniotic fluid is an indication for hospital admission.
14. The first maneuver to improve oxygenation after chest injury is:: administer
supplemental oxygen
15. 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:: 9
16. 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:: perform needle or finger decompression of the right chest
17. Which one of the following findings in an adult is most likely to require
immediate management during the primary survey?: respiratory rate of 40 breaths per
minute
18. The most important, immediate step in the management of an open pneu-
mothorax is:: placement of an occlusive dressing over the wound
19. The following are contraindications for tetanus toxoid administration:: history
of neurological reaction or severe hypersensitivity to the product
, 20. 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?: breath sounds
21. Bronchial intubation of the right or left mainstem bronchus can easily occur
during infant endotracheal intubation because:: The trachea is relatively short.
22. 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 sur-
gical capabilities. His wounds are all above the nipple. He is endotracheally
intubated, closed tube thoracostomy is performed, fluid resuscitation is initi-
ated 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:: urgently transfer the patient to the operating room
23. 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:: restrict cervical motion and attempt orotracheal
intubation using 2 people
24. 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?: Flaccidity of the lower extremities
and loss of deep tendon reflexes are expected.
25. Which one of the following is the most effective method for initially treating
frostbite?: moist heat
