ADVANCED TRAUMA CARE FOR NURSES (ATCN) EXAM PRACTICE
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES Q&A INSTANT DOWNLOAD PDF
129 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply systematic approach to trauma assessment and resuscitation
2 Analyze pathophysiology of shock and traumatic injuries
3 Integrate evidence-based interventions for trauma patient management
4 Evaluate complications and special considerations in trauma care
5 Advanced Trauma Care for Nurses
6 ATCN
7 Exam Practice Questions And Correct Answers
8 Verified Answers
9 Plus Rationales Q&A Instant Download Pdf
10 Foundations of Advanced Trauma Care for Nurses (ATCN)
11 Applied Advanced Trauma Care for Nurses (ATCN)
12 Advanced Advanced Trauma Care for Nurses (ATCN)
13 Advanced Trauma Care for Nurses (ATCN) Review
Page 1
,Q1 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
During the primary survey of a hypotensive trauma patient, which finding most
strongly indicates the need for immediate bilateral needle decompression before
proceeding to secondary survey?
A. Absent breath sounds on one side with tracheal deviation
B. Subcutaneous emphysema and respiratory distress with absent breath sounds bilaterally
CORRECT
C. Hypotension with distended neck veins and muffled heart sounds
D. Tachypnea with oxygen saturation of 88% on high-flow oxygen
RATIONALE: Bilateral absent breath sounds in a hypotensive patient indicate bilateral tension
pneumothorax, a life-threatening condition requiring immediate decompression bilaterally.
Unilateral tension pneumothorax (A) also requires decompression but is less immediately lethal
than bilateral. Cardiac tamponade (C) presents with Beck's triad, not bilateral breath sounds.
Hypoxia alone (D) does not mandate immediate needle decompression without signs of tension
physiology.
Q2 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
A trauma patient in hemorrhagic shock has received 2 units of packed red blood
cells and 2 liters of crystalloid. Which combination of blood products is most
appropriate to administer next to prevent dilutional coagulopathy?
A. Fresh frozen plasma and platelets CORRECT
B. Cryoprecipitate and platelets
C. Tranexamic acid and fresh frozen plasma
D. Additional packed red blood cells and crystalloid
RATIONALE: In massive transfusion, early administration of plasma and platelets in a 1:1:1 ratio
with red cells prevents dilutional coagulopathy. Cryoprecipitate (B) is reserved for fibrinogen
deficiency. Tranexamic acid (C) is adjunctive but does not replace clotting factors. Continuing
with only RBCs and crystalloid (D) worsens coagulopathy.
Page 2
,Q3 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
Which electrocardiographic finding is most indicative of hyperkalemia in a trauma
patient with crush injury, and what is the immediate treatment of choice?
A. Peaked T waves; administer intravenous calcium gluconate CORRECT
B. U waves; administer intravenous sodium bicarbonate
C. Prolonged PR interval; administer intravenous insulin with glucose
D. Wide QRS complex; administer nebulized albuterol
RATIONALE: Peaked T waves are the earliest ECG sign of hyperkalemia; calcium gluconate
stabilizes the myocardium and is the immediate treatment to prevent arrhythmias. Sodium
bicarbonate (B) and insulin/glucose (C) shift potassium into cells but do not stabilize myocardium
immediately. Albuterol (D) also shifts potassium but is slower and not the first-line immediate
therapy.
Q4 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
In a patient with blunt abdominal trauma and a positive FAST exam, which finding
on CT would most likely prompt immediate laparotomy rather than non-operative
management?
A. Grade III splenic laceration with active contrast extravasation CORRECT
B. Grade II liver laceration with hemoperitoneum
C. Small bowel mesenteric hematoma without extravasation
D. Perinephric hematoma without active bleeding
RATIONALE: Active contrast extravasation on CT indicates ongoing hemorrhage, which is a
strong indication for angioembolization or laparotomy. Grade II liver laceration (B) and perinephric
hematoma (D) are often managed non-operatively. Mesenteric hematoma (C) may require
surgery if there is ischemia, but extravasation is more emergent.
Page 3
, Q5 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
Which of the following best describes the physiological rationale for permissive
hypotension in the management of a trauma patient with penetrating torso injury
and no head trauma?
A. Maintaining low blood pressure reduces bleeding by allowing clot formation while preserving
organ perfusion
B. Increasing blood pressure to normal levels improves oxygen delivery to vital organs
C. Avoiding crystalloid resuscitation prevents dilutional coagulopathy and clot disruption
CORRECT
D. Using vasopressors to maintain mean arterial pressure of 65 mmHg prevents further blood
loss
RATIONALE: Permissive hypotension aims to avoid aggressive crystalloid resuscitation, which
can dislodge clots and worsen bleeding. It does not involve vasopressors (D) nor does it aim for
low blood pressure per se (A). Maintaining normal blood pressure (B) is the opposite of
permissive hypotension.
Q6 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
A patient with a severe traumatic brain injury (GCS 6) is intubated. Which
ventilator strategy is most appropriate to minimize secondary brain injury while
maintaining oxygenation?
A. Target PaCO2 of 35-40 mmHg with low tidal volume ventilation CORRECT
B. Hyperventilate to PaCO2 of 25-30 mmHg to reduce intracranial pressure
C. Maintain PaO2 > 60 mmHg and allow PaCO2 to rise above 45 mmHg
D. Use high positive end-expiratory pressure (PEEP) to improve oxygenation regardless of
intracranial pressure
RATIONALE: Normocapnia (PaCO2 35-40 mmHg) is recommended to avoid vasoconstriction
from hypocapnia and vasodilation from hypercapnia. Hyperventilation (B) is only transiently used
for herniation. Allowing hypercapnia (C) increases ICP. High PEEP (D) can decrease venous
return and increase ICP.
Page 4
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES Q&A INSTANT DOWNLOAD PDF
129 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Apply systematic approach to trauma assessment and resuscitation
2 Analyze pathophysiology of shock and traumatic injuries
3 Integrate evidence-based interventions for trauma patient management
4 Evaluate complications and special considerations in trauma care
5 Advanced Trauma Care for Nurses
6 ATCN
7 Exam Practice Questions And Correct Answers
8 Verified Answers
9 Plus Rationales Q&A Instant Download Pdf
10 Foundations of Advanced Trauma Care for Nurses (ATCN)
11 Applied Advanced Trauma Care for Nurses (ATCN)
12 Advanced Advanced Trauma Care for Nurses (ATCN)
13 Advanced Trauma Care for Nurses (ATCN) Review
Page 1
,Q1 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
During the primary survey of a hypotensive trauma patient, which finding most
strongly indicates the need for immediate bilateral needle decompression before
proceeding to secondary survey?
A. Absent breath sounds on one side with tracheal deviation
B. Subcutaneous emphysema and respiratory distress with absent breath sounds bilaterally
CORRECT
C. Hypotension with distended neck veins and muffled heart sounds
D. Tachypnea with oxygen saturation of 88% on high-flow oxygen
RATIONALE: Bilateral absent breath sounds in a hypotensive patient indicate bilateral tension
pneumothorax, a life-threatening condition requiring immediate decompression bilaterally.
Unilateral tension pneumothorax (A) also requires decompression but is less immediately lethal
than bilateral. Cardiac tamponade (C) presents with Beck's triad, not bilateral breath sounds.
Hypoxia alone (D) does not mandate immediate needle decompression without signs of tension
physiology.
Q2 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
A trauma patient in hemorrhagic shock has received 2 units of packed red blood
cells and 2 liters of crystalloid. Which combination of blood products is most
appropriate to administer next to prevent dilutional coagulopathy?
A. Fresh frozen plasma and platelets CORRECT
B. Cryoprecipitate and platelets
C. Tranexamic acid and fresh frozen plasma
D. Additional packed red blood cells and crystalloid
RATIONALE: In massive transfusion, early administration of plasma and platelets in a 1:1:1 ratio
with red cells prevents dilutional coagulopathy. Cryoprecipitate (B) is reserved for fibrinogen
deficiency. Tranexamic acid (C) is adjunctive but does not replace clotting factors. Continuing
with only RBCs and crystalloid (D) worsens coagulopathy.
Page 2
,Q3 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
Which electrocardiographic finding is most indicative of hyperkalemia in a trauma
patient with crush injury, and what is the immediate treatment of choice?
A. Peaked T waves; administer intravenous calcium gluconate CORRECT
B. U waves; administer intravenous sodium bicarbonate
C. Prolonged PR interval; administer intravenous insulin with glucose
D. Wide QRS complex; administer nebulized albuterol
RATIONALE: Peaked T waves are the earliest ECG sign of hyperkalemia; calcium gluconate
stabilizes the myocardium and is the immediate treatment to prevent arrhythmias. Sodium
bicarbonate (B) and insulin/glucose (C) shift potassium into cells but do not stabilize myocardium
immediately. Albuterol (D) also shifts potassium but is slower and not the first-line immediate
therapy.
Q4 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
In a patient with blunt abdominal trauma and a positive FAST exam, which finding
on CT would most likely prompt immediate laparotomy rather than non-operative
management?
A. Grade III splenic laceration with active contrast extravasation CORRECT
B. Grade II liver laceration with hemoperitoneum
C. Small bowel mesenteric hematoma without extravasation
D. Perinephric hematoma without active bleeding
RATIONALE: Active contrast extravasation on CT indicates ongoing hemorrhage, which is a
strong indication for angioembolization or laparotomy. Grade II liver laceration (B) and perinephric
hematoma (D) are often managed non-operatively. Mesenteric hematoma (C) may require
surgery if there is ischemia, but extravasation is more emergent.
Page 3
, Q5 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
Which of the following best describes the physiological rationale for permissive
hypotension in the management of a trauma patient with penetrating torso injury
and no head trauma?
A. Maintaining low blood pressure reduces bleeding by allowing clot formation while preserving
organ perfusion
B. Increasing blood pressure to normal levels improves oxygen delivery to vital organs
C. Avoiding crystalloid resuscitation prevents dilutional coagulopathy and clot disruption
CORRECT
D. Using vasopressors to maintain mean arterial pressure of 65 mmHg prevents further blood
loss
RATIONALE: Permissive hypotension aims to avoid aggressive crystalloid resuscitation, which
can dislodge clots and worsen bleeding. It does not involve vasopressors (D) nor does it aim for
low blood pressure per se (A). Maintaining normal blood pressure (B) is the opposite of
permissive hypotension.
Q6 APPLY SYSTEMATIC APPROACH TO TRAUMA ASSESSMENT AND RESUSCITATION
A patient with a severe traumatic brain injury (GCS 6) is intubated. Which
ventilator strategy is most appropriate to minimize secondary brain injury while
maintaining oxygenation?
A. Target PaCO2 of 35-40 mmHg with low tidal volume ventilation CORRECT
B. Hyperventilate to PaCO2 of 25-30 mmHg to reduce intracranial pressure
C. Maintain PaO2 > 60 mmHg and allow PaCO2 to rise above 45 mmHg
D. Use high positive end-expiratory pressure (PEEP) to improve oxygenation regardless of
intracranial pressure
RATIONALE: Normocapnia (PaCO2 35-40 mmHg) is recommended to avoid vasoconstriction
from hypocapnia and vasodilation from hypercapnia. Hyperventilation (B) is only transiently used
for herniation. Allowing hypercapnia (C) increases ICP. High PEEP (D) can decrease venous
return and increase ICP.
Page 4
