ATLS 10TH EDITION POST-TEST PRACTICE SET 1
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During a reassessment after the first intervention, a large sucking chest wound produces obvious air
movement through the defect with respiratory distress. Which action should the trauma team take first?
A. apply an occlusive or vented dressing and place a chest tube at a separate site, with definitive wound closure
B. obtain CT angiography of the chest and involve aortic specialists early
C. continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy
D. obtain an ECG and appropriate cardiac monitoring, adding biomarkers and further evaluation when indicated
Correct Answer: A. apply an occlusive or vented dressing and place a chest tube at a separate site, with
definitive wound closure
Explanation: The priority is to apply an occlusive or vented dressing and place a chest tube at a separate site,
with definitive wound closure. a large open chest defect prevents effective ventilation unless the wound is sealed
and the pleural space drained.
2. During a reassessment after the first intervention, penetrating abdominal trauma leaves viable bowel
protruding through the wound. The team responds by cover the bowel with warm sterile saline-moistened
dressings and obtain urgent surgical management. Which finding best indicates that the immediate
objective of this intervention has been achieved?
A. intraperitoneal or extraperitoneal bladder disruption is defined for correct treatment
B. exposed viscera remain protected and viable until operative repair
C. urethral disruption is defined without converting a partial injury into a worse one
D. the presence or absence of major intraperitoneal blood is established quickly
Correct Answer: B. exposed viscera remain protected and viable until operative repair
Explanation: The desired immediate response is that exposed viscera remain protected and viable until operative
repair. eviscerated bowel should be protected from drying and further injury and should not be blindly pushed
back into the abdomen.
3. During a focused trauma evaluation, the patient is stable enough for a focused history after
primary-survey priorities have been addressed. The team responds by obtain allergies, medications, past
illnesses or pregnancy, last meal, and events or environment related to the injury. Which finding best
indicates that the immediate objective of this intervention has been achieved?
A. ventilation and oxygenation improve after the thoracic problem is corrected
B. air moves freely with improving oxygen saturation and no recurrent obstruction
C. key history that changes medication, aspiration, bleeding, and mechanism-related risk is identified
D. oxygenation and perfusion are restored and the neurologic examination can be interpreted more reliably
Correct Answer: C. key history that changes medication, aspiration, bleeding, and mechanism-related risk is
identified
Explanation: The desired immediate response is that key history that changes medication, aspiration, bleeding,
and mechanism-related risk is identified. the AMPLE history efficiently captures high-yield information during
the trauma secondary survey.
4. While the trauma team is working through the primary survey, a trauma patient is pale, cool,
tachycardic, confused, and hypotensive after a high-energy mechanism. The team responds by control
bleeding and begin balanced resuscitation with early blood products while limiting unnecessary crystalloid.
Which finding best indicates that the immediate objective of this intervention has been achieved?
A. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
B. ongoing resuscitation proceeds with timely antifibrinolytic therapy added to definitive bleeding control
C. blood pressure and ventilation improve after pleural pressure is relieved
D. perfusion improves with better mental status, pulse quality, blood pressure, and urine output
Correct Answer: D. perfusion improves with better mental status, pulse quality, blood pressure, and urine output
Explanation: The desired immediate response is that perfusion improves with better mental status, pulse quality,
blood pressure, and urine output. ongoing blood loss is the most common cause of shock after injury and
definitive hemorrhage control must accompany resuscitation.
5. During preparation for definitive care, a trauma patient has a clinically significant pneumothorax and is
likely to require positive-pressure ventilation. The team responds by place a tube thoracostomy before or
with positive-pressure ventilation as indicated. Which finding best indicates that the immediate objective of
this intervention has been achieved?
,A. the pleural air is evacuated and the lung re-expands
B. the aortic injury is defined without delaying stabilization of other life threats
C. respiratory distress and hemodynamic compromise improve rapidly after decompression
D. ongoing hemorrhage is surgically controlled and perfusion improves
Correct Answer: A. the pleural air is evacuated and the lung re-expands
Explanation: The desired immediate response is that the pleural air is evacuated and the lung re-expands.
positive-pressure ventilation can convert a pneumothorax into a tension pneumothorax if the pleural space is not
drained.
6. During preparation for definitive care, a burn patient has facial burns, soot in the mouth, hoarseness,
and increasing edema. The team chooses to secure the airway early before edema makes intubation
difficult or impossible. Which rationale best explains why this is the preferred ATLS priority?
A. capnography provides rapid objective evidence of tracheal rather than esophageal tube placement
B. when ventilation and intubation fail, a surgical airway is a time-critical rescue intervention
C. upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer than waiting for
obstruction
D. an oropharyngeal airway helps prevent the tongue from occluding the pharynx in an unconscious patient
without a gag reflex
Correct Answer: C. upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer
than waiting for obstruction
Explanation: upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer than
waiting for obstruction. Therefore the selected action - secure the airway early before edema makes intubation
difficult or impossible -addresses the most time-sensitive threat first.
7. In the emergency department, a hypotensive patient has pelvic instability after a crush mechanism and
no obvious external bleeding. Which condition or ATLS priority is most consistent with this presentation?
A. Unstable patient with positive FAST
B. Hemorrhage from an unstable pelvic ring injury
C. Bladder injury after pelvic trauma
D. Stable blunt abdominal trauma
Correct Answer: B. Hemorrhage from an unstable pelvic ring injury
Explanation: early pelvic stabilization can reduce pelvic volume and tamponade venous bleeding while further
hemorrhage control proceeds. The best match is hemorrhage from an unstable pelvic ring injury, and the
recommended immediate management is to apply a pelvic binder at the level of the greater trochanters and
activate a pelvic hemorrhage-control pathway.
8. During a focused trauma evaluation, a shocked trauma patient remains hypotensive despite initial
blood-product resuscitation. The team chooses to look immediately for uncontrolled hemorrhage or
another cause of shock and move toward definitive control. Which rationale best explains why this is the
preferred ATLS priority?
A. ongoing blood loss is the most common cause of shock after injury and definitive hemorrhage control must
accompany resuscitation
B. hypothermia aggravates coagulopathy and acidosis, contributing to the lethal trauma triad
C. failure to respond signals ongoing major bleeding or an alternative shock mechanism and demands rapid
reassessment
D. a transient responder has persistent blood loss and needs definitive hemorrhage control rather than repeated
crystalloid boluses
Correct Answer: C. failure to respond signals ongoing major bleeding or an alternative shock mechanism and
demands rapid reassessment
Explanation: failure to respond signals ongoing major bleeding or an alternative shock mechanism and demands
rapid reassessment. Therefore the selected action - look immediately for uncontrolled hemorrhage or another
cause of shock and move toward definitive control - addresses the most time-sensitive threat first.
9. During preparation for definitive care, a head-injured patient develops hypertension, bradycardia, and
irregular respirations. The team responds by treat this as a late warning of critically raised intracranial
pressure and impending herniation. Which finding best indicates that the immediate objective of this
intervention has been achieved?
A. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical strategies instead
, B. oxygenation and perfusion are maintained while the intracranial injury is defined
C. subtle neurologic worsening is recognized early enough to trigger repeat imaging or intervention
D. urgent ICP-directed treatment is initiated before further neurologic collapse
Correct Answer: D. urgent ICP-directed treatment is initiated before further neurologic collapse
Explanation: The desired immediate response is that urgent ICP-directed treatment is initiated before further
neurologic collapse. the Cushing response is a late and ominous manifestation of intracranial hypertension.
10. In the emergency department, a patient at a small facility has severe multisystem injuries that exceed
the hospital's operative and critical-care resources. The team chooses to initiate contact with an
appropriate trauma center early while continuing necessary stabilization. Which rationale best explains
why this is the preferred ATLS priority?
A. exposure is necessary to avoid missed injuries, but hypothermia worsens coagulopathy and trauma outcomes
B. catastrophic external blood loss is a circulation threat that must be controlled immediately
C. hypoxia and hypotension worsen secondary brain injury and can also mimic or aggravate neurologic
deterioration
D. transfer planning should begin as soon as the need is recognized because unnecessary delay can worsen
outcome
Correct Answer: D. transfer planning should begin as soon as the need is recognized because unnecessary delay
can worsen outcome
Explanation: transfer planning should begin as soon as the need is recognized because unnecessary delay can
worsen outcome. Therefore the selected action - initiate contact with an appropriate trauma center early while
continuing necessary stabilization -addresses the most time-sensitive threat first.
11. In the emergency department, a head-injured patient has Battle sign, periorbital ecchymosis, and
cerebrospinal fluid rhinorrhea. Which condition or ATLS priority is most consistent with this
presentation?
A. Cushing response as a late sign
B. Basilar skull fracture
C. Severe traumatic brain injury
D. Epidural hematoma pattern
Correct Answer: B. Basilar skull fracture
Explanation: nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region.
The best match is basilar skull fracture, and the recommended immediate management is to avoid nasal
instrumentation and evaluate the intracranial injury with CT.
12. A few minutes into resuscitation, a patient trapped under debris for hours has swollen muscles, dark
urine, and evolving hyperkalemia. Which condition or ATLS priority is most consistent with this
presentation?
A. Hard signs of extremity vascular injury
B. Femoral shaft fracture hemorrhage
C. Acute compartment syndrome
D. Crush injury with rhabdomyolysis
Correct Answer: D. Crush injury with rhabdomyolysis
Explanation: crushed muscle releases myoglobin and potassium, creating risks of acute kidney injury and fatal
dysrhythmia. The best match is crush injury with rhabdomyolysis, and the recommended immediate management
is to begin aggressive monitoring and resuscitation for rhabdomyolysis, treating life-threatening hyperkalemia
promptly.
13. A few minutes into resuscitation, an unconscious patient without a gag reflex has upper-airway soft
tissue obstruction but does not yet require intubation. Which action should the trauma team take first?
A. insert an appropriately sized oropharyngeal airway while continuing oxygenation and reassessment
B. use aggressive suction, manual airway maneuvers with cervical motion restriction, and secure a definitive
airway when needed
C. perform definitive airway control with appropriate cervical motion restriction and ventilation
D. obtain expert airway control with preparation for a surgical airway rather than repeated blind intubation
attempts
Correct Answer: A. insert an appropriately sized oropharyngeal airway while continuing oxygenation and
reassessment
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During a reassessment after the first intervention, a large sucking chest wound produces obvious air
movement through the defect with respiratory distress. Which action should the trauma team take first?
A. apply an occlusive or vented dressing and place a chest tube at a separate site, with definitive wound closure
B. obtain CT angiography of the chest and involve aortic specialists early
C. continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy
D. obtain an ECG and appropriate cardiac monitoring, adding biomarkers and further evaluation when indicated
Correct Answer: A. apply an occlusive or vented dressing and place a chest tube at a separate site, with
definitive wound closure
Explanation: The priority is to apply an occlusive or vented dressing and place a chest tube at a separate site,
with definitive wound closure. a large open chest defect prevents effective ventilation unless the wound is sealed
and the pleural space drained.
2. During a reassessment after the first intervention, penetrating abdominal trauma leaves viable bowel
protruding through the wound. The team responds by cover the bowel with warm sterile saline-moistened
dressings and obtain urgent surgical management. Which finding best indicates that the immediate
objective of this intervention has been achieved?
A. intraperitoneal or extraperitoneal bladder disruption is defined for correct treatment
B. exposed viscera remain protected and viable until operative repair
C. urethral disruption is defined without converting a partial injury into a worse one
D. the presence or absence of major intraperitoneal blood is established quickly
Correct Answer: B. exposed viscera remain protected and viable until operative repair
Explanation: The desired immediate response is that exposed viscera remain protected and viable until operative
repair. eviscerated bowel should be protected from drying and further injury and should not be blindly pushed
back into the abdomen.
3. During a focused trauma evaluation, the patient is stable enough for a focused history after
primary-survey priorities have been addressed. The team responds by obtain allergies, medications, past
illnesses or pregnancy, last meal, and events or environment related to the injury. Which finding best
indicates that the immediate objective of this intervention has been achieved?
A. ventilation and oxygenation improve after the thoracic problem is corrected
B. air moves freely with improving oxygen saturation and no recurrent obstruction
C. key history that changes medication, aspiration, bleeding, and mechanism-related risk is identified
D. oxygenation and perfusion are restored and the neurologic examination can be interpreted more reliably
Correct Answer: C. key history that changes medication, aspiration, bleeding, and mechanism-related risk is
identified
Explanation: The desired immediate response is that key history that changes medication, aspiration, bleeding,
and mechanism-related risk is identified. the AMPLE history efficiently captures high-yield information during
the trauma secondary survey.
4. While the trauma team is working through the primary survey, a trauma patient is pale, cool,
tachycardic, confused, and hypotensive after a high-energy mechanism. The team responds by control
bleeding and begin balanced resuscitation with early blood products while limiting unnecessary crystalloid.
Which finding best indicates that the immediate objective of this intervention has been achieved?
A. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
B. ongoing resuscitation proceeds with timely antifibrinolytic therapy added to definitive bleeding control
C. blood pressure and ventilation improve after pleural pressure is relieved
D. perfusion improves with better mental status, pulse quality, blood pressure, and urine output
Correct Answer: D. perfusion improves with better mental status, pulse quality, blood pressure, and urine output
Explanation: The desired immediate response is that perfusion improves with better mental status, pulse quality,
blood pressure, and urine output. ongoing blood loss is the most common cause of shock after injury and
definitive hemorrhage control must accompany resuscitation.
5. During preparation for definitive care, a trauma patient has a clinically significant pneumothorax and is
likely to require positive-pressure ventilation. The team responds by place a tube thoracostomy before or
with positive-pressure ventilation as indicated. Which finding best indicates that the immediate objective of
this intervention has been achieved?
,A. the pleural air is evacuated and the lung re-expands
B. the aortic injury is defined without delaying stabilization of other life threats
C. respiratory distress and hemodynamic compromise improve rapidly after decompression
D. ongoing hemorrhage is surgically controlled and perfusion improves
Correct Answer: A. the pleural air is evacuated and the lung re-expands
Explanation: The desired immediate response is that the pleural air is evacuated and the lung re-expands.
positive-pressure ventilation can convert a pneumothorax into a tension pneumothorax if the pleural space is not
drained.
6. During preparation for definitive care, a burn patient has facial burns, soot in the mouth, hoarseness,
and increasing edema. The team chooses to secure the airway early before edema makes intubation
difficult or impossible. Which rationale best explains why this is the preferred ATLS priority?
A. capnography provides rapid objective evidence of tracheal rather than esophageal tube placement
B. when ventilation and intubation fail, a surgical airway is a time-critical rescue intervention
C. upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer than waiting for
obstruction
D. an oropharyngeal airway helps prevent the tongue from occluding the pharynx in an unconscious patient
without a gag reflex
Correct Answer: C. upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer
than waiting for obstruction
Explanation: upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer than
waiting for obstruction. Therefore the selected action - secure the airway early before edema makes intubation
difficult or impossible -addresses the most time-sensitive threat first.
7. In the emergency department, a hypotensive patient has pelvic instability after a crush mechanism and
no obvious external bleeding. Which condition or ATLS priority is most consistent with this presentation?
A. Unstable patient with positive FAST
B. Hemorrhage from an unstable pelvic ring injury
C. Bladder injury after pelvic trauma
D. Stable blunt abdominal trauma
Correct Answer: B. Hemorrhage from an unstable pelvic ring injury
Explanation: early pelvic stabilization can reduce pelvic volume and tamponade venous bleeding while further
hemorrhage control proceeds. The best match is hemorrhage from an unstable pelvic ring injury, and the
recommended immediate management is to apply a pelvic binder at the level of the greater trochanters and
activate a pelvic hemorrhage-control pathway.
8. During a focused trauma evaluation, a shocked trauma patient remains hypotensive despite initial
blood-product resuscitation. The team chooses to look immediately for uncontrolled hemorrhage or
another cause of shock and move toward definitive control. Which rationale best explains why this is the
preferred ATLS priority?
A. ongoing blood loss is the most common cause of shock after injury and definitive hemorrhage control must
accompany resuscitation
B. hypothermia aggravates coagulopathy and acidosis, contributing to the lethal trauma triad
C. failure to respond signals ongoing major bleeding or an alternative shock mechanism and demands rapid
reassessment
D. a transient responder has persistent blood loss and needs definitive hemorrhage control rather than repeated
crystalloid boluses
Correct Answer: C. failure to respond signals ongoing major bleeding or an alternative shock mechanism and
demands rapid reassessment
Explanation: failure to respond signals ongoing major bleeding or an alternative shock mechanism and demands
rapid reassessment. Therefore the selected action - look immediately for uncontrolled hemorrhage or another
cause of shock and move toward definitive control - addresses the most time-sensitive threat first.
9. During preparation for definitive care, a head-injured patient develops hypertension, bradycardia, and
irregular respirations. The team responds by treat this as a late warning of critically raised intracranial
pressure and impending herniation. Which finding best indicates that the immediate objective of this
intervention has been achieved?
A. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical strategies instead
, B. oxygenation and perfusion are maintained while the intracranial injury is defined
C. subtle neurologic worsening is recognized early enough to trigger repeat imaging or intervention
D. urgent ICP-directed treatment is initiated before further neurologic collapse
Correct Answer: D. urgent ICP-directed treatment is initiated before further neurologic collapse
Explanation: The desired immediate response is that urgent ICP-directed treatment is initiated before further
neurologic collapse. the Cushing response is a late and ominous manifestation of intracranial hypertension.
10. In the emergency department, a patient at a small facility has severe multisystem injuries that exceed
the hospital's operative and critical-care resources. The team chooses to initiate contact with an
appropriate trauma center early while continuing necessary stabilization. Which rationale best explains
why this is the preferred ATLS priority?
A. exposure is necessary to avoid missed injuries, but hypothermia worsens coagulopathy and trauma outcomes
B. catastrophic external blood loss is a circulation threat that must be controlled immediately
C. hypoxia and hypotension worsen secondary brain injury and can also mimic or aggravate neurologic
deterioration
D. transfer planning should begin as soon as the need is recognized because unnecessary delay can worsen
outcome
Correct Answer: D. transfer planning should begin as soon as the need is recognized because unnecessary delay
can worsen outcome
Explanation: transfer planning should begin as soon as the need is recognized because unnecessary delay can
worsen outcome. Therefore the selected action - initiate contact with an appropriate trauma center early while
continuing necessary stabilization -addresses the most time-sensitive threat first.
11. In the emergency department, a head-injured patient has Battle sign, periorbital ecchymosis, and
cerebrospinal fluid rhinorrhea. Which condition or ATLS priority is most consistent with this
presentation?
A. Cushing response as a late sign
B. Basilar skull fracture
C. Severe traumatic brain injury
D. Epidural hematoma pattern
Correct Answer: B. Basilar skull fracture
Explanation: nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region.
The best match is basilar skull fracture, and the recommended immediate management is to avoid nasal
instrumentation and evaluate the intracranial injury with CT.
12. A few minutes into resuscitation, a patient trapped under debris for hours has swollen muscles, dark
urine, and evolving hyperkalemia. Which condition or ATLS priority is most consistent with this
presentation?
A. Hard signs of extremity vascular injury
B. Femoral shaft fracture hemorrhage
C. Acute compartment syndrome
D. Crush injury with rhabdomyolysis
Correct Answer: D. Crush injury with rhabdomyolysis
Explanation: crushed muscle releases myoglobin and potassium, creating risks of acute kidney injury and fatal
dysrhythmia. The best match is crush injury with rhabdomyolysis, and the recommended immediate management
is to begin aggressive monitoring and resuscitation for rhabdomyolysis, treating life-threatening hyperkalemia
promptly.
13. A few minutes into resuscitation, an unconscious patient without a gag reflex has upper-airway soft
tissue obstruction but does not yet require intubation. Which action should the trauma team take first?
A. insert an appropriately sized oropharyngeal airway while continuing oxygenation and reassessment
B. use aggressive suction, manual airway maneuvers with cervical motion restriction, and secure a definitive
airway when needed
C. perform definitive airway control with appropriate cervical motion restriction and ventilation
D. obtain expert airway control with preparation for a surgical airway rather than repeated blind intubation
attempts
Correct Answer: A. insert an appropriately sized oropharyngeal airway while continuing oxygenation and
reassessment
