ATLS PRACTICE TEST ACTUAL EXAM 250 REAL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES (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: - correct 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: - correct answer
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - correct
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:
- correct 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? - correct 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: - correct answer increasing the volume of blood loss to
produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - correct answer urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - correct 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: - correct answer direct pressure on
the wound
,For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent: - correct 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: - correct answer perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is
TRUE? - correct answer Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - correct 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: - correct 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: - correct 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? - correct answer respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: - correct
answer placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - correct 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? - correct answer breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - correct 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: -
correct 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: - correct
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? - correct 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? - correct
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? - correct 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: - correct
answer suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a chest
tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in
transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure
decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step
should be to: - correct answer repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital
without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a
widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no
, pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart
rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross
hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of
providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you
should first: - correct answer call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - correct answer
tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - correct
answer Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the
emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is
80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size
and equally reactive to light. There is no other apparent injury. The most important principle to
follow in the early management of her head injury is to: - correct answer avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to
extricate her from the car. Upon arrival in the emergency department, her heart rate is 120
beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS
score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis,
and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable.
Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis
is: - correct answer cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III
(moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of
the following mandates prompt celiotomy (laparotomy)? - correct answer development of
peritonitis on physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the
emergency department. She is hemodynamically normal and found to be paraplegic at the level
of T10. Which of the following are true regarding her evaluation and management? - correct
answer Log rolling using 4 people is a safe approach to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a
suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing
mask. The most appropriate next step is to: - correct answer restrict cervical motion and
establish a definitive airway
When applying the Rule of Nines to infants: - correct answer The head is proportionally larger
in infants than in adults.
CORRECT DETAILED ANSWERS WITH RATIONALES (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: - correct 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: - correct answer
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - correct
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:
- correct 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? - correct 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: - correct answer increasing the volume of blood loss to
produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - correct answer urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - correct 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: - correct answer direct pressure on
the wound
,For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent: - correct 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: - correct answer perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is
TRUE? - correct answer Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - correct 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: - correct 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: - correct 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? - correct answer respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: - correct
answer placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - correct 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? - correct answer breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - correct 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: -
correct 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: - correct
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? - correct 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? - correct
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? - correct 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: - correct
answer suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a chest
tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in
transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure
decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step
should be to: - correct answer repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital
without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a
widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no
, pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart
rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross
hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of
providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you
should first: - correct answer call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - correct answer
tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - correct
answer Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the
emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is
80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size
and equally reactive to light. There is no other apparent injury. The most important principle to
follow in the early management of her head injury is to: - correct answer avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to
extricate her from the car. Upon arrival in the emergency department, her heart rate is 120
beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS
score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis,
and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable.
Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis
is: - correct answer cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III
(moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of
the following mandates prompt celiotomy (laparotomy)? - correct answer development of
peritonitis on physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the
emergency department. She is hemodynamically normal and found to be paraplegic at the level
of T10. Which of the following are true regarding her evaluation and management? - correct
answer Log rolling using 4 people is a safe approach to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a
suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing
mask. The most appropriate next step is to: - correct answer restrict cervical motion and
establish a definitive airway
When applying the Rule of Nines to infants: - correct answer The head is proportionally larger
in infants than in adults.
