ITLS 9TH EDITION (INTERNATIONAL
TRAUMA LIFE SUPPORT) EXAM (LATEST
2026/2027 UPDATE) QUESTIONS &
ANSWERS | 100% CORRECT | GRADE A
INTERNATIONAL TRAUMA LIFE SUPPORT
(ITLS) 9TH EDITION
1. Upon arrival at a trauma scene, you should complete a(n):
A. Primary survey
B. Secondary survey
C. Scene size-up
D. Rapid transport
Answer: C. Scene size-up
Rationale: The first step on any trauma scene is a scene size-up to ensure the safety
of both the patient and rescuers. This includes assessing hazards, mechanism of
injury, number of patients, and need for additional resources. Completing a proper
scene size-up prevents delays in patient care and avoids adding additional casualties.
It guides whether immediate life-saving interventions or rapid transport are necessary.
2. Prolonged scene times may reflect:
A. Ineffective team collaboration
B. Rapid extrication
C. Efficient triage
D. Minimal interventions
Answer: A. Ineffective team collaboration
Rationale: Prolonged scene times are often caused by poor coordination, unclear
roles, or inefficient communication among the prehospital team. Effective trauma care
relies on teamwork and delegation of responsibilities. Delays can increase morbidity
,and mortality, particularly in patients with hemorrhage, airway compromise, or shock.
Optimizing team performance ensures timely assessment, intervention, and transport.
3. Which of the following indicates a state of hyperventilation?
A. End tidal CO₂ level >45 mmHg
B. End tidal CO₂ level <30 mmHg
C. Oxygen saturation <90%
D. Respiratory rate <12
Answer: B. End tidal CO₂ level <30 mmHg
Rationale: Hyperventilation causes excessive exhalation of CO₂, lowering end-tidal
CO₂ (ETCO₂) below normal (typically <30 mmHg). ETCO₂ monitoring is a reliable
indicator of ventilatory status and adequacy. Hyperventilation can lead to respiratory
alkalosis and reduced cerebral perfusion, which may worsen outcomes in head-injured
patients. Recognition allows for adjustment of ventilatory support.
4. A 23-year-old female fell from a 2nd floor balcony. She responds
to verbal commands. Assessment: flat neck veins, normal
chest/abdomen/pelvis. Vital signs: BP 74/40, HR 54, weak, R 16. You
should suspect:
A. Hemorrhagic shock
B. Cardiogenic shock
C. Relative hypovolemic (high-space) shock
D. Obstructive shock
Answer: C. Relative hypovolemic (high-space) shock
Rationale: Relative hypovolemia occurs when the vascular space is too large for the
circulating volume, such as in neurogenic shock. Unlike hemorrhagic shock, there is no
tachycardia or pale, cool skin; instead, patients have bradycardia, hypotension, and
warm, pink skin. Recognition is crucial as fluid resuscitation may be necessary, but
understanding the underlying mechanism helps avoid over-resuscitation and guides
proper management.
5. An unresponsive 34-year-old female was struck by a vehicle. You
observe asymmetrical chest wall movement with a flail segment on
the right. After c-spine control and opening the airway, you should:
,A. Apply cervical traction
B. Perform rapid transport immediately
C. Stabilize the chest wall
D. Begin IV fluid resuscitation
Answer: C. Stabilize the chest wall
Rationale: Flail chest leads to paradoxical movement and impaired ventilation.
Stabilization can be done with manual pressure or bulky dressings to reduce
paradoxical motion and improve ventilation. Early intervention improves oxygenation
and reduces pain. Definitive management requires hospitalization, often including pain
control and mechanical ventilation if necessary.
6. Regarding patient positioning for external jugular cannulation,
which is incorrect?
A. Supine position, head down
B. Trendelenburg position
C. Elevate the head to distend the vein and prevent air embolism
D. Maintain sterile technique
Answer: C. Elevate the head to distend the vein and prevent air embolism
Rationale: To distend the external jugular vein, the patient should be supine with
head slightly down. Elevating the head reduces venous return and increases the risk of
air embolism. Proper positioning facilitates successful cannulation and minimizes
complications. Sterile technique must always be maintained.
7. Which set of vital signs is most compatible with isolated
traumatic brain injury with increasing ICP?
A. BP 90/60, HR 110
B. BP 170/100, HR 50
C. BP 120/80, HR 80
D. BP 80/40, HR 140
Answer: B. BP 170/100, HR 50
Rationale: Cushing’s triad—hypertension, bradycardia, and irregular respirations—is
a classic sign of increased intracranial pressure. The body increases systemic BP to
maintain cerebral perfusion, while baroreceptor-mediated bradycardia occurs in
response. Recognizing these signs allows timely interventions to prevent brain
herniation and secondary injury.
, 8. Which statement regarding spinal motion restriction is incorrect?
A. Manual in-line stabilization is used during collar placement
B. Neck traction should be applied to extend the neck upward
C. Immobilization devices should be applied as per protocol
D. Reassessment of neurologic function is essential
Answer: B. Neck traction should be applied to extend the neck upward
Rationale: Neck traction is not indicated for routine cervical collar application; it
may worsen injury. Proper spinal motion restriction involves neutral alignment with
minimal movement, manual stabilization, and immobilization devices. Frequent
reassessment ensures neurologic deterioration is detected early. Overzealous traction
can exacerbate spinal cord injury.
9. A 15-year-old male was stabbed and has an abdominal
evisceration. He is A/O, BP 112/68, HR 94, R18. You should:
A. Attempt to replace the organs immediately
B. Cover the evisceration with moist sterile dressings and transport
C. Begin aggressive IV fluid resuscitation on scene
D. Perform exploratory surgery prehospital
Answer: B. Cover the evisceration with moist sterile dressings and transport
Rationale: Abdominal eviscerations should never be reduced in the field. Covering
with moist sterile dressings prevents contamination and drying, which reduces the risk
of infection and tissue necrosis. Rapid transport to a definitive care facility is the
priority. IV access may be established during transport for fluids or medications.
10. A 33-year-old female’s leg was trapped in industrial equipment
and is now extricated. She complains of severe lower leg pain. Vital
signs: BP 132/78, HR 96, R 20. Which is indicated?
A. Immediate splinting without analgesia
B. Administer pain medication
C. Elevate limb without immobilization
D. Perform fasciotomy on scene
Answer: B. Administer pain medication
TRAUMA LIFE SUPPORT) EXAM (LATEST
2026/2027 UPDATE) QUESTIONS &
ANSWERS | 100% CORRECT | GRADE A
INTERNATIONAL TRAUMA LIFE SUPPORT
(ITLS) 9TH EDITION
1. Upon arrival at a trauma scene, you should complete a(n):
A. Primary survey
B. Secondary survey
C. Scene size-up
D. Rapid transport
Answer: C. Scene size-up
Rationale: The first step on any trauma scene is a scene size-up to ensure the safety
of both the patient and rescuers. This includes assessing hazards, mechanism of
injury, number of patients, and need for additional resources. Completing a proper
scene size-up prevents delays in patient care and avoids adding additional casualties.
It guides whether immediate life-saving interventions or rapid transport are necessary.
2. Prolonged scene times may reflect:
A. Ineffective team collaboration
B. Rapid extrication
C. Efficient triage
D. Minimal interventions
Answer: A. Ineffective team collaboration
Rationale: Prolonged scene times are often caused by poor coordination, unclear
roles, or inefficient communication among the prehospital team. Effective trauma care
relies on teamwork and delegation of responsibilities. Delays can increase morbidity
,and mortality, particularly in patients with hemorrhage, airway compromise, or shock.
Optimizing team performance ensures timely assessment, intervention, and transport.
3. Which of the following indicates a state of hyperventilation?
A. End tidal CO₂ level >45 mmHg
B. End tidal CO₂ level <30 mmHg
C. Oxygen saturation <90%
D. Respiratory rate <12
Answer: B. End tidal CO₂ level <30 mmHg
Rationale: Hyperventilation causes excessive exhalation of CO₂, lowering end-tidal
CO₂ (ETCO₂) below normal (typically <30 mmHg). ETCO₂ monitoring is a reliable
indicator of ventilatory status and adequacy. Hyperventilation can lead to respiratory
alkalosis and reduced cerebral perfusion, which may worsen outcomes in head-injured
patients. Recognition allows for adjustment of ventilatory support.
4. A 23-year-old female fell from a 2nd floor balcony. She responds
to verbal commands. Assessment: flat neck veins, normal
chest/abdomen/pelvis. Vital signs: BP 74/40, HR 54, weak, R 16. You
should suspect:
A. Hemorrhagic shock
B. Cardiogenic shock
C. Relative hypovolemic (high-space) shock
D. Obstructive shock
Answer: C. Relative hypovolemic (high-space) shock
Rationale: Relative hypovolemia occurs when the vascular space is too large for the
circulating volume, such as in neurogenic shock. Unlike hemorrhagic shock, there is no
tachycardia or pale, cool skin; instead, patients have bradycardia, hypotension, and
warm, pink skin. Recognition is crucial as fluid resuscitation may be necessary, but
understanding the underlying mechanism helps avoid over-resuscitation and guides
proper management.
5. An unresponsive 34-year-old female was struck by a vehicle. You
observe asymmetrical chest wall movement with a flail segment on
the right. After c-spine control and opening the airway, you should:
,A. Apply cervical traction
B. Perform rapid transport immediately
C. Stabilize the chest wall
D. Begin IV fluid resuscitation
Answer: C. Stabilize the chest wall
Rationale: Flail chest leads to paradoxical movement and impaired ventilation.
Stabilization can be done with manual pressure or bulky dressings to reduce
paradoxical motion and improve ventilation. Early intervention improves oxygenation
and reduces pain. Definitive management requires hospitalization, often including pain
control and mechanical ventilation if necessary.
6. Regarding patient positioning for external jugular cannulation,
which is incorrect?
A. Supine position, head down
B. Trendelenburg position
C. Elevate the head to distend the vein and prevent air embolism
D. Maintain sterile technique
Answer: C. Elevate the head to distend the vein and prevent air embolism
Rationale: To distend the external jugular vein, the patient should be supine with
head slightly down. Elevating the head reduces venous return and increases the risk of
air embolism. Proper positioning facilitates successful cannulation and minimizes
complications. Sterile technique must always be maintained.
7. Which set of vital signs is most compatible with isolated
traumatic brain injury with increasing ICP?
A. BP 90/60, HR 110
B. BP 170/100, HR 50
C. BP 120/80, HR 80
D. BP 80/40, HR 140
Answer: B. BP 170/100, HR 50
Rationale: Cushing’s triad—hypertension, bradycardia, and irregular respirations—is
a classic sign of increased intracranial pressure. The body increases systemic BP to
maintain cerebral perfusion, while baroreceptor-mediated bradycardia occurs in
response. Recognizing these signs allows timely interventions to prevent brain
herniation and secondary injury.
, 8. Which statement regarding spinal motion restriction is incorrect?
A. Manual in-line stabilization is used during collar placement
B. Neck traction should be applied to extend the neck upward
C. Immobilization devices should be applied as per protocol
D. Reassessment of neurologic function is essential
Answer: B. Neck traction should be applied to extend the neck upward
Rationale: Neck traction is not indicated for routine cervical collar application; it
may worsen injury. Proper spinal motion restriction involves neutral alignment with
minimal movement, manual stabilization, and immobilization devices. Frequent
reassessment ensures neurologic deterioration is detected early. Overzealous traction
can exacerbate spinal cord injury.
9. A 15-year-old male was stabbed and has an abdominal
evisceration. He is A/O, BP 112/68, HR 94, R18. You should:
A. Attempt to replace the organs immediately
B. Cover the evisceration with moist sterile dressings and transport
C. Begin aggressive IV fluid resuscitation on scene
D. Perform exploratory surgery prehospital
Answer: B. Cover the evisceration with moist sterile dressings and transport
Rationale: Abdominal eviscerations should never be reduced in the field. Covering
with moist sterile dressings prevents contamination and drying, which reduces the risk
of infection and tissue necrosis. Rapid transport to a definitive care facility is the
priority. IV access may be established during transport for fluids or medications.
10. A 33-year-old female’s leg was trapped in industrial equipment
and is now extricated. She complains of severe lower leg pain. Vital
signs: BP 132/78, HR 96, R 20. Which is indicated?
A. Immediate splinting without analgesia
B. Administer pain medication
C. Elevate limb without immobilization
D. Perform fasciotomy on scene
Answer: B. Administer pain medication
