NR 599 - ATLS Final Exam Review Study Guide with Practice
Questions Latest Edition (2026) - 100 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area Advanced Trauma Life Support (ATLS) - NR 599
Description This exam assesses comprehensive knowledge of ATLS protocols, trauma
resuscitation, surgical decision-making, and evidence-based management of
life-threatening injuries. It covers initial assessment, airway management, shock,
head trauma, thoracic trauma, abdominal trauma, musculoskeletal trauma, burns,
pediatric and geriatric considerations, and disaster management.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Systematically apply the primary and secondary survey in trauma patients.
2. Prioritize interventions based on injury severity and physiological derangement.
3. Interpret diagnostic findings and initiate appropriate management for
hemorrhagic shock, traumatic brain injury, and chest trauma.
4. Differentiate between surgical and non-surgical management of abdominal and
thoracic injuries.
5. Integrate age-specific considerations in trauma care across the lifespan.
Accreditation Adheres to American College of Surgeons ATLS guidelines and US university
accreditation standards for advanced clinical courses.
Page 1
,1. During the primary survey, a patient presents with tachypnea, absent breath
sounds on the left, and tracheal deviation to the right. After needle decompression,
the patient's oxygen saturation improves but then deteriorates again. What is the
most likely complication of the decompression procedure?
A. Injury to the intercostal neurovascular bundle
B. Iatrogenic pneumothorax from lung laceration
C. Catheter kinking or obstruction by clot
D. Development of a bronchopleural fistula
Answer: C. Catheter kinking or obstruction by clot
Recurrent tension pneumothorax after needle decompression is most commonly due to
catheter kinking or obstruction by clot, preventing continuous air evacuation. While
intercostal vessel injury is a risk, it would cause hemothorax, not recurrent tension.
Lung laceration or bronchopleural fistula are less common and usually present with
persistent air leak.
2. A trauma patient with a pelvic fracture and persistent hypotension after 2 units of
packed red blood cells has a focused assessment with sonography in trauma (FAST)
exam negative for intra-abdominal fluid. Which of the following is the most
appropriate next step in management?
A. Diagnostic peritoneal aspiration (DPA)
B. CT scan of abdomen and pelvis
C. Pelvic angiography with embolization
D. Exploratory laparotomy
Answer: C. Pelvic angiography with embolization
In a hemodynamically unstable patient with pelvic fracture and negative FAST, pelvic
bleeding is the likely source. Pelvic angiography with embolization is indicated to
control arterial hemorrhage. DPA is less sensitive for retroperitoneal bleeding. CT is
contraindicated in instability. Laparotomy is not indicated without evidence of
intra-abdominal injury.
Page 2
,3. Which of the following best describes the physiological rationale for permissive
hypotension in the initial resuscitation of a patient with penetrating torso trauma
and uncontrolled hemorrhage?
A. Maintaining low blood pressure reduces the risk of rebleeding by preventing clot
disruption
B. Hypotension decreases myocardial oxygen demand, reducing the risk of cardiac arrest
C. Lower perfusion pressure minimizes cerebral edema in patients with concurrent head
injury
D. Reducing fluid administration prevents dilutional coagulopathy and hypothermia
Answer: A. Maintaining low blood pressure reduces the risk of rebleeding by
preventing clot disruption
Permissive hypotension aims to maintain a lower blood pressure (e.g., systolic 80-90
mmHg) to avoid dislodging a tenuous clot while still perfusing vital organs. Options B
and C are not primary rationales; option D is a benefit but not the core physiological
rationale for the blood pressure target itself.
4. A patient with blunt abdominal trauma undergoes a CT scan showing a grade IV
liver laceration with active extravasation. The patient is hemodynamically stable.
What is the most appropriate management?
A. Immediate exploratory laparotomy with hepatic packing
B. Angiography with embolization
C. Non-operative management with serial hemoglobin checks
D. Endoscopic retrograde cholangiopancreatography (ERCP)
Answer: B. Angiography with embolization
For a hemodynamically stable patient with active extravasation on CT, angiography
with embolization is the first-line intervention to control bleeding without surgery.
Non-operative management without addressing the active extravasation risks delayed
hemorrhage. Laparotomy is reserved for instability. ERCP is for biliary tract injury,
not hemorrhage.
Page 3
, 5. In a patient with traumatic brain injury and an intracranial pressure (ICP) of 28
mmHg despite head-of-bed elevation and sedation, which intervention should be
initiated next?
A. Mannitol 0.25-1 g/kg IV bolus
B. Hyperventilation to PaCO2 of 25 mmHg
C. Decompressive craniectomy
D. Induced hypothermia to 34°C
Answer: A. Mannitol 0.25-1 g/kg IV bolus
Mannitol is a first-line osmotic agent for elevated ICP after basic measures.
Hyperventilation is reserved for acute neurological deterioration due to risk of
ischemia. Decompressive craniectomy is a second-tier therapy. Therapeutic
hypothermia is not routinely recommended for ICP control.
6. A patient with a femur fracture and hypotension has a FAST exam positive for
intra-abdominal fluid. After receiving 2 liters of crystalloid, the patient's blood
pressure transiently improves but then drops again. What is the most appropriate
next step?
A. Apply pelvic binder and obtain CT scan
B. Transfuse 2 units of packed red blood cells and repeat FAST
C. Proceed to emergent laparotomy
D. Perform diagnostic peritoneal aspiration (DPA)
Answer: C. Proceed to emergent laparotomy
The patient has a positive FAST and hemodynamic instability refractory to initial fluid
resuscitation, indicating ongoing intra-abdominal hemorrhage. Emergent laparotomy is
indicated without delay. Pelvic binder is for pelvic fractures, not femur. Additional
transfusions and repeat imaging waste critical time. DPA is unnecessary with positive
FAST.
Page 4
Questions Latest Edition (2026) - 100 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area Advanced Trauma Life Support (ATLS) - NR 599
Description This exam assesses comprehensive knowledge of ATLS protocols, trauma
resuscitation, surgical decision-making, and evidence-based management of
life-threatening injuries. It covers initial assessment, airway management, shock,
head trauma, thoracic trauma, abdominal trauma, musculoskeletal trauma, burns,
pediatric and geriatric considerations, and disaster management.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Systematically apply the primary and secondary survey in trauma patients.
2. Prioritize interventions based on injury severity and physiological derangement.
3. Interpret diagnostic findings and initiate appropriate management for
hemorrhagic shock, traumatic brain injury, and chest trauma.
4. Differentiate between surgical and non-surgical management of abdominal and
thoracic injuries.
5. Integrate age-specific considerations in trauma care across the lifespan.
Accreditation Adheres to American College of Surgeons ATLS guidelines and US university
accreditation standards for advanced clinical courses.
Page 1
,1. During the primary survey, a patient presents with tachypnea, absent breath
sounds on the left, and tracheal deviation to the right. After needle decompression,
the patient's oxygen saturation improves but then deteriorates again. What is the
most likely complication of the decompression procedure?
A. Injury to the intercostal neurovascular bundle
B. Iatrogenic pneumothorax from lung laceration
C. Catheter kinking or obstruction by clot
D. Development of a bronchopleural fistula
Answer: C. Catheter kinking or obstruction by clot
Recurrent tension pneumothorax after needle decompression is most commonly due to
catheter kinking or obstruction by clot, preventing continuous air evacuation. While
intercostal vessel injury is a risk, it would cause hemothorax, not recurrent tension.
Lung laceration or bronchopleural fistula are less common and usually present with
persistent air leak.
2. A trauma patient with a pelvic fracture and persistent hypotension after 2 units of
packed red blood cells has a focused assessment with sonography in trauma (FAST)
exam negative for intra-abdominal fluid. Which of the following is the most
appropriate next step in management?
A. Diagnostic peritoneal aspiration (DPA)
B. CT scan of abdomen and pelvis
C. Pelvic angiography with embolization
D. Exploratory laparotomy
Answer: C. Pelvic angiography with embolization
In a hemodynamically unstable patient with pelvic fracture and negative FAST, pelvic
bleeding is the likely source. Pelvic angiography with embolization is indicated to
control arterial hemorrhage. DPA is less sensitive for retroperitoneal bleeding. CT is
contraindicated in instability. Laparotomy is not indicated without evidence of
intra-abdominal injury.
Page 2
,3. Which of the following best describes the physiological rationale for permissive
hypotension in the initial resuscitation of a patient with penetrating torso trauma
and uncontrolled hemorrhage?
A. Maintaining low blood pressure reduces the risk of rebleeding by preventing clot
disruption
B. Hypotension decreases myocardial oxygen demand, reducing the risk of cardiac arrest
C. Lower perfusion pressure minimizes cerebral edema in patients with concurrent head
injury
D. Reducing fluid administration prevents dilutional coagulopathy and hypothermia
Answer: A. Maintaining low blood pressure reduces the risk of rebleeding by
preventing clot disruption
Permissive hypotension aims to maintain a lower blood pressure (e.g., systolic 80-90
mmHg) to avoid dislodging a tenuous clot while still perfusing vital organs. Options B
and C are not primary rationales; option D is a benefit but not the core physiological
rationale for the blood pressure target itself.
4. A patient with blunt abdominal trauma undergoes a CT scan showing a grade IV
liver laceration with active extravasation. The patient is hemodynamically stable.
What is the most appropriate management?
A. Immediate exploratory laparotomy with hepatic packing
B. Angiography with embolization
C. Non-operative management with serial hemoglobin checks
D. Endoscopic retrograde cholangiopancreatography (ERCP)
Answer: B. Angiography with embolization
For a hemodynamically stable patient with active extravasation on CT, angiography
with embolization is the first-line intervention to control bleeding without surgery.
Non-operative management without addressing the active extravasation risks delayed
hemorrhage. Laparotomy is reserved for instability. ERCP is for biliary tract injury,
not hemorrhage.
Page 3
, 5. In a patient with traumatic brain injury and an intracranial pressure (ICP) of 28
mmHg despite head-of-bed elevation and sedation, which intervention should be
initiated next?
A. Mannitol 0.25-1 g/kg IV bolus
B. Hyperventilation to PaCO2 of 25 mmHg
C. Decompressive craniectomy
D. Induced hypothermia to 34°C
Answer: A. Mannitol 0.25-1 g/kg IV bolus
Mannitol is a first-line osmotic agent for elevated ICP after basic measures.
Hyperventilation is reserved for acute neurological deterioration due to risk of
ischemia. Decompressive craniectomy is a second-tier therapy. Therapeutic
hypothermia is not routinely recommended for ICP control.
6. A patient with a femur fracture and hypotension has a FAST exam positive for
intra-abdominal fluid. After receiving 2 liters of crystalloid, the patient's blood
pressure transiently improves but then drops again. What is the most appropriate
next step?
A. Apply pelvic binder and obtain CT scan
B. Transfuse 2 units of packed red blood cells and repeat FAST
C. Proceed to emergent laparotomy
D. Perform diagnostic peritoneal aspiration (DPA)
Answer: C. Proceed to emergent laparotomy
The patient has a positive FAST and hemodynamic instability refractory to initial fluid
resuscitation, indicating ongoing intra-abdominal hemorrhage. Emergent laparotomy is
indicated without delay. Pelvic binder is for pelvic fractures, not femur. Additional
transfusions and repeat imaging waste critical time. DPA is unnecessary with positive
FAST.
Page 4
