Advanced Trauma Care for Nurses (ATCN)
Renewal Examination: Verified Questions and
Answers | Instant PDF Study Guide
1. A 32-year-old patient arrives after a high-speed motor
vehicle collision. The patient is restless, has a respiratory rate
of 30/min, BP 84/52 mmHg, HR 132/min, and cool clammy
skin. Which intervention should the trauma nurse prioritize?
A. Obtain a 12-lead ECG
B. Insert a urinary catheter
C. Assess for and control life-threatening hemorrhage
D. Obtain a complete neurologic history
Rationale: In the initial trauma assessment, immediately life-
threatening problems take priority. Hypotension, tachycardia,
altered behavior, and cool clammy skin strongly suggest
hemorrhagic shock. The nurse should rapidly identify and
control external hemorrhage while simultaneously supporting
airway and breathing. Diagnostic procedures that do not
immediately address a life threat should not delay hemorrhage
control.
,2. During the primary survey, a trauma patient has gurgling
respirations and is unable to maintain airway protection.
What is the most appropriate immediate action?
A. Obtain a portable chest radiograph
B. Administer a sedative
C. Suction the airway while maintaining cervical spine
precautions
D. Place the patient in a sitting position
Rationale: Gurgling indicates fluid or secretions obstructing the
airway. Immediate suctioning is required to restore airway
patency. Because cervical spine injury may coexist with major
trauma, manual stabilization and appropriate spinal
precautions should be maintained while airway interventions
are performed.
3. A patient with blunt chest trauma develops severe
respiratory distress, hypotension, distended neck veins, and
absent breath sounds on the right. What injury should the
nurse suspect?
A. Simple pneumothorax
B. Hemothorax
C. Pulmonary contusion
D. Tension pneumothorax
,Rationale: The combination of respiratory distress, unilateral
absent breath sounds, hypotension, and jugular venous
distention is classic for tension pneumothorax. Rising
intrathoracic pressure compresses the lung and impairs venous
return to the heart, producing obstructive shock. This is a
clinical emergency and treatment should not be delayed for
imaging when the presentation is strongly suggestive.
4. A patient with suspected tension pneumothorax is rapidly
deteriorating. Which intervention is anticipated?
A. Pericardiocentesis
B. Immediate chest decompression followed by definitive tube
thoracostomy
C. Administration of a loop diuretic
D. Delayed chest imaging
Rationale: Tension pneumothorax requires immediate
decompression to relieve pressure and restore ventilation and
venous return. Definitive management generally involves
placement of a chest tube after emergency decompression.
Waiting for radiographic confirmation in a clinically unstable
patient can result in preventable deterioration or cardiac arrest.
, 5. Which finding is most characteristic of cardiac tamponade
following penetrating chest trauma?
A. Unilateral absent breath sounds
B. Tracheal deviation
C. Hypotension, muffled heart sounds, and jugular venous
distention
D. Severe wheezing and prolonged expiration
Rationale: The classic clinical triad associated with cardiac
tamponade is hypotension, muffled heart sounds, and jugular
venous distention. Accumulation of blood in the pericardial sac
restricts cardiac filling and reduces cardiac output. Trauma
patients may not display every component of the classic triad,
so the overall clinical picture is important.
6. A patient with major trauma has uncontrolled external
bleeding from an extremity. Direct pressure is unsuccessful.
What should the nurse anticipate?
A. Application of a warm compress
B. Application of an appropriately placed tourniquet
C. Elevation of the extremity only
D. Administration of oral fluids
Rationale: Severe extremity hemorrhage that cannot be
controlled with direct pressure requires rapid escalation to
Renewal Examination: Verified Questions and
Answers | Instant PDF Study Guide
1. A 32-year-old patient arrives after a high-speed motor
vehicle collision. The patient is restless, has a respiratory rate
of 30/min, BP 84/52 mmHg, HR 132/min, and cool clammy
skin. Which intervention should the trauma nurse prioritize?
A. Obtain a 12-lead ECG
B. Insert a urinary catheter
C. Assess for and control life-threatening hemorrhage
D. Obtain a complete neurologic history
Rationale: In the initial trauma assessment, immediately life-
threatening problems take priority. Hypotension, tachycardia,
altered behavior, and cool clammy skin strongly suggest
hemorrhagic shock. The nurse should rapidly identify and
control external hemorrhage while simultaneously supporting
airway and breathing. Diagnostic procedures that do not
immediately address a life threat should not delay hemorrhage
control.
,2. During the primary survey, a trauma patient has gurgling
respirations and is unable to maintain airway protection.
What is the most appropriate immediate action?
A. Obtain a portable chest radiograph
B. Administer a sedative
C. Suction the airway while maintaining cervical spine
precautions
D. Place the patient in a sitting position
Rationale: Gurgling indicates fluid or secretions obstructing the
airway. Immediate suctioning is required to restore airway
patency. Because cervical spine injury may coexist with major
trauma, manual stabilization and appropriate spinal
precautions should be maintained while airway interventions
are performed.
3. A patient with blunt chest trauma develops severe
respiratory distress, hypotension, distended neck veins, and
absent breath sounds on the right. What injury should the
nurse suspect?
A. Simple pneumothorax
B. Hemothorax
C. Pulmonary contusion
D. Tension pneumothorax
,Rationale: The combination of respiratory distress, unilateral
absent breath sounds, hypotension, and jugular venous
distention is classic for tension pneumothorax. Rising
intrathoracic pressure compresses the lung and impairs venous
return to the heart, producing obstructive shock. This is a
clinical emergency and treatment should not be delayed for
imaging when the presentation is strongly suggestive.
4. A patient with suspected tension pneumothorax is rapidly
deteriorating. Which intervention is anticipated?
A. Pericardiocentesis
B. Immediate chest decompression followed by definitive tube
thoracostomy
C. Administration of a loop diuretic
D. Delayed chest imaging
Rationale: Tension pneumothorax requires immediate
decompression to relieve pressure and restore ventilation and
venous return. Definitive management generally involves
placement of a chest tube after emergency decompression.
Waiting for radiographic confirmation in a clinically unstable
patient can result in preventable deterioration or cardiac arrest.
, 5. Which finding is most characteristic of cardiac tamponade
following penetrating chest trauma?
A. Unilateral absent breath sounds
B. Tracheal deviation
C. Hypotension, muffled heart sounds, and jugular venous
distention
D. Severe wheezing and prolonged expiration
Rationale: The classic clinical triad associated with cardiac
tamponade is hypotension, muffled heart sounds, and jugular
venous distention. Accumulation of blood in the pericardial sac
restricts cardiac filling and reduces cardiac output. Trauma
patients may not display every component of the classic triad,
so the overall clinical picture is important.
6. A patient with major trauma has uncontrolled external
bleeding from an extremity. Direct pressure is unsuccessful.
What should the nurse anticipate?
A. Application of a warm compress
B. Application of an appropriately placed tourniquet
C. Elevation of the extremity only
D. Administration of oral fluids
Rationale: Severe extremity hemorrhage that cannot be
controlled with direct pressure requires rapid escalation to
