ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
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: - 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: - ANSWER complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - 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: -
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? - 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: - ANSWER increasing the volume of blood loss to produce maternal
hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER urinary output of 0.5
mL/kg/hr
,ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
The diagnosis of shock must include: - 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: - ANSWER direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: -
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: - ANSWER perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? -
ANSWER Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - 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: - 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: - 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? - ANSWER respiratory rate of 40 breaths per minute
,ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
The most important, immediate step in the management of an open pneumothorax is: - ANSWER
placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - 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? -
ANSWER breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal
intubation because: - 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: - 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: - 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? - ANSWER Flaccidity of the lower extremities and loss of deep
tendon reflexes are expected.
, ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
Which one of the following is the most effective method for initially treating frostbite? - 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? - 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: - 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: - 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: - 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: - ANSWER tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - ANSWER Aspiration
of bone marrow confirms appropriate positioning of the needle.
complete solutions.
ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
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: - 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: - ANSWER complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? - 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: -
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? - 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: - ANSWER increasing the volume of blood loss to produce maternal
hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER urinary output of 0.5
mL/kg/hr
,ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
The diagnosis of shock must include: - 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: - ANSWER direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: -
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: - ANSWER perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? -
ANSWER Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - 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: - 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: - 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? - ANSWER respiratory rate of 40 breaths per minute
,ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
The most important, immediate step in the management of an open pneumothorax is: - ANSWER
placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - 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? -
ANSWER breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal
intubation because: - 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: - 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: - 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? - ANSWER Flaccidity of the lower extremities and loss of deep
tendon reflexes are expected.
, ATLS PRACTICE TEST 2026 EXAM 274
complete solutions.
Which one of the following is the most effective method for initially treating frostbite? - 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? - 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: - 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: - 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: - 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: - ANSWER tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - ANSWER Aspiration
of bone marrow confirms appropriate positioning of the needle.
