PHTLS PRE & POST TEST 2026 | 100% Answered Correct |
Prehospital Trauma Life Support | NAEMT Certification Prep
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Section 1: Trauma Assessment & Scene Management (Questions 1-12)
Question 1
During scene size-up, which action should be performed FIRST before approaching the trauma
patient?
A. Apply a cervical collar
B. Assess the mechanism of injury
C. Ensure BSI/scene safety
D. Determine the number of patients
C. Ensure BSI/scene safety [CORRECT]
Rationale: Scene size-up follows a strict sequence: BSI/scene safety always comes first—providers
cannot help patients if they become casualties themselves. A (cervical collar) occurs during the
primary survey after scene safety is established. B (mechanism of injury) and D (number of patients)
are critical but come after ensuring the scene is safe. PHTLS Principle: "BSI, Scene Safe" is the
universal first step in all EMS protocols. Clinical Reasoning: Gunshot scenes, hazardous materials, or
unstable vehicles require staging until secured. NAEMT Guideline: Scene safety is non-negotiable;
no patient contact until provider safety is assured.
Correct Answer: C
Question 2
Which component of the primary survey is assessed FIRST in the XABCDE approach?
A. Airway with c-spine control
B. Breathing/ventilation
C. Exsanguination (massive hemorrhage control)
D. Circulation
C. Exsanguination (massive hemorrhage control) [CORRECT]
Rationale: The updated XABCDE sequence places exsanguinating hemorrhage control before airway
because uncontrolled bleeding kills faster than airway compromise in trauma. A (airway) follows
exsanguination control. B (breathing) and D (circulation/hemorrhage control beyond tourniquet)
follow sequentially. PHTLS Principle: The "X" in XABCDE recognizes that exsanguination is the most
immediate threat to life in penetrating trauma. Clinical Reasoning: A patient can survive 4-6 minutes
,without airway but only 2-3 minutes with a severed femoral artery. NAEMT Guideline: XABCDE is
the current PHTLS primary survey sequence, replacing the older ABCDE in trauma-specific contexts.
Correct Answer: C
Question 3
During the primary survey, which finding indicates the need for immediate airway intervention?
A. SpO₂ of 96% on room air
B. GCS verbal score of 4 (confused conversation)
C. Gag reflex present with snoring respirations
D. Radial pulse of 88 bpm
C. Gag reflex present with snoring respirations [CORRECT]
Rationale: Snoring respirations indicate partial upper airway obstruction from the tongue or soft
tissues—an immediate threat requiring jaw thrust, oral airway, or advanced airway. A (SpO₂ 96%) is
normal. B (GCS verbal 4) indicates altered mental status but not immediate airway compromise. D
(pulse 88) is normal. PHTLS Principle: Airway obstruction sounds (snoring, gurgling, stridor) take
priority over oxygen saturation numbers in the primary survey. Clinical Reasoning: Snoring
progresses to complete obstruction; early intervention prevents hypoxic cardiac arrest. NAEMT
Guideline: Airway with c-spine control is the second step in XABCDE after exsanguination control.
Correct Answer: C
Question 4
Which finding during the breathing assessment requires immediate needle decompression?
A. Bilateral clear breath sounds with SpO₂ 94%
B. Absent breath sounds on the right, JVD, tracheal deviation to the left
C. Bilateral wheezing with respiratory rate 24
D. Decreased breath sounds on the left with dullness to percussion
B. Absent breath sounds on the right, JVD, tracheal deviation to the left [CORRECT]
Rationale: This triad (absent breath sounds, JVD, tracheal deviation) indicates tension
pneumothorax—a life-threatening condition requiring immediate needle decompression. A is
normal. C indicates bronchospasm, not tension pneumothorax. D describes hemothorax (dullness to
percussion), not tension pneumothorax (hyperresonance). PHTLS Principle: Tension pneumothorax
is a clinical diagnosis—do not wait for imaging. Clinical Reasoning: Tracheal deviation is a late sign;
needle decompression should occur when absent breath sounds + JVD + hypotension are present,
even before deviation. NAEMT Guideline: Decompress at second intercostal space midclavicular line
or 4th/5th intercostal space anterior axillary line with 14g needle.
Correct Answer: B
Question 5
,In the primary survey, which finding during the disability (neurologic) assessment indicates the most
severe traumatic brain injury?
A. GCS 14, opens eyes spontaneously, confused conversation
B. GCS 9, opens eyes to pain, withdraws from pain, incomprehensible sounds
C. GCS 13, opens eyes to voice, oriented, follows commands
D. GCS 3, no eye opening, no motor response, no verbal response
D. GCS 3, no eye opening, no motor response, no verbal response [CORRECT]
Rationale: GCS 3 is the lowest possible score, indicating severe brain injury with no response to any
stimulus. A (GCS 14) is mild TBI. B (GCS 9) is moderate TBI. C (GCS 13) is mild TBI. PHTLS Principle:
GCS ≤8 indicates severe TBI requiring airway protection and immediate transport to a trauma center.
Clinical Reasoning: GCS 3 suggests brainstem dysfunction or severe diffuse axonal injury; prognosis
is grave without rapid neurosurgical intervention. NAEMT Guideline: GCS is calculated as E___ +
V___ + M___ = total; severe ≤8, moderate 9-12, mild 13-15.
Correct Answer: D
Question 6
Which action is appropriate during the exposure/environment component of the primary survey?
A. Leave the patient fully clothed to maintain dignity
B. Remove all clothing to assess for hidden injuries while preventing hypothermia
C. Expose only the chest and abdomen
D. Cover the patient with a warm blanket and defer full exposure to the hospital
B. Remove all clothing to assess for hidden injuries while preventing hypothermia [CORRECT]
Rationale: Full exposure is necessary to identify life-threatening injuries (stab wounds, open
fractures, burns) not visible through clothing, but hypothermia prevention is simultaneous—trauma
patients lose heat rapidly. A misses hidden injuries. C may miss posterior or extremity injuries. D
delays critical injury identification. PHTLS Principle: "Exposure" and "environment" are linked—
expose to assess, then immediately cover and warm. Clinical Reasoning: Hypothermia in trauma
increases mortality, coagulopathy, and acidosis (the lethal triad); warm blankets, warmed IV fluids,
and ambient temperature control are essential. NAEMT Guideline: Remove clothing completely,
assess front and back (log roll), then cover with warm blankets.
Correct Answer: B
Question 7
During the secondary survey, which mnemonic is used to obtain the patient's history?
A. OPQRST
B. SAMPLE
C. DCAP-BTLS
D. AVPU
B. SAMPLE [CORRECT]
, Rationale: SAMPLE stands for Signs/Symptoms, Allergies, Medications, Past medical history, Last
meal, Events leading to injury—standard for trauma history. A (OPQRST) is for pain assessment. C
(DCAP-BTLS) is for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations,
swelling during the physical exam. D (AVPU) is a rapid mental status assessment (Alert, Voice, Pain,
Unresponsive). PHTLS Principle: SAMPLE history provides critical information for hospital handoff
and guides treatment decisions. Clinical Reasoning: Knowing medications (anticoagulants, beta-
blockers) and allergies (latex, contrast) directly affects trauma management. NAEMT Guideline:
SAMPLE is obtained during the secondary survey after life threats are addressed in the primary
survey.
Correct Answer: B
Question 8
A trauma patient has a heart rate of 110 bpm, blood pressure of 118/78 mmHg, and respiratory rate
of 22. Based on these vital signs, which class of hemorrhagic shock is most likely?
A. Class I
B. Class II
C. Class III
D. Class IV
B. Class II [CORRECT]
Rationale: Class II hemorrhagic shock involves 15-30% blood loss (750-1500 mL) with tachycardia
(HR 100-120), normal blood pressure, and increased respiratory rate. A (Class I, <15% loss) has
minimal vital sign changes. C (Class III, 30-40% loss) shows decreased BP and altered mental status. D
(Class IV, >40% loss) shows severe hypotension and imminent arrest. PHTLS Principle: Blood
pressure is maintained by compensatory mechanisms until Class III; tachycardia is the earliest
reliable sign. Clinical Reasoning: Normal BP with tachycardia indicates compensated shock—fluid
resuscitation should begin before decompensation. NAEMT Guideline: Class II requires crystalloid
resuscitation and rapid transport; blood products if progression occurs.
Correct Answer: B
Question 9
Which criterion is NOT part of the NEXUS criteria for cervical spine clearance in the prehospital
setting?
A. No midline cervical tenderness
B. No focal neurologic deficit
C. No distracting injury
D. Glasgow Coma Scale score of 15
D. Glasgow Coma Scale score of 15 [CORRECT]
Rationale: NEXUS criteria include: no midline cervical tenderness (A), no focal neurologic deficit (B),
normal alertness, no intoxication, and no distracting painful injury (C). GCS 15 (D) is not explicitly
part of NEXUS—NEXUS uses "normal alertness" rather than a specific GCS score. PHTLS Principle:
Prehospital Trauma Life Support | NAEMT Certification Prep
| Pass Guaranteed - A+ Graded
Section 1: Trauma Assessment & Scene Management (Questions 1-12)
Question 1
During scene size-up, which action should be performed FIRST before approaching the trauma
patient?
A. Apply a cervical collar
B. Assess the mechanism of injury
C. Ensure BSI/scene safety
D. Determine the number of patients
C. Ensure BSI/scene safety [CORRECT]
Rationale: Scene size-up follows a strict sequence: BSI/scene safety always comes first—providers
cannot help patients if they become casualties themselves. A (cervical collar) occurs during the
primary survey after scene safety is established. B (mechanism of injury) and D (number of patients)
are critical but come after ensuring the scene is safe. PHTLS Principle: "BSI, Scene Safe" is the
universal first step in all EMS protocols. Clinical Reasoning: Gunshot scenes, hazardous materials, or
unstable vehicles require staging until secured. NAEMT Guideline: Scene safety is non-negotiable;
no patient contact until provider safety is assured.
Correct Answer: C
Question 2
Which component of the primary survey is assessed FIRST in the XABCDE approach?
A. Airway with c-spine control
B. Breathing/ventilation
C. Exsanguination (massive hemorrhage control)
D. Circulation
C. Exsanguination (massive hemorrhage control) [CORRECT]
Rationale: The updated XABCDE sequence places exsanguinating hemorrhage control before airway
because uncontrolled bleeding kills faster than airway compromise in trauma. A (airway) follows
exsanguination control. B (breathing) and D (circulation/hemorrhage control beyond tourniquet)
follow sequentially. PHTLS Principle: The "X" in XABCDE recognizes that exsanguination is the most
immediate threat to life in penetrating trauma. Clinical Reasoning: A patient can survive 4-6 minutes
,without airway but only 2-3 minutes with a severed femoral artery. NAEMT Guideline: XABCDE is
the current PHTLS primary survey sequence, replacing the older ABCDE in trauma-specific contexts.
Correct Answer: C
Question 3
During the primary survey, which finding indicates the need for immediate airway intervention?
A. SpO₂ of 96% on room air
B. GCS verbal score of 4 (confused conversation)
C. Gag reflex present with snoring respirations
D. Radial pulse of 88 bpm
C. Gag reflex present with snoring respirations [CORRECT]
Rationale: Snoring respirations indicate partial upper airway obstruction from the tongue or soft
tissues—an immediate threat requiring jaw thrust, oral airway, or advanced airway. A (SpO₂ 96%) is
normal. B (GCS verbal 4) indicates altered mental status but not immediate airway compromise. D
(pulse 88) is normal. PHTLS Principle: Airway obstruction sounds (snoring, gurgling, stridor) take
priority over oxygen saturation numbers in the primary survey. Clinical Reasoning: Snoring
progresses to complete obstruction; early intervention prevents hypoxic cardiac arrest. NAEMT
Guideline: Airway with c-spine control is the second step in XABCDE after exsanguination control.
Correct Answer: C
Question 4
Which finding during the breathing assessment requires immediate needle decompression?
A. Bilateral clear breath sounds with SpO₂ 94%
B. Absent breath sounds on the right, JVD, tracheal deviation to the left
C. Bilateral wheezing with respiratory rate 24
D. Decreased breath sounds on the left with dullness to percussion
B. Absent breath sounds on the right, JVD, tracheal deviation to the left [CORRECT]
Rationale: This triad (absent breath sounds, JVD, tracheal deviation) indicates tension
pneumothorax—a life-threatening condition requiring immediate needle decompression. A is
normal. C indicates bronchospasm, not tension pneumothorax. D describes hemothorax (dullness to
percussion), not tension pneumothorax (hyperresonance). PHTLS Principle: Tension pneumothorax
is a clinical diagnosis—do not wait for imaging. Clinical Reasoning: Tracheal deviation is a late sign;
needle decompression should occur when absent breath sounds + JVD + hypotension are present,
even before deviation. NAEMT Guideline: Decompress at second intercostal space midclavicular line
or 4th/5th intercostal space anterior axillary line with 14g needle.
Correct Answer: B
Question 5
,In the primary survey, which finding during the disability (neurologic) assessment indicates the most
severe traumatic brain injury?
A. GCS 14, opens eyes spontaneously, confused conversation
B. GCS 9, opens eyes to pain, withdraws from pain, incomprehensible sounds
C. GCS 13, opens eyes to voice, oriented, follows commands
D. GCS 3, no eye opening, no motor response, no verbal response
D. GCS 3, no eye opening, no motor response, no verbal response [CORRECT]
Rationale: GCS 3 is the lowest possible score, indicating severe brain injury with no response to any
stimulus. A (GCS 14) is mild TBI. B (GCS 9) is moderate TBI. C (GCS 13) is mild TBI. PHTLS Principle:
GCS ≤8 indicates severe TBI requiring airway protection and immediate transport to a trauma center.
Clinical Reasoning: GCS 3 suggests brainstem dysfunction or severe diffuse axonal injury; prognosis
is grave without rapid neurosurgical intervention. NAEMT Guideline: GCS is calculated as E___ +
V___ + M___ = total; severe ≤8, moderate 9-12, mild 13-15.
Correct Answer: D
Question 6
Which action is appropriate during the exposure/environment component of the primary survey?
A. Leave the patient fully clothed to maintain dignity
B. Remove all clothing to assess for hidden injuries while preventing hypothermia
C. Expose only the chest and abdomen
D. Cover the patient with a warm blanket and defer full exposure to the hospital
B. Remove all clothing to assess for hidden injuries while preventing hypothermia [CORRECT]
Rationale: Full exposure is necessary to identify life-threatening injuries (stab wounds, open
fractures, burns) not visible through clothing, but hypothermia prevention is simultaneous—trauma
patients lose heat rapidly. A misses hidden injuries. C may miss posterior or extremity injuries. D
delays critical injury identification. PHTLS Principle: "Exposure" and "environment" are linked—
expose to assess, then immediately cover and warm. Clinical Reasoning: Hypothermia in trauma
increases mortality, coagulopathy, and acidosis (the lethal triad); warm blankets, warmed IV fluids,
and ambient temperature control are essential. NAEMT Guideline: Remove clothing completely,
assess front and back (log roll), then cover with warm blankets.
Correct Answer: B
Question 7
During the secondary survey, which mnemonic is used to obtain the patient's history?
A. OPQRST
B. SAMPLE
C. DCAP-BTLS
D. AVPU
B. SAMPLE [CORRECT]
, Rationale: SAMPLE stands for Signs/Symptoms, Allergies, Medications, Past medical history, Last
meal, Events leading to injury—standard for trauma history. A (OPQRST) is for pain assessment. C
(DCAP-BTLS) is for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations,
swelling during the physical exam. D (AVPU) is a rapid mental status assessment (Alert, Voice, Pain,
Unresponsive). PHTLS Principle: SAMPLE history provides critical information for hospital handoff
and guides treatment decisions. Clinical Reasoning: Knowing medications (anticoagulants, beta-
blockers) and allergies (latex, contrast) directly affects trauma management. NAEMT Guideline:
SAMPLE is obtained during the secondary survey after life threats are addressed in the primary
survey.
Correct Answer: B
Question 8
A trauma patient has a heart rate of 110 bpm, blood pressure of 118/78 mmHg, and respiratory rate
of 22. Based on these vital signs, which class of hemorrhagic shock is most likely?
A. Class I
B. Class II
C. Class III
D. Class IV
B. Class II [CORRECT]
Rationale: Class II hemorrhagic shock involves 15-30% blood loss (750-1500 mL) with tachycardia
(HR 100-120), normal blood pressure, and increased respiratory rate. A (Class I, <15% loss) has
minimal vital sign changes. C (Class III, 30-40% loss) shows decreased BP and altered mental status. D
(Class IV, >40% loss) shows severe hypotension and imminent arrest. PHTLS Principle: Blood
pressure is maintained by compensatory mechanisms until Class III; tachycardia is the earliest
reliable sign. Clinical Reasoning: Normal BP with tachycardia indicates compensated shock—fluid
resuscitation should begin before decompensation. NAEMT Guideline: Class II requires crystalloid
resuscitation and rapid transport; blood products if progression occurs.
Correct Answer: B
Question 9
Which criterion is NOT part of the NEXUS criteria for cervical spine clearance in the prehospital
setting?
A. No midline cervical tenderness
B. No focal neurologic deficit
C. No distracting injury
D. Glasgow Coma Scale score of 15
D. Glasgow Coma Scale score of 15 [CORRECT]
Rationale: NEXUS criteria include: no midline cervical tenderness (A), no focal neurologic deficit (B),
normal alertness, no intoxication, and no distracting painful injury (C). GCS 15 (D) is not explicitly
part of NEXUS—NEXUS uses "normal alertness" rather than a specific GCS score. PHTLS Principle:
