ATLS Pretest Exam (Verified) ().

ATLS Pretest Exam ^^^^^^^^^^^^^^^^^^ 1. 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:: re-examine the chest 2. A construction worker falls two stories from a building and sustains bilat- eral 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:: complete spine x-ray series 3. Which of the following is true regarding the initial resuscitation of a trauma patient?: Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation. 4. In managing a patient with a severe traumatic brain injury, the most impor- tant initial step is to:: secure the airway 5. 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?: An ABG would demonstrate a base deficit between -6 and -10 mEq/L. 6. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by:: increasing the volume of blood loss to produce maternal hypotension 7. The best assessment of fluid resuscitation of the adult burn patient is:: - urinary output of 0.5 mL/kg/hr 8. The diagnosis of shock must include:: evidence of inadequate organ perfu- sion 9. 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:: direct pressure on the wound 10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:: cerebral vasoconstriction with diminished perfu- sion 11. 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:: perform an exploratory laparotomy 12. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?: Leakage of amniotic fluid is an indication for hospital admission. 13. The first maneuver to improve oxygenation after chest injury is:: admin- ister supplemental oxygen 14. 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:: 9 15. 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:: perform needle or finger decompression of the right chest 16. Which one of the following findings in an adult is most likely to require immediate management during the primary survey?: respiratory rate of 40 breaths per minute 17. The most important, immediate step in the management of an open pneumothorax is:: placement of an occlusive dressing over the wound 18. The following are contraindications for tetanus toxoid administration:: - history of neurological reaction or severe hypersensitivity to the product 19. 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?: breath sounds 20. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because:: The trachea is relatively short. 21. 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 surgi- cal capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is ini- tiated 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:: urgently transfer the patient to the operating room 22. 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:: restrict cervical motion and attempt orotracheal intubation using 2 people 23. 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?: Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. 24. Which one of the following is the most effective method for initially treating frostbite?: moist heat