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ITLS 9th Edition Actual Exam Questions and Answers 2025. 1.In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic CORRECT ANSWER >>>>A. C. Lumbar D. Sacral-coccygeal - Cervical Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the headrest is not properly adjusted. The potential for cervical-spine injuries is great.
2.A 36-year-old male sustains blunt force thoracic trauma and fits the criteria for a load- and-go patient. Which of the following should be performed on the scene? A. Obtain an EKG B. B. Establish vascular access C. Obtain a finger-stick serum lactate level D. Assess for other potentially life-threatening conditions - CORRECT ANSWER >>>>D. Assess for other potentially life-threatening conditions Rationale: The purpose of the initial assessment is to prioritize the patient and to identify all immediately life-threatening conditions. The information gathered is used to make decisions about critical interventions and time of transport.
- The use of external laryngeal manipulation: A. Decreases the risk of airway trauma B. Reduces gastric distention C. Improves glottic visualization D. Causes aspiration - CORRECT ANSWER >>>>C. Improves glottic visualization
at the carotid, and R 24 and shallow. The target of fluid resuscitation is: A. Return of peripheral pulses B. Maintenance of central pulses C. Systolic blood pressure of 110- D. Pulse rate of 100 - CORRECT ANSWER >>>>A. Return of peripheral pulses Rationale: This is an example of internal, uncontrolled hemorrhage. Administer sufficient normal saline to maintain peripheral perfusion, following local or EMS agency medical direction policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in boluses—to return a peripheral pulse, such as a radial pulse. 6.An unconscious 15-year-old male was struck on the head with a baseball bat. His arms and legs are extended and his right pupil is dilated and fixed. You should: A.Insert an oropharyngeal airway, administer oxygen, and restrict fluids B.Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation D. Perform bag-mask ventilation at 20 per minute Exam - CORRECT ANSWER >>>>D. Perform bag-mask ventilation at 20 per minute Exam Rationale: The classic findings of this life-threatening situation are a decreasing level of consciousness (LOC) that rapidly progresses to coma, dilation of the pupil and an outward- downward deviation of the eye on the side of the injury, paralysis of the arm and leg on the side opposite the injury, or decerebrate posturing (arms and legs extended). The danger of immediate herniation outweighs the risk of cerebral ischemia that can follow hyperventilation. The cerebral herniation syndrome is the only situation in which hyperventilation is still indicated. (You must ventilate every three seconds [20/minute] for adults.) 7.Which of the following mechanisms of injury does not commonly cause damage to the spinal cord? A. Hyperextension B. Hyperflexion C. Lateral stress
9.When performing the ITLS Primary Survey, the team leader may minimize errors by: A. Performing all interventions B. Limiting crew roles C. Permitting crew to continue the assessment D. Delegating interventions - CORRECT ANSWER
D. Delegating interventions Rationale: This team approach makes the most efficient use of time and allows you to rapidly perform the initial assessment without becoming distracted by performing the necessary interventions yourself, which can interrupt your thought process and cause errors.
- You have placed an NPA in your patient and now observe mild hemorrhage from the nares. You should: A.Immediately remove the NPA and pack the nose with gauze B.Immediately remove the NPA and reinsert on the opposite nare C.Leave the NPA in place so as not to disturb the clot or reactivate bleeding D. Contact medical control as NPAs will not cause hemorrhage - CORRECT ANSWER >>>>C. Leave the
NPA in place so as not to disturb the clot or reactivate bleeding Rationale: Mild hemorrhage from the nose after insertion of the airway is not an indication to remove it. In fact, it is probably better to keep an NPA in place so as not to disturb the clot or reactivate the bleeding.
- A 27-year-old male with blunt chest trauma from a motor vehicle collision was successfully intubated at the scene. While ventilating the patient, you note resistance with absence of right chest wall movement. You should suspect a: A. Flail chest B. Gastric distention C. Mucus obstruction D. Tension pneumothorax - CORRECT ANSWER >>>>D. Tension pneumothorax Rationale: The development of decreased lung compliance (difficulty in squeezing the bag-mask device) in the intubated patient should always alert you to the possibility of a tension pneumothorax.
C. Waveform capnography D. Presence of condensation in the tube - CORRECT ANSWER >>>>C. Waveform capnography Rationale: Although the most reliable method of ensuring proper placement is actually visualizing the tube passing through the glottic opening, even this is not 100% sure. In fact, it is only reliable for the moment you see it. The gold standard for confirming and monitoring ETT placement is waveform capnography.
- Common mechanisms of injury for the pediatric patient include all of the following except: A. Falls B. Animal bites CORRECT ANSWER >>>>B. C. Burns D. Motor vehicle collisions - Animal bites Rationale: Children are most commonly injured from falls (either from standing height or higher), motor vehicle collisions, automobile-pedestrian or bicycle crashes, burns, submersion injuries (drowning), and child abuse.
- Which of the following injuries would change a trauma patient's transport classification from "stable" to "load and go"? A. Clavicle fracture B. Pelvic fracture C. Bilateral humerus fractures D. Bilateral tibia fractures - (^) CORRECT ANSWER >>>>B. Pelvic fracture Rationale: Conditions that can rapidly lead to shock include penetrating wounds to the torso, abnormal chest exam, tender distended abdomen pelvic instability and bilateral fractures.
- Which of the following findings would not make a patient difficult to ventilate with a bag-valve mask? A. Beard B. Obesity CORRECT ANSWER >>>>D. C. Elderly patient D. Multiple nose piercings - Multiple nose piercings Rationale: Predictors of difficult mask ventilation can be remembered using the "BOOTS" mnemonic:
D. Elevation of the wound above the level of the heart
- CORRECT ANSWER >>>>A. Direct pressure to the wound Rationale: Pack the hemostatic agent in the wound, and hold firm pressure. Hemostatic agent is an "adjunct" to assist in controlling hemorrhage, not a hemorrhage control by itself.
- Routine use of hyperventilation in the traumatic brain injured (TBI) patient will: A.Cause vasoconstriction and increased cerebral ischemia B.Cause vasodilation and decreased intracranial pressure (ICP) C. Cause an increase of end-tidal CO D. Cause peripheral hypoxia and cyanosis - CORRECT ANSWER >>>>A. Cause vasoconstriction and increased cerebral ischemia Rationale: Hyperventilation actually has only a slight effect on brain swelling, but causes a significant decrease in cerebral perfusion from that same vasoconstriction, resulting in cerebral hypoxia. Thus, both hyperventilation and hypoventilation can cause
cerebral ischemia and increased mortality in the TBI patient.
- Which finding requires interruption of the ITLS Primary Survey? A. Complete airway obstruction B. Gasping respirations C. Impaled object in abdomen D. Very weak pulse - CORRECT ANSWER >>>>A. Complete airway obstruction Rationale: You may interrupt the assessment sequence only if (1) the scene becomes unsafe, (2) you must treat exsanguinating hemorrhage, (3) you must treat an airway obstruction, or (4) you must treat cardiac arrest. (Respiratory arrest, dyspnea, or bleeding management should be delegated to other team members while you continue assessment of the patient.)
- Bag-valve-mask ventilation: A.Rarely causes gastric distention due to low airway pressures B.Is more effective in patients whose dentures have been removed
A pulmonary contusion takes hours to develop and rarely develops during prehospital care.
- A 25-year-old female was stabbed in the left arm. She presents with an altered mental status and signs of shock. Bleeding is controlled by direct pressure and use of a tourniquet. Which intravenous fluid therapy is appropriate? A.Estimate blood loss and administer fluid at a 3: ratio B. Fluid administration of 250 ml C.Fluid administration to maintain systolic pressure of 60 mmHg D. Intravenous fluid administration bolus of 500- mL, then reassess - CORRECT ANSWER >>>>D. Intravenous fluid administration bolus of 500- mL, then reassess Rationale: When bleeding is controlled, give normal saline as a bolus (500 to 1,000 mL in adults; 20 mL/kg in pediatric patients) rapidly and then repeat the ITLS Ongoing Exam.
- In the absence of herniation syndrome, adult patients with suspected traumatic brain injury should be ventilated as a rate of: A. 8-10 per minute B. 12-14 per minute CORRECT ANSWER >>>>A. 8- C. 16-18 per minute D. 20-22 per minute - per minute Rationale: Hyperventilation and hypoventilation can cause cerebral ischemia and increased mortality in the TBI patient. Maintaining normal ventilation (not hyperventilation) with high- flow oxygen at a rate of about one breath every 6 to 8 seconds (8 to 10 per minute) to maintain an end-tidal CO2 (ETCO2) of 35- 45 mmHg.
- What is the most likely cause of unequal pupils in a patient whose mental status is altered due to a head injury? A. Increased intracranial pressure B. Pre-existing condition C. Alcohol intoxication D. Hypotension - CORRECT ANSWER >>>>A. Increased intracranial pressure
CORRECT ANSWER >>>>D.
B. Flail chest C. Tension pneumothorax D.Massive hemothorax - Massive hemothorax Rationale: Clinical signs of shock may be apparent. The neck veins are usually flat secondary to profound hypovolemia, but may very rarely be distended due to mediastinal compression. Other signs of hemothorax include decreased breath sounds and dullness to percussion on the affected side.
- A 45-year-old female is found unconscious at the scene of a motor vehicle collision. Her vital signs are BP 80/40, P 130, and R 30. Which of the following is the most likely cause for her vital signs? A. Fractured lower legs B. Intracranial hemorrhage C. Bleeding into the chest or abdomen D. Spinal cord injury with neurogenic shock - CORRECT ANSWER >>>>C. Bleeding into the chest or abdomen Rationale: Hypovolemic shock victims usually have tachycardia, are pale, and have flat neck veins. So, if
you find a trauma victim with a fast heart rate, who is pale, with weak radial pulses and flat neck veins, this patient is probably bleeding from some injury, either internally or externally (or possibly both).
- The cause of a secondary brain injury is: A. Contra-coup B. Coup C. Hemorrhage D. Hypoxia - CORRECT ANSWER >>>>D. Hypoxia Rationale: Secondary brain injury is the result of hypoxia and/or decreased perfusion of brain tissue. 30.Which one of the following is a reason to interrupt the initial assessment? A. Cardiac arrest B. Multiple open (compound) fractures C. Severe head injury with brain tissue visible D. Severe shock - CORRECT ANSWER >>>>A. Cardiac arrest Rationale: Remember, once you begin patient assessment in the ITLS Primary Survey, only four things should cause you to interrupt completion of the
