# A nurse responds to a 32-year-old client found unresponsive after a motor vehicle crash. Place the following primary survey assessment steps in the correct ABCDE order from first (1) to last (5).

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368318&lang=en  
> language: en  
> subject: System-Specific Assessments  
> category: ROR

## Question

A nurse responds to a 32-year-old client found unresponsive after a motor vehicle crash. Place the following primary survey assessment steps in the correct ABCDE order from first (1) to last (5).

Assess circulation including pulse, blood pressure, capillary refill, and obvious bleeding

Assess and clear the airway, considering cervical spine protection if trauma is suspected

Assess breathing including respiratory rate, effort, oxygen saturation, and breath sounds

Assess disability with a brief neurologic exam (LOC, pupils, AVPU or GCS, glucose)

Assess exposure by removing clothes for full examination while preventing hypothermia

## Explanation

The ABCDE primary survey is the international standard for rapid emergency assessment, used in trauma (ATLS), medical emergencies, and ACLS. The order reflects the time to death from each problem if untreated: an obstructed airway kills in minutes, breathing failure shortly after, then circulatory collapse, then neurologic injury, then environmental exposure. (A) Airway with C-spine protection if trauma — open the airway with a jaw thrust (not head tilt) when neck injury is suspected. (B) Breathing — RR, effort, oxygen saturation, breath sounds, chest rise. (C) Circulation — pulse, BP, capillary refill, obvious bleeding; control major hemorrhage. (D) Disability — brief neuro exam: LOC, pupils, AVPU or GCS, glucose. (E) Exposure — fully examine while preventing hypothermia (warm blankets, warm fluids, raise room temperature).

## In-depth explanation

ABCDE Primary Survey
International standard for rapid emergency assessment.

Sequence and Rationale
A — Airway with C-spine if trauma. Obstruction is fatal in minutes.
B — Breathing: RR, effort, SpO2, breath sounds, symmetry.
C — Circulation: pulse, BP, perfusion, control hemorrhage.
D — Disability: LOC, pupils, AVPU or GCS, glucose.
E — Exposure: full exam, prevent hypothermia.

Trauma Adaptations
- C-spine immobilization throughout
- Jaw thrust (not head tilt) for suspected neck injury
- Tourniquet for life-threatening limb hemorrhage
- Permissive hypotension in some bleeding scenarios
- Warming during exposure (Stop the Bleed)

When to Repeat
- After every intervention
- After deterioration
- During continuous monitoring

NCSBN Theme
ROR — Reduction of risk and emergency assessment.

## Clinical scenario

Scenario
32-year-old client found unresponsive after MVC.

Required
Primary survey 5 steps in correct ABCDE order from first (1) to last (5).

Trauma Considerations
- C-spine protection
- Hemorrhage control
- Hypothermia prevention

Principle
Treat what kills first. Address findings before moving to the next letter.

## Key concepts

- **ABCDE primary survey** — Standardized rapid emergency assessment protocol used in trauma (ATLS), medical emergencies, ACLS, and EMS. Order reflects mortality time: A (airway) under minutes, B (breathing) minutes, C (circulation) minutes, D (disability) hours, E (exposure) hours to days. Each letter is addressed and any life-threatening problem stabilized before progressing. The survey is repeated after every intervention and any patient deterioration.
- **AVPU vs GCS** — AVPU is a rapid level-of-consciousness scale: Alert, Verbal response, Pain response, Unresponsive. Used during primary survey for speed. Glasgow Coma Scale (GCS, range 3 to 15) is more detailed (eye opening, verbal, motor) and used during secondary survey or when AVPU finds altered LOC. GCS under 8 generally indicates intubation for airway protection.
- **Hypothermia prevention in trauma** — The lethal triad in major trauma: hypothermia, acidosis, coagulopathy. Hypothermia worsens coagulation and increases mortality. Prevention during exposure: warm blankets, warmed IV fluids (39 to 42 C), warmed blood products, room temperature 24 to 27 C, remove only as needed, replace clothing or warm coverings as soon as exam done.

## Related questions

- [A nurse on a medical-surgical unit reviews the morning labs for a 67-year-old male client …](https://mymerci.kr/pages/nclex_q.php?qn_id=361711&lang=en)
- [A 6-year-old client is on the pediatric surgical unit on postoperative day 1 following ton…](https://mymerci.kr/pages/nclex_q.php?qn_id=361812&lang=en)
- [A 45-year-old female client with severe iron-deficiency anemia is receiving the first unit…](https://mymerci.kr/pages/nclex_q.php?qn_id=361898&lang=en)
- [A 72-year-old male client is receiving a continuous IV heparin infusion for a left lower-e…](https://mymerci.kr/pages/nclex_q.php?qn_id=362064&lang=en)
- [A nurse is monitoring an adult client 4 hours after an open abdominal hysterectomy. Which …](https://mymerci.kr/pages/nclex_q.php?qn_id=363990&lang=en)
- [A nurse is teaching a 65-year-old client recovering from open upper abdominal surgery how …](https://mymerci.kr/pages/nclex_q.php?qn_id=363997&lang=en)
- [A nurse is conducting morning rounds on adult medical-surgical clients. Which clients shou…](https://mymerci.kr/pages/nclex_q.php?qn_id=364014&lang=en)
- [A nurse is administering a unit of packed red blood cells to a client. Twenty minutes afte…](https://mymerci.kr/pages/nclex_q.php?qn_id=364947&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=368318&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=368318&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=368318&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=368318&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=368318&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._