Chapters 25 to 29: Exam 3 Part 1

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should:

Select one:

A. repeat the epinephrine injection after consulting with medical control.
B. transport him immediately and provide supportive care while en route.
C. consider that he may actually be experiencing an acute asthma attack.
D. request a paramedic unit that is stationed approximately 15 miles away.

A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient’s wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient’s present condition is:

Select one:

A. cardiogenic hypoperfusion.
B. acute myocardial infarction.
C. a ruptured aortic aneurysm.
D. severe septic hypoperfusion.

Clinical signs of compensated shock include all of the following, EXCEPT:

Select one:

A. cool and clammy skin.
B. restlessness or anxiety.
C. absent peripheral pulses.
D. rapid, shallow breathing.

Neurogenic shock occurs when:

Select one:

A. failure of the nervous system causes widespread vasodilation.
B. massive vasoconstriction occurs distal to a spinal cord injury.
C. there is too much blood to fill a smaller vascular container.
D. the spinal cord is severed and causes massive hemorrhaging.

Which of the following MOST accurately describes septic shock?

Select one:

A. Bacterial infection of the nervous system with widespread vasodilation
B. Viral infection of the blood vessels, vascular damage, and vasoconstriction
C. Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
D. Widespread vasoconstriction and plasma loss due to a severe viral infection

Which of the following statements regarding anaphylactic shock is correct?

Select one:

A. Anaphylactic shock occurs immediately after a person is sensitized to an allergen.
B. Anaphylactic shock is caused by immune system failure due to a toxic exposure.
C. Subsequent exposure after sensitization often produces a more severe reaction.
D. Sensitized people will experience less severe reactions upon subsequent exposure.

You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point, your primary concern should be to:

Select one:

A. provide emotional support regarding her sister.
B. advise her that she needs to go to the hospital.
C. determine if she was injured when she fainted.
D. obtain baseline vital signs and a medical history.

You are transporting a 33-year-old male who was involved in a major motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should:

Select one:

A. take his vital signs in 15 minutes.
B. reassess his condition in 5 minutes.
C. arrange for an ALS rendezvous.
D. repeat your secondary assessment.

You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:

Select one:

A. immediately evaluate his airway.
B. assess the rate and quality of his pulse.
C. administer 100% supplemental oxygen.
D. apply direct pressure to the wound.

Your assessment of an unresponsive patient reveals that her breathing is inadequate. Your MOST immediate action should be to:

Select one:

A. move her to the ambulance stretcher.
B. check her airway for obstructions.
C. administer high-flow oxygen.
D. ventilate her with a bag-valve mask.

A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should first:

Select one:

A. place the patient on high-flow oxygen.
B. perform a rapid head-to-toe assessment.
C. apply direct pressure to the wound.
D. follow appropriate standard precautions.

A 70-year-old man presents with a severe nosebleed. His medical history includes COPD, depression, and a hemorrhagic stroke 3 years ago. His BP is 190/110 mm Hg, his pulse is 100 beats/min, and his respirations are 24 breaths/min. His medications include albuterol, sertraline (Zoloft), and multivitamins. Which of the following is MOST likely causing his nosebleed today?

Select one:

A. Diabetic complications
B. High blood pressure
C. His prescribed albuterol
D. Hemorrhagic stroke

A patient is bleeding severely from a severed femoral artery high in the groin region. Which of the following would MOST likely control the bleeding?

Select one:

A. Apply a pelvic binder device to stabilize the pelvis
B. Apply a topical hemostatic agent with direct pressure
C. Apply chemical ice packs to the wound and transport
D. Position the patient with his injured side down

An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost.

Select one:

A. 100 mL
B. 50 mL
C. 150 mL
D. 200 mL

An organ or tissue may be better able to resist damage from hypoperfusion if the:

Select one:

A. systolic arterial blood pressure is at least 60 mm Hg.
B. body’s demand for oxygen is markedly increased.
C. body’s temperature is considerably less than 98.6°F (37.0°C).
D. heart rate is maintained at more than 100 beats/min.

Blood stasis, changes in the vessel wall, and certain medications affect the:

Select one:

A. systolic blood pressure exclusively.
B. ability of the blood to effectively clot.
C. ability of red blood cells to carry oxygen.
D. white blood cells’ ability to fight infection.

Early signs and symptoms of intra-abdominal bleeding include:

Select one:

A. bruising only.
B. widespread ecchymosis.
C. significant hypotension.
D. pain and distention.

Gastrointestinal bleeding should be suspected if a patient presents with:

Select one:

A. hematemesis.
B. dyspnea.
C. hematuria.
D. hemoptysis.

In nontrauma patients, an early indicator of internal bleeding is:

Select one:

A. a decreasing blood pressure.
B. dizziness upon standing.
C. rapid, shallow breathing.
D. a rapid, thready pulse.

Most cases of external bleeding from an extremity can be controlled by:

Select one:

A. elevating the injured extremity.
B. compressing a pressure point.
C. packing the wound with gauze.
D. applying local direct pressure.

The ability of a person’s cardiovascular system to compensate for blood loss is MOST related to:

Select one:

A. the part of the body injured.
B. how fast his or her heart beats.
C. his or her baseline blood pressure.
D. how rapidly he or she bleeds.

The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the:

Select one:

A. venules.
B. arterioles.
C. vena cavae.
D. capillary arteries.

The systemic veins function by:

Select one:

A. returning deoxygenated blood back to the heart.
B. delivering oxygen-poor blood to the capillaries.
C. returning oxygen-rich blood back to the left atrium.
D. delivering deoxygenated blood to the capillaries.

Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body?

Select one:

A. An effectively pumping heart
B. The filtering of blood cells in the spleen
C. Adequate blood in the vasculature
D. An intact system of blood vessels

Which of the following occurs after tissues are injured?

Select one:

A. Local blood vessels begin to dilate
B. Red blood cells separate from plasma
C. Red blood cells become less sticky
D. Platelets collect at the injury site

Which of the following organs can tolerate inadequate perfusion for 2 to 3 hours?

Select one:

A. Brain
B. Heart
C. Skeletal muscle
D. Kidneys

A 17-year-old male was shot in the right anterior chest during an altercation. As your partner is applying oxygen, you perform a rapid assessment and find an open chest wound with a small amount of blood bubbling from it. You should:

Select one:

A. apply an occlusive dressing to the wound and continue your assessment.
B. place a sterile dressing over the wound and apply direct pressure.
C. direct your partner to assist the patient's ventilations with a BVM.
D. control the bleeding from the wound and prepare to transport at once.

A 38-year-old male was electrocuted while attempting to wire a house. Your assessment reveals that he is unresponsive, pulseless, and apneic. A coworker has shut off the power to the house. You should:

Select one:

A. begin CPR and apply the AED.
B. begin CPR and transport at once.
C. assess for entry and exit wounds.
D. fully immobilize his spinal column.

A laceration:

Select one:

A. rarely penetrates through the subcutaneous tissue to the muscle.
B. is a jagged cut caused by a sharp object or blunt force trauma.
C. is an injury that separates various layers of soft tissue.
D. is a sharp, smooth cut that is made by a surgical scalpel.

A partial-thickness burn involves the outer layer of skin and a portion of the:

Select one:

A. muscle fascia.
B. fatty layer.
C. epidermis.
D. dermal layer.

A utility worker was trimming branches and was electrocuted when he accidentally cut a high-power line. He fell approximately 20 feet and is lying unresponsive on the ground; the power line is lying across his chest. You should:

Select one:

A. rapidly assess the patient after ensuring that the power line is not live.
B. apply insulated gloves and assume manual control of his c-spine.
C. quickly but carefully move the patient away from the power line.
D. manually stabilize his head as your partner assesses for breathing.

All of the following body structures are lined with mucous membranes, EXCEPT for the:

Select one:

A. mouth.
B. nose.
C. anus.
D. lips.

An injury that separates various layers of soft tissue, resulting in complete detachment or a flap of skin, is called a(n):

Select one:

A. amputation.
B. laceration.
C. avulsion.
D. incision.

During an altercation in a bar, two patrons got into a fist fight. The first patient, a 44-year-old female, was struck in the mouth and refuses EMS care. The second patient, a 39-year-old female, has a small laceration to her left knuckle and also refuses EMS care. Which of the following statements regarding this scenario is correct?

Select one:

A. You should contact the police and have the patients arrested.
B. The 39-year-old female is at high risk for an infection.
C. The 44-year-old female is at high risk for an infection.
D. The patient struck in the mouth should be immobilized.

During the normal wound-healing process, bleeding may occur from even a minor injury because:

Select one:

A. there is a substantial decrease in the number of platelets in and around the wound, which increases the risk of bleeding.
B. new capillaries that stem from intact capillaries are delicate and take time to become as stable as the preexisting capillaries.
C. bacteria and other microorganisms invade the wound site and damage the capillaries, which makes them more prone to bleeding.
D. histamines released by the immune system constrict the blood vessels, which increases the pressure within them.

Patients with full-thickness (third-degree) burns generally do not complain of pain because:

Select one:

A. subcutaneous vessels are usually clotted.
B. the nerve endings have been destroyed.
C. blister formation protects the burn.
D. they are generally not conscious.

What layer of the skin forms a watertight, protective seal for the body?

Select one:

A. Muscular layer
B. Epidermis
C. Dermis
D. Subcutaneous layer

When a person is exposed to a cold environment:

Select one:

A. the skin becomes flushed secondary to peripheral vasodilation.
B. peripheral vessels constrict and divert blood away from the skin.
C. sweat is produced and is warmed when the vessels constrict.
D. blood vessels dilate and divert blood to the core of the body.

When assessing a patient with a closed soft-tissue injury, it is MOST important to:

Select one:

A. manipulate the injury site for signs of a fracture.
B. remain alert for more severe underlying injuries.
C. assess circulation distal to the site of the injury.
D. recognize that the integrity of the skin is broken.

Which of the following is a severe burn in a 2-year-old child?

Select one:

A. Superficial burn that covers 25% of the BSA
B. Partial-thickness burn that covers 10% of the BSA
C. Any burn that involves the arms, legs, or posterior part of the body
D. Any full-thickness burn, regardless of its location on the body

Which of the following is a severe burn in a 35-year-old patient?

Select one:

A. Partial-thickness burn to 20% of the body surface area
B. Full-thickness burn to 5% of the body surface area
C. Superficial burn covering 50% of the body surface area
D. Circumferential partial-thickness burn to the chest

Which of the following is of LEAST importance when initially assessing the severity of a burn?

Select one:

A. Past medical history
B. Known drug allergies
C. Age of the patient
D. Area(s) burned

Which of the following statements regarding electrical burns is correct?

Select one:

A. Entrance wounds are small relative to the amount of internal tissue damage.
B. The exit wound caused by electrical burns is smaller than the entrance wound.
C. Respiratory or cardiac arrest following an electrical burn is very uncommon.
D. The size of the entry and exit wounds is a reliable indicator of internal damage.

Which of the following statements regarding the dermis is correct?

Select one:

A. The dermis lies above the germinal layer and provides protection.
B. The dermis contains hair follicles, sweat glands, and nerve endings.
C. The dermis produces a substance that provides color to the skin.
D. The cells of the dermis are worn away and are constantly replaced.

Which of the following statements regarding the rule of nines is correct?

Select one:

A. The posterior of a child's leg is equal to 13.5% of the BSA.
B. The anterior arm in the adult is equal to 9% of the total BSA.
C. The anterior trunk of an adult is equal to 18% of the BSA.
D. A child's head is equal to 14% of his or her total BSA.

With regard to the pediatric rule of nines, the:

Select one:

A. thorax is proportionately larger than an adult's.
B. head is proportionately smaller than an adult's.
C. arms are proportionately larger than an adult's.
D. legs are proportionately smaller than an adult's.

A 39-year-old female experienced a severe closed head injury. She is unresponsive with her eyes slightly open; her pupils are bilaterally dilated and slow to react. In addition to managing problems with airway, breathing, and circulation, you should:

Select one:

A. irrigate her eyes with water to prevent mucosal drying.
B. secure her eyes open so you can reassess her pupils.
C. inspect her eyes and gently remove impaled objects.
D. close her eyes and cover them with a moist dressing.

A patient who is complaining of seeing flashing lights, specks, or “floaters” in his or her field of vision has MOST likely experienced:

Select one:

A. a blowout fracture.
B. acute hyphema.
C. conjunctivitis.
D. a detached retina.

A young female experienced a laceration to her left eyeball from flying glass when her boyfriend broke a soda bottle against a wall. There is moderate bleeding and the patient states that she cannot see out of the injured eye. You should:

Select one:

A. apply firm direct pressure to the injured eye and cover the opposite eye.
B. ask her to move the injured eye to assess the integrity of the optic nerve.
C. carefully examine her eye and remove any foreign objects if needed.
D. avoid applying pressure to the globe when you are covering the eye.

The cricoid cartilage:

Select one:

A. lies superior to the thyroid cartilage in the neck.
B. is easier to see and palpate than the thyroid cartilage.
C. lies superior to the cricothyroid membrane in the neck.
D. is the only complete circular cartilage of the trachea.

The eyeball itself is referred to as the:

Select one:

A. sclera.
B. cornea.
C. globe.
D. orbit.

The inner surface of the eyelids and the exposed surface of the eye itself are covered by a delicate membrane called the:

Select one:

A. cornea.
B. sclera.
C. retina.
D. conjunctiva.

The lower jawbone is called the:

Select one:

A. mandible.
B. zygoma.
C. mastoid.
D. maxillae.

The mastoid process is located approximately:

Select one:

A. half an inch anterior to the external opening of the ear.
B. 1 inch inferior to the external opening of the ear.
C. 1 inch posterior to the angle of the mandible.
D. 1 inch posterior to the external opening of the ear.

The optic nerve endings are located within the:

Select one:

A. pupil.
B. sclera.
C. cornea.
D. retina.

The white portion of the eye is called the:

Select one:

A. cornea.
B. retina.
C. sclera.
D. iris.

A 45-year-old male was working on his roof when he fell approximately 12 feet, landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should:

Select one:

A. perform a rapid head-to-toe exam and immobilize his spine.
B. allow him to refuse transport if his vital signs remain stable.
C. obtain a Glasgow Coma Score value and give him oxygen.
D. immobilize his spine and perform a focused secondary exam.

A female patient with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes:

Select one:

A. administering oxygen via a nonrebreathing mask.
B. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.
C. ventilation assistance to maintain an oxygen saturation of 90%.
D. hyperventilating her at 30 breaths/min.

A reflex arc occurs when:

Select one:

A. the motor nerves function automatically without receiving a message from the CNS.
B. the brain interprets sensory information that it receives from peripheral and cranial nerves and sends a signal to the muscles.
C. a sensory nerve sends a message to the brain but the motor nerve fails to send the appropriate response to the body.
D. a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

A short backboard or vest-style immobilization device is indicated for patients who:

Select one:

A. are sitting in their car and are clinically unstable.
B. are in a sitting position and are clinically stable.
C. require prompt extrication from an automobile.
D. are found supine and have stable vital signs.

A temporary loss or alteration of part or all of the brain's abilities to function without physical damage to the brain MOST accurately describes a(n):

Select one:

A. cerebral contusion.
B. cerebral concussion.
C. intracranial hemorrhage.
D. intracerebral hematoma.

After your partner assumes manual in-line stabilization of the patient's head, you should:

Select one:

A. assess distal neurovascular status in the extremities.
B. apply an appropriately sized rigid cervical collar.
C. thoroughly palpate the patient's head for deformities.
D. use four people to log roll the patient onto a backboard.

An epidural hematoma is MOST accurately defined as:

Select one:

A. venous lacerations that occur within the brain.
B. an injury caused by a damaged cerebral artery.
C. bleeding between the skull and dura mater.
D. bleeding between the dura mater and brain.

Bleeding within the brain tissue itself is called a(n):

Select one:

A. subarachnoid hemorrhage.
B. subdural hematoma.
C. epidural hematoma.
D. intracerebral hematoma.

If you do not have the appropriate-size cervical collar, you should:

Select one:

A. defer cervical immobilization and apply lateral head blocks.
B. use rolled towels to immobilize the patient's head.
C. place sandbags on either side of the patient's head.
D. ask the patient to keep his or her head in a neutral position.

In a patient with a head injury, hypertension, bradycardia, and Biot respirations indicate:

Select one:

A. an underlying skull fracture.
B. decreased cerebral blood flow.
C. herniation of the brain stem.
D. internal bleeding in the chest.

In which of the following situations would the EMT be the LEAST likely to immobilize a patient's spine?

Select one:

A. No distracting injuries or evidence of intoxication
B. Unresponsive, but moving all extremities equally
C. No spinal pain, but tingling in the extremities
D. Pain to the c-spine, but no numbness or tingling.

It would be MOST appropriate to perform a focused secondary assessment on a patient who:

Select one:

A. struck his or her head and is experiencing nausea or vomiting.
B. has blood draining from the ears following a head injury.
C. fainted and fell to the ground from a standing position.
D. was restrained during a high-speed motor vehicle crash.

Rapid deceleration of the head, such as when it impacts the windshield, causes:

Select one:

A. compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.
B. primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels.
C. compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.
D. stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain.

The _ contain(s) about 75% of the brain's total volume.

Select one:

A. cerebellum
B. meninges
C. brain stem
D. cerebrum

The _ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems.

Select one:

A. cerebellum
B. cerebral cortex
C. spinal cord
D. brain stem

The cerebrospinal fluid (CSF) that circulates in between each meningeal layer:

Select one:

A. delivers oxygen directly to the CNS.
B. regenerates brain cells after they have been damaged.
C. acts as a shock absorber for the brain and spinal cord.
D. produces leukocytes that protect the brain from infection.

The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by:

Select one:

A. a neurosurgeon or emergency department physician.
B. reassessing the patient's blood pressure after 10 minutes.
C. noting a decrease in the heart rate during ventilations.
D. immediate reassessment following the intervention.

The frontal and parietal bones of the skull are especially susceptible to:

Select one:

A. linear skull fractures.
B. nondisplaced skull fractures.
C. depressed skull fractures.
D. basilar skull fractures.

The hormone responsible for the actions of the sympathetic nervous system is:

Select one:

A. epinephrine.
B. thyroxine.
C. aldosterone.
D. insulin.

The MOST common and serious complication of a significant head injury is:

Select one:

A. acute hypotension.
B. a skull fracture.
C. cerebral edema.
D. a hypoxic seizure.

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should:

Select one:

A. request a paramedic ambulance.
B. perform a secondary assessment.
C. aggressively manage his airway.
D. suspect a severe hemopneumothorax.

A patient who presents with profound cyanosis following a chest injury:

Select one:

A. should be placed in Trendelenburg position.
B. has most likely experienced a ruptured aorta.
C. requires prompt ventilation and oxygenation.
D. is most likely experiencing severe blood loss.

During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should:

Select one:

A. make note of it and continue your assessment.
B. apply high-flow oxygen via nonrebreathing mask.
C. request a paramedic to decompress the chest.
D. assist ventilations with a bag-valve mask.

Elevation of the rib cage during inhalation occurs when:

Select one:

A. intrathoracic pressure decreases.
B. the intercostal muscles contract.
C. abdominal contents descend.
D. the diaphragm descends.