EMS 212 Paramedic Trauma Emergencies Final

Question 1

A flail chest is characterized by:
A) a free-floating segment of fractured ribs.
B) bulging of fractured ribs during inspiration.
C) excessive negative intrathoracic pressure.
D) drawing in of fractured ribs during expiration.

Answer 1

A) a free-floating segment of fractured ribs.

Question 2

Pneumothorax is MOST accurately defined as:
A) air or gas within the pleural cavity.
B) perforation of a lung by a broken rib.
C) injury to the visceral or parietal pleura.
D) partial or complete collapse of a lung.

Answer 2

A) air or gas within the pleural cavity.

Question 3

Ribs 4 through 9 are the most commonly fractured because:
A) they are not anteriorly attached to any portion of the sternum.
B) these particular ribs are inherently weak compared to other ribs.
C) the person’s height predisposes him or her to injury in this area.
D) they are less protected by other bony and muscular structures.

Answer 3

D) they are less protected by other bony and muscular structures.

Question 4

An open pneumothorax causes ventilatory inadequacy when:
A) positive pressure created by expiration forces air into the pleural space.
B) the heart stops perfusing the lung on the side of the open chest injury.
C) negative pressure created by inspiration draws air into the pleural space.
D) the glottic opening is much larger than the open wound on the chest wall.

Answer 4

C) negative pressure created by inspiration draws air into the pleural space.

Question 5

Pneumothoraxes create a ventilation-perfusion mismatch when:
A) concomitant myocardial injury prevents adequate pulmonary perfusion and the lung collapses.
B) perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.
C) the vasculature of the affected lung is not intact and intrapulmonary gas exchange is impaired.
D) the affected lung continues to expand adequately despite a decrease in pulmonary perfusion.

Answer 5

B) perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.

Question 6

What type of chest injury is characterized by air accumulation in the pleural space when a perforation in the lung parenchyma acts as a one-way valve?
A) Tension pneumothorax
B) Simple pneumothorax
C) Massive hemothorax
D) Spontaneous pneumothorax

Answer 6

A) Tension pneumothorax

Question 7

Most hemothoraces occur when:
A) the intercostal arteries are lacerated.
B) a penetrating injury perforates the lung.
C) severe barotrauma ruptures one of the lungs.
D) a fractured rib injures the lung parenchyma.

Answer 7

D) a fractured rib injures the lung parenchyma.

Question 8

By definition, a massive hemothorax is characterized by:
A) pulmonary injury with secondary myocardial injury.
B) 10% of circulating blood volume within the pleural space.
C) cardiac arrest secondary to severe intrapleural bleeding.
D) more than 1,500 mL of blood within the pleural space.

Answer 8

D) more than 1,500 mL of blood within the pleural space.

Question 9

A pulmonary contusion following blunt chest trauma results in:
A) blood leakage from injured lung tissue into the pleural space.
B) decreased pulmonary shunting with rupture of the alveolar sacs.
C) alveolar and capillary damage with intraparenchymal lung hemorrhage.
D) pulmonary vasodilation as the body attempts to shunt blood to the injury.

Answer 9

C) alveolar and capillary damage with intraparenchymal lung hemorrhage.

Question 10

Which of the following statements regarding a pericardial tamponade is correct?
A) Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.
B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.
C) Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.
D) The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.

Answer 10

B) In a pericardial tamponade, blood collects between the visceral and parietal pericardium.

Question 11

Commotio cordis is a phenomenon in which:
A) ventricular fibrillation is induced following blunt trauma to the chest during the heart’s repolarization period.
B) excessive pressure within the pericardial sac impairs cardiac contractility as well as venous return to the heart.
C) penetrating thoracic trauma perforates the atria or ventricles, causing acute rupture and massive hemorrhage.
D) myocardial tissue at the cellular level is damaged by blunt or penetrating trauma, resulting in cardiac arrest.

Answer 11

A) ventricular fibrillation is induced following blunt trauma to the chest during the heart’s repolarization period.

Question 12

Traumatic injuries to the aorta are MOST commonly the result of:
A) shearing forces.
B) rear-end collisions.
C) penetrating trauma.
D) motorcycle crashes.

Answer 12

A) shearing forces.

Question 13

Which of the following statements regarding diaphragmatic injury is correct?
A) During the latent phase of a diaphragmatic injury, abdominal contents herniate through the defect, cutting off their blood supply.
B) The spleen provides significant protection to the diaphragm on the left side, resulting in a higher incidence of right-sided diaphragmatic injuries.
C) Because the diaphragm is protected by the liver on the right side, most diaphragmatic injuries caused by blunt force trauma occur on the left side.
D) Once the diaphragm has been injured, the healing process is facilitated by the natural pressure differences between the abdominal and thoracic cavities.

Answer 13

C) Because the diaphragm is protected by the liver on the right side, most diaphragmatic injuries caused by blunt force trauma occur on the left side.

Question 14

Tracheobronchial injuries have a high mortality due to:
A) massive internal hemorrhage.
B) associated airway obstruction.
C) perforation of the esophagus.
D) concomitant spinal cord injury.

Answer 14

B) associated airway obstruction.

Question 15

Common clinical findings associated with traumatic asphyxia include all of the following, EXCEPT:
A) hyphemia.
B) exophthalmos.
C) facial cyanosis.
D) tongue swelling.

Answer 15

A) hyphemia.

Question 16

Any patient with a presumptive diagnosis of a pneumothorax should:
A) receive a prophylactic needle thoracentesis.
B) be intubated and ventilated at a rate of 15 breaths/min.
C) be considered unstable and reassessed every 5 minutes.
D) be transported to a trauma center via air medical transport.

Answer 16

C) be considered unstable and reassessed every 5 minutes.

Question 17

Which of the following thoracic injuries would you LEAST likely discover in the primary assessment?
A) Flail chest
B) Myocardial contusion
C) Bronchial disruption
D) Open pneumothorax

Answer 17

B) Myocardial contusion

Question 18

In general, patients suspected of having a partial tracheal tear should be managed with:
A) immediate endotracheal intubation.
B) an oxygen-powered ventilation device.
C) the least invasive airway techniques possible.
D) placement of a laryngeal mask airway device.

Answer 18

C) the least invasive airway techniques possible.

Question 19

Which of the following thoracic injuries generally does NOT require immediate treatment?
A) Flail chest
B) Open pneumothorax
C) Tension pneumothorax
D) Myocardial contusion

Answer 19

D) Myocardial contusion

Question 20

You would NOT expect a patient with a flail chest to present with:
A) cyanosis.
B) hyperpnea.
C) shallow breathing.
D) decreased breath sounds.

Answer 20

B) hyperpnea.

Question 21

Any normotensive patient with a sternal fracture should receive:
A) ECG monitoring.
B) IV fluid boluses.
C) ventilation assistance.
D) antiarrhythmic drugs.

Answer 21

A) ECG monitoring.

Question 22

Immediate treatment for an open pneumothorax involves:
A) assisting ventilations with a bag-mask device.
B) covering the open wound with a porous dressing.
C) converting the pneumothorax to a closed injury.
D) administering oxygen via a nonrebreathing mask.

Answer 22

C) converting the pneumothorax to a closed injury.

Question 23

Most patients with an aortic injury will complain of pain:
A) while taking a shallow breath.
B) behind the sternum or in the scapula.
C) in the region of the posterior pharynx.
D) that radiates from the chest to the flank.

Answer 23

B) behind the sternum or in the scapula.

Question 24

Management of a diaphragmatic injury focuses on:
A) maintaining adequate oxygenation and ventilation, and rapid transport.
B) inserting a nasogastric tube to decompress the gastrointestinal organs.
C) applying the pneumatic antishock garment to stabilize the diaphragm.
D) intubation and hyperventilation with 100% supplemental oxygen.

Answer 24

A) maintaining adequate oxygenation and ventilation, and rapid transport.

Question 25

A 16-year-old man collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to:
A) perform intubation to secure the patient’s airway.
B) rapidly assess the chest for signs of a sternal fracture.
C) start an IV line and administer an antiarrhythmic drug.
D) attach the ECG leads and be prepared to defibrillate.

Answer 25

D) attach the ECG leads and be prepared to defibrillate.

Question 26

You are assessing a 39-year-old man who experienced blunt chest trauma. He is semiconscious and has poor respiratory effort with stridor. You should:
A) perform a laryngoscopy to visualize his airway for an obstruction.
B) administer oxygen via a nonrebreathing mask and assess circulation.
C) insert a nasal airway and assist ventilations with a bag-mask device.
D) suction his airway and prepare for immediate orotracheal intubation.

Answer 26

C) insert a nasal airway and assist ventilations with a bag-mask device.

Question 27

A 50-year-old man was working on his car when the jacks collapsed and the car landed on his chest. Your assessment reveals profound cyanosis and swelling to his chest and face, agonal respirations, and a weak carotid pulse. This patient will benefit MOST from:
A) bilateral needle thoracentesis and 100% oxygen.
B) rapid IV fluid boluses en route to a trauma center.
C) aggressive airway management and rapid transport.
D) prompt endotracheal intubation and hyperventilation.

Answer 27

C) aggressive airway management and rapid transport.

Question 28

A 26-year-old unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. After performing your primary assessment and administering high-flow oxygen, you assess her chest and note a segment of obviously fractured ribs that bulges outward during exhalation. You should:
A) increase intrathoracic pressure with a demand valve.
B) apply a bulky dressing to the segment of fractured ribs.
C) position her on her injured side and monitor her breathing.
D) apply pressure to the segment of ribs as the patient inhales.

Answer 28

B) apply a bulky dressing to the segment of fractured ribs.

Question 29

A 30-year-old man felt a snap in his chest when he abruptly twisted his torso. He is conscious and alert and complains of severe pain during inhalation. Your assessment reveals palpable tenderness over the fifth and sixth ribs on the left side. His vital signs are stable and he denies other injuries. In addition to administering supplemental oxygen, the MOST appropriate treatment for this patient involves:
A) instructing the patient to hold a pillow against his chest, considering IV analgesics, and transporting him to the hospital.
B) stabilizing the injured area by circumferentially wrapping the chest with 3-inch tape and transporting him to a local hospital.
C) encouraging the patient to take deeper breaths to maintain adequate minute volume and transporting him to the hospital.
D) sedating the patient with midazolam or diazepam, assisting ventilations with a bag-mask device, and transporting at once.

Answer 29

A) instructing the patient to hold a pillow against his chest, considering IV analgesics, and transporting him to the hospital.

Question 30

You are transporting a conscious and alert man who experienced an isolated blunt injury to the right anterolateral chest. His vital signs are stable, but he is dyspneic and his breath sounds are diminished over the apex of his right lung. In addition to administering high-flow oxygen, the MOST critical intervention for this patient involves:
A) frequently reassessing him for signs of clinical deterioration.
B) performing a needle thoracentesis to release intrapleural tension.
C) positioning him on his right side to facilitate effective breathing.
D) administering a 500-mL normal saline bolus to maintain perfusion.

Answer 30

A) frequently reassessing him for signs of clinical deterioration.

Question 31

A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are distended and his breath sounds are bilaterally diminished but equal. The MOST appropriate treatment for this patient involves:
A) performing bilateral needle thoracentesis, intubating the patient and ventilating at 10 to 12 breaths/min, and transporting him to a trauma center.
B) administering oxygen via a nonrebreathing mask, transporting at once, and placing an occlusive dressing over the stab wound if his oxygen saturation is low.
C) assisting his ventilations, initiating transport, starting a large-bore IV line en route, and administering fluids to maintain a systolic blood pressure of 100 mm Hg.
D) covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route.

Answer 31

D) covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route.

Question 32

You are dispatched to a residence for an injured person. The scene has been secured by law. The patient, a young female, tells you that her boyfriend kicked her in the chest yesterday during an argument. Your assessment reveals that the patient is in significant pain, is dyspneic, has a strong heart rate of 98 beats/min, and has an area of ecchymosis over her left lower rib cage. Auscultation to the left side of her chest reveals coarse crackles. Which of the following treatment interventions is likely NOT indicated for this patient?
A) Cardiac monitoring
B) Titrated IV analgesics
C) IV fluid boluses
D) End-tidal CO2 monitoring

Answer 32

C) IV fluid boluses

Question 33

A robbery suspect was shot once in the left anterior chest by law enforcement personnel when he pulled a gun on them. The patient is exhibiting obvious signs of shock, is in significant respiratory distress, and is coughing up blood. Further assessment reveals collapsed jugular veins and absent breath sounds over the left hemithorax. After covering the gunshot wound with the appropriate dressing, you should:
A) perform a needle thoracentesis to the left side of the chest, initiate rapid transport, and administer 20-mL/kg fluid boluses en route.
B) administer 100% oxygen, administer 1 to 2 L of normal saline, and transport to a trauma center for an emergency pericardiocentesis.
C) provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center.
D) ventilate the patient with a demand valve, transport to a trauma center, and run two large-bore IV lines wide open while en route to the hospital.

Answer 33

C) provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center.

Question 34

Following blunt trauma to the anterior chest, a 44-year-old man presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of his chest. You should:
A) ventilate the patient with a bag-mask device and transport immediately.
B) perform an immediate needle thoracentesis to the right side of the chest.
C) give 100% oxygen and start a large-bore IV line en route to the hospital.
D) transport at once and decompress the chest if tracheal deviation is observed.

Answer 34

B) perform an immediate needle thoracentesis to the right side of the chest.

Question 35

Which of the following is NOT an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury?
A) Prehospital fracture reduction
B) Prevention of gross contamination
C) Pain reduction with cold and analgesia
D) Transport to an appropriate medical facility

Answer 35

A) Prehospital fracture reduction

Question 36

Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine?
A) Retropharyngeal hematoma
B) Blood or secretions in the mouth
C) Oropharyngeal occlusion by the tongue
D) Improperly inserted oropharyngeal airway

Answer 36

A) Retropharyngeal hematoma

Question 37

A motorcycle or football helmet should be removed if:
A) the patient complains of severe neck pain and the helmet fits snugly.
B) you are going to transport the patient to a medical treatment facility.
C) the patient is breathing shallowly and access to the airway is difficult.
D) you are properly trained in the technique, even if you are by yourself.

Answer 37

C) the patient is breathing shallowly and access to the airway is difficult.

Question 38

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:
A) applying a cervical collar and assisting his ventilations with a bag-mask device.
B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds.
C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions.
D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver

Answer 38

D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver

Question 39

An increase in core body temperature due to inadequate thermolysis is called:
A) heatstroke.
B) heat illness.
C) heat cramps.
D) heat exhaustion.

Answer 39

B) heat illness.

Question 40

All of the following factors contribute to heat cramps, EXCEPT:
A) Gender
B) Dehydration
C) Salt depletion
D) Muscle fatigue

Answer 40

A) Gender

Question 41

Heat cramps are caused by:
A) sodium loss due to sweating.
B) failure of the hypothalamus.
C) increased potassium levels.
D) increased urinary frequency.

Answer 41

A) sodium loss due to sweating.

Question 42

The FIRST step in treating a patient with a heat emergency is to:
A) ensure that the airway is patent.
B) assess the core body temperature.
C) employ active cooling measures.
D) move the patient to a cooler area.

Answer 42

D) move the patient to a cooler area.

Question 43

In contrast to salt-depleted heat exhaustion, water-depleted heat exhaustion:
A) is much less likely to occur in a patient who takes diuretic medications for hypertension.
B) occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility.
C) usually takes several hours or days to develop and occurs when regular water is used to replenish sodium and water.
D) is the result of prolonged exertion in a hot environment coupled with the excessive intake of hypotonic fluids.

Answer 43

B) occurs primarily in geriatric patients and is due to factors such as decreased thirst sensitivity and immobility.

Question 44

Which of the following clinical findings would you NOT expect to encounter in a patient with heat exhaustion?
A) Abdominal cramping
B) Mental disorientation
C) Hypertension upon standing
D) Body temperature of 103°F

Answer 44

C) Hypertension upon standing

Question 45

The diagnosis of heatstroke is usually made when a patient has a high core body temperature and:
A) an altered mental status.
B) an absence of sweating.
C) a history of heat exposure.
D) a heart rate above 140 beats/min.

Answer 45

A) an altered mental status.

Question 46

Classic heatstroke:
A) is also called active heatstroke and is usually seen in diabetics.
B) presents with a high core body temperature and profuse sweating.
C) affects young people and is often accompanied by hypoglycemia.
D) typically affects older people and is not associated with exertion.

Answer 46

D) typically affects older people and is not associated with exertion.

Question 47

In contrast to classic heatstroke, exertional heatstroke:
A) causes hyperglycemia.
B) presents with hot, dry skin.
C) affects young, healthy people.
D) is associated with diuretic use.

Answer 47

C) affects young, healthy people.

Question 48

Patients with heatstroke:
A) present initially with hot, dry skin.
B) are typically bradypneic and hypotensive.
C) have a core temperature greater than 104°F.
D) should routinely be given 50% dextrose.

Answer 48

C) have a core temperature greater than 104°F.

Question 49

The MOST important treatment for a patient experiencing heatstroke involves:
A) antipyretic administration and high-flow oxygen.
B) rehydration with IV fluids and ice water submersion.
C) rapid transport and cooling to the point of shivering.
D) removal from the hot environment and rapid cooling.

Answer 49

D) removal from the hot environment and rapid cooling.

Question 50

A 45-year-old man presents with severe cramps in his legs, nausea, and lightheadedness after running laps at the track. The temperature outside is 95°F and the relative humidity is 80%. The patient is conscious and alert and is sweating profusely. His blood pressure is 100/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and regular. The MOST appropriate treatment for this patient involves:
A) giving him a salt-containing solution to drink, applying chemical ice packs to the back of his neck, and discouraging further activity for the day.
B) administering high-flow oxygen, gently massaging his lower extremities to enhance circulation, administering 1 µg/kg of fentanyl IM, and transporting.
C) offering him oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation.
D) having him chew salt tablets, starting an IV with D5W at a keep-vein-open rate, administering 12.5 mg of promethazine IV, and transporting to the hospital.

Answer 50

C) offering him oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation.

Question 51

A 19-year-old man presents with hot, moist skin; confusion; tachycardia; and tachypnea shortly after completing a marathon. According to his marathon registration form, he has no significant medical problems and takes no medications. Treatment for this patient may include all of the following, EXCEPT:
A) prostaglandin inhibitors.
B) immersion in ice water.
C) 25 g of 50% dextrose.
D) ventilation assistance.

Answer 51

A) prostaglandin inhibitors.

Question 52

A superficial burn is:
A) usually painless because the nerve endings are not exposed.
B) characterized by reddened skin with varying degrees of pain.
C) painful, but will heal spontaneously, often with scar formation.
D) a second-degree burn that is characterized by blister formation.

Answer 52

B) characterized by reddened skin with varying degrees of pain.

Question 53

Which of the following statements regarding partial-thickness burns is correct?
A) Partial-thickness burns are usually extremely painful for the patient.
B) Partial-thickness burns are difficult to distinguish from superficial burns in the field.
C) The majority of partial-thickness burns are caused by an open flame.
D) Partial-thickness burns typically heal spontaneously without scarring.

Answer 53

A) Partial-thickness burns are usually extremely painful for the patient.

Question 54

Unlike partial-thickness burns, full-thickness burns:
A) extend completely through the epidermis and produce severe pain.
B) are characterized by reddened, moist skin and large fluid-filled blisters.
C) destroy the base membrane of the dermis that produces new skin cells.
D) often heal spontaneously over a long period of time with massive scarring.

Answer 54

C) destroy the base membrane of the dermis that produces new skin cells.

Question 55

Immediate care for a burn patient involves:
A) applying sterile burn sheets.
B) establishing a patent airway.
C) stopping the burning process.
D) maintaining body temperature.

Answer 55

C) stopping the burning process.

Question 56

The MOST acute complication associated with large body surface area burns is:
A) infection.
B) hypovolemia.
C) hypothermia.
D) myoglobinemia.

Answer 56

C) hypothermia.

Question 57

Nasotracheal intubation of a patient with upper airway burns:
A) is a complicated procedure and should be avoided.
B) should be performed if the patient has mild stridor.
C) is indicated if the patient is unconscious and apneic.
D) is generally well tolerated in patients who are awake.

Answer 57

B) should be performed if the patient has mild stridor.

Question 58

When considering analgesia for a burn patient who is in severe pain, you must remember that:
A) due to the risk of causing hemodynamic compromise, analgesia should be avoided in the field.
B) one half of the usual dose of narcotic analgesics should be given in order to avoid drug toxicity.
C) benzodiazepines are preferred over narcotics because they are less likely to cause hypotension.
D) burns increase the metabolic rate, which may necessitate higher than normal doses of analgesics.

Answer 58

D) burns increase the metabolic rate, which may necessitate higher than normal doses of analgesics.

Question 59

A patient with full-thickness burns surrounded by areas of superficial and partial-thickness burns should be treated with all of the following, EXCEPT:
A) analgesia.
B) high-flow oxygen.
C) moist dressings.
D) sterile burn pads.

Answer 59

C) moist dressings.

Question 60

A partial-thickness burn is considered to be critical if it:
A) occurs in any patient over the age of 45 years.
B) is located on the proximal aspect of an extremity.
C) is rated as at least a 5 on a pain scale of 0 to 10.
D) involves more than 30% of the body surface area.

Answer 60

D) involves more than 30% of the body surface area.

Question 61

A full-thickness burn is considered to be critical if it:
A) is located on any part of the thorax or abdomen.
B) covers more than 5% of the total body surface area.
C) was irrigated with water before the arrival of EMS.
D) occurs in a patient with a significant medical illness.

Answer 61

D) occurs in a patient with a significant medical illness.

Question 62

Full-thickness circumferential burns to the chest:
A) require the paramedic to incise the burn to decompress it.
B) may cause significant restriction of respiratory excursion.
C) are generally not significant unless the skin is unyielding.
D) necessitate immediate intubation and ventilatory support.

Answer 62

B) may cause significant restriction of respiratory excursion.

Question 63

A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 99% on room air. He denies any other injuries. Initial management for this patient involves:
A) applying ice to the burn to provide immediate pain relief.
B) applying cool, wet dressings to the burn and elevating his arm.
C) starting an IV of normal saline and administering 2 mg of morphine.
D) administering oxygen and applying an anesthetic cream to the burn.

Answer 63

B) applying cool, wet dressings to the burn and elevating his arm.

Question 64

A 33-year-old man was burned when the hot water heater he was working on exploded. The patient has superficial and partial-thickness burns to his face, neck, and arms. Your primary assessment reveals that he is restless and tachypneic. His BP is 80/54 mm Hg and his heart rate is 120 beats/min and weak. You should:
A) conclude that he is experiencing burn shock, start two large-bore IV lines of normal saline, and administer fluids based on the Parkland formula.
B) assist his ventilations with a bag-mask device, cover him with a blanket, and start a large-bore IV of normal saline set at a keep-vein-open rate.
C) apply oxygen via a nonrebreathing mask, cover his burns with cold moist dressings, start an IV with normal saline, and give up to 4 mg of morphine for pain.
D) administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion.

Answer 64

C) apply oxygen via a nonrebreathing mask, cover his burns with cold moist dressings, start an IV with normal saline, and give up to 4 mg of morphine for pain.

Question 65

A 74-year-old man experienced partial- and full-thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking his cigar. The patient’s son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and atrial fibrillation. In addition to administering supplemental oxygen, it is MOST important for you to:
A) avoid narcotic analgesics because of his medical history.
B) auscultate his breath sounds before administering IV fluids.
C) obtain a 12-lead ECG to assess for signs of cardiac ischemia.
D) apply cold, moist dressings to his burns to provide pain relief.

Answer 65

B) auscultate his breath sounds before administering IV fluids.

Question 66

A fracture of all midfacial bones, separating the entire midface from the cranium:
A) is commonly associated with facial elongation and dental malocclusion.
B) should be stabilized by placing bulky dressings across the fractured area.
C) is almost always accompanied by multiple severe fractures of the mandible.
D) is referred to as a Le Fort I fracture and most commonly results from a fall.

Answer 66

A) is commonly associated with facial elongation and dental malocclusion.

Question 67

If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be MOST suspicious for a(n):
A) Le Fort II fracture.
B) nasal bone fracture.
C) orbital skull fracture.
D) basilar skull fracture.

Answer 67

C) orbital skull fracture.

Question 68

A flattened appearance to the face and loss of sensation over the cheek following blunt facial trauma is MOST indicative of a(n):
A) zygomatic fracture.
B) orbital skull fracture.
C) Le Fort I fracture.
D) temporomandibular joint dislocation.

Answer 68

A) zygomatic fracture.

Question 69

A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting from the injury site. Despite direct pressure and a pressure dressing, the wound continues to bleed heavily. You should:
A) apply supplemental oxygen and keep her warm.
B) elevate the extremity above the level of her heart.
C) apply a tourniquet between her elbow and wrist.
D) locate and apply digital pressure to the brachial artery.

Answer 69

C) apply a tourniquet between her elbow and wrist.

Question 70

The MOST common and reliable sign of pit viper envenomation is:
A) tachycardia within 30 seconds of the bite.
B) patient anxiety and a slow, bounding pulse.
C) swelling of the tongue and marked hypertension.
D) rapidly developing edema around the bite area.

Answer 70

D) rapidly developing edema around the bite area.

Question 71

A hiker was bitten on the left lower leg by a rattlesnake. He is conscious and alert, but complains of nausea and generalized weakness. The affected area, which has two distinct puncture wounds, is swollen markedly. The patient’s blood pressure is 114/66 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min and regular. The MOST appropriate treatment for this patient involves:
A) keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.
B) applying venous tourniquets proximal and distal to the affected site, elevating the limb no more than 12 inches, applying a splint, and establishing vascular access.
C) administering oxygen, providing emotional support, establishing vascular access, administering a 250-mL saline bolus, and splinting the affected extremity.
D) placing him in a supine position, elevating the affected extremity and applying ice to reduce the swelling, establishing vascular access, and administering fentanyl for pain

Answer 71

A) keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.

Question 72

Which of the following statements regarding the black widow spider is correct?
A) The venom of a black widow spider contains a necrotoxin, which results in local tissue necrosis.
B) Because the mortality rate from a black widow spider bite is about 40%, a prehospital antidote is crucial.
C) Following a black widow spider bite, the patient’s abdomen is often rigid due to severe muscle spasms.
D) The male black widow spider, which is the sex that poses a danger to humans, contains a red hourglass on its back.

Answer 72

C) Following a black widow spider bite, the patient’s abdomen is often rigid due to severe muscle spasms.

Question 73

Pharmacologic management for a black widow spider bite may include:
A) atropine.
B) diazepam.
C) diltiazem.
D) etomidate.

Answer 73

B) diazepam.

Question 74

The bite of a brown recluse spider:
A) may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.
B) manifests with immediate and intense pain and the formation of a blister and a white surrounding area of ischemia.
C) most often causes severe central nervous system depression because its venom contains a powerful neurotoxin.
D) results in a local reaction only because the spider’s venom is cytotoxic and spreads slowly throughout the bloodstream.

Answer 74

A) may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.

Question 75

Mortality and morbidity are greatest following the bite of a:
A) coral snake.
B) copperhead.
C) rattlesnake.
D) cottonmouth.

Answer 75

C) rattlesnake.

Question 76

The venom from a pit viper causes all of the following effects, EXCEPT:
A) local tissue necrosis.
B) increased blood clotting.
C) neuromuscular dysfunction.
D) increased vascular permeability.

Answer 76

B) increased blood clotting.

Question 77

A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should be MOST suspicious that this patient has a(n):
A) poorly healed diabetic ulcer.
B) local reaction to an ant bite.
C) infection caused by a tick.
D) brown recluse spider bite.

Answer 77

D) brown recluse spider bite.

Question 78

A motorcycle or football helmet should be removed if:
A) the patient complains of severe neck pain and the helmet fits snugly.
B) you are going to transport the patient to a medical treatment facility.
C) the patient is breathing shallowly and access to the airway is difficult.
D) you are properly trained in the technique, even if you are by yourself.

Answer 78

C) the patient is breathing shallowly and access to the airway is difficult.

Question 79

Decerebrate posturing is characterized by:
A) flexion of the arms and extension of the legs.
B) inward flexion of the wrists and flexed knees.
C) extension of the arms and extension of the legs.
D) pulling in of the arms toward the core of the body.

Answer 79

C) extension of the arms and extension of the legs.

Question 80

Early signs and symptoms of increased intracranial pressure include:
A) headache and vomiting.
B) hypertension and bradycardia.
C) widening of the pulse pressure.
D) arm flexion and leg extension.

Answer 80

A) headache and vomiting.

Question 81

If a patient with severe hypothermia is pulseless and apneic, you should:
A) attempt a single shock for V-fib or V-tach.
B) avoid placement of an advanced airway device.
C) infuse 4 L of warmed normal saline solution.
D) perform high-quality CPR at half the normal rate.

Answer 81

A) attempt a single shock for V-fib or V-tach.

Question 82

If you are unsure if a patient became hypothermic prior to developing cardiac arrest, you should:
A) withhold resuscitation.
B) contact medical control.
C) transport with BLS only.
D) begin resuscitative efforts.

Answer 82

D) begin resuscitative efforts.

Question 83

Prehospital treatment of the patient with a traumatic brain injury must focus primarily on:
A) maintaining cerebral perfusion pressure.
B) hyperventilating the patient at 20 breaths/min.
C) maintaining a systolic blood pressure of at least 120 mm Hg.
D) taking measures to decrease intracranial pressure.

Answer 83

A) maintaining cerebral perfusion pressure.

Question 84

Hyperventilation of the brain-injured patient:
A) shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.
B) has clearly demonstrated decreased mortality and morbidity in patients with a severe head injury.
C) causes cerebral vasodilation with increased intracranial pressure and should be avoided.
D) is only appropriate if the patient is unresponsive and has bilaterally dilated and sluggishly reactive pupils.

Answer 84

A) shunts oxygen away from the brain and may result in decreased cerebral perfusion pressure.

Question 85

Signs of neurogenic shock include all of the following, EXCEPT:
A) bradycardia.
B) flushed skin.
C) diaphoresis.
D) hypothermia.

Answer 85

A) bradycardia.

Question 86

Hypotension that is associated with neurogenic shock is the result of:
A) loss of alpha receptor stimulation.
B) concomitant internal hemorrhage.
C) increased peripheral vascular tone.
D) profound peripheral vasoconstriction

Answer 86

A) loss of alpha receptor stimulation.

Question 87

Treatment for a patient with neurogenic shock may include all of the following, EXCEPT:
A) a vagolytic medication.
B) a vasopressor medication.
C) prevention of hyperthermia.
D) fluid volume to maintain perfusion.

Answer 87

C) prevention of hyperthermia.

Question 88

Spinal cord injuries that cause neurogenic shock generally produce:
A) cool, clammy skin distal to the site of the spinal cord injury.
B) reflex tachycardia due to sympathetic nervous system stimulation.
C) flaccid paralysis and complete loss of sensation distal to the injury.
D) signs and symptoms that are identical to those of hypovolemic shock.

Answer 88

C) flaccid paralysis and complete loss of sensation distal to the injury.

Question 89

Spinal shock is a condition that:
A) generally affects the sensory nerves but spares the motor nerves.
B) is usually temporary and results from swelling of the spinal cord.
C) typically manifests within 24 to 36 hours following a spinal injury.
D) results in permanent neurologic deficits in the majority of patients.

Answer 89

B) is usually temporary and results from swelling of the spinal cord.

Question 90

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 148/94 mm Hg, heart rate of 58 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves:
A) hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center.
B) preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score.
C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.
D) applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital.

Answer 90

C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

Question 91

In mild hypothermia, an older person would likely present with all of the following, EXCEPT:
A) shivering.
B) dysarthria.
C) a flat affect.
D) noted ataxia.

Answer 91

A) shivering.

Question 92

Prehospital treatment for a patient with moderate hypothermia may include:
A) esophageal rewarming tubes.
B) warm IV fluids and heat packs.
C) caffeine to increase metabolism.
D) extracorporeal rewarming.

Answer 92

B) warm IV fluids and heat packs.

Question 93

If a patient with severe hypothermia is pulseless and apneic, you should:
A) attempt a single shock for V-fib or V-tach.
B) avoid placement of an advanced airway device.
C) infuse 4 L of warmed normal saline solution.
D) perform high-quality CPR at half the normal rate.

Answer 93

A) attempt a single shock for V-fib or V-tach.

Question 94

Nitrogen causes decompression sickness:
A) on descent because of the bubbles that form on reduction of pressure.
B) on ascent because of the bubbles that form on reduction of pressure.
C) on descent because of a progressive increase in atmospheric absolute.
D) on ascent because of a progressive increase in atmospheric absolute.

Answer 94

B) on ascent because of the bubbles that form on reduction of pressure.

Question 95

What is the pathophysiology of decompression sickness?
A) Diffusion of nitrogen out of the tissues during too slow of an ascent
B) An imbalance of nitrogen in the tissues and alveoli due to rapid ascent
C) Increasing quantities of nitrogen and oxygen in the blood during descent
D) Excess carbon dioxide accumulation in the muscles due to a rapid ascent

Answer 95

B) An imbalance of nitrogen in the tissues and alveoli due to rapid ascent

Question 96

The MOST common clinical finding observed in patients with type I decompression sickness is:
A) joint pain.
B) unsteadiness.
C) pruritus and rashes.
D) a cough and dyspnea.

Answer 96

A) joint pain.

Question 97

The initial point of bodily impact when an unrestrained passenger takes the “down and under” pathway during a frontal collision is the:
A) knees.
B) pelvis.
C) femurs.
D) abdomen.

Answer 97

A) knees.

Question 98

When a patient takes the “up and over” pathway during a head-on collision:
A) the head takes a higher trajectory, striking the windshield and causing stretching injuries to the neck.
B) secondary injuries as the patient is ejected are often less severe than the primary injuries.
C) the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx.
D) injuries to the parietal aspect of the skull are common as the head strikes the side window.

Answer 98

C) the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx.

Question 99

All of the following are functions of the skin, EXCEPT:
A) providing the immune response for the body.
B) protecting the underlying tissue from injury.
C) sensing changes in the external environment.
D) assisting in the regulation of body temperature.

Answer 99

A) providing the immune response for the body.

Question 100

When the ambient temperature is high:
A) the dermis produces less collagen, which temporarily decreases the skin’s ability to retain warmth.
B) blood vessels in the dermis dilate, which increases blood flow to the skin and allows heat to dissipate.
C) sweat glands in the epidermis produce sweat, which is evaporated from the skin surface by the air.
D) constriction of the vessels in the dermis brings warm blood to the surface of the skin, where it is eliminated.

Answer 100

B) blood vessels in the dermis dilate, which increases blood flow to the skin and allows heat to dissipate.

Question 101

The skin helps regulate body temperature through:
A) peripheral vasodilation, which shunts cool blood to the core of the body.
B) the production of sweat, which is evaporated from the surface of the skin.
C) increased elastin production, which provides insulation to the epidermis.
D) cutaneous vasoconstriction, which brings warm blood to the skin’s surface.

Answer 101

B) the production of sweat, which is evaporated from the surface of the skin.

Question 102

What aggregates in a clump and forms much of the foundation of a blood clot during the process of coagulation?
A) Fibrin
B) Calcium
C) Plasmin
D) Platelets

Answer 102

D) Platelets

Question 103

When applying a tourniquet to control major external hemorrhage from an extremity injury, you should:
A) apply the tourniquet over a joint, as this will further help compress blood vessels.
B) maintain direct pressure to the wound until the tourniquet has been fully applied.
C) secure the tourniquet in place until the pulses distal to the injury have weakened.
D) apply a pressure dressing over the tourniquet to further help control the bleeding.

Answer 103

B) maintain direct pressure to the wound until the tourniquet has been fully applied.

Question 104

Agents such as Celox, HemCon, and QuikClot are used to:
A) repair damaged vessels.
B) replace lost blood.
C) raise blood pressure.
D) promote hemostasis.

Answer 104

D) promote hemostasis.

Question 105

Venous bleeding:
A) is dark red in color and usually oozes from the wound.
B) is bright red in color and typically spurts from a wound.
C) is more likely to clot spontaneously than arterial bleeding.
D) is generally more difficult to control than arterial bleeding.

Answer 105

C) is more likely to clot spontaneously than arterial bleeding.

Question 106

Much of the bleeding associated with un-splinted fractures continues because:
A) most fractures are unstable and usually lacerate major blood vessels.
B) swelling associated with such fractures prevents platelet aggregation.
C) bone ends will continue to move and destroy partially formed clots.
D) patient anxiety increases the blood pressure, which exacerbates bleeding.

Answer 106

C) bone ends will continue to move and destroy partially formed clots.

Question 107

A blood pressure of 100/70 mm Hg in the presence of clinical signs of a tension pneumothorax:
A) should be treated with crystalloid fluid boluses to prevent hypotension.
B) indicates that prehospital needle decompression likely will not be required.
C) is likely the result of systemic vasodilation in an attempt to reduce preload.
D) suggests adequate cardiac compensation for the diminished venous return.

Answer 107

D) suggests adequate cardiac compensation for the diminished venous return.

Question 108

When performing a needle decompression of the chest, you should insert the needle:
A) at a 90-degree angle and listen for the release of air.
B) on the side of the chest that has audible breath sounds.
C) at a 45-degree angle until you hear a sudden release of air.
D) on the inferior rib border to avoid vasculature and nerves.

Answer 108

A) at a 90-degree angle and listen for the release of air.

Question 109

You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and:
A) loud heart tones.
B) respiratory distress.
C) a bounding pulse.
D) normal lung sounds.

Answer 109

D) normal lung sounds.