PHTLS 10TH EDITION QUESTIONS WITH 100% CORRECT VERIFIED ANSWERS, Exams of Nursing

Download PHTLS 10TH EDITION QUESTIONS WITH 100% CORRECT VERIFIED ANSWERS and more Exams Nursing in PDF only on Docsity! HOSMERIT PHTLS 10TH EDITION QUESTIONS WITH 100% CORRECT VERIFIED ANSWERS Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? a. Principles of PHTLS b. The Golden Period c. The XABCDE assessment d. Critical thinking process -correct answer-D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient. When using the XABCDE assessment, which of the following takes precedence over all other actions? a. Controlling severe bleeding from a limb or other compressible site b. Airway stabilization and assessing circulatory status c. Exposing the body to allow a thorough evaluation d. Ensuring adequate breathing -correct answer-A The "X" placed before "ABCDE" in the primary survey refers to the need to address exsanguinating hemorrhage immediately after establishing scene safety and before addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding, has the potential to lead to loss of total or near total blood volume in a relatively short period of time. Which of the following is the basis on which a patient's chance of survival is maximized? a. Preferences b. Phases c. Principles d. Transport -correct answer-C The science of medicine provides the principles of medical care. Simply stated, principles define the duties required of the prehospital care practitioner in optimizing patient survival and outcome. Which of the following is a goal of the Golden Period? a. Provide written documentation from field care to receiving hospital. b. Expedite the field care and transport of the patient. c. Use a team approach for optimal patient care. d. Use the XABCDE approach to patient assessment. -correct answer-B One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the time from injuryto arrival at the appropriate site fordefinitive care is critical to survival. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? a. Immediately begin triaging patients. b. Treat the patient with the most visible blood loss. c. Determine the need for additional resources. d. Assess the scene and ensure it is safe. -correct answer-D c. Children have smaller heads, so there is less room to clear the obstruction. d. A child's epiglottis is smaller and stiffer than an adult's. -correct answer-B Children have larger heads and tongues as compared to an adult so there is a greater potential for airway obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric patient to maintain a patent airway. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient? a. Shorter tracheas in geriatric patients create the need for ventilation assistance. b. Laxity of the rib cage makes hyperventilation more likely. c. Geriatric patients have greatly limited physiologic reserve. d. Geriatric patients have a greater alveolar surface area of the lungs. -correct answer- C Early mechanical ventilation via bag mask device or advanced airway measures should be considered in geriatric trauma patients because of their greatly limited physiologic reserve. When securing a patient to a backboard, which body part should you secure first? a. Head b. Torso c. Legs d. Pelvis -correct answer-B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis. You are responding to a call for 25-year-old, fit and healthy female who fell off a mountain bike. Upon arrival, you find the patient walking around. She is alert but complaining of pain in her clavicle and on her right side when she inhales. You notice that her helmet is split in two. What is the first thing you need to do? a. Complete a review of the ABCs. b. Check motor and sensory function. c. Perform manual in-line stabilization. d. Place her on a backboard. -correct answer-C Because there's a possibility of spinal injury, you should bring the patient's head into a neutral in-line position. During primary survey, you find the following: . LOC: alert and oriented; speaking in full sentences . GCS: 15 . Airway: good air entry to bases . Breathing: bilateral . Circulation: skin warm, flushed, dry . Pulse rate: 112 bpm, strong andregular . BP: 90/42 mm Hg . Pain: Patient complains of severe pain at clavicle site and pain on inspiration at site of possible fractured ribs. No other injuries detected. What is your next step? a. Apply a cervical collar and in-line immobilization device. b. Treat for hypovolemic shock. c. Apply an arm sling for the clavicle injury. d. Administer pain medication. -correct answer-A Although the patient's GCS is normal, she does have a distracting injury, and the state of her helmet indicates possible spinal compression/flexion, so you should immobilize the patient. What type of padding should you provide for this patient? a. Use compressible padding under the shoulders and torso to prevent hyperflexion. b. Use firm padding between the back of the head and the backboard to prevent hyperextension. c. Do not use any padding. It can cause extension or flexion in the neck. d. No padding needed, but to avoid decreased venous return you should tip the backboard to a left lateral position. -correct answer-B Because the patient is an adult, you should use firm padding between the back of the head and the backboard to prevent hyperextension. You would pad a child's shoulder and torso to prevent hyperflexion, and you would tip the backboard for a pregnant patient to prevent decreased venous return. The patient's care giver is a babysitter who reports the child was crawling on the counter and placed his hand in a pot of water that was boiling on the stove. She is applying ice to the burn and the child is shivering. What is your next step? a. Administer analgesia for pain. b. Cover the patient with a blanket to stop the shivering. c. Start IV for fluid resuscitation. d. Stop the burning process and remove the ice pack. -correct answer-D A common error that results in damage to the zone of stasis is the application of ice by a bystander or prehospital care practitioner. When ice is applied to a burn, the patient will experience some reduction in pain; however, the pain relief will be at the expense of additional tissue destruction. After exposing the patient, no other burn injuries were found, but blisters have started to form on the hand and the child is crying from pain. How should you manage the blisters? a. Lance the blisters to drain the fluidand relieve the pressure. b. Cover the injury with a dry, loose, sterile dressing, being sure to leave the blisters intact. c. Use a topical antibiotic ointment and firmly wrap the burn injury. d. Establish an IV for fluid resuscitation. -correct answer-B In the prehospital setting, blisters are generally best left alone during the relatively short transport time. Blisters that have already ruptured should be covered with a clean, dry dressing. You have been performing ongoing management on a 35-year-old female patient who sustained thoracic trauma when a car hit her as she crossed the street. Originally, your electronic monitoring devices all produce results consistent with your patient's clinical condition. However, en route the trauma center, the monitors start to differ from your patient's current clinical condition each time you reassess. How should you handle this situation? a. Treat the patient's condition, not the monitor results. b. Continue to reassess the patient and record the results for the trauma center. c. Treat your patient based on the test results. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze- release-release" timing technique. As you watch for the rise and fall of the chest, you check end- tidal CO2 (ETCO2) monitoring aiming to maintain what level? a. Between 40 and 45 mm Hg b. Between 30 and 35 mm Hg c. Between 35 and 40 mm Hg d. The level is irrelevant because capnography is inaccurate in pediatric patients. - correct answer-C The proper level to maintain is between 35 and 40 mm Hg. While attempting to lay the patient supine for spinal motion restriction she becomes increasingly distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to move distally and increases the difficulty of breathing as the patient lies back. What should you do? a. Tip the backboard to a left lateral position. b. Raise the back of the stretcher. c. Let her sit up in a position of comfort. d. Administer morphine. -correct answer-Question 5: B Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? a. Superficial (first degree) b. Partial thickness (second degree) c. Full thickness (third degree) d. Subdermal (fourth degree) -correct answer-B Scald burns are the most common burns seen in the pediatric population ages 1 to 5 years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters are present or popped. It is also the most painful type of burn. What is one reason to use capnography as part of your patient reassessment? a. To get accurate readings for blood pressure b. To assure proper ET tube placement c. To measure arterial blood saturation d. To ensure proper placement for needle decompression -correct answer-B Capnography can monitor proper endotracheal tube placement. It doesn't read blood pressure, so it cannot beused to determine if a patient is hypotensive. Pulse oximetry, not capnography, measures arterial blood saturation. Capnography is not useful in needle decompression. Your partner is compressing the bleeding site of a male patient who was stabbed multiple times in the left chest. The bleeding seems to be controlled, yet the patient becomes combative. He is pale and is breathing rapidly, yet states that he "can't breathe" and feels that he is about to die. Your next step in patient management is to: A. start assisted ventilation. B. give high-flow oxygen. C. decompress the left chest. D. give a 250-mL fluid bolus. -correct answer-C After X come A and B. You can quickly auscultate the lungs (pneumothorax is almost certain with multiple stabs in the chest) and decompress the chest. Decompressing a tension pneumothorax is the quickest way to treat shock. The patient's respiration improves markedly, but he remains confused. He has an absent radial pulse, and his carotid pulse is fast and thready. Your partner asks if he can let the compression go to put in an IV. How should you respond? A. "Oh yes, that's a great idea!" B. "Yes, but we have to immobilize him first" C. "Take a blood pressure first to see if he needs an IV." D. "No, keep the pressure and let's get out of here!" -correct answer-D This patient is likely in decompensated shock with internal bleeding, so rapid transport is the next priority. You should maintain pressure on the wound, because having massive external bleeding start up again is the last thing you want in this situation. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still confused, and you still have no radial pulse. Your next move is to: A. give 1-L fluid bolus. B. give one 250-mL fluid bolus, and then stop. C. give fluid until you get a radial pulse. D. administer TXA. -correct answer-C Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids. After 400 mL of lactated Ringer solution, you get a radial pulse and his level of consciousness improves. The monitor shows heart rate 110 beats/minute, blood pressure 85/60mm Hg, SpO2 95%, ventilation rate 25 breaths/minute. What should you do? A. Give an additional 500 mL of lactated Ringer solution. B. Stop fluids and give 2 g of TXA. C. Give TXA and 500 mL of normal saline. D. Give 2 mg of morphine for analgesia. -correct answer-B The patient does not need more fluids right now. Giving morphine in a shocked patient is a risky move and could lead to dangerous hypotension. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful? A. No, he should stop talking and breathe. B. Yes, he should see a cardiologist once in the local hospital.