Trauma Assessment and Management, Exams of Nursing

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A 12-year-old male jumped approximately 12 feet from a tree and landed on his feet. He complains of pain to his lower back. What injury mechanism is MOST likely responsible for his back pain? - Energy transmission to the spine A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to: - stabilize her entire spine A young male sustained a gunshot wound to the abdomen during an altercation. As your partner is assessing and managing his airway, you should control the obvious bleeding and then: - assess for an exit wound According to the American College of Surgeons Committee on Trauma (ACS-COT), an adult trauma patient should be transported to the highest level of trauma center if he or she: - has a GCS score of less than or equal to 13 with a mechanism attributed to trauma According to the Association of Air Medical Services, you should consider air medical transport of a trauma patient if: - traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome Approximately 25% of severe injuries to the aorta occur during: - lateral collisions Following a blunt injury to the head, a 22-year-old female is confused and complains of a severe headache and nausea. On the basis of these signs and symptoms, you should be MOST concerned with the possibility of: - intracranial bleeding Force acting over a distance is the definition of: - work The index of suspicion is MOST accurately defined as: - your awareness and concern for potentially serious underlying injuries When assessing a patient who experienced a blast injury, it is important to remember that: - primary blast injuries are the most easily overlooked When assessing an elderly patient who fell, it is important to remember that: - osteoporosis can cause a fracture as a result of a fall from a standing position When the speed of a motor vehicle doubles, the amount of kinetic energy: - quadruples Which of the following destinations is most appropriate for a 41-year-old male patient who was involved in a rollover motor vehicle collision and is unconscious and unresponsive, assuming that travel times to each is equal? -

A Level I or Level II trauma center Which of the following findings would be LEAST suggestive of the presence of high-energy trauma? - Deployment of the air bag Which of the following injuries would MOST likely occur as a direct result of the third collision in a motor vehicle crash? - Aortic rupture Which of the following interventions is the MOST critical to the outcome of a patient with multisystem trauma? - Rapid transport to a trauma center Which of the following statements regarding gunshot wounds is correct? - The speed of a bullet has the greatest impact on the injury produced Which types of motor vehicle collisions present the greatest potential for multiple impacts? - Rotational and rollover While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year- old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced: - neck and facial injuries Your patient has a Glasgow Coma Scale (GCS) score of 13, a systolic blood pressure of 80 mm Hg, and a respiratory rate of 8 breaths/min. His Revised Trauma Score (RTS) is: - 9 A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. Preferred treatment for this patient includes: - pinching the patient's nostrils and having him lean forward A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing: - gastrointestinal bleeding A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should: - assist the patient's ventilations Circulation of blood within an organ or tissue in adequate amounts to meet the cells' oxygen, nutritional, and waste-removal needs is termed _______. - perfusion Following blunt trauma to the abdomen, a 21-year-old female complains of diffuse abdominal pain and pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the: - spleen

Hypovolemic shock occurs when: - the body cannot compensate for rapid blood loss If applying a dressing to control the bleeding of a patient's arm, the EMT should ________. - A. apply direct pressure first B. use large or small gauze pads or dressings depending upon the size of the wound C. cover the entire wound, above and below, with the dressing D. All of these answers are correct If direct pressure fails to immediately stop severe bleeding from an extremity, you should apply: - a tourniquet proximal to the injury In older patients, the first indicator of non-traumatic internal bleeding may be: - weakness or dizziness Internal bleeding into a fractured extremity is MOST often controlled by: - splinting the extremity Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume. - 20% The severity of bleeding should be based on all of the following findings, EXCEPT: - systolic blood pressure What mechanism(s) does the body use to control bleeding? - A. Clotting B. Coagulation C. Vasoconstriction D. All of these answers are correct Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that: - the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released Which of the following findings would be the MOST significant when assessing a patient with possible internal bleeding? - The patient takes rivaroxaban (Xeralto) Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding? - Air splint Which of the following statements regarding hemophilia is correct? - Patients with hemophilia may bleed spontaneously Which organ or organ system has the greatest tolerance for lack of perfusion (shock)? - Gastrointestinal system Which portion of the blood carries oxygen to and wastes away from body tissues? -

Red blood cells Which section of the heart receives deoxygenated blood? - Right A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA. - 18% A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound? - Cover it with moist, sterile gauze and secure with an occlusive dressing A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He has a large hematoma in the center of his forehead and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should: - administer high-flow oxygen A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should: - replace the avulsed flap to its original position and cover it with a sterile dressing A burn that is characterized by redness and pain is classified as a: - superficial burn A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): - contusion An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should: - report the incident to the appropriate authorities As you approach a young male who was involved in an industrial accident, you note that his eyes are closed and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with minimal bleeding, and a closed deformity to his right leg. You should: - open his airway and assess his breathing status Burns to pediatric patients are generally considered more serious than burns to adults because: - pediatric patients have more surface area relative to total body mass During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a: - shotgun In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is: - an air embolism

In which of the following patients should you remove an impaled object? - A pulseless and apneic patient with a knife impaled in the back The sebaceous glands produce sebum, a material that: - waterproofs the skin and keeps it supple When caring for a patient whose arm is covered with a dry chemical, you should: - brush away the chemical before flushing with water Which of the following areas of the body has the thinnest skin? - Ears Which of the following is a severe burn in a 65-year-old patient? - Partial-thickness burn to 20% of the BSA Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss? - Abrasion Which of the following processes occurs during the inflammation phase of the healing process? - The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling Which of the following statements regarding crush syndrome is correct? - Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should: - assess distal circulation and readjust the bandage as needed A 30-year-old female presents with redness, inflammation, and pain to her left eye. During your assessment, you note that she is having difficulty keeping her eyes open. You should suspect that she is experiencing: - conjunctivitis. Correct A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should: - transport her to the emergency department. Correct A 52-year-old unrestrained female struck the steering wheel with her face when her truck collided with another vehicle. She has obvious swelling to her face and several dislodged teeth. A visual exam of her mouth reveals minimal bleeding. She is conscious and alert with a blood pressure of 130/80 mm Hg, a pulse of 110 beats/min, and respirations of 22 breaths/min with adequate tidal volume. You should: - fully immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport. A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is: -

rapidly transporting her to the hospital. Correct A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should: - irrigate both eyes continuously for 20 minutes with plain water. Correct Bleeding from soft-tissue injuries to the face is MOST effectively controlled with: - direct pressure using dry, sterile dressings. Correct Following blunt trauma to the face, a 21-year-old male complains of a severe headache and decreased ability to move his eyes. This patient's clinical presentation is MOST consistent with: - a blowout fracture. Correct If your patient swallows blood following facial trauma, there is an increased risk of ________. - vomiting Correct Significant trauma to the face should increase the EMT's index of suspicion for a(n): - spinal column injury. Correct The Adam's apple is: - the upper part of the larynx that is formed by the thyroid cartilage. Correct The MOST significant complication associated with facial injuries is: - airway compromise. Correct The superficial temporal artery can be palpated: - just anterior to the tragus. Correct The upper jawbones are called the: - maxillae. Correct When a light is shone into the pupil: - it should become smaller in size. Correct When caring for a patient with an open facial injury, the EMT's immediate priority should be to: - wear gloves and facial protection. Correct When performing a full body scan, you should assess for ________. - DCAP-BTLS Correct Which of the following statements regarding anterior nosebleeds is correct? - They usually originate from the septum area and bleed slowly. Correct Which of the following statements regarding the vitreous humor is correct? - It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost. Correct You are assessing a 59-year-old male and note that his pupils are unequal. He is conscious and alert. When obtaining his medical history, it is MOST pertinent to ask him if he: - has a history of eye surgeries. Correct

When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with the hospital regarding the patient's injuries because: - they may need to call a specialist to see the patient. Correct A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of: - axial loading A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response? - 3 A tight-fitting motorcycle helmet should be left in place unless: - it interferes with your assessment of the airway. An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is: - a rapid deterioration of neurologic signs. Common signs and symptoms of a serious head injury include all of the following, EXCEPT: - a rapid, thready pulse During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should: - suction his oropharynx for up to 15 seconds. Hyperextension injuries of the spine are MOST commonly the result of: - hangings In contrast to a cerebral concussion, a cerebral contusion: - involves physical injury to the brain tissue. Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless: - it causes a problem managing the airway. The central nervous system (CNS) is composed of the: - brain and spinal cord The five sections of the spinal column, in descending order, are the: - cervical, thoracic, lumbar, sacral, and coccygeal The Glasgow Coma Scale (GCS) is used to assess: - eye opening, verbal response, and motor response The ideal procedure for moving an injured patient from the ground to a backboard is: - the four-person log roll What part of the nervous system controls the body's voluntary activities? - Somatic When activated, the sympathetic nervous system produces all of the following effects, EXCEPT: -

pupillary constriction. When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates: - rupture of the tympanic membrane following diffuse impact to the head When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until: - the patient has been completely secured to the backboard Which of the following breathing patterns is MOST indicative of increased intracranial pressure? - Irregular rate, pattern, and volume of breathing with intermittent periods of apnea Which of the following statements regarding secondary brain injury is correct? - Hypoxia and hypotension are the two most common causes of secondary brain injury. You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is: - slow A 28 year old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to providing supplemental oxygen, you should: - prepare for immediate transport A flail chest occurs when: - a segment of the chest wall is detached from the thoracic cage. A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturations is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect: - pulmonary contusion A simple pneumothorax: - is commonly caused by blunt chest trauma A spinal cord injury at the level of C7 would MOST likely result in: - paralysis of the intercostal muscles An open pneumothorax occurs when: - air enters the pleural space from outside the body. Children are often "belly breathers" because _________? - their intercostal muscles are not developed Closed chest injuries are typically caused by ________? - blunt trauma Following a stab wound to the left anterior chest, a 25 year old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? -

Engorged jugular veins If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: - must increase his or her respiratory rate to maintain adequate minute volume. Immediately life-threatening chest injuries must be found and managed during the _________? - primary assessment In order to avoid exacerbating a patients injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a: - pneumothorax Patients with chest injuries will often present with _______? - tachypnea The thoracic cavity is separated from the abdominal cavity by the: - diaphram When a person is lying supine at the end of exhalation, the diaphragm: - may rise as high as the nipple line Which of the following is most likely to cause immediate death? - aortic rupture While jogging, a 19 year old male experienced an acute onset of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should: - administer oxygen and transport to the hospital You arrive at the scene of a major motor vehicle crash. The patient, a 50 year old female, was removed form her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a: - laceration of the aorta You have sealed the open chest wound of a 40 year old male who was stabbed in the anterior chest. Your assessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should: - partially remove the dressing. You respond to a residence for a 40 year old female who was assaulted by her husband, the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breath sounds. As your partner is supporting her ventilations, you should: - immediately request ALS support A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes: - A. applying direct pressure with a dry, sterile dressing.

Abdominal pain, vomiting, and fever are most likely due to _______. - B. infection All of the following are hollow abdominal organs, EXCEPT the: - A. spleen. Because the depth of an open abdominal wound is often difficult to determine: - B. prompt transport to the hospital is essential. Compression injury is most likely due to which of the following? - A. Improperly placed lab belt Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: - A. diaphragm. In pediatric patients, the liver and spleen are _______. - B. larger in proportion to the abdomen Injuries to the external male genitalia _______. - B. are rarely life-threatening Placing a pregnant patient in a supine position during the third trimester of pregnancy: - D. may decrease the amount of blood that returns to the heart. When a hollow organ is punctured during a penetrating injury to the abdomen: - C. peritonitis may not develop for several hours. When a patient stiffens the muscles of the abdomen, it is known as _______. - A. guarding. When should you visually inspect the external genitalia on your patient? - D. Only when there is a complaint of severe pain or other injury Which of the following is true regarding injury to the kidneys? - A. Injury to the kidneys usually indicates injury to other organs. Which of the following organs would MOST likely bleed profusely when injured? - C. Liver Which of the following statements regarding abdominal eviscerations is correct? - D. The protruding organs should be kept warm and moist. You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should: - D. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately, you should: - B. closely monitor him and reassess him frequently. You should suspect a kidney injury anytime the patient presents with _______. - D. a hematoma in the flank region Your documentation on a sexual assault victim should _______. - A. be objective and factual Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should: - A. control any external bleeding, administer oxygen, and transport at once. A "hip" fracture is actually a fracture of the: - A. proximal femur. A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should - D. keep her knee flexed and secure it with padded board splints. A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should: - D. stabilize her head and perform a primary assessment. With regard to musculoskeletal injuries, the zone of injury is defined as the: - D. area of soft-tissue damage surrounding the injury. A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should -

. control the bleeding and cover the wound with a sterile dressing. Which of the following musculoskeletal injuries would MOST likely result in deformity? - B. Displaced fracture Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? - D. Pelvic fracture with hypotension Which of the following statements regarding compartment syndrome is correct? - C. Compartment syndrome typically develops within 6 to 12 hours after an injury. A fracture is MOST accurately defined as a(n): - B. break in the continuity of the bone A supracondylar or intercondylar fracture is also known as a fracture of the: - D. distal humerus.

An open fracture is MOST accurately defined as a fracture in which: - A. the overlying skin is no longer intact. When caring for a patient with a possible fracture of the scapula, the EMT should: - B. carefully assess the patient for breathing problems Crepitus and false motion are: - A. positive indicators of a fracture. The musculoskeletal system refers to the: - B. bones and voluntary muscles of the body. The MOST significant hazard associated with splinting is: - D. delaying transport of a critically injured patient. During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should: - A. apply gentle manual traction in line with the limb and reassess for a pulse. During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should: - D. stabilize the pelvis with a pelvic binder and protect the spine. Skeletal muscle is attached to the bone by tough, ropelike, fibrous structures called: - A. tendons. In which of the following situations should the EMT splint an injured limb in the position of deformity? - B. If resistance is encountered or the patient experiences severe pain In general, musculoskeletal injuries should be splinted before moving the patient unless: - C. the patient is clinically unstable.