Block 3

Question 1

When applying a dressing and bandage to a scalp wound, you should

A. always use a loose dressing to soak up the blood.

B. apply a cervical collar in case the c-spine is injured.

C. carefully assess the skull for an underlying fracture.

D. remove any foreign particles from the wound first.

Answer 1

C. carefully assess the skull for an underlying fracture

Question 2

When managing a patient who is entrapped by a crushing object, it is MOST important to:

A. infuse 2 L of lactated Ringer’s solution to combat hyperkalemia.

B. make every effort to treat the patient before removing the crushing object.

C. assess perfusion and sensory and motor functions every 5 minutes.

D. give sodium bicarbonate immediately after removing the crushing object

Answer 2

B. make every effort to treat the patient before removing the crushing object

Question 3

The skin is also referred to as the:

A. integument.

B. epithelium.

C. melanin.

D. collagen

Answer 3

A. integument.

Question 4

When caring for a patient with an open chest wound, you should:

A. place a porous dressing over the wound and secure it on three sides.

B. secure a dressing in place by circumferentially wrapping the chest.

C. frequently assess breath sounds for indications of a pneumothorax.

D. routinely transport the patient in a left lateral recumbent position

Answer 4

C. frequently assess breath sounds for indications of a pneumothorax.

Question 5

The skin helps regulate body temperature through:

A. increased elastin production, which provides insulation to the epidermis.

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

C. peripheral vasodilation, which shunts cool blood to the core of the body.

D. cutaneous vasoconstriction, which brings warm blood to the skin’s surface.

Answer 5

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

Question 6

A patient with nerve compromise following an open injury to the hand:

A. will not be able to move his or her hand.

B. should be given analgesia for the pain.

C. requires prompt transport to the hospital.

D. will likely lose all neurologic function.

Answer 6

C. requires prompt transport to the hospital.

Question 7

When the ambient temperature is high:

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

B. the dermis produces less collagen, which temporarily decreases the skin’s ability to retain warmth.

C. constriction of the vessels in the dermis brings warm blood to the surface of the skin, where it is eliminated.

D. sweat glands in the epidermis produce sweat, which is evaporated from the skin surface by the air.

Answer 7

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

Question 8

A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should be MOST suspicious that this patient has:

A. a staph infection.

B. a viral infection.

C. meningitis.

D. tetanus.

Answer 8

D. tetanus

Question 9

Which of the following interventions encourages drainage from the site of a closed wound and reduces swelling?

A. Firm compression

B. Application of ice

C. Splinting

D. Elevation

Answer 9

D. Elevation

Question 10

Your MAIN concern when caring for a patient with a soft-tissue injury to the face should be:

A. airway compromise.

B. hypovolemic shock.

C. preventing contamination.

D. injuries to the eyes.

Answer 10

A. airway compromise

Question 11

Compared to the bleeding from an open wound, bleeding from a closed wound:

A. is not significant enough to produce shock.

B. can usually be controlled with direct pressure.

C. generally requires surgical intervention.

D. is limited because the skin is unbroken

Answer 11

D. is limited because the skin is unbroken

Question 12

Which of the following substances is produced in the dermis and keeps the skin supple so that it doesn’t crack?

A. Ground substance

B. Sebum

C. Elastin

D. Collagen

Answer 12

B. Sebum

Question 13

Which of the following medications would MOST likely interfere with hemostasis?

A. Tylenol

B. Procrit

C. Paxil

D. Plavix

Answer 13

D. Plavix

Question 14

Which of the following statements regarding soft-tissue injuries is correct?

A. They are often the most obvious, but are seldom the most life threatening.

B. Most soft-tissue injuries are hidden and require a systematic assessment.

C. Most soft-tissue injuries require immediate care to prevent blood loss.

D. Soft-tissue injuries should be covered immediately upon patient contact.

Answer 14

A. They are often the most obvious, but are seldom the most life threatening.

Question 15

During the neovascularization phase of the wound healing process:

A. histamine makes the capillaries more permeable, resulting in swelling in and around the injury site.

B. new blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue.

C. collagen provides stability to the damaged tissue and joins wound borders, thereby closing the open tissue.

D. microscopic vasculature damaged by the injury is digested by macrophages through a process called phagocytosis.

Answer 15

B. new blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue.

Question 16

While hiking, a 24-year-old woman was pinned from the waist down under a rock that collapsed on her. Upon your arrival, the patient is conscious and alert, and states that she can’t feel her legs. She further tells you that she thinks she has been pinned for about 5 hours. She is breathing adequately and has stable vital signs. In addition to administering supplemental oxygen, you should:

A. quickly remove the rock from her legs to restore distal neurovascular function, and administer a 20-mL/kg bolus of lactated Ringer’s solution.

B. start two large-bore IV lines of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs.

C. start at least one large-bore IV line and administer 2 to 4L of normal saline before attempting to remove the rock from her legs.

D. administer 2 mEq/kg of sodium bicarbonate followed by 25 g of 50% dextrose as you slowly and carefully remove the rock from her legs.

Answer 16

B. start two large-bore IV lines of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs.

Question 17

The outermost layer of the epidermis:

A. consists of nonliving cells that are continuously being shed.

B. contains numerous fibroblasts that secrete collagen and elastin.

C. is a tough, highly elastic layer than contains melanin granules.

D. is comprised of living cells that give rise to the stratum corneum

Answer 17

A. consists of nonliving cells that are continuously being shed.

Question 18

A 63-year-old diabetic woman presents with an open wound to her forearm that she experienced when she fell a week ago. She tells you that the wound has been draining purulent fluid, but has not been bleeding. The wound itself is red, inflamed, and warm to the touch. You should:

A. carefully irrigate the wound with sterile water for 5 minutes.

B. apply a light coat of antibiotic ointment and cover the wound.

C. apply a moist, sterile dressing and transport to the hospital.

D. apply a dry, sterile dressing and transport her to the hospital

Answer 18

D. apply a dry, sterile dressing and transport her to the hospital

Question 19

Which of the following is the MOST common cause of necrotizing fasciitis?

A. Clostridium tetani

B. Clostridium perfringens

C. A fungal infection

D. Hemolytic streptococci

Answer 19

D. Hemolytic streptococci

Question 20

When caring for an amputated body part:

A. the body part should be kept at room temperature.

B. applying ice to the body part will keep the cells viable.

C. early notification of the hospital is important.

D. the part should be tightly wrapped in a dry dressing.

Answer 20

C. early notification of the hospital is important.

Question 21

In which of the following patients should the impaled object be removed?

A. Apneic patient with a shard of glass impaled in the center of the chest

B. Semiconscious patient with a screwdriver impaled in the side of the head

C. Pulseless and apneic patient with a knife impaled in the lower abdomen

D. Cardiac arrest patient with an ice pick impaled in the center of the back

Answer 21

D. Cardiac arrest patient with an ice pick impaled in the center of the back

Question 22

A crushing or tearing amputation

A. cannot be surgically reattached due to the severe vascular and soft-tissue damage that accompanies it.

B. can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly.

C. is initially treated by applying a proximal tourniquet and retrieving any detached body parts.

D. causes less blood loss than expected because the blood vessels retain their ability to constrict.

Answer 22

B. can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly.

Question 23

A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should:

A. suction the blood from his mouth and assist ventilations with a bag-mask device.

B. apply direct pressure to his facial wounds and promptly intubate him.

C. insert a nasal airway, apply oxygen via nonrebreathing mask, and transport.

D. suction his oropharynx for 30 seconds and then perform endotracheal intubation.

Answer 23

A. suction the blood from his mouth and assist ventilations with a bag-mask device.

Question 24

A 22-year-old man was struck in the forehead by a softball. He is conscious and alert, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should

A. apply an icepack to the hematoma and monitor his level of consciousness.

B. place him in a sitting position and apply a chemical heat pack to his head.

C. apply firm manual pressure to the hematoma to reduce internal bleeding.

D. start an IV of normal saline and administer 2 mg of morphine for the pain

Answer 24

A. apply an icepack to the hematoma and monitor his level of consciousness.

Question 25

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 a tourniquet between her elbow and wrist.

B. locate and apply digital pressure to the brachial artery.

C. apply supplemental oxygen and keep her warm.

D. elevate the extremity above the level of her heart

Answer 25

A. apply a tourniquet between her elbow and wrist.

Question 26

When a patient’s leg is entrapped under a crushing object for a prolonged period of time, toxic metabolic waste products are released into the systemic circulation

A. after the leg has been entrapped for 2 hours.

B. after the patient’s leg is freed from entrapment.

C. only if the renal system is functioning properly.

D. and result in low serum potassium levels

Answer 26

B. after the patient’s leg is freed from entrapment.

Question 27

The use of wet dressings in the field is limited because:

A. their use may result in severe hypothermia.

B. they are of no value in providing pain relief.

C. their sterility cannot be maintained in the field.

D. they provide a medium for pathogens to grow.

Answer 27

D. they provide a medium for pathogens to grow.

Question 28

Which of the following wounds usually requires substantial irrigation and debridement prior to closure?

A. Any wound to the face

B. Jagged lacerations

C. Wounds over tension lines

D. Degloving injuries

Answer 28

D. Degloving injuries

Question 29

Necrosis of tissue caused by an anaerobic, toxin-producing bacterium is called:

A. fasciitis.

B. lymphedema.

C. tetanus.

D. gangrene.

Answer 29

D. gangrene

Question 30

Applying direct pressure to a bleeding wound stops the flow of blood because:

A. direct pressure facilitates vasoconstriction.

B. it allows platelets to seal the vascular walls.

C. pressure shunts blood away from the injury.

D. pressure stimulates the release of fibrin.

Answer 30

B. it allows platelets to seal the vascular walls.