Chapter 18

Question 1

A patient has a laceration on his arm from a table saw. Assessment reveals dark red blood flowing steadily from the wound. You would recognize this type of bleeding as:

a. arterial bleeding.
b. capillary bleeding.
c. venous bleeding.
d. lymphatic bleeding.

Answer 1

a. arterial bleeding.
b. capillary bleeding.
c. venous bleeding.
d. lymphatic bleeding.

Answer: c
Objective: 18-4
Reference: 540, 542

Question 2

You are responding to a call to aid a patient who has cut himself with a knife. Reportedly arterial bleeding is involved. Given this information, which of the following findings do you expect?

a. Flowing dark-red blood that is difficult to control
b. Oozing bright-red blood that is easy to control
c. Spurting dark-red blood that is difficult to control
d. Bright-red blood that is spurting with each beat of the heart

Answer 2

a. Flowing dark-red blood that is difficult to control
b. Oozing bright-red blood that is easy to control
c. Spurting dark-red blood that is difficult to control
d. Bright-red blood that is spurting with each beat of the heart

Answer: d
Objective: 18-4
Reference: 540, 542

Question 3

You arrive at a scene at which a 16-year-old girl has cut her wrist with a knife. She appears to be pale, and blood is spurting from the cut. Which of the following actions should you take first?

a. Ask her how the injury happened.
b. Apply direct pressure to the cut.
c. Apply oxygen at 15 LPM via a nonrebreather mask.
d. Obtain a blood pressure reading.

Answer 3

a. Ask her how the injury happened.
b. Apply direct pressure to the cut.
c. Apply oxygen at 15 LPM via a nonrebreather mask.
d. Obtain a blood pressure reading.

Answer: b
Objective: 18-5
Reference: 551, 553

Question 4

Severe external bleeding should be controlled during what phase of a patient assessment?

a. The primary assessment
b. The scene size-up
c. The rapid secondary survey
d. The reassessment

Answer 4

a. The primary assessment
b. The scene size-up
c. The rapid secondary survey
d. The reassessment

Answer: a
Objective: 18-5
Reference: 551

Question 5

You are treating a patient who has cut herself while working in the lodge kitchen. She has a jagged laceration on her left forearm that is bleeding steadily and heavily. While attempting to control the bleeding, you should first:

a. tightly wrap roller gauze around a large sterile dressing placed over the injury.
b. apply direct pressure to the elbow pressure point to slow the flow of blood into the arm.
c. place a sterile dressing over the site and hold steady pressure on the dressing with your hand.
d. wrap the injury tightly with roller gauze and apply a tourniquet proximal to the laceration.

Answer 5

a. tightly wrap roller gauze around a large sterile dressing placed over the injury.
b. apply direct pressure to the elbow pressure point to slow the flow of blood into the arm.
c. place a sterile dressing over the site and hold steady pressure on the dressing with your hand.
d. wrap the injury tightly with roller gauze and apply a tourniquet proximal to the laceration.

Answer: c
Objective: 18-6
Reference: 553

Question 6

Which of the following actions should you take next when direct pressure, elevation, and femoral artery pressure have failed to control arterial bleeding on a patient’s leg?

a. Provide oxygen at 15 LPM with a nonrebreather mask.
b. Apply a tourniquet proximal to the injury.
c. Immediately transport the patient by ambulance.
d. Splint the extremity.

Answer 6

a. Provide oxygen at 15 LPM with a nonrebreather mask.
b. Apply a tourniquet proximal to the injury.
c. Immediately transport the patient by ambulance.
d. Splint the extremity.

Answer: b
Objective: 18-6
Reference: 553-554

Question 7

Which of the following statements indicates that the speaker understands the application of a tourniquet?

a. “A tourniquet should be applied tightly enough so that arterial blood flow distal to the tourniquet is completely stopped.”
b. “If the tourniquet appears to have stopped the bleeding, you should loosen it slightly to allow a small amount of blood to perfuse the tissues.”
c. “Arteries run close to the body’s surface in a joint, so the best place to apply a tourniquet is over the joint just above the artery.”
d. “A tourniquet should be applied only when directed by medical control.”

Answer 7

a. “A tourniquet should be applied tightly enough so that arterial blood flow distal to the tourniquet is completely stopped.”
b. “If the tourniquet appears to have stopped the bleeding, you should loosen it slightly to allow a small amount of blood to perfuse the tissues.”
c. “Arteries run close to the body’s surface in a joint, so the best place to apply a tourniquet is over the joint just above the artery.”
d. “A tourniquet should be applied only when directed by medical control.”

Answer: a
Objective: 18-8
Reference: 554

Question 8

You have just arrived on scene, where a young girl has pushed her arm through a plate glass window. She is responsive and has a patent airway. Bright red blood is spurting from a large laceration on her right upper arm. When your partner tells you to apply direct pressure to the laceration to prevent the further blood loss, you would:

a. place a tourniquet proximal to the laceration, being careful not to get blood on your hands.
b. put gloves on before applying direct pressure over the injury site.
c. control the bleeding by pushing the edges of the laceration together until you can put gloves on.
d. apply direct pressure to the site with your hands until someone wearing gloves can take over.

Answer 8

a. place a tourniquet proximal to the laceration, being careful not to get blood on your hands.
b. put gloves on before applying direct pressure over the injury site.
c. control the bleeding by pushing the edges of the laceration together until you can put gloves on.
d. apply direct pressure to the site with your hands until someone wearing gloves can take over.

Answer: b
Objective: 18-5
Reference: 553

Question 9

You are having a difficult time controlling bleeding from a small skin avulsion on a patient’s ankle. Which of the following statements made by the patient best explains why the bleeding has been so difficult to control?

a. “I take Coumadin for my irregular heartbeat.”
b. “My blood pressure sometimes runs a little high.”
c. “I take steroids for my lung disease.”
d. “I drank a lot of alcohol last night.”

Answer 9

a. “I take Coumadin for my irregular heartbeat.”
b. “My blood pressure sometimes runs a little high.”
c. “I take steroids for my lung disease.”
d. “I drank a lot of alcohol last night.”

Answer: a
Objective: 18-5
Reference: 551

Question 10

The skin performs which of the following functions?

a. Regulation of temperature
b. Prevention of blood loss
c. Elimination of carbon dioxide
d. Dissipation of internal cold

Answer 10

a. Regulation of temperature
b. Prevention of blood loss
c. Elimination of carbon dioxide
d. Dissipation of internal cold

Answer: a
Objective: 18-1
Reference: 539–540

Question 11

A patient has suffered abrasions to the legs after falling on a moving treadmill. In treating this injury you would be most concerned about:

a. the loss of body heat.
b. the risk of infection.
c. the formation of scar tissue.
d. swelling and bruising.

Answer 11

a. the loss of body heat.
b. the risk of infection.
c. the formation of scar tissue.
d. swelling and bruising.

Answer: b
Objective: 18-5
Reference: 545

Question 12

Which of the following lists correctly names the layers of the skin?

a. Dermis, muscle, epidermis
b. Epidermis, subcutaneous, muscle
c. Dermis, subcutaneous, muscle
d. Subcutaneous, epidermis, dermis

Answer 12

a. Dermis, muscle, epidermis
b. Epidermis, subcutaneous, muscle
c. Dermis, subcutaneous, muscle
d. Subcutaneous, epidermis, dermis

Answer: d
Objective: 18-2
Reference: 539-540

Question 13

When managing a patient with soft-tissue injuries, it is essential that you:

a. thoroughly clean all lacerations.
b. control any bleeding with sterile dressings only.
c. use the appropriate personal protective equipment.
d. cover any hematomas with an occlusive dressing.

Answer 13

a. thoroughly clean all lacerations.
b. control any bleeding with sterile dressings only.
c. use the appropriate personal protective equipment.
d. cover any hematomas with an occlusive dressing.

Answer: c
Objective: 18-5
Reference: 551

Question 14

Assessment of a patient who fell reveals bruising to her right buttock. Her skin is intact and she complains of tenderness in the area when you palpate it. You would recognize which of the following types of injury?

a. An avulsion
b. An abrasion
c. An open injury
d. A contusion

Answer 14

a. An avulsion
b. An abrasion
c. An open injury
d. A contusion

Answer: d
Objective: 18-3
Reference: 543

Question 15

When assessing a patient you note a bruise on the chest. Another word for documenting a bruise is:

a. ecchymosis.
b. cyanosis.
c. erythematic.
d. hematoma.

Answer 15

a. ecchymosis.
b. cyanosis.
c. erythematic.
d. hematoma.

Answer: a
Objective: 18-3
Reference: 543

Question 16

Which of the following assessment findings best indicates that a patient’s injury should be classified as an abrasion?

a. Intact skin with ecchymosis noted; patient describes minor pain
b. Jagged breaks in the skin; bleeding moderate but controllable
c. Intact skin with a large accumulation of dark blood underneath
d. Red scrapes involving the outermost layer of skin only

Answer 16

a. Intact skin with ecchymosis noted; patient describes minor pain
b. Jagged breaks in the skin; bleeding moderate but controllable
c. Intact skin with a large accumulation of dark blood underneath
d. Red scrapes involving the outermost layer of skin only

Answer: d
Objective: 18-4
Reference: 546

Question 17

You respond to a patient who has an avulsion on the left arm. When you assess this patient, you would expect to find:

a. a loose flap of torn skin on the left arm.
b. abraded skin with an underlying bone fracture.
c. bruised skin with a piece of bone protruding from the left arm.
d. a long and deep laceration on the left arm.

Answer 17

a. a loose flap of torn skin on the left arm.
b. abraded skin with an underlying bone fracture.
c. bruised skin with a piece of bone protruding from the left arm.
d. a long and deep laceration on the left arm.

Answer: a
Objective: 18-4
Reference: 546-547

Question 18

A 49-year-old man was climbing on rocks when he fell backward to the ground. He presents with a two-inch linear wound on the top of his head. Bleeding has been controlled. You would document this type of injury as a(n):

a. avulsion.
b. contusion.
c. crushing injury.
d. laceration.

Answer 18

a. avulsion.
b. contusion.
c. crushing injury.
d. laceration.

Answer: d
Objective: 18-4
Reference: 546

Question 19

You are assessing a patient who received multiple injuries in a fight. Which of the following injuries would present the greatest danger for infection?

a. A contusion to the chin
b. A closed crushing injury to the thigh
c. An abrasion on the right side of the face
d. A hematoma in the left foot

Answer 19

a. A contusion to the chin
b. A closed crushing injury to the thigh
c. An abrasion on the right side of the face
d. A hematoma in the left foot

Answer: c
Objective: 18-4
Reference: 546

Question 20

Which of the following instructions is appropriate for helping a new patroller care for a patient with a large abrasion on his arm?

a. “When you are done cleaning the abrasion, apply some sterile gauze soaked in sterile saline.”
b. “It is best to let the wound bleed some. This is the body’s natural way of cleaning the wound.”
c. “Don’t worry about cleaning the wound. The patient is going to the hospital, which is only 30 minutes away.”
d. “Do not cut away the sleeve over the top of the laceration because that will restart the bleeding.”

Answer 20

a. “When you are done cleaning the abrasion, apply some sterile gauze soaked in sterile saline.”
b. “It is best to let the wound bleed some. This is the body’s natural way of cleaning the wound.”
c. “Don’t worry about cleaning the wound. The patient is going to the hospital, which is only 30 minutes away.”
d. “Do not cut away the sleeve over the top of the laceration because that will restart the bleeding.”

Answer: c
Objective: 18-5
Reference: 555

Question 21

A young boy was out riding his bike in the neighborhood when he fell onto a stick protruding from the ground. The stick impaled him in the neck. The boy immediately pulled the stick out. Assessment reveals a gaping wound to the boy’s right neck. Which of the following types of dressing would you use on this injury?

a. Sterile gauze carefully placed inside the open wound to control bleeding
b. An occlusive dressing that is taped on all sides
c. A sterile dressing placed over the wound and bandaged with roller gauze around the neck
d. A moist sterile dressing that is taped to the neck

Answer 21

a. Sterile gauze carefully placed inside the open wound to control bleeding
b. An occlusive dressing that is taped on all sides
c. A sterile dressing placed over the wound and bandaged with roller gauze around the neck
d. A moist sterile dressing that is taped to the neck

Answer: b
Objective: 18-5
Reference: 561

Question 22

A patient has had part of his right thumb amputated in an accident. Friends have retrieved the thumb and wrapped it in a towel. When you arrive, you would demonstrate appropriate handling of the amputated part by:

a. placing the thumb in a plastic bag filled with ice.
b. keeping the thumb in the towel.
c. placing the thumb in a container of sterile saline or sterile water.
d. wrapping the thumb in a moist sterile dressing and keeping it cool.

Answer 22

a. placing the thumb in a plastic bag filled with ice.
b. keeping the thumb in the towel.
c. placing the thumb in a container of sterile saline or sterile water.
d. wrapping the thumb in a moist sterile dressing and keeping it cool.

Answer: d
Objective: 18-5
Reference: 556

Question 23

Which of the following statements indicates that the speaker understands bandaging?

a. “Bandages are sterile gauze pads used to stop bleeding.”
b. “Bandaging material is used to secure a dressing in place.”
c. “Bandaging material must always be sterile.”
d. “After you apply a bandage, a dressing should always be put over it.”

Answer 23

a. “Bandages are sterile gauze pads used to stop bleeding.”
b. “Bandaging material is used to secure a dressing in place.”
c. “Bandaging material must always be sterile.”
d. “After you apply a bandage, a dressing should always be put over it.”

Answer: b
Objective: 18-7
Reference: 559

Question 24

Which of the following statements indicates that the speaker understands dressing and bandaging a wound?

a. “When applying a bandage over a dressing, apply it very tightly so the bandage won’t fall off.”
b. “If bleeding from a wound cannot be stopped initially with direct pressure, apply a bandage so you can take care of other injuries.”
c. “Leave the tips of the fingers or toes exposed when bandaging an arm or a leg so you can continue to assess CMS.”
d. “Place a bandage across the joint proximal to the wound because this helps control bleeding by applying pressure to the underlying blood vessels.”

Answer 24

a. “When applying a bandage over a dressing, apply it very tightly so the bandage won’t fall off.”
b. “If bleeding from a wound cannot be stopped initially with direct pressure, apply a bandage so you can take care of other injuries.”
c. “Leave the tips of the fingers or toes exposed when bandaging an arm or a leg so you can continue to assess CMS.”
d. “Place a bandage across the joint proximal to the wound because this helps control bleeding by applying pressure to the underlying blood vessels.”

Answer: c
Objective: 18-8
Reference: 560

Question 25

You have applied a pressure dressing to the calf of a woman who suffered a deep laceration from a piece of broken glass. Which of the following actions should you take next?

a. Apply a splint.
b. Obtain a follow-up blood pressure reading.
c. Apply a tourniquet above the laceration.
d. Check CMS in the patient’s foot.

Answer 25

a. Apply a splint.
b. Obtain a follow-up blood pressure reading.
c. Apply a tourniquet above the laceration.
d. Check CMS in the patient’s foot.

Answer: d
Objective: 18-8
Reference: 561

Question 26

Which of the following statements about pressure dressings and bandages is true?

a. All pressure dressings must be airtight to prevent contamination.
b. Bandages should be applied in a distal-to-proximal manner.
c. Dressings are placed over bandages.
d. Gauze should be placed in an open wound before a pressure dressing is applied.

Answer 26

a. All pressure dressings must be airtight to prevent contamination.
b. Bandages should be applied in a distal-to-proximal manner.
c. Dressings are placed over bandages.
d. Gauze should be placed in an open wound before a pressure dressing is applied.

Answer: b
Objective: 18-8
Reference: 561

Question 27

Which of the following injuries is most likely to result in capillary bleeding only?

a. An avulsion
b. An abrasion
c. A laceration
d. A penetration

Answer 27

a. An avulsion
b. An abrasion
c. A laceration
d. A penetration

Answer: b
Objective: 18-4
Reference: 546

Question 28

What is the function of subcutaneous fat?

a. It produces glucose needed for energy.
b. It has no real function and is unhealthy and detrimental to survival.
c. It always projects underlying organs from trauma.
d. It insulates the body and stores energy.

Answer 28

a. It produces glucose needed for energy.
b. It has no real function and is unhealthy and detrimental to survival.
c. It always projects underlying organs from trauma.
d. It insulates the body and stores energy.

Answer: d
Objective: 18-2
Reference: 540

Question 29

Which of the following phrases best describes a closed-tissue injury?

a. A wound that has scabbed over or healed
b. A wound in which platelets and proteins have formed a plug
c. A wound with no obviously visible opening, such as a needle stick
d. A wound in which underlying tissues are damaged but the overlying skin remains intact

Answer 29

a. A wound that has scabbed over or healed
b. A wound in which platelets and proteins have formed a plug
c. A wound with no obviously visible opening, such as a needle stick
d. A wound in which underlying tissues are damaged but the overlying skin remains intact

Answer: d
Objective: 18-3
Reference: 542

Question 30

Which of the following statements about impaled objects is true?

a. Allow only the patient to pull the impaled object out because that will hurt less.
b. The impaled object should be left in place during transport.
c. A wound made by an impaled object always bleeds profusely.
d. An impaled object never causes serious underlying tissue damage.

Answer 30

a. Allow only the patient to pull the impaled object out because that will hurt less.
b. The impaled object should be left in place during transport.
c. A wound made by an impaled object always bleeds profusely.
d. An impaled object never causes serious underlying tissue damage.

Answer: b
Objective: 18-4
Reference: 558

Question 31

Which of the following statements about a high-pressure injection injury is false?

a. The presenting wound is typically large.
b. The injury involves the introduction of a liquid or gas into the body from a pressurized source.
c. The injury often requires surgical amputation of the injured part.
d. The injury typically involves the limbs.

Answer 31

a. The presenting wound is typically large.
b. The injury involves the introduction of a liquid or gas into the body from a pressurized source.
c. The injury often requires surgical amputation of the injured part.
d. The injury typically involves the limbs.

Answer: a
Objective: 18-4
Reference: 548

Question 32

Mechanical tattooing is defined as:

a. a form of body art in which dye is injected under the skin.
b. a type of self-mutilation requiring psychiatric follow-up for the patient.
c. the introduction of foreign debris such as dirt, gunpowder, or small rocks into the skin.
d. multiple punctures made by a nail gun.

Answer 32

a. a form of body art in which dye is injected under the skin.
b. a type of self-mutilation requiring psychiatric follow-up for the patient.
c. the introduction of foreign debris such as dirt, gunpowder, or small rocks into the skin.
d. multiple punctures made by a nail gun.

Answer: c
Objective: 18-4
Reference: 549

Question 33

A patient has been stabbed in the chest with a 6-inch-long ice pick. When you assess the wound you find it to be very small and insignificant in appearance, with minimal bleeding. Which of the following assumptions can you correctly make about this injury?

a. The wound is most likely superficial.
b. Damage to the underlying structures is likely.
c. Not enough information is available to make any assumptions.
d. Because the entrance wound is small, severe bleeding is highly unlikely.

Answer 33

a. The wound is most likely superficial.
b. Damage to the underlying structures is likely.
c. Not enough information is available to make any assumptions.
d. Because the entrance wound is small, severe bleeding is highly unlikely.

Answer: b
Objective: 18-4
Reference: 547

Question 34

For which of the following injuries may elevation be used to control bleeding?

a. For a laceration to the flank
b. For no injuries; elevation is no longer used to control bleeding.
c. For an abrasion on the lower back
d. For a puncture wound to the abdomen

Answer 34

a. For a laceration to the flank
b. For no injuries; elevation is no longer used to control bleeding.
c. For an abrasion on the lower back
d. For a puncture wound to the abdomen

Answer: b
Objective: 18-6
Reference: 553

Question 35

Which of the following statements about the use of a tourniquet is true?

a. It should be placed as distal as possible but at least several inches proximal to the wound.
b. It can be used on most any part of the body except the neck.
c. On an arm or leg, it should be placed 1 inch from either the elbow or knee.
d. Tourniquets are a last resort and should be used rarely, if ever.

Answer 35

a. It should be placed as distal as possible but at least several inches proximal to the wound.
b. It can be used on most any part of the body except the neck.
c. On an arm or leg, it should be placed 1 inch from either the elbow or knee.
d. Tourniquets are a last resort and should be used rarely, if ever.

Answer: a
Objective: 18-8
Reference: 554

Question 36

Using a very narrow material such as wire or rope for a tourniquet can cause:

a. serious tissue damage.
b. inadequate pressure to control bleeding.
c. worse bleeding.
d. venous pooling.

Answer 36

a. serious tissue damage.
b. inadequate pressure to control bleeding.
c. worse bleeding.
d. venous pooling.

Answer: a
Objective: 18-8
Reference: 554

Question 37

The most effective method for treating a contusion is to apply a(n):

a. pressure dressing.
b. tourniquet.
c. bandage.
d. ice pack.

Answer 37

a. pressure dressing.
b. tourniquet.
c. bandage.
d. ice pack.

Answer: d
Objective: 18-5
Reference: 555

Question 38

Which of the following statements about amputations is true?

a. An amputation involves a completely severed body part.
b. A badly mangled or damaged amputated part should not be preserved or sent to the hospital because it cannot be reattached.
c. Surgeons can reattach an amputated part only if it has been without a blood supply for less than one hour.
d. All amputated body parts should be preserved and sent to the hospital with the patient.

Answer 38

a. An amputation involves a completely severed body part.
b. A badly mangled or damaged amputated part should not be preserved or sent to the hospital because it cannot be reattached.
c. Surgeons can reattach an amputated part only if it has been without a blood supply for less than one hour.
d. All amputated body parts should be preserved and sent to the hospital with the patient.

Answer: d
Objective: 18-5
Reference: 556

Question 39

Which of the following statements about an impaled object is true?

a. The primary treatment goal in the field is to stabilize the object in the position found.
b. The primary treatment in the field is to remove the object without causing further bleeding or causing as little bleeding as possible.
c. OEC Technicians may remove only objects that are impaled in an extremity.
d. OEC Technicians may remove objects that are impaled in the chest or abdomen.

Answer 39

a. The primary treatment goal in the field is to stabilize the object in the position found.
b. The primary treatment in the field is to remove the object without causing further bleeding or causing as little bleeding as possible.
c. OEC Technicians may remove only objects that are impaled in an extremity.
d. OEC Technicians may remove objects that are impaled in the chest or abdomen.

Answer: a
Objective: 18-5
Reference: 558

Question 40

During your secondary assessment, a patient with a stab wound to the abdomen tells you that he is taking Coumadin, a blood thinner. Which of the following implications would taking this medication have for this patient?

a. The medication would not affect the patient or the care you provide.
b. The medication would cause this patient’s blood to clot more quickly, thereby minimizing any bleeding that might occur.
c. The medication could cause the patient to bleed more profusely.
d. The medication would reduce the patient’s blood pressure, so bleeding would be less profuse.

Answer 40

a. The medication would not affect the patient or the care you provide.
b. The medication would cause this patient’s blood to clot more quickly, thereby minimizing any bleeding that might occur.
c. The medication could cause the patient to bleed more profusely.
d. The medication would reduce the patient’s blood pressure, so bleeding would be less profuse.

Answer: c
Objective: 18-5
Reference: 542, 553