Chapter 26: Emergency or Life-Threatening Situations

Question 1

During initial ABCDE assessments of life-threatening conditions, D (disability) in neurologic
status is assessed by the patient’s
a. pupil size.
b. degree of responsiveness.
c. nuchal rigidity.
d. mood and affect.

Answer 1

ANS: B
The D (disability) in neurologic status of the primary assessment is assessed by determination
of the patient’s degree of responsiveness to stimuli.

Question 2

You have gone by ambulance to a construction site where an adult male is lying on the street.
The only information you have is that he fell three stories. His neck is immobilized with sacks
of concrete mix on either side. Your first action should be to determine
a. airway patency.
b. bleeding sites.
c. cranial nerve function.
d. limb position.

Answer 2

ANS: A
On arriving at the site, the patency of the upper airway is the priority and should be managed
before proceeding with further assessments.

Question 3

The ABCs of a primary survey would be interrupted to
a. complete the assessment record.
b. manage life-threatening conditions.
c. reassess the patient’s temperature.
d. transport the patient via airlift.

Answer 3

ANS: B
The primary assessment is interrupted to manage a life-threatening condition as soon as it is detected. Once the condition is stabilized, the primary assessment is continued. Recording of
events as they occur should be completed in a manner that does not interrupt continued care or
transport. Reassessment of the patient’s temperature is inappropriate because it would
interrupt the continued assessment process. Transporting the patient may begin after the
primary assessment has been completed to determine the needs of the patient adequately.

Question 4

The term status epilepticus is defined as
a. convulsive activity uncontrolled by medication.
b. nonconvulsive brain wave disturbance, with psychomotor dysfunction.
c. prolonged seizures that occur without recovery of consciousness.
d. seizures that result in hypotension, pallor, and prolonged diaphoresis.

Answer 4

ANS: C
Status epilepticus is a prolonged seizure or series of seizures that occur without recovery of
consciousness

Question 5

Pulsus paradoxus greater than 20 mm Hg, tachycardia greater than 130 beats/min, and
increasing dyspnea are signs of
a. intracranial pressure.
b. pulmonary hypertension.
c. status asthmaticus.
d. tetanic contractions.

Answer 5

ANS: C
Status asthmaticus is a severe and prolonged asthma attack that resists the usual therapeutic
approaches. The patient experiences dyspnea, can only get out a few words between breaths,
and has tachycardia often greater than 130 beats/min and pulsus paradoxus greater than 20
mm Hg. Pulsus paradoxus is more likely in pericardial effusion, constrictive pericarditis, and
severe asthma.

Question 6

The Cushing triad includes
a. tachycardia.
b. irregular respirations.
c. tachypnea.
d. constricted pupils.

Answer 6

ANS: B
The Cushing triad is associated with increased intracranial pressure. It includes bradycardia,
hypertension, and irregular respirations, even Cheyne-Stokes respirations.

Question 7

Blood, vomitus, and foreign bodies are removed from the oropharynx of the unconscious
patient by
a. stimulating the cough reflex.
b. using a sweeping motion with the finger.
c. performing a back thrust.
d. using suction.

Answer 7

ANS: D
Suction is used to remove blood, vomitus, or foreign bodies from the airway of an
unconscious patient. The other choices put the patient at risk for aspiration or further injury if
a neck injury is involved.

Question 8

While performing the primary survey on a trauma victim, the patient is answering your
questions. You may assume that during the time of the questioning
a. his airway is open.
b. he is alert and oriented.
c. no head injury has occurred.
d. there is no respiratory compromise.

Answer 8

ANS: A
The patency of the upper airway is assessed at the start by asking the patient a question. If the
patient answers, this is a sign that the airway is open at this time

Question 9

If trauma above the clavicle is suspected, it is important to
a. test range of motion of the neck.
b. remove any headgear.
c. arrange for neck extension x-ray studies.
d. stabilize the neck in a neutral position.

Answer 9

ANS: D
If trauma above the clavicle is suspected, it is necessary to control the cervical spine by
stabilizing the neck in a neutral position. Excessive movement can convert a fracture or
dislocation without neurologic damage to one with neurologic damage.

Question 10

Paradoxical chest movement suggests a
a. spontaneous pneumothorax.
b. flail chest.
c. clavicle fracture.
d. pulmonary contusion.

Answer 10

ANS: B
Paradoxical chest movement is associated with fractured ribs or a flail chest. This fracture
should be stabilized immediately.

Question 11

Respiratory distress may be evidenced by
a. retractions of accessory muscles.
b. bradycardia.
c. flushed skin.
d. decreased capillary refill time.

Answer 11

ANS: A
Respiratory distress results in an increased intrathoracic negative pressure as the body
attempts to suck in more atmospheric air. This increased negative pressure causes the chest
wall skin to retract around the ribs during inspiration. The other choices are related to
cardiovascular distress.

Question 12

On palpating the chest wall of a trauma patient, you feel subcutaneous crepitus (emphysema),
which is a sign that
a. air has leaked into soft tissue.
b. a fracture underlies the injury.
c. a foreign body is present.
d. there is vascular obstruction.

Answer 12

ANS: A
Crepitus is a sign of air leakage into soft tissue. Crepitus in soft tissues is caused by air that
has penetrated the area as a result of injury; it is also referred to as subcutaneous emphysema.
Bony crepitus is a grating or grinding sensation caused by fractured bone ends or joints
rubbing together. A foreign body could obstruct the patient’s airway, producing stridor, or a
bark may be heard with an obstructed airway.

Question 13

Clear or amber drainage from the nose or ears of a blunt trauma patient may indicate
a. epiglottitis.
b. a retropharyngeal abscess.
c. a basilar skull fracture.
d. a perforated tympanic membrane.

Answer 13

ANS: C
Clear or amber drainage from the nose or ears may indicate a basilar skull fracture. Bloody
drainage is associated with a perforated tympanic membrane

Question 14

Delayed capillary refill may alert you to
a. hypovolemic shock.
b. moderate hypoxemia.
c. subnormal intracranial pressure.
d. upper respiratory infection.

Answer 14

ANS: A
Delayed capillary refill means that the vessels are taking an extended time to fill, which is a
sign of decreased cardiac output. To assess peripheral perfusion further and detect
hypovolemic shock, note the skin color, presence and quality of pulses, and temperature of the
extremities.

Question 15

Capillary refill can be assessed by applying pressure over a nail bed or a(n)
a. bony prominence.
b. eyelid.
c. mucous membrane.
d. femoral vein.

Answer 15

ANS: A
Capillary refill can be assessed by pressing firmly over a nail bed or bony prominence such as
the chin, forehead, or sternum until the skin blanches. Count the seconds it takes for color to
return. Less than 2 seconds is a normal finding, and longer than 2 seconds indicates poor
perfusion.

Question 16

The secondary survey of a patient with hypotension would begin with the assessment of
a. blood type.
b. level of consciousness.
c. number of fractures.
d. swallowing ability.

Answer 16

ANS: B
Secondary assessments are done after life-threatening problems are determined. For the
hypotensive patient, it would be most important to begin secondary assessment of cerebral
perfusion by determining the patient’s level of consciousness.

Question 17

You would complete a Glasgow Coma Scale rating during the
a. health history.
b. physical examination.
c. primary survey.
d. secondary survey

Answer 17

ANS: D
During the secondary survey, the full range of injuries is determined. The level of
consciousness is determined, and the Glasgow Coma Scale is scored as indicated.

Question 18

Mr. Stinson is a 34-year-old patient who presents to the emergency department after an auto accident. On examination, you note raccoon eyes and a positive Battle sign. Raccoon eyes and the Battle sign are associated with
a. multisystem trauma.
b. orbital fractures.
c. basilar skull fractures.
d. subdural hematoma.

Answer 18

ANS: C
Raccoon eyes (bruising around the eyes) and the Battle sign (bruising behind the ears) both
indicate a basilar skull fracture. Symptoms of orbital fractures are swelling of the eyelid,
bruising of the eye, pain in the eye, double vision, and decreased movement of the affected
eye. Signs and symptoms of a subdural hematoma are loss of consciousness after the original
injury, steady or fluctuating headache, weakness, numbness or inability to speak, slurred
speech, nausea, vomiting, lethargy, and seizures.

Question 19

A life-threatening condition is recognized with the assessment of
a. pain with downward pressure on both anterior superior iliac spines.
b. guarding and intense pain with deep palpation of the abdomen.
c. distant and muffled heart sounds, with distended neck veins.
d. severe throbbing pain in one eye, with photophobia.

Answer 19

ANS: C
Distant, muffled heart sounds and distended neck veins may indicate cardiac tamponade, a
life-threatening condition. Iliac spine pain indicates a pelvic fracture that may become
life-threatening depending on the extent of occult bleeding. Intense pain with deep palpation
is not certain to be deadly. Eye pain with photophobia signals acute glaucoma, which can lead
to blindness if treatment is delayed.

Question 20

The application of blunt sternal pressure is used to detect
a. a fracture of attached ribs.
b. the motor function of the T7 dermatome.
c. pneumothorax.
d. cardiac contusion.

Answer 20

ANS: A
Blunt sternal pressure will be painful if any attached ribs are fractured. Sternal pressure is
applied to the chest to assess the stability of the chest wall.

Question 21

Until they are stabilized, trauma patients require reevaluation
a. every 2 minutes.
b. every 5 minutes.
c. every 10 minutes.
d. every hour.

Answer 21

ANS: B
An unstable patient must be reevaluated frequently so that any new signs and symptoms are
not overlooked. A primary survey should be performed every 5 minutes and the results
compared with those obtained in previous surveys.

Question 22

During injury assessment, one of the most crucial historical components is
a. number of siblings.
b. history of prior fractures.
c. mechanism of injury.
d. past and current occupational exposure

Answer 22

ANS: C
In cases of trauma, the secondary assessment is intended to identify the full range of injuries,
with particular focus on body systems affected by the mechanism of injury. All the other
choices are not crucial for the emergency.

Question 23

Which condition manifests as unexplained shortness of breath (SOB) and cough with
hemoptysis?
a. Bleeding ulcer
b. Myocardial infarction
c. Pulmonary embolism
d. Transient ischemia

Answer 23

ANS: C
Symptoms of pulmonary embolism include sudden onset of unexplained SOB, pleuritic chest
pain, and coughing, with pink frothy sputum. Bleeding ulcer symptoms are coffee grounds
emesis with gnawing pain in the upper abdomen. Myocardial infarction is signified by
crushing pain in the center of the chest radiating to the arm, neck, or jaw, diaphoresis, nausea
and vomiting, SOB, and a feeling of impending doom. Transient ischemia occurs with a
sudden feeling of weakness and loss of movement of the arms or legs, numbness and/or
tingling in any part of the body, excruciating headache, and/or difficulty speaking

Question 24

Which injury is the most common precipitator of blunt trauma?
a. Age-related falls
b. Motor vehicle accidents
c. Work-related injuries
d. Childhood play injuries

Answer 24

ANS: B
Motor vehicle accidents account for the majority of severe blunt trauma cases.

Question 25

When calculating the force of impact of a penetrating object, use
a. the size of the missile and size of the patient.
b. the time of the incident and depth of the wound.
c. the amount of blood loss and level of consciousness.
d. the velocity of the missile and distance from the source.

Answer 25

ANS: D
When calculating the force of impact of a penetrating object, the amount of force is measured
by the velocity of the missile and distance from the source. The force of the penetrating object
on impact determines the transfer of energy.

Question 26

Adults and children display different physiologic responses to injury and acute illness. An
important concept to remember when assessing infants and children is that they
a. experience lethal dysrhythmias first, progressing to respiratory failure.
b. usually experience cardiac arrest before respiratory failure.
c. usually experience respiratory arrest before circulatory failure.
d. tolerate greater volume changes, with less severe consequences.

Answer 26

ANS: C
Cardiac arrest is rarely a primary event in children, as it is in adults. The child usually
experiences respiratory and ventilatory failure that progresses to respiratory arrest first.
Without rapid intervention, a cardiac arrest occurs as a secondary event

Question 27

The approximate expected systolic blood pressure for a child older than 1 year is
a. 120 + child’s age in years.
b. 80 – child’s age in years.
c. 120 – child’s age in years.
d. 80 + (the child’s age in years).

Answer 27

ANS: D
Use the equation 80 + (the child’s age in years) to calculate the expected systolic blood
pressure for a child older than 1 year.

Question 28

In life-threatening emergencies, consent for treatment
a. is obtained before treatment to protect the facility from liability.
b. is not necessary.
c. occurs after treatment is administered.
d. is not valid because the patient is not competent.

Answer 28

ANS: C
In life-threatening emergencies, the needed treatment should usually be given and formal
consent obtained later.