chapter 3 extended Flashcards
Which of the following guidelines applies to the prehospital administration of IV fluids in the
patient with hemorrhagic shock?
A) Administer hypertonic saline solution or colloids at a keep-open rate.
B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of
consciousness.
C) Begin with a 2,000 mL bolus of isotonic crystalloid solution infused under pressure.
D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion.
Administer isotonic crystalloid fluids only as necessary to maintain perfusion
Your patient is a 23-year-old man with a gunshot wound to the abdomen and an exit wound in
the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart
rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of
the following kind of shock?
A) Compensated
B) Irreversible
C) Decompensated
D) Neurogenic
Decompensated
As a patient with hemorrhagic blood loss becomes more acidotic, what homeostatic process is usually impaired? A) Coagulation B) Hemoptysis C) Vascular phase D) Aerobic metabolism
coagulation
) Your patient is a 42-year-old man with multiple lacerations on his arms, head, and torso after
falling through a plate-glass window. On your arrival, he appears to be unresponsive, lying prone
on the sidewalk. Which of the following is the correct sequence of actions in caring for this
patient?
1. Control major hemorrhage.
2. Take Standard Precautions.
3. Check the area for broken glass before kneeling next to the patient.
4. Turn him to a supine position.
5. Open his airway.
A) 2, 3, 1, 4, 5
B) 2, 5, 1, 3, 4
C) 2, 3, 4, 1, 5
D) 2, 3, 4, 5, 1
2, 3, 4, 1, 5
Managing a laceration with arterial bleeding most often requires: A) cauterization. B) a tourniquet. C) PASG. D) direct pressure.
direct pressure
Which of the following patients with hemorrhagic shock is likely to be internally bleeding,
solely?
A) A 50-year-old man with a stab wound to the neck
B) A 45-year-old woman with a suspected ruptured ectopic pregnancy
C) A 38-year-old man with an open femur fracture
D) A 26-year-old man with a gunshot wound involving the popliteal artery
a 45 year old woman with a suspected ruptured ectopic pregnancy
When a patient has lost 2 liters or more of blood from hemorrhage, which classification is that? A) I B) III C) IV D) II
IV
Which of the following is defined as the volume of blood ejected from the heart with each beat? A) Stroke volume B) Ventricular capacitance C) Cardiac output D) Afterload
stroke volume
) A fracture of the femur may result in a hematoma that contains enough blood to make it a class \_\_\_\_\_\_\_\_ hemorrhage. A) I B) III C) IV D) II
III
Your patient is a 45-year-old man who has received several stab wounds to the chest and
abdomen. Although bleeding was significant at first, the rate of bleeding had slowed
considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool
to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28
and shallow. Which of the following is certain with this patient?
A) He is in irreversible shock.
B) He is in decompensated shock.
C) He is in compensated shock.
D) None of the above is certain.
he is in decompensated shock
Peripheral vascular resistance is measured as which of the following? A) Pulse pressure B) Mean arterial pressure C) Hydrostatic pressure D) Oncotic pressure
mean arterial pressure
Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock? A) Fresh frozen plasma B) Lactated Ringer's C) Whole blood D) Normal saline
whole blood
) The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the \_\_\_\_\_\_\_\_ phase. A) hemolytic B) hemostatic C) vascular D) ischemic
vascular
Which of the following findings indicates a progression from compensated shock to decompensated shock? A) Narrowing pulse pressure B) Tachycardia C) Altered mental status D) Diaphoresis
altered mental status
When assessing the chest during a rapid trauma assessment, what is MOST likely to indicate major internal hemorrhage? A) Hyporesonance to percussion B) Increased respiratory rate C) Distended neck veins D) Muffled heart tones
hyporesonance to percussion
Which type of wound facilitates the effectiveness of normal blood clotting mechanisms?
A) Vessels torn by stretching, such as when a limb is caught in farm machinery
B) Transverse laceration of the vessel
C) Longitudinal laceration of the vessel
D) Crushing injuries
transverse laceration of the vessel
Which of the following mechanisms is responsible for accumulating lactic acid in shock? A) The citric acid cycle B) Gluconeogenesis C) Hemostasis D) Anaerobic metabolism
anerobic metabolism
A hematoma resulting from a fracture of the humerus may contain enough blood to make it a class \_\_\_\_\_\_\_\_ hemorrhage. A) II B) IV C) III D) I
I
Which of the following does NOT indicate compensated shock? A) Anxiety B) Altered mental status C) Weakness D) Thirst
altered mental status
What is the best course of action in the case of hemorrhage from either the nose or ear canal?
A) Cover the area with a soft, porous dressing
B) Apply direct pressure to the upper face
C) Squeeze the nostrils closed
D) Apply pressure to the forehead
cover the area with a soft porous dressing
) Even with intervention, survival is unlikely with blood loss over \_\_\_\_\_\_\_\_ percent of the total blood volume. A) 25 B) 15 C) 50 D) 35
35
) Which of the following indicates that a patient has transitioned from compensated to decompensated shock? A) Widening pulse pressure B) Increased respiratory rate C) Hypotension D) Peripheral vasoconstriction
hypotension
Red blood cells make up approximately \_\_\_\_\_\_\_\_ percent of whole blood volume. A) 45 B) 60 C) 30 D) 15
45
Which of the following is a manifestation of orthostatic hypotension?
A) Your patient’s pulse is 76 when he is supine but 88 when he sits up.
B) Your patient’s blood pressure is 142/90 when she is supine but 116/88 when she sits up.
C) Your patient’s blood pressure is 150/100 when he is supine but 134/90 when he sits up.
D) Your patient’s pulse is 80 when she is supine but 96 when she sits up.
your patients blood pressure is 142/90 when she is supine but 116/88 when she sits up
What method of controlling hemmorage should be done as a last resort?
A) Elevation
B) Direct pressure
C) Tourniquet
D) Packing the wound with bandages and dressings
tournaquet
) The blood flowing to the heart best describes: A) contractility. B) afterload. C) preload. D) vascular phase.
preload
) Under normal circumstances, at any given moment most of the blood is in the \_\_\_\_\_\_\_\_ system. A) venous B) capillary C) hematopoietic D) arterial
venous
Which of the following best describes definitive care for the trauma patient with ongoing,
significant hemorrhage?
A) Administration of blood or blood products
B) Administration of hypertonic crystalloid or colloid solution
C) Invasive hemodynamic monitoring and serial hematocrits
D) Immediate surgery
immediate surgery
Which of the following impairs blood clotting?
A) Hypothermia
B) Administration of IV fluids
C) Use of nonsteroidal, anti-inflammatory medications
D) All of the above
all of the above
The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas? 1. Head 2. Neck 3. Chest 4. Abdomen 5. Pelvis 6. Proximal extremities 7. Distal extremities A) 1, 2, 3, 4, and 5 B) 1, 4, 5, and 6 C) 1, 2, 3, 4, 5, 6, and 7 D) 3, 4, 5, and 6
1, 2, 3, 4, and 5
Which of the following statements about the patient in neurogenic shock is FALSE?
A) Signs of hypovolemic shock may be masked.
B) Unopposed sympathetic nervous stimulation results in systemic pallor and diaphoresis.
C) Can present with neck and/or back pain.
D) Neurogenic shock may require IV fluid resuscitation
unopposed sympathetic nervous stimulation results in systemic pallor and diaphoresis
Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle
collision. Which of the following should you remember when assessing and treating this patient?
A) Relative to body size, this patient can tolerate a larger amount of hemorrhage before showing
signs of shock.
B) This patient will tolerate blood loss well, as only non-vital tissues will become ischemic.
C) Relative to body weight, a smaller amount of hemorrhage may result in shock.
D) Blood volume increases proportionally with body weight, and the patient will experience
signs of shock consistent with the classic stages of hemorrhage.
relative to body weight a smaller amount of hemorrhage may result in shock
Which of the following fluids is appropriate for the prehospital management of hypovolemic shock? A) Five percent dextrose in water B) Lactated Ringer's C) A 0.2% sodium chloride solution D) A 0.45% sodium chloride solution
lactated ringers
Which of the following would be the MOST likely cause of neurogenic shock? A) Pericardial tamponade B) Spinal cord injury C) Systemic infection D) Massive histamine release
spinal cord injury
Rapid volume replacement is best achieved under which of the following conditions?
A) Use of a long catheter with a large internal diameter
B) Use of a long catheter with a small internal diameter
C) Use of a short catheter with a small internal diameter
D) Use of a short catheter with a large internal diameter
use of a short catheter with a large internal diameter
Which of the following vessels has the greatest ability to change diameter? A) Arteriole B) Capillary C) Systemic artery D) Aorta
arteriole
Your patient is a 29-year-old man who works in a meat-processing plant. He received a knife
wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is
restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood
pressure of 118/88 mmHg. This patient is exhibiting signs and symptoms consistent with a class
________ hemorrhage.
A) III
B) II
C) IV
D) I
II
Which of the following early signs of shock is easily missed?
A) Tachycardia
B) Decrease in respiratory rate and volume
C) Decrease in blood pressure
D) Narrowing pulse pressure
tachycardia
Which of the following is TRUE of the elderly trauma patient?
A) The elderly trauma patient is more likely to experience myocardial ischemia as a result of
hemorrhage.
B) Medications like beta-blockers may interfere with normal compensatory mechanisms.
C) Hemorrhage may not result in tachycardia as expected.
D) All of the above are true
all of the above are true
Which of the following is NOT a characteristic of arterial bleeding?
A) Rapid blood loss
B) Spurting or pumping as it leaves the body
C) Clots quickly on its own
D) Bright re
clots quickly on its own
In responding to a trauma patient at the scene of a motor vehicle crash, which of the
following is an early sign or signs of shock you might encounter during the primary assessment?
A) Rapid heart rate and anxiety
B) Rapidly dropping blood pressure
C) Rapid breathing and air hunger
D) Rapidly dropping level of responsiveness
rapid heart rate and anxiety
) Which of the following represents the correct sequence for controlling hemorrhage from an
extremity?
A) Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking
vessel, and, if pressure fails, application of a tourniquet
B) Direct pressure on the dressing and wound, elevation, ice
C) Finger pressure through the dressing to the leaking vessel, splinting, ice, elevation
D) Direct pressure on the dressing and wound, elevation, ice, tourniquet as a last resort
direct pressure on the dressing and wound finer pressure through the dressing to the leaking vessel and if pressure fails application of a tourniquet
) Which of the following terms is best described as the loss of blood from the vascular space? A) Hypovolemia B) Hemorrhage C) Hemostasis D) Shock
hemorrhage
Brighter red, slow, oozing blood flow is characteristic of which type of hemorrhage? A) Arterial B) Venous C) Capillary D) Arteriole
capillary
Which of the following may move more slowly through the early stages of hemorrhage with
greater loss percentages needed to transition from one stage class to another?
A) Elderly patients
B) Infants
C) Alcoholics
D) Athletes
athletes
In which stage of shock are the body’s cells are so badly injured and die in such quantities
that organs no longer are able to function normally?
A) Decompensated
B) Irreversible
C) Compensated
D) Class I
irreversible
Which of the following findings is NOT likely with a patient in cardiogenic shock? A) Pulmonary edema B) Excessive urination C) Arrhythmias D) Jugular vein distention
excessive urination
) What is the mechanism of TXA? A) Antifibrinolytic B) Coagulopathy C) Thrombocytopenia D) Development of metabolic acidosis
antifibrinolytic
Which of the following vessels does NOT make up the microcirculation in the circulatory system? A) Arterioles B) Capillaries C) Venules D) Veins
veins
Blood present in the stool of a patient is known as: A) hemoptysis. B) hematemesis. C) hematochezia. D) hemorrhage.
hematochezia
