Chapter 30 - [additional] Chest Injuries

Question 1

Beck’s Triad

Answer 1

• low BP
• jugular vein distention
• muffled/diminished heart sounds

… cardiac tamponade

Question 2

When the chest impacts the steering wheel during a motor vehicle crash with rapid deceleration, the resulting injury that kills almost one-third of patients, usually within seconds, is:
A. a hemothorax.
B. aortic shearing.
C. a pneumothorax.
D. a ruptured myocardium.

Answer 2

B. aortic shearing.

Question 3

Signs and symptoms of a chest injury include all of the following, EXCEPT:
A. hemoptysis.
B. hematemesis.
C. asymmetric chest movement.
D. increased pain with breathing.

Answer 3

B. hematemesis.

Question 4

During your assessment of a patient who was stabbed, you see an open wound to the left anterior chest. Your MOST immediate action should be to:
A. position the patient on the affected side.
B. transport immediately.
C. assess the patient for a tension pneumothorax.
D. cover the wound with an occlusive dressing.

Answer 4

D. cover the wound with an occlusive dressing

Question 5

When caring for a patient with signs of a pneumothorax, your MOST immediate concern should be:
A. hypovolemia.
B. intrathoracic bleeding.
C. ventilatory inadequacy.
D. associated myocardial injury.

Answer 5

C. ventilatory inadequacy.

Question 6

What purpose does a one-way “flutter valve” serve when used on a patient with an open pneumothorax?
A. It prevents air escape from within the chest cavity.
B. It allows the release of air trapped in the pleural space.
C. It only prevents air from entering an open chest wound.
D. It allows air to freely move in and out of the chest cavity.

Answer 6

B. It allows the release of air trapped in the pleural space.

Question 7

Signs of a cardiac tamponade include all of the following, EXCEPT:
A. muffled heart tones.
B. a weak, rapid pulse.
C. collapsed jugular veins.
D. narrowing pulse pressure.

Answer 7

C. collapsed jugular veins.

Cardiac tamponade, which is almost always caused by penetrating chest trauma, occurs when blood accumulates in the pericardial sac.

Question 8

A patient experienced a severe compression to the chest when trapped between a vehicle and a brick wall. You suspect traumatic asphyxia due to the hemorrhage into the sclera of his eyes and which other sign?
A. Flat neck veins
B. Cyanosis in the face and neck
C. Asymmetric chest movement
D. Irregular heart rate

Answer 8

B. Cyanosis in the face and neck

Question 9

14-year-old baseball player was hit in the chest with a line drive. He is in cardiac arrest. Which of the following is the most likely explanation?
A. Myocardial contusion
B. Traumatic asphyxia
C. Commotio cordis
D. Hemothorax

Answer 9

C. Commotio cordis

Question 10

A40-year-old man, who was the unrestrained driver of a car that hit a tree at a high rate of speed, struck the steering wheel with his chest. He has a large bruise over the sternum and an irregular pulse rate of 120 beats/min. You should be MOST concerned that he:
A. has injured his myocardium.
B. has a collapsed lung and severe hypoxia.
C. has extensive bleeding into the pericardial sac.
D. is at extremely high risk for ventricular fibrillation.

Answer 10

A. has injured his myocardium.

In some cases, the injury may be so severe that it renders the heart unable to maintain adequate cardiac output; as a result, blood pressure falls. The pulse rate is often irregular; however, lethal cardiac dysrhythmias such as ventricular tachycardia and ventricular fibrillation are uncommon.

Question 11

Which of the following organs or structures does not reside within the mediastinum?
Select one:
A.
Lungs
B.
Vena cavae
C.
Trachea
D.
Esophagus

Answer 11

A.
Lungs

Question 12

While jogging, a 19-year-old male experienced an acute onset of shortness 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:
Select one:
A.
administer oxygen and transport to the hospital.
B.
immediately perform a rapid head-to-toe exam.
C.
circumferentially tape a dressing around his chest.
D.
recognize that he needs a needle decompression.

Answer 12

A.
administer oxygen and transport to the hospital.

Question 13

A rapid, irregular pulse following blunt trauma to the chest is most suggestive of a:
Select one:
A.
pericardial tamponade.
B.
myocardial contusion.
C.
ruptured aorta.
D.
tension pneumothorax.

Answer 13

B.
myocardial contusion.

Question 14

Subcutaneous emphysema is an indication that:
Select one:
A.
at least half of one lung has completely collapsed.
B.
air is escaping into the chest wall from a damaged lung.
C.
blood is slowly accumulating within the tissue of the lung.
D.
your patient is experiencing a pericardial tamponade

Answer 14

B.
air is escaping into the chest wall from a damaged lung.

Question 15

Very young children tend to breathe predominantly with their diaphragm because:
Select one:
A.
there is no nerve innervation of the intercostal muscles.
B.
they require less tidal volume per breath.
C.
their chest wall and ribs are very pliable.
D.
their intercostal muscles are not fully developed.

Answer 15

D.
their intercostal muscles are not fully developed.

Question 16

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?
Select one:
A.
Widening pulse pressure
B.
Engorged jugular veins
C.
A rapid, irregular pulse
D.
Diminished breath sounds

Answer 16

B.
Engorged jugular veins

Question 17

The ________ nerves supply the diaphragm.
Select one:
A.
phrenic
B.
intercostal
C.
vagus
D.
costal

Answer 17

A.
phrenic