Module 7

Question 1

Early signs and symptoms of increased intracranial pressure include:

A) headache and vomiting.
B) hypertension and bradycardia.
C) widening of the pulse pressure.
D) arm flexion and leg extension.

Answer 1

A) headache and vomiting.

Question 2

Signs of neurogenic shock include all of the following, EXCEPT:

A) bradycardia.
B) flushed skin.
C) diaphoresis.
D) hypothermia.

Answer 2

C) diaphoresis.

Question 3

Hypotension that is associated with neurogenic shock is the result of:

A) loss of alpha receptor stimulation.
B) concomitant internal hemorrhage.
C) increased peripheral vascular tone.
D) profound peripheral vasoconstriction.

Answer 3

A) loss of alpha receptor stimulation.

Question 4

Treatment for a patient with neurogenic shock may include all of the following, EXCEPT:

A) a vagolytic medication.
B) a vasopressor medication.
C) prevention of hyperthermia.
D) fluid volume to maintain perfusion.

Answer 4

C) prevention of hyperthermia.

Question 5

Spinal cord injuries that cause neurogenic shock generally produce:

A) cool, clammy skin distal to the site of the spinal cord injury.
B) reflex tachycardia due to sympathetic nervous system stimulation.
C) flaccid paralysis and complete loss of sensation distal to the injury.
D) signs and symptoms that are identical to those of hypovolemic shock.

Answer 5

C) flaccid paralysis and complete loss of sensation distal to the injury.

Question 6

A 39-year-old man crashed his vehicle into a wooded area and was not found for approximately 8 hours. When you arrive at the scene and assess him, you note that he is conscious but anxious. He is unable to feel or move below his mid-thoracic area and complains of a severe headache. His blood pressure is 210/130 mm Hg, heart rate is 44 beats/min, and respirations are 22 breaths/min. This patient’s clinical presentation is MOST consistent with:

A) neurogenic shock.
B) intracranial pressure.
C) autonomic dysreflexia.
D) symptomatic bradycardia.

Answer 6

C) autonomic dysreflexia.

Question 7

A diffuse axonal injury:

A) is a specific, grossly observable brain injury that can easily be diagnosed with a computer tomography scan of the head.

B) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

C) results in severe stretching or tearing of the portion of the nerve cell that receives sensory messages from the rest of the body.

D) is generally associated with better neurologic outcomes than a cerebral concussion because permanent brain damage does not occur.

Answer 7

B) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

Question 8

A moderate diffuse axonal injury:

A) is generally characterized by a brief loss of consciousness, with or without retrograde amnesia.

B) causes a prolonged loss of consciousness and affects axons in both cerebral hemispheres.

C) is the most common result of blunt head trauma and is associated with temporary neuronal dysfunction.

D) produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.

Answer 8

D) produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.

Question 9

A subluxation occurs when:

A) a joint is partially dislocated.
B) a dislocation spontaneously reduces.
C) a fracture occurs through both cortices.
D) dislocated bones are locked in position.

Answer 9

A) a joint is partially dislocated.

Question 10

The sudden twisting of a joint beyond its normal range of motion, causing a temporary subluxation, is called a:

A) strain.
B) sprain.
C) dislocation.
D) fracture-dislocation.

Answer 10

B) sprain.

Question 11

Autoregulation is defined as:

A) reflex bradycardia that occurs secondary to systemic hypertension.
B) an increase in mean arterial pressure to maintain cerebral blood flow.
C) the forcing of cerebrospinal fluid into the spinal cord as intracranial pressure increases.
D) a decrease in cerebral perfusion pressure that reduces intracranial pressure.

Answer 11

B) an increase in mean arterial pressure to maintain cerebral blood flow.

Question 12

The periumbilical area refers to the:

A) space behind the navel.
B) external umbilical orifice.
C) area lateral to the umbilicus.
D) area around the umbilicus.

Answer 12

D) area around the umbilicus.

Question 13

Which of the following organs lies within the retroperitoneal space?

A) Liver
B) Kidneys
C) Spleen
D) Ovaries

Answer 13

B) Kidneys

Question 14

Osteoporosis is MOST accurately defined as a(n):

A) progressive loss of bone marrow.
B) reduced range of motion in the joints.
C) estrogen-related change in bone strength.
D) significant decrease in bone density.

Answer 14

D) significant decrease in bone density.

Question 15

When a person jumps from a height and lands on his or her feet, direct trauma occurs to the:

A) tarsals.
B) malleolus.
C) calcaneus.
D) metatarsals.

Answer 15

C) calcaneus.

Question 16

The transfer of heat from a hotter object to a cooler object by direct physical contact is called:

A) radiation.
B) convection.
C) conduction.
D) evaporation.

Answer 16

C) conduction.

Question 17

A decreased wind chill factor increases heat loss through:

A) radiation.
B) convection.
C) conduction.
D) evaporation.

Answer 17

B) convection.

Question 18

A person blowing on hot food in an attempt to cool it is an example of:

A) radiation.
B) convection.
C) conduction.
D) passive cooling.

Answer 18

B) convection.

Question 19

When the outside temperature approaches or exceeds skin surface temperature, heat loss by _________ and _________ diminishes and eventually ceases.

A) convection, conduction
B) conduction, evaporation
C) evaporation, radiation
D) radiation, convection

Answer 19

D) radiation, convection

Question 20

Spinal shock is a condition that:

A) generally affects the sensory nerves but spares the motor nerves.
B) is usually temporary and results from swelling of the spinal cord.
C) typically manifests within 24 to 36 hours following a spinal injury.
D) results in permanent neurologic deficits in the majority of patients.

Answer 20

B) is usually temporary and results from swelling of the spinal cord.

Question 21

Hypothermia is defined as a decrease in core body temperature, generally starting at:

A) 96°F.
B) 95°F.
C) 94°F.
D) 93°F.

Answer 21

B) 95°F.

Question 22

An epidural hematoma typically causes rapid deterioration in the head-injured patient’s condition because:

A) numerous axons are severely damaged.
B) the meningeal veins are often disrupted.
C) it is associated with brisk arterial bleeding.
D) concomitant spinal cord injury is often present.

Answer 22

C) it is associated with brisk arterial bleeding.

Question 23

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include:

A) applying a cervical collar and assisting his ventilations with a bag-mask device.
B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds.
C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions.
D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

Answer 23

D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

Question 24

A complete spinal cord injury to the upper cervical spine:

A) results in quadriplegia but the patient usually retains his or her ability to breathe spontaneously.
B) is not compatible with life and results in immediate death due to cardiopulmonary failure.
C) will result in permanent loss of all cord-mediated functions below the level of the injury.
D) results in neurologic dysfunction that is considered to be permanent if it lasts longer than 24 hours.

Answer 24

C) will result in permanent loss of all cord-mediated functions below the level of the injury.

Question 25

A compression or burst fracture of the cervical spine would MOST likely occur following:

A) a direct blow to the occipital region of the skull.
B) rapid acceleration following a motor vehicle crash.
C) axial loading after a patient falls and lands feet first.
D) a significant fall in which the patient lands head first.

Answer 25

D) a significant fall in which the patient lands head first.

Question 26

The LEAST common cause of death in spinal cord injury patients who are discharged from the hospital is:

A) pneumonia.
B) septicemia.
C) muscular atrophy.
D) pulmonary embolism.

Answer 26

C) muscular atrophy.

Question 27

A motorcycle or football helmet should be removed if:

A). The patient complains of severe neck pain and the helmet fits snugly.
B) you are going to transport the patient to a medical treatment facility.
C) the patient is breathing shallowly and access to the airway is difficult.
D) you are properly trained in the technique, even if you are by yourself.

Answer 27

C) the patient is breathing shallowly and access to the airway is difficult.

Question 28

Corticosteroid use for a spinal cord injury may lead to significant complications, particularly if:

A) the patient is younger than 45 years of age.
B) it is initiated less than 3 hours after the injury.
C) the patient is also taking beta-blocker medications.
D) the injury is accompanied by penetrating trauma.

Answer 28

D) the injury is accompanied by penetrating trauma.

Question 29

You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should:

A) give 0.5 mg of atropine and consider a dopamine infusion.
B) administer 1 mg of epinephrine 1:10,000 via rapid IV push.
C) apply the pneumatic antishock garment and inflate all sections.
D) administer a corticosteroid to reduce spinal cord inflammation.

Answer 29

A) give 0.5 mg of atropine and consider a dopamine infusion.

Question 30

A patient with diaphragmatic breathing without intercostal muscle use has MOST likely experienced a spinal injury above the level of:

A) C2.
B) C5.
C) C7.
D) T2.

Answer 30

D) T2.

Question 31

A positive Babinski reflex is observed when the:

A) toes curve or move downward when the sole of the foot is touched.
B) patient responds to pain by flexing the arms and extending the legs.
C) patient’s reflexes are hyperactive in response to an external stimulus.
D) toes move upward in response to stimulation of the sole of the foot.

Answer 31

D) toes move upward in response to stimulation of the sole of the foot.

Question 32

Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:

A) rapidly increasing intracranial pressure.
B) an underlying skull fracture.
C) a fluctuating level of consciousness.
D) unilateral hemiparesis or slurred speech.

Answer 32

A) rapidly increasing intracranial pressure.

Question 33

According to the National Spinal Cord Injury Database, MOST spinal cord injuries are caused by:

A) acts of violence.
B) athletic activities.
C) falls in the elderly.
D) motor vehicle crashes.

Answer 33

D) motor vehicle crashes.

Question 34

An injured patient’s head should be secured to the long backboard only after:

A) you have placed padding under the shoulders.
B) his or her torso has been secured adequately.
C) both of the legs are secured to the board properly.
D) a vest-style immobilization device has been applied.

Answer 34

B) his or her torso has been secured adequately.

Question 35

As the body ages, the intervertebral discs:

A) calcify and become more rigid.
B) enlarge and result in increased height.
C) are not able to protect the spinal cord.
D) lose water content and become thinner.

Answer 35

D) lose water content and become thinner.

Question 36

A blood pressure of 100/70 mm Hg in the presence of clinical signs of a tension pneumothorax:

A) should be treated with crystalloid fluid boluses to prevent hypotension.
B) indicates that prehospital needle decompression likely will not be required.
C) is likely the result of systemic vasodilation in an attempt to reduce preload.
D) suggests adequate cardiac compensation for the diminished venous return.

Answer 36

D) suggests adequate cardiac compensation for the diminished venous return.

Question 37

A pulmonary contusion following blunt chest trauma results in:

A) blood leakage from injured lung tissue into the pleural space.
B) decreased pulmonary shunting with rupture of the alveolar sacs.
C) alveolar and capillary damage with intraparenchymal lung hemorrhage.
D) pulmonary vasodilation as the body attempts to shunt blood to the injury.

Answer 37

C) alveolar and capillary damage with intraparenchymal lung hemorrhage.

Question 38

Due to intrapulmonary hemorrhage, patients with a pulmonary contusion may present with:

A) hypocarbia.
B) hemoptysis.
C) hematemesis.
D) hematochezia.

Answer 38

B) hemoptysis.

Question 39

An open pneumothorax causes ventilatory inadequacy when:

A) positive pressure created by expiration forces air into the pleural space.
B) the heart stops perfusing the lung on the side of the open chest injury.
C) negative pressure created by inspiration draws air into the pleural space.
D) the glottic opening is much larger than the open wound on the chest wall.

Answer 39

C) negative pressure created by inspiration draws air into the pleural space.

Question 40

If the pleural space becomes filled with air or blood:

A) increased surface tension ruptures the lung.
B) surface tension forces the pleurae together.
C) the lung expands and fills the thoracic space.
D) surface tension is lost and the lung collapses.

Answer 40

D) surface tension is lost and the lung collapses.

Question 41

As air accumulates in the pleural space, the FIRST thing to occur is:

A) decreased pulmonary function.
B) contralateral tracheal deviation.
C) compression of the great vessels.
D) marked decrease in venous return.

Answer 41

A) decreased pulmonary function.

Question 42

Dysrhythmias following a myocardial contusion are usually secondary to:

A) excess tachycardia that accompanies the injury.
B) damage to myocardial tissue at the cellular level.
C) aneurysm formation caused by vascular damage.
D) direct damage to the vasculature of the epicardium.

Answer 42

B) damage to myocardial tissue at the cellular level.

Question 43

Increased intravenous pressure commonly manifests as:

A) jugular venous distention.
B) a widened pulse pressure.
C) bounding peripheral pulses.
D) a pulsating abdominal mass.

Answer 43

A) jugular venous distention.

Question 44

Isolated rib fractures may result in inadequate ventilation because:

A) the patient often purposely limits chest wall movement.
B) most rib fractures cause paradoxical chest wall movement.
C) the pain associated with the fracture causes hyperventilation.
D) preferential use of the intercostal muscles reduces tidal volume.

Answer 44

A) the patient often purposely limits chest wall movement.

Question 45

Tracheobronchial injuries have a high mortality due to:

A) massive internal hemorrhage.
B) associated airway obstruction.
C) perforation of the esophagus.
D) concomitant spinal cord injury.

Answer 45

B) associated airway obstruction.

Question 46

A 17-year-old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient’s left shoulder, which is unremarkable for trauma. Examination of the patient’s abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient’s clinical presentation, you should be MOST suspicious of:

A) a lacerated liver.
B) acute peritonitis.
C) an injury to the spleen
D) retroperitoneal bleeding.

Answer 46

C) an injury to the spleen

Question 47

A 24-year-old male intentionally placed a commercially manufactured constricting object around the base of his penis. He complains of moderate pain, and assessment of his penis reveals that it is cyanotic. You should:

A) make one attempt to cut the constricting object away from his penis.
B) transport him to the hospital and provide emotional support en route.
C) apply ice to the area to reduce any swelling and then remove the object.
D) administer a narcotic analgesic prior to removing the constricting object.

Answer 47

B) transport him to the hospital and provide emotional support en route.

Question 48

A 39-year-old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should:

A) administer oxygen via nonrebreathing mask; cover the exposed bowel with dry, sterile dressings; start an IV and give a 500-mL fluid bolus; and transport to a trauma center.

B) assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route.

C) insert an oral airway, provide ventilatory assistance, cover the exposed bowel with aluminum foil, begin transport, and start two large-bore IV lines with normal saline en route.

D) consider intubation to protect his airway; cover the exposed bowel with moist, sterile dressings; start an IV and give analgesia; and transport to a trauma center with fluid boluses en route.

Answer 48

B) assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route.

Question 49

Because of its anatomic position in the retroperitoneum, it typically takes high-energy force to damage the:
A) liver.
B) spleen.
C) stomach.
D) pancreas.

Answer 49

D) pancreas.

Question 50

During the third collision in a motor vehicle crash:

A) hollow abdominal organs rupture upon impact.
B) the person’s abdomen collides with the steering wheel.
C) rapid deceleration propels an unrestrained person forward.
D) abdominal organs shear from their points of attachment.

Answer 50

D) abdominal organs shear from their points of attachment.

Question 51

Fractures of the lower rib cage should make you MOST suspicious for injuries to the:

A) liver or spleen.
B) urinary bladder.
C) ascending aorta.
D) kidneys or pancreas.

Answer 51

A) liver or spleen.

Question 52

Gross hematuria and suprapubic pain following a pelvic injury is MOST indicative of injury to the:

A) ureters.
B) urethra.
C) bladder.
D) kidney.

Answer 52

C) bladder.

Question 53

The major complication associated with hollow organ injury is:

A) massive internal hemorrhage and profound shock.
B) peritonitis caused by rupture and spillage of toxins.
C) immediate death secondary to a massive infection.
D) delayed treatment due to the absence of external signs.

Answer 53

B) peritonitis caused by rupture and spillage of toxins.

Question 54

Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of:

A) severe intraabdominal bleeding.
B) gas accumulation in the peritoneum.
C) diffuse peritoneal contamination.
D) inflammation of deep nerve endings.

Answer 54

C) diffuse peritoneal contamination.

Question 55

When assessing a patient with abdominal trauma for distention, you must recall that:

A) a distended abdomen is one of the earliest clinical findings in patients with abdominal trauma.
B) abdominal distention is usually caused by muscle tensing rather than intraabdominal bleeding.
C) a significant amount of blood volume in the abdominal cavity is required to produce distention.
D) because distention is a late sign of intraabdominal bleeding, it should not be assessed for in the field.

Answer 55

C) a significant amount of blood volume in the abdominal cavity is required to produce distention.

Question 56

Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen?

A) Size of the patient
B) Profile of the bullet
C) Trajectory of the bullet
D) Distance the bullet traveled

Answer 56

A) Size of the patient

Question 57

Which of the following is NOT a function of the pancreas?

A) Enzyme secretion
B) Secretion of insulin
C) Glucagon secretion
D) Reservoir for bile

Answer 57

D) Reservoir for bile

Question 58

A dislocation is considered an urgent injury because of its potential to cause:

A) neurovascular compromise.
B) significant internal bleeding.
C) severe hemodynamic instability
D) proximal sensory and motor loss.

Answer 58

A) neurovascular compromise.

Question 59

A stress fracture would MOST likely occur when:

A) a person with a relatively weak bone structure does not engage regularly in strenuous activities.
B) a person with large musculature regularly engages in strenuous activity using the upper extremities.
C) the muscle develops faster than the bone and places exaggerated stress on the bone.
D) an underlying medical condition causes progressive weakening of the bones, making them prone to fracture.

Answer 59

C) the muscle develops faster than the bone and places exaggerated stress on the bone.

Question 60

Common signs and symptoms of an acute pulmonary embolism include all of the following, EXCEPT:

A) pulmonary edema.
B) pleuritic chest pain.
C) right-sided heart failure.
D) tachycardia and tachypnea.

Answer 60

A) pulmonary edema.

Question 61

Correctly splinting an injured extremity:

A) typically provides complete pain relief without the need to administer narcotic analgesia.
B) effectively reduces swelling and inflammation by shunting blood away from the injured area.
C) eliminates the need to elevate the extremity because immobilization causes blood stasis.
D) helps to control internal bleeding by allowing clots to form where vessels are damaged.

Answer 61

D) helps to control internal bleeding by allowing clots to form where vessels are damaged.

Question 62

An epidural hematoma typically causes rapid deterioration in the head-injured patient’s condition because:

A) numerous axons are severely damaged.
B) the meningeal veins are often disrupted.
C) it is associated with brisk arterial bleeding.
D) concomitant spinal cord injury is often present.

Answer 62

C) it is associated with brisk arterial bleeding.

Question 63

Eliciting for crepitus during your exam of a deformed extremity:

A) should only be performed if the patient is not in significant pain.
B) may cause further injury to the bone and surrounding soft tissues.
C) should be performed to help confirm the presence of a fracture.
D) is generally not performed, but will likely not cause further injury.

Answer 63

B) may cause further injury to the bone and surrounding soft tissues.

Question 64

In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding.

A) 250 mL
B) 500 mL
C) 750 mL
D) 1,000 mL

Answer 64

D) 1,000 mL

Question 65

You should NOT apply a pneumatic splint on a patient if he or she:

A) has an open fracture in which bone ends are exposed.
B) is experiencing severe pain despite narcotic analgesia.
C) has a closed fracture involving the lower leg or forearm.
D) experienced a fracture or dislocation involving a major joint.

Answer 65

A) has an open fracture in which bone ends are exposed.

Question 66

The goal of prehospital pain control in a patient with a musculoskeletal injury should be to:

A) use cryotherapy instead of narcotic analgesics.
B) sedate the patient with diazepam or lorazepam.
C) diminish the patient’s pain to a tolerable level.
D) give enough analgesia to make the patient pain-free.

Answer 66

C) diminish the patient’s pain to a tolerable level.

Question 67

The main disadvantage of using a scoop stretcher to transfer a patient to a long backboard is:

A) inability to conduct a visual exam of the back for injuries.
B) patient discomfort due the cold metal frame of the scoop.
C) unnecessary patient movement and the risk for further harm.
D) inability to palpate the spinal vertebrae for gross deformities.

Answer 67

A) inability to conduct a visual exam of the back for injuries.

Question 68

The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT:

A) a decreased pH.
B) metabolic alkalosis.
C) hyperkalemia.
D) renal dysfunction.

Answer 68

B) metabolic alkalosis.

Question 69

The risk of a pulmonary embolism following musculoskeletal trauma is HIGHEST in patients with:

A) upper extremity fractures that result in lengthy hospital admissions.
B) pelvic and lower extremity injuries that lead to prolonged immobilization.
C) numerous rib fractures who are taking anticoagulant medications.
D) any proximal long bone fracture that occurred greater than 72 hours prior to medical intervention.

Answer 69

B) pelvic and lower extremity injuries that lead to prolonged immobilization.

Question 70

A 21-year-old man was removed from the water after being submerged for approximately 5 minutes. The patient’s friend, who was with him at the time of submersion, states that there was no trauma involved. Your assessment reveals that the patient is apneic; however, he has a slow, weak carotid pulse. After preoxygenating the patient, you insert an endotracheal tube. During auscultation of the lungs, you hear coarse crackles in all fields; the epigastrium is quiet. As you ventilate the patient, you note decreased compliance. The MOST effective way to treat this situation is to:

A) attach a portable ventilator that provides positive end-expiratory pressure
B) insert a nasogastric tube and remove any water from the patient’s stomach.
C) increase your ventilation rate to 15 breaths/min and provide higher volume.
D) administer morphine sulfate to promote venous pooling and decreased preload.

Answer 70

A) attach a portable ventilator that provides positive end-expiratory pressure

Question 71

In drowning victims, positive end-expiratory pressure is used to:

A) prevent atelectasis and force fluid from the alveoli
B) increase the rate and depth of the victim’s breathing
C) force fluid from the interstitial back into the alveoli.
D) increase cardiac contractility and improve stroke volume.

Answer 71

A) prevent atelectasis and force fluid from the alveoli

Question 72

A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should be MOST suspicious that this patient has a(n):

A) poorly healed diabetic ulcer
B) local reaction to an ant bite.
C) infection caused by a tick.
D) brown recluse spider bite.

Answer 72

D) brown recluse spider bite.

Question 73

The bite of a brown recluse spider:

A) may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.
B) manifests with immediate and intense pain and the formation of a blister and a white surrounding area of ischemia.
C) most often causes severe central nervous system depression because its venom contains a powerful neurotoxin.
D) results in a local reaction only because the spider’s venom is cytotoxic and spreads slowly throughout the bloodstream.

Answer 73

A) may not result in immediate symptoms but generally presents as a painful, reddened area with an overlying blister.

Question 74

Mortality and morbidity are greatest following the bite of a:
A) coral snake.
B) copperhead.
C) rattlesnake.
D) cottonmouth.

Answer 74

C) rattlesnake.

Question 75

A hiker was bitten on the left lower leg by a rattlesnake. He is conscious and alert, but complains of nausea and generalized weakness. The affected area, which has two distinct puncture wounds, is swollen markedly. The patient’s blood pressure is 114/66 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 22 breaths/min and regular. The MOST appropriate treatment for this patient involves:

A) keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.
B) applying venous tourniquets proximal and distal to the affected site, elevating the limb no more than 12 inches, applying a splint, and establishing vascular access.
C) administering oxygen, providing emotional support, establishing vascular access, administering a 250-mL saline bolus, and splinting the affected extremity.
D) placing him in a supine position, elevating the affected extremity and applying ice to reduce the swelling, establishing vascular access, and administering fentanyl for pain.

Answer 75

A) keeping him calm, administering high-flow oxygen, immobilizing the affected extremity and keeping it below heart level, and establishing vascular access.

Question 76

A patient may become hypothermic for all of the following reasons, EXCEPT:

A) decreased thermolysis.
B) inadequate thermogenesis.
C) impaired vasoconstriction.
D) excess environmental cold stress.

Answer 76

A) decreased thermolysis.

Question 77

A patient with diabetes would MOST likely experience heat loss secondary to:

A) insulin use.
B) ketoacidosis.
C) acute hyperglycemia.
D) peripheral neuropathy.

Answer 77

D) peripheral neuropathy.

Question 78

Liver disease predisposes a patient to hypothermia secondary to:

A) decreased glucagon uptake.
B) inadequate glycogen stores.
C) severe portal hypertension.
D) increased bilirubin production.

Answer 78

B) inadequate glycogen stores.

Question 79

Cold diuresis occurs when:

A) the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.

B) the sympathetic nervous system response in hypothermia increases blood flow to the kidneys, resulting in decreased sodium reabsorption and subsequent water excretion.

C) massive systemic vasoconstriction shunts cold body water to the renal system, where it is excreted from the body in an attempt to increase the core body temperature.

D) warmed IV fluids administered during severe hypothermia decrease the viscosity of the blood, resulting in an acute increase in output from the kidneys.

Answer 79

A) the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.

Question 80

An increase in core temperature causes the:

A) anterior pituitary gland to send signals via afferent pathways in the sympathetic nervous system to increase the heart rate
B) hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating.
C) anterior pituitary gland to send signals via efferent pathways in the sympathetic nervous system, causing widespread vasoconstriction.
D) hypothalamus to send signals via afferent pathways in the parasympathetic nervous system, resulting in vasoconstriction and sweat production.

Answer 80

B) hypothalamus to send signals via efferent pathways in the autonomic nervous system, causing vasodilation and sweating.

Question 81

Any diver who loses consciousness immediately following a dive should be assumed to have experienced:

A) barotrauma.
B) nitrogen narcosis.
C) an air embolism.
D) decompression sickness.

Answer 81

C) an air embolism.

Question 82

Approximately 5 minutes following ascent from the water, a 30-year-old male diver complains of sharp chest pain and mild dyspnea. By the time you arrive at the scene, the patient is unresponsive. You should be MOST suspicious for:

A) nitrogen narcosis.
B) a tension pneumothorax.
C) decompression sickness.
D) an arterial gas embolism.

Answer 82

D) an arterial gas embolism.

Question 83

At a core body temperature of 90°F:

A) hyperventilation is profound.
B) oxygen consumption decreases.
C) ventricular fibrillation is likely.
D) shivering becomes involuntary.

Answer 83

B) oxygen consumption decreases.

Question 84

Cigarette smoking predisposes a person to frostbite because it:

A) causes arteriolar constriction.
B) decreases the blood pressure.
C) causes peripheral vasodilation.
D) increases peripheral blood flow.

Answer 84

A) causes arteriolar constriction.

Question 85

The diagnosis of heatstroke is usually made when a patient has a high core body temperature and:

A) an altered mental status.
B) an absence of sweating.
C) a history of heat exposure.
D) a heart rate above 140 beats/min

Answer 85

A) an altered mental status.

Question 86

Patients with heatstroke:

A) present initially with hot, dry skin.
B) are typically bradypnea and hypotensive.
C) have a core temperature greater than 104°F.
D) should routinely be given 50% dextrose.

Answer 86

C) have a core temperature greater than 104°F.

Question 87

Which of the following clinical findings suggests a cause of a patient’s hyperthermia other than heatstroke?

A) Dehydration
B) Intermittent chills
C) Moist, pale, hot skin
D) Pupillary constriction

Answer 87

B) Intermittent chills

Question 88

Cold diuresis occurs when:

A) the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.
B) the sympathetic nervous system response in hypothermia increases blood flow to the kidneys, resulting in decreased sodium reabsorption and subsequent water excretion.
C) massive systemic vasoconstriction shunts cold body water to the renal system, where it is excreted from the body in an attempt to increase the core body temperature.
D) warmed IV fluids administered during severe hypothermia decrease the viscosity of the blood, resulting in an acute increase in output from the kidneys.

Answer 88

A) the initial peripheral vasoconstriction response in hypothermia is interpreted by the volume receptors as an increase in volume, causing the kidneys to produce more urine.

Question 89

Gas-filled organs are affected by the pressure changes experienced during descent and ascent through water because they:

A) expand rapidly.
B) contain oxygen
C) are compressible.
D) do not compress.

Answer 89

C) are compressible.

Question 90

If a patient with severe hypothermia is pulseless and apneic, you should:

A) attempt a single shock for V-fib or V-tach.
B) avoid placement of an advanced airway device.
C) infuse 4 L of warmed normal saline solution.
D) perform high-quality CPR at half the normal rate.

Answer 90

A) attempt a single shock for V-fib or V-tach.

Question 91

Common clinical findings associated with a subdural hematoma include all of the following, EXCEPT:

A) rapidly increasing intracranial pressure.
B) an underlying skull fracture.
C) a fluctuating level of consciousness.
D) unilateral hemiparesis or slurred speech.

Answer 91

A) rapidly increasing intracranial pressure.

Question 92

Decerebrate posturing is characterized by:

A) flexion of the arms and extension of the legs.
B) inward flexion of the wrists and flexed knees.
C) extension of the arms and extension of the legs.
D) pulling in of the arms toward the core of the body.

Answer 92

C) extension of the arms and extension of the legs.

Question 93

Early signs and symptoms of increased intracranial pressure include:

A) headache and vomiting.
B) hypertension and bradycardia.
C) widening of the pulse pressure.
D) arm flexion and leg extension.

Answer 93

A) headache and vomiting.

Question 94

Following a traumatic brain injury, initial swelling of the brain occurs due to:

A) severe ischemia.
B) acute hypertension.
C) cerebral vasodilation.
D) an increase in cerebral water.

Answer 94

C) cerebral vasodilation.

Question 95

Hypotension that is associated with neurogenic shock is the result of:

A) loss of alpha receptor stimulation.
B) concomitant internal hemorrhage.
C) increased peripheral vascular tone.
D) profound peripheral vasoconstriction.

Answer 95

A) loss of alpha receptor stimulation.

Question 96

In contrast to secondary spinal cord injury, primary spinal cord injury occurs:

A) from progressive swelling.
B) at the moment of impact.
C) from penetrating mechanisms.
D) within 24 hours of the injury.

Answer 96

B) at the moment of impact.

Question 97

In which of the following situations would it be MOST appropriate to apply a vest-type extrication device or a short backboard to a patient who is seated in his or her crashed motor vehicle?

A) Conscious with bilateral femur fractures
B) Unconscious with obvious spinal deformity
C) Confused with lower back pain and tachycardia
D) Conscious with neck pain and stable vital signs

Answer 97

D) Conscious with neck pain and stable vital signs

Question 98

Injury to the temporal lobe on the left side would MOST likely cause:

A) abnormal speech.
B) visual disturbances.
C) sleep abnormalities.
D) lack of coordination.

Answer 98

A) abnormal speech.

Question 99

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 148/94 mm Hg, heart rate of 58 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves:

A) hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center.

B) preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score.

C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

D) applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital.

Answer 99

B) preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score.

Question 100

A male patient with a closed head injury opens his eyes in response to pain, makes incomprehensible sounds, and responds to pain with flexion of his arms. His Glasgow Coma Scale score is ___, and the MOST appropriate treatment for him involves:

A) 6; intubation, hyperventilation at a rate of 20 breaths/min, two large-bore IV lines running wide open, keeping him warm, and maintaining his oxygen saturation at greater than 90%.

B) 7; intubation, ventilations performed at a rate of 10 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 95%.

C) 8; ventilation assistance with a bag-mask device, a 2-L bolus of normal saline or lactated Ringer’s solution, elevating his head 12 inches, and hyperventilating him if his heart rate falls below 60 beats/min.

D) 9; high-flow oxygen via nonrebreathing mask, IV fluids as needed to maintain a systolic blood pressure of at least 100 mm Hg, monitoring his oxygen saturation, and administering 1.5 mg/kg of lidocaine to decrease intracranial pressure.

Answer 100

B) 7; intubation, ventilations performed at a rate of 10 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 95%.