TCCC Final Review - CMS Quiz 3 Flashcards
When considering a location for peripheral IV cannulation, which of the following is true:
A. The veins of the hand are drained by the
metacarpal and dorsal veins; they are
excellent sites for a large bore (14-16 gauge)
IV catheter in trauma scenarios.
B. Veins that are firm and cordlike are good
choices for large-bore IVs, since they do not
tend to collapse when punctured by the IV
catheter.
C. The lower extremity is an ideal site for IV
access due to the low likelihood of trauma,
and low incidence of thrombosis.
D. The cephalic vein (“intern vein”) can
usually be successfully cannulated, but due
to the small size of the vein, the largest
catheter it can typically accommodate is a 22-
gauge.
E. The antecubital veins are often the best
location for a large bore (14-16 gauge)
peripheral IV due to their large size, but have
the disadvantage of causing discomfort and
restriction of mobility for the patient
E. The antecubital veins are often the best
location for a large bore (14-16 gauge)
peripheral IV due to their large size, but have
the disadvantage of causing discomfort and
restriction of mobility for the patient
An important component of IV care is maintaining patency of the IV site. To avoid clotting at the site of the IV, once a fluid infusion has been completed, the IV should be flushed with a heparin solution (ie, a “hep-lock” IV).
True
False
False
Which of the following are absolute or relative contraindications to placement of a peripheral
IV at that location/extremity (check all that apply):
A. Extremities with shunts or fistulas
B. Veins that drain from an area of neck
trauma or an affected traumatic extremity
C. Veins actively affected by phlebitis or
thrombosis
D. Extremities on the side of radical
mastectomies
E. Insertion of IV through site of cellulitis
F. Veins that are flattened and collapsed
because of systemic hypovolemia or
dehydration
G. Extremities with large area of burns
H. Extremities with massive edema
A,B,C,D,E,G,H
During cardiopulmonary resuscitation (CPR), medications have been shown to reach the
central circulation faster with central access than with peripheral venous access. However,
peripheral IV cannulation is still the procedure of choice even during CPR, because of the
usual speed, ease, and safety with which it can be accomplished.
True
False
True
Infiltration of a vein (ie, dislodgement of a catheter from the vein during infusion) is a
relatively common complication of IV therapy. Clues that an IV may have become dislodged
include pain at the infusion site, or the alarm sounding on an infusion pump device. Certain
infusions carry a significant risk of skin damage/sloughing. Which of the following may cause
tissue injury when extravasation occurs in a peripheral vein? (check all that apply)
A. phenytoin
B. norepinepherine
C. calcium chloride 10%
D. dextrose 50% in water
E. dextrose 10%
A,B,C,D,E
You are working at a Battalion Aid Station when a Marine arrives in shock. He was on guard
duty on a watchtower when he was shot through the thigh and fell about 15 feet to a cement surface below. He has evidence of a femur fracture with enormous swelling, and bruising at his thigh. His lower extremities are paralyzed and he complains of severe back pain. His heart rate is 125. What is the most accurate statement and initial treatment for his condition?
A. He should be treated with antibiotics
immediately for a possible septic shock
B. This patient is most likely in cardiogenic
shock and should be treated accordingly
C. He is in neurogenic shock and requires
treatment to counteract dilation of peripheral
arteries. He will not require treatment for
blood loss
D. He likely has components of both
hemorrhagic shock and neurogenic shock,
and should be treated immediately for
presumed blood loss
D. He likely has components of both hemorrhagic shock and neurogenic shock, and should be treated immediately for presumed blood loss Pg 189-90
Neurogenic shock refers to an injury to the spinal cord that results in a temporary loss of
sensory and motor function; the spinal cord has been damaged (“shocked”) and is not
working properly.
True
False
False
Pg 189-90
Among the many complications of shock is acute renal failure. Which of the following
combinations of metabolic derangements is most likely from renal failure?
A. Metabolic alkalosis and hyperkalemia
B. Metabolic alkalosis and hypokalemia
C. Metabolic acidosis and hyperkalemia
D. Metabolic acidosis and hypokalemia
C. Metabolic acidosis and hyperkalemia
Pg 191
Tourniquets should only be used as a last resort method for hemorrhage control, after
attempting control via elevation and pressure points
True
False
False
Pg 199-200
What amount of isotonic fluid remains in the intravascular space 1 hour after infusion? A. 25% - 33% B. 50%-75% C. 1% - 10% D. 100%
A. 25% - 33%
Pg 188
You are managing a patient with an acute tension pneumothorax. You note that he has
jugular venous distension with normal heart sounds but has a blood pressure of 70/30. His
blood pressure was 120/80 prior to his developing the tension pneumothorax. Which of the following would NOT be contributing to his hypotension?
A. Decreased venous return from the superior
vena cava
B. Decreased venous return from the inferior
vena cava
C. Increased peripheral vascular resistance
D. Increased pulmonary vascular resistance
C. Increased peripheral vascular resistance
Pg 191
All the following statements regarding physiologic changes in pregnancy are true EXCEPT:
A. Pregnant women may not demonstrate
signs of shock until losing about 1/3 of their
blood volume
B. A pregnant woman’s blood volume may
increase by 45-50%
C. The fetus will not be adversely effected by
hypoperfusion until long after the mother
demonstrates signs of hypoperfusion
D. The gravid uterus may compress the
inferior vena cava during the third trimester
C. The fetus will not be adversely effected by
hypoperfusion until long after the mother
demonstrates signs of hypoperfusion
Pg 197
A 3 year old child has had diarrhea and vomiting for the past three days secondary to a viral infection. Today his mother calls 911 because he has become lethargic. On arrival, you find the child to be only minimally responsive to you when you stick the IV in his arm. His blood pressure is low and his heart rate is very fast. Which of the following BEST describes this type of shock? A. Hypovolemic B. Neurogenic C. Distributive D. Cadiogenic
A. Hypovolemic
Pg 187-88
Which of the following can produce an altered level of consciousness in trauma casualties? [check all that apply] A. Shock with impaired cerebral perfusion B. Traumatic brain injury C. Metabolic processes such as diabetes, seizures, and eclampsia D. Intoxication with alcohol or drugs E. Hypoxia
A,B,C,D,E
Pg 194
In responding to a trauma victim, you find a respiratory rate of 22, oxygen saturation of 98%, heart rate 120 bpm, and narrowed pulse pressure. He is somewhat anxious but is able to give details of the event. He only complains of pain in his right leg where you notice an
obvious deformity and significant blood loss from an open femur fracture. Based on this
information, he would most likely be in which Class of Hemorrhagic Shock?
A. Class I
B. Class II
C. Class III
D. Class IV
B. Class II
Pg 187 Figure 8-12
