Unit Exam 3

Question 1

The progression of a chemical burn is MOSTLY dependent on:

Select one:

a. the length of time the corrosive chemical remains on the skin.
b. the surface area of the body exposed to a corrosive chemical.
c. whether the corrosive substance is a strong acid or alkali.
d. the patient’s general health and the thickness of his or her skin.

Answer 1

a. the length of time the corrosive chemical remains on the skin.

Question 2

Phosphorus is found in _____________ and burns when exposed to _____________.

Select one:

a. fireworks, air
b. oven cleaner, water
c. drain cleaner, air
d. battery acid, water

Answer 2

a. fireworks, air

Question 3

The outer zone of an entrance or exit wound caused by a contact electrical burn is:

Select one:

a. the red zone of coagulation necrosis.
b. simply caused by local inflammation.
c. a charred area of full-thickness burn.
d. characterized by cold, gray, dry tissue.

Answer 3

a. the red zone of coagulation necrosis.

Question 4

The peripheral area surrounding the zone of coagulation, which has decreased blood flow and inflammation, is called the zone of:

Select one:

a. stasis.
b. coagulation.
c. hyperemia.
d. liquefaction.

Answer 4

a. stasis.

Question 5

A 24-year-old woman was struck by lightning. Bystanders moved the patient to an area of safety but did not provide any other care before your arrival. Your primary assessment reveals that the patient is pulseless and apneic. You begin CPR and apply the cardiac monitor, which reveals asystole. After requesting a backup paramedic unit, the MOST appropriate treatment for this patient involves:

Select one:

a. instructing your partner to resume one-rescuer CPR, establishing an IV of normal saline, and reassessing her cardiac rhythm in 5 minutes.
b. continuing CPR, providing full spinal precautions, intubating her trachea, and ventilating her at a rate of 20 to 24 breaths per minute.
c. performing adequate BLS, following standard ACLS protocol, and considering terminating your efforts if asystole persists after 10 minutes.
d. continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.

Answer 5

d. continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary.

Question 6

A 74-year-old man experienced partial- and full-thickness burns to his arms and chest resulting from a fire that started after he fell asleep while smoking his cigar. The patient’s son, who arrived at the scene shortly after you, states that his father has congestive heart failure, rheumatoid arthritis, and atrial fibrillation. In addition to administering supplemental oxygen, it is MOST important for you to:

Select one:

a. avoid narcotic analgesics because of his medical history.
b. auscultate his breath sounds before administering IV fluids.
c. obtain a 12-lead ECG to assess for signs of cardiac ischemia.
d. apply cold, moist dressings to his burns to provide pain relief.

Answer 6

b. auscultate his breath sounds before administering IV fluids.

Question 7

A 4-year-old girl pulled a pot of boiling water off of the stove and experienced partial-thickness splash burns to her neck, anterior trunk, and both anterior arms. During your assessment, you note that the child is conscious but is not crying. She is tachypneic and tachycardic, and her skin is cool and moist. Other than the burns, there are no other gross injuries. Which of the following statements regarding this scenario is correct?

Select one:

a. You should assist the child’s ventilations and prepare to intubate her trachea.
b. An IV should be established and you should administer a 20-mL/kg bolus of D5W.
c. The child may be hypoglycemic and requires assessment of her blood glucose level.
d. It is likely that this child’s burn was intentionally inflicted and you should report it.

Answer 7

c. The child may be hypoglycemic and requires assessment of her blood glucose level.

Question 8

A 33-year-old man was burned when the hot water heater on which he was working exploded. The patient has superficial and partial-thickness burns to his face, neck, and arms. Your primary assessment reveals that he is restless and tachypneic. His BP is 80/54 mm Hg and his heart rate is 120 beats/min and weak. You should:

Select one:

a. conclude that he is experiencing burn shock, start two large-bore IV lines of normal saline, and administer fluids based on the Parkland formula.
b. assist his ventilations with a bag-mask device, cover him with a blanket, and start a large-bore IV of normal saline set at a keep vein open rate.
c. apply oxygen via nonrebreathing mask, cover his burns with cold moist dressings, start an IV with normal saline, and give up to 4 mg of morphine for pain.
d. administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion.

Answer 8

d. administer high-flow oxygen, keep him warm, start at least one large-bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion.

Question 9

A 52-year-old man sustained superficial and partial-thickness burns to his left arm approximately 15 minutes ago when he opened the radiator cap on his car. He is conscious, alert, and in severe pain. His BP is 138/76 mm Hg, pulse is 110 beats/min and strong, respirations are 22 breaths/min and regular, and oxygen saturation is 97% on room air. He denies any other injuries. Initial management for this patient involves:

Select one:

a. applying ice to the burn to provide immediate pain relief.
b. applying cool, wet dressings to the burn and elevating his arm.
c. starting an IV of normal saline and administering 2 mg of morphine.
d. administering oxygen and applying an anesthetic cream to the burn.

Answer 9

b. applying cool, wet dressings to the burn and elevating his arm.

Question 10

You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned?

Select one:

a. 18%
b. 27%
c. 36%
d. 45%

Answer 10

c. 36%

Question 11

A 30-year-old man felt a snap in his chest when he abruptly twisted his torso. He is conscious and alert, and complains of severe pain during inhalation. Your assessment reveals palpable tenderness over the fifth and sixth ribs on the left side. His vital signs are stable and he denies other injuries. In addition to administering supplemental oxygen, the MOST appropriate treatment for this patient involves:

Select one:

a. instructing the patient to hold a pillow against his chest, considering IV analgesics, and transporting to the hospital.
b. stabilizing the injured area by circumferentially wrapping the chest with 3-inch tape and transporting him to a local hospital.
c. encouraging the patient to take deeper breaths to maintain adequate minute volume and transporting him to the hospital.
d. sedating the patient with midazolam or diazepam, assisting ventilations with a bag-mask device, and transporting at once.

Answer 11

a. instructing the patient to hold a pillow against his chest, considering IV analgesics, and transporting to the hospital.

Question 12

Bony structures of the thorax include all of the following, EXCEPT the:

Select one:

a. ribs.
b. scapulae.
c. clavicles.
d. acromion.

Answer 12

d. acromion.

Question 13

Isolated rib fractures may result in inadequate ventilation because:

Select one:

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 13

a. the patient often purposely limits chest wall movement.

Question 14

Pneumothorax is MOST accurately defined as:

Select one:

a. air or gas within the pleural cavity.
b. perforation of a lung by a broken rib.
c. injury to the visceral or parietal pleura.
d. partial or complete collapse of a lung.

Answer 14

a. air or gas within the pleural cavity.

Question 15

Pneumothoraces create a ventilation-perfusion mismatch when:

Select one:

a. concomitant myocardial injury prevents adequate pulmonary perfusion and the lung collapses.
b. perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation. C
c. the vasculature of the affected lung is not intact and intrapulmonary gas exchange is impaired
d. the affected lung continues to expand adequately despite a decrease in pulmonary perfusion.

Answer 15

b. perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.

Question 16

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

Select one:

a. decreased pulmonary function.
b. contralateral tracheal deviation.
c. compression of the great vessels.
d. marked decrease in venous return.

Answer 16

a. decreased pulmonary function.

Question 17

By definition, a massive hemothorax is characterized by:

Select one:

a. pulmonary injury with secondary myocardial injury.
b. 10% of circulating blood volume within the pleural space.
c. cardiac arrest secondary to severe intrapleural bleeding.
d. more than 1,500 mL of blood within the pleural space.

Answer 17

d. more than 1,500 mL of blood within the pleural space.

Question 18

Which of the following statements regarding a pericardial tamponade is correct?

Select one:

a. Most pericardial tamponades are caused by blunt chest trauma during an automobile crash.
b. In a pericardial tamponade, blood collects between the visceral and parietal pericardium.
c. Pericardial tamponade is characterized by a marked increase in preload and flat jugular veins.
d. The parietal pericardium stretches easily, so significant blood accumulation is required before signs appear.

Answer 18

b. In a pericardial tamponade, blood collects between the visceral and parietal pericardium.

Question 19

Commotio cordis is a phenomenon in which:

Select one:

a. ventricular fibrillation is induced following blunt trauma to the chest during the heart’s repolarization period.
b. excessive pressure within the pericardial sac impairs cardiac contractility as well as venous return to the heart.
c. penetrating thoracic trauma perforates the atria or ventricles, causing acute rupture and massive hemorrhage.
d. myocardial tissue at the cellular level is damaged by blunt or penetrating trauma, resulting in cardiac arrest.

Answer 19

a. ventricular fibrillation is induced following blunt trauma to the chest during the heart’s repolarization period.

Question 20

With the exception of the aorta, great vessel injury is MOST likely to occur following:

Select one:

a. blunt trauma.
b. shearing forces.
c. rotational injury.
d. penetrating trauma.

Answer 20

d. penetrating trauma.

Question 21

During an explosion, a 42-year-old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious, but complains of difficulty hearing. In addition to protecting his spine, you should be MOST concerned with:

Select one:

a. administering high-flow oxygen via nonrebreathing mask as soon as possible.
b. covering the laceration with an occlusive dressing and controlling the bleeding.
c. carefully examining his ear to determine if his tympanic membrane is ruptured.
d. applying a bulky dressing to the laceration and securing it firmly with a bandage.

Answer 21

b. covering the laceration with an occlusive dressing and controlling the bleeding.

Question 22

A 51-year-old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has severe oral bleeding. She denies any other trauma. Your FIRST action should be to:

Select one:

a. suction her oropharynx for up to 15 seconds.
b. manually stabilize her head in a neutral position.
c. control the intraoral bleeding with sterile gauze.
d. ensure that she is sitting up and leaning forward.

Answer 22

d. ensure that she is sitting up and leaning forward.

Question 23

A conscious but combative patient with severe facial trauma is fully immobilized on a backboard. During your assessment, the patient begins coughing up large amounts of blood. You suction her oropharynx, but her mouth quickly refills with blood. You should:

Select one:

a. preoxygenate the patient with a bag-mask device for 2 minutes and then perform nasotracheal intubation.
b. roll the backboard on its side, suction her oropharynx, and prepare to perform pharmacologically assisted intubation.
c. alternate suctioning of her oropharynx for 15 seconds and assisting ventilations for 2 minutes until her airway is clear of blood.
d. continually suction her oropharynx until it is clear of blood, apply oxygen via nonrebreathing mask, and administer a sedative drug.

Answer 23

b. roll the backboard on its side, suction her oropharynx, and prepare to perform pharmacologically assisted intubation.

Question 24

The middle ear consists of the:

Select one:

a. cochlea and semicircular canals.
b. organ of Corti and the external auditory canal.
c. inner portion of the tympanic membrane and the ossicles.
d. pinna and the exterior portion of the tympanic membrane.

Answer 24

c. inner portion of the tymphanic membrane and the ossicles.

Question 25

Because significant force is required to fracture the mandible:

Select one:

a. most mandibular fractures are associated with a spinal fracture.
b. it is often fractured in more than one place and is unstable to palpation.
c. patients with a possible mandibular fracture should be intubated routinely.
d. a mandibular fracture can be ruled out in cases of minor blunt facial trauma.

Answer 25

b. it is often fractured in more than one place and is unstable to palpation.

Question 26

If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be MOST suspicious for an:

Select one:

a. Le Fort II fracture.
b. nasal bone fracture.
c. orbital skull fracture.
d. basilar skull fracture.

Answer 26

c. orbital skull fracture.

Question 27

When assessing a patient with maxillofacial trauma, it is MOST important to:

Select one:

a. gently palpate the maxilla, mandible, and zygoma to elicit crepitus.
b. protect the cervical spine and monitor the patient’s neurologic status.
c. apply a cervical collar and determine if the patient has visual disturbances.
d. have the patient open his or her mouth and assess for dental malocclusion.

Answer 27

b. protect the cervical spine and monitor the patient’s neurologic status.

Question 28

If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be MOST suspicious for aNo:

Select one:

a. Le Fort II fracture.
b. nasal bone fracture.
c. orbital skull fracture.
d. basilar skull fracture.

Answer 28

c. orbital skull fracture.

Question 29

Hyphema is defined as:

Select one:

a. severe ecchymosis to the orbital region.
b. blood in the anterior chamber of the eye.
c. marked swelling of the globe of the eye.
d. double vision following blunt eye trauma.

Answer 29

b. blood in the anterior chamber of the eye.

Question 30

Appropriate management for a patient with severe epistaxis, tachycardia, and diaphoresis following an injury to the face includes:

Select one:

a. positioning the patient supine and elevating his or her legs 12 to 18 inches.
b. administering enough IV crystalloid fluids to maintain adequate perfusion.
c. pinching the patient’s nares together and instructing him or her to lean back.
d. applying direct pressure to the bridge of the nose and keeping the patient calm.

Answer 30

b. administering enough IV crystalloid fluids to maintain adequate perfusion.

Question 31

A subluxation is defined as

Select one:

a. a completely severed spinal cord.
b. a partial or incomplete dislocation.
c. severe distraction injury of the neck.
d. a partially severed spinal cord.

Answer 31

b. a partial or incomplete dislocation.

Question 32

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:

Select one:

a. neurogenic shock.
b. intracranial pressure.
c. autonomic dysreflexia.
d. symptomatic bradycardia.

Answer 32

c. autonomic dysreflexia.

Question 33

Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should:

Select one:

a. start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion.
b. conclude that she is in neurogenic shock, start an IV line of normal saline, and initiate a dopamine infusion.
c. start at least one large-bore IV of normal saline and administer a narcotic analgesic to treat her severe pain.
d. perform a focused history and physical exam, start an IV of normal saline, and administer a corticosteroid.

Answer 33

a. start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion.

Question 34

Paralysis of the extremities would MOST likely result from injury to the:

Select one:

a. cerebellum.
b. diencephalon.
c. cerebral cortex.
d. hypothalamus.

Answer 34

c. cerebral cortex.

Question 35

The cerebellum is located in the ____________ part of the brain and is responsible for

Select one:

a. anteromedial, voluntary motor functions
b. inferoposterior, posture and equilibrium
c. anterolateral, short- and long-term memory
d. inferolateral, involuntary motor functions

Answer 35

b. inferoposterior, posture and equilibrium

Question 36

Which of the following statements regarding a closed head injury is correct?

Select one:

a. In a closed head injury, the dura mater remains intact.
b. Diffuse brain injury occurs with all open head injuries.
c. Closed head injuries are less common than open head injuries.
d. Intracranial pressure is usually minimal in a closed head injury.

Answer 36

a. In a closed head injury, the dura mater remains intact.

Question 37

Which of the following types of skull fracture would be the LEAST likely to present with gross physical signs?

Select one:

a. Open fracture
b. Depressed fracture
c. Basilar fracture
d. Linear fracture

Answer 37

d. Linear fracture

Question 38

Open fractures of the cranial vault:

Select one:

a. cause death due to increased intracranial pressure.
b. are associated with a high risk of bacterial meningitis.
c. typically cause lethal atrial cardiac dysrhythmias.
d. are uncommonly associated with multisystem trauma.

Answer 38

b. are associated with a high risk of bacterial meningitis.

Question 39

When an unrestrained passenger’s head strikes the windshield of a motor vehicle following rapid deceleration:

Select one:

a. the anterior portion of the brain sustains stretching or tearing injuries, and the posterior portion of the brain sustains compression injuries.
b. the head falls back against the headrest or seat and the brain collides with the rear of the skull, resulting in direct injury to the occipital lobe.
c. the brain initially strikes the rear of the skull, resulting in direct bruising, and then rebounds and strikes the front part of the skull.
d. compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.

Answer 39

d. compression injuries occur to the anterior portion of the brain, and stretching or tearing injuries occur to the posterior portion of the brain.

Question 40

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

Select one:

a. severe ischemia.
b. acute hypertension.
c. cerebral vasodilation.
d. an increase in cerebral water.

Answer 40

c. cerebral vasodilation.

Question 41

A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting from the injury site. Despite direct pressure, the wound continues to bleed heavily. You should:

Select one:

a. apply supplemental oxygen and keep her warm.
b. elevate the extremity above the level of her heart.
c. apply a tourniquet between her elbow and wrist.
d. locate and apply digital pressure to the brachial artery.

Answer 41

c. apply a tourniquet between her elbow and wrist.

Question 42

A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should:

Select one:

a. apply direct pressure to his facial wounds and promptly intubate him.
b. suction the blood from his mouth and assist ventilations with a bag-mask device.
c. insert a nasal airway, apply oxygen via nonrebreathing mask, and transport.
d. suction his oropharynx for 30 seconds and then perform endotracheal intubation.

Answer 42

b. suction the blood from his mouth and assist ventilations with a bag-mask device.

Question 43

When caring for a patient with an open chest wound, you should:

Select one:

a. routinely transport the patient in a left lateral recumbent position.
b. place a porous dressing over the wound and secure it on three sides.
c. secure a dressing in place by circumferentially wrapping the chest.
d. frequently assess breath sounds for indications of a pneumothorax.

Answer 43

d. frequently assess breath sounds for indications of a pneumothorax.

Question 44

Which of the following bandages is associated with the HIGHEST risk of blood flow compromise?

Select one:

a. Roller bandages
b. Elastic bandages
c. Triangular bandages
d. Nonabsorbent bandages

Answer 44

b. Elastic bandages

Question 45

The outermost layer of the epidermis:

Select one:

a. consists of nonliving cells that are continuously being shed.
b. is a tough, highly elastic layer than contains melanin granules.
c. contains numerous fibroblasts that secrete collagen and elastin.
d. is comprised of living cells that give rise to the stratum corneum.

Answer 45

a. consists of nonliving cells that are continuously being shed.

Question 46

The subcutaneous tissue is:

Select one:

a. the layer of tissue above the dermis that mainly produces sweat.
b. a thin layer of tissue from which blood vessels exclusively originate.
c. also called the superficial fascia and consists mainly of adipose tissue.
d. the deep fascial layer that ensheathes muscle and other internal structures.

Answer 46

c. also called the superficial fascia and consist mainly of adipose tissue.

Question 47

Which of the following conditions or factors would MOST likely delay or impair healing of a wound?

Select one:

a. Diabetes
b. Obesity
c. Alcohol use
d. Hypertension

Answer 47

a. Diabetes

Question 48

Which of the following patients is at HIGHEST risk for a pressure injury?

Select one:

a. An obese patient
b. A bedridden patient
c. A hypertensive patient
d. A patient with diabetes

Answer 48

b. A bedridden patient

Question 49

A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should suspect:

Select one:

a. tetanus.
b. meningitis.
c. a viral infection.
d. a staph infection.

Answer 49

a. tetanus

Question 50

A 22-year-old man was struck in the forehead by a softball. He is conscious and alert, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should:

Select one:

a. apply firm manual pressure to the hematoma to reduce internal bleeding.
b. place him in a sitting position and apply a chemical heat pack to his head.
c. apply an icepack to the hematoma and monitor his level of consciousness.
d. start an IV of normal saline and administer 2 mg of morphine for the pain.

Answer 50

c. apply an icepack to the hematoma and monitor his level of consciousness.