Trauma, Burns, and Bleeding

11. An organ or tissue that is considerably colder than 98.6°F is better able to resist damage from hypoperfusion because: A) the body's metabolic rate is slower. B) cells shrink as body temperature falls. C) hypothermia promotes oxygen metabolism. D) hypothermia protects hemoglobin molecules.

A Page: 1523 Type: General Knowledge

23. What is "warm ischemic time"? A) The period of time that organs and tissues can survive without perfusion, assuming a normal body temperature B) The preservation of ischemic organs and tissues when the patient's body temperature is reduced by 1°F per hour C) The period of time in which perfusion can be restored to ischemic organs and tissues before permanent damage occurs D) The preservation of ischemic organs and tissues when the patient's body temperature is increased to at least 101°F

A Page: 1523 Type: General Knowledge

15. What is the approximate total blood volume of a 150-pound male? A) 4.8 L B) 5.1 L C) 6.2 L D) 6.5 L

A Page: 1524 Type: General Knowledge

33. A healthy adult can tolerate blood loss of up to ____ mL over a period of 15 to 20 minutes without any negative effects. A) 500 B) 750 C) 1,000 D) 1,500

A Page: 1524 Type: General Knowledge

38. Which of the following types of shock is caused by poor blood vessel function? A) Septic B) Cardiogenic C) Hypovolemic D) Hemorrhagic

A Page: 1525 Type: General Knowledge

42. Which of the following signs would you MOST likely observe in a patient with compensated shock? A) Anxiety or agitation B) Dilation of the pupils C) Absent peripheral pulses D) Response to painful stimuli

A Page: 1527 Type: General Knowledge

21. All of the following are common early signs or symptoms of nontraumatic internal hemorrhage in older patients, EXCEPT: A) vomiting. B) syncope. C) weakness. D) dizziness.

A Page: 1528 Type: General Knowledge

29. A trauma patient with suspected internal hemorrhage and inadequate breathing requires: A) ventilation assistance and rapid transport. B) intubation that is facilitated by medications. C) on-scene IV therapy and rapid fluid boluses. D) oxygen via nonrebreathing mask and transport.

A Page: 1535-1536 Type: General Knowledge

4. At what age do the sutures of the skull solidify and the fontanelles close? A) 18 months B) 2 years C) 36 months D) 4 years

A Page: 1644

6. The crista galli: A) is the anatomic point of attachment of the meninges. B) is divided into the anterior, middle, and posterior fossae. C) is a horizontal bone perforated with numerous foramina. D) allows the passage of the olfactory nerves from the nasal cavity.

A Page: 1644

8. Which of the following statements regarding the brain is correct? A) The brain uses 45 to 50 L/min of oxygen. B) The brain occupies approximately 60% of the cranium. C) The brain metabolizes minimal amounts of glucose. D) The brain has the ability to store oxygen and glucose.

A Page: 1645

3. EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by: A) recognizing the need for rapid transport. B) initiating fluid resuscitation in the field. C) contacting medical control immediately. D) performing a careful abdominal assessment.

A Page: 1727

7. Intraperitoneal organs include all of the following, EXCEPT the: A) pancreas. B) stomach. C) small bowel. D) gallbladder.

A Page: 1729

11. As contents exit the stomach, they FIRST pass through the: A) pylorus. B) duodenum. C) gallbladder. D) cardiac sphincter.

A Page: 1731

13. Intraabdominal bleeding may produce few signs and symptoms of trauma because: A) the intraabdominal cavity can accommodate large amounts of blood. B) blood in the peritoneum can compress the aorta and maintain perfusion. C) it takes approximately 4 L of blood loss before signs of shock manifest. D) the abdominal musculature can sustain massive blunt force without bruising.

A Page: 1733

14. What do the spleen and liver have in common? A) They are both highly vascular and bleed profusely when injured. B) The liver and spleen are well protected by the abdominal muscles. C) They are less likely to be crushed by blunt trauma than other organs. D) The liver and spleen are the only solid organs in the abdominal cavity.

A Page: 1733

19. 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

A Page: 1735

21. 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.

A Page: 1735

31. Which of the following assessment findings is MOST suggestive of intraabdominal hemorrhage? A) Signs of shock B) Palpable pain C) Diffuse tenderness D) Nausea and vomiting

A Page: 1737, 1745

36. You are dispatched to the parking lot of a shopping mall for an injured person. While en route to the scene, it is MOST important for you to: A) request law enforcement assistance. B) alert the trauma center of the situation. C) take appropriate standard precautions. D) place air medical transport on standby.

A Page: 1738

8. Perfusion is defined as: A) the effective exchange of oxygen and carbon dioxide within the lungs and at the cellular level. B) the circulation of blood through an organ or tissue in amounts adequate to meet the body's demands. C) an ejection fraction that is adequate to maintain radial pulses or a systolic blood pressure of at least 90 mm Hg. D) the circulation of an adequate volume of blood to ensure uninterrupted cerebral and myocardial oxygenation.

B Page: 1522 Type: General Knowledge

16. The MOST significant factor that determines how well the body compensates for blood loss is: A) the patient's pulse rate at the time of the injury. B) the period of time over which the blood is lost. C) whether the bleeding is internal or external. D) whether the bleeding is venous or arterial.

B Page: 1524 Type: General Knowledge

44. A motorcycle rider struck a parked car and was catapulted over the handlebars of his bike. Your assessment reveals that he is tachypneic, diaphoretic, and tachycardic. There is no gross external bleeding present. What is the MOST likely cause of this patient's clinical presentation? A) Closed head injury B) Bilateral femur fractures C) Proximal upper extremity fractures D) Sympathetic nervous system failure

B Page: 1524, 1528 Type: Critical Thinking

27. A patient with hemorrhagic shock would be expected to have: A) warm, flushed skin. B) flattened jugular veins. C) a widened pulse pressure. D) an increased hematocrit.

B Page: 1527 Type: General Knowledge

20. Hematochezia: A) indicates digested blood from the upper gastrointestinal tract. B) is the passage of stools that contain bright red blood. C) suggests kidney injury and is characterized by bloody urine. D) is the passage of dark stools and indicates lower gastrointestinal bleeding.

B Page: 1529 Type: General Knowledge

31. Which of the following types of medication would MOST likely reduce a patient's ability to compensate when in shock? A) Tricyclic antidepressants B) Calcium channel blockers C) Nasal decongestants D) Beta-2 adrenergic agonists

B Page: 1529 Type: General Knowledge

1. The galea aponeurotica is: A) the dense fibrous membrane covering the surface of the cranium. B) a loose connective tissue that is easily damaged during "scalping" injuries. C) the subcutaneous layer of the scalp that contains easily damaged major veins. D) a tendon expansion that connects the frontal and occipital muscles of the cranium.

D Page: 1644

5. 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.

D Page: 1729

10. 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

D Page: 1730

16. At least two thirds of all abdominal injuries: A) result in death. B) are caused by falls. C) are penetrating injuries. D) involve blunt trauma.

D Page: 1734

17. 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.

D Page: 1734

32. The LEAST helpful technique when assessing the patient with abdominal trauma is: A) palpation. B) percussion. C) inspection. D) auscultation.

D Page: 1739

12. The diaphragm curves from its point of attachment at the _______ rib and peaks in the center at the _______ intercostal space. A) ninth, third B) tenth, seventh C) twelfth, fourth D) eighth, seventh

C Page: 1733

18. Penetrating abdominal trauma MOST commonly results from: A) flying debris following an explosion. B) high-powered rifles or military weapons. C) low-velocity gunshot or stab wounds. D) crush forces that separate the abdominal wall.

C Page: 1734

22. 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.

C Page: 1737

12. The amount of blood returned to the heart is called: A) preload. B) cardiac output. C) afterload. D) stroke volume.

A Page: 1520 Type: General Knowledge

3. Afterload is defined as the: A) pressure in the aorta against which the left ventricle must pump. B) amount of resistance to blood flow offered by the heart valves. C) amount of blood ejected from the ventricle with each contraction. D) volume of blood remaining in the ventricles following contraction.

A Page: 1520 Type: General Knowledge

5. Which of the following statements regarding blood flow is correct? A) Ejection fraction is the percentage of blood that the heart pumps per contraction. B) If more blood returns to the heart, stroke volume decreases and cardiac output falls. C) As more blood is pumped with each contraction, the ejection fraction increases. D) The amount of blood that returns to the atrium remains fixed from minute to minute.

A Page: 1520-1521 Type: General Knowledge

37. Circulation of blood within an organ or tissue in adequate amounts to meet the cells' current needs is called: A) perfusion. B) respiration. C) oxygenation. D) metabolism.

A Page: 1522 Type: General Knowledge

10. Which of the following organs can sustain the longest period of inadequate perfusion? A) Gastrointestinal tract B) Kidneys C) Spinal cord D) Skeletal muscle

A Page: 1522-1523 Type: General Knowledge

38. You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. His respirations are rapid and shallow and his pulse is rapid and weak. What will maximize this patient's chances of survival? A) Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route B) Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center C) Application and inflation of the PASG, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center D) Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route

A Page: 1741

26. Which of the following statements regarding stomach injuries is correct? A) Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use. B) The vast majority of injuries to the stomach are caused by blunt force trauma and result in severe peritoneal hemorrhage. C) Patients taking antacid medications usually experience immediate signs of peritoneal irritation following an injury to the stomach. D) Penetrating mechanisms are a rare cause of injury to the stomach because the stomach is well protected by the abdominal musculature.

A Page: 1743

43. Fournier gangrene is a potential complication associated with: A) scrotal lacerations. B) ovarian rupture. C) urethral injuries. D) urinary bladder rupture.

A Page: 1746

28. Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________. A) umbilicus, peritoneal bleeding B) epigastrium, stomach rupture C) flank, retroperitoneal bleeding D) back, traumatic aortic dissection

C Page: 1740, 1743

1. Which of the following components is LEAST crucial to the continuous circulation of oxygenated blood throughout the body? A) Heart B) Spleen C) Vasculature D) Fluid volume

B Page: 1519 Type: General Knowledge

6. Hemoglobin functions by: A) dissolving in blood plasma to create the partial pressure of carbon dioxide. B) binding to oxygen that is absorbed in the lungs and transporting it to the tissues. C) absorbing hydrogen ions in the blood in order to maintain acid-base balance. D) transporting red blood cells throughout the body to ensure adequate oxygenation.

B Page: 1522 Type: General Knowledge

45. You have successfully controlled a large arterial hemorrhage from a 42-year-old man's leg with direct pressure and a pressure dressing. He is conscious, but restless. His blood pressure is 84/58 mm Hg, pulse is 120 beats/min, and respirations are 24 breaths/min. You should: A) keep him warm, administer high-flow oxygen, establish one large-bore IV line at the scene, and transport. B) administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route. C) administer high-flow oxygen, start two large-bore IV lines at the scene and give a 2- to 3-L fluid bolus, and transport. D) Keep him warm, assist his ventilations, place a hemostatic agent in the wound, transport, and start a large-bore IV en route.

B Page: 1530-1531, 1536-1537 Type: Critical Thinking

25. When applying a tourniquet to control major external hemorrhage from an extremity injury, you should: A) apply the tourniquet over a joint, as this will further help compress blood vessels. B) maintain direct pressure to the wound until the tourniquet has been fully applied. C) secure the tourniquet in place until the pulses distal to the injury have weakened. D) apply a pressure dressing over the tourniquet to further help control the bleeding.

B Page: 1532-1534 Type: General Knowledge

3. The brain connects to the spinal cord through a large opening at the base of the skull called the: A) cribriform plate. B) foramen magnum. C) occipital condyle. D) palatine bone.

B Page: 1644

5. The cone-shaped section of bone located at the base of each temporal bone is called the: A) lamboid suture. B) mastoid process. C) cribriform plate. D) ethmoid bone.

B Page: 1644

2. Which of the following factors can decrease the potential damage caused by trauma to the abdomen? A) A seat belt that is worn above the iliac crests B) Toned abdominal muscles and an empty bladder C) Abdominal muscle tensing at the time of impact D) Air bags and being younger than 44 years old

B Page: 1727

6. What membranous tissue functions as the point of attachment for the various abdominal organs? A) Pleura B) Mesentery C) Peritoneum D) Ligamentum arteriosum

B Page: 1729

8. Which of the following organs lies within the retroperitoneal space? A) Liver B) Kidneys C) Spleen D) Ovaries

B Page: 1729

34. Following blunt force trauma to the lower right rib cage, a 40-year-old man presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that he has a: A) pyloric injury. B) liver injury. C) splenic rupture. D) pneumothorax.

B Page: 1730, 1742

15. 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.

B Page: 1733-1734

20. What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained? A) Frontal crash B) Rear-end crash C) Lateral crash D) Rollover crash

B Page: 1735

39. 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.

B Page: 1738, 1741

29. Periumbilical ecchymosis is: A) commonly observed in the prehospital setting following blunt force trauma to the abdomen. B) referred to as Cullen sign and may take hours or days to develop following abdominal trauma. C) usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen. D) also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma.

B Page: 1740, 1743

24. Left shoulder pain following injury to the spleen: A) typically precedes hypotension and other signs of shock. B) usually does not occur until 1 to 2 hours after the injury. C) is a sign of associated injury to a hollow abdominal organ. D) is called Cullen sign and indicates intraabdominal bleeding.

B Page: 1742

41. You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and: A) left shoulder pain. B) pain with inhalation. C) right shoulder pain. D) pain with exhalation.

B Page: 1744

44. 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.

B Page: 1746

40. What are the two layers that cover the testicles? A) Tunica vaginalis and tunica intima B) Tunica media and tunica albuginea C) Tunica albuginea and tunica vaginalis D) Tunica intima and tunica adventitia

C Page: 1732

4. Which of the following two factors DIRECTLY affect cardiac output? A) Preload and afterload B) Vessel size and stroke volume C) Stroke volume and pulse rate D) Blood pressure and pulse rate

C Page: 1520 Type: General Knowledge

9. Which of the following organs or body systems requires a constant blood supply, regardless of external factors? A) Skin B) Muscles C) Kidneys D) Gastrointestinal tract

C Page: 1522 Type: General Knowledge

36. A fall in blood pressure and the resultant changes in plasma osmolality cause the release of: A) glycogen and luteinizing hormone. B) T3 and T4 from the thyroid gland. C) aldosterone and antidiuretic hormone. D) acetylcholine and angiotensin I.

C Page: 1523 Type: General Knowledge

14. Patients with internal hemorrhage will benefit MOST from: A) IV therapy. B) high-flow oxygen. C) rapid transport. D) PASG placement.

C Page: 1524 Type: General Knowledge

17. Venous bleeding: A) is dark red in color and usually oozes from the wound. B) is bright red in color and typically spurts from a wound. C) is more likely to clot spontaneously than arterial bleeding. D) is generally more difficult to control than arterial bleeding.

C Page: 1525 Type: General Knowledge

32. Confusion, a sustained heart rate greater than 120 beats/min, and a respiratory rate of 32 breaths/min are MOST consistent with class ___ hemorrhage? A) I B) II C) III D) IV

C Page: 1526 Type: General Knowledge

40. The paramedic's MAIN goal in treating a patient with shock is to: A) administer oxygen in a concentration sufficient to maintain an oxygen saturation greater than 95%. B) start two large-bore IV lines and infuse enough isotonic crystalloid solution to maintain adequate tissue perfusion. C) recognize the signs and symptoms of shock in its earliest phase and begin immediate treatment before permanent damage occurs. D) maintain body temperature and elevate the patient's legs 6 to 12 inches in order to improve blood flow to the core of the body.

C Page: 1526 Type: General Knowledge

35. In contrast to a patient with compensated shock, a patient with decompensated shock would be expected to present with: A) polyuria and weak pulses. B) bounding radial pulses. C) mottled skin and dilated pupils. D) restlessness and pale cool skin.

C Page: 1527 Type: General Knowledge

22. Most external hemorrhage can be controlled with a combination of: A) pressure dressings and ice. B) elevation and immobilization. C) direct pressure and pressure dressings. D) pressure point control and elevation.

C Page: 1528 Type: General Knowledge

43. You are treating a 20-year-old man with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. Your initial attempts to control the bleeding have failed. You should: A) administer high-flow oxygen, establish vascular access at the scene, transport, and apply a proximal tourniquet en route. B) administer high-flow oxygen, transport, and apply a proximal tourniquet and establish vascular access en route. C) apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route. D) control the bleeding by applying pressure to a proximal pressure point, administer high-flow oxygen, and transport.

C Page: 1530-1532, 1537 Type: Critical Thinking

24. Much of the bleeding associated with unsplinted fractures continues because: A) most fractures are unstable and usually lacerate major blood vessels. B) swelling associated with such fractures prevents platelet aggregation. C) bone ends will continue to move and destroy partially formed clots. D) patient anxiety increases the blood pressure, which exacerbates bleeding.

C Page: 1534 Type: General Knowledge

2. The ______________ consists of eight bones that encase and protect the brain. A) skull B) cerebrum C) cranial vault D) cribriform plate

C Page: 1644

7. The occipital condyles are the: A) key anatomic structures to which the meninges are attached. B) passageways for the olfactory nerves to exit the nasal cavity. C) points of articulation between the skull and vertebral column. D) horizontal bones of the cribriform plate that contain foramina.

C Page: 1645

9. Paralysis of the extremities would MOST likely result from injury to the: A) cerebellum. B) diencephalon. C) cerebral cortex. D) hypothalamus.

C Page: 1645

10. The parietal lobe of the brain: A) is where the optic nerve originates and processes vision. B) is important for voluntary motor action and personality traits. C) controls somatic functions for the contralateral side of the body. D) controls functions such as long-term memory, taste, and smell.

C Page: 1646

1. Anatomically, the abdominal cavity extends from the: A) fifth rib to the pelvis. B) umbilicus to the pelvis. C) diaphragm to the pelvis. D) nipple line to the diaphragm.

C Page: 1728

4. The abdomen extends superiorly to the level of the: A) xiphoid process. B) second intercostal space. C) fourth intercostal space. D) two pairs of floating ribs.

C Page: 1728

9. Which of the following statements regarding the liver is correct? A) The liver is the largest hollow organ in the abdomen and is responsible for producing and storing bile. B) The liver is a relatively avascular organ that is uncommonly injured during blunt abdominal trauma. C) The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood. D) The liver is partially protected by the left lower rib cage and serves the function of filtering bacteria from the blood.

C Page: 1730

35. 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.

C Page: 1742

27. Gross hematuria and suprapubic pain following a pelvic injury is MOST indicative of injury to the: A) ureters. B) urethra. C) bladder. D) kidney.

C Page: 1745

33. 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.

C Page: 1745

45. A 36-year-old female was sexually assaulted and is experiencing intense pain. Your assessment reveals several open lacerations to her vaginal area and a painful distended abdomen. Her blood pressure is 86/50 mm Hg and her heart rate is 120 beats/min and weak. In addition to administering supplemental oxygen, you should: A) control any bleeding from her open wounds, establish two large-bore IV lines, and give 1 µg/kg of fentanyl. B) apply pressure dressings to her open injuries, cover the dressings with an ice pack, and transport rapidly. C) cover her open wounds with sterile dressings, establish at least one large-bore IV, and give a 20-mL/kg fluid bolus. D) insert a sterile dressing into her vagina to control any internal bleeding, establish a large-bore IV, and set it at a KVO rate.

C Page: 1747

30. A trauma patient with hypotension secondary to internal hemorrhage should receive IV fluid boluses in order to: A) increase the systolic blood pressure to at least 110 mm Hg. B) restore the patient's blood pressure to its pretrauma reading. C) increase the pulse rate by no more than 10 beats/min. D) maintain the systolic blood pressure in a low normal range.

D Page: 1537 Type: General Knowledge

2. The cardiac cycle begins with the onset of myocardial contraction and ends: A) as blood returns to the right atrium. B) as both ventricles are filling with blood. C) when the ventricles are emptied of blood. D) with the beginning of the next contraction.

D Page: 1520 Type: General Knowledge

7. What aggregates in a clump and forms much of the foundation of a blood clot during the process of coagulation? A) Fibrin B) Calcium C) Plasmin D) Platelets

D Page: 1522 Type: General Knowledge

13. External bleeding would be the MOST difficult to control in a patient with a large laceration to the _____________ and a blood pressure of ______ mm Hg. A) jugular vein, 96/62 B) brachial artery, 68/46 C) femoral vein, 114/60 D) carotid artery, 100/70

D Page: 1524-1525 Type: General Knowledge

18. Which of the following factors would have the MOST negative effect on the body's process of hemostasis? A) Bradycardia B) Hyperthermia C) Chronic heroin use D) Anticoagulant use

D Page: 1525 Type: General Knowledge

28. Which of the following injuries or mechanisms would MOST likely lead to nonhemorrhagic shock? A) Fractures B) Blunt trauma C) Hemothorax D) Severe burns

D Page: 1525 Type: General Knowledge

34. The physiologic process of hemostasis is achieved through: A) an increased production of red blood cells. B) the destruction of fibrin and platelets. C) the use of anticoagulants such as Coumadin. D) vasoconstriction and platelet aggregation.

D Page: 1525 Type: General Knowledge

41. Decompensated shock in the adult is characterized by: A) increased tidal volume. B) bounding radial pulses. C) 15% blood loss or more. D) a falling blood pressure.

D Page: 1527 Type: General Knowledge

39. If you discover minor external bleeding during your primary assessment of a patient, you should: A) stop your assessment and take the patient's blood pressure. B) establish a large-bore IV line immediately. C) stop your assessment and control the bleeding. D) make note of it and continue your assessment.

D Page: 1529 Type: Critical Thinking

19. If you suspect internal bleeding during the primary assessment, you should: A) stop the assessment and transport at once. B) start two large-bore IV lines of normal saline. C) determine the source of the internal bleeding. D) keep the patient warm and administer oxygen.

D Page: 1529 Type: General Knowledge

26. Agents such as Celox, HemCon, and QuikClot are used to: A) repair damaged vessels. B) replace lost blood. C) raise blood pressure. D) promote hemostasis.

D Page: 1535 Type: General Knowledge

37. A 59-year-old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12-inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should: A) trim the steel rod to 6 inches, stabilize it in place with bulky dressing, apply firm direct pressure around the rod, and initiate IV therapy en route to a trauma center. B) carefully remove the steel rod, apply direct pressure to the wound, assess his cardiac rhythm, start a large-bore IV line and give 2 L of normal saline, and transport. C) remove the rod so you can perform effective CPR, control any external bleeding, start two large-bore IV lines, and assess his cardiac rhythm en route to the hospital. D) control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital.

D Page: 1741-1742

23. When blood is released into the peritoneal cavity: A) the abdomen almost immediately becomes grossly distended. B) it is most often the result of blunt force trauma to the pancreas. C) blood pressure falls with as little as 500 mL of internal blood loss. D) nonspecific signs such as tachycardia and hypotension may occur.

D Page: 1742

25. 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.

D Page: 1742

30. Injuries to the vascular structures in the intraperitoneal space: A) commonly involve the inferior vena cava and phrenic artery. B) are most often associated with penetrating injury mechanisms. C) are generally associated with flank or periumbilical bruising. D) are often caused by shearing forces secondary to blunt trauma.

D Page: 1743

42. Traumatic urinary bladder rupture is seen MOST frequently in patients who are: A) diabetic. B) short and obese. C) tall and thin. D) intoxicated.

D Page: 1744-1745