EMT chapter 25 bleeding and shock

Which of the following physiological events generally indicates the onset of decompensated​ shock? A. ​Pale, cool, and clammy skin B. An increase in breathing rate C. An increase in heart rate D. A drop in the​ patient's blood pressure

A drop in the​ patient's blood pressure

Which of the following is MOST likely to cause cardiogenic​ shock? A. A drug that induces widespread vascular dilation B. Taking too much nitroglycerin for chest pain C. A massive MI that impairs the pump function of the heart D. A massive pulmonary embolus

A massive MI that impairs the pump function of the heart

During severe external​ bleeding, the brain MAY suffer a lack of oxygen. Which of the following contributes most to that lack of​ oxygen? A. The vasodilation that occurs during shock B. A reduction in the number of red blood cells and blood pressure C. A redirection of blood flow to the site of the injury D. A reduction in the rate of breathing from shock

A reduction in the number of red blood cells and blood pressure

Which of the following patients at the scene of an accident is most likely developing​ shock? A. A young adult female is gesturing for your attention B. A​ middle-aged male is leaning against a paramedic for support C. A male child is crying in an adult​ female's arms D. An elderly female is vomiting on her hands and knees

An elderly female is vomiting on her hands and knees

Your patient presents with signs and symptoms of shock after a motor vehicle crash. Which of the following would be one such​ sign? A. Increased docility B. Measured speech C. Apparent agitation D. Heightened alertness

Apparent agitation

In a patient with uncontrolled hemorrhage due to a traumatic​ amputation, which of the following interventions is likely to be MOST​ effective? A. Application of direct pressure B. Elevation of the extremity C. Application of pressure points D. Application of a tourniquet

Application of a tourniquet

You have a patient with a long laceration to his thigh after falling through a roof he was working on. The bleeding is bright red and​ spurting, and the patient is becoming increasingly pale and disoriented. How would you characterize this​ bleeding? A. Venous B. Arterial C. Capillary D. Noncritical

Arterial

Which of the following statements is​ TRUE? A. Arteries have valves that prevent backflow of blood. B. Arteries carry blood from the heart. C. Arteries carry only​ oxygen-rich blood. D. Arteries lack a middle layer of smooth muscle.

Arteries carry blood from the heart.

In neurogenic​ shock, what mechanism causes​ hypoperfusion? A. Nervous control necessary for the heart to continue to beat effectively is lost. B. Arteries that are under continuous nervous control lose their ability to maintain contraction and dilate​ fully, causing a drop in blood pressure. C. Injury to the neurological system causes the blood vessels to leak extensively. D. Loss of nervous regulation results in the blood vessels contracting​ completely, not allowing blood to flow.

Arteries that are under continuous nervous control lose their ability to maintain contraction and dilate​ fully, causing a drop in blood pressure.

You are treating a​ 42-year-old male complaining of chest pain and shortness of breath. You notice that he appears​ pale, cool, and sweaty. What is the MOST likely reason for these​ findings? A. The​ patient's pain receptors are causing his vessels to expand and dilate. B. Blood vessels constrict in response to sympathetic​ stimulation, causing a decrease in blood flow to the skin. C. The body is attempting to rid waste products through the skin as well as the kidneys. D. Blood vessels are​ dilating, causing inadequate gas exchange.

Blood vessels constrict in response to sympathetic​ stimulation, causing a decrease in blood flow to the skin.

You arrive on scene to an​ 8-year-old male patient who fell while skating. He is responsive but lying down on the pavement. As you assess the​ patient, you notice abrasions with​ self-controlled bleeding located on both his knees. Based on your​ assessment, what type of external bleeding is​ this? A. Capillary B. Arterial C. Venous D. ​Non-significant

Capillary

For a patient at what stage of shock are the efforts of EMTs likely to be MOST successful and have the GREATEST impact on a positive​ outcome? A. Irreversible shock B. Refractory shock C. Decompensated shock D. Compensated shock

Compensated shock

Of the following adjustments to the vascular​ system, which will contribute the most to increased perfusion to the​ core? A. Decreased vascular diameter B. Increased blood volume C. Decreased heart rate D. Increased oxygen consumption

Decreased vascular diameter

As you approach a patient with severe hemorrhaging from one​ arm, what should you do​ FIRST? A. Immediately elevate the arm and apply direct pressure. B. Place the patient on​ high-flow oxygen to manage the​ patient's hypoperfusion. C. Don standard precautions before touching the patient. D. Check the​ patient's airway.

Don standard precautions before touching the patient.

Which of the following is TRUE regarding decompensated​ shock? A. Decompensated shock is​ reversible, whereas compensated shock is not. B. During decompensated​ shock, the body can no longer compensate adequately. C. Compensated shock is shock that carries the ultimate costs to the body. D. The amount of oxygen availability to the tissues is greater during decompensated shock.

During decompensated​ shock, the body can no longer compensate adequately.

Which of the following blood vessels do you believe will cause the most significant hemorrhage if​ injured? A. Femoral artery B. Brachial artery C. Radial artery D. Saphenous vein

Femoral artery

You are on scene with a​ 45-year-male who lacerated his hands while working in his garage. The bleeding is dark red and has a steady flow. What is the best way to manage this​ patient's hemorrhage? A. Tourniquet application proximal to the injury site B. Firmly bandaging a dressing in place C. Elevation of the extremities D. Splinting the limb and applying a cold pack

Firmly bandaging a dressing in place

A​ 49-year-old male patient was injured with a chain saw while cutting down a tree. He sustained a​ deep, jagged laceration to his left thigh. On​ arrival, you find him to be conscious but breathing​ rapidly, with a rapid pulse and​ cold, clammy skin. What type of shock would you suspect that he is​ in? A. Cardiogenic shock B. Anaphylactic shock C. Neurogenic shock D. Hypovolemic shock

Hypovolemic shock

You are managing a​ 27-year-old female with severe hemorrhage from her right ankle after a motor vehicle collision. You are unable to stop the hemorrhage with direct pressure. What intervention should you do​ next? A. Place the patient on​ high-flow oxygen. B. Apply a pressure dressing. C. Apply a bulky sterile dressing. D. Immediately apply a tourniquet proximal to the wound on the​ patient's femur.

Immediately apply a tourniquet proximal to the wound on the​ patient's femur.

In all forms of​ shock, what is the greatest consequence to the​ body? A. Inadequate delivery of oxygen to the cells B. Inadequate delivery of nutrients to the tissue C. Decreased removal of waste from the tissue D. Decreased blood flow to the tissue

Inadequate delivery of oxygen to the cells

You are treating a​ 29-year-old motorcycle crash victim who appears​ pale, cool, and diaphoretic. You suspect he sustained a traumatic brain injury based on decreased pupillary response. Based on these findings and the mechanism of​ injury, which of the following is the MOST appropriate method to manage this​ patient? A. Perform a detailed secondary assessment on the patient prior to transportation. B. Limit​ on-scene time and promptly transport the patient to the hospital. C. Splint all orthopedic injuries found prior to transporting the patient to the hospital. D. Assess and catalog all major and minor injuries prior to transporting the patient to the hospital.

Limit​ on-scene time and promptly transport the patient to the hospital.

Which of the following is the BEST indicator of perfusion in the​ adult? A. Blood pressure B. Mental state and alertness C. Capillary refill D. Pulse

Mental state and alertness

In your care of a patient suffering from shock due to a motor vehicle​ crash, which of the following is MOST​ critical? A. Gathering information from the​ bystanders, family, or police officers before leaving the scene B. Closely examining the vehicles that were involved to determine the mechanisms of injury C. Minimizing your scene time D. Conducting a detailed secondary assessment at the scene

Minimizing your scene time

In shock​ states, what general principle can be observed regarding​ perfusion? A. Perfusion is increased in all regions of the body. B. Perfusion in some areas is inadequate because the circulatory system malfunctions. C. Increased perfusion to the core circulation is accomplished by vasodilation in the periphery. D. Perfusion is enhanced in shock by increased heart rate and an expansion of blood vessels to reduce resistance.

Perfusion in some areas is inadequate because the circulatory system malfunctions.

Which of the following would be the BEST approach for a patient who is in shock secondary to internal​ bleeding? A. Provide necessary care while transporting the patient to a hospital that can provide surgical intervention. B. Provide necessary care and transport the patient to the local surgery clinic. C. Provide necessary care while awaiting the arrival of paramedics. D. Provide necessary care and transport the patient to the closest hospital even though it is a community hospital.

Provide necessary care while transporting the patient to a hospital that can provide surgical intervention.

When a patient has significant blood​ loss, which of the following clinical findings would you expect to find that signifies the presence of​ shock? A. Rapid heart rate B. ​Flushed, warm, dry skin C. Slowed breathing and a bounding pulse D. Calm and relaxed demeanor with mental alertness and verbal responsiveness

Rapid heart rate

Which of the following principles may help the MOST in ensuring the survival of a patient who is suffering from shock due to massive​ trauma? A. Rapid transport to an appropriate facility B. Waiting for the arrival of paramedics so that they can administer IV fluids C. Facilitating immediate transport to the local community hospital D. Starting oxygen administration at a low concentration and increasing it gradually to the desired levels to avoid hyperoxia

Rapid transport to an appropriate facility

What could be a sign of a patient experiencing internal bleeding into the​ abdomen? A. Cyanosis B. Contraction C. Tenderness D. Erythema

Tenderness

Which of the following is TRUE about the cardiovascular system in a pediatric patient that should be considered whenever trauma causes blood​ loss? A. The femoral pulse is considered a peripheral pulse in an infant. B. The right side of the heart receives​ oxygen-rich blood from the lungs. C. The blood volume of a child is far less than that of an adult. D. Oxygen and carbon dioxide are exchanged at a slower rate in a child.

The blood volume of a child is far less than that of an adult.

Why does a patient in shock secondary to blood loss develop​ pale, cool, and clammy​ skin? A. The sympathetic nervous system limits peripheral circulation. B. Blood flow is being redirected to the periphery of the body to combat the heat load. C. The blood has lost some of its red blood​ cells, which give the blood​ (and skin) the red color. D. The​ patient's body is using all available energy to combat the blood​ loss, so sweating is to expected.

The sympathetic nervous system limits peripheral circulation.

You respond to the scene of​ 34-year-old male whose left lower arm is bleeding profusely after an accidental amputation at the wrist while cutting planks with a circular saw. Direct pressure does not stop the​ bleeding, so you decide to place a tourniquet on the​ patient's limp. Which of the following statements is the MOST​ accurate? A. Apply the tourniquet distal to the wound. B. Apply the tourniquet over the elbow joint to stop the bleeding. C. Twist the rod or windlass until the bleeding is not​ spurting, just flowing. D. The tourniquet should be applied proximal to the wound but not over a joint.

The tourniquet should be applied proximal to the wound but not over a joint.

Which of the following is a function of the vascular​ system? A. Transportation of gases B. Metabolism C. Production of red blood cells D. Hormone production

Transportation of gases

A substance that will stop bleeding is​ called: A. a pressure dressing. B. a hemostatic agent. C. a tourniquet. D. a coalescent.

a hemostatic agent.

Your​ 35-year-old female patient has accidentally cut her forearm with a kitchen knife. You notice that the blood is dark red and has a steady flow. The patient is concerned she may have​ "cut an​ artery." Based on this​ finding, you should tell her that the source of the hemorrhage​ is: A. a capillary. B. an arteriole. C. a vein. D. an artery.

a vein

The severity of external bleeding is influenced by several​ factors, including the bleeding​ person's: A. resistance to trauma. B. height and weight. C. ability to clot. D. cardiovascular health.

ability to clot.

It is characteristic of arterial bleeding to​ be: A. inconsistent. B. constant. C. abundant. D. gradual.

abundant

A 29-year-old male has fallen from a utility pole he was working on. He presents with an obviously fractured leg and a severe hemorrhage from the area around the fracture site. You are applying direct pressure but despite your best efforts the bleeding has not stopped and your original dressing has soaked through. You should next: A add an additional dressing over the original. B elevate the extremity. C apply a traction splint. D apply a tourniquet.

apply a tourniquet.

A 44-year-old male fell through a plate glass window and has a severe laceration to the side of his neck. He is bleeding severely. You should first: A apply a tourniquet. B sit him up to elevate the wound. C apply direct pressure. D apply a pressure bandage.

apply direct pressure.

A 35-year-old male has severely lacerated his upper leg. Emergency medical dispatch reports "spurting blood" coming from the wound. Upon your arrival 10 minutes later, the wound is simply flowing blood but not spurting. The patient is semiconscious. This bleeding is most likely: A controlled. B capillary in nature. C arterial. D venous.

arterial

Shock is typically caused by a problem with the​ heart, fluid​ volume, or: A. blood vessels. B. age of the patient. C. cerebral hypoxia. D. core temperature.

blood vessels

During severe​ bleeding, which of the following structures is most sensitive to hypoxia from blood​ loss? A. Brain B. Heart muscle C. Lungs D. Skeletal muscle

brain

Microscopically small structures in the circulatory system that supply every cell in the body​ are: A. capillaries. B. arterioles. C. veins. D. arteries.

capillaries.

You are caring for a​ 62-year-old male patient who complains of chest​ pain, shortness of​ breath, and nausea. His heart rate is more than​ 120, and his blood pressure is​ 90/60. You notice some pallor and peripheral cyanosis on his​ cool, clammy skin. He is MOST likely suffering​ from: A. neurogenic shock. B. septic shock. C. anaphylactic shock. D. cardiogenic shock.

cardiogenic shock.

You respond to the scene of a​ 27-year-old female who was working on her car when she​ "snagged her hand on a sharp​ edge." She has napkins around her hand covering the wound. You uncover it and note that the bleeding is slow and dark red in color. Direct pressure easily stops the bleeding. Based on this​ information, what is the source of her​ bleeding? A. Radial artery B. Brachial artery C. Cephalic vein D. Capillary bleed

cephalic vein

A 72-year-old woman has fallen down some stairs. As you approach her, you note she is awake and has minor bleeding from her left leg. After assuring that the scene is safe, you should next: A check her airway. B assure her breathing is adequate. C apply direct pressure to the bleeding. D assess her pulse and skin.

check her airway.

If a patient in shock is able to maintain​ perfusion, then this​ is: A. compensated shock. B. irreversible shock. C. physiological shock. D. decompensated shock.

compensated shock.

You suspect that your patient has a GI bleed. She presents with​ tachycardia, hypotension, and pale skin. What stage of shock is she MOST likely​ in? A. Hypovolemic shock B. Compensated shock C. Decompensated shock D. Early shock

decompensated shock

The method of bleeding control that is the FIRST and MOST successful method to try​ is: A. a tourniquet. B. the use of a pressure point. C. direct pressure. D. the application of cold.

direct pressure

Which method is the LEAST invasive and can control bleeding in MOST​ cases? A. Elevation B. Direct pressure C. Hemostatic agents D. Tourniquets

direct pressure

Once a pressure dressing has been​ applied, the EMT should​ NEXT: A. place the patient on​ high-flow oxygen. B. ensure that bleeding is controlled. C. immediately check for a distal pulse. D. obtain a baseline set of vital signs.

ensure that bleeding is controlled.

Which of the following conditions is associated with poor coagulation and accelerated blood loss? A Hypothermia B Hyperthermia C Hypotension D High cholesterol

hypothermia

Hypoperfusion​ is: A. inadequate blood flow to the tissue. B. reduced blood volume. C. reduced oxygen saturation of the blood. D. inadequate oxygen delivery to the tissue.

inadequate blood flow to the tissue.

All shock​ involves: A. inadequate tissue perfusion B. heart failure C. hypertension D. sepsis

inadequate tissue perfusion

A 17-year-old male has been shot. You note that he has a large wound at the connection of his arm to his shoulder. The bleeding from this injury would be referred to as: A capillary bleeding. B junctional hemorrhage. C internal hemorrhage. D uncontrollable hemorrhage.

junctional hemorrhage.

Waste can build up in the body​ when: A. excretion increases. B. the blood volume reduces. C. perfusion decreases. D. the heart rate decreases.

perfusion decreases.

The supply of oxygen to and removal of wastes from the body's cells and tissues as a result of the flow of blood through the capillaries is known as: A shock. B hypoperfusion. C perfusion. D ventilation.

perfusion.

The term used for the delivery of oxygen and nutrients from the blood through the thin capillary walls into the cells and the removal of carbon dioxide and other waste products from the cells​ is: A. pulse pressure. B. perfusion. C. circulation. D. blood pressure.

perfusion.

The signs and symptoms of internal bleeding​ include: A. poor peripheral perfusion. B. ​slow, deep respirations. C. constricted pupils that are sluggish to respond. D. dropping blood pressure as an early sign.

poor peripheral perfusion.

You have been called to a nursing home where you find an​ 88-year-old female patient who is confused and combative. The staff states that this is not her normal behavior but that she has been bedridden from a previous stroke. They also report that she has had a recent urinary tract infection from an indwelling catheter. You note that her skin is flushed and​ warm, her pulse is​ 108, and her blood pressure is​ 80/44. You should​ suspect: A. anaphylactic shock. B. hypovolemic shock. C. septic shock. D. neurogenic shock.

septic shock

A 10-year-old male has been struck by a car while riding his bicycle. He has a minor hemorrhage on his lower left leg and complains of abdominal pain. He is awake and has pale skin. His vital signs are P 130, R 32, BP 100/60. These findings are most likely the result of: A a fracture in the leg. B hypothermia as evidenced by his pale skin. C pain associated with his abdomen. D shock.

shock.

A 25-year-old male has crashed his motorcycle and has a large open wound in his upper thigh. As you approach him, you note he has snoring respirations and spurting blood coming from the wound. After assuring the scene is safe, you should next: A stop the bleeding. B open the airway. C check for a pulse. D assure breathing is adequate.

stop the bleeding.

The problem of blood vessels dilating in compensation for trauma is primarily related​ to: A. lost blood volume. B. vascular capacity that is too great. C. heart failure. D. inadequate gas exchange.

vascular capacity that is too great.

Which of the following blood vessels carry deoxygenated blood back to the heart? A Arteries B Veins C Arterioles D Capillaries

veins

Internal bleeding may result from a variety of causes. If you suspect that your patient has internal​ bleeding, you should remember​ that: A. internal bleeding is usually very obvious and should be identified quickly. B. the two most common causes of internal bleeding are ruptured aortic aneurysm and bleeding stomach ulcers. C. head injury is more likely to cause unexplained shock than internal bleeding is. D. your suspicion of internal bleeding may be based only on the mechanism of injury.

your suspicion of internal bleeding may be based only on the mechanism of injury.