Maxillofacial Trauma

When assessing a patient with a naso-orbital-ethmoidal fracture, which finding should you suspect? A. A loss of chin projection B. An increased distance between the angles of the eyelids C. A spoonlike appearance of the face D. A flattening of the cheek

B. An increased distance between the angles of the eyelids

A patient presents with obvious nasal deformity and epistaxis after being struck in the face with a baseball. He blows his nose to clear the blood from his nasal passages and develops subcutaneous emphysema. What is this finding associated with? A. Septal hematoma B. Uncomplicated nasal fracture C. Fracture of the cribriform plate D. Involvement of the lacrimal system

D. Involvement of the lacrimal system

Le Fort I fractures are associated with which complication? A. Enophthalmos B. Lacrimal system obstruction C. Foreshortening of the nose with telescoping D. Loss of teeth

D. Loss of teeth

Which type of fracture is most likely to cause trismus? A. Le Fort I B. Le Fort II C. Le Fort III D. Mandibular

D. Mandibular

For a patient with a maxillary fracture, care may include which intervention? A. Place an eye shield over the affected eye. B. Insert a nasogastric tube. C. Place the patient in the left lateral recumbent position. D. Prepare for surgery.

D. Prepare for surgery.

For a patient with a nasal fracture, which intervention is indicated? A. Inject the area with a local anesthetic. B. Have the patient blow the nose to clear it of blood clots. C. Observe nasal hematomas to detect expansion. D. Splint the area.

D. Splint the area.

In the emergency department, a patient presents after "tripping over my dog" and landing face-first on the sidewalk. The assessment reveals a 1-cm (0.4-inch) laceration above her right eyebrow, bloody nasal drainage, and a step-off deformity of her right cheek with pain, edema, and swelling of the cheek and periorbital region. For this patient, which intervention has the highest priority? A. Determine her tetanus immunization status. B. Assess her visual acuity and extraocular movements. C. Irrigate the laceration and prepare for wound closure. D. Use a glucose strip to test nasal drainage for cerebrospinal fluid.

B. Assess her visual acuity and extraocular movements.

Which complication can result from a zygoma fracture? A. Exophthalmos B. Infraorbital nerve anesthesia C. Rhinorrhea D. Septal hematoma

B. Infraorbital nerve anesthesia

For a patient who presents with massive periorbital and midface swelling, which intervention is not appropriate? A. Test nasal drainage for cerebrospinal fluid. B. Insert a nasogastric tube. C. Inspect the eyes and assess gross visual acuity. D. Sit the patient upright or elevate the head of the bed if cervical precautions allow.

B. Insert a nasogastric tube.

Which type of fracture affects the pyramidal area? A. Le Fort I B. Le Fort II C. Le Fort III D. Mandibular

B. Le Fort II

In a patient with a Le Fort II fracture, which method is used to control facial bleeding? A. Embolization B. Manual reduction C. Cotton-tip swab D. Sterile sponge (Gelfoam)

B. Manual reduction

Malocclusion is associated with a fracture of which bone? A. Zygoma B. Maxilla C. Ethmoid D. Frontal

B. Maxilla

The foreshortening of the nose with telescoping is a finding of which type of fracture? A. Nasal B. Naso-orbital-ethmoidal C. Zygomatic D. Le Fort I

B. Naso-orbital-ethmoidal

Which sign or symptom is most commonly associated with a mandibular fracture? A. Double vision B. Anesthesia of the upper lip and cheek C. Subcutaneous orbital emphysema D. Trismus

D. Trismus

In which type of fracture can bleeding from the middle meningeal artery cause airway obstruction? A. Le Fort III B. Mandibular C. Le Fort I D. Naso-orbital-ethmoidal

A. Le Fort III

Which finding is expected in a patient with a maxillary fracture? A. Periorbital swelling B. Paresthesia of the lower lip C. Otorrhea D. Numbness of the upper eyelid

A. Periorbital swelling

The orbit of the eye includes which bone? A. Sphenoid B. Mandible C. Temporal D. Parietal

A. Sphenoid

In a patient with a mandibular fracture, which finding can lead to airway compromise? A. Sublingual hematoma B. An injury to the inferior alveolar nerve C. Ruptured tympanic membrane D. Rhinorrhea

A. Sublingual hematoma

After being in a high-speed motor vehicle crash, a patient is transported to the emergency department. He has multiple facial injuries and is actively bleeding from the mouth and nose. For this patient, what is the priority intervention? A. Suction blood from the oropharynx. B. Sit the patient upright. C. Apply ice to the injured areas. D. Control the bleeding.

A. Suction blood from the oropharynx.

After an altercation, a patient has a teardrop-shaped pupil. For this patient, which intervention is the priority? A. Prepare the patient for computed tomography. B. Place an eye shield over the affected eye. C. Position the patient supine to prevent leakage. D. Perform a halo test.

B. Place an eye shield over the affected eye. Because a teardrop-shaped pupil suggests a ruptured globe, place an eye shield or plastic cup over the eye to prevent further injury.

A teardrop-shaped pupil is a finding in which disorder? A. Hyphema B. Ruptured globe C. Subconjunctival hemorrhage D. Proptosis

B. Ruptured globe

To prevent epidermal staining, which step should occur first? A. Inject the area with a local anesthetic. B. Scrub the area vigorously with mild soap. C. Determine the need for tetanus prophylaxis. D. Soak the area with warm gauze.

B. Scrub the area vigorously with mild soap. Patients with friction injuries (abrasions) or road rash may sustain tattooing (epidermal staining). To prevent this, inject the area with a local anesthetic and then vigorously scrub the skin with mild soap

For a patient with an animal bite of the face, which intervention is appropriate? A. Scrub the area with a strong detergent. B. Warm the solution for irrigation. C. Cleanse the area with a povidone-iodine solution. D. Irrigate with a hydrogen peroxide solution.

B. Warm the solution for irrigation.

Which statement correctly characterizes a soft tissue injury of the face? A. Facial wounds have a high risk of infection. B. Abrasions need vigorous scrubbing with concentrated povidone-iodine solution. C. Animal or human bites on the face require prophylactic antibiotics. D. Hematomas of the ear call for treatment with warm compresses.

C. Animal or human bites on the face require prophylactic antibiotics.

When caring for a patient with an orbital blowout fracture, which intervention should you perform early? A. Prepare for endotracheal intubation. B. Obtain a Waters view radiograph. C. Assess visual acuity. D. Have the patient rinse the mouth with saline solution.

C. Assess visual acuity.

To prepare for a facial wound closure, which method is appropriate? A. Debride all injured tissue. B. Cleanse the area with hydrogen peroxide. C. Delay the repair for an uncooperative patient. D. Prepare the skin with an antibiotic solution.

C. Delay the repair for an uncooperative patient.

After being in a fistfight, a patient presents with malocclusion, tingling in his upper lip, and several fractured teeth. On assessment, you note that his upper teeth are mobile. Which injury should you suspect? A. Mandibular fracture B. Zygomatic fracture C. Le Fort I fracture D. Naso-orbital-ethmoidal fracture

C. Le Fort I fracture

An alert, intoxicated man presents to the emergency department after an assault. He states that he was struck in the face with a baseball bat. Which finding suggests that this patient has an orbital blowout fracture? A. Malocclusion B. Massive facial edema C. Limited upward gaze D. Cerebrospinal fluid leakage from the nose

C. Limited upward gaze

A laceration in which area requires the alignment of the vermillion border? A. Cheek B. Ear C. Lip D. Eyebrow

C. Lip

Rhinorrhea may result from which type of fracture? A. Zygomatic B. Mandibular C. Maxillary D. Orbital blowout

C. Maxillary

The ligation of bleeding vessels in the face can lead to which complication? A. Scarring B. Infection C. Nerve damage D. Hypotension

C. Nerve damage

Which type of fracture is associated with an abrupt rise in the orbital pressure? A. Le Fort II B. Zygomatic C. Orbital blowout fracture D. Naso-orbital-ethmoidal

C. Orbital blowout fracture

In a patient with a naso-orbital-ethmoidal fracture, which finding is expected? A. Flattening of the cheek B. Vermillion border laceration C. Traumatic telecanthus D. Malocclusion

C. Traumatic telecanthus

The displacement of the mandible places the patient at risk for which problem? A. Facial paralysis B. Excessive secretions C. Hematoma formation D. Airway obstruction

D. Airway obstruction

For a patient with a tripod fracture of the zygoma, the nurse should expect which finding? A. Ruptured tympanic membrane B. Numbness of the lower lip C. Otorrhea D. Diplopia

D. Diplopia

For a patient with multiple lacerations, a laceration in which area requires repair first? A. Cheek B. Lip C. Ear D. Eyebrow

D. Eyebrow Lacerations of the eyebrows and eyelids should be repaired initially before swelling occurs so that the borders can be matched.

An unrestrained driver presents with multisystem injuries after a high-speed motor vehicle crash. She has multiple facial lacerations and contusions from striking the dashboard. Your focused assessment reveals that she cannot raise her eyebrows or wrinkle her forehead. Based on these findings, you should suspect damage to a branch of which cranial nerve? A. Oculomotor (cranial nerve III) B. Trochlear (cranial nerve IV) C. Trigeminal (cranial nerve V) D. Facial (cranial nerve VII)

D. Facial (cranial nerve VII)

Which finding can result from a nasal fracture? A. The inability to purse the lips B. Otorrhea C. Ruptured tympanic membrane D. Hematoma

D. Hematoma

What is the maximum time that a facial wound closure can be extended? A. 4 hours B. 8 hours C. 14 hours D. 20 hours

D. 20 hours