Paramedic Program Review - Chapters 30-39

A compression or burst fracture of the cervical spine would most likely occur following: A) a direct blow to the occipital region of the skull. B) rapid acceleration following a motor vehicle crash. C) axial loading after a patient falls and lands feet first. D) a significant fall in which the patient lands head first.

D) a significant fall in which the patient lands head first.

According to the rule of nines, an adult with partial- and full-thickness burns to their head, face, and anterior chest has burns to what percentage of their total body surface area? A) 18% B) 27% C) 36% D) 45%

A) 18%

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

A) 500 mL

How can you tell if bleeding from the ears or nose contains cerebrospinal fluid (CSF)? A) CSF has a high glucose content. B) CSF clots within 10 seconds. C) CSF is a bright yellow color. D) CSF has a dark brown color.

A) CSF has a high glucose content.

A patient has partial-thickness burns to both lower extremities and blisters have formed. What should you do? A) Elevate the extremities to reduce edema. B) Administer 2 L of fluid within 45 minutes. C) Administer half the usual dose of IV analgesia. D) Carefully rupture the blisters and irrigate the burn.

A) Elevate the extremities to reduce edema.

A 19-year-old man presents with hot, moist skin; confusion; tachycardia; and tachypnea shortly after completing a marathon. According to his marathon registration form, he has no significant medical problems and takes no medications. Which of the following treatments are contraindicated for this patient? A) Prostaglandin inhibitors B) Immersion in ice water C) 25 g of 50% dextrose D) Ventilation assistance

A) Prostaglandin inhibitors

A 20-year-old female has a midshaft humeral fracture. Assessment reveals the presence of wrist drop. What should you suspect? A) Radial nerve injury B) Radial artery injury C) Brachial nerve injury D) Brachial artery compression

A) Radial nerve injury

If a knife is impaled in the neck: A) a cricothyrotomy may be required to establish a patent airway. B) it should be removed in case the airway becomes compromised. C) you should stabilize the object in place, regardless of its location. D) it should be shortened to facilitate proper airway management.

A) a cricothyrotomy may be required to establish a patent airway.

A patient taking which of the following medications would most likely experience a delay in the healing of a wound? A) Antidepressants B) Acetaminophen C) Antihypertensives D) Corticosteroids

D) Corticosteroids

Which of the following interventions would most likely convert a simple pneumothorax to a tension pneumothorax? A) A semi-sitting position B) A 500-mL fluid bolus C) Needle thoracentesis D) Positive-pressure ventilation

D) Positive-pressure ventilation

A patient with a possible spinal injury is acutely agitated. What type of medication, if any, should they receive after hypoxia has been ruled out? A) Corticosteroid B) Neuromuscular blocker C) Dissociative anesthetic D) Short-acting, reversible sedative

D) Short-acting, reversible sedative

Loss of function of the lower arms and hands following trauma to the anterior neck is indicative of damage to the: A) carotid artery. B) brachial plexus. C) vagus nerves. D) parathyroid glands.

B) brachial plexus.

During glycolysis, glucose is broken down into: A) water. B) ATP. C) pyruvic acid. D) heat.

B) ATP.

With the exception of the aorta, great vessel injury is most likely to occur following: A) blunt trauma. B) shearing forces. C) rotational injury. D) penetrating trauma.

D) penetrating trauma.

A 21-year-old man was removed from the water after being submerged for approximately 5 minutes. The patient's friend, who was with him at the time of submersion, states that there was no trauma involved. Your assessment reveals that the patient is apneic; however, he has a slow, weak carotid pulse. After preoxygenating the patient, you insert an endotracheal tube. During auscultation of the lungs, you hear coarse crackles in all fields; the epigastrium is quiet. As you ventilate the patient, you note decreased compliance. The most effective way to address this situation is to: A) attach a portable ventilator that provides positive end-expiratory pressure. B) insert a nasogastric tube and remove any water from the patient's stomach. C) increase your ventilation rate to 15 breaths/min and provide higher volume. D) administer morphine sulfate to promote venous pooling and decreased preload.

A) attach a portable ventilator that provides positive end-expiratory pressure.

Damage control resuscitation (DRC) focuses on: A) controlling hemorrhage, maintaining circulating volume, and correcting coagulopathy, acidosis, and hypothermia. B) definitive repair of all internal injuries, induction of hypothermia to reduce metabolic demand, and oxygen therapy. C) maintaining a systolic blood pressure of at least 100 mm Hg, administration of TXA, and providing advanced airway management. D) inducing a slightly alkaline state, increasing the blood pressure with vasoactive drugs, and administering high-flow oxygen.

A) controlling hemorrhage, maintaining circulating volume, and correcting coagulopathy, acidosis, and hypothermia.

As air accumulates in the pleural space, the first thing to occur is: A) decreased pulmonary function. B) jugular venous distension. C) compression of the great vessels. D) marked decrease in venous return.

A) decreased pulmonary function.

Increased central venous pressure commonly manifests as: A) jugular venous distention. B) a widened pulse pressure. C) bounding peripheral pulses. D) a pulsating abdominal mass.

A) jugular venous distention.

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) liver or spleen.

A dislocation is considered an urgent injury because of its potential to cause: A) neurovascular compromise. B) significant internal bleeding. C) severe hemodynamic instability. D) proximal sensory and motor loss.

A) neurovascular compromise.

A properly worn motorcycle helmet will: A) not protect the cervical spine. B) eliminate the risk of head trauma. C) decrease the risk of a spinal injury. D) minimize the trauma caused by secondary impacts.

A) not protect the cervical spine.

A leading cause of death in spinal cord injury patients who are discharged from the hospital includes: A) pneumonia. B) ischemic stroke. C) muscular atrophy. D) myocardial infarction.

A) pneumonia.

During abrupt deceleration: A) shearing or rupturing of internal organs can occur. B) the neck commonly sustains hyperextension injuries. C) the skull provides excellent protection for the brain. D) supporting structures of the aorta keep it attached.

A) shearing or rupturing of internal organs can occur.

A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should: A) splint the elbow in the position found and reassess distal circulation. B) carefully straighten the arm to facilitate placement of a vacuum splint. C) apply a sling and swathe to immobilize the injury and then apply heat. D) administer fentanyl for pain relief and then carefully straighten the arm.

A) splint the elbow in the position found and reassess distal circulation.

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: A) tetanus. B) meningitis. C) a viral infection. D) a staph infection.

A) tetanus.

Isolated rib fractures may result in inadequate ventilation because: 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.

A) the patient often purposely limits chest wall movement.

During a frontal collision, most pneumothoraces occur when: A) the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact. B) the diaphragm rapidly ascends into the chest cavity during impact, causing an increase in intrathoracic pressure. C) the chest strikes the steering wheel, which fractures one or more ribs and causes a perforation injury to one of the lungs. D) the patient is ejected through the windshield, and their chest collides with a secondary object outside the vehicle.

A) the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact.

A 60-year-old woman slipped and fell on an icy sidewalk and landed on her outstretched hand. Your assessment reveals that she has an obvious Colles fracture. The patient denies any other injuries and is conscious and alert. Her vital signs are stable and she describes her pain as a 2 on a scale of 0 to 10. Given this patient's current status, the most appropriate way to treat her injury involves: A) gently straightening the fracture site and then applying a splint. B) administering analgesia and then properly splinting her injury. C) giving her a sedative for pain relief and then applying an air splint. D) manually stabilizing her wrist as your partner applies a vacuum splint.

B) administering analgesia and then properly splinting her injury.

A 17-year-old man jumped from a second-story balcony and landed on his feet. He complains of pain to both of his heels and knees. Your assessment reveals swelling and ecchymosis to both of his feet. His vital signs are stable and he is breathing without difficulty. In addition to caring for his lower extremity injuries, it is most important that you: A) administer high-flow supplemental oxygen. B) apply spinal motion restriction precautions. C) try to determine why he jumped from the balcony. D) start a large-bore IV line of an isotonic crystalloid.

B) apply spinal motion restriction precautions.

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 blood pressure 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: 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.

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

A 39-year-old woman sustained an abdominal evisceration after she was cut in the abdomen with a large knife. 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) perform intubation to protect her 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) 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.

Tracheobronchial injuries have a high mortality rate due to: A) massive internal hemorrhage. B) associated airway obstruction. C) perforation of the esophagus. D) concomitant spinal cord injury.

B) associated airway obstruction.

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) binding to oxygen that is absorbed in the lungs and transporting it to the tissues.

Hyphema is defined as: 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.

B) blood in the anterior chamber of the eye.

In contrast to a contusion, a hematoma is: A) accompanied by ecchymosis. B) caused by large vessel damage. C) rarely accompanied by a bruise. D) a less significant closed injury.

B) caused by large vessel damage.

A superficial burn is: A) usually painless because the nerve endings are not exposed. B) characterized by reddened skin with varying degrees of pain. C) painful, but will heal spontaneously, often with scar formation. D) a second-degree burn that is characterized by blister formation.

B) characterized by reddened skin with varying degrees of pain.

If a person survives the initial trauma from a shotgun wound at close range: A) nervous system damage is likely due to the internal dispersal of the pellets. B) contaminants that were driven into the wound can cause a severe infection. C) they will typically die within 24 hours secondary to liver or renal failure. D) it is likely that only soft tissue was injured and major organs were spared.

B) contaminants that were driven into the wound can cause a severe infection.

Dysrhythmias following a myocardial contusion are usually secondary to: A) excess tachycardia that accompanies the injury. B) damage to myocardial tissue at the cellular level. C) aneurysm formation caused by vascular damage. D) direct damage to the vasculature of the epicardium.

B) damage to myocardial tissue at the cellular level.

Following a rotational impact, the most severely injured patient(s) will likely be found at the point of: A) least deceleration. B) greatest deceleration. C) secondary impact. D) greatest acceleration.

B) greatest deceleration.

During the inflammation phase of the healing process: A) white blood cells are forced away from the injury by vasoconstriction. B) histamine causes vasodilation and increased blood flow to the injury. C) damaged cell parts and microorganisms invade and infect the wound. D) the processes of epithelialization and collagen synthesis are impaired.

B) histamine causes vasodilation and increased blood flow to the injury.

After packing a severe groin injury with hemostatic gauze, you should: A) administer an IV analgesic. B) hold direct pressure for at least 3 minutes. C) soak the dressing with sterile saline. D) cover the gauze with a trauma dressing.

B) hold direct pressure for at least 3 minutes.

A diffuse axonal injury: A) is a specific, grossly observable brain injury that can easily be diagnosed with a computer tomography scan of the head. B) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body. C) results in severe stretching or tearing of the portion of the nerve cell that receives sensory messages from the rest of the body. D) is generally associated with better neurologic outcomes than a cerebral concussion because permanent brain damage does not occur.

B) involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

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) is the passage of stools that contain bright red blood.

When caring for a patient with a seemingly isolated ear injury, you should: A) carefully assess the external ear canal and inner ear for blood or CSF. B) perform a careful assessment to detect or rule out more serious injuries. C) recall that the pinna of the ear is highly vascular and bleeds profusely. D) consider direct transport of the patient to an audiologist for evaluation.

B) perform a careful assessment to detect or rule out more serious injuries.

The major complication associated with injury of a hollow organ 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) peritonitis caused by rupture and spillage of toxins.

When assessing a patient with maxillofacial trauma, it is most important to: 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 their mouth and assess for dental malocclusion.

B) protect the cervical spine and monitor the patient's neurologic status.

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: 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.

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

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) transport him to the hospital and provide emotional support en route.

The middle ear consists of the: 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.

C) inner portion of the tympanic membrane and the ossicles.

According to the Lund-Browder chart, one-half of a 5-year-old child's head accounts for what percentage of the body surface area? A) 18% B) 9% C) 6.5% D) 8.5%

C) 6.5%

A 39-year-old woman's car broke down, stranding her out in the country for approximately 18 hours. The outside temperature is 23 degrees Fahrenheit. When you arrive and assess the woman, you determine that she is pulseless and apneic; her core body temperature is estimated to be below 86 degrees Fahrenheit. CPR is immediately initiated and the woman is loaded into the ambulance quickly. The ECG reveals ventricular fibrillation. How should you proceed with the treatment of this patient? A) Give a single monophasic shock at 360 joules, reassess the rhythm and pulse, continue CPR, place an advanced airway, hyperventilate at 20 breaths/min, establish vascular access, give 300 mg of amiodarone, and provide rapid transport. B) Perform CPR for 2 minutes, give up to three stacked shocks, immediately resume CPR, reassess in 30 seconds, place an advanced airway, ventilate at 10 breaths/min, establish vascular access, give a saline bolus, and provide rapid transport. C) Give a single shock, immediately resume CPR, place an advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport. D) Provide immediate

C) Give a single shock, immediately resume CPR, place an advanced airway, provide ventilations at 10 breaths/min with warm humidified oxygen if possible, establish vascular access, and provide rapid transport.

Confusion, a sustained heart rate of 130 beats/min, and a respiratory rate of 32 breaths/min in a 70-kg patient are consistent with which class of hemorrhage? A) I B) II C) III D) IV

C) III

A 45-year-old man was cutting down a large tree when it collapsed, pinning him at the thighs. The patient's wife found him approximately 4 hours after the incident. The patient is conscious and in severe pain. His blood pressure is 128/68 mm Hg, pulse is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. In addition to supplemental oxygen and cardiac monitoring, which of the following treatments should you provide before the tree is removed from his legs? A) Two large-bore IV lines with a 3- to 4-L crystalloid bolus and 1 mEq/kg of sodium bicarbonate B) A large-bore IV line set to keep the vein open and 10 mL of a 10% solution of calcium chloride C) IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device D) An IV of normal saline, fluid restriction, and amiodarone if the ECG shows a widened QRS complex

C) IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device

When assessing a patient with abdominal trauma for distention, you should 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 intra-abdominal bleeding. C) a significant amount of blood accumulation in the abdominal cavity is required to produce distention. D) because distention is a late sign of intra-abdominal bleeding, it should not be assessed for in the field.

C) a significant amount of blood accumulation in the abdominal cavity is required to produce distention.

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) aldosterone and antidiuretic hormone.

Lap belts that are worn alone and too high by a pregnant woman: A) usually do not injure the fetus because the uterus is a highly muscular organ. B) will provide adequate protection for the uterus if the air bag properly deploys. C) allow enough forward flexion and subsequent compression to rupture the uterus. D) will provide equal distribution of forces and prevent forward flexion of the mother.

C) allow enough forward flexion and subsequent compression to rupture the uterus.

A pulmonary contusion following blunt chest trauma results in: A) blood leakage from injured lung tissue into the pleural space. B) decreased pulmonary shunting with rupture of the alveolar sacs. C) alveolar and capillary damage with intraparenchymal lung hemorrhage. D) pulmonary vasodilation as the body attempts to shunt blood to the injury.

C) alveolar and capillary damage with intraparenchymal lung hemorrhage.

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 suspect: A) a lacerated liver. B) acute peritonitis. C) an injury to the spleen. D) retroperitoneal bleeding.

C) an injury to the spleen.

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: 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.

C) apply a tourniquet between her elbow and wrist.

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: 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.

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

When caring for a patient with fractured or avulsed teeth following an assault, you should: A) handle any avulsed teeth by the root only, not the crown. B) flush the patient's mouth with sterile water for 20 minutes. C) assess the knuckles of the person who assaulted the patient. D) remove any partially avulsed teeth and immerse them in water.

C) assess the knuckles of the person who assaulted the patient.

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: A) neurogenic shock. B) intracranial pressure. C) autonomic dysreflexia. D) symptomatic bradycardia.

C) autonomic dysreflexia.

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) bladder.

Compared to a handgun, a rifle: A) is less accurate. B) fires a single projectile. C) fires at a higher velocity. D) has less powerful ammunition.

C) fires at a higher velocity.

A specific attribute of a Level I trauma center is that it: A) is involved in an injury prevention program. B) can initiate definitive care for all injured patients. C) has 24-hour in-house coverage by general surgeons. D) has rapid access to an off-site anesthesiologist.

C) has 24-hour in-house coverage by general surgeons.

A patient with a dysconjugate gaze following an ocular injury: A) most likely has a concomitant basilar skull fracture. B) should have ice applied to the eyes to prevent blindness. C) has discoordination between the movements of both eyes. D) should be treated by irrigating both eyes for 20 minutes.

C) has discoordination between the movements of both eyes.

A 19-year-old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, heart rate of 56 beats/min, and irregular respirations of 8 breaths/min. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the most appropriate treatment for this patient involves: A) hyperventilating her with a bag-mask device at a rate of 20 breaths/min, starting two large-bore IV lines, applying a cardiac monitor, administering 5 mg of Valium to prevent seizures, and transporting to a trauma center. B) preoxygenating her with a bag-mask device and 100% oxygen for 2 to 3 minutes, performing nasotracheal intubation, transporting at once, starting at least one large-bore IV line en route, and obtaining her Glasgow Coma Scale score. C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. D) applying oxygen via nonrebreathing mask, covering her with blankets, s

C) intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments.

Applying direct pressure to a bleeding wound stops the flow of blood because: A) pressure stimulates the release of fibrin. B) direct pressure facilitates vasoconstriction. C) it allows platelets to seal the vascular walls. D) pressure shunts blood away from the injury.

C) it allows platelets to seal the vascular walls.

A person who is exposed to cement: A) typically only experiences burns to the epidermal layer because calcium oxide is a weak chemical. B) often does not experience a burn unless they are exposed to the cement for longer than 2 hours. C) may not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat. D) experiences immediate pain and inflammation to the area because of the calcium oxide in the cement.

C) may not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat.

An open pneumothorax causes ventilatory inadequacy when: A) positive pressure created by expiration forces air into the pleural space. B) the heart stops perfusing the lung on the side of the open chest injury. C) negative pressure created by inspiration draws air into the pleural space. D) the glottic opening is much larger than the open wound on the chest wall.

C) negative pressure created by inspiration draws air into the pleural space.

A 45-year-old woman presents with severe cramps in her legs, nausea, and lightheadedness after running laps at the track. The temperature outside is 95 degrees Fahrenheit and the relative humidity is 80%. The patient is conscious and alert and is sweating profusely. Her blood pressure is 100/60 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and regular. The most appropriate treatment for this patient involves: A) giving her a salt-containing solution to drink, applying chemical ice packs to the back of her neck, and discouraging further activity for the day. B) administering high-flow oxygen, gently massaging her lower extremities to enhance circulation, administering 1 mg/kg of fentanyl IM, and transporting. C) offering her oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation. D) having her chew salt tablets, starting an IV with D5W at a keep-vein-open rate, administering 12.5 mg of promethazine IV, and transporting to the hospital.

C) offering her oxygen, starting an IV with normal saline, giving a 250- to 500-mL fluid bolus, and recommending transport to the hospital for evaluation.

A laceration that lies perpendicular to the skin's tension lines: A) results in minimal external bleeding and typically heals spontaneously within 2 to 3 hours. B) generally remains closed and does not require suturing or other methods of wound closure. C) often remains open, heals more slowly, and is more likely to result in abnormal scar formation. D) does not disrupt the body's blood-clotting process and tends to heal without the formation of a scar.

C) often remains open, heals more slowly, and is more likely to result in abnormal scar formation.

If a patient is unable to follow your finger above the midline following blunt trauma to the face, you should be most suspicious for a(n A) Le Fort II fracture. B) nasal bone fracture. C) orbital skull fracture. D) basilar skull fracture.

C) orbital skull fracture.

Patients with internal hemorrhage will benefit most from: A) IV therapy. B) high-flow oxygen. C) rapid transport. D) TXA administration.

C) rapid transport.

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) recognize the signs and symptoms of shock in its earliest phase and begin immediate treatment before permanent damage occurs.

A patient with nerve compromise following an open injury to the hand: A) should be given analgesia for the pain. B) will likely lose all neurologic function. C) requires prompt transport to the hospital. D) will not be able to move their hand.

C) requires prompt transport to the hospital.

The upper peritoneal cavity includes the: A) pancreas. B) sigmoid colon. C) spleen. D) bladder.

C) spleen.

After an adult victim is struck by lightning and experiences cardiac arrest: A) 5 minutes of CPR generally restores a pulse. B) perform a compression-to-ventilation ratio of 15:2. C) the heart may resume beating spontaneously. D) the ECG usually shows an organized cardiac rhythm.

C) the heart may resume beating spontaneously.

A stress fracture would most likely occur when: A) a person with a relatively weak bone structure does not engage regularly in strenuous activities. B) a person with large musculature regularly engages in strenuous activity using the upper extremities. C) the muscle develops faster than the bone and places exaggerated stress on the bone. D) an underlying medical condition causes progressive weakening of the bones, making them prone to fracture.

C) the muscle develops faster than the bone and places exaggerated stress on the bone.

A motorcycle or football helmet should be removed if: A) the patient complains of severe neck pain and the helmet fits snugly. B) you are going to transport the patient to a medical treatment facility. C) the patient is breathing shallowly and access to the airway is difficult. D) you are properly trained in the technique, even if you are by yourself.

C) the patient is breathing shallowly and access to the airway is difficult.

If a Level I trauma center is 30 miles away, and a Level II trauma center is 10 miles away, it would be most appropriate to transport a patient with a severe traumatic brain injury: A) by ground to the Level I trauma center. B) to the closest hospital for stabilization. C) via air transport to the Level I trauma center. D) by ground to the Level II trauma center.

C) via air transport to the Level I trauma center.

A complete spinal cord injury to the upper cervical spine: A) results in quadriplegia but the patient usually retains their ability to breathe spontaneously. B) is not compatible with life and results in immediate death due to cardiopulmonary failure. C) will result in permanent loss of all cord-mediated functions below the level of the injury. D) results in neurologic dysfunction that is considered to be permanent if it lasts longer than 24 hours.

C) will result in permanent loss of all cord-mediated functions below the level of the injury.

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) abdominal organs shear from their points of attachment.

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) area around the umbilicus.

A 56-year-old diabetic woman presents with a painful, reddened area on her left forearm, which she first noticed a few days ago. Closer examination reveals a blister in the center of the affected area. The patient denies being bitten or stung by anything and states that the only thing she has been doing is storing boxes in the attic. You should suspect a(n A) poorly healed diabetic ulcer. B) local reaction to an ant bite. C) infection caused by a tick. D) brown recluse spider bite.

D) brown recluse spider bite.

A crushing or tearing amputation: A) is initially treated by applying a proximal tourniquet and retrieving any detached body parts. B) causes less blood loss than expected because the blood vessels retain their ability to constrict. C) cannot be surgically reattached due to the severe vascular and soft-tissue damage that accompanies it. D) can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly.

D) can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly.

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: 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.

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

Following a head-on collision of a motorcycle and a truck, the motorcyclist would most likely experience initial injury to the: A) cervical spine. B) chest and abdomen. C) wrists and forearms. D) femurs and tibias.

D) femurs and tibias.

Correctly splinting an injured extremity: A) typically provides complete pain relief without the need to administer narcotic analgesia. B) effectively reduces swelling and inflammation by shunting blood away from the injured area. C) eliminates the need to elevate the extremity because immobilization causes blood stasis. D) helps to control internal bleeding by allowing clots to form where vessels are damaged.

D) helps to control internal bleeding by allowing clots to form where vessels are damaged.

A partial-thickness burn is considered to be a major burn in a 40-year-old patient if it: A) is located on the anterior chest. B) is located to the proximal aspect of an extremity. C) is rated as at least a 5 on a pain scale of 0 to 10. D) involves more than 25% of the body surface area.

D) involves more than 25% of the body surface area.

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) maintain the systolic blood pressure in a low normal range.

A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions should include: A) applying a cervical collar and assisting his ventilations with a bag-mask device. B) rolling the patient onto his side as a unit and suctioning his mouth for 15 seconds. C) performing a tongue-jaw lift and looking in his mouth for any obvious obstructions. D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

D) manually stabilizing his head and opening his airway with the jaw-thrust maneuver.

A burn patient with a history of chronic obstructive pulmonary disease: A) is at a higher risk for infection than a patient without any medical problems. B) often requires prophylactic beta-2 agonist drugs to prevent respiratory arrest. C) should only be given high-flow oxygen if signs of hypoxia are grossly present. D) may be triaged as a critically burned patient, even if the burn injury is small.

D) may be triaged as a critically burned patient, even if the burn injury is small.

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) pancreas.

Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is most likely the result of: A) decreased vagal tone secondary to direct injury to the vagus nerve. B) decreased venous return from the brain and an increase in intracranial pressure. C) an acute pulmonary embolism due to the entrainment of air into one of the jugular veins. D) parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

D) parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

A moderate diffuse axonal injury: A) is generally characterized by a brief loss of consciousness, with or without retrograde amnesia. B) causes a prolonged loss of consciousness and affects axons in both cerebral hemispheres. C) is the most common result of blunt head trauma and is associated with temporary neuronal dysfunction. D) produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.

D) produces an immediate loss of consciousness and residual neurologic deficits when the patient wakes up.

A blood pressure of 110/68 mm Hg in the presence of clinical signs of a tension pneumothorax: A) should be treated with crystalloid fluid boluses to prevent hypotension. B) indicates that prehospital needle decompression likely will not be required. C) is likely the result of systemic vasodilation in an attempt to reduce preload. D) suggests adequate cardiac compensation for the diminished venous return.

D) suggests adequate cardiac compensation for the diminished venous return.

Common signs and symptoms of an acute pulmonary embolism include: A) pulmonary edema. B) abdominal pain. C) left-sided heart failure. D) tachycardia and tachypnea.

D) tachycardia and tachypnea.

During a lateral impact collision: A) the far-side occupant, even if properly restrained, experiences double the amount of force as the driver. B) the patient's head moves away from the object causing the impact, resulting in stretching injuries. C) properly worn seat belts protect the passenger from pelvic trauma at the time of impact. D) trauma to the upper extremities depends on the spatial orientation of the arms upon impact.

D) trauma to the upper extremities depends on the spatial orientation of the arms upon impact.

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) with the beginning of the next contraction.