Chapter 26 tissue injuries

56.According to the palmar method for estimating the extent of a patient's burns, the palm of the patient's hand is equal to ___% of the body surface area.

1

35.A 5-year-old female pulled a pot of boiling water from the stove. She has superficial and partial-thickness burns to her head, face, and anterior trunk. What percentage of her body surface area has been burned?

30%

62.A 4-year-old female pulled a pot of boiling water from the stove. She has superficial and partial-thickness burns to her head and anterior trunk. What percentage of her body surface area has been burned?

36%

12.In which of the following patients should you remove an impaled object? A. A pulseless and apneic patient with a knife impaled in the back B. A semiconscious patient with an ice pick impaled in the chest C. An apneic patient with a shard of glass impaled in the abdomen D. A conscious and alert patient with a fishhook impaled in the eye

A pulseless and apneic patient with a knife impaled in the back

17.Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss? A. AvulsionB. IncisionC. LacerationD. Abrasion

Abrasion

52.Which of the following is considered to be a critical burn?

Circumferential partial-thickness burns to the chest

60.A teenage boy who was involved in a bicycle accident has a puncture wound in which the bicycle kickstand is impaled in his leg. The MOST appropriate method for treating this injury is to

unbolt the kickstand from the bike frame and stabilize it with bulky dressings.

13.The sebaceous glands produce sebum, a material that A. waterproofs the skin and keeps it supple. B. facilitates shedding of the epidermis. C. discharges sweat onto the skin's surface. D. pulls the hair erect when you are cold.

waterproofs the skin and keeps it supple.

66.A 50-year-old male with a history of diabetes sustained partial-thickness burns to approximately 15% of his body surface area (BSA) while attempting to light a barbeque pit. He is conscious and alert and in no respiratory distress. What factor makes this patient's burn a critical burn?

His history of diabetes

30.An abdominal evisceration

occurs when organs protrude through an open wound.

24.Which of the following is a sign of compartment syndrome?

Pain upon passive movement of the injury site

16.Which of the following is a severe burn in a 65-year-old patient? A. Superficial burn to 30% of the BSA B. Second-degree burn covering 10% of the BSA C. Full-thickness burn to 1% of the BSA D. Partial-thickness burn to 20% of the BSA

Partial-thickness burn to 20% of the BSA

53.Which of the following is considered a critical burn in a 60-year-old patient?

Partial-thickness burns to 20% of the body surface area

34.Which of the following statements regarding severe burns is correct? A) Once hot liquids come in contact with clothing, heat is rapidly dissipated. B) Scald burns often cover large surface areas because liquids spread quickly. C) Scald burns caused by grease or oil are typically limited to the epidermis. D) Scald burns are less commonly seen in pediatric patients than adult patients.

Severe burns are typically a combination of various degrees of burns.

8.As you approach a young male who was involved in an industrial accident, you note that his eyes are closed and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with minimal bleeding, and a closed deformity to his right leg. You should A. open his airway and assess his breathing status.B. perform an immediate head-to-toe assessment.C. assess his pulse for rate, regularity, and quality.D. apply high-flow oxygen and assess his injuries.

open his airway and assess his breathing status.

68.During an altercation in a bar, two patrons got into a fist fight. The first patient, a 44-year-old female, was struck in the mouth and refuses EMS care. The second patient, a 39-year-old female, has a small laceration to her left knuckle and also refuses EMS care. Which of the following statements regarding this scenario is MOST correct? A) You should contact the police and have the patients arrested. B) The 39-year-old female is at high risk for an infection. C) The patient struck in the mouth should be immobilized. D) The 44-year-old female is at high risk for an infection.

The 39-year-old female is at high risk for an infection.

57.Which of the following statements regarding the rule of nines is MOST correct? A) With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity.B) Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours.C) Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body.D) Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal.

The anterior trunk of an adult is equal to 18% of the body surface area.

41.Which of the following statements regarding the dermis is MOST correct?

The dermis contains hair follicles, sweat glands, and nerve endings.

55.Critical burns in an infant or child include

partial-thickness burns to more than 20% of the body surface area.

9.Burns to pediatric patients are generally considered more serious than burns to adults because A. most burns in children are the result of child abuse.B. pediatric patients have a proportionately larger volume of blood.C. pediatric patients are more prone to hyperthermia.D. pediatric patients have more surface area relative to total body mass.

pediatric patients have more surface area relative to total body mass.

43.When a person is exposed to a cold environment A) sweat is produced and is warmed when the vessels constrict.B) blood vessels dilate and divert blood to the core of the body.C) the skin becomes flushed secondary to peripheral vasodilation.D) peripheral vessels constrict and divert blood away from the skin.

peripheral vessels constrict and divert blood away from the skin.

3.A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He has a large hematoma in the center of his forehead and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should A. administer high-flow oxygen. B. apply ice to the hematoma. C. perform a neurologic exam. D. palpate his radial pulses.

administer high-flow oxygen.

28.During your assessment of a 22-year-old male who was assaulted, you note widespread contusions and abrasions to his face, chest, and abdomen. His pulse is rapid and weak, and his skin is cool and clammy. You should

administer oxygen and prepare for rapid transport.

11.In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is A. a spinal fracture.B. an ischemic stroke.C. nerve fiber damage.D. an air embolism.

an air embolism.

63.A 17-year-old male was shot in the right anterior chest during an altercation with a gang member. As your partner is applying 100% oxygen, you perform a rapid trauma assessment and find an open chest wound with a small amount of blood bubbling from it. You should

apply an occlusive dressing to the wound and continue your assessment.

65.You are assessing a 30-year-old male with an amputation just above the left wrist. He is conscious and alert and has a patent airway. Dark red blood is freely flowing from the injury. You should

apply direct pressure to the injury site.

20.You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should A. carefully manipulate her arm until the symptoms subside.B. remove the gauze bandage and replace it with an elastic one.C. assess distal circulation and readjust the bandage as needed.D. remove the bandage and dressing and apply another one.

assess distal circulation and readjust the bandage as needed.

14.When caring for a patient whose arm is covered with a dry chemical, you should A. brush away the chemical before flushing with water. B. quickly irrigate the arm with large amounts of water. C. use forceful streams of water to remove the chemical. D. deactivate the chemical with a 5% vinegar solution.

brush away the chemical before flushing with water.

64.You are dispatched to an industrial plant for a 47-year-old male who was exposed to an unknown chemical. Upon arrival, you find the patient standing outside the plant. He is conscious and alert and is covered with dry lime-colored powder. After taking the appropriate self-protective measures, you should

brush the dry chemical from his skin and clothing.

19.Which of the following statements regarding crush syndrome is correct? A. With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity. B. Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body. C. Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours. D. Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal.

Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours.

2.A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound? A. Carefully replace the exposed bowel into the abdomen and transport.B. Cover it with moist, sterile gauze and secure with an occlusive dressing.C. Irrigate it with sterile water and cover it with a dry dressing.D. Cover the exposed bowel and keep his legs in a straight position.

Cover it with moist, sterile gauze and secure with an occlusive dressing.

32.In contrast to animal bites, the bite of a human

carries with it a wide variety of virulent bacteria and viruses.

51.Common signs and symptoms of an airway burn include all of the following, EXCEPT

chest pressure.

21.The germinal layer of the epidermis contains pigment granules that are responsible for skin

color.

25.A 30-year-old male experienced a crushing injury when his forearm was trapped between the back of a truck and a loading dock. Upon your arrival, the man's arm has been freed. Your assessment reveals that his arm is obviously deformed and swollen and is cold and pale. Further assessment reveals an absent radial pulse. You should be MOST concerned that this patient has

compartment syndrome.

31.A construction worker fell approximately 30 feet and landed in a pile of steel rods. Your assessment reveals that he is pulseless and apneic and has a 10-inch steel rod impaled in his left leg. You should

control the bleeding, begin CPR, stabilize the steel rod, immobilize his spine, and transport immediately.

6.A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n) A. crush injury.B. contusion.C. hematoma.D. abrasion.

contusion.

61.A utility worker was trimming branches and was electrocuted when he accidentally cut a high-power line. He fell approximately 20 feet and is lying unconscious on the ground; the power line is lying across his chest. You should A) rapidly assess the patient after ensuring that the power line is not live.B) apply insulated gloves and assume manual control of his c-spine.C) quickly but carefully move the patient away from the power line.D) manually stabilize his head as your partner assesses for breathing.

rapidly assess the patient after ensuring the power line is not live.

45.When assessing a patient with a closed soft tissue injury, it is MOST important to

remain alert for more severe underlying injuries.

44.Compartment syndrome would MOST likely develop following a

crush injury

4.A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should A. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing.B. replace the avulsed flap to its original position and cover it with a sterile dressing.C. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.D. carefully probe the wound to determine if the bleeding is venous or arterial.

replace the avulsed flap to its original position and cover it with a sterile dressing.

7.An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should A. advise the child that he will need rabies shots.B. ask the child's father to try to locate the dog.C. report the incident to the appropriate authorities.D. administer oxygen via a nonrebreathing mask.

report the incident to the appropriate authorities.

10.During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a A. handgun.B. .22-caliber pistol.C. .357 magnum.D. shotgun.

shotgun.

33.Burns are classified according to

depth and extent.

49.A partial-thickness burn involves the outer layer of skin and a portion of the A) epidermis.B) fatty layer.C) muscle fascia.D) dermal layer.

dermal layer.

48.A burn that is characterized by redness and pain is classified as a A) full-thickness burn.B) superficial burn.C) second-degree burn.D) partial-thickness burn.

first-degree burn.

39.Functions of dressings and bandages include all of the following, EXCEPT

immobilization of the injury.

26.In addition to external bleeding, the MOST significant risk that an open soft-tissue injury exposes a patient to is

infection.

67.A 38-year-old male was electrocuted while attempting to wire a house. Your assessment reveals that he is unresponsive, pulseless, and apneic. A coworker has shut off the power to the house. You should A) begin CPR and apply the AED.B) begin CPR and transport at once.C) assess for entry and exit wounds.D) fully immobilize his spinal column.

initiate CPR and attach the AED.

58.With regard to the pediatric rule of nines, the A) head is proportionately smaller than an adult's.B) thorax is proportionately larger than an adult's.C) legs are proportionately smaller than an adult's.D) arms are proportionately larger than an adult's.

legs are proportionately smaller than an adult's.

42.All of the following body structures are lined with mucous membranes, EXCEPT for the A) lips.B) nose.C) anus.D) mouth.

lips.

5.A burn that is characterized by redness and pain is classified as a A. partial-thickness burn.B. second-degree burn.C. full-thickness burn.D. superficial burn.

superficial burn.

29.You are assessing a 30-year-old woman with multiple large bruises to her chest and abdomen that she experienced during an assault. She is conscious but restless, and her skin is cool and pale. You should be MOST concerned with

the fact that her clinical signs could indicate that she is bleeding internally.

50.Patients with full-thickness (third-degree) burns generally do not complain of pain because A) blister formation protects the burn.B) they are generally not conscious.C) the nerve endings have been destroyed.D) subcutaneous vessels are usually clotted.

the nerve endings have been destroyed.

37.You and your partner arrive at the scene of a house fire where firefighters have rescued a 50-year-old male from his burning house. The patient has superficial and partial-thickness burns to his face and chest. His nasal hairs are singed and he is coughing up sooty sputum. You should be MOST concerned with

the potential for airway swelling.

22.Functions of the skin include all of the following, EXCEPT

the production of key antibodies.

1.A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA. A. 45%B. 27%C. 18%D. 36%

18%

27.Which of the following statements regarding penetrating injuries is correct?

External bleeding may be minimal but internal injuries can be extensive.

15.Which of the following areas of the body has the thinnest skin? A. Soles of the feetB. BackC. ScalpD. Ears

Ears

59.Which of the following statements regarding electrical burns is MOST correct?

Entrance wounds are small relative to the amount of internal tissue damage.

40.What layer of the skin forms a watertight, protective seal for the body? A) DermisB) EpidermisC) Muscular layerD) Subcutaneous layer

Epidermis

18.Which of the following processes occurs during the inflammation phase of the healing process? A. The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound.B. The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection.C. White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow.D. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling.

The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling.

36.In order for electricity to flow through the body and cause damage

a complete circuit must exist between the electrical source and the ground.

38.When treating a partial-thickness burn, you should

avoid the use of creams, lotions, or antiseptics.

23.A hematoma develops when

large blood vessels beneath the skin are damaged.

46.A laceration

is a jagged cut caused by a sharp object or blunt force trauma.

47.When caring for an amputated body part, the EMT-B should

keep it cool without allowing it to freeze.

54.When assessing the severity of a patient's burn(s), you should routinely consider all of the following factors, EXCEPT

known drug allergies.