Chapter 29

Common signs and symptoms of a chest injury include all of the following, EXCEPT: a. hematemesis. b. localized pain. c. chest wall ecchymosis. d. tachypnea.

a. hematemesis

A spinal cord injury at the level of C7 would MOST likely result in: a. paralysis of the intercostal muscles. b. paralysis of all the respiratory muscles. c. paralysis of the diaphragm. d. immediate cardiac arrest.

a. paralysis of the intercostal muscles

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called: a. pleurisy. b. dyspnea. c. pneumonitis. d. pneumothorax

a. pleurisy

A patient who presents with profound cyanosis following a chest injury: a. requires prompt ventilation and oxygenation. b. has most likely experienced a ruptured aorta. c. is most likely experiencing severe blood loss. d. should be placed in Trendelenburg's position.

a. requires prompt ventilation and oxygenation

Pleural fluid is contained between the: a. visceral and parietal pleurae. b. visceral pleura and the lung. c. parietal pleura and the chest wall. d. parietal pleura and the heart.

a. visceral and parietal pleurae

Hemoptysis is defined as: a. vomiting blood. b. coughing up blood. c. abnormal blood clotting. d. blood in the pleural space.

b. coughing up blood

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? a. A rapid, irregular pulse b. Engorged jugular veins c. Diminished breath sounds d. Widening pulse pressure

b. engorged jugular veins

A simple pneumothorax: a. is caused by penetrating chest trauma. b. is commonly caused by blunt chest trauma. c. often has a nontraumatic cause. d. heals on its own without any treatment.

b. is commonly caused by blunt chest trauma

When a person is lying supine at the end of exhalation, the diaphragm: a. descends below the level of the navel. b. may rise as high as the nipple line. c. is less prone to penetrating trauma. d. contracts and flattens inferiorly.

b. may rise as high as the nipple line

Elevation of the rib cage during inhalation occurs when: a. abdominal contents descend. b. the intercostal muscles contract. c. intrathoracic pressure decreases. d. the diaphragm descends.

b. the intercoastal muscles contract

The phrenic nerves control the diaphragm and exit the spinal cord at: a. C3 and C4. b. C1, C2, and C3. c. C3, C4, and C5. d. C1 and C2.

c. C3,C4, and C5

A flail chest occurs when: a. more than three ribs are fractured on the same side of the chest. b. a segment of fractured ribs bulges during the inhalation phase. c. a segment of the chest wall is detached from the thoracic cage. d. multiple ribs are fractured on both sides of the thoracic cage.

c. a segment of the chest wall is detached from the thoracic cage

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should: a. immediately perform a rapid head-to-toe exam. b. circumferentially tape a dressing around his chest. c. administer oxygen and transport to the hospital. d. recognize that he needs a needle decompression.

c. administer oxygen and transport to the hospital

Subcutaneous emphysema is an indication that: a. at least half of one lung has completely collapsed. b. blood is slowly accumulating within the tissue of the lung. c. air is escaping into the chest wall from a damaged lung. d. your patient is experiencing a pericardial tamponade.

c. air escaping into the chest wall from a damaged lung

You are transporting a stable patient with a possible pneumothorax. The patient is receiving high-flow oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient's deterioration? a. Hidden bleeding in the thoracic cavity b. Blood accumulation in the pleural space c. Compression of the aorta and vena cava d. A total collapse of the affected lung

c. compression of the aorta and vena cava

Which of the following organs or structures does NOT reside within the mediastinum? a. Vena cavae b. Esophagus c. Lungs d. Trachea

c. lungs

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a: a. cardiac tamponade. b. myocardial contusion. c. pneumothorax. d. flail chest.

c. pneumothorax

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, shallow breathing, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should: a. place her supine and elevate her lower extremities. b. perform a rapid head-to-toe physical assessment. c. provide ventilation assistance with a BVM. d. apply 100% oxygen via a nonrebreathing mask.

c. provide ventilation assistance with a BVM

A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturation is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect: a. massive hemothorax. b. traumatic asphyxia. c. pulmonary contusion. d. tension pneumothorax.

c. pulmonary contusion

A patient with a chest injury has a blood pressure of 100/60 mm Hg and a pulse rate of 120 beats/min. Which of the following additional findings should make you suspect a pericardial tamponade? a. Flattening of the jugular veins b. Unilaterally absent breath sounds c. Repeat BP of 90/68 mm Hg d. The pulse becomes irregular

c. repeat BP of 90/68 mm Hg

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of: a. a massive cardiac contusion. b. a tension pneumothorax. c. traumatic aortic rupture. d. penetrating lung injuries.

c. traumatic aortic rupture

Pneumothorax is defined as: a. blood collection within the pleural space. b. accumulation of air between the lungs. c. blood collection within the lung tissue. d. accumulation of air in the pleural space.

d. accumulation of air in the pleural space

An open pneumothorax occurs when: a. a fractured rib perforates the tissue of the lung. b. air enters the pleural space from a perforated lung. c. extreme pleural pressure causes the lung to rupture. d. air enters the pleural space from outside the body.

d. air enters the pleural space from outside the body

During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should: a. request a paramedic to decompress the chest. b. make note of it and continue your assessment. c. apply high-flow oxygen via nonrebreathing mask. d. assist ventilations with a bag-valve mask.

d. assist ventilations with a bag-valve mask

Patients with rib fractures will commonly: a. take a series of deep breaths. b. develop a sucking chest wound. c. prefer to lie in a supine position. d. breathe rapidly and shallowly.

d. breathe rapidly and shallowly

The thoracic cavity is separated from the abdominal cavity by the: a. costovertebral angle. b. intercostal margin. c. anterior rib cage. d. diaphragm.

d. diaphragm

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged: a. minute volume will increase. b. excess carbon dioxide will be eliminated. c. minute volume will remain unchanged. d. minute volume will decrease.

d. minute volume will decrease

When assessing a patient with a hemothorax, you will MOST likely find: a. ipsilateral tracheal deviation. b. jugular venous engorgement. c. distant or muffled heart tones. d. signs and symptoms of shock.

d. signs and symptoms of shock

Very young children tend to breathe predominantly with their diaphragm because: a. they require less tidal volume per breath. b. their chest wall and ribs are very pliable. c. there is no nerve innervation of the intercostal muscles. d. their intercostal muscles are not fully developed.

d. their intercostal muscles are not fully developed

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred? a. Fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia b. Collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest c. Asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta d. Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

d. ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle