chapter 29 test
What is the Glasgow Coma Scale (GCS) of your adult male patient who has fallen off a horse, has his eyes open, can follow your commands to squeeze his hands, but is confused about what happened and his whereabouts? A. 15 B. 13 C. 12 D. 14
D. 14
You respond to a patient who was hit in the face with a chair. Upon arrival, you notice a patient leaning in the corner and bleeding profusely from the mouth and nose. Your first action should be which of the following? A. Assure scene safety. B. Place the patient on a nonrebreather mask (NRB) at 15 lpm. C. Take cervical spine precautions. D. Suction the airway and have the patient lean back.
A. Assure scene safety.
Which of the following is NOT a common field finding in spinal injuries? A. Deformity B. Impaired breathing C. Pain D. Tenderness
A. Deformity
Your patient is a 27-year-old male who has been involved in a motorcycle collision in which he was not wearing a helmet. He does not respond when you speak to him, but he makes incomprehensible sounds when you press your knuckles on his sternum. His level of consciousness would be best described as painful on the AVPU scale, but what would his verbal response be on the Glasgow Coma Scale (GCS)? A. 1 B. 2 C. 3 D. 4
B. 2
Your patient is a 38-year-old male driver of a vehicle that left the roadway and struck a bus stop shelter and a tree. He is conscious and alert, he has some abrasions on his forehead, his skin is warm and dry, and he has a strong radial pulse and no difficulty breathing. Which of the following descriptions represents the MOST appropriate way for removing the patient from the vehicle? A. Place the backboard on the stretcher and have the patient stand, turn, and lie down on the backboard while you maintain manual in-line stabilization of the cervical spine. B. Apply a cervical extrication collar and short spine immobilization device before removing to a long spine board. C. Have the patient stand up and then do a "standing take-down" onto a long spine board. D. Apply a cervical extrication collar and perform rapid extrication onto a long spine board.
B. Apply a cervical extrication collar and short spine immobilization device before removing to a long spine board.
Your patient is a 16-year-old center fielder on his high school baseball team. He was injured when he and the left fielder collided trying to catch a fly ball. He is disoriented and is unable to tell you what happened. His vital signs are pulse 88, blood pressure 132/86, respiratory rate 16, and pupils equal. As you assess his head, you do not see any cuts or bleeding, but you feel a spongy, depressed area over his left ear. You should suspect a(n): A. skull injury. B. open head injury. C. closed head injury. D. direct injury.
B. open head injury.
How many cervical vertebrae are there? A. 4 B. 5 C. 7 D. 12
C. 7
To which of the following sections of the spine are the ribs attached? A. Sacral B. Lumbar C. Cervical D. Thoracic
D. Thoracic
The maxillae form which of the following structures? A. Cheek bones B. Forehead C. Lower jaw D. Upper jaw
D. Upper jaw
A 65-year-old man was doing some work on his roof when he lost his footing and fell to the ground, approximately 15 feet. He is unconscious but his respirations are normal. You note an obviously angulated left leg. You are more concerned about a possible head injury. Which of the following would indicate a possible head injury? A. Increased blood pressure B. Increased pulse rate C. Glasgow Coma Scale (GCS) of 15 D. Constricted pupils
A. Increased blood pressure
Which of the following observations may the EMT use to rule out a spinal injury in a trauma patient? A. There is a lack of mechanism of injury. B. Patient is able to walk at the scene. C. Patient denies pain in his spine. D. There is a lack of numbness and paralysis of the extremities.
A. There is a lack of mechanism of injury.
Hyperventilating a patient with a brain injury: A. should be avoided when providing artificial ventilation. B. increases the amount of carbon dioxide in the blood. C. is inevitable when providing artificial ventilation. D. is indicated when the patient's blood pressure falls.
A. should be avoided when providing artificial ventilation.
For which of the following patients would the use of a short spine immobilization device be appropriate? A. 52-year-old female who crashed her vehicle into the front of a convenience store and who is awake, oriented, and complaining of neck pain B. Unresponsive driver who was found in the driver's seat of a pickup truck that crashed into a tree C. 77-year-old female who fell down a flight of stairs and is in an awkward position lying on her side on the landing D. 15-year-old male who struck a curb with his motorized scooter and flipped over the handlebars
A. 52-year-old female who crashed her vehicle into the front of a convenience store and who is awake, oriented, and complaining of neck pain
Which of the following is the correct sequence for securing the straps on a long spine board? A. Torso, legs, head B. Head, legs, torso C. Head, torso, legs D. Legs, torso, head
A. Torso, legs, head
When should the EMT calculate a GCS with a patient who suffered a fall of 20 feet from his apartment building? A. Before departing from the scene B. En route to the hospital C. As he approaches the patient D. At the hospital before writing the care report
B. En route to the hospital
When using a short spine immobilization device, which part of the body is secured last when time is not a factor? A. Hands and feet B. Torso C. Legs and wrists D. Head
C. Legs and wrists
Which of the following signs is LEAST likely to indicate a traumatic brain injury? A. Irrational behavior B. Vomiting C. Low blood pressure D. Irregular breathing pattern
C. Low blood pressure
While assessing a patient with a laceration to the neck, the EMT must be aware that which of the following conditions may develop? A. Deep vein embolus B. Air thrombosis C. Air embolus D. Deep vein thrombosis
C. Air embolus
Which portions of the spine are the most vulnerable to injury? A. Thoracic and lumbar B. Cervical and sacral C. Cervical and lumbar D. Thoracic and sacral
C. Cervical and lumbar
Your patient is a 10-year-old male whose jacket hood caught on a branch as he jumped out of a tree. He was momentarily suspended about 12 inches off the ground but was immediately lowered to the ground by his brothers. Which of the following injuries should you suspect? A. Soft-tissue injury of the neck only B. Thoracic spine injury C. Cervical spine injury D. Lumbar spine injury
C. Cervical spine injury
Which of the following injuries is considered an indirect brain injury? A. Gunshot wound to the head B. Depressed skull fracture with cerebral penetration by bone fragments C. Concussion D. Cerebral laceration
C. Concussion
Which of the following is a function of the autonomic nervous system? A. Running or walking B. Solving complex math problems C. Constriction of blood vessels D. Speaking
C. Constriction of blood vessels
Which of the following is defined as an area of the body surface that is innervated by a single spinal nerve? A. Transverse process B. Malar C. Dermatome D. Spinous process
C. Dermatome
Glasgow Coma Scale (GCS) is a neurological assessment that looks at which of the following? A. Grip strength, verbal response, and eye opening B. Motor response, arm movement, and speech C. Eye opening, verbal response, and motor response D. Verbal response, motor response, and AVPU
C. Eye opening, verbal response, and motor response
Your patient is a 30-year-old construction worker who fell from scaffolding and has been impaled by a piece of concrete reinforcement bar. The patient responds to verbal stimuli. You have determined the bar is too long to adequately secure during patient transport. Which of the following is your best course of action? A. Remove the reinforcement bar and pack the orbit with sterile moist dressings to keep the scene time under 10 minutes. B. Test the reinforcement bar for stability and remove it only if it is loose enough to be easily pulled from the wound. C. Firmly stabilize the reinforcement bar in place so that the rescue crew can cut it short. D. Transport with the reinforcement bar in place to prevent delay at the scene.
C. Firmly stabilize the reinforcement bar in place so that the rescue crew can cut it short.
Your patient is a 16-year-old center fielder on his high school baseball team. He was injured when he collided face first with the left fielder trying to catch a fly ball. He is disoriented and is unable to tell you what happened. His vital signs are pulse 88, blood pressure 132/86, respiratory rate 16, and pupils equal. As you assess his head, you do not see any cuts or bleeding, but he has a black eye. You should suspect a(n): A. direct injury. B. skull fracture. C. brain or skull injury. D. open head injury.
C. brain or skull injury.
To cut an object impaled into a patient's head, it's best to use a saw that: A. fits into one hand, must be plugged into an electrical outlet, and generates high heat. B. requires two hands, does not run on electricity, and has a large serrated blade. C. fits into one hand, does not run on electricity, and can be carefully controlled. D. requires two hands, must be plugged into an electrical outlet, and is extremely precise.
C. fits into one hand, does not run on electricity, and can be carefully controlled.
Of the following patients, which injury is the highest priority to receive assisted ventilation via bag-valve mask ventilations? A. 25-year-old male who regained consciousness one or two minutes after being struck on the head by a baseball bat and is now asking repetitive questions B. 25-year-old female victim of battery who is awake but complains of a headache and has bloody fluid draining from her nose and left ear C. 70-year-old male who struck his head when he fell in the parking lot, has a large laceration on his forehead, and is disoriented D. 15-year-old female who was ejected from a vehicle, struck her head on a tree, and displays decerebrate movements in response to painful stimuli
D. 15-year-old female who was ejected from a vehicle, struck her head on a tree, and displays decerebrate movements in response to painful stimuli
You are en route to the trauma center with a patient who was injured when he was thrown from a horse. You suspect multiple trauma injuries including a closed head injury. You will monitor his mental status using the Glasgow Coma Scale (GCS) per your protocols. Which of the following will you check? A. Motor response, verbal response, and attentiveness B. Eye opening, motor response, and verbal response C. Speech patterns, motor patterns, and mental status D. Verbal responses, motor skills, and mental status
B. Eye opening, motor response, and verbal response
Your patient has been involved in a motor vehicle collision. He has a contusion on his forehead, is confused, and is bleeding from his nose. His heart rate is 90 beats per minute, blood pressure is 80/58 mmHg, respirations are 20 breaths per minute, and his skin is cool and clammy. Which of the following sets of injuries should you suspect? A. Head injury and spine injury B. Head injury, spine injury, and internal bleeding C. Head injury and internal bleeding D. Head injury
B. Head injury, spine injury, and internal bleeding
In most cases, which of the following is the correct way to provide initial management of a suspected cervical spine injury? A. Gently apply pressure to the top of the patient's head. B. Hold the patient's head still in a neutral, "eyes forward" position. C. Maintain the patient's head and neck in the position they are found. D. Provide approximately 15 pounds of upward cervical traction.
B. Hold the patient's head still in a neutral, "eyes forward" position.
A 44-year-old male involved in a collision at 50 mph struck the windshield of his vehicle with his face. Which of the following injuries should you prepare to treat? A. Cervical spine trauma B. Brain injury C. Airway obstruction D. All of the above
D. All of the above
Which of the following is a sign of possible brain injury? A. Projectile vomiting B. Irregular breathing pattern C. Deep laceration of the scalp D. All of the above
D. All of the above
A fracture of which of the following bones would be considered a skull fracture? A. Maxilla B. Nasal bones C. Temporal bone D. Any of the above
D. Any of the above
What is another name for the zygomatic bone? A. Temporal B. Maxillae C. Mandible D. Malar
D. Malar
Your patient has been injured by a fall down a flight of steps. He is alert and oriented but complains of back and neck pain. You spinally immobilize him on a long spine board with a cervical collar on his neck as a precaution because you know that the: A. coccyx is easily dislocated. B. thoracic spine is especially vulnerable to injury. C. lumbar area is rarely injured due to the rib support. D. cervical spine is the most vulnerable part of the spine.
D. cervical spine is the most vulnerable part of the spine.
Your 38-year-old male patient has been injured in an assault. He has several facial lacerations and a large knot on his head. Bystanders say that he was thrown over a large table and landed on his head and shoulder. As part of your scene size-up and primary assessment, you should: A. complete an initial set of vital signs. B. wait for ALS to treat the patient. C. splint any other bone or joint injuries. D. immobilize his cervical spine.
D. immobilize his cervical spine.
Your patient has a suspected cervical spine injury from falling from a rope swing. His vital signs are pulse 62, respirations 20, and blood pressure 90/56. He has no feeling below his mid-chest area but is able to breathe on his own. You should suspect: A. psychogenic shock. B. hypovolemic shock. C. cardiogenic shock. D. neurogenic shock.
D. neurogenic shock.
Your patient has sustained a serious laceration to his neck. He appears to have lost a lot of blood and you are considering how you will control the bleeding. Your primary treatment should be to place a(n): A. dry, sterile dressing. B. bulky dressing. C. pressure dressing. D. occlusive dressing.
D. occlusive dressing.
Which of the following is the underlying cause of neurogenic shock? A. Dilation of blood vessels B. Failure of the heart to adequately pump blood C. Extreme emotional response to paralysis D. Blood loss from damaged spinal blood vessels
A. Dilation of blood vessels
When log-rolling a patient with a suspected spinal injury, which of the following EMTs directs the move? A. EMT at the head of the patient B. EMT with the highest level of training C. EMT with the most seniority D. EMT at the heaviest portion of the patient
A. EMT at the head of the patient
Which of the following may result from the application of a cervical collar that is too large for the patient? A. Hyperextension of the neck B. Hyperflexion of the neck C. Rotation of the head and neck D. Excessive lateral movement of the mandible
A. Hyperextension of the neck
Which of the following causes worsening of the damage in a brain injury? A. Failure to keep the patient awake and talking B. Improper management of airway and ventilation C. Allowing seepage of cerebrospinal fluid (CSF) from the ears or nose D. Administration of 100% oxygen
B. Improper management of airway and ventilation
As pressure within the cranium increases, which of the following is the result? A. Increased blood pressure, increased pulse B. Increased blood pressure, decreased pulse C. Decreased blood pressure, decreased pulse D. Decreased blood pressure, increased pulse
B. Increased blood pressure, decreased pulse
Which of the following is classified as an open head injury? A. Contusion without a skull fracture B. Laceration with a skull fracture C. Laceration without a skull fracture D. Both A and B
B. Laceration with a skull fracture
Which of the following systems includes the pairs of nerves that enter and exit the spinal cord between each pair of vertebrae? A. Autonomic nervous system B. Peripheral nervous system C. Central nervous system D. All of the above
B. Peripheral nervous system
Your patient is pregnant at 20 weeks' gestation and has been thrown from a horse. She is complaining of back pain. Which of the following is the correct procedure for immobilizing her spine? A. Use a short immobilization device and transport the patient in a sitting position. B. Place the patient supine on the backboard, then put a pillow under the right side of the backboard. C. Place the patient on her left side on the backboard. D. Place the patient supine on the backboard.
B. Place the patient supine on the backboard, then put a pillow under the right side of the backboard.
Your patient is a 30-year-old female involved in a motorcycle crash. She was not wearing a helmet and struck her head on the pavement. She is unresponsive and has a blood pressure of 152/110 mmHg. Her pulse is 60 beats per minute and respirations are 8 breaths per minute and shallow. Which of the following is an appropriate intervention? A. Elevate the legs. B. Provide cervical spine immobilization. C. Hyperventilate at a rate of 24 breaths per minute using supplemental oxygen. D. Apply a pressure dressing to her scalp lacerations.
B. Provide cervical spine immobilization.
The bony bumps you feel along the center of a person's back are known as which of the following? A. Transverse processes B. Spinous process C. Foramen magnum D. Vertebrae
B. Spinous process
If you are ready to terminate manual stabilization of the cervical spine for a patient, what has likely happened? A. A short immobilization device has been applied. B. The patient is secured to a long backboard. C. You have been directed to do so by medical control. D. A cervical collar has been applied.
B. The patient is secured to a long backboard.
Which of the following statements concerning a concussion is TRUE? A. It is a bruising of the brain tissue. B. The patient may not have any symptoms of the injury. C. It is accompanied by recurrent episodes of unconsciousness. D. All of the above
B. The patient may not have any symptoms of the injury.
Your patient is a 16-year-old male who ran his truck off of the road and into a ditch. He was driving just fast enough to cause the air bag to deploy when he hit the ditch. He is complaining of some neck and shoulder pain. His vital signs are respirations 20, pulse 110, blood pressure 116/80, and pupils equal and reactive. How should you manage this patient? A. Apply a cervical collar and then rotate him to a long spine board. B. Use a short spine board or vest device and then transfer him to a long spine board. C. Place him on oxygen, and then slowly move him to the stretcher. D. Perform a rapid extrication and spinally immobilize him on a long spine board.
B. Use a short spine board or vest device and then transfer him to a long spine board.
You are called for a man who is not acting right. His wife says he was outside working in the garden but didn't come in for lunch when he was called. She went to check on him and found him sitting next to a stump, confused. You assessment shows a pulse rate of 58, blood pressure of 186/82, respirations of 16, and one of his pupils is dilated. You are unable to detect any signs of trauma and you don't see any obvious indication that he has fallen. You should suspect: A. insecticide poisoning. B. a nontraumatic brain injury. C. a closed head injury. D. an open head injury.
B. a nontraumatic brain injury.
An example of a facial injury is one that involves: A. toothache. B. impact trauma to the jaw. C. a patient's forehead striking a windshield. D. an airway obstruction.
B. impact trauma to the jaw.
A patient whose head is in w of the following positions is in the proper head position for spinal immobilization? A. The "sniffing" position B. Neutral, in-line "eyes forward" position C. Chin tilted upward for airway maintenance D. Stabilized in position found
B. Neutral, in-line "eyes forward" position
In which of the following circumstances should a helmet be removed? A. If you want to place a nasal cannula on the patient but cannot because his ears are covered by the helmet B. If the helmet fits so snugly that you cannot inspect the ears for the presence of blood or fluid C. If the helmet interferes with airway management D. If you suspect a skull fracture and need to palpate the head
C. If the helmet interferes with airway management
Which of the following pieces of equipment is acceptable for use in the prehospital stabilization of suspected cervical spine injuries? A. Soft cervical collars B. 2" times ×4" wood cribbing C. Five-pound sand bags D. Rigid cervical collars
D. Rigid cervical collars
You are treating a 54-year-old female patient who was involved in a domestic dispute. You notice an abrasion to the side of her head. The patient is unresponsive with a blood pressure of 200/110, a pulse of 60 beats per minute, and slightly irregular breathing. The patient's presentation is most likely caused by which of the following? A. Coup-contrecoup injury B. Increased arterial pressure C. Increased intracranial pressure D. Minor closed head injury
C. Increased intracranial pressure
What is the first step in a rapid takedown of a standing patient? A. Applying oxygen B. Positioning a long spine board behind the patient C. Manually stabilizing the patient's head and neck D. Applying a properly sized cervical collar
C. Manually stabilizing the patient's head and neck
When blood accumulates between the brain and the dura mater, what is the result? A. Subdural contusion B. Epidural contusion C. Subdural hematoma D. Epidural hematoma
C. Subdural hematoma
Which of the following is NOT used to calculate a patient's GCS? A. Verbal response B. Motor response C. Work of breathing D. Eye movement
C. Work of breathing
Your patient was ejected from his motorcycle when he struck a deer. He is drowsy and unable to communicate clearly. You determine that the helmet he is wearing will not allow you to securely immobilize the patient to the long spine board. You should: A. pad under his shoulders to straighten his neck. B. tip his head back to gain neutral alignment. C. remove the helmet to better manage proper alignment. D. place towels on either side of the helmet to stabilize it.
C. remove the helmet to better manage proper alignment.
When a patient has a serious open wound to the neck, you are concerned about the possibility of an air embolism. The reason an air embolism can occur is because of: A. the higher pressure in the vessels of the neck. B. damage to the trachea. C. vessel pressure that is lower than atmospheric pressure. D. the negative pressure in the chest.
C. vessel pressure that is lower than atmospheric pressure.
A 17-year-old girl was injured when her car was struck from behind while she was stopped at a red light. She is complaining of a headache with neck and back pain. You suspect she has sustained a(n): A. distraction injury. B. extension injury. C. whiplash injury. D. compression fracture.
C. whiplash injury.
You are treating an unresponsive homeless patient found in an alley. During your assessment you notice bruising behind both ears, which is known as which of the following? A. Warrior's signs B. Fatigue signs C. Battle's signs D. Soldier's signs
C. Battle's signs
Which of the following is controlled by the left side of the brain? A. Movement of the left arm B. Sensation in the left arm C. Movement of both lower extremities D. Sensation of the right leg
D. Sensation of the right leg
Messages from the body to the brain are carried by which of the following types of nerves? A. Skeletal B. Cranial C. Motor D. Sensory
D. Sensory
Your patient is a 16-year-old male who was ejected from an all-terrain vehicle and struck a large rock face first, causing severe trauma to the face and jaw. He was not wearing a helmet. He is unresponsive with shallow, irregular respirations; a blood pressure of 170/110 mmHg; and a heart rate of 50 beats per minute. Which of the following should be your first concern to assess? A. The presence of indirect head injuries B. Whether the patient is comatose C. Whether there is severe hemorrhaging D. The patency of the patient's airway
D. The patency of the patient's airway
A 36-year-old male was accidentally shot with a nail gun into the head. You see the nail, which protrudes about 2 to 3 centimeters from the skull, when you visualize the injury site. Under which of the following circumstances should you remove the nail from the injury site? A. The patient develops excessive intracranial pressure (ICP). B. The patient begins to complain of shortness of breath. C. Bleeding from the patient's wound is minimal. D. None of the above
D. None of the above
Your patient is a 35-year-old woman who was driving a minivan that was struck in the driver's side door by another vehicle. You notice that when you apply pressure to her sternum with your knuckles she extends her legs and flexes her arms and wrists. When giving your radio report, which of the following terms should you use to describe this? A. Cushing's reflex B. Battle's sign C. Tonic-clonic activity D. Posturing
D. Posturing
Your partner wants to use a cervical collar on a patient it doesn't fit properly. Which of the following is a potential hazard of an improperly fitting cervical collar that you could use as a reason to forbid your partner from taking this action? A. It could cause flexion of the neck. B. It could prevent the patient from opening his mouth. C. It could cause hyperextension of the neck. D. All of the above
D. All of the above
Which of the following is the opening at the base of the skull? A. Temporomandibular joint B. Orbits C. Spinous process D. Foramen magnum
D. Foramen magnum
You are treating a 35-year-old male patient who has been involved in a motorcycle incident. The patient is unresponsive with a blood pressure of 60/40, a pulse of 66 beats per minute, and respirations of 18 breaths per minute. The patient's presentation is most likely caused by which of the following? A. Cardiogenic shock B. Increased intracranial pressure C. Septic shock D. Neurogenic shock
D. Neurogenic shock
You are the second unit on the scene of a multivehicle crash. You and your partner are caring for a middle-aged woman who is sitting in the passenger seat of a vehicle that seems undamaged. You see no signs of injury in this patient. When you ask her about pain, she replies in a foreign language. What should you do? A. Take full spinal precautions because you cannot determine the extent of the patient's injuries. B. Examine the patient more closely and look for physical signs of pain when you palpate her back. C. Although communication is important, given the fact that there are no MOIs and no signs of injury, you can safely proceed without immobilizing the patient. D. The patient's language has no bearing on how you treat a patient. She does not require immobilization.
D. The patient's language has no bearing on how you treat a patient. She does not require immobilization.
Your patient has had his throat slashed during a robbery attempt. You are concerned because it is apparent that the vessels in his neck have been lacerated. A breach in which of the following vessels would be most likely to lead to an air embolism? A. Arterioles B. Capillaries C. Arteries D. Veins
D. Veins
