NMETC Module 6: Trauma

The greatest amount of kinetic energy would be created if a ____-pound driver struck a tree while traveling at ____ mph. 170, 30 140, 50 150, 40 160, 30

140, 50 Trauma, Energy, and Kinetics, pages 1543-1545

In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding. 1,000 mL 750 mL 250 mL 500 mL

Correct! 1,000 mL Pathophysiology, page 1848

What is the Glasgow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain? 12 13 10 11

Correct! 12 Primary Survey, page 515

Closed bilaterally fractured femurs can result in internal blood loss of up to: 1,500 mL. 3,000 mL. 2,000 mL. 1,000 mL.

Correct! 3,000 mL. Emergency Medical Care, page 1858

When summoning an air transport service to transport a critically injured patient, it is MOST important to: predetermine the destination facility. determine the flight crew's credentials. ensure that the fire department is present. activate the service as soon as possible.

activate the service as soon as possible. Management of Trauma, page 1573

According to the Waddell triad, the second impact from a motor vehicle occurs when the: chest and abdomen strike the grille or low on the hood of the car. head strikes the ground, resulting in skull and facial fractures. child is run over by the car as he or she is propelled to the ground. car's bumper strikes the pelvis and femurs instead of the knees.

chest and abdomen strike the grille or low on the hood of the car. Blunt Trauma, page 1556

If your patient has an open wound in which there is a risk of air being drawn into the vasculature, you should: cover the wound with an occlusive dressing. cover the wound with a hemostatic agent. apply direct pressure with moist dressings. transport quickly to a hyperbaric chamber.

cover the wound with an occlusive dressing. Emergency Medical Care, page 1619

When assessing any patient, the paramedic should remember that: the past medical history is of even greater importance if the patient has a traumatic injury. the patient's underlying medical problem can usually be identified by a rapid assessment. it is extremely common for patients with a medical complaint to have an underlying injury. some patients with a traumatic injury could also have an underlying medical component.

some patients with a traumatic injury could also have an underlying medical component. Introduction, page 503

During an explosion, secondary blast injuries occur when: the patient is struck by flying debris, such as shrapnel. hollow organs rupture due to the pressure wave. the patient is thrown against a stationary object. the patient sustains severe burns from the intense heat.

the patient is struck by flying debris, such as shrapnel. Blast Injuries, page 1561

The severity of hyperextension injuries to the neck following a rear-end collision depends MOSTLY on: the proper use of seat belts. whether the driver tenses up. the position of the headrest. proper deployment of the air bags.

the position of the headrest. Blunt Trauma, page 1550

You are caring for a 41-year-old man who was trapped in his burning house before being rescued by fire fighters. He has full-thickness burns to his head and anterior trunk, and mixed partial- and full-thickness burns to both anterior upper extremities. What percentage of his total body surface area has been burned? 36% 45% 27% 18%

Correct! 36% Patient Assessment, page 1648

Which of the following patients is at HIGHEST risk for a pressure injury? An obese patient A bedridden patient A hypertensive patient A patient with diabetes

Correct! A bedridden patient Wound Healing, page 1615

Immediate pain from the heel to the calf and a sudden inability for plantar flexion of the foot is MOST indicative of: Achilles tendon rupture. ligament disruption. acute tendonitis. a dislocated ankle.

Correct! Achilles tendon rupture. Pathophysiology, Assessment, and Management of Ligament Injuries and Dislocations, page 1877

During your assessment of a patient with a femur fracture, you discover a rapidly expanding hematoma on the medial aspect of his thigh. What should you suspect? Compartment syndrome Venous thrombus Arterial injury Fasciitis

Correct! Arterial injury Patient Assessment, page 1855

Which of the following is the MOST practical method of assessing for gross neurologic deficits during your assessment of a patient? Ask the patient if he or she can feel and move his or her fingers and toes. Assess capillary refill time at the forehead and the fingernails and toenails. Check deep tendon reflexes with a reflex hammer or similar object. Ask the patient to lift both legs and hold them up for 20 to 30 seconds.

Correct! Ask the patient if he or she can feel and move his or her fingers and toes. Primary Survey, page 514

Which of the following statements regarding prehospital vascular access and fluid therapy in the severely burned patient is correct? Most burn patients will require at least 4 L of IV fluid immediately. At least one large-bore IV should be started while en route to the hospital. An IV line in a lower extremity is preferable to one in a burned upper extremity. Intraosseous cannulation is absolutely contraindicated in severely burned patients.

Correct! At least one large-bore IV should be started while en route to the hospital. Emergency Medical Care, page 1652

Which of the following statements regarding crush injury is correct? A crush injury can occur if the PASG is left in place for greater than 1 hour. Gangrene often sets in if a body part is entrapped for longer than 30 minutes. Crush syndrome can occur if the body part is entrapped for more than 4 hours. In a crush injury, the external appearance is a good predictor of internal damage.

Correct! Crush syndrome can occur if the body part is entrapped for more than 4 hours. General Pathophysiology: Closed Versus Open Wounds, page 1613

Which of the following wounds usually requires substantial irrigation and debridement prior to closure? Degloving injuries Jagged lacerations Any wound to the face Wounds over tension lines

Correct! Degloving injuries Wound Healing, page 1615

Which of the following significant mechanisms of injury is unique to the infant and child? Ejection from a car's back seat Fall from greater than 10 feet History Taking Vehicle-pedestrian collision Penetrating injury to the head

Correct! Fall from greater than 10 feet History Taking, page 535

Treatment for suspected compartment syndrome includes: warm packs over the affected extremity. calcium chloride to prevent rhabdomyolysis. IV boluses of a crystalloid solution. elevating the extremity above the heart.

Correct! IV boluses of a crystalloid solution. Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, page 1864

Which of the following organs is LEAST susceptible to pressure changes caused by an explosion? Liver Lungs Tympanic membrane Gastrointestinal tract

Correct! Liver Blast Injuries, page 1563

Which of the following will be of MOST benefit in helping the paramedic predict the type of injuries that a patient experienced? Past medical history Index of suspicion Age of the patient Mechanism of injury

Correct! Mechanism of injury Trauma, Energy, and Kinetics, pages 1543-1544

A 68-year-old woman presents with an acute onset of dyspnea and sharp chest pain. Her medical history is significant for a hip replacement 2 weeks ago. The patient is conscious and alert, with a blood pressure of 112/58 mm Hg, pulse rate of 90 beats/min and irregular, and respirations of 22 breaths/min and labored. Which of the following treatment interventions is MOST appropriate for this patient? Pharmacologically assisted intubation and IV therapy Supplemental oxygen and elevation of the lower extremities Oxygenation and ventilation support and rapid transport 324 mg of aspirin and ventilation support with a bag-mask

Correct! Oxygenation and ventilation support and rapid transport Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, page 1865

Which of the following chemicals causes a painless burn and can result in significant damage before it is identified? Sulfur mustard Phenol Potassium hydroxide Sulfuric acid

Correct! Phenol Pathophysiology, Assessment, and Management of Specific Burns, page 1655

Which of the following mechanisms of injury would be the LEAST likely to cause life-threatening injuries? Restrained occupant in a vehicle rollover Motorcycle crash without a helmet Ejection from an all-terrain vehicle Penetrating injury to the chest or abdomen

Correct! Restrained occupant in a vehicle rollover History Taking, pages 534-535

Which of the following is the BEST example of an indirect injury? Dislocated olecranon process following direct trauma to the elbow Fractured ankle after stepping in a hole and twisting the lower leg Shoulder dislocation secondary to falling on an outstretched hand Patellar fracture after the knee strikes an automobile's dashboard

Correct! Shoulder dislocation secondary to falling on an outstretched hand Patterns and Mechanisms of Musculoskeletal Injury, pages 1846-1847

What type of thermal burn is MOST commonly associated with inhalation injury? Arc burns Steam burns Scald burns Flame burns

Correct! Steam burns Pathophysiology, page 1642

Phosphorus is found in _____________ and burns when exposed to _____________. drain cleaner, air battery acid, water fireworks, air oven cleaner, water

Correct! fireworks, air Pathophysiology, Assessment, and Management of Specific Burns, page 1655

Which of the following statements regarding the rapid full-body exam of a trauma patient is correct? Any trauma patient should receive a rapid head-to-toe exam, even if his or her injury is minor and the mechanism of injury is not significant. The rapid exam is the first assessment you will perform on a trauma patient and is designed to find and treat immediate threats to life. The rapid exam is a detailed exam that should take between 1 and 2 minutes and should primarily focus on the patient's chief complaint. The rapid exam is used to identify injuries that must be managed before and during packaging and loading the patient for transport.

Correct! The rapid exam is used to identify injuries that must be managed before and during packaging and loading the patient for transport. Secondary Assessment, page 540

Which of the following factors is the LEAST influential in the severity of a stab wound? The anatomic area involved The angle of penetration The size of the attacker The length of the knife blade

Correct! The size of the attacker Penetrating Trauma, page 1558

Which of the following statements regarding rollover motor vehicle crashes is correct? Ejection of the patient from the vehicle increases the chance of death by five times. The restrained occupant's head and neck usually remain stationary during a rollover. Injuries to the passengers are usually not serious if seat belts are worn properly. Unrestrained passengers are struck with each change in direction the car makes.

Correct! Unrestrained passengers are struck with each change in direction the car makes. Blunt Trauma, page 1552

Which of the following hazards would you LEAST likely encounter at the scene of a motor vehicle crash? Unruly patient Scene Size-up Broken glass Moving traffic Hazardous materials

Correct! Unruly patient Scene Size-up, pages 504-506

Percussion of the chest produces ____________ if the pleural space is full of blood. hyperresonance a dull sound a hollow sound a high-pitched note

Correct! a dull sound Secondary Assessment, page 565

A subluxation occurs when: a fracture occurs through both cortices. dislocated bones are locked in position. a joint is partially dislocated. a dislocation spontaneously reduces.

Correct! a joint is partially dislocated. Pathophysiology, page 1851

In addition to bleeding and contamination, the principal danger associated with an avulsion is: undetectable internal damage. disfigurement due to severe scarring. invasion of the wound with Clostridium tetani. a loss of blood supply to the avulsed flap.

Correct! a loss of blood supply to the avulsed flap. Pathophysiology, Assessment, and Management of Specific Injuries, pages 1625-1626

When a patient's leg is entrapped under a crushing object for a prolonged period of time, toxic metabolic waste products are released into the systemic circulation: and result in low serum potassium levels. after the patient's leg is freed from entrapment. after the leg has been entrapped for 2 hours. only if the renal system is functioning properly.

Correct! after the patient's leg is freed from entrapment.General Pathophysiology: Closed Versus Open Wounds, page 1613

Your MAIN concern when caring for a patient with a soft-tissue injury to the face should be: airway compromise. hypovolemic shock. injuries to the eyes. preventing contamination.

Correct! airway compromise. Emergency Medical Care, pages 1621-1622

A pathologic fracture occurs when: a particular mechanism of injury cannot be identified readily. an occult medical condition causes abnormal bone weakness. greater-than-usual forces are required to fracture a large bone. underdeveloped bones sustain a low-impact traumatic injury.

Correct! an occult medical condition causes abnormal bone weakness. Patterns and Mechanisms of Musculoskeletal Injury, page 1846

Thermal burns are MOST commonly caused by exposure to: an open flame. superheated steam. hot solid objects. hot liquids.

Correct! an open flame. Pathophysiology, page 1641

Upon completing your rapid full-body exam of an unresponsive trauma patient's head and neck, you should next: assess the integrity of the 12 cranial nerves. ventilate the patient at 12 to 20 breaths/min. apply a properly sized rigid cervical collar. log roll the patient onto a long backboard.

Correct! apply a properly sized rigid cervical collar. Secondary Assessment, page 541

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: apply supplemental oxygen and keep her warm. elevate the extremity above the level of her heart. apply a tourniquet between her elbow and wrist. locate and apply digital pressure to the brachial artery.

Correct! apply a tourniquet between her elbow and wrist. Emergency Medical Care, pages 1618, 1620

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: apply firm manual pressure to the hematoma to reduce internal bleeding. place him in a sitting position and apply a chemical heat pack to his head. apply an icepack to the hematoma and monitor his level of consciousness. start an IV of normal saline and administer 2 mg of morphine for the pain.

Correct! apply an icepack to the hematoma and monitor his level of consciousness. Emergency Medical Care, pages 1617-1618

The two MOST common causes of death from an electrical injury are: full-thickness burns and respiratory arrest. asphyxia and cardiopulmonary arrest. myoglobinuria and diaphragmatic paralysis. nervous system damage and massive sepsis.

Correct! asphyxia and cardiopulmonary arrest. Pathophysiology, Assessment, and Management of Specific Burns, page 1662

The FIRST step in splinting a musculoskeletal injury involves: exposing and assessing the injury site. assessing distal neurovascular functions. thoroughly assessing range of motion. straightening the injury if it is angulated.

Correct! exposing and assessing the injury site. Emergency Medical Care, page 1859

The shock wave velocity from an explosion is slower and its duration is longer if a person is: standing behind a solid object. farther from the explosion. closer to the explosion. standing beside a solid object.

Correct! farther from the explosion. Blast Injuries, page 1562

During your primary assessment of a 21-year-old woman with a suspected inhalation injury, you note that she is combative and her respirations are profoundly labored and stridorous. The closest appropriate medical facility is approximately 25 miles by ground, and the local air transport service is unavailable. You should: provide supplemental oxygen via nonrebreathing mask, insert an intraosseous catheter, and administer a sedative medication. insert an oropharyngeal airway, ventilate her with a bag-mask device at 20 breaths/min, and prepare to nasotracheally intubate her. administer humidified oxygen, start at least one large-bore IV, and visualize her upper airway to assess the severity of soft-tissue swelling. assist ventilations with a bag-mask device, start an IV, administer a sedative and a neuromuscular blocker, and intubate her trachea.

Correct! assist ventilations with a bag-mask device, start an IV, administer a sedative and a neuromuscular blocker, and intubate her trachea. Emergency Medical Care, pages 1651-1652

When assessing the head and face during the full-body exam, you should: remove any dentures if they are present. avoid palpating any cranial depressions. apply pressure to the eyes to elicit pain. pack the ears if blood drainage is present.

Correct! avoid palpating any cranial depressions. Secondary Assessment, page 555

Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a(n): orbital blowout fracture. ruptured tympanic membrane. basilar skull fracture. fracture of the cribriform plate.

Correct! basilar skull fracture. Secondary Assessment, page 559

At a minimum, a Level II trauma center should: have access to an emergency physician within 20 minutes. provide total care for every aspect of a patient's injuries. have an in-house neurosurgeon 24 hours a day. be able to initiate definitive care for all injured patients.

Correct! be able to initiate definitive care for all injured patients. Management of Trauma, page 1572

When assessing a burn patient, it is MOST important to: be alert for occult trauma that could affect patient outcome. accurately calculate the extent of body surface area burned. rapidly determine if the patient will require an escharotomy. apprise medical control of the situation as soon as possible.

Correct! be alert for occult trauma that could affect patient outcome. Patient Assessment, pages 1646-1648

When a person jumps from a height and lands on his or her feet, direct trauma occurs to the: tarsals. malleolus. calcaneus. metatarsals.

Correct! calcaneus. Pathophysiology, Assessment, and Management of Specific Fractures, page 1874

Relative to the entrance wound caused by an electrical burn, the exit wound: is often much smaller in diameter. can be quite extensive and deep. heals without surgical intervention. is a predictor of internal injury.

Correct! can be quite extensive and deep. Pathophysiology, Assessment, and Management of Specific Burns, page 1659

You would NOT expect to encounter decreased breath sounds in a patient with: opiate intoxication. status asthmaticus. cardiac tamponade. pulmonary edema.

Correct! cardiac tamponade. Secondary Assessment, pages 564-566

When applying a dressing and bandage to a scalp wound, you should: carefully assess the skull for an underlying fracture. remove any foreign particles from the wound first. always use a loose dressing to soak up the blood. apply a cervical collar in case the c-spine is injured.

Correct! carefully assess the skull for an underlying fracture. Emergency Medical Care, page 1621

After a motorcyclist is ejected from his or her motorcycle, secondary collisions: typically cause bilateral fractures of the femurs and tibias. result in less severe injuries if the rider is wearing leather. cause an unpredictable combination of blunt injuries. most commonly involve a stationary object.

Correct! cause an unpredictable combination of blunt injuries. Blunt Trauma, page 1555

The BEST way to detect deformity or any other abnormality in an injured extremity is to: reduce any swelling with ice before performing the exam. compare it to the extremity on the opposite side. manipulate the extremity to assess for false motion. gently palpate the entire length of the extremity.

Correct! compare it to the extremity on the opposite side. Patient Assessment, page 1854

When assessing distal pulses in a patient with a lower extremity injury, it is MOST important to: suspect severe shock if a unilateral pulse deficit is present. compare the strength of the pulses in both lower extremities. count the pedal pulse rate and compare it to the radial pulse rate. remember that most people do not have a palpable pedal pulse.

Correct! compare the strength of the pulses in both lower extremities. Patient Assessment, page 1855

A patient taking _______________ would MOST likely experience a delay in the healing of a wound. antidepressants acetaminophen antihypertensives corticosteroids

Correct! corticosteroids Wound Healing, page 1614

Signs of bursitis include all of the following, EXCEPT: swelling. deformity. warmth. erythema.

Correct! deformity. Pathophysiology, Assessment, and Management of Nontraumatic Musculoskeletal Disorders, page 1879

Rapid deceleration of a motor vehicle that is traveling at 60 mph: typically generates forces of up to 10 to 20 g. dissipates tremendous forces and can cause major injuries. causes the driver's body to stop moving at the same time. initially causes whiplash injuries to the patient's neck.

Correct! dissipates tremendous forces and can cause major injuries. Trauma, Energy, and Kinetics, page 1545

When caring for an amputated body part: early notification of the hospital is important. the body part should be kept at room temperature. the part should be tightly wrapped in a dry dressing. applying ice to the body part will keep the cells viable.

Correct! early notification of the hospital is important. Pathophysiology, Assessment, and Management of Specific Injuries, page 1626

Upon initial contact with a severely burned patient, you must: assess airway and breathing adequacy. quickly establish the extent of the burns. ensure that the patient is not still burning. cover the patient to prevent hypothermia.

Correct! ensure that the patient is not still burning. Patient Assessment, pages 1646

Burn shock is caused by: renal failure secondary to excess myoglobin production from burned muscle. a massive infection that occurs when microorganisms breach burned skin. fluid loss across damaged skin and volume shifts within the rest of the body. acute dehydration, and it commonly manifests within 30 minutes after the burn.

Correct! fluid loss across damaged skin and volume shifts within the rest of the body. Patient Assessment, page 1647

When caring for a patient with an open chest wound, you should: routinely transport the patient in a left lateral recumbent position. place a porous dressing over the wound and secure it on three sides. secure a dressing in place by circumferentially wrapping the chest. frequently assess breath sounds for indications of a pneumothorax.

Correct! frequently assess breath sounds for indications of a pneumothorax. Emergency Medical Care, page 1622

Structural integrity of the pelvis should be assessed by: applying firm upward pressure to the pelvic wings. carefully rocking the pelvis back and forth. gently pushing in and down on the iliac crests. placing the patient on his or her side to elicit pain.

Correct! gently pushing in and down on the iliac crests. Secondary Assessment, page 576

If the mechanism of injury does not appear to be significant, you should consider transporting an injured patient to a Level I trauma center if he or she: takes any kind of medication. is emotionally upset or angry. is older than 45 years of age. has a known bleeding disorder.

Correct! has a known bleeding disorder. Management of Trauma, pages 1570-1571

You arrive at the scene of a motor vehicle crash in which a small passenger car struck a bridge pillar. The patient, a conscious young woman, is still seated in her car. The scene is safe and law enforcement is directing traffic. Upon initial contact with the patient, you should: open her airway with the jaw-thrust maneuver and assess respiratory quality have your partner manually stabilize her head as you assess her mental status. apply a rigid cervical collar and obtain an initial Glasgow Coma Scale score. assess her respiratory quality and then apply oxygen via nonrebreathing mask.

Correct! have your partner manually stabilize her head as you assess her mental status. Primary Survey, pages 510-511

Bruising in the periumbilical area is indicative of: a leaking aortic aneurysm. ruptured ectopic pregnancy. a ruptured urinary bladder. intraperitoneal hemorrhage.

Correct! intraperitoneal hemorrhage. Secondary Assessment, page 571

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

Correct! it allows platelets to seal the vascular walls. Emergency Medical Care, page 1618

A wound is at HIGHEST risk for infection if: the patient uses an antibacterial spray. it occurs to any part of the facial area. it is caused by a human or animal bite. the patient has poor peripheral circulation.

Correct! it is caused by a human or animal bite. Wound Healing, page 1614

The initial point of bodily impact when an unrestrained passenger takes the "down-and-under" pathway during a frontal collision is the: abdomen. knees pelvis. femurs.

Correct! knees. Blunt Trauma, page 1549

A patient in shock due to internal bleeding will benefit MOST from: oxygen and thermal management. a comprehensive physical examination. limited scene time and rapid transport. two large-bore IV lines of normal saline.

Correct! limited scene time and rapid transport. Primary Survey, pages 515-516

You have applied board splints to a suspected lower leg fracture in a young woman and have given her fentanyl for pain. En route to the hospital, the patient states that the pain is excruciating. Further narcotics fail to relieve the pain. Reassessment of the injured area reveals that the overlying skin is taut and the pedal pulse is weak. You should: start a second IV line and administer 1 mEq/kg of sodium bicarbonate. loosen the splint, elevate the leg, apply ice, and notify the hospital. remove the board splints, apply an air splint, and then reassess her. remove the splint to prevent excessive swelling of the extremity.

Correct! loosen the splint, elevate the leg, apply ice, and notify the hospital. Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, pages 1863-1864

You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should: remove his helmet and apply a cervical collar. immediately stabilize both lower extremities. carefully straighten his legs and assess distal pulses. manually stabilize his head and assess his airway.

Correct! manually stabilize his head and assess his airway. Patient Assessment, pages 1852-1853

The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT: renal dysfunction. metabolic alkalosis. hyperkalemia. a decreased pH.

Correct! metabolic alkalosis. Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, pages 1864-1865

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

Correct! neurovascular compromise. Pathophysiology, page 1851

Damage to the kidneys following an electrical injury: is the result of electricity passing through the kidneys. occurs when damaged muscle produces myoglobin. can be prevented with boluses of lactated Ringer's. is caused by excess serum potassium levels.

Correct! occurs when damaged muscle produces myoglobin. Pathophysiology, Assessment, and Management of Specific Burns, page 1662

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

Correct! often remains open, heals more slowly, and is more likely to result in abnormal scar formation. Anatomy and Physiology Review, page 1612

When assessing a trauma patient's chest, you should remember that: the presence of hyporesonance to percussion is an indicator of air trapping in the pleural space. breath sounds should be assessed routinely in at least two fields prior to visual or tactile assessment. paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms. a structurally nonintact chest wall should be stabilized by circumferentially wrapping the chest with bandages.

Correct! paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms. Secondary Assessment, page 562

The appendicular skeleton is composed of the: pectoral girdle, pelvic girdle, and bones of the extremities. bones of the spinal column, scapulae, and clavicles. bones of the upper extremities and the structures of the torso. thoracic ribs, cervical vertebrae, and bones of the cranium.

Correct! pectoral girdle, pelvic girdle, and bones of the extremities. Anatomy and Physiology Review, page 1845

Compartment syndrome occurs when: pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death. blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue. metabolic waste products accumulate within a large hematoma that develops near a fracture site. yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling.

Correct! pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death. Pathophysiology, Assessment, and Management of Complications of Musculoskeletal Injuries, page 1864

All of the following are functions of the skin, EXCEPT: providing the immune response for the body. protecting the underlying tissue from injury. sensing changes in the external environment. assisting in the regulation of body temperature.

Correct! providing the immune response for the body. Anatomy and Physiology Review, page 1611

You are transporting a conscious but confused 29-year-old man after he was electrocuted. The patient is on high-flow oxygen, has an IV line of normal saline in place, is on a cardiac monitor, and has his spine fully immobilized. During transport, it is especially important for you to: remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. administer at least 2 L of normal saline solution to prevent renal failure. reassess his vital signs every 15 minutes and treat any fractures or dislocations. thoroughly assess and clean the entry and exit wounds to prevent an infection.

Correct! remain alert for lethal cardiac dysrhythmias and be prepared to defibrillate. Pathophysiology, Assessment, and Management of Specific Burns, pages 1662

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: splint the elbow in the position found and reassess distal circulation. carefully straighten the arm to facilitate placement of a vacuum splint. apply a sling and swathe to immobilize the injury and then apply heat. administer fentanyl for pain relief and then carefully straighten the arm.

Correct! splint the elbow in the position found and reassess distal circulation. Emergency Medical Care, pages 1858-1859

The diameter of a patient's pupils and their reactivity to light provide information about the: intactness of the first cranial nerve. status of cerebral perfusion. level of carbon dioxide in the brain. amount of vitreous humor.

Correct! status of cerebral perfusion. Secondary Assessment, page 557

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: apply direct pressure to his facial wounds and promptly intubate him. suction the blood from his mouth and assist ventilations with a bag-mask device. insert a nasal airway, apply oxygen via nonrebreathing mask, and transport. suction his oropharynx for 30 seconds and then perform endotracheal intubation.

Correct! suction the blood from his mouth and assist ventilations with a bag-mask device. Patient Assessment, page 1616

A 71-year-old man slipped on wet grass and landed on his left side. He denies losing consciousness before or after the fall and is presently conscious and alert. He complains of pain to his left hip and in his neck. Your assessment reveals a hematoma to the left side of his head and an external rotation and shortening of his left leg. His vital signs are stable. The MOST appropriate treatment for this patient includes: supplemental oxygen, spinal motion restriction precautions, an IV line of normal saline, stabilization of his hip with pillows, fentanyl if needed, and transport. spinal motion restriction precautions, stabilization of his hip with a traction splint, an IV of normal saline, 5 µg/kg of fentanyl, and transport. supplemental oxygen, application and inflation of the PASG to stabilize his hip, an IV line of lactated Ringer solution, midazolam to relieve his pain, and transport. placing him on a scoop stretcher and stabilizing his hip with pillows, applying a cervical collar, starting an IV line set to keep the vein open, and transport.

Correct! supplemental oxygen, spinal motion restriction precautions, an IV line of normal saline, stabilization of his hip with pillows, fentanyl if needed, and transport. Pathophysiology, Assessment, and Management of Specific Fractures, page 1871

According to the American College of Surgeons, an injured patient should be transported to a Level I trauma center if his or her: systolic blood pressure is less than 90 mm Hg. Glasgow Coma Scale score is less than 15. respiratory rate is less than 14 breaths/min. heart rate is greater than 100 beats/min.

Correct! systolic blood pressure is less than 90 mm Hg. Management of Trauma, pages 1569-1571

During the process of wound healing, hemostasis: permanently stops the wound from bleeding and facilitates healing. is a physiologic process in which the body's platelets are destroyed. occurs when the bone marrow transiently produces more red blood cells. temporarily stops bleeding via vasoconstriction and platelet aggregation.

Correct! temporarily stops bleeding via vasoconstriction and platelet aggregation. Wound Healing, page 1613

When a patient takes the "up-and-over" pathway during a head-on collision: secondary injuries as the patient is ejected are often less severe than the primary injuries. injuries to the parietal aspect of the skull are common as the head strikes the side window. the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx. the head takes a higher trajectory, striking the windshield and causing stretching injuries to the neck.

Correct! the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx. Blunt Trauma, page 1550

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

Correct! the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact. Blunt Trauma, page 1550

The skin helps regulate body temperature through: peripheral vasodilation, which shunts cool blood to the core of the body. the production of sweat, which is evaporated from the surface of the skin. increased elastin production, which provides insulation to the epidermis. cutaneous vasoconstriction, which brings warm blood to the skin's surface.

Correct! the production of sweat, which is evaporated from the surface of the skin. Anatomy and Physiology Review, page 1611

An open-book pelvis fracture has the potential for massive blood loss because: the volume of the pelvis is increased. the abdominal aorta is often injured. the femoral vein is often injured. the femur is usually also fractured.

Correct! the volume of the pelvis is increased. Pathophysiology, Assessment, and Management of Specific Fractures, page 1869

Vascular compromise in a lower extremity is characterized by: inability to feel or move the extremity. bilaterally diminished pedal pulses. unilateral pulse deficit and pallor. warm, flushed skin to the extremity.

Correct! unilateral pulse deficit and pallor. Secondary Assessment, page 580

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: by ground to the Level II trauma center. via air transport to the Level I trauma center. to the closest hospital for stabilization. by ground to the Level I trauma center.

Correct! via air transport to the Level I trauma center. Management of Trauma, pages 1569-1572

The onset of ___________ soon after exposure to radiation is a predictor of poor outcomes. tachycardia confusion hair loss vomiting

Correct! vomiting Pathophysiology, Assessment, and Management of Specific Burns, page 1665

When caring for an unresponsive trauma patient, a complete secondary assessment: must be performed after the primary assessment. should be performed before you begin transport. will enable you to immediately detect life threats. will probably not be performed in its entirety.

Correct! will probably not be performed in its entirety. Secondary Assessment, page 539

Avascular necrosis is a major complication of a fracture of which bone? Metacarpal Calcaneus Clavicle Scaphoid

Scaphoid

The law of conservation of energy states that: the force that an object can exert is the product of its mass multiplied by its acceleration. kinetic energy can be converted only to thermal or chemical energy. energy can be neither created nor destroyed; it can only change form. a body at rest will remain at rest unless acted upon by an outside force

energy can be neither created nor destroyed; it can only change form. Trauma, Energy, and Kinetics, page 1545

The MOST significant immediate risk associated with an open fracture is: bone marrow loss. infection. nerve damage. hemorrhage.

hemorrhage.