PMED CH 31
The use of wet dressings in the field is limited because: A) their use may result in severe hypothermia. B) they are of no value in providing pain relief. C) their sterility cannot be maintained in the field. D) they provide a medium for pathogens to grow.
D
When caring for a patient with an open chest wound, you should: A) routinely transport the patient in a left lateral recumbent position. B) place a porous dressing over the wound and secure it on three sides. C) secure a dressing in place by circumferentially wrapping the chest. D) frequently assess breath sounds for indications of a pneumothorax.
D
You are dispatched to a residence for a man who cut his hand with a chainsaw. Upon arriving at the scene, your FIRST action should be to: A) immediately gain access to the patient. B) apply gloves, a gown, and facial protection. C) determine if air medical transport is available. D) carefully assess the scene for safety hazards.
D
You are the first unit to arrive at the scene of a small building collapse. As you exit the ambulance, you can see a man pinned under a large metal beam. You should: A) free the patient first and then assess him. B) carefully access the patient and assess him. C) contact medical control for further guidance. D) immediately request a special rescue team.
D
You should splint an open soft-tissue injury to an extremity because: A) most patients do not keep the extremity still when asked to do so. B) most open soft-tissue injuries are associated with a fracture. C) splinting is an excellent means of providing relief from pain. D) motion of the extremity may disrupt the blood-clotting process.
D
The swelling that occurs in conjunction with a contusion is caused by: A) inflammation of the injured blood vessels. B) rupture of large blood vessels in the dermis. C) aggregation of platelets to the injured site. D) leakage of fluid into spaces between the cells.
D
A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment, he tells you that he cut his hand on a piece of metal about a week ago. You should be MOST suspicious that this patient has: A) tetanus. B) meningitis. C) a viral infection. D) a staph infection.
A
After controlling the bleeding from a grossly contaminated open wound to the leg, you should next: A) irrigate with sterile water and apply a sterile dressing. B) apply a pressure bandage and elevate the extremity. C) elevate the extremity and administer 100% oxygen. D) gently pick out any foreign bodies with hemostats.
A
All of the following are functions of the skin, EXCEPT: A) providing the immune response for the body. B) protecting the underlying tissue from injury. C) sensing changes in the external environment. D) assisting in the regulation of body temperature.
A
Compared to the bleeding from an open wound, bleeding from a closed wound: A) is limited because the skin is unbroken. B) generally requires surgical intervention. C) is not significant enough to produce shock. D) can usually be controlled with direct pressure.
A
During the neovascularization phase of the wound healing process: A) new blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue. B) histamine makes the capillaries more permeable, resulting in swelling in and around the injury site. C) collagen provides stability to the damaged tissue and joins wound borders, thereby closing the open tissue. D) microscopic vasculature damaged by the injury is digested by macrophages through a process called phagocytosis.
A
If your patient has an open wound in which there is a risk of air being drawn into the vasculature, you should: A) cover the wound with an occlusive dressing. B) cover the wound with a hemostatic agent. C) apply direct pressure with moist dressings. D) transport quickly to a hyperbaric chamber.
A
The outermost layer of the epidermis: A) consists of nonliving cells that are continuously being shed. B) is a tough, highly elastic layer than contains melanin granules. C) contains numerous fibroblasts that secrete collagen and elastin. D) is comprised of living cells that give rise to the stratum corneum.
A
When applying a dressing and bandage to a scalp wound, you should: A) carefully assess the skull for an underlying fracture. B) remove any foreign particles from the wound first. C) always use a loose dressing to soak up the blood. D) apply a cervical collar in case the c-spine is injured.
A
When caring for an amputated body part: A) early notification of the hospital is important. B) the body part should be kept at room temperature. C) the part should be tightly wrapped in a dry dressing. D) applying ice to the body part will keep the cells viable.
A
When muscles are crushed beyond repair, tissue necrosis develops and causes the release of harmful products. This process is called: A) rhabdomyolysis. B) myoglobinuria. C) hyperphosphatemia. D) necrotizing fasciitis.
A
Whether the contamination from an open wound produces infection depends MOSTLY on: A) how the wound is managed. B) the location of the wound. C) the patient's medical history. D) how large the open wound is.
A
Which of the following conditions or factors would MOST likely delay or impair healing of a wound? A) Diabetes B) Obesity C) Alcohol use D) Hypertension
A
Which of the following interventions encourages drainage from the site of a closed wound and reduces swelling? A) Elevation B) Splinting C) Firm compression D) Application of ice
A
Which of the following statements regarding compartment syndrome is correct? A) Compartment syndrome is more likely to occur with closed injuries. B) Compartment syndrome is caused by increased pressure within the bone. C) Definitive treatment almost always includes amputation of the affected limb. D) Local tissue death occurs after 2 hours of persistent compartment syndrome.
A
Which of the following substances is produced in the dermis and keeps the skin supple so that it doesn't crack? A) Sebum B) Elastin C) Collagen D) Ground substance
A
Which of the following wounds usually requires substantial irrigation and debridement prior to closure? A) Degloving injuries B) Jagged lacerations C) Any wound to the face D) Wounds over tension lines
A
While hiking, a 24-year-old woman was pinned from the waist down under a rock that collapsed on her. Upon your arrival, the patient is conscious and alert, and states that she can't feel her legs. She further tells you that she thinks she has been pinned for about 5 hours. She is breathing adequately and has stable vital signs. In addition to administering supplemental oxygen, you should: A) start two large-bore IV lines of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs. B) quickly remove the rock from her legs to restore distal neurovascular function, and administer a 20-mL/kg bolus of lactated Ringer's solution. C) administer 2 mEq/kg of sodium bicarbonate followed by 25 g of 50% dextrose as you slowly and carefully remove the rock from her legs. D) start at least one large-bore IV line and administer 2 to 4 L of normal saline before attempting to remove the rock from her legs.
A
You have dressed and bandaged a laceration to the arm of a 16-year-old woman and are transporting her to the hospital. En route, the patient complains that her fingers are tingling. You touch her hand and note that it is cool. You should: A) readjust the bandage if needed and reassess distal neurovascular function. B) conclude that the laceration has probably severed a major nerve in her arm. C) elevate her arm, apply an icepack over the bandage, and reassess her hand. D) contact the receiving facility and have them place a neurosurgeon on standby.
A
Your MAIN concern when caring for a patient with a soft-tissue injury to the face should be: A) airway compromise. B) hypovolemic shock. C) injuries to the eyes. D) preventing contamination.
A
Which of the following statements regarding soft-tissue injuries is correct? A) Most soft-tissue injuries require immediate care to prevent blood loss. B) They are often the most obvious, but are seldom the most life threatening. C) Soft-tissue injuries should be covered immediately upon patient contact. D) Most soft-tissue injuries are hidden and require a systematic assessment.
B
A 41-year-old man was assaulted during a robbery attempt. Your primary assessment reveals that the patient is semiconscious. He has massive soft-tissue trauma to the face, inadequate breathing, and oropharyngeal bleeding. You should: A) apply direct pressure to his facial wounds and promptly intubate him. B) suction the blood from his mouth and assist ventilations with a bag-mask device. C) insert a nasal airway, apply oxygen via nonrebreathing mask, and transport. D) suction his oropharynx for 30 seconds and then perform endotracheal intubation.
B
During the inflammation phase of the healing process: A) white blood cells are forced away from the injury by vasoconstriction. B) histamine causes vasodilation and increased blood flow to the injury. C) damaged cell parts and microorganisms invade and infect the wound. D) the processes of epithelialization and collagen synthesis are impaired.
B
Elevation of an extremity that has a venous laceration to it: A) is often the only intervention needed to control the bleeding effectively. B) helps control the bleeding when used in conjunction with direct pressure. C) should only be performed if pressure point control has proven ineffective. D) is of minimal to no benefit if the patient is bradycardic and hypotensive.
B
In contrast to a contusion, a hematoma is: A) accompanied by ecchymosis. B) caused by large vessel damage. C) rarely accompanied by a bruise. D) a less significant closed injury.
B
Necrosis of tissue caused by an anaerobic, toxin-producing bacterium is called: A) tetanus. B) gangrene. C) fasciitis. D) lymphedema.
B
Signs and symptoms of compartment syndrome include all of the following, EXCEPT: A) pressure. B) erythema. C) parasthesia. D) passive stretch pain.
B
The FIRST aspect to address in any patient with a soft-tissue injury is: A) bleeding. B) your safety. C) airway patency. D) decontamination.
B
The skin helps regulate body temperature through: A) peripheral vasodilation, which shunts cool blood to the core of the body. B) the production of sweat, which is evaporated from the surface of the skin. C) increased elastin production, which provides insulation to the epidermis. D) cutaneous vasoconstriction, which brings warm blood to the skin's surface.
B
The skin is also referred to as the: A) melanin. B) integument. C) epithelium. D) collagen.
B
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: A) and result in low serum potassium levels. B) after the patient's leg is freed from entrapment. C) after the leg has been entrapped for 2 hours. D) only if the renal system is functioning properly.
B
When managing a patient who is entrapped by a crushing object, it is MOST important to: A) assess perfusion and sensory and motor functions every 5 minutes. B) make every effort to treat the patient before removing the crushing object. C) infuse 2 L of lactated Ringer's solution to combat hyperkalemia. D) give sodium bicarbonate immediately after removing the crushing object.
B
When the ambient temperature is high: A) the dermis produces less collagen, which temporarily decreases the skin's ability to retain warmth. B) blood vessels in the dermis dilate, which increases blood flow to the skin and allows heat to dissipate. C) sweat glands in the epidermis produce sweat, which is evaporated from the skin surface by the air. D) constriction of the vessels in the dermis brings warm blood to the surface of the skin, where it is eliminated.
B
Which of the following bandages is associated with the HIGHEST risk of blood flow compromise? A) Roller bandages B) Elastic bandages C) Triangular bandages D) Nonabsorbent bandages
B
Which of the following patients is at HIGHEST risk for a pressure injury? A) An obese patient B) A bedridden patient C) A hypertensive patient D) A patient with diabetes
B
Which of the following statements regarding lacerations is correct? A) Lacerations are linear cuts that tend to heal well due to their relatively even wound margins. B) The seriousness of a laceration depends on its depth and the structures that have been damaged. C) The first priority in treating a laceration is to cover it with a sterile dressing to prevent infection. D) A laceration must be sutured or otherwise closed within 8 to 10 hours following the injury.
B
A 22-year-old man was struck in the forehead by a softball. He is conscious and alert, but complains of a severe headache. Your assessment reveals a large hematoma to his forehead. His vital signs are stable and his breathing is adequate. You should: A) apply firm manual pressure to the hematoma to reduce internal bleeding. B) place him in a sitting position and apply a chemical heat pack to his head. C) apply an icepack to the hematoma and monitor his level of consciousness. D) start an IV of normal saline and administer 2 mg of morphine for the pain.
C
A 63-year-old diabetic woman presents with an open wound to her forearm that she experienced when she fell a week ago. She tells you that the wound has been draining purulent fluid, but has not been bleeding. The wound itself is red, inflamed, and warm to the touch. You should:
C
A laceration that lies perpendicular to the skin's tension lines: A) results in minimal external bleeding and typically heals spontaneously within 2 to 3 hours. B) generally remains closed and does not require suturing or other methods of wound closure. C) often remains open, heals more slowly, and is more likely to result in abnormal scar formation. D) does not disrupt the body's blood-clotting process and tends to heal without the formation of a scar.
C
A patient with nerve compromise following an open injury to the hand: A) should be given analgesia for the pain. B) will likely lose all neurologic function. C) requires prompt transport to the hospital. D) will not be able to move his or her hand.
C
A wound is at HIGHEST risk for infection if: A) the patient uses an antibacterial spray. B) it occurs to any part of the facial area. C) it is caused by a human or animal bite. D) the patient has poor peripheral circulation.
C
A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting from the injury site. Despite direct pressure and a pressure dressing, the wound continues to bleed heavily. You should: A) apply supplemental oxygen and keep her warm. B) elevate the extremity above the level of her heart. C) apply a tourniquet between her elbow and wrist. D) locate and apply digital pressure to the brachial artery.
C
Applying direct pressure to a bleeding wound stops the flow of blood because: A) pressure stimulates the release of fibrin. B) direct pressure facilitates vasoconstriction. C) it allows platelets to seal the vascular walls. D) pressure shunts blood away from the injury.
C
In which of the following patients should the impaled object be removed? A) Apneic patient with a shard of glass impaled in the center of the chest B) Pulseless and apneic patient with a knife impaled in the lower abdomen C) Cardiac arrest patient with an ice pick impaled in the center of the back D) Semiconscious patient with a screwdriver impaled in the side of the head
C
Primary treatment in the prehospital setting for an abrasion involves: A) administering a narcotic analgesic. B) applying an antibiotic ointment or cream. C) covering it lightly with a sterile dressing. D) thoroughly cleaning it to prevent infection.
C
Systemic signs of infection secondary to a soft-tissue injury include: A) erythema. B) pus drainage. C) fever and chills. D) lymphangitis.
C
The subcutaneous tissue is: A) the layer of tissue above the dermis that mainly produces sweat. B) a thin layer of tissue from which blood vessels exclusively originate. C) also called the superficial fascia and consists mainly of adipose tissue. D) the deep fascial layer that ensheathes muscle and other internal structures.
C
Which of the following is the MOST common cause of necrotizing fasciitis? A) A fungal infection B) Clostridium tetani C) Hemolytic streptococci D) Clostridium perfringens
C
Which of the following medications would MOST likely interfere with hemostasis? A) Paxil B) Procrit C) Plavix D) Tylenol
C
Which of the following statements regarding crush injury is correct? A) A crush injury can occur if the PASG is left in place for greater than 1 hour. B) Gangrene often sets in if a body part is entrapped for longer than 30 minutes. C) Crush syndrome can occur if the body part is entrapped for more than 4 hours. D) In a crush injury, the external appearance is a good predictor of internal damage.
C
_________ is a fibrous protein that gives the skin high resistance to breakage under mechanical stress. A) Fibrin B) Elastin C) Collagen D) Melanin
C
A crushing or tearing amputation: A) is initially treated by applying a proximal tourniquet and retrieving any detached body parts. B) causes less blood loss than expected because the blood vessels retain their ability to constrict. C) cannot be surgically reattached due to the severe vascular and soft-tissue damage that accompanies it. D) can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly.
D
A patient taking _______________ would MOST likely experience a delay in the healing of a wound. A) antidepressants B) acetaminophen C) antihypertensives D) corticosteroids
D
An infection characterized by painful muscle contractions is called: A) pertussis. B) polio. C) rabies. D) tetanus.
D
During the process of wound healing, hemostasis: A) permanently stops the wound from bleeding and facilitates healing. B) is a physiologic process in which the body's platelets are destroyed. C) occurs when the bone marrow transiently produces more red blood cells. D) temporarily stops bleeding via vasoconstriction and platelet aggregation.
D
In addition to bleeding and contamination, the principal danger associated with an avulsion is: A) undetectable internal damage. B) disfigurement due to severe scarring. C) invasion of the wound with Clostridium tetani. D) a loss of blood supply to the avulsed flap.
D
Physical injury to the skin: A) causes a decrease in the production of macrophages and lymphocytes, thus increasing the risk of infection. B) commonly destroys the stratum corneum, the deep dermal layer of the skin, and causes nerve damage. C) promotes cutaneous vasoconstriction, which shunts blood away from the injury and manifests as pallor around the injury site. D) triggers mast cells to degranulate and synthesize special chemical mediators, which causes the injured area to become warm and red.
D
Renal failure, a key complication of crush syndrome, can be prevented by: A) administering calcium chloride. B) giving 40 mL/kg of lactated Ringer's. C) giving the patient 25 g of glucose. D) aggressively infusing normal saline.
D
The MOST significant immediate threat to a patient with a soft-tissue injury is: A) nerve damage. B) infection. C) disfigurement. D) hemorrhage.
D
The bite from a ________ poses the greatest risk for serious infection. A) cat B) dog C) raccoon D) human
D
