Chapter 23
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A fractured femur can result in the loss of ______ or more of blood into the soft tissues of the thigh. A. 250 mL B. 500 mL C. 1 L D. 2 L
1 L
An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost. A. 50 mL B. 100 mL C. 150 mL D. 200 mL
100 mL
Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume. A. 5% B. 10% C. 15% D. 20%
20%
What is the approximate blood volume of a 75-kg adult? A. 5.25 L B. 5.50 L C. 6.25 L D. 6.50 L
5.25 L
Which of the following statements regarding the clotting of blood is correct? A. Venous and capillary blood typically does not clot spontaneously. B. Bleeding begins to clot when the end of a damaged vessel dilates. C. Direct contact with the environment prevents blood from clotting. D. A person taking aspirin will experience slower blood clotting.
A person taking aspirin will experience slower blood clotting.
_____ shock is a condition in which low blood volume results in inadequate perfusion or even death. A. Hypovolemic B. Metabolic C. Septic D. Pshycogenic
A. Hypovolemic
Which of the following statements regarding hemophilia is correct? A. Patients with hemophilia may bleed spontaneously B. Hemophiliacs takes aspirin to enhance blood clotting C. Hemophilia is defined as a total lack of platelets D. Approximately 25% of the population has hemophilia
A. Patients with hemophilia may bleed spontaneously
_______ is inadequate tissue perfusion. A. Shock B. Hyperperfusion C. Hypertension D. Contraction
A. Shock
When applying a bandage to hold a dressing in place, stretch the bandage tight enough to control the bleeding but not so tight as to decrease _____ to the extremity. A. blood flow B. pulses C. oxygen D. CRTs
A. blood flow
An organ or tissue may be better able to resist damage from hypoperfusion if the: A. body's temp is considerably less than 98.6F. B. heart rate is maintained at more than 100 beats/min C. body's demand for oxygen is markedly increased D. systolic arterial blood pressure is at least 60 mm Hg
A. body's temp is considerably less than 98.6F
A 39 year old male accidentally cut his wrist while sharpening his hunting knife. He is conscious and alert with adequate breathing, but is bleeding significantly from the wound. You should: A. control the bleeding with direct pressure B. apply oxygen with a nonrebreathing mask C. ensure the patient has a patent airway D. apply a tourniquet proximal to the wound
A. control the bleeding with direct pressure
The ability of a person's cardiovascular system to compensate for blood loss is MOST related to: A. how rapidly he or she bleeds B. the part of the body injured C. his or her baseline blood pressure D. how fast his or her heart beats
A. how rapidly he or she bleeds
The only arteries in the body that carry deoxygenated blood are the: A. pulmonary arteries B. coronary arteries C. femoral arteries D. subclavian arteries
A. pulmonary arteries
If bleeding continues after applying dressing, you should do all of the following EXCEPT: A. remove the dressing and apply another sterile dressing B. apply manual pressure through the dressing C. add more gauze pads over the first dressing D. secure both dressings tighter with a roller bandage
A. remove the dressing and apply another sterile dressing
The severity of bleeding should be based on all of the following findings EXCEPT: A. systolic blood pressure B. poor general appearance C. clinical signs and symptoms D. the mechanism of injury
A. systolic blood pressure
Hypovolemic shock occurs when: A. the body cannot compensate for rapid blood loss B. the patient's systolic blood pressure is less than 100 mm Hg C. the clotting ability of the blood is enhanced D. at least 10% of the patient's blood volume is lost
A. the body cannot compensate for rapid blood loss
In older patients, the first indicator of non traumatic internal bleeding may be: A. weakness or dizziness B. a heart rate over 120 beats/min C. low blood pressure D. diaphoresis and pale skin
A. weakness or dizziness
The body will not tolerate an acute blood loss of greater than _____ of blood volume. A. 10% B. 20% C. 30% D. 40%
B. 20%
____ is the circulation of blood within an organ or tissue in adequate amounts to meet the cell's current needs for oxygen, nutrients and waste removal. A. Anatomy B. Perfusion C. Physiology D. Conduction
B. Perfusion
The ______ link(s) the arterioles and the venules. A. aorta B. capillaries C. vena cava D. valves
B. capillaries
An organ or tissue that is considerably _____ is much better able to resist damage from hypoperfusion. A. warmer B. colder C. younger D. older
B. colder
The function of the blood is to _____ all of the body's cells and tissues. A. remove oxygen from B. deliver nutrients to C. carry waste products to D. all of the above
B. deliver nutrients to
Gastrointestinal bleeding should be suspected if a patient presents with: A. hematuria B. hematemesis C. hemoptysis D. dyspnea
B. hematemesis
A lack of one or more of the blood's clotting factors is called: A. a deficiency B. hemophilia C. platelet anomaly D. anemia
B. hemophilia
If the typical adult loses more than 1 L of blood, significant changes in vital signs, such as _____, will occur. A. decreased heart rate B. increased resp rate C. increased blood pressure D. all of the above
B. increased resp rate
You should consider bleeding to be serious if all of the following conditions are present EXCEPT: A. blood loss is rapid B. there is no mechanism of injury C. the patient has a poor general appearance D. assessment reveals signs and symptoms of shock
B. there is no mechanism of injury
You respond to a 25 year old man who has cut his arm with a circular saw. The bleeding appears to be bright red and spurting. The patient is alert and oriented and converses with you freely. He appears to be stable at this point. What is your first step in controlling his bleeding? A. Direct pressure B. Maintain the airway C. Standard precautions D. Elevation
C. Standard precautions
Blood contains all of the following EXCEPT: A. white blood cells B. plasma C. cerebrospinal fluid D. platelets
C. cerebrospinal fluid
When using an air splint to control bleeding in a fractured extremity, you should reassess the ______ frequently. A. airway B. breathing C. circulation in the injuried extremity D. fracture site
C. circulation in the injuried extremity
Significant blood loss demands your immediate attention as soon as the _____ has been managed. A. fracture B. extrication C. coagulation D. coalition
C. coagulation
The process of blood clotting and plugging the hole is called: A. conglomeration B. configuaration C. coagulation D. coalition
C. coagulation
The term _____ means "constantly adapting to changing conditions." A. perfusion B. conduction C. dynamic D. autonomic
C. dynamic
The _____ only require (s) a minimal blood supply when at rest: A. lungs B. kidneys C. muscles D. heart
C. muscles
Blood leaves each chamber of a normal heart through a(n): A. vein B. artery C. one-way valve D. capillary
C. one-way valve
Hypoperfusion is another name for: A. hypoxemia B. cyanosis C. shock D. cellular death
C. shock
Blood enters the right atrium from the: A. coronary arteries B. lungs C. vena cava D. coronary veins
C. vena cava
The brain and spinal cord usually cannot go for more than ____ minutes without perfusion or the nerve cells will be permanently damaged. A. 30 to 45 B. 12 to 20 C. 8 to 10 D. 4 to 6
D. 4 to 6
At the end of the capillaries, the muscle dilate and constrict in response to conditions such as: A. fright B. a specific need for oxygen C. a need to dispose of metabolic wastes D. all of the above
D. all of the above
Even though the body is very efficient at controlling bleeding on its own, it may fail in situations such as: A. when medications interfere with normal clotting B. when damage to the vessel may be so large that a clot cannot completely block the hole C. when only part of the vessel wall is cut, preventing it from constricting D. all of the above
D. all of the above
The cardiovascular system consists of: A. a pump B. a container C. fluid D. all of the above
D. all of the above
The _____ is the thickest chamber of the heart. A. right atrium B. right ventricle C. left atrium D. left ventricle
D. left ventricle
Which of the following statements regarding hemophilia is correct? A. Hemophilia is defined as a total lack of platelets. B. Patients with hemophilia may bleed spontaneously. C. Hemophiliacs take aspirin to enhance blood clotting. D. Approximately 25% of the population has hemophilia.
Patients with hemophilia may bleed spontaneously.
Following blunt trauma to the abdomen, a 21-year-old female complains of left upper quadrant abdominal pain with referred pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the: A. liver. B. spleen. C. pancreas. D. gallbladder.
Spleen
If direct pressure with a sterile dressing fails to immediately stop severe bleeding from an extremity, you should apply: A. additional sterile dressings. B. a splint and elevate the extremity. C. a tourniquet proximal to the injury. D. digital pressure to a proximal artery.
a tourniquet proximal to the injury.
Blood stasis, changes in the vessel wall, and certain medications affect the: a) systolic blood pressure exclusively. b) white blood cell's ability to fight infection. c) ability of red blood cells to carry oxygen. d) ability of the blood to effectively clot.
ability of the blood to effectively clot.
Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding? A. air splint B. vacuum splint C. sling and swathe D. cardboard splint
air splint
Most cases of external bleeding from an extremity can be controlled by: A. elevating the injured extremity. B. packing the wound with gauze. C. compressing a pressure point. D. applying local direct pressure.
applying local direct pressure
The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the: a) venules. b) arterioles. c) vena cavae. d) capillary arteries.
arterioles.
A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should: A. obtain baseline vital signs. B. apply a nonrebreathing mask. C. perform a secondary assessment. D. assist the patient's ventilations.
assist the patient's ventilations.
An organ or tissue may be better able to resist damage from hypoperfusion if the: A. body's demand for oxygen is markedly increased. B. body's temperature is considerably less than 98.6°F (37.0°C). C. systolic arterial blood pressure is at least 60 mm Hg. D. heart rate is maintained at more than 100 beats/min.
body's temperature is considerably less than 98.6°F (37.0°C).
Perfusion is MOST accurately defined as the: A. effective transfer of oxygen from the venules across the systemic capillary membrane walls. B. ability of the systemic arteries to constrict as needed to maintain an adequate blood pressure. C. effective removal of carbon dioxide and other metabolic waste products from the body's cells. D. circulation of blood within an organ in adequate amounts to meet the body's metabolic needs.
circulation of blood within an organ in adequate amounts to meet the body's metabolic needs.
In nontrauma patients, an early indicator of internal bleeding is: a) dizziness upon standing. b) a rapid, thready pulse. c) a decreasing blood pressure. d) rapid, shallow breathing.
dizziness upon standing.
In which of the following situations would external bleeding be the MOST difficult to control? A. femoral artery laceration and a blood pressure of 140/90 mm Hg B. jugular vein laceration and a systolic blood pressure of 90 mm Hg C. carotid artery laceration and a systolic blood pressure of 60 mm Hg D. antecubital vein laceration and a blood pressure of 138/92 mm Hg
femoral artery laceration and a blood pressure of 140/90 mm Hg
As red blood cells begin to clump together to form a clot, __________ reinforces the clumped red blood cells. A. fibrin B. plasma C. fibrinogen D. plasminogen
fibrinogen
A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should: A. apply direct pressure to the wound. B. place the patient on 100% oxygen. C. follow appropriate standard precautions. D. perform a rapid head-to-toe assessment.
follow appropriate standard precautions.
A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing: a) acute appendicitis. b) intrathoracic hemorrhaging. c) an aortic aneurysm. d) gastrointestinal bleeding.
gastrointestinal bleeding.
When using a stick and square knot as a tourniquet to control severe bleeding from an amputated arm, the EMT should: A. cover the tourniquet with a sterile dressing. B. stop twisting the stick when the bleeding stops. C. twist the stick until the radial pulse disappears. D. remove the tourniquet if the bleeding has stopped.
hematemesis.
Bleeding from the nose following head trauma: A. is a sign of a skull fracture and should not be stopped. B. should be controlled by packing the nostril with gauze. C. should be assumed to be caused by a fractured septum. D. is usually due to hypertension caused by the head injury.
is a sign of a skull fracture and should not be stopped.
Early signs and symptoms of intra-abdominal bleeding include: A. bruising only. B. pain and distention. C. widespread ecchymosis. D. significant hypotension.
pain and distention.
A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. Appropriate treatment for this patient includes: A. having the patient pinch his own nostrils and then lie supine. B. pinching the patient's nostrils and having him lean forward. C. placing a rolled 4″ × 4″ dressing between his lower lip and gum. D. packing both nostrils with gauze pads until the bleeding stops.
pinching the patient's nostrils and having him lean forward.
A 22-year-old male was kicked in the abdomen multiple times during an attack by a gang. He is conscious but restless and his pulse is rapid. Your assessment reveals a large area of bruising to the right upper quadrant of his abdomen. The MOST appropriate treatment for this patient includes: A. preparing for immediate transport. B. applying oxygen via nasal cannula. C. performing a focused physical exam. D. a detailed assessment of his abdomen.
preparing for immediate transport.
During transport of a 40-year-old female with acute abdominal pain, you note that she has stopped talking to you and has become extremely diaphoretic. You should: a) assess the quality of her pulse. b) repeat the primary assessment. c) perform a secondary assessment. d) begin assisting her ventilations.
repeat the primary assessment.
The systemic veins function by: A. returning deoxygenated blood back to the heart. B. delivering oxygen-poor blood to the capillaries. C. returning oxygen-rich blood back to the left atrium. D. delivering deoxygenated blood to the capillaries.
returning deoxygenated blood back to the heart.
Which of the following organs can tolerate inadequate perfusion for up to 2 hours? A. brain B. heart C. kidneys D. skeletal muscle
skeletal muscle
The severity of bleeding should be based on all of the following findings, EXCEPT: A. systolic blood pressure. B. poor general appearance. C. the mechanism of injury. D. clinical signs and symptoms.
systolic blood pressure.
Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body? A. an effectively pumping heart B. an intact system of blood vessels C. adequate blood in the vasculature D. the filtering of blood cells in the spleen
the filtering of blood cells in the spleen
You arrive at the home of a 50-year-old female with severe epistaxis. As you are treating her, it is MOST important to recall that: A. the patient may be significantly hypertensive. B. the patient is at risk for vomiting and aspiration. C. a detailed exam is needed to determine the cause. D. many medications interfere with blood clotting.
the patient is at risk for vomiting and aspiration
Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that: A. you should try to control the bleeding by applying pressure to a proximal arterial pressure point first. B. the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released. C. bulky dressings should be securely applied over the tourniquet to further assist in controlling the bleeding. D. the tourniquet should be applied directly over a joint if possible because this provides better bleeding control.
the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released.
In older patients, the first indicator of nontraumatic internal bleeding may be: a) a low blood pressure. b) weakness or dizziness. c) a heart rate over 120 beats/min. d) diaphoresis and pale skin.
weakness or dizziness.
