Chapter 23 bleeding
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: Select one: A. control the bleeding with direct pressure. B. ensure the patient has a patent airway. C. apply a tourniquet proximal to the wound. D. apply oxygen with a nonrebreathing mask.
A
A fractured femur can result in the loss of ______ or more of blood into the soft tissues of the thigh. Select one: A. 1 L B. 250 mL C. 500 mL D. 2 L
A
After applying a pressure dressing to a laceration on a patient's arm, you notice that blood is slowly beginning to saturate it. You should: Select one: A. place additional dressings over the wound. B. replace the dressing with another dressing. C. splint the arm and keep it below heart level. D. apply a tourniquet proximal to the wound.
A
Bleeding from the nose following head trauma: Select one: A. is a sign of a skull fracture and should not be stopped. B. should be assumed to be caused by a fractured septum. C. is usually due to hypertension caused by the head injury. D. should be controlled by packing the nostril with gauz
A
Early signs and symptoms of intra-abdominal bleeding include: Select one: A. pain and distention. B. significant hypotension. C. widespread ecchymosis. D. bruising only.
A
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: Select one: A. spleen. B. pancreas. C. liver. D. gallbladder.
A
Hypoperfusion is another name for: Select one: A. shock. B. cyanosis. C. hypoxemia. D. cellular death.
A
In nontrauma patients, an early indicator of internal bleeding is: Select one: A. dizziness upon standing. B. a rapid, thready pulse. C. rapid, shallow breathing. D. a decreasing blood pressure.
A
In older patients, the first indicator of nontraumatic internal bleeding may be: Select one: A. weakness or dizziness. B. a heart rate over 120 beats/min. C. diaphoresis and pale skin. D. a low blood pressure.
A
In which of the following situations would external bleeding be the MOST difficult to control? Select one: A. femoral artery laceration and a blood pressure of 140/90 mm Hg B. antecubital vein laceration and a blood pressure of 138/92 mm Hg C. carotid artery laceration and a systolic blood pressure of 60 mm Hg D. jugular vein laceration and a systolic blood pressure of 90 mm Hg
A
Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume. Select one: A. 20% B. 10% C. 5% D. 15%
A
When using a stick and square knot as a tourniquet to control severe bleeding from an amputated arm, the EMT should: Select one: A. stop twisting the stick when the bleeding stops. B. cover the tourniquet with a sterile dressing. C. remove the tourniquet if the bleeding has stopped. D. twist the stick until the radial pulse disappears.
A
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? Select one: A. air splint B. vacuum splint C. cardboard splint D. sling and swathe
A
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: Select one: A. acute appendicitis. B. gastrointestinal bleeding. C. intrathoracic hemorrhaging. D. an aortic aneurysm.
B
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: Select one: A. apply a nonrebreathing mask. B. assist the patient's ventilations. C. obtain baseline vital signs. D. perform a secondary assessment.
B
If direct pressure with a sterile dressing fails to immediately stop severe bleeding from an extremity, you should apply: Select one: A. a splint and elevate the extremity. B. a tourniquet proximal to the injury. C. additional sterile dressings. D. digital pressure to a proximal artery.
B
The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the: Select one: A. vena cavae. B. arterioles. C. venules. D. capillary arteries.
B
The systemic veins function by: Select one: A. returning oxygen-rich blood back to the left atrium. B. returning deoxygenated blood back to the heart. C. delivering deoxygenated blood to the capillaries. D. delivering oxygen-poor blood to the capillaries.
B
What is the approximate blood volume of a 75-kg adult? Select one: A. 5.50 L B. 5.25 L C. 6.25 L D. 6.50 L
B
Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that: Select one: 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.
B
Which of the following organs can tolerate inadequate perfusion for up to 2 hours? Select one: A. brain B. skeletal muscle C. kidneys D. heart
B
Which of the following statements regarding the clotting of blood is correct? Select one: A. Venous and capillary blood typically does not clot spontaneously. B. A person taking aspirin will experience slower blood clotting. C. Bleeding begins to clot when the end of a damaged vessel dilates. D. Direct contact with the environment prevents blood from clotting.
B
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: Select one: 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.
B
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: Select one: A. placing a rolled 4″ × 4″ dressing between his lower lip and gum. B. having the patient pinch his own nostrils and then lie supine. C. pinching the patient's nostrils and having him lean forward. D. packing both nostrils with gauze pads until the bleeding stops.
C
An organ or tissue may be better able to resist damage from hypoperfusion if the: Select one: A. systolic arterial blood pressure is at least 60 mm Hg. B. heart rate is maintained at more than 100 beats/min. C. body's temperature is considerably less than 98.6°F (37.0°C). D. body's demand for oxygen is markedly increased.
C
Gastrointestinal bleeding should be suspected if a patient presents with: Select one: A. hematuria. B. hemoptysis. C. hematemesis. D. dyspnea.
C
Most cases of external bleeding from an extremity can be controlled by: Select one: A. packing the wound with gauze. B. compressing a pressure point. C. applying local direct pressure. D. elevating the injured extremity.
C
Perfusion is MOST accurately defined as the: Select one: A. effective removal of carbon dioxide and other metabolic waste products from the body's cells. B. effective transfer of oxygen from the venules across the systemic capillary membrane walls. C. circulation of blood within an organ in adequate amounts to meet the body's metabolic needs. D. ability of the systemic arteries to constrict as needed to maintain an adequate blood pressure.
C
Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body? Select one: A. an effectively pumping heart B. an intact system of blood vessels C. the filtering of blood cells in the spleen D. adequate blood in the vasculature
C
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: Select one: A. applying oxygen via nasal cannula. B. a detailed assessment of his abdomen. C. performing a focused physical exam. D. preparing for immediate transport.
D
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: Select one: A. perform a rapid head-to-toe assessment. B. place the patient on 100% oxygen. C. apply direct pressure to the wound. D. follow appropriate standard precautions.
D
An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost. Select one: A. 200 mL B. 50 mL C. 150 mL D. 100 mL
D
As red blood cells begin to clump together to form a clot, __________ reinforces the clumped red blood cells. Select one: A. plasma B. fibrin C. plasminogen D. fibrinogen
D
Blood stasis, changes in the vessel wall, and certain medications affect the: Select one: A. white blood cell's ability to fight infection. B. ability of red blood cells to carry oxygen. C. systolic blood pressure exclusively. D. ability of the blood to effectively clot
D
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: Select one: A. begin assisting her ventilations. B. assess the quality of her pulse. C. perform a secondary assessment. D. repeat the primary assessment.
D
External bleeding from a vein is relatively easy to control because: Select one: A. blood typically oozes from a vein. B. veins hold smaller blood volume. C. veins carry deoxygenated blood. D. veins are under a lower pressure.
D
Hypovolemic shock occurs when: Select one: A. the patient's systolic blood pressure is less than 100 mm Hg. B. the clotting ability of the blood is enhanced. C. at least 10% of the patient's blood volume is lost. D. the body cannot compensate for rapid blood loss.
D
The ability of a person's cardiovascular system to compensate for blood loss is MOST related to: Select one: A. the part of the body injured. B. how fast his or her heart beats. C. his or her baseline blood pressure. D. how rapidly he or she bleeds.
D
The severity of bleeding should be based on all of the following findings, EXCEPT: Select one: A. the mechanism of injury. B. clinical signs and symptoms. C. poor general appearance. D. systolic blood pressure.
D
Which of the following statements regarding hemophilia is correct? Select one: A. Hemophilia is defined as a total lack of platelets. B. Hemophiliacs take aspirin to enhance blood clotting. C. Approximately 25% of the population has hemophilia. D. Patients with hemophilia may bleed spontaneously.
D