Chapter 27 Chest Injuries

A flail chest occurs when: A. a segment of the chest wall is detached from the thoracic cage. B. more than three ribs are fractured on the same side of the chest. C. multiple ribs are fractured on both sides of the thoracic cage. D. a segment of fractured ribs bulges during the inhalation phase.

The correct answer is: a segment of the chest wall is detached from the thoracic cage.

Pneumothorax is defined as: A. blood collection within the pleural space. B. accumulation of air in the pleural space. C. accumulation of air between the lungs. D. blood collection within the lung tissue.

The correct answer is: accumulation of air in the pleural space.

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should: A. circumferentially tape a dressing around his chest. B. immediately perform a rapid head-to-toe exam. C. recognize that he needs a needle decompression. D. administer oxygen and transport to the hospital.

The correct answer is: administer oxygen and transport to the hospital.

An open pneumothorax occurs when: A. air enters the pleural space from a perforated lung. B. extreme pleural pressure causes the lung to rupture. C. air enters the pleural space from outside the body. D. a fractured rib perforates the tissue of the lung.

The correct answer is: air enters the pleural space from outside the body.

Subcutaneous emphysema is an indication that: A. at least half of one lung has completely collapsed. B. blood is slowly accumulating within the tissue of the lung. C. your patient is experiencing a pericardial tamponade. D. air is escaping into the chest wall from a damaged lung.

The correct answer is: air is escaping into the chest wall from a damaged lung.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT: A. bulging intercostal muscles. B. profound cyanosis. C. collapsed jugular veins. D. unilaterally absent breath sounds.

The correct answer is: collapsed jugular veins.

You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient's deterioration? A. compression of the aorta and vena cava B. hidden bleeding in the thoracic cavity C. a total collapse of the affected lung D. blood accumulation in the pleural space

The correct answer is: compression of the aorta and vena cava

Hemoptysis is defined as: A. blood in the pleural space. B. coughing up blood. C. abnormal blood clotting. D. vomiting blood.

The correct answer is: coughing up blood.

The thoracic cavity is separated from the abdominal cavity by the: A. diaphragm. B. anterior rib cage. C. intercostal margin. D. costovertebral angle.

The correct answer is: diaphragm.

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? A. a rapid, irregular pulse B. engorged jugular veins C. widening pulse pressure D. diminished breath sounds

The correct answer is: engorged jugular veins

A spontaneous pneumothorax would MOST likely occur as the result of: A. exertion of a person with a congenital lung defect. B. abnormally slow breathing in a patient with pleurisy. C. blunt or penetrating trauma to the anterior chest wall. D. excessive coughing in a patient with pneumonitis.

The correct answer is: exertion of a person with a congenital lung defect.

Common signs and symptoms of a chest injury include all of the following, EXCEPT: A. localized pain. B. tachypnea. C. hematemesis. D. chest wall ecchymosis.

The correct answer is: hematemesis.

You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should: A. immediately request ALS support. B. obtain a set of baseline vital signs. C. perform a focused secondary exam. D. insert an oropharyngeal airway.

The correct answer is: immediately request ALS support.

The MOST critical treatment for a tension pneumothorax involves: A. inserting a needle through the rib cage into the pleural space. B. assisting the patient's breathing with increased tidal volume. C. surgically removing the portion of the lung that is damaged. D. placing a bulky dressing over the affected side of the chest.

The correct answer is: inserting a needle through the rib cage into the pleural space.

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unconscious, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a: A. tension pneumothorax. B. laceration of the aorta. C. massive hemothorax. D. pericardial tamponade.

The correct answer is: laceration of the aorta.

Which of the following organs or structures does NOT reside within the mediastinum? A. lungs B. trachea C. esophagus D. vena cavae

The correct answer is: lungs

When a person is lying supine at the end of exhalation, the diaphragm: A. may rise as high as the nipple line. B. contracts and flattens inferiorly. C. is less prone to penetrating trauma. D. descends below the level of the navel.

The correct answer is: may rise as high as the nipple line.

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged: A. minute volume will decrease. B. excess carbon dioxide will be eliminated. C. minute volume will remain unchanged. D. minute volume will increase.

The correct answer is: minute volume will decrease.

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: A. will eliminate more carbon dioxide than if he or she were breathing deeply. B. often breathes at a slower rate because of lung damage caused by the injury. C. will maintain adequate minute volume if his or her respiratory rate stays the same. D. must increase his or her respiratory rate to maintain adequate minute volume.

The correct answer is: must increase his or her respiratory rate to maintain adequate minute volume.

A spinal cord injury at the level of C7 would MOST likely result in: A. paralysis of all the respiratory muscles. B. immediate cardiac arrest. C. paralysis of the diaphragm. D. paralysis of the intercostal muscles.

The correct answer is: paralysis of the intercostal muscles.

The ________ nerves control the diaphragm. A. costal B. phrenic C. intercostal D. vagus

The correct answer is: phrenic

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called: A. pleurisy. B. dyspnea. C. pneumonitis. D. pneumothorax.

The correct answer is: pleurisy.

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a: A. cardiac tamponade. B. flail chest. C. pneumothorax. D. myocardial contusion.

The correct answer is: pneumothorax.

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to applying 100% oxygen, you should: A. prepare for immediate transport. B. apply an automated external defibrillator (AED) and take his blood pressure. C. determine if he has cardiac problems. D. apply bulky dressings to the sternum.

The correct answer is: prepare for immediate transport.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should: A. perform a rapid head-to-toe physical assessment. B. provide some form of positive-pressure ventilation. C. apply 100% oxygen and immediately transport. D. place her supine and elevate her lower extremities.

The correct answer is: provide some form of positive-pressure ventilation.

A patient who presents with profound cyanosis following a chest injury: A. requires prompt ventilation and oxygenation. B. has most likely experienced a ruptured aorta. C. should be placed in Trendelenburg's position. D. is most likely experiencing severe blood loss.

The correct answer is: requires prompt ventilation and oxygenation.

Elevation of the rib cage during inhalation occurs when: A. the intercostal muscles contract. B. the diaphragm descends. C. abdominal contents descend. D. intrathoracic pressure decreases.

The correct answer is: the intercostal muscles contract.

Very young children tend to breathe predominantly with their diaphragm because: A. they require less tidal volume per breath. B. their intercostal muscles are not fully developed. C. their chest wall and ribs are very pliable. D. there is no nerve innervation of the intercostal muscles.

The correct answer is: their intercostal muscles are not fully developed.

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred? A. ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle B. fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia C. asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta D. collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest

The correct answer is: ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

Pleural fluid is contained between the: A. visceral and parietal pleurae. B. parietal pleura and the chest wall. C. parietal pleura and the heart. D. visceral pleura and the lung.

The correct answer is: visceral and parietal pleurae.