Chapter 28

73.In supine patients with a head injury, the head should be elevated _____ to help reduce intracranial pressure.

30 degrees

95.You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate?

A fixed, dilated pupil indicates increased ICP.

89.Which of the following acts as a shock absorber for the CNS?

Cerebrospinal fluid (CSF)

94.The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what?

Lucid interval

48.The body's functions that occur without conscious effort are regulated by the _________ nervous system. sensory somatic autonomic voluntary

autonomic

96.Battle sign is an indication of which of the following?

skull fracture

78.Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of 12. 13. 14. 15.

14

8.A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response? A. 4B. 5C. 2D. 3

3

120.Which of the following interventions may be used to help reduce intracranial pressure?

30-degree elevation of the head

62.The cervical spine is composed of _____ vertebrae.

7

53.Which of the following statements regarding cervical collars is MOST correct? Once a cervical collar is applied, you can cease manual head stabilization. A cervical collar is used in addition to, not instead of, manual immobilization. Cervical collars are contraindicated in patients with numbness to the extremities. The patient's head should be forced into a neutral position to apply a cervical collar.

A cervical collar is used in addition to, not instead of, manual immobilization.

85.When assessing a patient with a suspected head or spine injury, which of the following should you do?

Administer high flow oxygen and assess the patient in the position found.

100.Which of the following sets of vital signs MOST accurately depicts Cushing's triad?

BP, 190/110; pulse, 55; respirations, 30

87.Which of the following are signs of Cushing triad?

Bradycardia, hypertension, irregular respirations

97.You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. Which of the following should you suspect?

Cushing triad

56.Which of the following statements regarding the cranium is MOST correct? A.Once a cervical collar is applied, you can cease manual head stabilization.B.A cervical collar is used in addition to, not instead of, manual immobilization.C.Cervical collars are contraindicated in patients with numbness to the extremities.D.The patient's head should be forced into a neutral position to apply a cervical collar.

Eighty percent of the cranium is occupied by brain tissue.

92.While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient's left ear. This indicates that the patient could have which of the following?

Epidural hematoma

93.When securing a patient to a backboard, what area of the body should you secure last?

Head

12.Which of the following statements regarding secondary brain injury is correct? A. It results from direct brain trauma following an impact to the head.B. Hypoxia and hypotension are the two most common causes of secondary brain injury.C. Signs are often present immediately after an impact to the head.D. Because cerebral edema develops quickly, it is considered to be a primary brain injury.

Hypoxia and hypotension are the two most common causes of secondary brain injury.

86.Signs of Cushing triad include

Increased blood pressure (hypertension), Decreased heart rate (bradycardia), Irregular respirations such as Cheyenne-Stokes respiration and Biot respiration

19.Which of the following breathing patterns is MOST indicative of increased intracranial pressure? A. Irregular rate, pattern, and volume of breathing with intermittent periods of apnea B. Increased rate and depth with the distinct odor of acetone on the patient's breath C. Slow, shallow, occasional gasps that progress to prolonged periods of apnea D. Increased rate with a normal inspiratory time and a prolonged expiratory time

Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

75.Which of the following is NOT a symptom of a concussion?

Muscle tremors

105.Which of the following statements regarding helmet removal is MOST correct?

Padding should be placed under the occiput as the helmet is removed.

10.What part of the nervous system controls the body's voluntary activities? A. CentralB. SensoryC. AutonomicD. Somatic

Somatic

72.Neck rigidity, bloody cerebrospinal fluid, and headache are associated with what kind of bleeding in the brain?

Subarachnoid hemorrhage

43.Which of the following statements regarding a basilar skull fracture is correct? A. Bloody CSF commonly leaks from the nose .B. In most cases, mastoid bruising occurs. C. The absence of raccoon eyes or Battle's sign does not rule it out .D. They are typically the result of local, low-energy trauma to the head.

The absence of raccoon eyes or Battle's sign does not rule it out.

83.The brain is divided into three major areas

The cerebrum; The cerebellum;The brainstem

88.four-person log roll

The recommended procedure for moving a patient with a suspected spinal injury from the ground to a long backboard or other spinal immobilization device.

66.Which of the following statements regarding motor nerves is correct? a) They perform special functions such as sight, smell, and hearing. b) They are part of the CNS and control reflexes. c) They transmit information from the body to the brain via the spinal cord. d) They carry information from the CNS to the muscles.

They carry information from the CNS to the muscles.

39.The MOST reliable sign of a head injury is A.a pulse that is rapid and thready. B.a decreased level of consciousness. C.an abnormally low blood pressure .D.decreased sensation in the extremities.

a decreased level of consciousness.

17.An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is A. acute unilateral paralysis following the injury. B. a rapid deterioration of neurologic signs. C. an acute increase in the patient's pulse rate. D. a progressively lowering blood pressure.

a rapid deterioration of neurologic signs.

18.Common signs and symptoms of a serious head injury include all of the following, EXCEPT A. decerebrate posturing. B. widening pulse pressure. C. a rapid, thready pulse. D. CSF leakage from the ears.

a rapid, thready pulse.

99.A reflex arc occurs when

a sensory nerve detects an irritating stimulus and bypasses the brain by sending a direct message to the motor nerve.

54.The meninges, along with the cerebrospinal fluid (CSF) that circulates in between each meningeal layer, function by A. regenerating brain cells after they have been damaged.B. acting as a shock absorber for the brain and spinal cord.C. delivering oxygen directly to the CNS.D. producing leukocytes that protect the brain from infection.

acting as a shock absorber for the brain and spinal cord.

59.When immobilizing a seated patient with a short backboard or vest-style immobilization device, you should apply a cervical collar A. after the torso has been adequately secured. B. after moving the patient to a long backboard. C. after assessing distal neurovascular functions. D. before manually stabilizing the patient's head.

after assessing distal neurovascular functions.

68.Any unresponsive trauma patient should be assumed to have a) an accompanying spinal injury. b) a history of diabetes mellitus. c) a severe intracranial hemorrhage. d) internal bleeding in the abdomen.

an accompanying spinal injury.

21.A short backboard or vest-style immobilization device is indicated for patients who A.are found supine and have stable vital signs .B.are in a sitting position and are clinically stable .C.require prompt extrication from an automobile. D.are sitting in their car and are clinically unstable.

are in a sitting position and are clinically stable.

41.After your partner assumes manual in-line stabilization of the patient's head, you should A.apply an appropriately sized rigid cervical collar .B.assess distal neurovascular status in the extremities. C.thoroughly palpate the patient's head for deformities .D.use four people to log roll the patient onto a backboard.

assess distal neurovascular status in the extremities.

42.A female patient with a suspected spinal injury is breathing with a marked reduction in tidal volume. The MOST appropriate airway management for her includes A.hyperventilating her at 30 breaths/min. B.administering oxygen via a nonrebreathing mask. C.ventilation assistance to maintain an oxygen saturation of 90%. D.assisting ventilations at an age-appropriate rate.

assisting ventilations at an age-appropriate rate.

64.When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should elevate the patient's head and apply an ice pack. apply manual pressure and avoid applying a bandage. avoid excessive pressure when applying the bandage. apply firm compression for no longer than 5 minutes.

avoid excessive pressure when applying the bandage.

5.A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of A. hyperflexion.B. hyperextension.C. distraction.D. axial loading.

axial loading.

81.You are assessing a man who has a head injury and note that cerebrospinal fluid is leaking from his ear. You should recognize that this patient is at risk for bacterial meningitis .hypovolemic shock. sudden hypotension .permanent hearing loss.

bacterial meningitis.

84.In a(n) ________, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph.

basilar skull fracture

45.An epidural hematoma is MOST accurately defined as A. bleeding between the skull and dura mater. B. bleeding between the dura mater and brain. C. venous lacerations that occur within the brain. D. an injury caused by a damaged cerebral artery.

bleeding between the skull and dura mater.

24.Which of the following sets of vital signs depicts Cushing's triad? A.blood pressure, 190/110 mm Hg pulse, 55 beats/min respirations, 30 breaths/min B.blood pressure, 90/50 mm Hg pulse, 120 beats/minrespirations, 10 breaths/min C.blood pressure, 200/100 mm Hg pulse, 140 beats/min pulse, 140 beats/min respirations, 28 breaths/min D.blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min

blood pressure, 80/40 mm Hg pulse, pulse 30 beats/min respirations, 32 breaths/min

9.The central nervous system (CNS) is composed of the A. meninges and spinal cord.B. brain and spinal cord.C. cerebellum and brain.D. cerebrum and meninges.

brain and spinal cord.

31.The _________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. A.brain stem B.cerebellum C.spinal cord D.cerebral cortex

brain stem

113.A football player experienced a possible spinal injury when he was tackled. He is conscious and alert, but tells you that he is having trouble breathing. His respirations are 28 breaths/min and labored. He is still wearing his helmet. You should

carefully remove the helmet, immobilize his spine, and administer oxygen.

44.Coordination of balance and body movement is controlled by the medulla. cerebrum .cerebellum .brain stem.

cerebellum.

108.You arrive at the scene shortly after a 50-year-old male fell and struck his head on an end table. The patient is conscious and alert, complains of a mild headache, and can recall the events before and after the fall. This patient's presentation is MOST consistent with a/an

cerebral concussion.

38.A temporary loss or alteration of part or all of the brain's abilities to function without physical damage to the brain MOST accurately describes a(n) A.cerebral contusion. B.cerebral concussion .C.intracranial hemorrhage .D.intracerebral hematoma.

cerebral concussion.

67.The MOST common and serious complication of a significant head injury is a) a hypoxic seizure. b) cerebral edema. c) a skull fracture. d) acute hypotension.

cerebral edema.

52.The _________ contain(s) about 75% of the brain's total volume. A. cerebrumB. cerebellumC. brain stemD. meninges

cerebrum

98.The major mass of the brain is called the

cerebrum.

74.Injury to the head and neck may indicate injury to the

cervical spine.

6.The five sections of the spinal column, in descending order, are the A. thoracic, cervical, lumbar, coccygeal, and sacral.B. coccygeal, sacral, lumbar, thoracic, and cervical.C. cervical, coccygeal, thoracic, sacral, and lumbar.D. cervical, thoracic, lumbar, sacral, and coccygeal.

cervical, thoracic, lumbar, sacral, and coccygeal.

63.Rapid deceleration of the head, such as when it impacts the windshield, causes a) primary impact to the posterior aspect of the brain, resulting in compression injuries, bruising, or torn blood vessels. b) stretching or tearing of the anterior aspect of the brain and compression injuries or bruising to the posterior aspect of the brain. c) compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain. d) compression injuries and contusions to the anterior, posterior, and lateral aspects of the brain.

compression injuries or bruising to the anterior portion of the brain and stretching or tearing to the posterior portion of the brain.

114.What nerves allow sensory and motor impulses to be sent from one nerve directly to another?

connecting

27.Which of the following nerves allow sensory and motor impulses to be sent from one nerve directly to another? A.somatic B.connecting C.peripheral D.autonomic

connecting

35.When assessing a conscious patient with an MOI that suggests spinal injury, you should determine if the strength in all extremities is equal. rule out a spinal injury if the patient denies neck pain. defer spinal immobilization if the patient is ambulatory. ask the patient to move his or her head to assess for pain.

determine if the strength in all extremities is equal.

33.The tough, fibrous outer meningeal layer is called the A. pia materB. arachnoid spaceC. gray materD. dura mater

dura mater.

47.When immobilizing a patient on a long backboard, you should A. have the patient exhale before fastening the torso straps.B. secure the torso and then center the patient on the board.C. follow the commands of the person at the patient's torso.D. ensure that you secure the torso before securing the head.

ensure that you secure the torso before securing the head.

60.Which of the following head injuries would cause the patient's condition to deteriorate MOST rapidly? A. cerebral contusionB. subdural hematomaC. cerebral concussionD. epidural hematoma

epidural hematoma

50.The hormone responsible for the actions of the sympathetic nervous system is A.insulin.B.thyroxine.C.epinephrine.D.aldosterone.

epinephrine.

79.The MOST important immediate treatment for patients with a head injury, regardless of severity, is to immobilize the entire spine .administer high-flow oxygen. establish an adequate airway. transport to a trauma center.

establish an adequate airway.

7.The Glasgow Coma Scale (GCS) is used to assess A. eye opening, verbal response, and motor response.B. sensory response, pupil reaction, and heart rate.C. mental status, eye opening, and respiratory rate.D. verbal response, eye opening, and mental status.

eye opening, verbal response, and motor response.

102.It would be MOST appropriate to perform a focused physical exam on a patient who

fainted and fell to the ground from a standing position.

51.It would be MOST appropriate to perform a focused secondary assessment on a patient who A.fainted and fell to the ground from a standing position.B.was restrained during a high-speed motor vehicle crash.C.has blood draining from the ears following a head injury.D.struck his or her head and is experiencing nausea or vomiting.

fainted and fell to the ground from a standing position.

4.Hyperextension injuries of the spine are MOST commonly the result of A. hangings.B. compression.C. diving.D. falls.

hangings.

49.Distraction injuries of the spine are MOST commonly the result of A.falls.B.diving.C.hangings.D.compression.

hangings.

61.When placing a patient onto a long backboard, the EMT at the patient's _________ is in charge of all patient movements. head chest waist lower extremities

head

116.Airbags, in conjunction with properly worn seatbelts, are of MOST benefit when a person is involved in a

head-on crash

30.The effectiveness of positive-pressure ventilations when treating a head-injured patient can ONLY be determined by A.immediate reassessment following the intervention. B.a neurosurgeon or emergency department physician. C.reassessing the patient's blood pressure after at least 10 minutes .D.noting a decrease in the heart rate during ventilations.

immediate reassessment following the intervention.

57.A 45-year-old male was working on his roof when he fell approximately 12',landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should A.obtain a Glasgow Coma Score value and give him oxygen. B.immobilize his spine and perform a focused secondary exam. C.allow him to refuse transport if his vital signs remain stable. D.perform a rapid head-to-toe exam and immobilize his spine.

immobilize his spine and perform a focused secondary exam.

110.You respond to a motor-vehicle crash involving a small car versus a tree. When you arrive, you find the patient, a 39-year-old male, still seated in his vehicle. He is conscious and alert and is complaining of neck pain. He does not have any immediately life-threatening injuries. You should

immobilize his spine with a short backboard and remove him from the car.

71.You respond to a 38-year-old man who fell while rock climbing. He is unconscious with an open airway. The respiration and pulse rates are within normal limits. His distal pulses are intact. You check his pupils and find that they are unequal. You know this could be a sign of

increased intracranial pressure.

32.During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, shallow breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should perform a focused secondary assessment of the patient's head and neck. instruct him to assist her ventilations while you perform a rapid assessment. apply 100% oxygen via a nonrebreathing mask and obtain baseline vital signs. immediately place her on a long backboard and prepare for rapid transport.

instruct him to assist her ventilations while you perform a rapid assessment.

58.Bleeding within the brain parenchyma (tissue) is MOST appropriately called a/an A.epidural hematoma. B.intracerebral hematoma. C.subdural hematoma. D.intracranial hematoma.

intracerebral hematoma.

76.Cushing triad in a patient is a sign of which of the following?

intracranial pressure.

3.In contrast to a cerebral concussion, a cerebral contusion A. involves physical injury to the brain tissue.B. does not cause pressure within the skull.C. results from a laceration to the brain tissue.D. usually does not cause a loss of consciousness.

involves physical injury to the brain tissue.

26.Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless A.the patient adamantly denies neck pain. B.lateral immobilization has been applied. C.it causes a problem managing the ABCs. D.sensory and motor functions remain intact.

it causes a problem managing the ABCs.

16.Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless A. the patient adamantly denies neck pain. B. it causes a problem managing the airway. C. sensory and motor functions remain intact. D. lateral immobilization has been applied.

it causes a problem managing the airway.

20.A tight-fitting motorcycle helmet should be left in place unless A. it interferes with your assessment of the airway. B. the helmet is equipped with a full face shield or visor. C. the patient must be placed onto a long backboard. D. the patient complains of severe neck or back pain.

it interferes with your assessment of the airway.

82.When opening the airway of a patient with a suspected spinal injury, you should use the tongue-jaw lift maneuver .head tilt-neck lift maneuver .head tilt-chin lift maneuver. jaw-thrust maneuver.

jaw-thrust maneuver.

119.You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if

law enforcement is at the scene

80.A high school football player was injured during a tackle and complains of neck and upper back pain. He is conscious and alert and is breathing without difficulty. The EMT should remove his helmet and shoulder pads .leave his helmet and shoulder pads in place.remove his helmet, but leave his shoulder pads in place. leave his helmet in place, but remove his shoulder pads.

leave his helmet and shoulder pads in place.

77.When caring for a patient with a possible head injury, it is MOST important to monitor the patient's pupil size .blood pressure. pulse regularity. level of consciousness.

level of consciousness.

23.Which of the following skull fractures would be the LEAST likely to present with palpable deformity or other outward signs? Linear Basilar Open Depressed

linear

90.Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs?

linear skull fractures

103.The MOST important treatment for patients with a head injury, regardless of severity, is to

maintain airway patency.

106.After removing a motorcycle helmet, you should

maintain manual stabilization of the head and apply a cervical collar.

107.A 30-year-old male experienced closed head trauma when he crashed his motorcycle; he was not wearing a helmet. As you approach the patient, you can hear snoring respirations and can see blood draining from his mouth. You should

manually stabilize his head and perform a jaw-thrust maneuver.

101.Assessing an unconscious trauma patient's airway begins by

manually stabilizing his or her head.

34.Lacerations to the scalp bleed minimally because the scalp has few vessels. uncommonly cause hypovolemic shock in children. may be an indicator of deeper, more serious injuries. are most commonly associated with skull fractures.

may be an indicator of deeper, more serious injuries.

46.When a patient experiences a severe spinal injury, he or she A.will likely be paralyzed from the neck down.B.may lose sensation below the level of the injury.C.most commonly has a palpable spinal deformity.D.often loses motor function on one side of the body.

may lose sensation below the level of the injury.

115.The mesentary is/are

membranous folds that attach the intestines to the walls of the body

36.The _________ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. central somatic autonomic peripheral

peripheral

70.The nervous system is divided into the central nervous system and the

peripheral nervous system.

117.When a hollow organ is punctured during a penetrating injury to the abdomen

peritonitis may not develop for several hours

37.When immobilizing a child on a long backboard, you should secure the head prior to securing the torso and legs. defer cervical collar placement to avoid discomfort. place the child's head in a slightly extended position .place padding under the child's shoulders as needed.

place padding under the child's shoulders as needed.

118.Because the depth of an open abdominal wound is often difficult to determine

prompt transport to the hospital is essential.

15.When activated, the sympathetic nervous system produces all of the following effects, EXCEPT A. shunting of blood to vital organs. B. pupillary constriction. C. increase in heart rate. D. dilation of the bronchiole smooth muscle.

pupillary constriction.

22.A patient who cannot remember the events that preceded his or her head injury is experiencing retrograde amnesia. anterograde amnesia prograde amnesia. posttraumatic amnesia.

retrograde amnesia.

11.When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates A. significant pressure and bleeding in between the skull and dura mater. B. rupture of the tympanic membrane following diffuse impact to the head. C. fractures to the internal structures of the ear following direct trauma. D. a linear skull fracture and a significant increase in intracranial pressure.

rupture of the tympanic membrane following diffuse impact to the head.

28.Which of the following nerves carry information from the body to the brain via the spinal cord? A.motor B.central C.somatic D.sensory

sensory

91.You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked?

simply apply a clean dressing over the soaked dressing

111.A young male was assaulted and is found unconscious. Your assessment reveals bruising around his eyes and blood-tinged fluid draining from his nose. You should be MOST suspicious for a/an

skull fracture.

2.You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is A. slow.B. weak.C. irregular.D. rapid.

slow.

40.Moderate elevation in intracranial pressure with middle brain stem involvement is characterized by A. increased blood pressure, bradycardia, reactive pupils, and rapid respirations. B. sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing. C. ataxic respirations, unequal pupils, no response to pain, and an irregular pulse. D. fixed and dilated pupils, decreased blood pressure, and irregular respirations.

sluggishly reactive pupils, widened pulse pressure, bradycardia, and posturing.

29.The spinal cord is encased in and protected by the A.spinal canal .B.vertebral body. C.vertebral arch. D.intervertebral disc.

spinal canal.

112.You are assessing a 27-year-old female who was ejected from her car when it struck a utility pole at a high rate of speed. She is unconscious and has slow, irregular breathing. Her blood pressure is 180/90 mm Hg and her pulse rate is 50 beats/min and bounding. The MOST appropriate treatment for this patient includes

spinal immobilization, assisted ventilation with oxygen, and rapid transport.

14.During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should A. suction his oropharynx for up to 15 seconds.B. pack his nostrils to stop the drainage of blood.C. immobilize his spine and transport immediately.D. assist his ventilations with a BVM.

suction his oropharynx for up to 15 seconds.

25.Common signs of a skull fracture include all of the following, EXCEPT A.mastoid process bruising. B.ecchymosis around the eyes. C.noted deformity to the skull. D.superficial scalp lacerations.

superficial scalp lacerations.

13.The ideal procedure for moving an injured patient from the ground to a backboard is A. the use of a scoop stretcher.B. the four-person log roll.C. the direct patient carry.D. the clothes drag.

the four-person log roll.

65.When the parasympathetic nervous system is activated a) hormones are released that prepare the body for stress. b) heart rate and blood pressure increase. c) the heart rate decreases and the blood vessels dilate d) blood is shunted away from the digestive organs.

the heart rate decreases and the blood vessels dilate

1.When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until A. the head has been stabilized with lateral immobilization. B. the patient has been secured to the ambulance stretcher. C. the patient has been completely secured to the backboard. D. an appropriately sized cervical collar has been applied.

the patient has been completely secured to the backboard.

55.If you do not have the appropriate size cervical collar, you should A.use rolled towels to immobilize the patient's head. B.place sandbags on either side of the patient's head. C.ask the patient to keep his or her head in a neutral position. D.defer cervical immobilization and apply lateral hea

use rolled towels to immobilize the patient's head.

69.Helmets must be removed in all of the following cases, EXCEPT

when there are no impending airway or breathing problems.