CHAPTER 30

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

A

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. asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta C. fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia D. collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest

A

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should: A. aggressively manage his airway. B. request a paramedic ambulance. C. perform a secondary assessment. D. suspect a severe hemopneumothorax.

A

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.

A

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

A

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. engorged jugular veins B. widening pulse pressure C. diminished breath sounds D. a rapid, irregular pulse

A

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

A

Patients with rib fractures will commonly: A. breathe rapidly and shallowly. B. take a series of deep breaths. C. prefer to lie in a supine position. D. develop a sucking chest wound.

A

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

A

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

A

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. administer oxygen and transport to the hospital. B. immediately perform a rapid head-to-toe exam. C. recognize that he needs a needle decompression. D. circumferentially tape a dressing around his chest.

A

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. apply an automated external defibrillator (AED) and take his blood pressure. B. prepare for immediate transport. C. determine if he has cardiac problems. D. apply bulky dressings to the sternum.

B

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a: A. ruptured aorta. B. myocardial contusion. C. pericardial tamponade. D. tension pneumothorax.

B

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

B

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

B

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

B

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

B

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of: A. a tension pneumothorax. B. traumatic aortic rupture. C. penetrating lung injuries. D. a massive cardiac contusion.

B

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. flail chest. B. pneumothorax. C. cardiac tamponade. D. myocardial contusion.

B

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

B

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

B

You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should: A. begin ventilatory assistance. B. partially remove the dressing. C. begin rapid transport at once. D. call for a paramedic ambulance.

B

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

C

During your assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should: A. request a paramedic to decompress the chest. B. make note of it and continue your assessment. C. stabilize the chest wall with a bulky dressing. D. reassess the adequacy of the patient's breathing.

C

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

C

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

C

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

C

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

C

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

C

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. a total collapse of the affected lung B. hidden bleeding in the thoracic cavity C. compression of the aorta and vena cava D. blood accumulation in the pleural space

C

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

D

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

D

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. apply 100% oxygen and immediately transport. B. place her supine and elevate her lower extremities. C. perform a rapid head-to-toe physical assessment.

D

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

D

The phrenic nerves control the diaphragm and exit the spinal cord at: A. C1 and C2. B. C3 and C4. C. C1, C2, and C3. D. C3, C4, and C5.

D

When assessing a patient with a hemothorax, you will MOST likely find: A. jugular venous engorgement. B. ipsilateral tracheal deviation. C. distant or muffled heart tones. D. signs and symptoms of shock.

D

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. massive hemothorax. B. tension pneumothorax. C. pericardial tamponade. D. laceration of the aorta.

D

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. insert an oropharyngeal airway. B. obtain a set of baseline vital signs. C. perform a focused secondary exam. D. immediately request ALS support.

D