EXAM 5
The EMT shows that he understands the seriousness of a prolapsed umbilical cord when he states:
"A prolapsed cord that is pinched can stop the flow of oxygen to the baby and must be addressed immediately."
Which statement by the patient best indicates that the patient is in the second stage of labor?
"I feel like I have to move my bowels."
You are presenting information on emergency care to a class of pregnant women. A participant asks you what the most frequent cause of injury is to a woman during pregnancy. What is the correct response?
"Motor vehicle collisions account for about half of all injuries sustained during pregnancy."
You are assessing a young male patient who was assaulted with a baseball bat and struck once on the left upper quadrant of the abdomen. You would recognize that this patient has Kehr's sign when he makes which statement?
"My left shoulder is killing me!"
Assessment of a newborn indicates that she has slow and irregular respirations with a weak cry. You should award her how many points according to the Apgar scoring system?
1
What percentage of minor trauma involving pregnant patients results in fetal loss?
1-3%
Approximately 80 percent of spontaneous abortions occur prior to the __________ week of gestation.
12th
Blood pressure readings in children ______ are unreliable due to their ability to compensate.
3
During pregnancy, maternal blood volume increases by __________ percent.
45
The initial Apgar score should be completed at _______ seconds after birth.
60
During spine motion restriction, the EMT must pad from the shoulders to the hip in patients younger than ____ years old to assure proper spinal alignment.
8
The EMT should recognize a full-term pregnancy has occurred in which patient?
A 21-year-old woman who is 39 weeks pregnant and feeling dizzy
Which patient should the EMT be most suspicious of having a spontaneous abortion?
A 21-year-old woman, 6 weeks pregnant, passing vaginal blood clots
Which action shows that the EMT is properly caring for the umbilical cord after delivery?
A 6-inch segment of cord is still connected to the baby
While delivering a baby, you note that the umbilical cord is wrapped around the baby's neck. You would:
Attempt to slip the cord over the baby's shoulders or head
A middle-aged male patient has been stabbed once in the right anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear on the left and severely diminished on the right. JVD and tracheal deviation are present. His SpO2 is 93% on supplemental oxygen via BVM. The vital signs are pulse, 140 beats/min; respirations, 28 breaths/min; and blood pressure, 100/78 mmHg. Your next action should be to:
Call for an ALS intercept en route to the ED and lift the dressing to see if air escapes during exhalation
You arrive at the side of a pregnant patient in her third trimester who has had vaginal bleeding for several hours. Observation reveals several blood-soaked towels on the bed. She is alert and oriented with a patent airway and adequate breathing. Her pulse is 88 beats per minute and her blood pressure is 104/66 mmHg. In caring for this patient you would:
Collect all towels with blood and transport them with the patient
After the EMT observes that secretions are interfering with the baby's breathing, which action indicates that the EMT is properly suctioning the newborn?
He squeezes the bulb syringe prior to placing it in the baby's nose
You are transporting a female patient who was sexually assaulted by having a foreign body inserted deep into her vagina. You are attempting to control hemorrhage by the appropriate means. As you reassess the patient, which finding is of most concern?
Heart rate increases from 116 to 140 beats/min
Shoulder pain caused by blood irritating the diaphragm is called
Kehr sign
You are transporting a 19-year-old male with a gunshot wound to the chest. On scene, you covered the wound with an appropriate dressing. Now, as you reassess the patient, you note that the patient is tachypneic and complains of increased difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be to:
Lift the dressing from the wound briefly during exhalation
An 81-year-old woman with severe kyphosis and osteoporosis fell and now complains of neck pain, back pain, and nausea. You can palpate a lateral displacement of a cervical vertebrae. Given the patient's past medical history, what is most appropriate?
Place her in a supine position on the long spine board and pad all voids
Assessment of a pregnant patient in labor reveals what appears to be the baby's buttocks presenting at the vaginal opening. The EMT would immediately:
Place the patient in supine, head-down position, with hips elevated, and administer supplemental oxygen
Why are premature uterine contractions of concern in the pregnant trauma victim?
Premature contractions can cause the release of oxytocin, which can start labor
Which finding is of greatest concern when assessing a 33-year-old female who is eight months pregnant?
Vaginal bleeding not associated with pain
The most common cause of cardiac tamponade is
a stab wound to the heart
When a patient presents with jugular venous distention, respiratory distress, and hypotension following a closed chest injury, the EMT should suspect
a tension pneumothorax
A 36-year-old pregnant woman was the driver of a car that struck a tree while traveling at a slow speed. The patient is complaining of severe tearing abdominal pain and vaginal bleeding. The most likely injury to this patient is
abriptio placentae
tension pneumothorax
air trapped in the thoracic cavity under pressure
You have applied a nonporous dressing to a stab wound on a patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides and not all four. Your best response is that taping the dressing on three sides:
allows trapped air to escape on exhalation
Despite the increase in maternal blood volume, the pregnant patient is typically:
anemic
Management of a female patient who has suffered a laceration to the genital area will include all of the following
assessment for hypoperfusion, direct pressure, use of a sanitary pad
What would the expected preductal SpO2 reading be at 5 minutes after birth?
at least 80%
When do most women experience a decrease in the nausea and vomiting associated with hyperemesis gravidarum?
between 14 and 20 weeks
Management of an injury caused by blunt trauma to the scrotum may include
bleeding control, direct pressure, cold compress
You are by the side of an 11-month-old female with a decreased level of consciousness. Caregivers will not provide an accurate history of how the child came to this condition, only that she was difficult to wake up this morning, about 30 minutes ago. When assessing the child, which finding would be most immediately concerning?
bradycardic heart rate
The second stage of labor begins with _____ cervical ______ and ends with delivery of the baby.
complete, dilation
It has been 30 minutes and the placenta has yet to deliver. The EMT should:
continue to monitor the mother and baby
Fractured ribs may produce ______, a grating sound or sensation
crepitus
signs of major chest trauma
cyanosis, paradoxical movement, hemoptysis
The third stage of labor begins following
delivery of the baby
A car swerved to miss a deer in the road and hit a utility pole at a low rate of speed. Damage to the car is minimal, but the 82-year-old male passenger was not wearing a seat belt and hit his head on the dashboard. He presents as confused and diaphoretic. His daughter, the driver, states that he has a history of dementia, high blood pressure, and diabetes, as well as coronary artery disease. She adds that he took his insulin about 2 hours ago. Which question to the daughter would be most important at this time?
did he eat anything today?
A 32-year-old female complains of the sudden onset of sharp pain to the left side of her abdomen. She denies any medical history and when asked, admits to being sexually active. Her last menstrual period was two months ago. As an EMT, you should immediately suspect:
ectopic pregnancy
A young female complains of sharp pain to the left lower quadrant of her abdomen. She states that her last period was seven weeks ago. With this information, the EMT should be suspicious of:
ectopic pregnancy
Trauma is the leading cause of death for pregnant women. They are especially susceptible to abuse and _____
falls
a ____ _____ is an injury created by adjacent rib segments that are unattached to the rest of the rib cage.
flail chest
You are assessing a female patient who informs you that she has been pregnant four times before but delivered only once. What would be a correct way to document that information on the prehospital care report?
gravida IV; para I
You arrive at the residence of a physician who informs you that his pregnant wife requires immediate transport to the hospital because she is bleeding and has a history of abruptio placentae. As a knowledgeable EMT, you should recognize that the greatest threat to the baby is:
hypoxia
You are transporting a female patient who is seven months pregnant. She has been diagnosed with preeclampsia and is currently hypertensive. Which statement made by the patient indicates she may be transitioning from preeclampsia to eclampsia?
i feel like i am going to have a seizure
A newborn's first Apgar score was 6. His second Apgar score is 9. What does this information mean to the EMT
improvement
You have completed the assessment of a 32-year-old patient who is starting her seventh month of pregnancy. During your assessment, which finding should you be most concerned about?
intermittent vaginal bleeding
an ______ emergency is one that occurs during the period from the onset of labor to the actual delivery of the neonate.
intrapartum
During a continuing education session on OB/GYN topics, the EMT would recognize which statement about the umbilical cord as true?
it contains one vein and two arteries
When dealing with a prolapsed cord, you should position the patient in the _____ ______ position
knee chest
On scene at a college football game, a wide receiver is unresponsive after colliding with another player and forcefully taking a helmet to the chest. The athletic trainer reports that the patient is pulseless and apneic. Given the mechanism of injury and patient's presentation, which instruction would be appropriate?
lets apply the AED and follow all prompts
A patient has been stabbed in the right upper quadrant of the abdomen. Which solid organ should the EMT be most concerned with being injured?
liver
The aorta, vena cava, esophagus, and trachea are located in the _______ , a hollow area in the center of the thoracic cavity.
mediastinum
the _____ houses the trachea
mediastinum
An alert and oriented young male fell 5 feet from a stage, impacting a metal railing with the right side of his chest, just under his armpit. The primary assessment is negative for life threats, although he does complain of very painful breathing and has remarkable tenderness and crepitus over the fifth rib laterally in this area. Throughout care, which action is essential to perform?
monitor breath sounds
What is the most common cause of blunt abdominal trauma?
motor vehicle crashes
Which statement made by a pregnant patient in labor should be of most concern to the EMT?
my water broke two days ago
_______ chest trauma occurs more often with violence than with blunt trauma
penetrating
blood in the sac surrounding the heart
pericardial tamponade
Blood is not irritating to the _______ lining and may not cause acute severe abdominal pain suddenly.
peritoneal
collapsed lung
pneumothorax
Which of the following is (are) sign(s) of severely depressed newborns?
pulse rate less than 100/min, resp rate greater than 60 bpm, diminished breath sounds
During traumatic asphyxia there is
rapid increase in pressure in the chest
A pulmonary contusion can be life threatening because it can
reduce oxygen exchange via the alveoli
In a cardiac contusion the area of the heart most likely to be injured is the
right ventricle
A patient has been involved in a motorcycle crash and has a flail segment to the right lateral chest. His airway is open and he is breathing poorly at 24 breaths per minute with a decreasing SpO2. The EMT shows that he is appropriately caring for this injury when he:
start ppv
An open chest wound can pull air into the thoracic cavity, sometimes with a noticeable sound. This injury is referred to as a ______ _____ ______
sucking chest wound
When placing a patient in her third trimester in the supine position, the EMT must elevate the right hip 4 to 6 inches to prevent _____ ____ _____
supine hypotensive syndrome
According to the neonatal resuscitation pyramid, which level of care will most newborns require?
tactile stimulation and drying
a _____ ______ occurs when air trapped in the thoracic cavity expands under pressure.
tension pneumothorax
All of the following are signs of imminent delivery except
the patient's water broke
A 31-year-old female in her third trimester of pregnancy lost her balance and fell down a flight of stairs. Treatment included spinal motion precautions and oxygen therapy. When transporting her, the EMT should:
tilt the long spine board to the left
movement of the primary breathing tube from its usual position
tracheal deviation
sudden compression of the thoracic cavity
traumatic asphyxia
A flail segment occurs
with fracture of two or more ribs in two or more places.
