Elements of Ecology, 9e (Smith) – Test Bank


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ExamName___________________________________MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.1)Theabdominal quadrantsinclude all of the followingexceptthe:1)A)right medial.B)left lower.C)left upper.D)right upper.Answer:AExplanation:A)CORRECT. There is no right medial abdominal quadrant.B)INCORRECT. The left lower quadrant is one of the abdominal quadrants.C)INCORRECT. The four abdominal quadrants include the left upper quadrant.D)INCORRECT. The abdominal quadrants include the right upper quadrant.2)What is the distinction betweenanatomyandphysiology?2)A)The terms are synonymous.B)Anatomy is the study of physical body structures, whereas physiology is the study ofemotions and behavior.C)Anatomy is the study of body components and systems, and physiology is the study ofinjuries and disease processes.D)Anatomy is the study of body structures, and physiology is the study of body function.Answer:DExplanation:A)INCORRECT. Anatomy and physiology refer to different studies; they do notmean the same thing.B)INCORRECT. Physiology is not the study of emotions and behavior.C)INCORRECT.Pathophysiology is the study of disease processes, not physiology.D)CORRECT. Anatomy is the study of body structures, organs and systems, andphysiology is the study of the actions of those organs and systems.3)Which of the following BEST describes the anatomic position?3)A)Standing, facing forward, with arms raised above the headB)Standing in profile with the hands on the hipsC)Supine with arms crossed over the chest and knees slightly bentD)Standing, facing forward, with arms at the side, palms forwardAnswer:DExplanation:A)INCORRECT. In the anatomic position, the patient’s arms are not above the head.B)INCORRECT. The anatomic position does not describe a person standing sidewayswith hands on the hips.C)INCORRECT. Lying on the back with arms crossed is not a description of theanatomic position.D)CORRECT. The anatomic position is the body standing erect, facing the observer,with arms down at the sides and the palms of the hands facing forward.1
4)A postal worker has been attacked by a dog during her mail delivery route. The patient is a54-year-old female with several dog bites on her lower extremities and left arm. The worst of thesebites is located on the back of her right leg just above the ankle. How can you explain the locationof this injury using anatomical landmarks?4)A)The bite is located on the anterior aspect of the calf just distal to the knee.B)The bite is located on the anterior aspect of the calf just proximal to the knee.C)The bite is located on the posterior aspect of the calf just proximal to the knee.D)The bite is located on the posterior aspect of the calf distal to the knee.Answer:DExplanation:A)INCORRECT. Describing the bite as beinganteriorindicates that it is on the front ofthe leg.B)INCORRECT. This description would describe a bite on the front of the patient’sleg.C)INCORRECT. This description would describe a bite on the back of the patient’scalf, but close to the knee.D)CORRECT. Since the dog bite is on the back of the leg or calf, it is on the posterioraspect of the leg. Since it is below the knee, use the termdistalto describe an injurythat is distant or away from the knee.5)What is the primary reason for an EMT to use specific and proper medical terminology?5)A)EMS providers can’t bill for services unless the correct terminology is used in alldocumentation.B)Medical communication needs to be exact and consistent.C)It will make patients and family members trust in the EMT’s abilities more.D)People may think that an EMT is not intelligent or professional unless she uses medical terms.Answer:BExplanation:A)INCORRECT. Although proper documentation is important for billing purposes,this is not the primary reason to use proper terminology.B)CORRECT. Communication about medical assessment and care needs to beclear-cut and exact so that everyone involved in the process understands. Whetherdescribing a patient over the radio for medical direction or documenting findingsin a prehospital care report, being specific matters. Proper medical terminologyallows a precision that common terms may not permit.C)INCORRECT. Good rapport and interpersonal skills will aid in building trust withpatients and family members much more than using medical terminology;excessive use of medical terms may actually alienate patients.D)INCORRECT. Having others think that an EMT is intelligent or professionalshould not be the motivation for using medical terminology.6)With regard to medical terminology, aprefixis:6)A)added to the beginnings of roots or words to modify or qualify their meaning.B)the combination of any two or more whole words.C)the foundation of a word or term.D)a modifier that indicates if a term is singular or plural.Answer:AExplanation:A)CORRECT.Prefixesare added to the beginnings of roots or words to modify orqualify their meaning.B)INCORRECT. Combining any two whole words into another word is calledcompounding.C)INCORRECT. The foundation of a word is called aroot.D)INCORRECT. A prefix will generally not indicate if a word or term is singular orplural.2
7)Which of the following are the abdominal regions created by drawing two imaginary linesintersecting at the navel?7)A)Abdominal regionsB)Abdominal planesC)Abdominal sextantsD)Abdominal quadrantsAnswer:DExplanation:A)INCORRECT.Abdominal regionsis a generic term that doesn’t refer to the specificareas identified by two imaginary lines intersecting at the navel.B)INCORRECT. A plane is an imaginary flat surface formed when slicing through asolid object; the termabdominal planedoesn’t adequately describe the abdominalregions.C)INCORRECT. A sextant is an instrument used to measure the angle between twoobjects; it does not apply to defining abdominal regions.D)CORRECT.Abdominal quadrantsare four divisions of the abdomen used to pinpointthe location of a pain or injury: they are defined by drawing two imaginary linesthrough the abdomen, intersecting at the navel.8)Which of the following describes Fowler’s position?8)A)Sitting upright with the legs straightB)Lying on the sideC)Lying flat on the backD)Lying on the stomachAnswer:AExplanation:A)CORRECT. When in the Fowler’s position, the patient is seated with her legs eitherstraight or bent in front of her.B)INCORRECT. The lateral recumbent (recovery) position has the patient lying onher side.C)INCORRECT. Lying flat on the back is called the supine position.D)INCORRECT. The positional term prone describes a patient who is lying on hisstomach.9)While transporting a patient with a traumatic wound to the back, you call in report to the receivinghospital over the radio. Due to radio static and background noise in the Emergency Department,the physician has had to ask you twice to repeat if the wound wassuperiororinferior. Why wouldthis distinction be important?9)A)The physician is just trying to determine if the wound is deep or not so she knows what toprepare for.B)The location of the wound is important in determining which types of resources to haveavailable when the patient arrives.C)The answer is not necessarily important. The physician is just focusing on getting herstandard questions answered while dealing with an inadequate radio system.D)It is a triage question to determine if the patient iscriticalor not so the hospital can prioritize.Answer:BExplanation:A)INCORRECT. The termssuperiorandinferiordon’t describe the depth of a wound.B)CORRECT. If a traumatic back injury is near the head (superior), there may be theneed to involve other specialists in care, such as neurology. In determining thespecific wound location, the receiving physician is trying to determine whichresources to have available.C)INCORRECT. The questions asked by physicians are generally important;although radio transmissions can occasionally be interrupted, the physicianwouldn’t persist if the answer wasn’t needed.D)INCORRECT. Simply knowing a more specific location of this back injurywouldn’t necessarily indicate whether the patient was critical or not.3
10)The inside of a person’s thigh is also known as its ________ aspect.10)A)axillaryB)inferiorC)lateralD)medialAnswer:DExplanation:A)INCORRECT. Axillary refers to the armpit of a patient, not the thigh.B)INCORRECT. Using the term inferior in reference to a thigh would describe apoint away from the head, not inside or outside.C)INCORRECT. The lateral aspect of the thigh would refer to the outside of the thigh.D)CORRECT. A part of the body that is toward the midline is described asmedial.11)You and your EMT partner are responding to a medical aid call in the rural West County area. Thedispatcher advises that the caller is reporting the patient as having a history of “plegia.” Why wouldit be beneficial to have the dispatcher clarify a prefix for the wordplegia?11)A)Without a clarifying prefix, it is difficult for the EMTs to effectively prepare for the type ofpatient they may encounter.B)A patient withplegiais potentially contagious, and the EMTs need to know what precautionsare required.C)Because adysplegiac patient generally requires an EMT-Paramedic level of care, and it maychange the level of response.D)There is actually no need to clarify the word.Answer:AExplanation:A)CORRECT. The rootplegiameans paralysis of the limbs; without a prefix, it isunclear to what extent the patient may be paralyzed, which may impact thechallenges encountered by medical responders. The EMTs would want to know ifthey are responding to a partially (para-) or fully (quadri-) paralyzed patient.B)INCORRECT.Plegia, the paralysis of the limbs, is not an infectious disease.C)INCORRECT. Dysplegia is not a recognized medical condition and would notimpact the response decisions.D)INCORRECT. The prefix to the rootplegiais important for responders to know.12)What is another term for the frontal aspect of the body?12)A)DorsalB)CaudalC)AnteriorD)PosteriorAnswer:CExplanation:A)INCORRECT.Dorsalindicates the back of the body.B)INCORRECT. The anatomic termcaudalrefers to the back of the body or tail.C)CORRECT. The front aspect of a body or body part is called theanterior.D)INCORRECT. The termposterioris used to describe the back aspect of the body orbody part.13)With regard to anatomical locations, which of the following is NOT true?13)A)The ears are located on the lateral aspect of the head.B)The foot is distal to the knee.C)The umbilicus is located on the ventral aspect of the body.D)The mouth is proximal to the nose.Answer:DExplanation:A)INCORRECT. The ears are located to the sides of the head and would be describedas being on the lateral aspect of the head.B)INCORRECT. Since the foot is further from the body than the knee, the termdistalis correct.C)INCORRECT.Ventralmeans front; the umbilicus is located on the front of thebody.D)CORRECT. The correct terminology would be to say the mouth is inferior to thenose.4
14)Why should an EMTavoidthe use of acronyms and abbreviations when communicating?14)A)Using acronyms and abbreviations is considered unprofessional.B)The medical acronyms and abbreviations used by prehospital care providers and hospitalstaff are different.C)They should only be avoided in verbal communications, where they can be misunderstood;they are expected in written patient care reports.D)There is a chance that they can lead to errors in continued care for the patient.Answer:DExplanation:A)INCORRECT. It is only considered unprofessional when acronyms andabbreviations are used incorrectly or in excess.B)INCORRECT. Although there are some regional differences with certain acronymsor abbreviations, they are usually the same between prehospital and facility-basedproviders.C)INCORRECT. Acronyms and abbreviations can be misunderstood, whethercommunicated verballyorin writing.D)CORRECT. Research has shown that the use of acronyms and abbreviations is acommon cause of medical errors.15)Which of the following describes the midline of the body?15)A)An imaginary line dividing the body into a front and a back portionB)The intersection of two imaginary lines crossing at the umbilicusC)An imaginary line dividing the body into a top and bottom portionD)An imaginary line dividing the body into equal right and left halvesAnswer:DExplanation:A)INCORRECT. The mid-axillary line divides the body into front and back halves,not the midline.B)INCORRECT. The intersection of two imaginary lines crossing at the umbilicus isnot called a midline.C)INCORRECT. An imaginary line dividing a person into upper and lower halves isnot referred to as amidline.D)CORRECT. Themidlineis an imaginary line splitting the body into equal right andleft halves.16)The termlateralis best defined as:16)A)to the back of.B)under the arms.C)toward the middle of.D)to the side.Answer:DExplanation:A)INCORRECT. The medical term for the back of something is calleddorsal.B)INCORRECT. Although the area under the armscouldbe lateral to something else,it is not the best description of the term.C)INCORRECT. Toward the middle of the body is described asmedial.D)CORRECT. Lateral is defined asto the side, away from the midline of the body.5
17)What word would be used to refer to a patient’s rapid breathing?17)A)DyseffusionB)TachypneaC)DyspneaD)TachycardiaAnswer:BExplanation:A)INCORRECT. When used medically, the wordeffusionrefers to the escape of fluidor gas; dyseffusion would not describe the rate of a patient’s breathing.B)CORRECT. The prefixtachymeans fast or rapid and the rootpnearefers tobreathing.C)INCORRECT. A patient who is having difficulty breathing is described with theworddyspnea.D)INCORRECT. Tachycardia describes a heart rate that is rapid.18)You and your newly hired EMT partner arrive on the scene of a bicycle collision at the localcommunity park. One cyclist stands by and says that she has no injuries. The other is lying on hisside on the bike path, guarding his ribs and holding the lower part of his left leg. Your partnerkneels next to the man, introduces herself, and asks, “Can you ambulate?” The patient looks up,confused and in obvious pain. “Can you ambulate? You know…walk?” Your partner says, a littlelouder. After transporting the patient, you discuss the call with your partner and suggest that sheavoid using medical terms unnecessarily when talking with patients. She seems insulted and says,”Why?” What would you say?18)A)Tell her that the point of communicating with patients and other providers is so there is clearunderstanding; using medical terms when not necessary can cause confusion.B)You should say that you are an experienced EMT and since she is new, she should just takeyour advice and apply it.C)Tell her that the general public isn’t smart enough to understand medical terminology andthat all communication must be “dumbed down” when talking to patients.D)Explain that using large words and medical terms can be seen as being egotistical, which canalienate both patients and other providers.Answer:AExplanation:A)CORRECT. Occasionally complex terms used in messages can cause confusioneven among trained health care professionals. If there is a potential for ambiguityor if the person you are speaking to may not understand medically-specific terms,do not be reluctant to revert to clearer terms.B)INCORRECT. Important educational opportunities are missed when experiencedproviders do not explain thereasonsbehind their advice to their newer coworkers.C)INCORRECT. The potential confusion caused by using detailed medicalterminology is not related to intelligence, and saying that communication needs tobe “dumbed down” is inappropriate for a professional EMT.D)INCORRECT. Simply using medical terms does not make a provider egotistical.19)Which of the following BEST describes the location of the mid-axillary line?19)A)A line drawn horizontally from one armpit to the other, across the front of the bodyB)A line from the center of the armpit, extending vertically down the side of the chestC)A line drawn diagonally from the outer end of the clavicle to the navelD)A line drawn vertically from the xiphoid process to the pubic boneAnswer:BExplanation:A)INCORRECT. A line drawn across the body from one armpit to the other wouldnot be called a mid-axillary line.B)CORRECT. A line drawn vertically from the middle of the armpit to the ankle iscalled the mid-axillary line.C)INCORRECT. Drawing a line from the clavicle to the navel does not describe thelocation of the mid-axillary line.D)INCORRECT. This would best be described as themidline.6
20)To check the distal pulse of a patient with an injury to the forearm, the EMT would check for apulse in which location?20)A)ThroatB)WristC)Upper armD)ArmpitAnswer:BExplanation:A)INCORRECT. The throat would not be described asdistalto the elbow.B)CORRECT. The wrist isdistalto the elbow.C)INCORRECT. The upper arm is notdistalto the elbow.D)INCORRECT. The armpit is consideredproximal; closer to the torso.21)A patient with bilateral femur fractures would have which of the following?21)A)A femur fracture in which the bone ends have punctured the muscle and skin of the thighB)A femur fracture occurring with little or no traumaC)Fractures of both femursD)Two fractures in the same femurAnswer:CExplanation:A)INCORRECT. The severity of a fracture is not addressed by the anatomic termbilateral.B)INCORRECT. The cause of the fractures is not related to the term bilateral.C)CORRECT. Bilateral means “on both sides”; bilateral femur fractures means thatboth femurs have been fractured.D)INCORRECT. Bilateral does not simply mean two; two fractures of the same femurwould not be called bilateral.22)The wrist is ________ to the elbow.22)A)dorsalB)medialC)inferiorD)distalAnswer:DExplanation:A)INCORRECT.Dorsalmeans on the back of.B)INCORRECT.Medialmeans closer to the midline of the body.C)INCORRECT.Inferiormeans below or further from the head; although thismayapply, it is not the correct terminology.D)CORRECT. The wrist isdistalto the elbow; further from the torso and nearer thefree end of the extremity.23)Your 79-year-old female patient appears to show all signs and symptoms of a stroke. Her level ofconsciousness has rapidly deteriorated, she is now unconscious, and she can no longer control herown airway. While you intervene to manage her airway, the best position in which to keep fluid orvomitus from occluding her airway would be the:23)A)Trendelenburg position.B)recovery position.C)Fowler position.D)prone position.Answer:BExplanation:A)INCORRECT. The Trendelenburg position is on the back with legs raised, whichwould be potentially dangerous to the airway of an unconscious person.B)CORRECT. The recovery position, also known as the lateral recumbent position, isthe preferred position for any unconscious nontrauma patient because it is aposition in which fluids and vomitus can drain from the mouth and be less likelyto be aspirated into the lungs.C)INCORRECT. The Fowler position is seated full upright, which wouldn’t beappropriate for an unconscious patient.D)INCORRECT. No patient is ever positioned or transported in the prone position.7
24)You respond to a large concert venue where a number of spectators are reported to be severelyintoxicated. You are directed to an area where several patients appear to be unconscious, lying facedown on the ground. The position of these patients is described as:24)A)supine.B)anterior.C)prone.D)posterior.Answer:CExplanation:A)INCORRECT. Thesupineposition is one where the patient is lying on his back orface up.B)INCORRECT.Anteriordoes not describe a position; it just means “the front of thebody.”C)CORRECT. Always compare the patient’s position to the universal reference, or theanatomic position. Theproneposition is one where the patient is lying on hisabdomen or face down.D)INCORRECT.Posteriorsimply refers to “the back of the body” and does notdescribe a position.25)When discussingleftandrightin terms of anatomic locations, what do they refer to?25)A)Whoever is speaking about the anatomic location determines left and right orientation.B)Anatomic left and right refer to the provider’s left and right orientation when facing a patientin the anatomic position.C)Left and right from the patient’s perspectiveD)What left and right refer to anatomically is dependent on the patient’s positioning when careis provided.Answer:CExplanation:A)INCORRECT. Whoever is speaking does not play a role in determining anatomicleft or right.B)INCORRECT. Anatomic locations are not based on the perspective of the careprovider.C)CORRECT. The directionsleftandrightalways refer to the patient’s left and right.D)INCORRECT. The patient’s positioning does not alter the locations of anatomic leftand right.8
Answer KeyTestname: C51)A2)D3)D4)D5)B6)A7)D8)A9)B10)D11)A12)C13)D14)D15)D16)D17)B18)A19)B20)B21)C22)D23)B24)C25)C9






ExamName___________________________________MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.1)A 36-year-old male was accidentally shot with a nail gun into the chest. You see the nail, whichprotrudes about 2 to 3 centimeters from the thorax, when you visualize the injury site. Under whichof the following circumstances should you remove the nail from the injury site?1)A)The patient develops a tension pneumothorax.B)The patient begins to complain of shortness of breath.C)Bleeding from the patient’s wound is minimal.D)None of the aboveAnswer:DExplanation:A)INCORRECT. Even if the patient develops a tension pneumothorax, the objectshould not be removed from the chest.B)INCORRECT. If the patient complains of dyspnea, the object should still not beremoved from the chest.C)INCORRECT. Even if the bleeding from an impaled object is minimal, removingthe object will likely cause the bleeding to worsen.D)CORRECT. An impaled object should not be removed from the chest.2)Which of the following types of bandages should NOT be used by the EMT providing wound care?2)A)TourniquetB)Self-adherent roller gauzeC)Adhesive tapeD)Triangular bandageAnswer:AExplanation:A)CORRECT. A tourniquet is not a type of bandage and is only used as a last resortto stop bleeding if direct pressure and pressure bandaging does not work.B)INCORRECT. Self-adherent roller gauze is used to treat certain injuries.C)INCORRECT. Adhesive tape is used to secure dressings and bandages in place onthe skin and body.D)INCORRECT. A triangular bandage is used to treat certain injuries.1
3)You are on an EMS standby for a boxing tournament. During one of the matches, one of the femaleboxers delivers a forcible uppercut to the chest of her opponent, who falls to the ground. The matchis declared over on the basis of a TKO. However, the opponent fails to arise following a 1 to 2minute interval. EMS is summoned to the ring. You find the patient pulseless and breathing agonalgasps. You suspect which of the following traumatic conditions?3)A)Tension pneumothoraxB)Cardiac tamponadeC)Commotio cordisD)Aortic dissectionAnswer:CExplanation:A)INCORRECT. A tension pneumothorax is a collapsed lung under pressure causedby blunt force trauma. In this case, the blow delivered to the center of the chestwould not typically cause a tension pneumothorax.B)INCORRECT. Cardiac tamponade is a collection of blood in the pericardial sacsurrounding the heart most often caused by penetrating trauma like a knife or aprojectile.C)CORRECT. In commotio cordis the impact occurs just when the heart is vulnerable.There are several hundredths of a second during each heartbeat when the heart, ifsufficiently stimulated, will go into ventricular fibrillation (VF). The patientsustained a blow strong enough at just the right time to go into cardiac arrest.D)INCORRECT. An aortic dissection is massive hemorrhage of the aorta caused fromthe buildup of pressures within the aorta and the weakening of the arterial walls.This injury would not be caused from blunt force trauma to the chest.4)Some drawbacks to using sterile aluminum foil as an occlusive dressing include:4)A)skin lacerations may occur from the sharp edges.B)sterility cannot be ensured unless the materials were autoclaved.C)foil cannot create an airtight seal.D)a flutter valve is difficult to create.Answer:AExplanation:A)CORRECT. Aluminum foil may cause skin lacerations from the sharp edges whenused as an occlusive dressing.B)INCORRECT. Aluminum foil is not autoclaved due to damaging or destroying thematerial.C)INCORRECT. Aluminum foil will create an airtight seal.D)INCORRECT. A flutter valve is relatively easy to create by only taping on 3 sidesversus 4 sides of the occlusive dressing.5)Which of the following injuries requires the use of an occlusive dressing?5)A)Open wound to the abdomen from which a loop of intestine is protrudingB)Open wound to the chestC)Open wound to the neckD)All of the aboveAnswer:DExplanation:A)INCORRECT. An evisceration requires the use of an occlusive dressing, but so doother injuries.B)INCORRECT. An open wound to the chest requires an occlusive dressing, but sodo other injuries.C)INCORRECT. An open wound of the neck requires an occlusive dressing, but so doother injuries.D)CORRECT. Open neck wounds, abdominal eviscerations, and chest woundsrequire the use of occlusive dressing so that air from the atmosphere is notentrained into the body through the open wound.2
6)Which of the following is an accurate definition of a flail chest?6)A)Fracture of at least four ribs in two or more placesB)Lung that has been punctured by a fractured rib, resulting in a buildup of airC)Fracture of one rib in two or more consecutive placesD)Section of the chest wall that is unstable, leading to breathing problemsAnswer:DExplanation:A)INCORRECT. For a flail segment the break must be in consecutive ribs (not justany ribs) in two or more places.B)INCORRECT. This would describe a lung puncture and not a flail segment.C)INCORRECT. This would describe a single broken rib and not a flail chestsegment.D)CORRECT. Closed chest injuries may cause a condition known as flail chest. Thiscondition is defined as a fracture of two or more consecutive ribs in two or moreplaces. (Some sources say three or more ribs in two or more places.) The mostimportant factor to remember–even more than the number of broken ribs–is thatflail chest leaves a portion of the chest wall unstable, which affects breathing andreduces lung expansion.7)Which of the following describes the proper application of an occlusive dressing for an open chestwound?7)A)Trim the dressing so that it is the exact size of the wound.B)Tape the dressing securely on three sides.C)Use a porous material such as a 4″ by 4″ gauze pad.D)Tape the occlusive dressing on two sides only to create dual flaps for relief pressure build-up.Answer:BExplanation:A)INCORRECT. The dressing should be larger than the wound so that a seal may beachieved.B)CORRECT. An occlusive dressing should be taped on 3 sides securely to seal thechest.C)INCORRECT. Porous materials such as a standard 4″×4″ gauze will not occludethe air that may become entrained from the open chest wound.D)INCORRECT. An occlusive dressing for an open chest wound must be sealed on atleast 3 sides to create an adequate seal of the wound to keep it from becoming asucking chest wound.8)The chest cavity can hold up to ________ liter(s) of blood in an adult, leading to the possibility ofmassive internal hemorrhage without any external blood loss.8)A)5B)3C)0.5D)1Answer:BExplanation:A)INCORRECT. The total body contains 5 to 6 liters of blood, thus 5 liters would notfit in the chest cavity.B)CORRECT. Since the blood vessels that run through the chest are the largest in thebody, injury to these vessels is often fatal. In fact, the chest can hold over 3 liters ofblood. It is possible to bleed to death within the chest cavity and never spill a dropoutside the body.C)INCORRECT. 500 mL is a low level of blood loss that the body may stillcompensate for.D)INCORRECT. A liter of blood would fit in the chest cavity, but the space canreadily hold three times as much fluid.3
9)You are stabilizing a patient who has just been stabbed in the chest to the right of the mediastinum.After placing the patient on supplemental oxygen, his shortness of breath resolves. You also coverthe wound with an occlusive dressing. The patient is asymptomatic at the time you’re making thedecision to transport. Which of the following BEST encapsulates the correct strategy for transport?9)A)Transport the patient non-emergently because he’s complaint free.B)The patient does not necessarily need transport, so allow him to refuse if he wants.C)Begin transport non-emergently and upgrade if the patient’s condition deteriorates.D)Transport the patient emergently because of the high index of suspicion for a serious injury.Answer:DExplanation:A)INCORRECT. The patient in this case must be transported emergently due to theinjuries, despite the fact that the patient is hemodynamically stable at this time. Thepatient’s condition may worsen en route to the hospital.B)INCORRECT. Any patient with an open injury to the chest should be transportedto the proper ED for further treatment and evaluation.C)INCORRECT. The patient in this case must be transported emergently due to theinjuries.D)CORRECT. The patient should be transported emergently because of the highindex of suspicion of serious injury.10)What is the correct terminology for a wound in which a vacuum has been created within the chest,drawing air into the thorax with each breath?10)A)Gurgling chest woundB)Open chest woundC)Closed tension pneumothoraxD)Sucking chest woundAnswer:DExplanation:A)INCORRECT. A gurgling chest wound is not a classification of an open chestwound like the sucking chest wound is. Gurgling is a sound made from the mouthwhen the oropharynx is filled with fluid or vomitus.B)INCORRECT. An open chest wound may not be large enough to allow air to beentrained inward like a sucking chest wound.C)INCORRECT. A closed tension pneumothorax does not draw air into the thorax.D)CORRECT. A sucking chest wound is an open chest wound in which air is”sucked” into the chest cavity with each breath.11)Which of the following is NOT an open tissue injury?11)A)AvulsionB)ContusionC)EviscerationD)AbrasionAnswer:BExplanation:A)INCORRECT. An avulsion is an open soft tissue injury where the skin is tornaway, completely or partially.B)CORRECT. A contusion (bruising) is a closed soft tissue injury caused by bluntforce trauma.C)INCORRECT. An evisceration is an open soft tissue injury of the abdominal cavity,where organs are protruding out.D)INCORRECT. An abrasion is an open soft tissue injury involving the epidermiscaused by the skin being scraped.4
12)Your patient is a 17-year-old male baseball player found pulseless and apneic after being struck inthe chest by a baseball 6 minutes ago. He is surrounded by other players and staff but no one isproviding care. You should:12)A)place him on a backboard.B)begin chest compressions.C)elevate the patient’s legs.D)attach the AED and analyze.Answer:BExplanation:A)INCORRECT. Backboarding the patient prior to chest compressions will delaylifesaving care.B)CORRECT. The scenario suggests that this patient has suffered commotio cordis.The appropriate treatment for this patient is the same as any other pulseless arrestwhere the patient has been down for over 5 minutes. Chest compressions shouldbegin immediately followed by application of the AED. Elevation of the patient’slegs and backboarding prior to chest compressions will delay lifesaving care.C)INCORRECT. Elevation of the patient’s legs prior to chest compressions will delaylifesaving care.D)INCORRECT. The appropriate treatment for this patient is the same as any otherpulseless arrest where the patient has been down for over 5 minutes. Chestcompressions should begin immediately followed by application of the AED after2 minutes of CPR.13)Which of the following is atruestatement regarding the skin’s status in the case of a closed chestinjury?13)A)The skin is penetrated.B)The skin is not penetrated.C)Internal contusions and lacerations cannot occur.D)The skin may be penetrated and occluded.Answer:BExplanation:A)INCORRECT. The skin is not penetrated in a closed chest injury.B)CORRECT. In a closed chest injury, the skin is not penetrated.C)INCORRECT. Internal contusions and lacerations may occur with closed chestinjuries.D)INCORRECT. The skin is not penetrated and occluded in a closed chest injury.14)The pathophysiology of ________ is one in which the pericardial sac fills with blood to the pointwhere the chambers of the heart no longer fill adequately, usually secondary to trauma.14)A)hemopneumothoraxB)cardiac tamponadeC)commotio cordisD)pericardial effusionAnswer:BExplanation:A)INCORRECT. A hemopneumothorax is blood and air in the chest cavity caused byrupture of one of the great vessels.B)CORRECT. When an injury to the heart causes blood to flow into the surroundingpericardial sac, the condition produced is cardiac tamponade. The heart’sunyielding sac fills with blood and compresses the chambers of the heart to a pointwhere they will no longer adequately fill, backing up blood into the veins.C)INCORRECT. In commotio cordis the impact occurs just when the heart isvulnerable. There are several hundredths of a second during each heartbeat whenthe heart, if sufficiently stimulated, will go into ventricular fibrillation (VF).D)INCORRECT. Pericardial effusion would imply that the heart was flowing forthblood, instead of being collected in the pericardial space.5
15)Which of the following istrueconcerning lacerations?15)A)They may be caused by penetrating trauma.B)They may indicate deeper underlying tissue damage.C)They may be caused by blunt trauma.D)All of the aboveAnswer:DExplanation:A)INCORRECT. Lacerations may be caused by penetrating trauma, but may also becaused by other trauma.B)INCORRECT. Lacerations may indicate deeper underlying tissue damage and mayalso be caused by trauma.C)INCORRECT. Lacerations may be caused by blunt force trauma, but may also becaused by other trauma.D)CORRECT. Lacerations may be caused by blunt force trauma, penetrating trauma,and may indicate deeper underlying tissue damage.16)Which of the following is a strategy to maintain an occlusive dressing to bloody or diaphoreticskin?16)A)Do not use occlusive dressings in this case.B)Manually maintain pressure.C)Wrap the dressing circumferentially with gauze.D)Do not use adhesive tape.Answer:BExplanation:A)INCORRECT. If an occlusive dressing is called for as part of the treatment plan, itmust be applied.B)CORRECT. To help hold an occlusive dressing to blood or sweaty skin, the EMTmay have to maintain constant pressure over the dressing so as to hold it in place.C)INCORRECT. Do not wrap the occlusive dressing circumferentially as thecirculation to the area may be occluded.D)INCORRECT. Tape still must be used to secure the edges of an occlusive dressing.17)For which of the following wounds should the EMT apply an absorbent dressing moistened withsterile saline and then cover it with an occlusive dressing?17)A)Laceration to the neckB)The stump of an amputated extremityC)Stab wound to the chestD)Gunshot wound (GSW) to the abdomen from which a loop of intestine is protrudingAnswer:DExplanation:A)INCORRECT. A laceration to the neck should be covered with an occlusivedressing.B)INCORRECT. A stump of an amputated extremity should be covered with a steriledressing and pressure bandage.C)INCORRECT. A stab wound to the chest should be covered with an occlusivedressing only.D)CORRECT. A GSW to the abdomen with an evisceration should have the organscovered with an absorbent dressing moistened with saline and then covered by anocclusive dressing.6
18)Which of the following traumatic chest injuries may result in massive, often fatal internalhemorrhage?18)A)Aortic dissectionB)HemopneumothoraxC)Cardiac tamponadeD)HemothoraxAnswer:AExplanation:A)CORRECT. An aortic dissection results in massive, often fatal internal hemorrhage.The reason is so little time that elapses from dissection until the patient bleeds outinternally away from the surgery suite of a trauma hospital.B)INCORRECT. A hemopneumothorax is bleeding and air trapped in the chestcavity. The blood flow is related to the size of the vessel rupture, and with rapidtransport to a trauma center, the patient may survive.C)INCORRECT. A cardiac tamponade is bleeding within the pericardial sac. Withrapid transport to a trauma center, the patient may survive.D)INCORRECT. A hemothorax is blood trapped in the chest cavity. The blood flow isrelated to the size of the vessel rupture, and with rapid transport to a traumacenter, the patient may survive.19)The mechanism of injury in which a patient’s chest has struck an immovable object, such as asteering wheel, may most accurately be described as a(n):19)A)penetrating injury.B)coup contrecoup injury.C)open trauma injury.D)compression injury.Answer:DExplanation:A)INCORRECT. Penetrating injury is an open wound of the chest caused by aprojectile or a handheld weapon.B)INCORRECT. The coup contrecoup injury is an injury of the head where the brainmoves back and forth in the head striking the inside of the skull.C)INCORRECT. An open trauma injury is an injury caused by being cut by a sharpobject or a projectile breaking the skin.D)CORRECT. Compression injuries develop from severe blunt trauma in which thechest is rapidly compressed, such as when a driver strikes his chest on the steeringcolumn or when a person is trapped in a trench-wall collapse. The key is theinternal chest organs are compressed between the sternum, ribs, and vertebra.20)Your patient was working on a car when it fell off the jack and trapped him between the tire andground. His face is very blue and his eyes are bloodshot. Which of the following has the patientmost likely suffered?20)A)PneumothoraxB)Traumatic asphyxiaC)Flail chestD)HemothoraxAnswer:BExplanation:A)INCORRECT. A pneumothorax is a collapsed lung, which does not present withbloodshot eyes.B)CORRECT. The bluish appearance and bloodshot eyes suggest the increasedpressure build up in the chest causing the blood to back up from the right atriuminto the head, neck, and face.C)INCORRECT. A flail chest is a contiguous section of broken ribs in two or moreplaces. This injury does not present with bloodshot eyes.D)INCORRECT. A hemothorax is bleeding from a great vessel within the chestcavity.7
21)While palpating the radial pulses of a patient who was involved in a motor vehicle crash, younotice a difference in the strength of the pulses bilaterally. This is a finding that you suspect may beassociated with:21)A)aortic dissection.B)tension pneumothorax.C)flail chest.D)commotio cordis.Answer:AExplanation:A)CORRECT. Aortic dissection may cause blood pressures and pulse pressures thatare different bilaterally and also from upper and lower extremities.B)INCORRECT. A tension pneumothorax would cause pulses to be diminished dueto the drop in preload, but the pulses would be the same bilaterally.C)INCORRECT. A flail chest segment would not cause pulses that are differentbilaterally.D)INCORRECT. Commotio cordis is cardiac arrest caused from a blow to the chest,which would have pulses that are absent.22)Which of the following is an unreliable sign for determining the presence of a tensionpneumothorax?22)A)Trachea that shifts to the side opposite the injuryB)Signs and symptoms of shockC)Shortness of breathD)Distended neck veinsAnswer:AExplanation:A)CORRECT. In a tension pneumothorax the trachea may shift to the opposite side,but this is a very late sign and one which is difficult to detect, making it anunreliable sign.B)INCORRECT. The signs and symptoms of shock in a patient with a possibletension pneumothorax is a reliable early sign as the vena cava is being compressedby the pressure buildup in the chest cavity.C)INCORRECT. Shortness of breath is an early reliable sign of tension pneumothoraxwhen coupled with diminished or absent breath sound on one side of the chestcavity.D)INCORRECT. Distended neck veins are an early and reliable sign of possibletension pneumothorax.23)A teenage male has fallen onto a railing while skateboarding. He complains of right-sided chestpain and moderate dyspnea. Exposure of the chest reveals a section of his ribs that is movingopposite of the rest of the ribs. You should:23)A)begin positive pressure ventilation.B)roll the patient over onto his right side.C)apply a bulky dressing over the section.D)cover the wound with an occlusive dressing.Answer:CExplanation:A)INCORRECT. Positive pressure ventilation is difficult in a conscious patient who isbreathing adequately.B)INCORRECT. Airway management of this patient will best be accomplished bykeeping the patient supine.C)CORRECT. This patient probably has a flail segment. The appropriatemanagement for a patient with a flail segment that is breathing adequately is toapply a bulky dressing and secure it with tape. Positive pressure ventilation isdifficult in a conscious patient who is breathing adequately, and an occlusivedressing would not help this patient.D)INCORRECT. An occlusive dressing would not help this patient.8
24)You are treating a patient with paradoxical motion on the left side of the chest. He is breathingshallow at a rate of 4 breaths per minute. You should:24)A)apply a bulky dressing to the chest.B)roll the patient onto his left side.C)administer 15 lpm oxygen via mask.D)begin positive pressure ventilation.Answer:DExplanation:A)INCORRECT. The presence of paradoxical motion indicates that he could have aflail segment, which would be treated with a bulky dressing if the patient werebreathing adequately, which in this case he is not.B)INCORRECT. The patient should be kept face up due to the management of theairway is the highest priority.C)INCORRECT. This patient requires aggressive BVM ventilations and notadministration of 15 lpm oxygen via mask.D)CORRECT. This patient is not breathing adequately and needs to be ventilated.The presence of paradoxical motion indicates that he could have a flail segment,which would be treated with a bulky dressing if the patient were breathingadequately.25)Which of the following is a vascular organ in the abdomen that can produce blood loss quicklyenough to result in life-threatening hemorrhage following high mechanism of injury blunt trauma?25)A)LiverB)KidneysC)PancreasD)IntestinesAnswer:AExplanation:A)CORRECT. The liver is a very vascular organ that can cause blood loss quicklyresulting in life-threatening hemorrhage.B)INCORRECT. The kidneys are vascular organs with blood flow, but not as much asthe liver has.C)INCORRECT. The pancreas is a vascular organ with blood flow, but not as muchas the liver would have.D)INCORRECT. The intestines are hollow organs with a diffuse blood supply.26)Bleeding from open abdominal injuries should initially be controlled with which one of thefollowing techniques?26)A)Packing the wound with rolled gauzeB)Applying direct pressure to the woundC)Applying an occlusive dressingD)Applying an ice pack or chemical cold packAnswer:BExplanation:A)INCORRECT. The abdominal wound is not packed with rolled gauze.B)CORRECT. Direct pressure is the initial way to control bleeding from a wound.C)INCORRECT. Occlusive dressings are applied to abdomen after direct pressurefrom a gloved hand.D)INCORRECT. Application of an ice pack is not done for bleeding control.9
27)Which of the following BEST describes the benefit of a three-sided occlusive dressing over afour-sided occlusive dressing for an open chest wound?27)A)It eliminates the need to continue monitoring the patient’s respiratory status.B)It reduces the chances of developing a tension pneumothorax.C)It prevents the development of a hemothorax by allowing blood to escape.D)It allows easy access for re-examination of the wound en route to the hospital.Answer:BExplanation:A)INCORRECT. The patient’s respiratory status must be continuously monitoredduring transport.B)CORRECT. The three-sided taped occlusive dressing would allow for easier reliefof pressure build up by the EMT. The EMT would simply lift the un-taped sideand lift to create a relief valve for the pressure. A four-sided taped occlusivedressing must have one side of the tape removed to relieve the pressure from atension pneumothorax.C)INCORRECT. The occlusive dressing will have no bearing on if a hemothorax willdevelop or not.D)INCORRECT. The re-examination of the open chest wound by the EMT is notmade any easier with where the occlusive dressing is taped.28)Which of the following is of concern with a puncture wound?28)A)The object that remains impaled in the bodyB)Hidden internal bleeding with minimal external bleedingC)Strong possibility of contaminationD)All of the aboveAnswer:DExplanation:A)INCORRECT. A puncture wound with an object that remains impaled is a concernfor the EMT as well as other concerns.B)INCORRECT. Hidden internal bleeding with a puncture wound is a concern evenwith minimal external bleeding as well as other concerns.C)INCORRECT. The threat of contamination must be seriously considered with apuncture wound as well as other concerns.D)CORRECT. A puncture wound has a strong possibility of contamination. In apuncture wound there may be hidden internal bleeding with minimal externalbleeding. Another concern with a puncture wound is the object that remainsimpaled in the body.10
29)Your patient is a 55-year-old male who was found in the parking lot behind a tavern. He statesthat he was assaulted and robbed by three individuals. He is complaining of being “hit in the faceand kicked and punched in his ribs and stomach.” Your examination reveals contusions andswelling around both eyes, bleeding from the nose, a laceration of his upper lip, and multiplecontusions of the chest, abdomen, and flanks. Which of the following should cause the greatestconcern regarding the prehospital care of this patient?29)A)The possibility of a pneumothoraxB)Getting a description of the assailantsC)The presence of any defensive wounds the patient may have sustainedD)Reducing the swelling around his eyes by applying a cold packAnswer:AExplanation:A)CORRECT. Due to the mechanism of injury, the potential of internal injuries like apneumothorax is the greatest concern.B)INCORRECT. Getting a description is an important police matter but not thebiggest concern from a mechanism of injury (MOI) standpoint.C)INCORRECT. Defensive wounds would typically be on the extremities and not ofgreat concern at this time.D)INCORRECT. The swelling around the eyes is a cosmetic issue and not the biggestthreat to life.30)Which of the following patients is at greatest risk of respiratory failure and should be carefullymonitored for ventilatory status throughout treatment and transport?30)A)HemopneumothoraxB)Flail chestC)Tension pneumothoraxD)Abdominal eviscerationAnswer:CExplanation:A)INCORRECT. A patient with a hemopneumothorax will experience respiratorydistress, but will usually respond to oxygenation.B)INCORRECT. A patient with a flail chest may experience respiratory distress as aresult of the injury, but will usually respond favorably to oxygenation therapy.C)CORRECT. Due the chest cavity being filled with air under pressure, the patientwith a tension pneumothorax is at the greatest risk for going into respiratoryfailure as a result of the injury.D)INCORRECT. A patient with an abdominal evisceration may experience tachypneaduring treatment and transport.31)A patient with jugular vein distention (JVD) is most likely suffering from which of the followinginjuries?31)A)PneumothoraxB)Tension pneumothoraxC)HemopneumothoraxD)HemothoraxAnswer:BExplanation:A)INCORRECT. A simple pneumothorax would not cause JVD.B)CORRECT. A tension pneumothorax would cause increased pressure in thesuperior vena cava and could allow blood to back up into the circulation of theneck, thus causing jugular vein distension (JVD).C)INCORRECT. A hemopneumothorax may cause hypotension and not JVD.D)INCORRECT. A hemothorax may cause hypotension and not JVD.11
32)You’re an off-duty EMT who encounters a patient sitting behind the wheel of a vehicle that ran offthe road along an isolated county road. It appears the patient was unrestrained, or not wearing aseat belt, and struck the steering wheel with his chest. On assessment, you notice a paradoxicalmotion to the patient’s chest on inspiration and expiration. When you radio for dispatch of anambulance, which of the following pieces of information would you be sure to include?32)A)The patient is showing signs of abdominal bleeding.B)The patient may have a flail chest.C)The patient may have an abdominal evisceration.D)The patient is showing signs of an open chest injury.Answer:BExplanation:A)INCORRECT. The patient with abdominal bleeding would have internal bleedingin the abdominal cavity not the chest cavity.B)CORRECT. Blunt force trauma may cause injuries such as a flail segment of thechest.C)INCORRECT. An abdominal evisceration is an open wound of the abdomen andnot a chest injury.D)INCORRECT. Striking the steering wheel would not cause an open chest injury butinstead a closed chest injury like a flail segment.33)You have covered an open chest wound with your gloved hand and the patient’s breathing hasimproved. In order to free your hand to provide further care, you should:33)A)remove your hand to see if the wound has closed.B)cover the wound with an occlusive dressing.C)apply a bulky dressing over the wound.D)cover the wound with a sterile dressing.Answer:BExplanation:A)INCORRECT. Even if the wound has closed on its own, you should still apply anocclusive dressing in case the wound opens again, thus do not remove your handuntil ready to place the occlusive dressing on the patient.B)CORRECT. Open chest wounds should be covered with an occlusive dressing toprevent air from being drawn into the chest. In an emergency, a gloved hand maybe used temporarily to close the wound. However, eventually a dressing must beapplied to free the EMT to provide further care. Although it is important for thedressing to be sterile, it is essential that the dressing does not allow air to passthrough the wound. A bulky dressing will probably not be needed to controlbleeding and it will not prevent air from being sucked into the chest. Even if thewound has closed on its own, you should still apply an occlusive dressing in casethe wound opens again.C)INCORRECT. A bulky dressing will probably not be needed to control bleedingand it will not prevent air from being sucked into the chest.D)INCORRECT. Although it is important for the dressing to be sterile, it is essentialthat the dressing does not allow air to pass through the wound.12
34)In addition to lacerations, blunt trauma resulting in a closed chest injury creates the potential forwhich of the following internal injuries?34)A)AbrasionB)EviscerationC)AvulsionD)ContusionAnswer:DExplanation:A)INCORRECT. An abrasion is an open soft tissue injury involving the epidermis.B)INCORRECT. An evisceration is an open soft tissue injury of the abdominal cavity.C)INCORRECT. An avulsion is an open soft tissue injury where the skin is tornaway.D)CORRECT. A contusion (bruising) is a closed soft tissue injury caused by bluntforce trauma.35)What is the underlying cause of bluish or reddish facial discoloration following a traumaticasphyxiation?35)A)The physiological strain of the body results in a flushed appearance and increased risk of ahypertensive event.B)Bluish or reddish facial discoloration is not associated with traumatic asphyxiation; a palediscoloration is usually present.C)The patient has become hypoxic due to a chest injury and the finding suggests centralcyanosis.D)High pressure on the chest leads to blood being forced from the right atrium into the face andneck.Answer:DExplanation:A)INCORRECT. The patient with traumatic asphyxiation is not experiencing ahypertensive crisis.B)INCORRECT. Traumatic asphyxiation is not associated with a pale appearance butinstead a bluish or reddish appearance.C)INCORRECT. Central cyanosis would mean that blood is shunted away from theperipheral circulation into the central torso. In traumatic asphyxiation caused frompressure on the chest, the blood would collect in the upper torso and face and notthe lower torso.D)CORRECT. In traumatic asphyxiation the high pressure on the chest leads to bloodbeing forced from the right atrium into the face and neck.36)You find a middle-aged male is sitting against a wall in obvious distress. The patient appears to beextremely short of breath and has an open wound to his chest that is making a sucking sound. Youshould:36)A)cover the wound with an occlusive dressing.B)place a trauma dressing over the wound.C)place your gloved hand over the wound.D)place the patient on high-concentration oxygen.Answer:CExplanation:A)INCORRECT. An occlusive dressing is appropriate but it takes time to apply,making the gloved hand the best choice.B)INCORRECT. A trauma dressing would not stop air from entering the chest.C)CORRECT. This patient has a wound that is immediately life threatening, makingquick action vital. Placing your gloved hand over the wound will stop air fromentering the chest. An occlusive dressing is appropriate but it takes time to apply.A trauma dressing would not stop air from entering the chest. Supplementaloxygen will be needed in this patient, but his ventilation must be attended to first.D)INCORRECT. Supplemental oxygen will be needed in this patient, but hisventilation status correction must be attended to first.13
37)On assessment of the midsection of a 32-year-old male who was struck by a car, you find anabdominal evisceration with several loops of his large intestine exposed. The abdomen appears tohave a clean-cut laceration and the bleeding is controlled. Which of the following is the BESTapproach toward managing the exposed intestines?37)A)Gently replace the intestines after moistening with sterile saline solution.B)Leave the abdominal contents in the place in which they were found and transportimmediately.C)Cover the abdomen with an occlusive dressing of aluminum foil.D)Moisten a sterile dressing with saline solution and cover the abdominal contents.Answer:DExplanation:A)INCORRECT. The intestines should not be replaced by the EMT in the field.B)INCORRECT. The organs must be kept moist and clean so leaving the organs alonefor transport would not be a good option as contamination will occur withoutproper care and covering of the protruding organs.C)INCORRECT. An occlusive dressing of aluminum foil would cause the organs tobe cut by the edges of the aluminum foil.D)CORRECT. For an evisceration it is important to moisten a sterile dressing withsaline solution and cover the abdominal contents with an occlusive dressing.38)Which of the following is a desirable characteristic of dressings used in the prehospitalmanagement of most open wounds?38)A)SterileB)AdherentC)OcclusiveD)NonabsorbentAnswer:AExplanation:A)CORRECT. Most open wounds are treated with dry, sterile dressings.B)INCORRECT. Adherent implies that the dressing will stick to the wound. This typeof dressing is to be avoided in the care of open wounds.C)INCORRECT. Occlusive dressings are used for open injuries of the chest, neck, andabdomen, but are not routinely used on other open wounds.D)INCORRECT. Absorbent is a material that absorbs liquids, but is not readily usedon open wounds. Nonabsorbent would not absorb liquids.39)Common signs and symptoms following an injury to a hollow abdominal organ include:39)A)increasing intrathoracic pressures.B)absence of unilateral pulses.C)massive hemorrhage.D)irritation and peritonitis.Answer:DExplanation:A)INCORRECT. Increasing intrathoracic pressures would indicate that the lungwithin the chest cavity had collapsed and was building up pressures.B)INCORRECT. The absence of unilateral pulses would be a sign of an aorticdissection.C)INCORRECT. Massive hemorrhage would usually be attributed to vascular solidorgans like the liver or spleen.D)CORRECT. A ruptured hollow organ would cause irritation and peritonitis.14
40)You are caring for a 27-year-old male who has a puncture wound to the right upper chest. Thepatient was stabbed with a serrated steak knife by his ex-girlfriend. You have placed an occlusivedressing to the site and began emergent transport to the closest trauma center. However, while enroute the patient begins to complain of increasing shortness of breath. You notice a decrease inventilatory volume and an increase in thoracic diameter. Which of the following options would bethe best step to perform next?40)A)Begin providing CPR to the patient.B)Call dispatch for an ALS intercept en route to the hospital.C)Begin providing BVM-assisted ventilations to the patient.D)Free a corner or edge of the dressing and have the patient exhale to release pressure buildup.And re-seal the woundAnswer:DExplanation:A)INCORRECT. CPR should not be begun on this patient as the patient is not iscardiac arrest yet and a simple airway maneuver should correct the problem.B)INCORRECT. BLS procedures should be attempted by the EMT before calling anALS intercept.C)INCORRECT. Simple maneuvers like releasing pressure on the occlusive dressingshould be tried before BVM ventilation is started.D)CORRECT. An open chest wound covered with an occlusive that begins to developpressure should have the corner lifted to release the built up pressure.41)Your patient is a 21-year-old male who has a gunshot wound to the chest. Which of the followingis the highest priority in managing this patient?41)A)Placing the patient in the shock positionB)Performing a rapid trauma assessmentC)Placing an occlusive dressing over the woundD)Placing a pressure dressing over the wound to control bleedingAnswer:CExplanation:A)INCORRECT. The patient being placed in the recovery position is done during thesecondary assessment after treating obvious threats to life.B)INCORRECT. A rapid trauma assessment is done after correcting the threat to lifethat exists due to the open chest wound.C)CORRECT. The most important first step for this patient is to place an occlusivedressing over the sucking chest wound.D)INCORRECT. A pressure dressing would still allow air to be entrained into thewound since it is not an occlusive dressing.15
42)You are dispatched to a 42-year-old male who was shot in the abdomen and thrown from avehicle. The patient is critical and a high-category trauma; however, due to the mechanism ofinjury, it is necessary to backboard the patient prior to transport. What is an important assessmentbefore securing the patient?42)A)Verifying trauma center ER bed availabilityB)Performing a distal neurological assessmentC)Examining the patient for entrance and exit woundsD)Searching for presence of diaphoresis, tachycardia, and hypotensionAnswer:CExplanation:A)INCORRECT. Hospital bed availability is not an important matter for the EMTwhen dealing with critical patients.B)INCORRECT. Performing a neurological assessment on the patient would be partof the secondary assessment and done en route if there is time when the patient’scritical status improves.C)CORRECT. Part of the primary assessment of the patient that has been shot is tolook for the presence of entrance and exit wounds to effectively manage them.D)INCORRECT. The presence of hypotension, tachycardia, and sweating issecondary to primary assessment key points like searching for gunshot wound(GSW) injuries.43)Your patient has an open abdominal wound with intestines protruding. You should:43)A)attempt to place the organs back into the abdomen.B)cover the organs with moist sterile dressings.C)cover the entire abdomen with a blanket.D)leave them alone and transport rapidly.Answer:BExplanation:A)INCORRECT. Do not attempt to replace the protruding organs in the field. EMTsshould never manipulate eviscerated abdominal organs.B)CORRECT. Abdominal organs that are protruding from an open wound should becovered with moist sterile dressings and then an occlusive dressing. It is importantto keep the organs moist and clean. EMTs should never manipulate evisceratedabdominal organs. Blankets are good for keeping abdominal organs warm after theinitial care is given.C)INCORRECT. Blankets are good for keeping abdominal organs warm after theinitial care of the occlusive dressing is given.D)INCORRECT. Abdominal organs that are protruding from an open wound shouldbe covered with moist sterile dressings and then an occlusive dressing. It isimportant to keep the organs moist and clean.16
44)Which of the following BEST describes an evisceration?44)A)Open wound of the abdomen from which organs protrudeB)Accumulation of blood beneath the skin, resulting in swellingC)Flap of skin that is partially or completely torn away from the underlying tissueD)Epidermis that is scraped away by a rough surfaceAnswer:AExplanation:A)CORRECT. An evisceration is an open wound of the abdomen from which theorgans protrude.B)INCORRECT. A contusion is an accumulation of blood beneath the skin, resultingin swelling.C)INCORRECT. An avulsion is a flap of skin that is completely or partially torn awayfrom the underlying tissue.D)INCORRECT. An abrasion is an injury where the epidermis is scraped away by arough surface.45)You are palpating the abdomen of a motor vehicle collision patient when you feel a pulsing mass.You should:45)A)ask your partner to verify your findings.B)defer further abdominal palpation.C)apply cold packs to the abdomen.D)bind the abdomen with an elastic bandage.Answer:BExplanation:A)INCORRECT. The injury should be palpated initially and then left alone.B)CORRECT. A pulsing mass in the abdomen may indicate an aortic injury. Once itis palpated initially, it should not be reassessed again in the field. This patientneeds to be transported to a trauma center immediately.C)INCORRECT. Cold packs are not applied to the abdomen with a pulsating mass.D)INCORRECT. The use of an abdominal elastic bandage is not utilized for apulsating mass.46)Which of the following injuries may produce distended neck veins (JVD)?46)A)Cardiac tamponadeB)Traumatic asphyxiaC)Tension pneumothoraxD)All of the aboveAnswer:DExplanation:A)INCORRECT. Cardiac tamponade may cause JVD as well as other injuries.B)INCORRECT. Traumatic asphyxia may cause distend neck veins (JVD) as well asother injuries.C)INCORRECT. Tension pneumothorax may cause JVD as well as other injuries.D)CORRECT. Traumatic asphyxia, tension pneumothorax, and cardiac tamponademay all cause distended neck veins (jugular vein distensionNJVD).17
47)Which of the following is NOT appropriate in caring for a patient with closed soft-tissue injuriesand a significant mechanism of injury?47)A)Anticipate vomiting.B)Treat for shock if you think there are internal injuries even if the patient’s vital signs arenormal.C)Splint any swollen, deformed extremities.D)All of the aboveAnswer:DExplanation:A)INCORRECT. With a significant MOI, the EMT should anticipate vomiting by thepatient along with other care.B)INCORRECT. With a significant mechanism of injury (MOI), treating for shockmust be done along with other care.C)INCORRECT. With a significant MOI, splinting of extremities may be performedalong with other care.D)CORRECT. With closed soft-tissue injuries and a significant MOI, treat the patientfor shock, anticipate vomiting by the patient, and splint any deformed extremities,if time allows.48)Which of the following is required in the management of all open soft-tissue injuries?48)A)Application of a disinfectant solution during clean-upB)Cervical spine precautionsC)The use of Standard Precautions by the EMTD)Provision of high-concentration oxygen to the patientAnswer:CExplanation:A)INCORRECT. A disinfection solution is used on contact surfaces and not directlyon the patient. The application of a disinfectant solution is not done duringmanagement of the patient with open soft-tissue injuries, but only sometimes onthe cleanup procedures.B)INCORRECT. Not all open soft tissue injuries will require cervical spineprecautions.C)CORRECT. All open soft-tissue injuries should alert the EMT to use standard bodysubstance isolation (BSI) precautions such as gloves.D)INCORRECT. Not all open soft tissue injuries will require the provision of highflow O2.18
Answer KeyTestname: C271)D2)A3)C4)A5)D6)D7)B8)B9)D10)D11)B12)B13)B14)B15)D16)B17)D18)A19)D20)B21)A22)A23)C24)D25)A26)B27)B28)D29)A30)C31)B32)B33)B34)D35)D36)C37)D38)A39)D40)D41)C42)C43)B44)A45)B46)D47)D48)C19


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