Deck 3: Hemorrhage and Shock

Question 1

When a patient has lost 2 liters or more of blood from hemorrhage, which classification is that?

A) I
B) III
C) IV
D) II

Answer 1

IV

Question 2

When assessing the chest during a rapid trauma assessment, what is MOST likely to indicate major internal hemorrhage?

A) Hyporesonance to percussion
B) Increased respiratory rate
C) Distended neck veins
D) Muffled heart tones

Answer 2

Hyporesonance to percussion

Question 3

Your patient is a 23-year-old man with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock?

A) Compensated
B) Irreversible
C) Decompensated
D) Neurogenic

Answer 3

Decompensated

Question 4

Peripheral vascular resistance is measured as which of the following?

A) Pulse pressure
B) Mean arterial pressure
C) Hydrostatic pressure
D) Oncotic pressure

Question 5

A fracture of the femur may result in a hematoma that contains enough blood to make it a class ________ hemorrhage.

A) I
B) III
C) IV
D) II

Question 6

Your patient is a 42-year-old man with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival, he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient?
1) Control major hemorrhage.
2) Take Standard Precautions.
3) Check the area for broken glass before kneeling next to the patient.
4) Turn him to a supine position.
5) Open his airway.

A) 2, 3, 1, 4, 5
B) 2, 5, 1, 3, 4
C) 2, 3, 4, 1, 5
D) 2, 3, 4, 5, 1

Question 7

As a patient with hemorrhagic blood loss becomes more acidotic, what homeostatic process is usually impaired?

A) Coagulation
B) Hemoptysis
C) Vascular phase
D) Aerobic metabolism

Question 8

Which of the following findings indicates a progression from compensated shock to decompensated shock?

A) Narrowing pulse pressure
B) Tachycardia
C) Altered mental status
D) Diaphoresis

Question 9

What is the best course of action in the case of hemorrhage from either the nose or ear canal?

A) Cover the area with a soft, porous dressing
B) Apply direct pressure to the upper face
C) Squeeze the nostrils closed
D) Apply pressure to the forehead

Question 10

Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock?

A) Administer hypertonic saline solution or colloids at a keep-open rate.
B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness.
C) Begin with a 2,000 mL bolus of isotonic crystalloid solution infused under pressure.
D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion.

Question 11

Which type of wound facilitates the effectiveness of normal blood clotting mechanisms?

A) Vessels torn by stretching, such as when a limb is caught in farm machinery
B) Transverse laceration of the vessel
C) Longitudinal laceration of the vessel
D) Crushing injuries

Question 12

Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock?

A) Fresh frozen plasma
B) Lactated Ringer's
C) Whole blood
D) Normal saline

Question 13

Which of the following patients with hemorrhagic shock is likely to be internally bleeding, solely?

A) A 50-year-old man with a stab wound to the neck
B) A 45-year-old woman with a suspected ruptured ectopic pregnancy
C) A 38-year-old man with an open femur fracture
D) A 26-year-old man with a gunshot wound involving the popliteal artery

Question 14

Which of the following mechanisms is responsible for accumulating lactic acid in shock?

A) The citric acid cycle
B) Gluconeogenesis
C) Hemostasis
D) Anaerobic metabolism

Question 15

A hematoma resulting from a fracture of the humerus may contain enough blood to make it a class ________ hemorrhage.

A) II
B) IV
C) III
D) I

Question 16

The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase.

A) hemolytic
B) hemostatic
C) vascular
D) ischemic

Question 17

Your patient is a 45-year-old man who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient?

A) He is in irreversible shock.
B) He is in decompensated shock.
C) He is in compensated shock.
D) None of the above is certain.

Question 18

Which of the following does NOT indicate compensated shock?

A) Anxiety
B) Altered mental status
C) Weakness
D) Thirst

Question 19

Managing a laceration with arterial bleeding most often requires:

A) cauterization.
B) a tourniquet.
C) PASG.
D) direct pressure.

Question 20

Which of the following is defined as the volume of blood ejected from the heart with each beat?

A) Stroke volume
B) Ventricular capacitance
C) Cardiac output
D) Afterload

Question 21

Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient?

A) Relative to body size, this patient can tolerate a larger amount of hemorrhage before showing signs of shock.
B) This patient will tolerate blood loss well, as only non-vital tissues will become ischemic.
C) Relative to body weight, a smaller amount of hemorrhage may result in shock.
D) Blood volume increases proportionally with body weight, and the patient will experience signs of shock consistent with the classic stages of hemorrhage.

Question 22

Red blood cells make up approximately ________ percent of whole blood volume.

A) 45
B) 60
C) 30
D) 15

Question 23

Rapid volume replacement is best achieved under which of the following conditions?

A) Use of a long catheter with a large internal diameter
B) Use of a long catheter with a small internal diameter
C) Use of a short catheter with a small internal diameter
D) Use of a short catheter with a large internal diameter

Question 24

Which of the following is a manifestation of orthostatic hypotension?

A) Your patient's pulse is 76 when he is supine but 88 when he sits up.
B) Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up.
C) Your patient's blood pressure is 150/100 when he is supine but 134/90 when he sits up.
D) Your patient's pulse is 80 when she is supine but 96 when she sits up.

Question 25

The blood flowing to the heart best describes:

A) contractility.
B) afterload.
C) preload.
D) vascular phase.

Question 26

What method of controlling hemmorage should be done as a last resort?

A) Elevation
B) Direct pressure
C) Tourniquet
D) Packing the wound with bandages and dressings

Question 27

Which of the following is NOT a characteristic of arterial bleeding?

A) Rapid blood loss
B) Spurting or pumping as it leaves the body
C) Clots quickly on its own
D) Bright red

Question 28

Your patient is a 29-year-old man who works in a meat-processing plant. He received a knife wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood pressure of 118/88 mmHg. This patient is exhibiting signs and symptoms consistent with a class ________ hemorrhage.

A) III
B) II
C) IV
D) I

Question 29

Which of the following vessels has the greatest ability to change diameter?

A) Arteriole
B) Capillary
C) Systemic artery
D) Aorta

Question 30

Which of the following fluids is appropriate for the prehospital management of hypovolemic shock?

A) Five percent dextrose in water
B) Lactated Ringer's
C) A 0.2% sodium chloride solution
D) A 0.45% sodium chloride solution

Question 31

Which of the following impairs blood clotting?

A) Hypothermia
B) Administration of IV fluids
C) Use of nonsteroidal, anti-inflammatory medications
D) All of the above

Question 32

Which of the following statements about the patient in neurogenic shock is FALSE?

A) Signs of hypovolemic shock may be masked.
B) Unopposed sympathetic nervous stimulation results in systemic pallor and diaphoresis.
C) Can present with neck and/or back pain.
D) Neurogenic shock may require IV fluid resuscitation.

Question 33

Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage?

A) Administration of blood or blood products
B) Administration of hypertonic crystalloid or colloid solution
C) Invasive hemodynamic monitoring and serial hematocrits
D) Immediate surgery

Question 34

Which of the following early signs of shock is easily missed?

A) Tachycardia
B) Decrease in respiratory rate and volume
C) Decrease in blood pressure
D) Narrowing pulse pressure

Question 35

Which of the following indicates that a patient has transitioned from compensated to decompensated shock?

A) Widening pulse pressure
B) Increased respiratory rate
C) Hypotension
D) Peripheral vasoconstriction

Question 36

Which of the following is TRUE of the elderly trauma patient?

A) The elderly trauma patient is more likely to experience myocardial ischemia as a result of hemorrhage.
B) Medications like beta-blockers may interfere with normal compensatory mechanisms.
C) Hemorrhage may not result in tachycardia as expected.
D) All of the above are true.

Question 37

Which of the following would be the MOST likely cause of neurogenic shock?

A) Pericardial tamponade
B) Spinal cord injury
C) Systemic infection
D) Massive histamine release

Question 38

The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas?
1) Head
2) Neck
3) Chest
4) Abdomen
5) Pelvis
6) Proximal extremities
7) Distal extremities

A) 1, 2, 3, 4, and 5
B) 1, 4, 5, and 6
C) 1, 2, 3, 4, 5, 6, and 7
D) 3, 4, 5, and 6

Question 39

Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume.

A) 25
B) 15
C) 50
D) 35

Question 40

Under normal circumstances, at any given moment most of the blood is in the ________ system.

A) venous
B) capillary
C) hematopoietic
D) arterial

Question 41

In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment?

A) Rapid heart rate and anxiety
B) Rapidly dropping blood pressure
C) Rapid breathing and air hunger
D) Rapidly dropping level of responsiveness

Question 42

Which of the following findings is NOT likely with a patient in cardiogenic shock?

A) Pulmonary edema
B) Excessive urination
C) Arrhythmias
D) Jugular vein distention

Question 43

Which of the following terms is best described as the loss of blood from the vascular space?

A) Hypovolemia
B) Hemorrhage
C) Hemostasis
D) Shock

Question 44

Brighter red, slow, oozing blood flow is characteristic of which type of hemorrhage?

A) Arterial
B) Venous
C) Capillary
D) Arteriole

Question 45

What is the mechanism of TXA?

A) Antifibrinolytic
B) Coagulopathy
C) Thrombocytopenia
D) Development of metabolic acidosis

Question 46

Blood present in the stool of a patient is known as:

A) hemoptysis.
B) hematemesis.
C) hematochezia.
D) hemorrhage.

Question 47

In which stage of shock are the body's cells are so badly injured and die in such quantities that organs no longer are able to function normally?

A) Decompensated
B) Irreversible
C) Compensated
D) Class I

Question 48

Which of the following may move more slowly through the early stages of hemorrhage with greater loss percentages needed to transition from one stage class to another?

A) Elderly patients
B) Infants
C) Alcoholics
D) Athletes

Question 49

Which of the following represents the correct sequence for controlling hemorrhage from an extremity?

A) Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet
B) Direct pressure on the dressing and wound, elevation, ice
C) Finger pressure through the dressing to the leaking vessel, splinting, ice, elevation
D) Direct pressure on the dressing and wound, elevation, ice, tourniquet as a last resort

Question 50

Which of the following vessels does NOT make up the microcirculation in the circulatory system?

A) Arterioles
B) Capillaries
C) Venules
D) Veins