Deck 27: Emergency or Life-Threatening Situations

Question 1

On palpating the chest wall of a trauma patient, you feel subcutaneous crepitus (emphysema), which is a sign that:

A) air has leaked into soft tissue.
B) a fracture underlies the injury.
C) a foreign body is present.
D) there is vascular obstruction.

Answer 1

air has leaked into soft tissue.

Question 2

The application of blunt sternal pressure is used to detect:

A) a fracture of attached ribs.
B) the motor function of the T7 dermatome.
C) pneumothorax.
D) cardiac contusion.

Answer 2

a fracture of attached ribs.

Question 3

While performing the primary survey on a trauma victim, the patient is answering your questions. You may assume that during the time of the questioning:

A) his airway is open.
B) he is alert and oriented.
C) no head injury has occurred.
D) there is no respiratory compromise.

Answer 3

his airway is open.

Question 4

Respiratory distress may be evidenced by:

A) retractions of accessory muscles.
B) bradycardia.
C) flushed skin.
D) decreased capillary refill time.

Question 5

During initial ABCDE assessments of life-threatening conditions, D (disability) in neurologic status is assessed by the patient's:

A) pupil size.
B) degree of responsiveness.
C) nuchal rigidity.
D) mood and affect.

Question 6

Paradoxical chest movement suggests a:

A) spontaneous pneumothorax.
B) flail chest.
C) clavicle fracture.
D) pulmonary contusion.

Question 7

The ABCs of a primary survey would be interrupted to:

A) complete the assessment record.
B) manage life-threatening conditions.
C) reassess the patient's temperature.
D) transport the patient via airlift.

Question 8

You have gone by ambulance to a construction site where an adult male is lying on the street. The only information you have is that he fell three stories. His neck is immobilized with sacks of concrete mix on either side. Your first action should be to determine:

A) airway patency.
B) bleeding sites.
C) cranial nerve function.
D) limb position.

Question 9

Pulsus paradoxus greater than 20 mm Hg, tachycardia greater than 130 beats/min, and increasing dyspnea are signs of:

A) intracranial pressure.
B) pulmonary hypertension.
C) status asthmaticus.
D) tetanic contractions.

Question 10

You would complete a Glasgow Coma Scale rating during the:

A) health history.
B) physical examination.
C) primary survey.
D) secondary survey.

Question 11

Mr. Stinson is a 34-year-old patient who presents to the emergency department after an auto accident. On examination, you note raccoon eyes and a positive Battle sign. Raccoon eyes and the Battle sign are associated with:

A) multisystem trauma.
B) orbital fractures.
C) basilar skull fractures.
D) subdural hematoma.

Question 12

If trauma above the clavicle is suspected, it is important to:

A) test range of motion of the neck.
B) remove any headgear.
C) arrange for neck extension x-ray studies.
D) stabilize the neck in a neutral position.

Question 13

The Cushing triad includes:

A) tachycardia.
B) irregular respirations.
C) tachypnea.
D) constricted pupils.

Question 14

A life-threatening condition is recognized with the assessment of:

A) pain with downward pressure on both anterior superior iliac spines.
B) guarding and intense pain with deep palpation of the abdomen.
C) distant and muffled heart sounds, with distended neck veins.
D) severe throbbing pain in one eye, with photophobia.

Question 15

Clear or amber drainage from the nose or ears of a blunt trauma patient may indicate:

A) epiglottitis.
B) a retropharyngeal abscess.
C) a basilar skull fracture.
D) a perforated tympanic membrane.

Question 16

Delayed capillary refill may alert you to:

A) hypovolemic shock.
B) moderate hypoxemia.
C) subnormal intracranial pressure.
D) upper respiratory infection.

Question 17

Capillary refill can be assessed by applying pressure over a nail bed or a(n):

A) bony prominence.
B) eyelid.
C) mucous membrane.
D) femoral vein.

Question 18

Blood, vomitus, and foreign bodies are removed from the oropharynx of the unconscious patient by:

A) stimulating the cough reflex.
B) using a sweeping motion with the finger.
C) performing a back thrust.
D) using suction.

Question 19

The secondary survey of a patient with hypotension would begin with the assessment of:

A) blood type.
B) level of consciousness.
C) number of fractures.
D) swallowing ability.

Question 20

The term status epilepticus is defined as:

A) convulsive activity uncontrolled by medication.
B) nonconvulsive brain wave disturbance, with psychomotor dysfunction.
C) protracted convulsions with unresponsiveness lasting up to 1 hour.
D) seizures that result in hypotension, pallor, and prolonged diaphoresis.

Question 21

Which condition manifests as unexplained shortness of breath (SOB) and cough with hemoptysis?

A) Bleeding ulcer
B) Myocardial infarction
C) Pulmonary embolism
D) Transient ischemia

Question 22

A patient whose spleen is ruptured will show a positive ________ sign.

A) Battle
B) Gower
C) Grey Turner
D) Kehr

Question 23

Adults and children display different physiologic responses to injury and acute illness. An important concept to remember when assessing infants and children is that they:

A) experience lethal arrhythmias first, progressing to respiratory failure.
B) usually experience cardiac arrest before respiratory failure.
C) usually experience respiratory arrest before circulatory failure.
D) tolerate greater volume changes, with less severe consequences.

Question 24

The approximate expected systolic blood pressure for a child older than 1 year is:

A) 120 + child's age in years.
B) 80 + child's age in years.
C) 120 - child's age in years.
D) 80 + (2 $\times$ the child's age in years).

Question 25

In the primary survey of your trauma patient, you discover a bluish discoloration in the periumbilical area. You will chart this as a _________ sign.

Question 26

When calculating the force of impact of a penetrating object, use:

A) the size of the missile and size of the patient.
B) the time of the incident and depth of the wound.
C) the amount of blood loss and level of consciousness.
D) the velocity of the missile and distance from the source.

Question 27

Which injury is the most common precipitator of blunt trauma?

A) Age-related falls
B) Motor vehicle accidents
C) Work-related injuries
D) Childhood play injuries

Question 28

During injury assessment, one of the most crucial historical components is:

A) number of siblings.
B) history of prior fractures.
C) mechanism of injury.
D) past and current occupational exposure.

Question 29

In life-threatening emergencies, consent for treatment:

A) is obtained before treatment to protect the facility from liability.
B) is not necessary.
C) occurs after treatment is administered.
D) is not valid because the patient is not competent.

Question 30

Until they are stabilized, trauma patients require reevaluation:

A) every 2 minutes.
B) every 5 minutes.
C) every 10 minutes.
D) every hour.