Question 1

Paradoxical chest movement suggests a:

Accepted Answer

Paradoxical chest movement is associated with fractured ribs or a flail chest. This fracture should be stabilized immediately.

Question 2

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

Accepted Answer

The D (disability) in neurologic status of the primary assessment is assessed by determination of the patient's degree of responsiveness to stimuli.

Question 3

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

Accepted Answer

Crepitus is a sign of air leakage into soft tissue. Crepitus in soft tissues is caused by air that has penetrated the area as a result of injury; it is also referred to as subcutaneous emphysema. Bony crepitus is a grating or grinding sensation caused by fractured bone ends or joints rubbing together. A foreign body could obstruct the patient's airway, producing stridor, or a bark may be heard with an obstructed airway.

Question 4

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

Accepted Answer

Suction is used to remove blood, vomitus, or foreign bodies from the airway of an unconscious patient. The other choices put the patient at risk for aspiration or further injury if a neck injury is involved.

Question 5

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

Accepted Answer

Distant, muffled heart sounds and distended neck veins may indicate cardiac tamponade, a life-threatening condition. Iliac spine pain indicates a pelvic fracture that may become life-threatening depending on the extent of occult bleeding. Intense pain with deep palpation is not certain to be deadly. Eye pain with photophobia signals acute glaucoma, which can lead to blindness if treatment is delayed.

Question 6

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:

Accepted Answer

On arriving at the site, the patency of the upper airway is the priority and should be managed before proceeding with further assessments.

Question 7

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

Accepted Answer

If trauma above the clavicle is suspected, it is necessary to control the cervical spine by stabilizing the neck in a neutral position. Excessive movement can convert a fracture or dislocation without neurologic damage to one with neurologic damage.

Question 8

The ABCs of a primary survey would be interrupted to:

Accepted Answer

The primary assessment is interrupted to manage a life-threatening condition as soon as it is detected. Once the condition is stabilized, the primary assessment is continued. Recording of events as they occur should be completed in a manner that does not interrupt continued care or transport. Reassessment of the patient's temperature is inappropriate because it would interrupt the continued assessment process. Transporting the patient may begin after the primary assessment has been completed to determine the needs of the patient adequately.

Question 9

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

Accepted Answer

Capillary refill can be assessed by pressing firmly over a nail bed or bony prominence such as the chin, forehead, or sternum until the skin blanches. Count the seconds it takes for color to return. Less than 2 seconds is a normal finding, and longer than 2 seconds indicates poor perfusion.

Question 10

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:

Accepted Answer

The patency of the upper airway is assessed at the start by asking the patient a question. If the patient answers, this is a sign that the airway is open at this time.

Question 11

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

Accepted Answer

Secondary assessments are done after life-threatening problems are determined. For the hypotensive patient, it would be most important to begin secondary assessment of cerebral perfusion by determining the patient's level of consciousness.

Question 12

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:

Accepted Answer

Raccoon eyes (bruising around the eyes) and the Battle sign (bruising behind the ears) both indicate a basilar skull fracture. Symptoms of orbital fractures are swelling of the eyelid, bruising of the eye, pain in the eye, double vision, and decreased movement of the affected eye. Signs and symptoms of a subdural hematoma are loss of consciousness after the original injury, steady or fluctuating headache, weakness, numbness or inability to speak, slurred speech, nausea, vomiting, lethargy, and seizures.

Question 13

The Cushing triad includes:

Accepted Answer

The Cushing triad is associated with increased intracranial pressure. It includes bradycardia, hypertension, and irregular respirations, even Cheyne-Stokes respirations.

Question 14

You would complete a Glasgow Coma Scale rating during the:

Accepted Answer

During the secondary survey, the full range of injuries is determined. The level of consciousness is determined, and the Glasgow Coma Scale is scored as indicated.

Question 15

Delayed capillary refill may alert you to:

Accepted Answer

Delayed capillary refill means that the vessels are taking an extended time to fill, which is a sign of decreased cardiac output. To assess peripheral perfusion further and detect hypovolemic shock, note the skin color, presence and quality of pulses, and temperature of the extremities.

Question 16

The application of blunt sternal pressure is used to detect:

Accepted Answer

Blunt sternal pressure will be painful if any attached ribs are fractured. Sternal pressure is applied to the chest to assess the stability of the chest wall.

Question 17

Respiratory distress may be evidenced by:

Accepted Answer

Respiratory distress results in an increased intrathoracic negative pressure as the body attempts to suck in more atmospheric air. This increased negative pressure causes the chest wall skin to retract around the ribs during inspiration. The other choices are related to cardiovascular distress.

Question 18

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

Accepted Answer

Status asthmaticus is a severe and prolonged asthma attack that resists the usual therapeutic approaches. The patient experiences dyspnea, can only get out a few words between breaths, and has tachycardia often greater than 130 beats/min and pulsus paradoxus greater than 20 mm Hg. Pulsus paradoxus is more likely in pericardial effusion, constrictive pericarditis, and severe asthma.

Question 19

The term status epilepticus is defined as:

Accepted Answer

Status epilepticus is a prolonged seizure or series of seizures that occur without recovery of consciousness.

Question 20

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

Accepted Answer

Clear or amber drainage from the nose or ears may indicate a basilar skull fracture. Bloody drainage is associated with a perforated tympanic membrane.

Quiz 26: Emergency or Life-Threatening Situations