PCare, Ch 19 Quiz Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume. A) 15 B) 25 C) 50 D) 35 2) Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock? A) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness. B) Begin with a 2000 ml bolus of isotonic crystalloid solution infused under pressure. C) Administer isotonic crystalloid fluids only as necessary to maintain perfusion. D) Administer hypertonic saline solution or colloids at a keep-open rate. 3) Which of the following results from relaxation of the postcapillary sphincters in shock? A) Septicemia B) "Washout" of microemboli and lactic acid C) Melena D) Diffuse intravascular coagulation 4) 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) Immediate surgery D) Invasive hemodynamic monitoring and serial hematocrits 5) Which of the following measures effectively controls bleeding in body cavities? A) PASG B) Surgery C) Therapeutic hypotension D) Administration of platelets and clotting factors 6) Which layer of the arteries controls the diameter of the vessel? A) Tunica adventitia B) Tunica intima C) Tunica externa D) Tunica media 7) Your patient is a 23-year-old male cyclist who was impaled in the chest by a small tree branch as he was riding on a trail. The branch has been removed on your arrival. You note a 1 cm wound in the third intercostal space in the midclavicular line on the right. There is minimal bleeding. You note air being sucked into the wound when the patient inhales, but air does not exit the wound on exhalation. The patient is anxious and has a weak radial pulse of 116 that disappears on inhalation. The patient's respiratory rate is 28, and breath sounds are absent on the right side. The patient is sitting against a tree and refuses to lie down. You note jugular venous distention, but no tracheal deviation. Which types of shock should you suspect in this patient? A) Respiratory and hypovolemic B) Obstructive and respiratory C) Hypovolemic and obstructive D) Distributive and respiratory 1)

2)

3)

4)

5)

6)

7)

8) The rapid trauma exam focuses on finding injuries that may cause shock. Components of the rapid trauma assessment include all of the following EXCEPT: A) Chest and abdomen for blunt or penetrating trauma. B) Extremities for fractures. C) Posterior for minor abrasions or lacerations. D) Head for serious bleeding. 9) Which of the following represents the correct sequence for controlling hemorrhage from an extremity? A) Pressure bandage, splinting, ice, elevation, tourniquet as a last resort B) Direct pressure, elevation, ice, tourniquet C) Direct pressure, elevation, pressure point compression D) Pressure bandage, pressure point compression, elevation, ice 10) Which of the following is NOT a benefit of PASG? A) Increasing peripheral vascular resistance B) An autotransfusion of up to 2000 ml of blood from the lower extremities C) Decreasing the size of the vascular container D) Minimizing movement of the pelvis and lower extremities 11) Anaphylactic shock is a form of ________ shock. A) cardiogenic B) hypovolemic

8)

9)

10)

11) C) neurogenic D) distributive 12)

12) Which of the following terms is best described as the loss of blood from the vascular space? A) Hypovolemia B) Shock C) Hemostasis D) Hemorrhage 13) Which of the following fluids is appropriate for the prehospital management of hypovolemic shock? A) 0.2% sodium chloride solution B) 0.45% sodium chloride solution C) 5% dextrose in water D) Lactated Ringer's 14) Which of the following is the preferred fluid for resuscitation in hemorrhagic shock? A) Fresh frozen plasma B) Whole blood C) Normal saline D) Lactated Ringer's 15) In which of the following patients with hemorrhagic shock can you employ aggressive fluid resuscitation? A) A 45-year-old woman with a suspected ruptured ectopic pregnancy B) A 50-year-old male with a stab wound to the right upper quadrant of the abdomen C) A 26-year-old male with a gunshot wound involving the popliteal artery D) A 38-year-old male with an open femur fracture and a developing bruise beneath the right scapula following an assault

13)

14)

15)

16) When cells become hypoxic and the amount of carbon dioxide in them increases, reducing tissue pH, which of the following occurs to restore homeostasis? A) The precapillary sphincters open, increasing blood flow to the tissues. The postcapillary sphincters remain closed so that increased hydrostatic pressure forces lactic acid into the interstitial fluid, where it is buffered. B) The sympathetic nervous systems constricts the capillary sphincters to prevent washout of the accumulated lactic acid. C) Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. D) Mast cells release serotonin, resulting in dilation of the capillary sphincters and an increase in tissue perfusion. 17) Septic shock is a form of which of the following types of shock? A) Distributive B) Neurogenic C) Hypovolemic

16)

17) D) Obstructive 18)

18) Under normal circumstances, at any given moment, most of the blood is in the ________ system. A) hemopoetic B) capillary C) arterial D) venous 19) Which of the following is a manifestation of orthostatic hypotension? A) Your patient's pulse is 80 when she is supine, but 96 when she sits up. B) Your patient's pulse is 76 when he is supine, but 88 when he sits up. C) Your patient's blood pressure is 142/90 when she is supine, but 116/88 when she sits up. D) Your patient's blood pressure is 150/100 when he is supine, but 134/90 when he sits up. 20) Your patient is a 42-year-old male 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. 2. 3. 4. 5. Control major hemorrhage. Take body-substance-isolation precautions. Check the area for broken glass before kneeling next to the patient. Turn him to a supine position. Open his airway. A) 3, 2, 4, 1, 5 B) 2, 3, 1, 4, 5 C) 2, 3, 4, 5, 1

19)

20)

D) 2, 5, 1, 3, 4

Answer Key Testname: PCARE, CH 19 W-KEY QUIZ

1) D
Diff: 1 Page Ref: 830 Objective: 4

17) A
Diff: 1 Page Ref: 843 Objective: 4

2) C
Diff: 2 Page Ref: 844 Objective: 8

18) D
Diff: 1 Page Ref: 840 Objective: 2

3) B
Diff: 2 Page Ref: 839 Objective: 5

19) C
Diff: 2 Page Ref: 834 Objective: 24

4) C
Diff: 1 Page Ref: 837 Objective: 10

20) C
Diff: 3 Page Ref: 843 Objective: 33

5) B
Diff: 1 Page Ref: 826 Objective: 8

6) D
Diff: 1 Page Ref: 824 Objective: 2

7) B
Diff: 3 Page Ref: 842 Objective: 4

8) C
Diff: 1 Page Ref: 842 Objective: 6

9) C
Diff: 1 Page Ref: 825 Objective: 9

10) B
Diff: 2 Page Ref: 846 Objective: 39

11) D
Diff: 1 Page Ref: 843 Objective: 4

12) D
Diff: 1 Page Ref: 822 Objective: 1

13) D
Diff: 2 Page Ref: 844 Objective: 8

14) B
Diff: 1 Page Ref: 844 Objective: 33

15) C
Diff: 2 Page Ref: 846 Objective: 33

16) C
Diff: 2 Page Ref: 839 Objective: 18