1. A patient has sustained an injury to his mediastinum.

Based on the anatomy of his chest, which of the following structures may have been injured? a. b. c. d. The diaphragm The esophagus The lungs A bronchus

Answer: b bjective: !"#1 $eference: %%! !. &hich of the following statements indicates that the spea'er understands chest trauma? a. ( pen chest injuries are more serious than closed chest injuries because air and bacteria can enter the chest through the open wound.) b. (*n general, an open chest injury caused by blunt trauma is more life threatening than a closed one due to increased blood loss.) c. (*nternal chest injuries are more difficult to assess and manage than are the more obvious e+ternal chest injuries.) d. (,losed chest injuries are caused by penetrating trauma and cause more life#threatening injuries than do open chest injuries.) Answer: c bjective: -upplemental $eference: %%. ". A "/#year#old man has been stabbed once in the anterior chest. &hen notifying the patrol aid room by radio, you inform them that the patient has suffered what possible type of injury? a. b. c. d. 0lail chest 1visceration A lacerated heart An open chest injury

Answer: d bjective: -upplemental $eference: %%. .. An 1, candidate as's you to e+plain a pneumothora+. 2our response should be that it occurs when: a. the lung becomes overinflated with air and then collapses. b. air accumulates between the inner chest wall and the outside of the lung, causing the lung to collapse. c. the trachea becomes obstructed, causing the lungs to collapse. d. air enters the lung alveoli through a traumatic opening in the chest wall. Answer: b bjective: !"#" $eference: %%%

3. &hen assessing a patient, which of the following signs or symptoms is most indicative that the patient is suffering from a pneumothora+? a. b. c. d. -hortness of breath -evere pain upon each inspiration 4ecreased breath sounds in the right lung ,repitus to the chest wall

Answer: c bjective: !"#. $eference: %%5 6. 2ou are at the scene of a shooting. 2our assessment reveals a !"#year#old man who has been shot twice. The first wound is to the left lower 7uadrant of the abdomen and is bleeding. The second wound is to the left lateral chest and ma'es a suc'ing sound every time the patient ta'es a breath. The initial action of an 1, Technician should be which of the following actions? a. b. c. d. ,over the chest wound with a gau8e dressing. ,over the chest wound with a gloved hand. 9lace direct pressure over the abdominal wound. 9lace the patient on high#flow o+ygen using a nonrebreather mas'.

Answer: b bjective: !"#6 $eference: %53 %. &hich of the following phrases best describes a flail segment? a. b. c. d. :ultiple rib fractures with bruising of the underlying lung 0ractured ribs that have collapsed the underlying lung :ultiple fractures to the rib cage caused by blunt trauma Two or more adjacent ribs that have been bro'en in two or more places.

Answer: d bjective: !"#" $eference: %%3 5. 2our patient was involved in a serious motor vehicle collision. &hich of the following assessment findings best helps to determine that the patient has a flail segment? a. b. c. d. 9arado+ical chest wall movement -hortness of breath 9ain upon inspiration ,hest wall bruising

Answer: a bjective: !"#. $eference: %%3 /. 2ou are managing a patient with a large flail segment in the right lateral chest. The immediate threat to this patient;s life is:

a. b. c. d.

blood loss. hypo+ia. infection. rib fractures.

Answer: b bjective: !"#. $eference: %%3 1<. &hen assessing a patient who sustained blunt trauma to the chest, which of the following assessment findings is most indicative of a serious injury to the lung? a. b. c. d. =ypo+ia 9ainful respirations A respiratory rate of !< breaths per minute An ecchymotic area on the anterior chest

Answer: a bjective: !"#. $eference: %51 11. A patient with blunt chest trauma has parado+ical chest movement. -he is conscious and confused and is breathing rapidly and shallowly. After manually stabili8ing the flail section of the chest wall, you should: a. b. c. d. apply an ice pac' to the flail section to decrease bruising. administer o+ygen through a nonrebreather facemas'. apply a flutter valve dressing. insert an oropharyngeal airway.

Answer: b bjective: -upplemental $eference: %53 1!. 2ou are assisting at an accident scene and are as'ed to apply a dressing over a suc'ing chest wound on the patient;s left anterior chest wall. &hich of the following items would you use? a. b. c. d. A dry sterile gau8e dressing -terile gau8e soa'ed in sterile water A clean cravat >aseline gau8e

Answer: d bjective: !"#6 $eference: %53 1". 2ou have applied a nonporous dressing to a puncture wound on a patient;s chest. An 1, candidate as's you why the dressing was taped only on three sides. 2our best response is that taping the dressing on three sides: a. permits o+ygen to enter the lungs. b. allows trapped air to escape upon e+halation.

c. is less painful for the patient. d. decreases the chances that air will enter the chest upon e+halation. Answer: b bjective: !"#6 $eference: %53 1.. 2ou treated a 1/ year old with a puncture wound to the chest by covering the wound with an impermeable dressing. ?ow, as you perform your ongoing assessment, you note that the patient is tachypneic and is complaining of difficulty breathing. Breath sounds on the side of the injury are also diminished. &hich of the following actions should you ta'e immediately? a. Assist his breathing with a bag#valve mas'. b. @ift a corner of the dressing from the wound for a few secondsA then reapply and chec' his breath sounds. c. Add another layer to the dressing. d. @oad the patient 7uic'ly and transport him to a higher level of care. Answer: b bjective: !"#6 $eference: %53 13. 2ou have placed an occlusive dressing on a puncture wound on the right side of the chest of a ""#year#old woman. 4uring your ongoing assessment your primary concern is monitoring the injury for: a. b. c. d. arterial bleeding. infection at the wound site. tension pneumothora+. ecchymosis at the wound site.

Answer: c bjective: !"#. $eference: %53 16. An 1, candidate indicates that she understands the difference between a pneumothora+ and a tension pneumothora+ when she ma'es which of the following statements? a. (A tension pneumothora+ causes blood to accumulate around the lungA a pneumothora+ involves the accumulation of air only around the lung.) b. (A tension pneumothora+ can cause cardiac output to decreaseA a pneumothora+ does not.) c. (A pneumothora+ describes a collapsed lungA a tension pneumothora+ involves both a collapsed lung and blood loss.) d. (A pneumothora+ is caused by a closed chest injuryA a tension pneumothora+ is caused by an open chest injury.) Answer: b bjective: !"#" $eference: %%%

1%. 2ou suspect that a trauma patient is suffering from a hemothora+ to the left lung. &hich of the following assessment findings would reinforce your suspicion? a. b. c. d. ?ec' vein distention and absent breath sounds in the right lung ,yanosis and a blood pressure of !1<B1<< Bradycardia and hypertension $espiratory distress and the signs and symptoms of shoc'

Answer: d bjective: !"#" $eference: %%5 15. 2ou are listening to two patrollers discuss the accident to which they just responded. &hich of the following injuries would lead you to believe that one of the patients had suffered from traumatic asphy+ia? a. b. c. d. A chest wound that ma'es a suc'ing sound Abdominal bruising and distention Bluish discoloration of the nec' and face A bilateral femur deformity

Answer: c bjective: !"#. $eference: %51 1/. &hich of the following actions occurs when the diaphragm and the intercostal muscles rela+? a. b. c. d. *nhalation $elease *nspiration 1+halation

Answer: d bjective: !"#! $eference: %%! !<. The thora+ is enclosed by the: a. b. c. d. ribs, sternum, thoracic spine, and diaphragm. ribs, clavicles, diaphragm, and mediastinum. thoracic vertebrae, diaphragm, mediastinum, and clavicles. clavicles, sternum, diaphragm, and thoracic spine.

Answer: a bjective: !"#1 $eference: %%! !1. The heart and lungs are located in the: a. thoracic cavity. b. pericardial cavity. c. pleural cavity.

d. mediastinum. Answer: a bjective: !"#1 $eference: %%! !!. The diaphragm separates the: a. b. c. d. right lung from the left lung. lungs from the heart. thoracic cavity from the abdominal cavity. heart and lungs from the spine.

Answer: c bjective: !"#1 $eference: %%! !". The diaphragm plays a major role in respiration. 4uring inhalation, the diaphragm: a. b. c. d. elongates and descends into the abdomen, allowing air to enter the lungs. contracts and creates a negative pressure in the thora+, which draws air into the lungs. rela+es so that it can be stretched as you pull air into the lungs. contracts and increases internal thoracic pressure, which suc's air into the lungs.

Answer: b bjective: !"#! $eference: %%! !.. *njuries at which level of the spinal cord can affect the phrenic nerves and therefore respiration? a. b. c. d. T1CT" T.CT6 ,6CT1 ,"C,3

Answer: d bjective: !"#! $eference: %%! !3. 2our "3#year#old patient has received major chest trauma. =e complains of shortness of breath and pain. 2our assessment reveals distended nec' veins and pulsus parado+us. Based on these signs and symptoms, you believe the patient to be suffering from: a. b. c. d. acute myocardial infarction. pericardial tamponade. pleural effusions. traumatic asphy+ia.

Answer: b bjective: !"#" $eference: %%/

!6. The most serious chest injury resulting from rapid deceleration is a. b. c. d. aortic rupture. hemothora+. subcutaneous emphysema. sternoclavicular separation.

Answer: a bjective: -upplemental $eference: %%/ !%. ,ommotio cordis is sudden cardiac death resulting from a. b. c. d. a hereditary defect that affects infants and toddlers. blunt trauma, usually in children younger than 16 years old. a crushing injury to the chest in teenage auto collision victims. cardiac arrest secondary to pulmonary embolism.

Answer: b bjective: -upplemental $eference: %5< !5. 2ou are instructing a class in utdoor 1mergency ,are when a student as's you to e+plain the @.A.9. method of e+amining the thora+. 2our best reply to this 7uestion would be which of the following statements? a. (The @.A.9. method divides the chest into three e+am areas: the lateral, anterior, and posterior thora+.) b. (The @.A.9. method can be used under any conditions and in any environment.) c. (The @.A.9. method is a rapid assessment for deformities of the chest.) d. (The @.A.9. method directs you to loo', auscultate, and palpate the chest.) Answer: d bjective: !"#3 $eference: %5" !/. 2ou are following the @.A.9. method to e+amine the chest of a "5#year#old trauma patient. To assess for thoracic cage instability, you would apply moderate downward pressure on the sternum while as'ing the patient to ta'e a deep breath, and then you would: a. (wal') the patient;s clavicles with your fingertips while the patient e+hales. b. have the patient e+hale slowly while you listen to the breath sounds. c. apply moderate inward pressure on the lateral walls of the rib cage and as' the patient to ta'e a deep breath. d. palpate the upper thora+ for subcutaneous emphysema. Answer: c bjective: !"#3 $eference: %5.

"<. 2ou are treating a !6#year#old man with a pneumothora+. The patient;s breathing has been inade7uate, and you have been assisting his ventilations with a bag valve mas'. The patient;s condition seems to be worsening. Because you understand the physiology involved in a pneumothora+, you are most concerned that: a. you are not maintaining an ade7uate seal around the facemas', and thus the patient is not getting enough o+ygen. b. the pressure from the B>: is causing more air to enter the pleural space and is causing a tension pneumothora+. c. the patient;s airway is not being maintained, so you should insert an oropharyngeal airway. d. you may have missed an injury. Answer: b bjective: -upplemental $eference: %53 "1. 2ou are treating a !6#year#old man who fell about !< feet while roc' climbing. =e is complaining of right sided chest discomfort and dyspnea. 2ou note that his respiratory rate is !5 and shallow. Based on this assessment, the best emergency care would be: a. achieving spinal immobili8ation, splinting the affected area of the chest, and administering high#flow o+ygen. b. performing a rapid body survey and assisting ventilations with B>: and high#flow o+ygen. c. achieving spinal immobili8ation, administering high#flow o+ygen, and then performing (load and go.) d. placing the patient in a position of comfort to help breathing, performing an @.A.9. e+am of the thora+, and administering high#flow o+ygen. Answer: b bjective: -upplemental $eference: %56 "!. 2ou are treating a 16#year#old male who was s'iing out of control and ran off the trail and into the woods. &hen you arrive, he is alert and complaining of pain in his right lower chest. Dpon e+amination you note that he has impaled himself with a tree branch. =e tells you he will feel better if you just remove the branch. Based on your training as an 1, technician, you would respond by ma'ing which of the following statements? a. b. c. d. (* need to get a bul'y dressing ready in case there is bleeding when * remove the branch.) ( nce my helpers arrive and we are ready to transport you, we can remove the branch.) (&e need to leave the branch in place until we get you to a hospital.) (*;m not supposed to remove the branch, but you can if you thin' it will ma'e you more comfortable.)

Answer: c bjective: -upplemental $eference: %56