Chapter 23- Bleeding (Questions)

If direct pressure with a sterile dressing fails to immediately stop severe bleeding from an extremity, you should apply:
A. additional sterile dressings.
B. a splint and elevate the extremity.
C. a tourniquet proximal to the injury.
D. digital pressure to a proximal artery.

C

A 22-year-old male was kicked in the abdomen multiple times during an attack by a gang. He is conscious but restless and his pulse is rapid. Your assessment reveals a large area of bruising to the right upper quadrant of his abdomen. The MOST appropriate treatment for this patient includes:
A. preparing for immediate transport.
B. applying oxygen via nasal cannula.
C. performing a focused physical exam.
D. a detailed assessment of his abdomen.

A

What is the approximate blood volume of a 75-kg adult?
A. 5.25 L
B. 5.50 L
C. 6.25 L
D. 6.50 L

A

An organ or tissue may be better able to resist damage from hypoperfusion if the:
A. body’s demand for oxygen is markedly increased.
B. body’s temperature is considerably less than 98.6°F (37.0°C).
C. systolic arterial blood pressure is at least 60 mm Hg.
D. heart rate is maintained at more than 100 beats/min.

B

The severity of bleeding should be based on all of the following findings, EXCEPT:
A. systolic blood pressure.
B. poor general appearance.
C. the mechanism of injury.
D. clinical signs and symptoms.

A

Which of the following organs can tolerate inadequate perfusion for up to 2 hours?
A. brain
B. heart
C. kidneys
D. skeletal muscle

D

Which of the following statements regarding the clotting of blood is correct?
A. Venous and capillary blood typically does not clot spontaneously.
B. Bleeding begins to clot when the end of a damaged vessel dilates.
C. Direct contact with the environment prevents blood from clotting.
D. A person taking aspirin will experience slower blood clotting.

D

A fractured femur can result in the loss of ______ or more of blood into the soft tissues of the thigh.
A. 250 mL
B. 500 mL
C. 1 L
D. 2 L

C

Perfusion is MOST accurately defined as the:
A. effective transfer of oxygen from the venules across the systemic capillary membrane walls.
B. ability of the systemic arteries to constrict as needed to maintain an adequate blood pressure.
C. effective removal of carbon dioxide and other metabolic waste products from the body’s cells.
D. circulation of blood within an organ in adequate amounts to meet the body’s metabolic needs.

D

In which of the following situations would external bleeding be the MOST difficult to control?
A. femoral artery laceration and a blood pressure of 140/90 mm Hg
B. jugular vein laceration and a systolic blood pressure of 90 mm Hg
C. carotid artery laceration and a systolic blood pressure of 60 mm Hg
D. antecubital vein laceration and a blood pressure of 138/92 mm Hg

A

You arrive at the home of a 50-year-old female with severe epistaxis. As you are treating her, it is MOST important to recall that:
A. the patient may be significantly hypertensive.
B. the patient is at risk for vomiting and aspiration.
C. a detailed exam is needed to determine the cause.
D. many medications interfere with blood clotting.

B

A 43-year-old man is experiencing a severe nosebleed. His BP is 190/110 mm Hg and his HR is 90 beats/min and bounding. Appropriate treatment for this patient includes:
A. having the patient pinch his own nostrils and then lie supine.
B. pinching the patient’s nostrils and having him lean forward.
C. placing a rolled 4″ × 4″ dressing between his lower lip and gum.
D. packing both nostrils with gauze pads until the bleeding stops.

B

Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding?
A. air splint
B. vacuum splint
C. sling and swathe
D. cardboard splint

A

Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body?
A. an effectively pumping heart
B. an intact system of blood vessels
C. adequate blood in the vasculature
D. the filtering of blood cells in the spleen

D

Gastrointestinal bleeding should be suspected if a patient presents with:
A. dyspnea.
B. hematuria.
C. hemoptysis.
D. hematemesis.

D

When using a stick and square knot as a tourniquet to control severe bleeding from an amputated arm, the EMT should:
A. cover the tourniquet with a sterile dressing.
B. stop twisting the stick when the bleeding stops.
C. twist the stick until the radial pulse disappears.
D. remove the tourniquet if the bleeding has stopped.

B

A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should:
A. apply direct pressure to the wound.
B. place the patient on 100% oxygen.
C. follow appropriate standard precautions.
D. perform a rapid head-to-toe assessment.

C

A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:
A. obtain baseline vital signs.
B. apply a nonrebreathing mask.
C. perform a secondary assessment.
D. assist the patient’s ventilations.

D

Hypovolemic shock occurs when:
A. the clotting ability of the blood is enhanced.
B. the body cannot compensate for rapid blood loss.
C. the patient’s systolic blood pressure is less than 100 mm Hg.
D. at least 10% of the patient’s blood volume is lost.

B

Most cases of external bleeding from an extremity can be controlled by:
A. elevating the injured extremity.
B. packing the wound with gauze.
C. compressing a pressure point.
D. applying local direct pressure.

D

Following blunt trauma to the abdomen, a 21-year-old female complains of left upper quadrant abdominal pain with referred pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the:
A. liver.
B. spleen.
C. pancreas.
D. gallbladder.

B

A 39-year-old male accidentally cut his wrist while sharpening his hunting knife. He is conscious and alert with adequate breathing, but is bleeding significantly from the wound. You should:
A. ensure the patient has a patent airway.
B. control the bleeding with direct pressure.
C. apply oxygen with a nonrebreathing mask.
D. apply a tourniquet proximal to the wound.

B

As red blood cells begin to clump together to form a clot, __________ reinforces the clumped red blood cells.
A. fibrin
B. plasma
C. fibrinogen
D. plasminogen

C

Early signs and symptoms of intra-abdominal bleeding include:
A. bruising only.
B. pain and distention.
C. widespread ecchymosis.
D. significant hypotension.

B

An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost.
A. 50 mL
B. 100 mL
C. 150 mL
D. 200 mL

B

Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume.
A. 5%
B. 10%
C. 15%
D. 20%

D

Bleeding from the nose following head trauma:
A. is a sign of a skull fracture and should not be stopped.
B. should be controlled by packing the nostril with gauze.
C. should be assumed to be caused by a fractured septum.
D. is usually due to hypertension caused by the head injury.

A

Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that:
A. you should try to control the bleeding by applying pressure to a proximal arterial pressure point first.
B. the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released.
C. bulky dressings should be securely applied over the tourniquet to further assist in controlling the bleeding.
D. the tourniquet should be applied directly over a joint if possible because this provides better bleeding control.

B

Which of the following statements regarding hemophilia is correct?
A. Hemophilia is defined as a total lack of platelets.
B. Patients with hemophilia may bleed spontaneously.
C. Hemophiliacs take aspirin to enhance blood clotting.
D. Approximately 25% of the population has hemophilia.

B

The systemic veins function by:
A. returning deoxygenated blood back to the heart.
B. delivering oxygen-poor blood to the capillaries.
C. returning oxygen-rich blood back to the left atrium.
D. delivering deoxygenated blood to the capillaries.

A

In nontrauma patients, an early indicator of internal bleeding is:
a) dizziness upon standing.
b) a rapid, thready pulse.
c) a decreasing blood pressure.
d) rapid, shallow breathing.

A

A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:
a) acute appendicitis.
b) intrathoracic hemorrhaging.
c) an aortic aneurysm.
d) gastrointestinal bleeding.

D

The ability of a person’s cardiovascular system to compensate for blood loss is MOST related to:
a) how fast his or her heart beats.
b) how rapidly he or she bleeds.
c) his or her baseline blood pressure.
d) the part of the body injured.

B

Blood stasis, changes in the vessel wall, and certain medications affect the:
a) systolic blood pressure exclusively.
b) white blood cell’s ability to fight infection.
c) ability of red blood cells to carry oxygen.
d) ability of the blood to effectively clot.

D

During transport of a 40-year-old female with acute abdominal pain, you note that she has stopped talking to you and has become extremely diaphoretic. You should:
a) assess the quality of her pulse.
b) repeat the primary assessment.
c) perform a secondary assessment.
d) begin assisting her ventilations.

B

Hypoperfusion is another name for:
a) hypoxemia.
b) cyanosis.
c) shock.
d) cellular death.

C

The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the:
a) venules.
b) arterioles.
c) vena cavae.
d) capillary arteries.

B

In older patients, the first indicator of nontraumatic internal bleeding may be:
a) a low blood pressure.
b) weakness or dizziness.
c) a heart rate over 120 beats/min.
d) diaphoresis and pale skin.

B

A 39-year-old male accidentally cut his wrist while sharpening his hunting knife. He is conscious and alert with adequate breathing, but is bleeding significantly from the wound. You should:

control the bleeding with direct pressure.

After applying a pressure dressing to a laceration on a patient’s arm, you notice that blood is slowly beginning to saturate it. You should:

place additional dressings over the wound.

External bleeding from a vein is relatively easy to control because:

veins are under a lower pressure.

After taking standard precautions, the first step in treating a patient suffering from epistaxis is to:
A. apply direct pressure.
B. apply ice.
C. help the patient sit forward.
D. transport the patient.

C

The body will not tolerate an acute blood loss of greater than __% of blood volume.

20

Cells in other organs, such as the lungs and kidneys, can survive for almost:

An Hour

Do not attempt to stop blood flow from a ____ injury.

head Applying excessive pressure to the injury may force the blood leaking through the ear or nose to collect within the head. This could increase the pressure on the brain and possibly cause permanent damage.

Ecchymosis

Bruising

Effect of blood loss on HR, RR, and BP:

Increase in HR Increase in RR Decrease in BP

Elevate a bleeding extremity by as little as _" while applying direct pressure.

6

Epistaxis

Nosebleed

The following are all indications for applying the pneumatic antishock garment (PASG) EXCEPT:
A. control of massive soft-tissue bleeding in the lower extremities.
B. control of internal bleeding associated with pelvic fractures.
C. control of massive bleeding in a pregnant woman.
D. stabilize fractures of the pelvis and femurs.

C

Hematemesis

Vomited Blood

Hematuria

Blood in the urine

Hemoptysis

Bright red blood that is coughed up

Hold uninterrupted pressure for at least _ minutes.

5

If bleeding from the nose is present and a skull fracture is not suspected, pinch both nostrils together for __ minutes.

15

The left side of the heart supplies oxygen-rich blood to the ____ (which carry it throughout the body).

arteries

Melena

black, foul-smelling, tarry stool with digested blood

Most common symptom of internal bleeding:

Pain

The right side of the heart receives oxygen-poor blood from the ____.

Veins

Skeletal muscle cells may survive for __ hours in a state of inadequate perfusion.

2

A systolic blood pressure of less than ___ mm Hg with a weak, rapid pulse should suggest the presence of hypoperfusion.

100

The brain and spinal cord may last _ to _ minutes without perfusion.
Kidneys may survive __ minutes.
Skeletal muscles may last _ hours.
The gastrointestinal tract can tolerate slightly longer periods of inadequate perfusion.

4 to 6 45 2

The typical adult has approximately __ mL of blood per kilogram of body weight.

70

A mass of blood in the soft tissues beneath the skin

Hematoma