Trauma Exam UPDATED Study Guide
ACTUAL QUESTIONS AND CORRECT
ANSWERS
If a vehicle strikes a tree at 60 mph, the unrestrained driver would likely experience the
MOST severe injuries during the:
A) first collision.
B) second collision.
C) third collision.
D) fourth collision. - CORRECT ANSWER C
Motor-vehicle crashes typically consist of three separate collisions. Understanding the events
that occur during each collision will help you remain alert for certain types of injury patterns.
During the first collision, the vehicle strikes another object. Damage to the car is perhaps the
most dramatic part of the collision, but it does not directly affect patient care. It does,
however, provide information about the severity of the collision; thus, it has an indirect effect
on patient care. During the second collision, the passenger collides with the interior of the
vehicle. Just like the obvious damage to the exterior of the car, the injuries that result are
often dramatic and usually apparent during your primary assessment. During the third
collision, the occupant's internal organs collide with the solid structures of the body. Although
the injuries that occur during the third collision may not be as obvious as those that occur
during the second collision, they are often the most life-threatening.
Following penetrating trauma to the abdomen, a 50-year-old woman has a large laceration
with a loop of protruding bowel. How should you manage this injury?
A) Carefully replace the bowel and apply an occlusive dressing.
B) Apply a tight pressure dressing to control any external bleeding.
C) Apply a dry, sterile dressing covered by an occlusive dressing.
D) Apply a moist, sterile dressing covered by a dry, sterile dressing. - CORRECT
ANSWER D
Management of an open abdominal wound with an eviscerated bowel includes controlling
any external bleeding, covering the exposed bowel with a moist, sterile dressing, and
,covering that with a dry, sterile dressing. Applying a dry dressing directly to the exposed
bowel will cause the bowel to dry. You must never replace the exposed bowel into the
abdominal cavity or apply pressure to the wound. Doing so significantly increases the
patient's risk for infection as well as further trauma.
Prior to your arrival at the scene, a young female was removed from a body of water after
being submerged for an unknown period of time. You should manage her airway
appropriately while considering the possibility of:
A) spinal injury.
B) hyperthermia.
C) internal bleeding.
D) airway obstruction. - CORRECT ANSWER A
When caring for a patient with a submersion injury (ie, near-drowning), you should consider
the possibility of a spinal injury. Many water-related incidents occur when a patient dives into
shallow water and strikes his or her head. Water can be aspirated into the lungs, but will not
cause an obstruction of the upper airway. Another common finding in patients with a
submersion injury is hypothermia. Although it is possible for the patient to have internal
bleeding at the same time, especially if he or she experienced a traumatic injury before the
submersion, spinal injuries are more common.
During which part of your assessment would you MOST likely discover a small-caliber
gunshot wound to the back with minimal bleeding?
A) General impression
B) Primary assessment
C) Rapid head-to-toe assessment
D) Detailed secondary assessment - CORRECT ANSWER C
During both the general impression and the primary assessment, you should assess for major
bleeding. If there is no obvious bleeding, you should continue your assessment as usual. It is
during the rapid head-to-toe assessment, when log rolling the patient to assess the posterior
(back), that you would most likely find a small-caliber gunshot wound, especially if there is
little or no bleeding. A secondary assessment should be performed, and focuses primarily on
the patient's chief complaint; however, this may not be practical with a critically ill or injured
patient. If a secondary assessment is performed on a critically ill or injured patient, it should
,occur en route to the hospital. All bleeding should have been controlled long before
performing a secondary assessment.
In which of the following situations would external bleeding be the MOST difficult to
control?
A) Scalp laceration, BP of 130/70 mm Hg
B) Jugular vein laceration, BP of 104/60 mm Hg
C) Carotid artery laceration, BP of 70/50 mm Hg
D) Femoral artery laceration, BP of 140/90 mm Hg - CORRECT ANSWER D
In general, the larger the size and type (eg, artery versus vein) of blood vessel injured, and the
higher the patient's blood pressure, the more difficult the external bleeding will be to control.
Of the choices listed, bleeding from a lacerated femoral artery (large, high-pressure vessel) in
a patient with a blood pressure of 140/90 mm Hg (the highest BP listed) would be the most
difficult to control. As a patient's blood pressure begins to fall, the driving force of blood in
the arteries decreases and the bleeding becomes easier to control. Unfortunately, the patient is
usually in decompensated shock at this point. The scalp contains many small blood vessels
and tends to bleed heavily; however, direct pressure usually controls the bleeding with
relative ease, regardless of the patient's blood pressure.
Upon discovering an open chest wound, you should:
A) prevent air from entering the open wound.
B) begin assisted ventilation and prepare for transport.
C) immediately reassess the patient's ventilatory status.
D) quickly cover the wound with a porous trauma dressing. - CORRECT ANSWER A
Upon discovering an open chest wound (ie, sucking chest wound), you must take immediate
action to prevent air from entering the wound. This is most effectively accomplished by
applying an occlusive dressing or similar material to the wound. A porous (non-occlusive)
trauma dressing will not prevent air from entering the wound. Tape three sides of the
occlusive dressing and closely monitor the patient. If worsened respiratory distress and signs
of shock are noted, a tension pneumothorax is probably developing, and you must release
pressure from the pleural space by lifting up the unsecured portion of the occlusive dressing.
, Following blunt force trauma to the anterior chest, a man presents with difficulty breathing,
distended jugular veins, absent breath sounds over the left side of the chest, and hypotension.
Which of the following BEST describes the pathophysiology of this patient's injury?
A) Increased pressure in the pleural space is compressing the great vessels
B) Blood is filling the pleural space and is collapsing the lung on the left side
C) Blood is filling the pericardial sac and is restricting cardiac contraction
D) The aorta has been injured and blood is rapidly filling the thoracic cavity - CORRECT
ANSWER A
The patient is experiencing a tension pneumothorax. This type of injury occurs when air fills
the pleural space and progressively collapses the lung. In the process, the vena cavae are
compressed and blood return to the heart is reduced; clinically, this manifests as jugular vein
distention because blood is backing up into the systemic venous system. If blood return to the
heart is reduced, the amount of blood that leaves the heart will also be reduced; as a result,
cardiac output falls and the patient becomes hypotensive. Breath sounds are markedly
decreased or absent on the affected side of the chest because the lung is being collapsed. In a
hemothorax, blood fills the pleural space instead of air. Breath sounds are decreased or absent
on the affected side; however, because the patient is losing blood volume into the chest, the
jugular veins would be collapsed, not distended as they are with a tension pneumothorax.
Pericardial tamponade also causes jugular vein distention; however, the patient's breath
sounds are equal bilaterally (unless a pneumothorax is also present). Aortic injury would be
expected to cause collapsed jugular veins; like the hemothorax, the patient is losing blood
volume into the chest cavity. By itself, aortic injury does not cause unequal breath sounds.
A young male has a large laceration to his lateral neck, directly over his jugular vein. His
airway is patent and his breathing is adequate. Your MOST immediate priority should be to:
A) apply high-flow oxygen via a nonrebreathing mask.
B) perform a rapid assessment to detect other injuries.
C) obtain vital signs to determine if he is hypotensive.
D) keep air out of the wound and control the bleeding. - CORRECT ANSWER D
Jugular vein lacerations pose two immediate life threats: entrainment of air into the wound
(which may cause a fatal air embolism) and severe external bleeding. The patient's airway is
patent and his breathing is adequate; therefore, your most immediate priority is to apply an
occlusive dressing directly over the wound, which will keep air from entering the venous
circulation, and then cover the occlusive dressing with bulky dressings to control the external
ACTUAL QUESTIONS AND CORRECT
ANSWERS
If a vehicle strikes a tree at 60 mph, the unrestrained driver would likely experience the
MOST severe injuries during the:
A) first collision.
B) second collision.
C) third collision.
D) fourth collision. - CORRECT ANSWER C
Motor-vehicle crashes typically consist of three separate collisions. Understanding the events
that occur during each collision will help you remain alert for certain types of injury patterns.
During the first collision, the vehicle strikes another object. Damage to the car is perhaps the
most dramatic part of the collision, but it does not directly affect patient care. It does,
however, provide information about the severity of the collision; thus, it has an indirect effect
on patient care. During the second collision, the passenger collides with the interior of the
vehicle. Just like the obvious damage to the exterior of the car, the injuries that result are
often dramatic and usually apparent during your primary assessment. During the third
collision, the occupant's internal organs collide with the solid structures of the body. Although
the injuries that occur during the third collision may not be as obvious as those that occur
during the second collision, they are often the most life-threatening.
Following penetrating trauma to the abdomen, a 50-year-old woman has a large laceration
with a loop of protruding bowel. How should you manage this injury?
A) Carefully replace the bowel and apply an occlusive dressing.
B) Apply a tight pressure dressing to control any external bleeding.
C) Apply a dry, sterile dressing covered by an occlusive dressing.
D) Apply a moist, sterile dressing covered by a dry, sterile dressing. - CORRECT
ANSWER D
Management of an open abdominal wound with an eviscerated bowel includes controlling
any external bleeding, covering the exposed bowel with a moist, sterile dressing, and
,covering that with a dry, sterile dressing. Applying a dry dressing directly to the exposed
bowel will cause the bowel to dry. You must never replace the exposed bowel into the
abdominal cavity or apply pressure to the wound. Doing so significantly increases the
patient's risk for infection as well as further trauma.
Prior to your arrival at the scene, a young female was removed from a body of water after
being submerged for an unknown period of time. You should manage her airway
appropriately while considering the possibility of:
A) spinal injury.
B) hyperthermia.
C) internal bleeding.
D) airway obstruction. - CORRECT ANSWER A
When caring for a patient with a submersion injury (ie, near-drowning), you should consider
the possibility of a spinal injury. Many water-related incidents occur when a patient dives into
shallow water and strikes his or her head. Water can be aspirated into the lungs, but will not
cause an obstruction of the upper airway. Another common finding in patients with a
submersion injury is hypothermia. Although it is possible for the patient to have internal
bleeding at the same time, especially if he or she experienced a traumatic injury before the
submersion, spinal injuries are more common.
During which part of your assessment would you MOST likely discover a small-caliber
gunshot wound to the back with minimal bleeding?
A) General impression
B) Primary assessment
C) Rapid head-to-toe assessment
D) Detailed secondary assessment - CORRECT ANSWER C
During both the general impression and the primary assessment, you should assess for major
bleeding. If there is no obvious bleeding, you should continue your assessment as usual. It is
during the rapid head-to-toe assessment, when log rolling the patient to assess the posterior
(back), that you would most likely find a small-caliber gunshot wound, especially if there is
little or no bleeding. A secondary assessment should be performed, and focuses primarily on
the patient's chief complaint; however, this may not be practical with a critically ill or injured
patient. If a secondary assessment is performed on a critically ill or injured patient, it should
,occur en route to the hospital. All bleeding should have been controlled long before
performing a secondary assessment.
In which of the following situations would external bleeding be the MOST difficult to
control?
A) Scalp laceration, BP of 130/70 mm Hg
B) Jugular vein laceration, BP of 104/60 mm Hg
C) Carotid artery laceration, BP of 70/50 mm Hg
D) Femoral artery laceration, BP of 140/90 mm Hg - CORRECT ANSWER D
In general, the larger the size and type (eg, artery versus vein) of blood vessel injured, and the
higher the patient's blood pressure, the more difficult the external bleeding will be to control.
Of the choices listed, bleeding from a lacerated femoral artery (large, high-pressure vessel) in
a patient with a blood pressure of 140/90 mm Hg (the highest BP listed) would be the most
difficult to control. As a patient's blood pressure begins to fall, the driving force of blood in
the arteries decreases and the bleeding becomes easier to control. Unfortunately, the patient is
usually in decompensated shock at this point. The scalp contains many small blood vessels
and tends to bleed heavily; however, direct pressure usually controls the bleeding with
relative ease, regardless of the patient's blood pressure.
Upon discovering an open chest wound, you should:
A) prevent air from entering the open wound.
B) begin assisted ventilation and prepare for transport.
C) immediately reassess the patient's ventilatory status.
D) quickly cover the wound with a porous trauma dressing. - CORRECT ANSWER A
Upon discovering an open chest wound (ie, sucking chest wound), you must take immediate
action to prevent air from entering the wound. This is most effectively accomplished by
applying an occlusive dressing or similar material to the wound. A porous (non-occlusive)
trauma dressing will not prevent air from entering the wound. Tape three sides of the
occlusive dressing and closely monitor the patient. If worsened respiratory distress and signs
of shock are noted, a tension pneumothorax is probably developing, and you must release
pressure from the pleural space by lifting up the unsecured portion of the occlusive dressing.
, Following blunt force trauma to the anterior chest, a man presents with difficulty breathing,
distended jugular veins, absent breath sounds over the left side of the chest, and hypotension.
Which of the following BEST describes the pathophysiology of this patient's injury?
A) Increased pressure in the pleural space is compressing the great vessels
B) Blood is filling the pleural space and is collapsing the lung on the left side
C) Blood is filling the pericardial sac and is restricting cardiac contraction
D) The aorta has been injured and blood is rapidly filling the thoracic cavity - CORRECT
ANSWER A
The patient is experiencing a tension pneumothorax. This type of injury occurs when air fills
the pleural space and progressively collapses the lung. In the process, the vena cavae are
compressed and blood return to the heart is reduced; clinically, this manifests as jugular vein
distention because blood is backing up into the systemic venous system. If blood return to the
heart is reduced, the amount of blood that leaves the heart will also be reduced; as a result,
cardiac output falls and the patient becomes hypotensive. Breath sounds are markedly
decreased or absent on the affected side of the chest because the lung is being collapsed. In a
hemothorax, blood fills the pleural space instead of air. Breath sounds are decreased or absent
on the affected side; however, because the patient is losing blood volume into the chest, the
jugular veins would be collapsed, not distended as they are with a tension pneumothorax.
Pericardial tamponade also causes jugular vein distention; however, the patient's breath
sounds are equal bilaterally (unless a pneumothorax is also present). Aortic injury would be
expected to cause collapsed jugular veins; like the hemothorax, the patient is losing blood
volume into the chest cavity. By itself, aortic injury does not cause unequal breath sounds.
A young male has a large laceration to his lateral neck, directly over his jugular vein. His
airway is patent and his breathing is adequate. Your MOST immediate priority should be to:
A) apply high-flow oxygen via a nonrebreathing mask.
B) perform a rapid assessment to detect other injuries.
C) obtain vital signs to determine if he is hypotensive.
D) keep air out of the wound and control the bleeding. - CORRECT ANSWER D
Jugular vein lacerations pose two immediate life threats: entrainment of air into the wound
(which may cause a fatal air embolism) and severe external bleeding. The patient's airway is
patent and his breathing is adequate; therefore, your most immediate priority is to apply an
occlusive dressing directly over the wound, which will keep air from entering the venous
circulation, and then cover the occlusive dressing with bulky dressings to control the external
