Assessment and Management Priorities and Special Populations Practice Questions

25 multiple-choice questions on Assessment and management priorities and special populations for paramedic and EMT students, from Chapter 34 (Face and Neck Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A patient with facial injuries is coughing and spitting blood. Beyond gloves, the most important protective equipment for you is:

   1. A. Eye protection and mask
   2. B. A second pair of gloves
   3. C. A gown worn over boots
   4. D. A helmet with a visor
   Show answer

   Answer: A. Eye protection and mask

   Spitting and coughing blood can splash your eyes, nose, and mouth, so eye protection and a mask (or face shield) are essential when managing a bleeding face or airway. Double gloves and gowns protect other areas but not mucous membranes, and a helmet is for scene hazards, not splash protection.

2. During the primary survey of a patient with facial trauma, the airway should be assessed for:

   1. A. Visual acuity in each eye
   2. B. Symmetry of facial expression
   3. C. Tenderness over the nasal and facial bones
   4. D. Blood, teeth, vomitus, and swelling
   Show answer

   Answer: D. Blood, teeth, vomitus, and swelling

   The primary survey targets immediate threats, and blood, debris, and swelling are the main causes of obstruction in facial trauma. Visual acuity and facial symmetry belong in the secondary assessment.

3. A 27-year-old man was assaulted with a pipe. He has severe facial injuries and his GCS is 7. In addition to the airway, you should be most concerned about:

   1. A. Hemorrhagic shock from facial bleeding
   2. B. A traumatic brain injury
   3. C. A facial nerve injury
   4. D. A dental avulsion
   Show answer

   Answer: B. A traumatic brain injury

   The force that produces severe facial fractures is often transmitted to the brain, and a GCS of 7 indicates serious brain injury. Facial bleeding seldom causes shock by itself in an adult, and facial nerve and dental injuries are not life-threatening.

4. A patient with a facial injury is awake and talking at first but becomes drowsier during transport. Which assessment best detects a developing brain injury?

   1. A. Serial GCS and pupil checks
   2. B. A single initial GCS
   3. C. A formal hearing test at the scene
   4. D. A visual field exam
   Show answer

   Answer: A. Serial GCS and pupil checks

   Brain injury can evolve, so repeated GCS scores and pupil checks reveal deterioration. One initial score cannot show a trend.

5. A 33-year-old was struck in the face with a bottle. When you palpate his face, which finding suggests a fracture?

   1. A. Warm and dry skin
   2. B. Symmetric expression
   3. C. Crepitus or step-off of the bone
   4. D. Moist mucous membranes in the mouth
   Show answer

   Answer: C. Crepitus or step-off of the bone

   Crepitus, step-offs, instability, and tenderness over the facial bones suggest fractures. Warm, dry skin is a normal finding.

6. Which part of the secondary assessment is specific to patients with facial trauma?

   1. A. Palpating the cervical spine for tenderness
   2. B. Checking the GCS score
   3. C. Checking the bite and eye movements
   4. D. Checking the radial pulses
   Show answer

   Answer: C. Checking the bite and eye movements

   Asking whether the bite feels normal and testing eye movement in all directions can reveal mandible and orbital fractures. Spinal palpation, the GCS, and pulses are part of every trauma assessment, not specific to facial trauma.

7. A trauma patient with facial fractures has a GCS of 15, no neck pain or tenderness, no neurologic deficit, no intoxication, and no distracting injury. Based on these findings, spinal motion restriction:

   1. A. Is required because of the facial injury
   2. B. May be withheld according to protocol
   3. C. Must be applied with a long backboard
   4. D. Is needed only if the patient is elderly
   Show answer

   Answer: B. May be withheld according to protocol

   Validated criteria such as NEXUS allow SMR to be withheld in an alert, sober patient without neck pain, tenderness, deficit, or distracting injury. Facial fractures alone do not mandate SMR, though they should raise your index of suspicion.

8. In a facial trauma patient who requires spinal motion restriction, the airway takes priority. This means that:

   1. A. Airway care can be done with manual stabilization
   2. B. The collar must stay on even if the patient chokes
   3. C. The patient must remain supine at all times
   4. D. Suctioning must wait until the hospital
   Show answer

   Answer: A. Airway care can be done with manual stabilization

   Manual in-line stabilization lets you open and clear the airway, log roll for drainage, or loosen a collar when needed. An obstructed airway kills faster than a spinal cord injury.

9. A woman who is 30 weeks pregnant was punched in the face by her partner. Besides her facial injuries, which concern is most important?

   1. A. Hypovolemia from her facial bleeding
   2. B. A basilar skull fracture from the punch
   3. C. Permanent scarring from the facial wounds
   4. D. Abdominal trauma and placental abruption
   Show answer

   Answer: D. Abdominal trauma and placental abruption

   Intimate partner violence often escalates during pregnancy and often targets the abdomen as well as the face, and placental abruption can follow even modest abdominal trauma. Ask about blows to the abdomen, cramping, vaginal bleeding, and fetal movement, check the uterus for tenderness, tilt her to the left if she must lie supine, and take her to a facility with obstetric capability while addressing her safety. Facial bleeding seldom causes shock, a basilar skull fracture from a punch is uncommon, and scarring matters for recovery but does not threaten the life of the mother or the fetus.

10. Which patient most clearly needs rapid transport to a trauma center?

    1. A. A stab wound to the neck with a hematoma
    2. B. A dog bite to the cheek with normal vitals
    3. C. An isolated corneal abrasion
    4. D. A simple nosebleed that has stopped
    Show answer

    Answer: A. A stab wound to the neck with a hematoma

    Penetrating neck injury with a hematoma may involve major vessels or the airway and needs surgical capability. The others can be managed at a general emergency department.

11. During transport, a patient with a stab wound to the middle of the neck develops a hoarse voice, and the swelling around the wound is enlarging. His SpO2 is 95%, and he has no spinal concern. The best action is to:

    1. A. Remove the dressing and inspect the wound
    2. B. Wrap a firm bandage around the neck
    3. C. Lay him flat with the neck extended
    4. D. Prepare a surgical airway and call ahead
    Show answer

    Answer: D. Prepare a surgical airway and call ahead

    An expanding hematoma is a hard sign of vascular injury, and a new hoarse voice means it is starting to compress the larynx, so the airway may close before arrival. Keep pressure on the wound, keep him in a position of comfort, ready the difficult-airway and surgical-airway equipment, and notify the trauma center so a surgeon and airway team are waiting. Removing the dressing can restart heavy bleeding and let air into an open vein. A circumferential bandage tight enough to compress the hematoma also compresses the airway and venous drainage. Lying flat with the neck extended worsens airway narrowing and venous congestion.

12. A 5-year-old fell from a bicycle and has a laceration under the chin and a swollen jaw. Which consideration is most important for children with facial trauma?

    1. A. Their facial bones break more easily
    2. B. Their airway obstructs more easily
    3. C. They seldom need airway management
    4. D. Their jaw cannot be dislocated
    Show answer

    Answer: B. Their airway obstructs more easily

    Children have a large tongue, a small mouth and jaw, and a narrow airway, so even modest bleeding or swelling can block it quickly; position for drainage, suction, and reassess often. Children's facial bones do not break more easily than adults', children with facial injuries often do need airway support, and a child's jaw can be injured or dislocated like an adult's.

13. Facial fractures in young children are less common than in adults mainly because:

    1. A. Their skulls are proportionally small
    2. B. They have less soft-tissue padding
    3. C. Their facial bones are more elastic
    4. D. Their sinuses are fully formed
    Show answer

    Answer: C. Their facial bones are more elastic

    Children's bones bend before breaking and their sinuses are not yet developed, so the face is more resistant to fracture. When children do have facial fractures, a large force is implied.

14. A 3-year-old is brought in with a torn upper lip frenulum, and the caregiver gives a vague history. You should consider:

    1. A. A normal toddler injury
    2. B. Possible child abuse
    3. C. A dental infection
    4. D. A congenital defect
    Show answer

    Answer: B. Possible child abuse

    A torn frenulum in an infant or young child, especially with an inconsistent history, can result from forced feeding or a blow to the mouth. Document the findings and report per local law.

15. An 80-year-old woman tripped and struck her face on a table. Even a minor fall like this can cause a serious brain injury in older adults mainly because:

    1. A. Facial bones become denser with age
    2. B. Cerebral blood flow rises with age
    3. C. The skull thickens and becomes brittle
    4. D. Brain atrophy stretches the bridging veins
    Show answer

    Answer: D. Brain atrophy stretches the bridging veins

    Age-related brain atrophy widens the space between brain and skull and stretches the bridging veins, so a subdural hematoma can follow a minor fall, especially with anticoagulants. Osteoporosis makes facial bones less dense, not more, so they fracture more easily.

16. In older adults, a fall that causes facial injury should also prompt you to:

    1. A. Assume the fall was purely mechanical
    2. B. Treat only the facial injury
    3. C. Investigate the cause of the fall
    4. D. Delay transport to observe
    Show answer

    Answer: C. Investigate the cause of the fall

    A fall may be due to syncope, dysrhythmia, stroke, or medication effects, so ask what happened before the fall and obtain an ECG. Treating only the face can miss the underlying cause.

17. When a helmeted football player has a facial injury and a suspected spinal injury, the face mask should be:

    1. A. Removed to give access to the airway
    2. B. Left on so the head stays immobilized
    3. C. Removed only at the hospital
    4. D. Pushed upward along with the helmet
    Show answer

    Answer: A. Removed to give access to the airway

    Inter-association guidance says the face mask should be removed with a cordless screwdriver or cutting tool before transport, regardless of current breathing, so the airway can be reached at once. If equipment is removed, at least three trained rescuers take off the helmet and shoulder pads together, preferably before transport, so the neck stays neutral; one is never removed without the other. Leaving the mask on blocks the airway, waiting for the hospital delays airway access, and pushing the helmet upward moves the cervical spine.

18. A 22-year-old has a penetrating eye injury and a facial fracture. When transporting with no spinal concern, the best position is:

    1. A. Supine with the head elevated
    2. B. Prone with the head turned
    3. C. Trendelenburg position
    4. D. Left lateral recumbent position
    Show answer

    Answer: A. Supine with the head elevated

    Elevating the head reduces intraocular and intracranial pressure and swelling. Trendelenburg raises both.

19. A patient with facial trauma is agitated and combative. Which cause should be considered first?

    1. A. Intoxication
    2. B. Anxiety
    3. C. Pain
    4. D. Hypoxia
    Show answer

    Answer: D. Hypoxia

    Agitation in a trauma patient should be assumed to be hypoxia or brain injury until proven otherwise. Intoxication may be present, but it must not be assumed.

20. Pain management for an isolated facial fracture with a patent airway and normal mental status may include:

    1. A. Oral ibuprofen in high doses
    2. B. Midazolam as a first-line agent
    3. C. Fentanyl in small titrated doses
    4. D. Ketorolac as the preferred agent
    Show answer

    Answer: C. Fentanyl in small titrated doses

    Small, titrated IV or intranasal doses of fentanyl (typically about 1 mcg/kg, repeated per protocol) act quickly, wear off quickly, and let you recheck breathing and mental status between doses. Oral ibuprofen is a poor choice for a patient with facial fractures who may need surgery and may not swallow safely, and high doses add bleeding risk. Midazolam is a sedative, not an analgesic, and can depress breathing. Ketorolac is an option for some trauma pain but is not preferred when bleeding is a concern, because it impairs platelet function.

21. A 40-year-old with a mandible fracture and a patent airway becomes nauseated. You give an antiemetic mainly to:

    1. A. Relieve the pain of the fracture
    2. B. Reduce the risk of vomiting and aspiration
    3. C. Prevent the development of shock
    4. D. Lower the patient's blood pressure quickly
    Show answer

    Answer: B. Reduce the risk of vomiting and aspiration

    Vomiting with facial fractures risks aspiration and, with eye or head injury, raises intraocular and intracranial pressure. Antiemetics do not treat pain or shock.

22. During transport, a man stabbed in the neck who was talking normally develops a muffled, changing voice. This change most likely means:

    1. A. Normal fatigue after a long transport
    2. B. Anxiety about arrival at the hospital
    3. C. An expanding hematoma or airway swelling
    4. D. Dryness from breathing supplemental oxygen
    Show answer

    Answer: C. An expanding hematoma or airway swelling

    A new or changing voice after neck trauma suggests that an expanding hematoma or laryngeal swelling is compressing the airway. Prepare for a difficult airway, including a surgical airway, and notify the receiving center. Attributing it to fatigue, anxiety, or dry oxygen risks a sudden loss of the airway.

23. When giving a radio report on a patient with a penetrating neck wound, the most useful information for the trauma team is:

    1. A. The full past surgical history of the patient
    2. B. The names of the witnesses
    3. C. A list of every minor abrasion
    4. D. Airway status and signs of vessel injury
    Show answer

    Answer: D. Airway status and signs of vessel injury

    Airway status and hard signs such as an expanding hematoma tell the team to prepare for a surgical airway or the operating room. A full surgical history or a list of minor abrasions delays the report and can wait for the bedside handoff.

24. A 45-year-old man has an eye injury from a fight. He also smells of alcohol and refuses care. Before accepting the refusal, you must:

    1. A. Have him sign a refusal form at once
    2. B. Determine his decision-making capacity
    3. C. Obtain consent from his family members instead
    4. D. Measure his blood alcohol level
    Show answer

    Answer: B. Determine his decision-making capacity

    A patient must be alert, oriented, and able to understand the risks of refusing; intoxication and head injury can impair capacity. Having him sign a form does not make a refusal valid if he lacks capacity.

25. Facial injuries in a patient who was assaulted should be documented carefully because:

    1. A. The record may be used in court
    2. B. Photos must be taken of every wound
    3. C. It decides who was at fault
    4. D. It determines the charges filed
    Show answer

    Answer: A. The record may be used in court

    Accurate descriptions of the injuries and the patient's own statements support clinical care and any legal proceedings. Paramedics document findings; deciding fault or charges is for the courts and police, and photography policies vary by agency.