EMT Chapter 9 - Patient Assessment

Which of the following scenarios does NOT involve the presence of any symptoms? A. A 44-year-old male with abdominal pain and severe dizziness B. A 61-year-old female who is unconscious with facial cyanosis C. A 55-year-old male with a severe headache and 2 days of nausea D. A 49-year-old female with blurred vision and ringing in the ears

Which of the following actions would NOT be performed during the scene size-up? A. Asking a neighbor to secure the patient's dog B. Notifying the dispatcher to send fire personnel C. Rapidly assessing a patient's respiratory status D. Noting the position of a crashed motor vehicle

You are assessing a 72-year-old man with abdominal pain. The patient is sitting in a chair; he is conscious, alert, and calm. As you are talking to the patient, your partner discreetly directs your attention to a handgun, which is located on a nearby table. You should: A. position yourself in between the patient and the gun and ask your partner to request law enforcement assistance. B. direct your partner to move the gun to a safe area and then advise the patient that his weapon has been secured. C. document the presence of the weapon, including its specific location, and continue your assessment of the patient. D. immediately cease all patient care, carefully back out of the residence, and request law enforcement assistance.

Which of the following statements regarding the mechanism of injury (MOI) is correct? A. A significant MOI always results in patient death or permanent disability. B. The exact location of a patient's injuries can be determined by the MOI. C. The MOI may allow you to predict the severity of a patient's injuries. D. A nonsignificant MOI rules out the possibility of serious trauma.

During an EMS call, you should take standard precautions: A. before exiting the ambulance and before actual patient contact. B. before you load the patient into the ambulance. C. after it has been determined that the patient is bleeding. D. immediately after completion of your primary assessment.

Treatment and transport priorities at the scene of a mass-casualty incident should be determined after: A. all the patients have been triaged. B. a physician arrives at the scene. C. area hospitals have been notified. D. the number of patients is known.

When approaching a 32-year-old male who is complaining of traumatic neck pain, you should: A. ensure that the patient can see you approaching him. B. stand behind him and immediately stabilize his head. C. assess his mental status by having him move his head. D. approach him from behind and ask him not to move.

Which of the following conditions would be LEAST likely to cause an altered level of consciousness? A. Inadequate perfusion B. Acute anxiety C. Drug overdose D. Poisoning

An elderly patient has fallen and hit her head. Your initial care should focus on: A. obtaining baseline vital signs. B. providing immediate transport. C. gathering medical history data. D. airway, breathing, and circulation.

An injured patient is assigned a total score of 9 on the GCS. He is assigned a score of 2 for eye opening, a score of 3 for verbal response, and a score of 4 for motor response. Which of the following clinical findings is consistent with his GCS score? A. Opens eyes in response to pain, uses inappropriate words, withdraws from pain B. Opens eyes in response to voice, makes incomprehensible sounds, localizes pain C. Opens eyes spontaneously, is confused when spoken to, exhibits abnormal flexion D. Eyes remain closed, makes incomprehensible sounds, exhibits abnormal extension

When you shine a light into one pupil, the normal reaction of the other pupil should be to: A. become larger. B. dilate. C. not react. D. become smaller.

What maneuver should be used to open the airway of an unresponsive patient with suspected trauma? A. Tongue-jaw lift B. Head tilt-neck lift C. Head tilt-chin lift D. Jaw-thrust maneuver

You should suspect that a patient is experiencing respiratory failure if he or she: A. has an increased heart rate and retractions. B. is anxious, tachycardic, and leaning forward. C. is restless and is working hard to breathe. D. has bradycardia and diminished muscle tone.

A palpable pulse is created by: A. pressure waves through the arteries caused by cardiac contraction. B. the pressure that is caused when venous blood returns to the heart. C. the pressure of circulating blood against the walls of the arteries. D. electrical conduction in the heart producing ventricular contraction.

In patients with deeply pigmented skin, changes in color may be apparent only in certain areas, such as the: A. lips or oral mucosa. B. forehead and face. C. back of the neck. D. dorsum of the hand.

A 39-year-old male sustained a stab wound to the groin during an altercation at a bar. As you approach the patient, you note that he is conscious. He is screaming in pain and is attempting to control the bleeding, which is bright red and spurting from his groin area. You should: A. elevate his legs and keep him warm. B. apply direct pressure to the wound. C. administer 100% supplemental oxygen. D. ensure that his airway is patent.

The rapid exam of a patient that occurs following the primary assessment should take no longer than: A. 120 to 180 seconds. B. 90 to 120 seconds. C. 60 to 90 seconds. D. 30 seconds.

The chief complaint is MOST accurately defined as the: A. most serious thing the patient is concerned about. B. most life-threatening condition that you discover. C. gross physical signs that you detect on assessment. D. condition that exacerbates an underlying problem.

Which of the following statements regarding the secondary assessment is correct? a. the secondary assessment should focus on a certain area or region of the body as determined by the chief complaint b. during the secondary assessment, the EMT's primary focus should be on taking the patients vital signs and obtaining a SAMPLE history c. the secondary assessment should be performed en route to the hospital, regardless of the severity of the patients condition d. a secondary assessment should always be performed, even if you must continually manage life threats that were identified in the primary assessment

Reassessment is performed to determine all of the following, EXCEPT: A. whether or not the patient is deteriorating. B. the patient's response to your treatment. C. the reason why the patient called EMS. D. the nature of any newly identified problems.

Upon arriving at a potentially unsafe scene, you should: A) remove all bystanders. B) request another ambulance. C) move the patient to safety. D) ensure that you are safe.

A patient who does not respond to your questions, but moves or cries out when his or her trapezius muscle is pinched, is said to be: A) conscious and alert. B) completely unresponsive. C) responsive to verbal stimuli. D) responsive to painful stimuli.

A patient's short-term memory is MOST likely intact if he or she correctly answers questions regarding:Select one: A. date and event. B. event and person. C. time and place. D. person and place.

A 29-year-old male with a head injury opens his eyes when you speak to him, is confused as to the time and date, and is able to move all of his extremities on command. His Glasgow Coma Scale (GCS) score is: A) 10. B) 12. C) 13. D) 14.

When you inspect a patient's pupils with a penlight, the pupils should normally react to the light by: A) constricting. B) enlarging. C) dilating. D) fluttering.

Which of the following statements regarding stridor is correct? A) It is a whistling sound heard in the lower airway. B) It is caused by incorrect airway positioning. C) It is a high-pitched, crowing upper airway sound. D) It suggests the presence of fluid in the lungs.

Which of the following findings indicates that your patient has a patent airway?Select one: a. Audible breathing b. Forceful coughing c. Inspiratory stridor d. Unresponsiveness

A 40-year-old male crashed his motorcycle into a tree. He is semiconscious, has snoring respirations, and has a laceration to the forearm with minimal bleeding. You should: A) apply a cervical collar and suction his airway. B) open his airway with the jaw-thrust maneuver. C) apply a pressure dressing to the patient's arm. D) tilt the patient's head back and lift up on his chin.

After performing a head tilt-chin lift maneuver to open the airway of an unresponsive patient who has a pulse, you should: A) place him or her in the recovery position. B) provide positive-pressure ventilatory assistance. C) assess respiratory rate, depth, and regularity. D) suction as needed and insert an airway adjunct.

A patient with spontaneous respirations is breathing: A. at a normal rate. B. with shallow depth. C. without difficulty. D. without assistance

Supplemental oxygen without assisted ventilation would MOST likely be administered to patients: A) who are semiconscious with shallow respirations. B) with rapid respirations and a reduced tidal volume. C) who have accessory muscle use and slow breathing. D) with difficulty breathing and adequate tidal volume.

You are dispatched to the county jail for an inmate who is "sick." When you arrive, you find the patient, a 33-year-old male, unresponsive. His airway is patent and his respirations are rapid and shallow. Your initial action should be to: A) apply a pulse oximeter. B) request a paramedic unit. C) provide assisted ventilation. D) assess his blood pressure

If a patient develops difficulty breathing after your primary assessment, you should immediately: A) determine his or her respiratory rate. B) begin assisting his or her breathing. C) reevaluate his or her airway status. D) auscultate his or her breath sounds.

Normal respiratory rates should not exceed _______ breaths per minute in toddlers and _______ breaths per minute in infants. A) 18, 28 B) 20, 30 C) 30, 40 D) 40, 60

Which of the following is the MOST effective method of assessing the quality of air movement in the lungs? A) Evaluating the patient's chest for cyanosis B) Applying a pulse oximeter and monitoring the SpO2 C) Auscultating breath sounds with a stethoscope D) Looking for the presence of accessory muscle use

Which of the following abnormal breath sounds indicates obstruction of the upper airway? A) Rales B) Stridor C) Crackles D) Rhonchi

Clinical signs of labored breathing include all of the following, EXCEPT: A. shallow chest movement. B. use of accessory muscles. C. supraclavicular retractions. D. gasping attempts to breathe

When a patient's respirations are shallow: A) chest rise will be easily noticeable. B) tidal volume is markedly reduced. C) oxygenation occurs more efficiently. D) carbon dioxide elimination is increased.

Which of the following signs of respiratory distress is seen MOST commonly in pediatric patients? A) Seesaw breathing B) Rapid respirations C) Pursed-lip breathing D) Accessory muscle use

An adult patient who is NOT experiencing difficulty breathing will: A) be able to speak in complete sentences without unusual pauses. B) assume a position that will facilitate effective and easy breathing. C) exhibit an indentation above the clavicles and in between the ribs. D) have a respiratory rate that is between 20 and 24 breaths/min.

Which of the following is the MOST accurate guide to palpating a pulse? A. Avoid compressing the artery against a bone or solid structure. B. Place the tips of your index and long fingers over the pulse point. C. Use your thumb to increase the surface area that you are palpating. D. Apply firm pressure to the artery with your ring and little fingers.

In responsive patients who are older than 1 year of age, you should palpate the pulse at the ________ artery. A) radial B) carotid C) brachial D) femoral

A patient is sitting in a chair, leaning forward on his outstretched arms. His head and chin are thrust forward. This position indicates that he: A) has abdominal muscle spasms. B) is experiencing severe back pain. C) has a decreased level of consciousness. D) is experiencing difficulty breathing.

When palpating the carotid pulse of a responsive patient, you should: A) avoid compressing both carotid arteries simultaneously. B) ensure that his or her head is in a hyperextended position. C) avoid gentle pressure so that weak pulses can be detected. D) firmly compress the artery because the pulse is often weak.

You receive a call to a daycare center for an unresponsive 8-month-old infant. Upon arrival, you perform an assessment and determine that the infant is not breathing. Your next action should be to: A) open the airway and give two rescue breaths. B) begin chest compressions and request backup. C) immediately transport the child to the hospital. D) assess for a brachial pulse for 5 to 10 seconds.

You respond to the residence of a 62-year-old male who is unresponsive. Your primary assessment reveals that he is apneic and pulseless. You should: A) start CPR and attach the AED as soon as possible. B) ask the family if the patient has a terminal disease. C) perform CPR and transport the patient immediately. D) notify dispatch and request a paramedic ambulance.

Which of the following factors would MOST likely cause a patient's pulse rate to be slower than normal? A) Anxiety or severe stress B) Beta-blocker medications C) Internal bleeding from trauma D) Lack of a regular exercise routine

When palpating a patient's pulse, you note that it is grossly irregular. You should: A) count the pulse rate for at least 30 seconds to ensure accuracy. B) count the number of pulsations in 15 seconds and multiply by four. C) count the number of pulsations in 30 seconds and multiply by two. D) count the pulse rate for a full minute to obtain an accurate reading.

For an adult, the normal resting pulse should be between: A. 50 and 60 beats/min. B. 50 and 70 beats/min. C. 60 and 100 beats/min. D. 70 and 110 beats/min

In the adult, bradycardia is defined as a pulse rate less than _______ beats/min, and tachycardia is defined as a heart rate greater than _______ beats/min. A. 60, 100 B. 50, 110 C. 40, 120 D. 30, 130

A pulse with a consistent pattern is considered to be: A. weak. B. strong. C. regular. D. irregular

When palpating a patient's pulse, you note that there is a short interval between pulsations. This indicates that the pulse is: A. slow. B. rapid. C. irregular. D. thready

When assessing a 62-year-old female with crushing chest pain, you note that her pulse is rapid and irregular. You should administer supplemental oxygen if needed and then: A) apply the AED and analyze her cardiac rhythm. B) transport at once and consider requesting a paramedic unit. C) document your findings and perform a detailed assessment. D) conclude that the irregular pulse is normal based on her age.

Poor peripheral circulation will cause the skin to appear: A) pink. B) ashen. C) flushed. D) cyanotic.

When assessing the skin of an unresponsive patient, you note that it has a bluish tint to it. This finding is called: A) pallor. B) flushing. C) cyanosis. D) mottling.

Cyanosis of the skin is caused by: A. increased blood oxygen. B. peripheral vasodilation. C. venous vasoconstriction. D. decreased blood oxygen

Normal skin color, temperature, and condition should be: A. flushed, cool, and dry B. pale, cool, and moist C. pink, warm, and moist D. pink, warm, and dry

A patient with high blood pressure would be expected to have skin that is: A) flushed and red. B) mottled and cool. C) pale and moist. D) cyanotic and dry.

A 40-year-old male presents with pain to the right upper quadrant of his abdomen. He is conscious and alert with stable vital signs. During your assessment, you note that his skin and sclera are jaundiced. You should suspect: A) acute pancreatitis. B) liver dysfunction. C) gallbladder disease. D) renal insufficiency.

A patient with profuse sweating is referred to as being: A) flushed. B) plethoric. C) diaphoretic. D) edematous.

When you assess capillary refill time in an infant, normal color to the tested area should return within: A) 1 second. B) 2 seconds. C) 3 seconds. D) 4 seconds.

With regard to the assessment of a patient's cardiovascular status, capillary refill time is MOST reliable in: A. children who are younger than 6 years of age. B. patients who are significantly hypotensive. C. children who are older than 6 years of age. D. patients with decreased peripheral perfusion

After performing a primary assessment, a rapid exam of the body should be performed to: A) determine the need for spinal motion restriction precautions. B) identify less-obvious injuries that require immediate treatment. C) look specifically for signs and symptoms of inadequate perfusion. D) find and treat injuries or conditions that do not pose a threat to life.

You should gently palpate a patient's pelvis only if: A) you note gross deformity to the pelvic area. B) the patient does not complain of pelvic pain. C) the MOI suggests significant trauma to the pelvis. D) the possibility of a pelvic fracture has been ruled out.

A 71-year-old female slipped on a rug and fell. She is conscious and alert and complains of severe pelvic pain. Her respirations are 22 breaths/min with adequate depth and her heart rate is 120 beats/min. Which of the following is NOT indicated for this patient? A) Rapid head-to-toe exam B) Application of a cervical collar C) Treating her for possible shock D) Gentle palpation of the pelvis

When assessing a patient's abdomen, you will evaluate for all of the following, EXCEPT: A. open wounds or eviscerations. B. gross bleeding and tenderness. C. rigidity and obvious bleeding. D. subcutaneous emphysema.

Which of the following situations or conditions warrants immediate transport? A) Mild pain in the lower abdomen B) Severe chest pain and cool, pale skin C) Decreased ability to move an extremity D) Responsiveness and ability to follow commands

When performing a rapid exam on a supine patient, what part of the body is typically assessed last? A) Abdomen B) Posterior C) Extremities D) Anterior chest

As you assess the head of a patient with a suspected spinal injury, your partner should: A. maintain stabilization of the head. B. look in the ears for gross bleeding. C. prepare the immobilization equipment. D. assess the rest of the body for bleeding

A 50-year-old male presents with altered mental status. His wife tells you that he had a "small stroke" three years ago but has otherwise been in good health. The patient is responsive but unable to follow commands. After administering oxygen if needed, you should: A) repeat the primary assessment. B) inquire about his family history. C) prepare for immediate transport. D) perform a head-to-toe assessment.

The "Golden Hour" begins when an injury occurs and ends when: A) the patient receives definitive care. B) the patient is admitted to the ICU. C) you depart the scene for the hospital. D) you arrive at the emergency department.

As time progresses following a significant injury: A. the patient's blood pressure elevates significantly. B. the body's ability to compensate for shock decreases. C. the patient's injuries will most likely be irreparable. D. most patients will die secondary to internal bleeding.

During a 30-minute transport of a stable patient, you should reassess him or her at least ________ times. A) 2 B) 3 C) 4 D) 6

What part of the patient assessment process focuses on obtaining additional information about the patient's chief complaint and any medical problems he or she may have? A) History taking B) General impression C) Primary assessment D) Secondary assessment

Upon arriving at the scene of a patient with difficulty breathing, you determine that the scene is safe. You enter the residence and find the patient sitting in a chair in respiratory distress. Your first action should be to: A) ask the patient what's wrong. B) obtain a set of baseline vital signs. C) assess the patient's airway status. D) introduce yourself to the patient.

Which of the following questions is used to determine a patient's chief complaint? A) "What seems to be the matter?" B) "When did the chest pain begin?" C) "Are you having trouble breathing?" D) "Do you have a history of diabetes?"

When interviewing a patient, you can show him or her that you understand the situation by: A) repeating statements back to him or her. B) using medical terminology whenever possible. C) maintaining constant eye contact with him or her. D) interrupting him or her as needed for clarification.

Which of the following medical history questions would be of LEAST pertinence in an acute situation? A) "Does the pain stay in your chest?" B) "Does your mother have diabetes?" C) "Has this ever happened to you before?" D) "Are there medications that you cannot take?"

Which of the following questions would you ask a patient to ascertain the "M" in the SAMPLE history? A) "Have you ever had any major surgeries?" B) "How long have you had your chest pain?" C) "How much Tylenol do you take each day?" D) "When was the last time you ate a meal?"

Palliating factors regarding a patient's pain involve those that: A. worsen the pain. B. alleviate the pain. C. initiate the pain. D. change the pain.

Pain that moves from its point of origin to another body location is said to be: A) radiating. B) referred. C) palliating. D) provoking.

In which of the following situations is a pertinent negative identified? A) A 50-year-old woman states that nothing makes her chest pain better or worse. B) A 53-year-old man with dizziness also tells you that he has vomited three times. C) A 56-year-old woman states that her chest hurts when she takes a deep breath. D) A 59-year-old man complains of crushing chest pain but denies shortness of breath.

When using the pulse oximeter as part of your assessment of a patient, it is important to remember that: A) pulse oximetry is especially useful in patients who have cold extremities because vasoconstriction forces blood to the capillary beds. B) carbon monoxide has no effect on pulse oximetry readings because the pulse oximeter presumes that oxygen is saturating the hemoglobin. C) as long as the patient's oxygen saturation is greater than 95%, oxygen is usually not necessary, even if the patient is experiencing respiratory distress. D) any situation that causes vasoconstriction or loss of red blood cells, such as anemia or bleeding, may result in an inaccurate or misleading value.

Capnography is used to: A) determine how much carbon dioxide is being exhaled. B) assess how much oxygen is bound to the hemoglobin. C) trend a patient's blood pressure and assess for shock. D) assess how much oxygen is reaching the body's tissues.

Which of the following would the EMT likely NOT perform on a responsive patient with a headache and no apparent life-threatening conditions? A) Focused secondary assessment B) Assessment of oxygen saturation C) Systematic head-to-toe examination D) Noninvasive blood pressure monitoring

The goal of the systematic head-to-toe exam that is performed during the secondary assessment is to:Select one: A. assess only the parts of the body that are injured. B. detect and treat all non-life-threatening injuries. C. definitively rule out significant internal injuries. D. locate injuries not found in the primary assessment

The systematic head-to-toe assessment should be performed on: A) stable patients who are able to tell you exactly what happened. B) all patients with traumatic injuries who will require EMS transport. C) responsive medical patients and patients without a significant MOI. D) patients with a significant MOI and unresponsive medical patients

When performing the secondary assessment on a trauma patient, you note the presence of Battle sign. This is defined as: A) unequal pupils. B) bruising behind the ear. C) swelling to the orbital area. D) fluid drainage from the nose.

A decrease in blood pressure may indicate: A) loss of vascular tone. B) arterial constriction. C) increased blood volume. D) forceful cardiac contraction.

The pressure exerted against the walls of the artery when the left ventricle contracts is called the: A. blood pressure. B. systolic pressure. C. diastolic pressure. D. pulse pressure.

The diastolic blood pressure represents the: A) average pressure against the arterial walls during a cardiac cycle. B) minimum amount of pressure that is always present in the arteries. C) increased arterial pressure that occurs during ventricular contraction. D) difference in pressure between ventricular contraction and relaxation.

While evaluating a patient with chest pain, your partner tells you that the patient's blood pressure is 140/94 mm Hg. The lower number represents the pressure from the: A) atria relaxing. B) atria contracting. C) ventricles relaxing. D) ventricles contracting.

A blood pressure cuff that is too small for a patient's arm will give a: A) falsely low systolic and diastolic reading. B) falsely high systolic but low diastolic reading. C) falsely high systolic and diastolic reading. D) falsely low systolic but high diastolic reading.

A properly sized blood pressure cuff should cover: A) two thirds the length from the armpit to the crease at the elbow. B) one half the length between the armpit and the crease at the elbow. C) one third the length from the armpit to the crease at the elbow. D) the entire upper arm between the armpit and the crease at the elbow.

A crackling sound produced by air bubbles under the skin is called: A) crepitus B) rhonchi. C) Korotkoff sounds. D) subcutaneous emphysema.

Jugular venous distention suggests a problem with blood returning to the heart if the patient is: A) in a supine position. B) in a prone position. C) in a recumbent position. D) sitting up at a 45° angle.

Which of the following MOST accurately describes paradoxical movement of the chest wall? A) Multiple rib fractures that cause a marked deformity of the chest wall B) A marked decrease in chest wall movement due to abdominal breathing C) Only one section of the chest rises on inspiration, while another area falls D) One side of the chest wall moves opposite the direction of the other

Which of the following assessments would be the MOST useful in determining the possible cause of a patient's altered mental status? A) Respiratory rate B) Blood pressure C) Blood glucose level D) Capillary refill time

Which of the following statements regarding the blood pressure is correct?Select one: A. The systolic pressure represents ventricular relaxation. B. Blood pressure falls early in patients with hypoperfusion. C. Blood pressure is the most reliable indicator of perfusion. D. Blood pressure is usually not measured in children younger than 3 years of age