Chapter 13:Patient Assessment

You are transporting a 31-year-old male who was severely injured in a motor vehicle collision. He is unresponsive and being ventilated by your partner with a bag-valve mask. How will you conduct the rapid secondary assessment on this patient?

Perform a head-to-toe exam

As you arrive by the side of a 64-year-old unresponsive female, you hear snoring respirations. Your immediate action would be to:

Perform a manual jaw-thrust maneuver

A 69-year-old male called 911 because of the sudden onset of pain and numbness to his left leg. He states that he has a history of blood clots that form in the leg and the pain feels exactly as it did the last time that this occurred. He denies any trauma to the extremity. You perform the primary assessment and find him to be alert and oriented with no life-threatening conditions to the airway, breathing, or circulation. When performing the secondary assessment on this patient, which one of the following is most appropriate?

Physical exam of the leg

A 5-year-old boy has been vomiting profusely for two days. Your assessment indicates that his airway is open, respirations adequate, and radial pulse fast and weak. His skin is cool and capillary refill time is 5 seconds. The EMT should understand that the patient is:

Poorly perfused

Forming the general impression is started during which phase of patient assessment?

Primary assessment

You arrive on the scene of a motor vehicle collision and are presented with a patient complaining of chest pain after striking his chest on the steering wheel. On scene Emergency Medical Responders (EMRs) are maintaining cervical immobilization manually. He is alert and oriented and has a patent airway. His respirations are 24 with good chest rise and fall, and his skin is warm and dry. His heart rate is 96 and SpO2 92% on room air. At this time you should:

Provide supplemental oxygen

When performing the primary assessment of a conscious adult, you typically palpate which pulse first?

Radial

When assessing an adult trauma patient's circulation status during the primary assessment, the EMT's assessment should include:

Radial pulse, skin temperature, and presence of external bleeding

Trends in a patient's condition are best noted during what phase of a patient assessment?

Reassessment

An intoxicated 19-year-old female has fallen through a large plate glass window. As you approach, you note her to be sitting up and holding her hand over a large laceration that is spurting bright red blood. In this situation, you would immediately:

Apply direct pressure to the laceration

A 28-year-old female has fallen 20 feet from the roof a house. She is lying supine and does not appear to be conscious or breathing. On arrival at her side, what should the EMT do first?

Apply manual in-line spinal stabilization

You have been dispatched to an apartment for an elderly male complaining of shortness of breath. When do you start the process of forming a general impression about this patient?

As you and your partner approach him

A responsive patient is complaining of a migraine headache, of which she has a known medical history. Which one of the following would be most appropriate when conducting her secondary exam?

Assess her visual acuity

You have been summoned to a retail store where you are directed to a middle-aged woman who was found in the bathroom on the toilet. Your assessment shows her to be responsive to painful stimuli with an open airway and labored breathing. Her pulse is fast and regular and her skin is warm to the touch. The primary assessment has been completed and the appropriate care given. As the stretcher is prepared, you perform the secondary assessment. When assessing her chest, you note the presence of crackles to both lungs. What should you do next?

Assess the abdomen

A 62-year-old female was struck by a car traveling approximately 45 miles per hour. After being struck, she was thrown 15 feet onto the sidewalk, impacting the pavement with her head and chest. The primary assessment has been completed and life threats addressed. The patient's husband is by her side. When performing the secondary exam on this patient, which of the following should the EMT perform first?

Assess the patient from head to toe for additional injuries

A 20-year-old female patient is found unresponsive. The first step of the secondary assessment for her is to:

Conduct a rapid medical assessment

At a nursing home, you find an elderly patient extremely short of breath. To best determine if the patient is cyanotic, you should:

Examine the lining of the lips and mouth

During the primary assessment, how should you best determine the adequacy of a patient's breathing?

Examine the rise and fall of the chest

When performing a secondary assessment on an alert and oriented female with a deformed left leg, the EMT should:

Explain to the patient what you are doing before and during assessment.

A patient has been shot once in the left hand. After performing the primary assessment, the EMT quickly focuses his attention on the left hand and begins a specific assessment of the injury. What type of exam is the EMT performing?

Focused

Which one of the following assessment findings indicates that the patient has intact motor function in his lower extremities?

He can wiggle his toes when instructed

Forming a general impression is essential in the assessment of any patient because it:

Helps to determine the clinical status of a patient

An emergency Medical Responder informs you that a 59-year-old female is responsive to verbal stimuli. Which one of the following presentations should you expect?

Her eyes are closed, but she will wiggle her fingers if told

The EMT determines the medications a patient takes during which phase of the patient assessment?

History

You have been called to the side of a 37-year-old female whose chief complaint is confusion, anxiety, and chest tightness. Assessment shows her airway to be patent, respirations 46 per minute, heart rate 134, blood pressure 128/54 mmHg, and SpO2 at 93%. In regards to the respiratory rate, you would recognize:

It does not allow the lungs enough time to adequately fill

What item regarding breathing rates must the EMT remember when assessing the respirations of a pediatric patient?

It is usually faster than that of an adult

You have been called for an 83-year-old female who is having difficulty breathing. She informs you that she has congestive heart failure and feels as though she is filled up with fluid. The primary assessment shows her to be alert and oreinted with inadequate breathing. Her pulse is rapid and weak, and her skin is cool and dry. When performing a secondary assessment, which one of the following signs related to heart failure would you specifically look for when examining the patient's neck?

Jugular vein distention

A patient has called 911 for abdominal pain and generalized weakness. On arrival you note that the patient's skin is a yellow-orange color. Which one of the following diseases revealed to you during the history would best correlate to this patient' skin.

Liver disease

To stabilize the cervical spine of a trauma patient while simultaneously opening the airway, how should you position your head?

Neutral and in-line.

An alert and oriented 69-year old female is complaining of low, right-sided abdominal pain. She describes the pain as "knife-like" and states that it started suddenly one hour ago. Her only medical history is hypertension for which she takes the medication enalapril. Which one of the following assessment findings shows that the EMT is appropriately assessing this patient?

No abdominal guarding is noted

During your primary assessment, you find your patient's skin to be warm, pink, and dry. This should seemingly indicate:

Normal circulation

To best evaluate the adequacy of breathing in an unresponsive adult, the EMT should:

Observe the chest rise

When assessing a stable patient with a medical complaint, which piece of information will be obtained first and will help to guide the type of exam after the primary assessment has been completed?

Past medical history

The EMT recognizes that the best source of information for a responsive medical patient with a specific chief complaint and no known medical history is obtained from the:

Patient

When assessing the breath sounds (during a rapid secondary exam) of a critical trauma patient, it is best to auscultate each lung in at least how many places?

2

During assessment of a responsive medical patient, you gather a medical history using the memory aid SAMPLE. To obtain information related to "M," which one of the following questions should you ask?

"Are you currently taking any medications?"

Which one of the following statements made by an EMT shows he correctly understands capillary refill?

"For a capillary refill test to be normal for a child, it must be assessed at room temperature and be less than two seconds."

On scene you find a 91-year-old female who fell down two steps after suddenly complaining of a severe headache. She is unresponsive with gurgling respirations. What instructions should you immediately give your partner?

"Get the suction out and clear out the airway."

You are interviewing a prospective candidate for the position of EMT with your service. During the interview, you ask the applicant to describe the purpose of the primary assessment. Which statement best describes that purpose?

"Identify and treat life-threatening conditions."

The EMT is using the OPQRST mnemonic to gather information from a patient with abdominal pain. Which one of the following patient statements is a response to the letter "P" in this memory aid?

"It hurts worse when I take a deep breath."

At a continuing education seminar being taught by your medical director, he asks the group for one reason why the secondary assessment is beneficial to perform on the trauma patient. Which response is most appropriate?

"It is useful in finding additional injuries and guiding additional care."

You are instructing an Emergency Medical Responder course. One of the students asks you how the head-tilt, chin-lift airway maneuver works to open the airway. Your response is:

"It opens the airway by lifting the tongue from the back of the throat."

You are by the side of a 64-year-old male patient who collapsed at home. After assessing his level of consciousness, airway, and breathing, you determine that he is unresponsive with an open airway, but not breathing. What instruction should you immediately give your partner?

"Let's place an oral airway and start ventilations."

Which one of the following statements made by the EMT indicates that he has appropriately initiated the first phase of the patient assessment?

"The scene appears to be free of hazards."

Which one of the following capillary refill times is considered normal for a 5-year-old child?

2 seconds

On what patient should the EMT perform a rapid head-to-toe secondary assessment, as opposed to a focused secondary assessment?

24-year-old male with stable vitals who is alert and oriented and is complaining of chest pain secondary to a motor vehicle collision in which the passenger was killed

Which one of the following capillary refill times is considered the upper limit of normal for an adult female?

3 seconds

Which one of the following patients should the EMT identify as having the most adequate breathing?

34-year-old male with abdominal pain who is alert and oriented with good chest rise and fall

Which one of the following patients should receive supplemental oxygen with a nonrebreather mask or nasal cannula?

42-year-old female who is confused, weak, and dizzy, and adequately breathing 14 times per minute

Which one of the following patients should be classified as unresponsive?

46-year-old male who does not respond when his fingers are pinched

The EMT would recognize which one of the following patients as breathing at a normal rate?

8-year-old male breathing 26 times per minute

An EMT is assessing a 9-month-old infant who is "not acting right" per his mother. Assessment reveals him to be extremely irritable, crying weakly, and shows he does not want to be touched by the EMT. Which one of the following best describes this infant's mental status?

Alert

You have been called for an adult patient who suffered a seizure. He is sitting on the floor, and he looks at you as you enter the room. When questioned, he cannot remember the date or where he is. The patient's mental status can be described as:

Alert, but confused

An 18-year-old female with a history of diabetes twisted her right ankle while playing volleyball. She is alert and oriented and states that the pain is excruciating. The primary assessment is complete and yields no life-threatening conditions. Which of the following would you do next?

Assess the right ankle and foot

When assessing breath sounds during the secondary assessment, the EMT shows he is employing a correct technique when he listens:

At the left second intercostal space followed by the right second intercostal space

A 66-year-old female patient was involved in a vehicle rollover. While evaluating her abdomen, which one of the following abdominal assessment parameters should you be least concerned about?

Bowel sounds

You are assessing an 8-month-old whose mother states has been vomiting for two days and not eating or drinking. When assessing the pulse, you should check which site?

Brachial

When assessing a critically injured patient, the EMT should detect which one of the following injuries or conditions when performing the secondary assessment?

Bruising and tenderness to the abdomen

When performing the secondary assessment, the EMT would find which one of the following injuries first?

Bruising to the abdomen

Your patient is an 82-year-old and diabetic. Which one of the following assessment parameters is the least reliable sign indicating circulatory status?

Capillary refill

You cannot locate a radial pulse on a 54-year-old male who is alert, confused, and breathing adequately. Which of the following should you do immediately?

Check for the carotid pulse

You have been called for a 6-month-old male with a high fever who has seized. Currently, he is not seizing and appears to be sleeping. When performing the primary assessment on this patient, which of the following is appropriate?

Check for the presence of a pulse in the brachial artery

A 36-year-old patient who has overdosed on an unknown drug presents with his eyes closed, even when his name is loudly called. Which one of the following should the EMT do first?

Check the mental status

You are performing a secondary assessment on the unrestrained adult passenger involved in a motor vehicle collision, in which the car rolled end over end several times at a high rate of speed. The patient is responsive to painful stimuli and in a state of shock. When assessing the head, which one of the following is appropriate?

Checking the pupils with a penlight

Assessment of a patient's neck reveals that the trachea is deviated to the left. Based on this assessment finding, the EMT should suspect an injury located to the patient's:

Chest

When performing the primary assessment of a 45-year-old patient, which one of the following skin findings should concern the EMT?

Cool and moist skin

When assessing the chest of a patient who was shot multiple times, you find a gunshot wound to the third intercostal space on the left lateral chest. Which one of the following should you do immediately?

Cover the opening with a gloved hand

A 40-year-old male patient has crashed his motorcycle. He complains of pain to his right leg. When palpating his leg, you are assessing for:

Crepitation

You have been dispatched to a residence for an 89-year-old female with a nonspecific complaint. When assessing this patient, which of the following will you do first to develop a better understanding of the emergency?

Determine if the complaint is medical or trauma related

A conscious and alert 44-year-old female complains of chest pain and mild shortness of breath. She appears to have no difficulty speaking and states that the pain suddenly started about 2 hours ago. There is a history of blood clots in the lungs in her family, and she is scared and would like to be evaluated. Which of the following should you do first?

Determine the adequacy of her breathing

What is the purpose of assessing the pulse on an unresponsive patient during the primary assessment?

Determine the presence of a heartbeat

A 43-year-old male has called 911 with the complaint of difficulty breathing. On scene you note he is breathing at a rate of 18 breaths per minute. He also exhibits intercostal retractions and nasal flaring. The EMT should document this patient's breathing as:

Dyspneic

A 31-year-old male is complaining of left-side flank pain that radiates into his groin. He is alert and oriented and the primary assessment reveals no life-threatening conditions. A nonrebreather face mask delivering 15 liters per minute of oxygen has been applied. Given the patient's status, from the list below. your next step should be to:

Obtain a medical history from the patient

A 44-year-old male was cutting limbs from high in a tree when he fell. He is found to be unresponsive with snoring respirations. His breathing is inadequate at a rate of 8 per minute and his carotid pulse is weak and difficult to locate. Following the primary assessment and initial management of life threats, which of the following actions will the EMT complete while performing the secondary assessment?

Obtain vital signs and get a past medical history from the family

You have just determined that a 92-year-old female is unresponsive. Your next action would be to:

Open the airway

A 41-year-old male patient has fallen from a second-story roof. He is complaining of right leg pain and pain to his pelvic region. When performing the secondary assessment on this patient, which one of the following should the EMT intentionally not perform?

Palpation of the pelvic region

You are performing a secondary assessment and are assessing your patient's chest. Which one of the following findings do you associate most with fracture of the ribs?

Paradoxical chest wall motion

A male patient was found in cardiac arrest by coworkers. On arrival you determined him to be in cardiac arrest and you started CPR. The AED was quickly placed and you shocked him once, restoring a heartbeat. During transport, the patient remains unresponsive, but is breathing and has a pulse. When conducting the reassessment phase on this patient, you should do which one of the following?

Recheck vital signs

You have completed the primary assessment on a patient who was thrown from a motorcycle, impacting his head and back on the nearby sidewalk. After finding no life threats during the primary assessment, what action should you take first when starting a secondary assessment?

Reevaluate the mechanism of injury

En route to the hospital, you start the reassessment of a 22-year-old trauma patient. You should begin this assessment by:

Repeating the Primary Assessment

When assessing a sick or injured patient, which of the following indicates the appropriate order?

Scene size-up, primary assessment, secondary assessment

The EMT recognizes that for a trauma patient who is alert and oriented, he should obtain the history during what component of a patient assessment?

Secondary assessment

You are by the side of a patient complaining of shortness of breath with a history of heart problems, including congestive heart failure (CHF). When assessing the airway, which one of the following observations best indicates that it is patent?

She easily tells you that she is having chest pain

You arrive at the scene of a fall, where a 42-year-old woman fell backward off a step-ladder while cleaning windows in her kitchen. She is lying on the floor complaining of pain to her ankle. She tells you, "If I had just gone to work today instead of using vacation time, this never would have happened!" Based on information thus far, which one of the following can you conclude?

She is alert with an open airway

The "S" in SAMPLE stands for:

Sign

An unresponsible 54-year-old male was found by family in his bed. They state that he has not been feeling well and complained of chest pain before going to bed approximately one hour ago. According to family, he has no prior medical history and does not take any medications. The primary assessment reveals no life-threatening conditions. When performing the secondary assessment on this patient, the EMTshould:

Start by examining the patient's head

The patient's family states that their 16-year-old daugther has a history of asthma and has been complaining of shortness of breath for the past two days. She has been taking her metered-dose inhaler with some relief, but today they found her lethargic and struggling to breathe in bed. Your assessment reveals her to be responsive to verbal stimuli with an open airway and respirations of 36 per minute. You hear minimal bilateral wheezing. Your immediate action in caring for this patient is to:

Start positive pressure ventilation

As you perform the primary assessment on an unresponsive patient, you discover vomitus in her airway. Which of the following should you do next?

Suction the airway

As you approach a patient who was involved in a motor vehicle crash, you note that he has dark, oozing blood coming from an open fracture to his lower left tibia. The patient was removed from the car by bystanders and is being held by a family member. Which of the following should you do immediately?

Take manual in-line spinal stabilization

You are transporting an 18-year-old male, who has been injured in a motor-vehicle collision. He has a decreased level of consciousness and has suffered injuries to his, chest, and lower right leg. When you are conducting the reassessent of the patient's head and neck, which one of the following is appropriate?

Taking time to carefully re-palpate the face and scalp

When you assess the lower back of an elderly patient who fell, he grimaces and tells you that it hurts when you palpate the injury site. You should recognize which one of the following conditions?

Tenderness

When teaching a group of Emergency Medical Responders (EMRs) about the mechanism of injury, which one of the following points should you stress?

The more significant the mechanism of injury, the greater the chance the patient has been injured

A responsive but confused construction worker has fallen 10 feet from scaffolding, landing on his head and left shoulder. His airway is open and his breathing is adequate. Coworkers state that he was unresponsive for a period of 2 minutes following the fall and is on medications for depression and heart problems. Based on this information, the EMT should classify him as what kind of patient?

Trauma

While treating a patient who was assaulted by a mob of angry people in a bar, the EMTfinds the patient to be confused, tachycardic, with cool skin and a poor capillary refill. Into which physiologic category should the EMT place this patient?

Unstable

Which of the following physical findings is least consistent with an injured extremity?

Vomiting

When you are caring for a patient with either a medical complaint or traumatic injury, you should typically perform the reassessment:

While transporting the patient to the hospital

A 31-year-old male breathing at a rate of 6 times per minute can best be described as:

bradypneic

A 62-year-old female patient who has been working in her garden has hot, dry skin. You should recognize this as a possible sign of:

heat exposure

You are assessing a 4-year-old patient whose panicked mother states that she cannot wake him. The child is breathing but his eyes are closed. To best determine the child's mental status, you should first:

say loudly, "Open your eyes!"

While performing the secondary assessment on a male patient who was ejected from his motorcycle, he suddenly states that it has become very hard to breathe. You would:

stop your exam and evaluate the patient's new complaint