Chapter 9- Patient Assessment

During your assessment of a patient with closed head trauma, you note that he opens his eyes in response to pain, groans when you speak to him, and withdraws his shoulder when you pinch his earlobe. You should assign him a Glasgow Coma Scale score of: Select one: A. 8 B. 9 C. 10 D. 11

A. 8

Which of the following questions would allow you to assess the "P" in the SAMPLE history? Select one: A. Has this ever happened to you before? B. Do you take any prescription medications? C. Are there any medications you cannot take? D. What were you doing when this episode began?

A. Has this ever happened to you before?

Which of the following skin findings suggest liver dysfunction? Select one: A. Jaundice and dry B. Cyanotic and cool C. Flushed and warm D. Ashen and moist

A. Jaundice and dry

A 30-year-old male was ejected from his car after hitting a tree at a high rate of speed. Your assessment reveals that he is pulseless, apneic, and has multiple systems trauma. Treatment for this patient includes all of the following, EXCEPT: Select one: A. applying an AED and defibrillating if indicated. B. immediate transport to the closest trauma center. C. chest compressions and advanced airway management. D. large-bore IV lines with normal saline or lactated ringers.

A. applying an AED and defibrillating if indicated.

A patient with congenital anisocoria would be expected to have pupils that: Select one: A. are unequal in size. B. do not respond to light. C. dilate when exposed to light. D. are constricted and nonreactive.

A. are unequal in size.

You are transporting a 66-year-old male to the hospital following a seizure. As you reassess him, you note that his mental status is improving and he is now talking to you. You should: Select one: A. continue oxygenation and further monitoring. B. administer an IV fluid bolus to maintain perfusion. C. request a paramedic intercept in case he seizes again. D. reassess his vital signs every 3 minutes during transport.

A. continue oxygenation and further monitoring.

A 23-year-old female called EMS because of a sudden onset of abdominal pain. During your assessment, you ask her to point to the area of her abdomen that is painful. She encircles a large area of her left lower quadrant with her finger. You would describe this patient's pain as being: Select one: A. diffuse. B. focal. C. radiating. D. referred.

A. diffuse.

All of the following conditions would require immediate transport after the primary assessment and treatment phase, EXCEPT: Select one: A. headache without mental status change. B. abdominal pain and cool, clammy skin. C. responsiveness but inability to follow commands. D. inability to move the extremities following trauma.

A. headache without mental status change.

Trending a critically-injured patient's vital signs will allow you to determine: Select one: A. if the patient's condition is stabilizing or deteriorating. B. whether or not transport to a trauma center is necessary. C. the underlying injuries that are making the patient unstable. D. whether or not a rapid head-to-toe assessment is indicated.

A. if the patient's condition is stabilizing or deteriorating.

You are dispatched to an apartment complex, where a tenant was found unconscious by the landlord. There is no evidence of trauma. After completing the primary assessment and addressing immediate life-threats, you should: Select one: A. perform a rapid body scan. B. obtain baseline vital signs. C. perform a focused assessment. D. transport to the closest hospital.

A. perform a rapid body scan.

Proper use of personal protective equipment (PPE) will: Select one: A. reduce your risk of an infectious exposure. B. prevent you from being stuck with a needle. C. eliminate the possibility of contracting a disease. D. negate the need for hazardous material decontamination.

A. reduce your risk of an infectious exposure.

You are the first unit to arrive at the scene of a crash involving a minivan and a small passenger car. You see two patients in the minivan, one who appears to be unconscious and the other with severe bleeding from the face. A third patient is sitting on a curb holding his arm. Your initial action should be to: Select one: A. request at least one additional ambulance and law enforcement. B. begin immediate treatment of the most critically injured patients. C. triage the patients to assess the extent and severity of their injuries. D. notify the dispatcher and have a helicopter respond to the scene.

A. request at least one additional ambulance and law enforcement.

A patient who is in a tripod position is: Select one: A. sitting and leaning forward on outstretched arms with the head and chin thrust slightly forward. B. standing and leaning against an object, such as a wall, and has noticeable accessory muscle use C. kneeling and supporting himself with his hands with his head in a hyperextended position D. in a semisitting position, leaning slightly forward, with the chin drawn in toward the chest

A. sitting and leaning forward on outstretched arms with the head and chin thrust slightly forward.

A 66-year-old female is found unresponsive in her front yard by a neighbor. You perform a primary assessment and begin the appropriate treatment. There are no bystanders or witnesses to the patient's event. You should: Select one: A. transport the patient without delay. B. question other neighbors about the patient. C. inspect the patient's home for medications. D. attempt to notify the patient's family members.

A. transport the patient without delay.

All of the following elements are essential to the AEMT's critical-thinking ability, EXCEPT: Select one: A. using extraneous data to formulate an appropriate patient care plan. B. an understanding of how injuries and illnesses affect the human body. C. the ability to differentiate between relevant and irrelevant information. D. comparing a patient's complaint to past experiences with similar patients.

A. using extraneous data to formulate an appropriate patient care plan.

You are assessing a responsive patient who complains of abdominal pain. Which of the following questions would be MOST effective in determining the quality of the patient's pain? Select one: A. "Is the pain sharp or dull?" B. "What does the pain feel like?" C. "Does the pain feel like a stabbing pain?" D. "Does the pain travel anywhere?"

B. "What does the pain feel like?"

In general, you should assess the blood pressure in all patients who are at least ____ years of age. Select one: A. 1 B. 3 C. 5 D. 8

B. 3

In adult females and adolescents, systolic blood pressure is considered critically low when it is less _____ mm Hg or less. Select one: A. 90 B. 80 C. 70 D. 60

B. 80

You are dispatched to mile marker 539 for a vehicle that slid off the road and into the median. When you arrive at the scene, you note minimal damage to the vehicle. The patient, who is still inside his vehicle, appears to be unconscious. Which of the following statements regarding this situation is correct? Select one: A. The patient is probably unconscious due to blunt head trauma. B. An underlying medical condition may have resulted in this incident. C. C-spine control is not needed because of the minimal vehicle damage. D. The patient is most likely unconscious because he had a massive stroke.

B. An underlying medical condition may have resulted in this incident.

Which of the following methods of assessing circulation is LEAST reliable in adult patients? Select one: A. Condition of the skin B. Capillary refill time C. Temperature of the extremities

B. Capillary refill time

Loud, high-pitched and hollow sounds auscultated over the manubrium are called: Select one: A. tracheal sounds. B. bronchial sounds. C. vesicular sounds. D. bronchovesicular sounds.

B. bronchial sounds.

A 30-year-old male presents with signs of shock. He is conscious but anxious, and is in no obvious respiratory distress. After applying oxygen, you attach a pulse oximeter, which reads 78%. This low oxygen saturation reading is MOST likely the result of: Select one: A. a decreased PCO2. B. decreased perfusion. C. volume depletion. D. severe hypocarbia.

B. decreased perfusion.

During your reassessment of a patient with an illness or injury, it is important to: Select one: A. reassess vital signs only if a change is noted. B. document any changes in his or her condition. C. repeat the secondary assessment every 5 minutes. D. perform a head-to-toe assessment every 15 minutes.

B. document any changes in his or her condition.

A 50-year-old male has fallen from a significant height. He is conscious and alert, but is unable to feel or move both of his lower extremities. This is MOST likely the result of: Select one: A. local nerve injury. B. injury to the spinal cord. C. a response to severe pain. D. traumatic brain injury.

B. injury to the spinal cord.

A patient who remains flaccid without moving or making a sound with no indication of hearing you: Select one: A. requires assisted ventilation. B. is considered unresponsive. C. needs advanced airway care. D. likely requires defibrillation.

B. is considered unresponsive.

You are dispatched to a shopping mall for a female patient who is "sick." When you arrive, you find the patient, who appears confused, sitting on a bench in the middle of the mall. There is a small amount of blood in her hair. As you introduce yourself to the patient, you should direct your partner to: Select one: A. apply 100% oxygen with a nonrebreathing mask. B. manually stabilize her head in a neutral position. C. obtain vital signs and apply a bandage to her head. D. apply a cervical collar and assess for bleeding.

B. manually stabilize her head in a neutral position.

A small truck slid off the road and struck a utility pole. The driver, a 40-year-old male, has only minor abrasions from the airbag. His 38-year-old wife was killed in the crash. After performing a primary assessment of the driver, you should: Select one: A. obtain baseline vital signs. B. perform a rapid trauma assessment. C. perform a focused physical exam. D. immobilize his spine and transport.

B. perform a rapid trauma assessment.

Following the primary assessment, your actions prior to transport of a critically-injured patient should include: Select one: A. focused physical exam, spinal immobilization, IV therapy. B. rapid trauma assessment, spinal immobilization, vital signs. C. detailed physical examination, spinal immobilization, vital signs. D. rapid trauma assessment, vital signs, spinal immobilization, IV therapy.

B. rapid trauma assessment, spinal immobilization, vital signs.

During transport of a 34-year-old male with a possible femur fracture, you perform a reassessment. This process begins with: Select one: A. assessing his splinted extremity. B. repeating the primary assessment. C. conducting a head-to-toe assessment. D. reassessing his pulse, BP, and respirations.

B. repeating the primary assessment.

Upon arriving at the scene of a motor-vehicle crash involving two cars, you see an unconscious patient still in his vehicle, but cannot see the occupant of the other car. Your MOST appropriate initial action should be to: Select one: A. gain access to the unconscious patient. B. request at least one additional ambulance C. locate all patients before requesting assistance. D. notify law enforcement to search for another patient.

B. request at least one additional ambulance.

The need to perform a detailed physical exam on a patient is based on: Select one: A. your transport distance to the closest hospital. B. the nature of illness or mechanism of injury. C. the patient's response to initial management. D. whether or not a focused exam was performed.

B. the nature of illness or mechanism of injury.

The nature of a patient's illness is MOST often determined by: Select one: A. asking a family member. B. the patient's chief complaint. C. repeated calls to the patient's home. D. your general impression of the patient.

B. the patient's chief complaint.

You are attempting to obtain medical history information from a 20-year-old female. However, she does not answer your questions, despite the fact that she is conscious and alert and speaks English. You should: Select one: A. provide any necessary treatment and defer her medical history to the hospital staff. B. use close-ended questions and reassess the manner in which you are questioning her. C. decrease the amount of time in between each of the questions that you ask her. D. advise her that if she does not answer your questions, there is no way you can help.

B. use close-ended questions and reassess the manner in which you are questioning her.

You are transporting a critically-injured patient to a trauma center located 30 minutes away from the scene. At a minimum, how many times should you reassess the patient's vital signs during transport? Select one: A. 2 B. 4 C. 6 D. 8

C. 6

The rapid body scan of a seriously ill or injured patient should take no longer than: Select one: A. 30 seconds. B. 30 to 60 seconds. C. 60 to 90 seconds. D. 90 to 120 seconds.

C. 60 to 90 seconds.

A middle-aged woman presents with crushing chest pain, diaphoresis, tachycardia, and nausea. Which of these findings is/are signs? Select one: A. Chest pain and nausea B. Nausea and tachycardia C. Diaphoresis and tachycardia D. Chest pain and diaphoresis

C. Diaphoresis and tachycardia

Which of the following conditions can cause the skin to be abnormally flushed and red? Select one: A. Liver failure B. Hypothermia C. High blood pressure D. Poor peripheral circulation

C. High blood pressure

Which of the following patients requires immediate transport following initial stabilization at the scene? Select one: A. Conscious patient involved in a low-speed MVC B. Decreased movement of an extremity following trauma C. Severe pain to the left lower quadrant of the abdomen D. Large laceration to the arm with controlled bleeding

C. Severe pain to the left lower quadrant of the abdomen

A 55-year-old male complains of severe pain to the right lower quadrant of his abdomen. During your assessment, you should first palpate the: Select one: A. right lower quadrant. B. right upper quadrant. C. left upper quadrant. D. left lower quadrant.

C. left upper quadrant.

A 59-year-old male presents with right upper quadrant abdominal pain. Upon assessment, you note that his abdomen has an asymmetrical appearance. As you palpate the area, his jugular veins become slightly distended. These clinical findings are MOST suggestive of: Select one: A. an aortic aneurysm. B. a bowel obstruction. C. liver inflammation. D. fluid in the peritoneum.

C. liver inflammation.

When performing the rapid body scan on an unresponsive patient, you should follow the same approach as the: Select one: A. primary assessment. B. general impression. C. rapid trauma assessment. D. secondary assessment.

C. rapid trauma assessment.

You are called to a grocery store where a clerk has found an unresponsive female in one of the aisles. There were no witnesses to the event. You should immediately: Select one: A. assess the rate and regularity of the patient's respiratory effort. B. assist ventilations with a bag-mask device attached to 100% oxygen. C. stabilize her head and open her airway with the jaw-thrust maneuver. D. open her airway with a head-tilt chin lift maneuver and apply oxygen.

C. stabilize her head and open her airway with the jaw-thrust maneuver.

You will MOST likely be able to determine whether the cause of your patient's problem is medical or trauma in origin after you have: Select one: A. formed a general impression of the patient. B. asked the dispatcher why EMS was notified. C. surveyed the scene and assessed the patient. D. questioned bystanders regarding the incid

C. surveyed the scene and assessed the patient.

The focused assessment of a responsive medical patient is guided by: Select one: A. information obtained from the dispatcher. B. your general impression of the patient. C. the patient's reason for calling EMS. D. your perception of the patient's problem.

C. the patient's reason for calling EMS.

On which of the following patients should you perform a rapid trauma assessment (rapid scan)? Select one: A. A 24-year-old female restrained driver who struck a pedestrian at 20 mph. B. A 28-year-old male who fell approximately 10' from the roof of a small shed. C. A 33-year-old female with a penetrating injury to the left lower aspect of her leg. D. A 38-year-old male who was wearing a helmet while involved in a motorcycle crash.

D. A 38-year-old male who was wearing a helmet while involved in a motorcycle crash.

Which of the following patients would you describe as being disoriented? Select one: A. A 49-year-old male who is unresponsive to all forms of stimuli. B. A 52-year-old female who responds verbally when you talk to her. C. A 55-year-old male who moans in pain when you pinch his earlobe. D. A 60-year-old female who cannot recall events preceding her illness.

D. A 60-year-old female who cannot recall events preceding her illness.

Which of the following actions would you NOT perform during the scene size-up? Select one: A. Determine the number of patients. B. Request a hazardous materials team. C. Evaluate exterior damage to a car. D. Assess a patient's breathing effort.

D. Assess a patient's breathing effort.

You are assessing the quality of a trauma patient's respirations. Which of the following clinical findings would indicate labored breathing? Select one: A. Reduced tidal volume B. Gurgling in the upper airway C. Shallow chest movement D. Supraclavicular retractions

D. Supraclavicular retractions

A 56-year-old female called EMS because of shortness of breath. During your assessment, she tells you that this began four days ago. Which of the following questions would be MOST appropriate to ask her regarding the duration of her chief complaint? Select one: A. Why haven't you called your physician? B. Why is this suddenly an emergency today? C. Why didn't you call EMS when this began? D. What prompted you to call EMS today?

D. What prompted you to call EMS today?

Law enforcement requests your assistance at a local nightclub for a patient who was assaulted. Upon arrival, an officer escorts you to the patient, a 21-year-old male, who is bleeding severely from a lacerated brachial artery. The patient is conscious and is screaming in pain. You should immediately: Select one: A. ensure the patient's airway is patent. B. apply 100% supplemental oxygen. C. manually stabilize the patient's head. D. control the bleeding with direct pressure

D. control the bleeding with direct pressure

In a responsive patient, capnography is used to: Select one: A. determine the partial pressure of oxygen in the arterial blood. B. assess the percentage of hemoglobin that is saturated with oxygen. C. confirm the presence of shock if the ETCO2 is greater than 45 mm Hg. D. determine the amount of carbon dioxide produced by aerobic metabolism.

D. determine the amount of carbon dioxide produced by aerobic metabolism.

Following the primary assessment, the MOST appropriate order to proceed when treating a responsive medical patient is: Select one: A. baseline vital signs, focused physical exam, SAMPLE history, history of present illness. B. focused physical exam, history of present illness, baseline vital signs, SAMPLE history. C. SAMPLE history, baseline vital signs, focused physical exam, history of present illness. D. history of present illness, SAMPLE history, focused physical exam, baseline vital signs.

D. history of present illness, SAMPLE history, focused physical exam, baseline vital signs.

While treating a critically injured 23-year-old male with a gunshot wound to the chest, the perpetrator who shot the patient returns to the scene. You should: Select one: A. ask the perpetrator why he shot the patient. B. attempt to surprise and subdue the perpetrator. C. quickly move the patient to an area of safety. D. leave the scene immediately and request help.

D. leave the scene immediately and request help.

An electronic blood pressure cuff that measures readings using stepped deflation: Select one: A. is less accurate in hypotensive patients than the device that uses linear deflation because linear deflation allows a uniform decline in pressure during deflation. B. is ineffective in taking accurate measurements if the patient's blood pressure is greater than 200/100 mm Hg or if it detects any kind of patient movement. C. provides a more accurate measurement than auscultating a patient's blood pressure using a manual blood pressure cuff. D. may be more accurate in patients who are moving because the pressure in the cuff is released in intervals at variable lengths, allowing the system to better detect oscillations.

D. may be more accurate in patients who are moving because the pressure in the cuff is released in intervals at variable lengths, allowing the system to better detect oscillations.

A patient who coughs up thick yellow or green sputum: Select one: A. should be treated for congestive heart failure. B. should not be given oxygen via the nasal route. C. has a closed chest injury until proven otherwise. D. most likely has an advanced respiratory infection.

D. most likely has an advanced respiratory infection.

You are approximately 10 minutes away from the hospital with a 59-year-old female with a possible myocardial infarction when she suddenly loses consciousness. You should: Select one: A. attach an AED and analyze her cardiac rhythm. B. insert a nasal airway and place her on her side. C. assist her ventilations with a bag-mask device. D. open her airway and assess her breathing status.

D. open her airway and assess her breathing status.

Determining the mechanism of injury will contribute to your decision of whether you should: Select one: A. take body substance isolation precautions. B. perform an initial assessment of the patient. C. summon additional ambulances to the scene. D. perform a rapid assessment or focused exam

D. perform a rapid assessment or focused exam

When forming a general impression of your patient, you can determine the: Select one: A. nature of the patient's illness. B. patient's age and chief complaint. C. patient's pertinent medical history. D. presence of gross external bleeding.

D. presence of gross external bleeding.

A 60-year-old male complains of right upper quadrant abdominal pain and pain to his right shoulder. He denies pain in between his abdomen and shoulder. The patient's description of his pain describes: Select one: A. focal pain. B. radiating pain. C. diffuse pain. D. referred pain

D. referred pain

A restrained 19-year-old male was involved in a rollover motor-vehicle crash. With the exception of a small laceration to his forehead, he appears stable. When reconsidering the mechanism of injury, you should: Select one: A. reclassify him at a lower level of severity. B. guide your treatment based on his vital signs. C. perform a focused assessment since he is stable. D. treat him for potentially life-threatening injuries.

D. treat him for potentially life-threatening injuries.