Patient Assessment CH. 11

To appreciate the S2 sound:

ask the patient to breathe normally and hold his or her breath on inhalation.

When assessing the head and face during the full-body exam, you should:

avoid palpating any cranial depressions

Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a/an:

basilar skull fracture

A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is:

bounding

The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT:

bronchospasm

The breath sounds found on the posterior chest in between the scapulae are called:

bronchovesicular sounds

If a patient's trigeminal nerve is intact, he or she should be able to:

clench his or her jaw

S1, the first sound, represents:

closure of the mitral and tricuspid valves

A multisystems trauma patient opens his eyes in response to pain, moans when you ask him his name, and withdraws from painful stimuli. From this information, you should:

conclude that he has severe neurological dysfunction

Using casual nicknames can be especially problematic when:

cultural differences exist between the patient and the paramedic

An unresponsive patients who has been breathing slowly and shallowly for an extended period of time would MOST likely have_________skin.

cyanotic

After performing your primary assessment of a patient, your next action should be to:

decide what care is needed at the scene versus en route to the hospital

Clinical signs of an inflamed joint include all of the following EXCEPT:

deformity

Poor skin turgor in an infant or child is MOST indicative of:

dehydration

Stimulation of the sympathetic nervous system causes:

diaphoresis

The residual pressure in the circulatory system while the left ventricle is relaxing is called the:

diastolic pressure

A patient who complains of double vision has:

diplopia

A deformed steering wheel in conjunction with a deployed airbag indicates that the:

driver was not wearing a seatbelt

If your patient becomes seductive or makes sexual advances toward you, you should advise the patient that your relationship with him or her is strictly professional and then:

ensure that a witness is present at all times

Proper documentation of your physical examination of a patient is MOST important because it:

ensures an accurate historical accounting of the patients problems prior to entering the hospital

When assessing visual acuity in the prehospital setting, you should:

examine each eye in isolation

Asymmetry of the face could indicate:

facial nerve palsy

Paying attention, making eye contact, and repeating key information from the patient's answers are examples of:

facilitation

When ascultating heart sounds, you should place your stethoscope at the:

fifth intercostal space, over the apex of the heart

A conscious patient's respiratory rate should be measured:

for a minimum of 30 seconds

During a 20-minute transport of a critical patient, you should make a concerted effort to reassess the patient ___ times.

four

Structural integrity of the pelvis should be assessed by:

gently pushing in and down on the iliac crests

A responsive patient who is talking or crying:

has a patent airway

Examination of the head is MOST important when assessing a patient who:

has an altered mental status

Tidal volume is MOST effectively assessed by:

observing for rise and fall of the chest.

When asking questions pertaining to a patient's sexual history, it is important to remember that:

obtaining the history in a private setting is essential

The mnemonic "OPQRST" is a tool that:

offers an easy-to-remember approach to analyzing a patient's chief complaint.

Visceral abdominal pain is:

often less localized on palpation and is poorly described by the patient

If a patient is able to sense smell, his or her ___ nerve is intact.

olfactory

The skin becomes ___ when red blood cell perfusion to the capillary beds of the skin is poor.

pale

To obtain a heart rate in infants younger than 1 year of age, you should:

palpate the brachial artery

When assessing a trauma patient's chest, you should remember that:

paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms

On most runs, the two MOST important pieces of patient history information that you need to obtain initially are the:

patient's name and chief complaint

Abdominal guarding is MOST commonly encountered in patients with:

peritoneal irritation

The most effective way to obtain medical history from a patient who is crying is to:

place your hand on his or her shoulder (if appropriate for the patient) and reassure him or her that you are in control of the situation

When asking a patient if he or she uses illegal drugs, you will MOST likely get accurate information if you:

remain professional and non-judgmental

If you suspect a patient has been abused, it is MOST important that you:

request law enforcement personnel if necessary

Upon arriving at the scene of a patient with difficulty breathing, you find the patient, a 300 pound man, sitting on the couch in his living room. The patient is conscious and alert and tells you that he is chronically short of breath but feels worse today and wishes to be transported to the hospital. As you begin your assessment, your partner should:

request lifting assistance

At its worst, kyphosis can become a source of:

restrictive lung disease

If a hostile family member suddenly leaves the room, especially in the middle of a conversation with him or her, you should:

retreat to a place of safety and notify law enforcement personnel

Assessment of the female genitalia:

should be limited to inspection only

A patient with dysarthria has:

slurred speech

When assessing any patient, the paramedic should remember that:

some patients with traumatic injury could also have an underlying medical complaint

If a patient is able to shrug his or her shoulders and turn his or her head from left to right, the __________ nerve is likely intact.

spinal accessory

The diameter of a patient's pupils and their reactivity to light provide information about the:

status of cerebral perfusion

Cognitive function can be MOST accurately defined as:

the ability to use reasoning

The focused assessment of a responsive medical patient is guided by:

the chief complaint

A patient is generally considered to have orthostatic vital signs when:

the heart rate increases by 20 beats/min or more when going from a supine to a standing position

When caring for a patient who is mentally challenged:

you may have to obtain the medical history from a family member

What does a pulse oximetry measure?

The percentage of hemoglobin saturation

What are Korotkoff sounds?

The sounds heard when taking a blood pressure

The history of present illness is defined as:

a chronologic account of the patient's signs and symptoms.

Percussion of the chest produces ______ if the pleural space is full of BLOOD.

a dull sound

The MOST reliable means of attempting to determine an unresponsive medical patient's problem is:

a thorough head to toe physical examination

Gathering a patient's medical history and performing a secondary assessment should occur:

after life threats have been identified and corrected in the primary assessment

What is the Glascow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain?

12

Situational depression is:

A reaction to a stressful event in a patient's life.

When assessing a patient who is under the influence of alcohol, it is MOST important to remember that:

alcohol can mask any number of signs and symptoms

In contrast to dementia, delirium is:

an acute change in mental status.

Sonorous respirations are MOST likely caused by:

an anatomic airway obstruction.

The history of present illness is MOST accurately described as:

an elaboration of the chief complaint

Swollen lymph nodes in the anterior neck usually indicate:

an infection

During your primary survey of a 20-year-old man with blunt chest trauma, you note that he is semiconscious with rapid, shallow breathing. You do not see any obvious bleeding and note that his pulse is rapid and irregular, and his skin is cool and moist. An appropriate action would be to:

apply a cardiac monitor to assess for dysrhythmias

Upon completing your rapid full-body exam of an unresponsive trauma patient's head and neck, you should next:

apply a properly sized rigid cervical collar

The paramedic should address a patient:

as the patient wishes to be addressed

The general type of illness a patient is experiencing is called the:

nature of illness

It would MOST likely be necessary to ask a patient a direct question if:

he or she is not giving you usable facts about himself or herself

For a responsive patient with a medical complaint, you will MOST likely form your working diagnosis based on information gathered during the:

history-taking process

Distention of the jugular veins indicates:

increased venous capacitance

The fourth heart sound (S4):

indicates increased pressure in the atria

If a mechanical means is required to keep a patient's airway open, you should initially:

insert an airway adjunct

A neighbor finds her elderly female friend unresponsive on her kitchen floor. As you are performing your primary assessment, the neighbor tells you that she does not know what happened to her friend. The patient moans when you speak to her and is breathing at a normal rate with adequate depth. You should:

insert an airway adjunct, supply supplemental oxygen, and implement spinal motion restriction precautions

Bruising in the periumbilical area is indicative of:

intraperitoneal hemorrhage

After determining that the scene is safe, the FIRST step in approaching a patient is to:

introduce yourself to the patient

Objective patient information:

is based on fact or observation.

A patient in shock due to internal bleeding will benefit MOST from:

limited scene time and rapid transport

An inward curve of the lumbar spine just above the buttocks is called:

lordosis

A patient who is overly talkative during your assessment:

may have abused methamphetamines

The presence of rhonchi during auscultation of the lungs is MOST suggestive of:

pneumonia

A 29-year-old woman is in active labor. During your visual exam, you see a limb protruding from her vagina. Upon noticing this, it is MOST important to:

prepare for immediate transport

Serial vital signs:

provide comparative data regarding the patient's condition.

The most clinically significant indicator of ischemia in a limb is

pulselessness

What type of pain has its origin in a particular location but is described by the patient as pain in a different location?

referred pain

More often than not, the paramedic will form his or her general impression of a patient based on:

the initial presentation and chief complaint

The MOST negative immediate consequence of providing inappropriate reassurance to your patient in the prehospital setting is:

the patient's choice not to share as much information with you

When assessing an injured patient's mental status, the patient knows his name but is unable to recall the events that preceded the injury. From this, you can conclude that:

the patient's short-term memory is not intact

Clenching of the jaw muscles, as with chewing, is a function of which nerve?

trigeminal

A bruit indicates ________ blood flow and is MOST significant in the ________ arteries

turbulent, carotid

Vascular compromise in a lower extremity is characterized by:

unilateral pulse deficit and pallor

A patient who does not respond to verbal or tactile stimuli is:

unresponsive

Flushed skin is commonly seen as a result of all the following, EXCEPT:

vasoconstriction

All of the following are adventitious breath sounds, EXCEPT:

vesicular sounds

Diffuse pain caused by hollow organ obstruction and stretching of the smooth muscle wall is called __________ pain.

visceral

Anytime you encounter jugular venous distention in a patient, you should determine

where the venous obstruction is that is impeding blood return to the heart

When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine:

which complaint has a higher priority