chapter 11
Dilated pupils may be a sign of:
cocaine
When a penlight is shined into one eye, the opposite eye should:
constrict
As a paramedic interviews a patient, which statement reflects the use of confrontation during active listening? 24
"You state you do not use any illicit drugs, but your pupils are dilated and sensitive to light."
The average range for an adult's respirations would be:
12 to 20
What is the longest amount of time a patient should go without a vital sign reassessment?
15 minutes
In American culture, at what distance does intimate space generally begin? 26
18 inches
You are testing orthostatic vital signs on a patient. You have just taken the vital signs while the patient was lying supine and just assisted the patient to a standing position. You should wait how long before taking the next set of vital signs?
2 minutes
What is the normal range of EtCO2?21
35-45 mmHg
The emergency medical technician (EMT) should provide assisted ventilation to an adult breathing at a rate greater than:
40 breaths per minute.
A mnemonic or memory aid that is used to help the EMS provider remember the information that must be included in a patient history would be:21
SAMPLE.
You are treating a patient with the following vital signs: Blood pressure: 150/92, Pulse: 98, Respirations: 16, SpO2: 96 percent. The EMT knows that this patient has:
hypertension.
When assessing your patient's pupils, suspect stroke or a head injury if:
one pupil reacts but the other does not.
you are treating a patient who is complaining of weakness. The patient is lying flat on the couch on your arrival. Your initial vital signs are: BP: 160/90, HR: 80, RR: 16. Your patient insists on walking to the cot, which is located in the hallway. You begin to assist the patient to the cot when she says she wants to stop for a second because she is tired. You note that the patient is now more pale. You elect to take another set of vital signs and find: BP: 134/88, HR: 104, RR: 20. You know this finding means the patient is:
orthostatic positive.
You are treating a patient complaining of general tiredness. You take the patient's vital signs while lying flat and then you take the vital signs again when the patient is standing. You are testing:14
orthostatic vital signs
You note that the patient's pulse seems to weaken during inhalation. You would report this finding as:4
pulsus paradoxus.
Blood pressure can fall drastically due to:
spinal injury
Blood pressure reaches its maximum after the left ventricle contracts. This reading is known as the
systolic pressure
If the pulse rate on a pulse oximeter does not match the patients pulse
the SpO2 reading should not be relied upon
You are treating an 85-year-old patient who has a history of chronic obstructive pulmonary disease. The patient requires oxygen via nasal cannula 24 hours a day. The patient presents with a right ankle that is extremely swollen, and cannot bear any weight. While taking the patient's vital signs, you note his capillary refill time to be 4 seconds. You know:17
this finding is probably normal for the patient based on his history.
What term describes a weak rapid pulse assessed at the wrist?
thready
When a patient is suffering from constriction of the bronchioles, the breath sound MOST likely heard on auscultation would be:
wheezing
Pupils that are dilated but reactive may be an indicator of
amphetamine use.
pulse oximeter
an external monitor placed on the patient's finger or earlobe to measure the oxygen saturation level in the blood
A tilt test is the common name for: 8
an orthostatic vital sign test
Pulse oximetry
a method of measuring oxygen saturation levels in the blood
Your adolescent patient is unconscious. The BEST place to check a pulse in this patient is:
carotid
In which pulse location would you find a central pulse?
carotid and femoral locations
If you are obtaining a pedal pulse, you are palpating the:
foot.
A capillary refill time of 3 seconds in an asymptomatic elderly man is an indicator of:5
normalcy
Anytime you use a noninvasive blood pressure monitor, it is important to
obtain the first blood pressure by auscultation
Which of the following EtCO2 levels would be an indication of hypoventilation?
55 mmHg
The normal resting pulse for a 10-year-old child is:
75 to 118 beats per minute.
Which statement concerning palpating a blood pressure is MOST accurate?
A palpated systolic blood pressure is slightly lower than that taken by auscultation.
Kussmaul
A rapid respiratory rate with a deep and labored tidal volume
Central neurogenic hyperventilation
A sustained deep and rapid respiratory rate of at least 25 breaths per minute but with a regular pattern.
Ataxic
An irregularly irregular pattern of rate and tidal volume.
What is the condition in which the patient's pupils are normally unequal?
Anisocoria.
During your patient assessment, you ask your EMT partner to obtain a set of vitals after applying oxygen. If this is the first set of vitals, what are they called?
Baseline vital signs
Explain how to assess a patient's respiratory rate and quality of breathing. Also, state the normal ranges of respirations per minute for the adult, child, and infant.
Breathing is assessed by observing the patient's chest rise and fall. Breathing rate is determined by counting the number of breaths in a 30-second period and multiplying by two. Quality of breathing can be assessed while the rate is being counted. The normal respiratory rate range for an adult or adolescent patient at rest is 12-20, 18-25 for a school-age child, 20-28 for a preschooler, 22-37 for a toddler, 30-53 for an infant 1 month to 1 year, and 40-60 for a neonate up to 1 month.
Which of the following statements concerning capillary refill is MOST accurate?1
Capillary refill time alone does not provide sufficient information to determine shock.
Location of Pulses
Carotid artery. The pulses can be found on either side of the neck in the groove between the trachea and the muscle mass. Femoral artery. The pulses can be found in the crease between the lower abdomen and the upper thigh (groin). Radial artery. The pulses can be found proximal to the thumb on the palmar surface of the wrist. Brachial artery. The pulses can be found on the medial aspect of the arm, midway between the shoulder and the elbow between the biceps and triceps muscles. Popliteal artery. The pulses can be found in the crease behind the knee. Posterior tibial artery. The pulses can be found behind the medial malleolus (ankle bone). Dorsalis pedis artery. The pulses can be found on the top of the foot on the great-toe side.
When you are faced with a language barrier and are unable to find someone at the scene to translate, what would be the best way to proceed?3
Contact a telephone translation company.
What would be the best way to proceed when faced with collecting information from a patient who is also suffering from a progressive neurological disease such as dementia or from delirium when no family members or care providers are present?19
Do not spend much time collecting a history.
Which of the following is true regarding an adult patient breathing greater than 40 breaths per minute?
Respiratory muscle fatigue will develop.
Which of the following direct questions would be appropriate when taking a patient history?(closed question)
Does your chest pain increase when you exert yourself?
What does capnometry measure?4
Exhaled CO2
The EMT is assessing a patient who presents with shortness of breath and auscultates crackles in the bilateral lung bases. Which statement explains this occurrence?
Fluid surrounding and filling the alveoli
Which of the following is a reason for decreased EtCO2 levels?6
Hyperventilation
Apneustic
Is characterized by prolonged periods of inhalation.
The EMT responds to a call for a patient with increased weakness and falling. The patient has end-stage liver disease. Which integumentary assessment finding would the EMT expect to notice in the patient?
Jaundice
Agonal
Long periods of apnea with a gasping breath interposed
Which of the following is TRUE about blood pressure
Low blood pressure indicates that there is not enough pressure in the arteries to keep the organs supplied adequately with blood.
The paramedic is assessing the skin color of a patient who presents with shock due to blood pooling in the extremities. Which description should be included in the documentation?33
Mottling
The evaluation of a patient's symptoms, such as chest pain, may be accomplished by using the mnemonic:
OPQRST.
OPQRST
Onset, Provocation, Quality, Region/Radiation, Severity, Timing.
What does a sudden increase in EtCO2 during a cardiac arrest most likely indicate?9
ROSC
SAMPLE
Signs and symptoms Allergies Medications Pertinent past history Last oral intake Events leading to the injury or illness
Biot
Similar to Cheyne Stokes except that the tidal volume doesn't change, but the respiratory pattern is interrupted by a period of apnea.
Identify the components of vital signs, and state how often they should be taken.
Standard vital sign assessment includes checking breathing, pulse, skin signs, pupils, and blood pressure.
You have just performed a tilt test on your patient. Which of the following outcomes would indicate a positive result?13
The pulse increases by 15 bpm, and the systolic BP decreases by 15 mmHg.
Which pulse pattern can be a sign of pulsus paradoxus?
The pulse weakens or disappears during inhalation.
Cheyne Stokes
The respiratory rate and tidal volume gradually increase and gradually decrease followed by a period of apnea for up to 10 seconds. The pattern then repeats itself.
What would be an example of pertinent past medical history for a cardiac patient?15
Two prior heart attacks
The EMT arrives at the patient's home and determines the patient is having pain with ambulation. Which question should the EMT use to obtain the most information?
Which activities that you do make it worse?
Noisy respirations such wheezing, rhonchi, or crackles and absent breath sounds may be further evaluated by:9
auscultation
A reliable indicator of perfusion in children less than 6 years of age is:8
capillary refill
The EMT is providing care to a patient who sustained multiple injuries in a fall. The patient's level of consciousness is decreasing. How often should the EMT take the patient's vital signs?18
every 5 minutes
You are treating an unstable elderly patient for findings consistent with a stroke. At a minimum, how often should you reassess the patient's vital signs while transporting her to the stroke center 20 minutes away?
every 5 minutes
You are treating a patient that was just involved in an unrestrained motor vehicle collision. The patient is alert and has NO obvious injuries. The patient's vital signs are: BP: 80/60, HR: 148, RR: 22, SpO2: 94 percent. You know that this patient is exhibiting signs of:17
hypoperfusion (shock)
When assessing a patient's blood pressure with a sphygmomanometer cuff:2
inflate the cuff to 30 mmHg above the point where you can no longer feel a pulse.
Asking a bystander who witnessed the patient fall to the ground is a method of
investigation the chief complaint
A palpable pulse that presents with a chaotic rhythm and no predictable pattern is called:
irregularly irregular
In infants and children, retraction of the skin, muscles, and other tissues around the clavicle and between the ribs indicates:24
labored breathing.
The BEST places to assess skin color in adults are in the mucous membranes of the mouth and eyelids and:
nail bed
Your patient is very lethargic and NOT acting right. During your assessment, you note that the patient has bilateral pinpoint pupils. This finding is MOST likely due to
narcotic use
The difference between the systolic and diastolic blood pressures is called
pulse pressure
