Chapter 10 - Patient Assessment

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: assess his blood pressure. assist his ventilations. apply a pulse oximeter. request a paramedic unit.

assist his ventilations.

If you cannot palpate a pulse in an unresponsive patient whose collapse was not witnessed, you should: apply an AED at once. palpate at another pulse site. immediately begin CPR. assess for adequate breathing.

immediately begin CPR.

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

suction as needed and insert an airway adjunct.

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

without assistance.

The normal respiratory rate for an adult should range from: 12 to 20 breaths per minute. 24 to 28 breaths per minute. 10 to 12 breaths per minute. 18 to 24 breaths per minute.

12 to 20 breaths per minute.

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. 50, 110 40, 120 60, 100 30, 130

60, 100

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

A 61-year-old female who is unconscious with facial cyanosis

Which of the following findings indicates that your patient has a patent airway? Inspiratory stridor Ability to speak Audible breathing Unresponsiveness

Ability to speak

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

40, 60

Your primary assessment of an elderly woman who fell reveals an altered level of consciousness and a large hematoma to her forehead. After protecting her spine and administering oxygen, you should: A. reassess your interventions. B. perform a rapid exam. C. transport the patient immediately. D. perform a focused assessment of her head.

B. perform a rapid exam. A. reassess your interventions. Rationale: This is the last step of the patient assessment process. B. perform a rapid exam. Rationale: Correct answer C. transport the patient immediately. Rationale: This is determined after the completion of a rapid exam. D. perform a focused assessment of her head. Rationale: This performed during the secondary assessment.

When assessing your patient's pain, he says it started in his chest but has spread to his legs. This is an example of what part of the OPQRST mnemonic? A. Onset B. Quality C. Region/radiation D. Severity

C. Region/radiation A. Onset Rationale: This assesses the cause of the pain and when it began. B. Quality Rationale: This assesses the patient's description of the pain. C. Region/radiation Rationale: Correct answer D. Severity Rationale: This assesses the severity of the patient's pain.

A semiconscious patient pushes your hand away when you pinch his earlobe. You should describe his level of consciousness as: A. alert. B. unresponsive. C. responsive to painful stimuli. D. responsive to verbal stimuli.

C. responsive to painful stimuli. A. alert. Rationale: This is when the patient's eyes open spontaneously as you approach. B. unresponsive. Rationale: This is when the patient does not respond to any stimulus. C. responsive to painful stimuli. Rationale: Correct answer D. responsive to verbal stimuli. Rationale: This is when the patient's eyes open with verbal stimuli and he or she tries to respond.

How should you determine the pulse in an unresponsive 8-year-old patient? A. Palpate the radial pulse at the wrist. B. Palpate the brachial pulse inside the upper arm. C. Palpate the radial pulse with your thumb. D. Palpate the carotid pulse in the neck.

D. Palpate the carotid pulse in the neck. A. Palpate the radial pulse at the wrist. Rationale: Only palpate here in responsive patients who are older than 1 year. B. Palpate the brachial pulse inside the upper arm. Rationale: Only palpate here in children younger than 1 year because the radial and carotid pulses are difficult to locate. C. Palpate the radial pulse with your thumb. Rationale: Do not palpate a pulse with your thumb. You may mistake the strong pulsing circulation in your thumb for the patient's pulse. D. Palpate the carotid pulse in the neck. Rationale: Correct answer

Which of the following statements regarding the secondary assessment is correct? You may not have time to perform a secondary assessment if you must continually manage life threats that were identified during the primary assessment. If your general impression of a patient does not reveal any obvious life threats, you should proceed directly to the secondary assessment. The purpose of the secondary assessment is to systematically examine every patient from head to toe, regardless of the severity of his or her injury. A focused secondary assessment would be the most appropriate approach for a patient who experienced significant trauma to multiple body systems.

You may not have time to perform a secondary assessment if you must continually manage life threats that were identified during the primary assessment.

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

pink, warm, and dry.

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

regular.

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

the patient receives definitive care.

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

the reason why the patient called EMS.

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

"How much Tylenol do you take each day?"

Findings such as inadequate breathing or an altered level of consciousness should be identified in the: A. primary assessment. B. focused assessment. C. secondary assessment. D. reassessment.

A. primary assessment. A. primary assessment. Rationale: Correct answer B. focused assessment. Rationale: The focused assessment takes place during the secondary assessment, if appropriate. C. secondary assessment. Rationale: The purpose of the secondary assessment is to perform a systematic physical examination of the patient after the primary assessment. D. reassessment. Rationale: Reassessment is performed to identify and treat changes in a patient's condition after the primary assessment.

Assessment of an unconscious patient's breathing begins by: A. inserting an oral airway. B. manually positioning the head. C. assessing respiratory rate and depth. D. clearing the mouth with suction as needed.

B. manually positioning the head. A. inserting an oral airway. Rationale: You insert an airway adjunct to assist in maintaining airway patency after the head tilt-chin lift. B. manually positioning the head. Rationale: Correct answer C. assessing respiratory rate and depth. Rationale: After the airway is opened and suctioned, then determine the patient's respiratory effort by assessing the respiratory rate and depth. D. clearing the mouth with suction as needed. Rationale: This is done after attempting to open the airway with proper positioning.

During the scene size-up, you should routinely determine all of the following, EXCEPT: A. the mechanism of injury or nature of illness. B. the ratio of pediatric patients to adult patients. C. whether or not additional resources are needed. D. if there are any hazards that will jeopardize safety.

B. the ratio of pediatric patients to adult patients. A. the mechanism of injury or nature of illness. Rationale: This is part of the scene size-up. B. the ratio of pediatric patients to adult patients. Rationale: Correct answer C. whether or not additional resources are needed. Rationale: This is part of the scene size-up. D. if there are any hazards that will jeopardize safety. Rationale: This is part of the scene size-up.

Your 12-year-old patient can speak only two or three words without pausing to take a breath. He has a serious breathing problem known as: A. nasal flaring. B. two- to three-word dyspnea. C. labored breathing. D. shallow respirations.

B. two- to three-word dyspnea. Your 12-year-old patient can speak only two or three words without pausing to take a breath. He has a serious breathing problem known as: A. nasal flaring. Rationale: Nasal flaring is the flaring out of the nostrils. B. two- to three-word dyspnea. Rationale: Correct answer C. labored breathing. Rationale: Labored breathing requires increased effort and is characterized by increased effort and depth of each respiration. D. shallow respirations. Rationale: Shallow respirations are characterized by little movement of the chest wall or poor chest excursion.

Which of the following would you NOT detect while determining your initial general impression of a patient? A. Cyanosis B. Gurgling respirations C. Severe bleeding D. Rapid heart rate

D. Rapid heart rate A. Cyanosis Rationale: You can see cyanosis while determining your initial general impression. B. Gurgling respirations Rationale: You can hear gurgling while determining your initial general impression. C. Severe bleeding Rationale: You can see bleeding while determining your initial general impression. D. Rapid heart rate Rationale: Correct answer

You arrive at the scene of an "injured person." As you exit the ambulance, you see a man lying on the front porch of his house. He appears to have been shot in the head and is lying in a pool of blood. You should: A. immediately assess the patient. B. proceed to the patient with caution. C. quickly assess the scene for a gun. D. retreat to a safe place and wait for law enforcement to arrive.

D. retreat to a safe place and wait for law enforcement to arrive. A. immediately assess the patient. Rationale: You must wait until the scene is safe. B. proceed to the patient with caution. Rationale: You must wait until the scene is safe. C. quickly assess the scene for a gun. Rationale: This is the responsibility of law enforcement. D. retreat to a safe place and wait for law enforcement to arrive. Rationale: Correct answer

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? Opens eyes spontaneously, is confused when spoken to, exhibits abnormal flexion Opens eyes in response to voice, makes incomprehensible sounds, localizes pain Eyes remain closed, makes incomprehensible sounds, exhibits abnormal extension Opens eyes in response to pain, uses inappropriate words, withdraws from pain

Opens eyes in response to pain, uses inappropriate words, withdraws from pain

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

Rapidly assessing a patient's respiratory status

Which of the following signs of respiratory distress is usually observed only in pediatric patients? Rapid respirations Pursed-lip breathing Seesaw breathing Accessory muscle use

Seesaw breathing

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

Systematic head-to-toe examination

When is it MOST appropriate to consider requesting additional ambulances at an accident scene? When all the deceased patients are accounted for After noncritical patients have been identified After you have triaged all the critical patients When you determine there are multiple patients

When you determine there are multiple patients

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: begin chest compressions and request backup. open the airway and give two rescue breaths. immediately transport the child to the hospital. assess for a brachial pulse for 5 to 10 seconds.

assess for a brachial pulse for 5 to 10 seconds.

When auscultating the blood pressure in a patient's upper extremity, you should place the diaphragm (head) of the stethoscope over the _________ artery. apical brachial femoral radial

brachial

While en route to the scene of a shooting, the dispatcher advises you that the perpetrator has fled the scene. You should: proceed to the scene as usual but exercise extreme caution upon arrival. confirm this information with law enforcement personnel at the scene. request law enforcement personnel if the scene is unsafe upon arrival. ask the dispatcher if he or she knows the location of the perpetrator.

confirm this information with law enforcement personnel at the scene.

A patient's short-term memory is MOST likely intact if they correctly answer questions regarding: day and event. event and person. time and place. person and place.

day and event.

When evaluating a patient with multiple complaints, the EMT's responsibility is to: definitively rule out serious causes of each of the patient's complaints. assess each complaint based on the patient's perception of its seriousness. direct his or her attention to the most obvious signs and symptoms. determine which complaint poses the greatest threat to the patient's life.

determine which complaint poses the greatest threat to the patient's life.

The goal of the primary assessment is to: determine if the patient's problem is medical or traumatic. determine the need to perform a head-to-toe assessment. identify patients that require transport to a trauma center. identify and rapidly treat all life-threatening conditions.

identify and rapidly treat all life-threatening conditions.

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

identify less-obvious injuries that require immediate treatment.

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: has abdominal muscle spasms. is experiencing severe back pain. is experiencing difficulty breathing. has a decreased level of consciousness.

is experiencing difficulty breathing.

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

locate injuries not found in the primary assessment.

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

minimum amount of pressure that is always present in the arteries.

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

patients with a significant MOI and unresponsive medical patients.

The MOST effective way to determine whether your patient's problem is medical or traumatic in origin is to: perform a careful and thorough assessment. establish the patient's medical history early. ask if bystanders are familiar with the patient. take note of the patient's general appearance.

perform a careful and thorough assessment.

You respond to the scene of a motor vehicle collision. Upon arrival, you find the driver, a young female, sitting on the curb. She is confused; is in obvious respiratory distress; and has pale, moist skin. As your partner manually stabilizes her head, you perform a primary assessment. After performing any immediate life-saving treatment, you should: fully immobilize her spine, load her into the ambulance, and assess her vital signs. identify the specific areas of her injuries and focus your assessment on those areas. assess her vital signs, secure her to a backboard, and transport her immediately. perform a detailed head-to-toe exam and prepare for immediate transport.

perform a detailed head-to-toe exam and prepare for immediate transport.

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

radial

When performing a reassessment of your patient, you should first: reassess your interventions. obtain updated vital signs. repeat the primary assessment. confirm medical history findings.

repeat the primary assessment.

A patient who moves and cries out only when you pinch his or her trapezius muscle is said to be: responsive to painful stimuli. conscious and alert. responsive to verbal stimuli. completely unresponsive.

responsive to painful stimuli.