Chapter 11. Baseline Vital Signs EMT 111
When a penlight is shined into one eye, the opposite eye should: A. dilate. B. constrict. C. remain fixed. D. develop nystagmus.
constrict.
To adequately assess the patient's respirations, the EMT should: A. count the number over 20 seconds and multiply by 2. B. count the number of respirations over 15 seconds and multiply by 10. C. count the number of respirations over 30 seconds and multiply by 2. D. count the number of respirations over 45 seconds and divide by 3.
count the number of respirations over 30 seconds and multiply by 2.
What is the longest amount of time a patient should go without a vital sign reassessment? A. 1 hour B. 10 minutes C. 15 minutes D. 5 minutes
15 minutes
When measuring the blood pressure, the EMT would inflate the cuff to this many points above where the pulse disappears. A. 50 mmHg B. 70 mmHg C. 30 mmHg D. 10 mmHg
30 mmHg
An acronym used to help you remember information to include in your patient's history is: A. DCAP-BTLS. B. OPQRST. C. AVPU. D. SAMPLE.
SAMPLE.
Question Help 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: A. SOAP. B. SAMPLE. C. AVPU. D. DCAP-BTLS.
SAMPLE.
Your adolescent patient is unconscious. The BEST place to check a pulse in this patient is: A. brachial. B. dorsalis. C. carotid. D. radial.
carotid.
A bluish gray color to the skin is referred to as: A. flush. B. diaphoresis. C. mottling. D. cyanosis.
cyanosis.
Regarding skin color, inadequate oxygenation may be indicated by: A. jaundice. B. flushing. C. pallor. D. cyanosis.
cyanosis.
As you interview the patient about his history and injuries or medical problems, the reason why the ambulance was called is often called the: A. mechanism of injury. B. SAMPLE history. C. chief complaint. D. physical exam.
chief complaint.
When taking your patient's history, you should first determine his or her: A. vital signs. B. insurance information. C. demographic information. D. chief complaint.
chief complaint.
An example of an associated sign would be when the patient with a severe headache tells you he: A. was receiving treatment for the headache by his primary care physician. B. is allergic to certain drugs. C. has taken aspirin for his problem. D. has been vomiting.
has been vomiting.
You are assessing a 10-month-old infant who is acting lethargic, in the parents' judgment. His vital signs are: HR 140 and RR 32, his capillary refill is 2 seconds, and his color is good. With this information, you know that: A. his respiratory rate is high. B. his BP is low. C. his vital signs are normal. D. his heart rate is high.
his vital signs are normal.
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: A. orthopnea. B. hypertension. C. bradycardia. D. tachycardia.
hypertension.
When assessing your patient's pupils, suspect stroke or a head injury if: A. neither pupil reacts. B. both pupils are dilated. C. both pupils are constricted. D. one pupil reacts but the other does not.
one pupil reacts but the other does not.
You are treating a patient complaining of general tiredness. You take the patients vital signs while lying flat and then you take the vital signs again when the patient is standing. You are testing: A. aortic insufficiency. B. cardiac tamponade. C. orthostatic vital signs. D. hypotensive crisis.
orthostatic vital signs.
You note that the patient's pulse seems to weaken during inhalation. You would report this finding as: A. cardiac regurgitation. B. pulsus paradoxus. C. aortic stenosis. D. cardiac tamponade.
pulsus paradoxus.
An adult pulse rate of 110 beats per minute is considered: A. slow. B. normal. C. moderate. D. rapid.
rapid.
Only slight chest movement or abdominal wall motion is an indication of: A. labored breathing. B. normal breathing. C. noisy breathing. D. shallow breathing.
shallow breathing
Because of disease and environmental considerations, measurement of capillary refill time in the adult patient: A. is typically shorter for the elderly. B. should be used as only one tool in circulatory assessment. C. is typically shorter for men. D. cannot be relied upon.
should be used as only one tool in circulatory assessment.
You just asked your elderly patient to describe the pain in her chest. You note that the patient seems to be taking a long time to answer your question so you should: A. simply move onto another question as the patient is unable to answer your question. B. slow your talking speed down as it is obvious that this patient cannot understand and you need to talk at a really slow pace. C. keep revising the question and asking it differently until the patient can easily answer you. D. simply wait for the patient to respond as they might be forming their response.
simply wait for the patient to respond as they might be forming their response.
The amount of pressure that is exerted on the arteries when the left ventricle contracts is called the: A. diastolic blood pressure. B. mean arterial pressure. C. systolic blood pressure. D. pulse pressure.
systolic blood pressure.
All of the following are TRUE regarding taking a patient's blood pressure, EXCEPT: A. taking a blood pressure requires a sphygmomanometer and a stethoscope. B. the blood pressure cuff should cover two-thirds of the upper arm, elbow to shoulder. C. there should be no clothing under the cuff. D. center the bladder of the cuff over the brachial artery.
taking a blood pressure requires a sphygmomanometer and a stethoscope.
The reason that a patient calls EMS is known as: A. the primary exam. B. the chief complaint. C. method of injury (MOI). D. patient history.
the chief complaint.
Absence of a radial pulse may indicate all of the following EXCEPT: A. that the heart has stopped beating. B. that the blood pressure is extremely low. C. the patient is not breathing. D. that an artery has been injured.
the patient is not breathing.
Sonorous breath sounds are typically the result of: A. the tongue partially blocking the upper airway. B. an obstruction at the level of the larynx. C. constriction of the bronchioles. D. fluid in the upper airway.
the tongue partially blocking the upper airway.
Dilated pupils may be a sign of: A. the use of cocaine. B. a central nervous system disorder. C. the use of narcotics. D. early brain injury.
the use of cocaine.
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 tripped over a rug in his house but caught himself from falling. The patient thinks that he sprained his ankle during the event. His right ankle is extremely swollen, and he cannot bear any weight on it. While taking the patient's vital signs, you note his capillary refill time to be 4 seconds. You know: A. this finding is probably normal for the patient based on his history. B. the patient has lost a significant amount of blood. C. the patient is not being perfused and therefore needs blood administered quickly. D. the patient sustained a significant trauma and needs immediate transport to a level 1 trauma facility.
this finding is probably normal for the patient based on his history.
You take your trauma patient's blood pressure every five minutes. This is called: A. vital signs stacking. B. clinical documentation. C. validating. D. trending.
trending
When a patient is suffering from constriction of the bronchioles, the breath sound MOST likely heard on auscultation would be: A. snoring. B. wheezing. C. crowing. D. gurgling.
wheezing.
If you are unable to bring a scene under control, your first priority should be: A. your own safety. B. removing the patient from the scene. C. calling for additional resources. D. bringing bystanders under submission.
your own safety.
A tilt test is the common name for: A. an orthostatic vital sign test. B. a syncope test. C. lumbar traction. D. a chemical stress test.
an orthostatic vital sign test.
You are treating a patient that is complaining of sudden onset of shortness of breath. The patient was working in the garden when he was stung by a bee and shortly thereafter the difficulty in breathing began. The patient's vital signs are: BP: 160/90, HR: 160, RR: 34, SpO2: 89 percent. The EMT knows that the patient's vital signs and history are MOST consistent with a/an: A. anaphylactic reaction. B. diabetic problem. C. heart attack. D. stroke.
anaphylactic reaction
If you are obtaining a pedal pulse, you are palpating the: A. foot. B. upper arm. C. wrist. D. pelvis.
foot.
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? A. 10 minutes B. 5 minute C. 15 minutes D. 1 minutes
5 minute
The typical physiologic range for a pulse rate in a disease- and injury-free adult at rest is: A. 70 to 80 beats per minute. B. 80 to 100 beats per minute. C. 50 to 60 beats per minute. D. 60 to 80 beats per minute.
60 to 80 beats per minute.
What is the normal respiratory rate for an adult? A. 8 to 16 breaths per minute. B. 15 to 30 breaths per minute. C. 8 to 24 breaths per minute. D. 25 to 50 breaths per minute.
8 to 24 breaths per minute.
Which of the choices is TRUE regarding the difference between a sign and a symptom? A. A condition that must be described by the patient is a symptom. B. Information obtained during baseline vitals assessment are symptoms. C. Any objective physical evidence that you can see, hear, feel, or smell is a symptom. D. A vague complaint that cannot be specifically described is a sign.
A condition that must be described by the patient is a symptom
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? A. Do not spend much time collecting a history. B. Write the questions down. C. Be patient, and give the person additional time to respond. D. Deliberately ask redundant questions to try to ascertain the truth.
A. Do not spend much time collecting a history.
You have just performed a tilt test on your patient. Which of the following outcomes would indicate a positive result? A. The pulse increases by 15 bpm, and the systolic BP decreases by 15 mmHg. B. The pulse increases by 5 bpm, and the systolic BP increases by 10 mmHg. C. The pulse decreases by 5 bpm, and the systolic BP increases by 5 mmHg. D. The pulse increases by 15 bpm, and the systolic BP remains constant.
A. The pulse increases by 15 bpm, and the systolic BP decreases by 15 mmHg.
You are treating a patient who awoke to his carbon monoxide detector alarming. The patient is complaining of shortness of breath and a headache. You apply the pulse oximeter and you note the reading to be 99 percent SpO2. You should: A. apply oxygen via NRBM at 15 lpm as the pulse oximeter reading is not accurate due to the carbon monoxide. B. apply a nasal cannula at 2 lpm. C. reassure the patient and have him breathe into a paper bag as the event has sent him into a panic attack. D. administer aspirin for the patient's headache and allow the patient to refuse.
A. apply oxygen via NRBM at 15 lpm as the pulse oximeter reading is not accurate due to the carbon monoxide.
Noisy respirations such wheezing, rhonchi, or crackles and absent breath sounds may be further evaluated by: A. auscultation. B. vital sign assessment. C. sphygmomanometry. D. assisted ventilations.
A. auscultation.
You are dispatched to a residence for a 16-year-old female complaining of severe abdominal pain. On your arrival, the parents tell you that she was having "cramps" the day before and the condition progressively worsened overnight and then suddenly increased prior to their call. The patient is alert and oriented and her vitals are BP 90/70, pulse 110, respirations 20; her skin is warm and dry. Your primary exam reveals tenderness and guarding in the left lower quadrant but is otherwise unremarkable; you do NOT believe she has a fever. As you begin the patient interview, she responds quietly and you frequently cannot hold eye contact. Based on the information provided, what would your NEXT step be? A. Call medical direction. B. Transport the patient to the hospital while monitoring vitals. C. Start high flow oxygen and transport. D. Ask the parents to step out of the room and repeat the interview.
Ask the parents to step out of the room and repeat the interview.
You are dispatched to a residence for a 16-year-old female complaining of severe abdominal pain. On your arrival, the parents tell you that she was having "cramps" the day before and the condition progressively worsened overnight and then suddenly increased prior to their call. The patient is alert and oriented and her vitals are BP 90/70, pulse 110, respirations 20; her skin is warm and dry. Your primary exam reveals tenderness and guarding in the left lower quadrant but is otherwise unremarkable; you do NOT believe she has a fever. As you begin the patient interview, she responds quietly and you frequently cannot hold eye contact. Based on the information provided, what would your NEXT step be? A. Transport the patient to the hospital while monitoring vitals. B. Start high flow oxygen and transport. C. Ask the parents to step out of the room and repeat the interview. D. Call medical direction.
Ask the parents to step out of the room and repeat the interview.
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? A. 45 seconds B. 2 minutes C. 3 minutes D. 5 minutes
B. 2 minutes
A capillary refill time of 3 seconds in an asymptomatic elderly male is an indicator of: A. cyanosis. B. normalcy. C. high blood pressure. D. hypoperfusion.
B. normalcy.
When investigating the patient's chief complaint, pay close attention to statements family members may make, such as: A. she has always been a diabetic. B. she just does not seem to be herself today. C. she has been taking medicine for her ulcers. D. she always walks the dog in the morning.
B. she just does not seem to be herself today.
You are treating a stable elderly patient for nausea and vomiting. At a minimum, how often should you reassess the patient's vital signs during your 30-minute transport to the hospital? A. 5 minutes B. 10 minutes C. 15 minutes D. 1 minute
C. 15 minutes
Which of the following would likely present with breath sounds that are similar on both sides? A. Tension pneumothorax B. A collapsed lung C. Wheezing D. Hemothorax
C. Wheezing
You notice your EMT partner is taking a blood pressure without a stethoscope. This method is referred to as: A. pulsatile pressure. B. finger pressure. C. palpation. D. non-steth pressure.
C. palpation.
Which condition can cause the pulse oximeter not to display a value? A. Heart attack B. Traumatic brain injury C. High blood pressure D. Cardiac arrest
Cardiac arrest
You should be especially careful when palpating this pulse, because excess pressure can cut off circulation to the brain. A. Carotid B. Brachial C. Femoral D. Temporal
Carotid
What should you do after collecting baseline vital signs and available patient history and arriving at a field diagnosis for your unresponsive medical patient? A. Refine your patient history. B. Treat the patient symptomatically. C. Verify your rapid assessment. D. Devise a management plan.
Devise a management plan
Monitoring devices used by the EMT include each of the following, EXCEPT: A. pulse oximeter. B. ECG monitor. C. glucose meter. D. Blood pressure cuff.
ECG monitor.
Which condition will cause the pulse oximeter to produce an erroneous reading? A. Tachycardia B. High-flow oxygen C. Emphysema D. Hypothermia
Hypothermia
Which of the following is TRUE about blood pressure? A. An early sign of hypoperfusion (shock) to watch for is a drop in blood pressure. B. Low blood pressure indicates that there is not enough pressure in the arteries to keep the organs supplied adequately with blood. C. High blood pressure can occur after a spinal cord injury in which the blood vessels in the body constrict. D. Low blood pressure can result in the rupture or damage of arteries, such as those in the brain.
Low blood pressure indicates that there is not enough pressure in the arteries to keep the organs supplied adequately with blood.
The evaluation of a patient's symptoms, such as chest pain, may be accomplished by using the mnemonic: A. SAMPLE. B. OPQRST. C. AVPU. D. DCAP-BTLS.
OPQRST.
Periodically, parents may interfere with the treatment of a child. If this happens, what should the EMT do? A. Separate the parents from the child. B. Delay care of the patient until placed in the ambulance. C. Ignore the parents. D. Firmly rebuff the parents.
Separate the parents from the child.
In the OPQRST mnemonic, the S stands for A. Signs B. Severity C. Systolic D. Symptoms
Severity
The pressure wave generated by each individual contraction of the left ventricle is called: A. diastolic blood pressure. B. a pulse. C. pulse pressure. D. systolic blood pressure.
a pulse.
What term describes a weak rapid pulse assessed at the wrist? A. Bounding B. Thready C. Hypoperfusion D. Tachycardic
Thready
Which of the following initial patient questions is worded in an appropriate format? A. Were you walking when the pain started? B. Are you having trouble breathing? C. Are you having abdominal pain? D. What seems to be the problem?
What seems to be the problem?
You are dispatched to a residence for a 72-year-old male having difficulty breathing. On your arrival, you are led into the kitchen where the patient is sitting in the tripod position in apparent respiratory distress. Your history should begin with which of the following questions? A. How long have you been short of breath? B. What seems to be the problem? C. How long have you been dyspneic? D. Did you exert yourself prior to becoming short of breath?
What seems to be the problem?
Which of the following is a good example of appropriate language use when taking a history? A. So does the pain usually radiate dorsally or laterally? B. How long have you had this abdominal guarding? C. When was your most recent stroke? D. Have you ever had an MI?
When was your most recent stroke?
What is the most significant concern when dealing with an intoxicated patient? A. Collecting an accurate history B. Your own safety C. Performing a physical exam D. Ascertaining an accurate chief complaint
Your own safety
Pulsus paradoxus is defined as: A. a change in the patient's heart rate from sitting position to a standing position. B. a decrease in the strength of the pulse during the inspiratory phase of the patient. C. an increase in the pulse strength during the expiratory phase of the patient. D. a change in the heart's rhythm.
a decrease in the strength of the pulse during the inspiratory phase of the patient.
Pulsus paradoxus is defined as: A. an increase in the pulse strength during the expiratory phase of the patient. B. a change in the heart's rhythm. C. a decrease in the strength of the pulse during the inspiratory phase of the patient. D. a change in the patient's heart rate from sitting position to a standing position.
a decrease in the strength of the pulse during the inspiratory phase of the patient.
Arterial pressure exerted by the blood when the left ventricle contracts is detected: A. as the first sound heard when pressure in the B/P cuff is slowly released. B. when sounds of the pulse disappear during deflation of the B/P cuff. C. by a stethoscope as the diastolic reading. D. by the difference between the systolic and diastolic pressure.
as the first sound heard when pressure in the B/P cuff is slowly released.
In checking a patient's blood pressure for the FIRST time utilizing a noninvasive blood pressure monitor, it is BEST to: A. use a wrist or finger blood pressure monitor. B. use a noninvasive blood pressure monitor. C. initiate invasive blood pressure monitoring. D. auscultate a manual blood pressure first.
auscultate a manual blood pressure first.
The FIRST blood pressure the EMT takes should be done by: A. auscultation method using a sphygmomanometer and stethoscope. B. using a noninvasive automatic blood pressure machine. C. assessing the B/P after you have begun transporting the patient to the hospital to make sure you do not delay transport. D. using the palpation method as it is quicker.
auscultation method using a sphygmomanometer and stethoscope.
As an EMT, you will be measuring breathing, pulse, skin, pupils, and blood pressure. The FIRST set of measurements you take are known as: A. initial vital signs. B. ongoing vital signs. C. baseline vital signs. D. primary vital signs.
baseline vital signs.
The properly placed sphygmomanometer cuff should: A. cover the entire upper arm. B. fit loosely until inflated. C. have a bladder that overlaps slightly. D. be centered over the brachial artery.
be centered over the brachial artery.
A heart rate of less than 60 beats per minute is called: A. bradycardia. B. tachycardia. C. synchronous rate. D. sinus rhythm.
bradycardia.
You arrive at a chaotic scene. The EMT should initially attempt to: A. physically restrain anyone who is not complying with your orders. B. bring order to the environment. C. shout loudly at the people to be quiet. D. have law enforcement arrest everyone at the scene but the patient.
bring order to the environment.
A reliable indicator of perfusion in children less than six years of age is: A. pulse rate. B. pupil size. C. skin color. D. capillary refill.
capillary refill.
Your infant patient is breathing 44 times a minute with a strong cry and you are going to administer oxygen. The MOST appropriate treatment for this patient is to: A. apply a nasal cannula at 8 lpm. B. deliver oxygen via blow-by with a mask. C. begin bag-valve mask ventilations. D. initiate a nebulizer mask with albuterol.
deliver oxygen via blow-by with a mask.
The amount of pressure on the arterial walls when the left ventricle is at rest is called the: A. pulse pressure. B. systolic blood pressure. C. diastolic blood pressure. D. mean arterial pressure.
diastolic blood pressure.
As you evaluate your patient's skin color, you find it is pale and moist. Pallor and moist skin may indicate: A. heat exposure. B. hypoperfusion, or shock. C. late carbon monoxide poisoning. D. liver disease.
hypoperfusion, or shock
Asking a bystander who witnessed the patient fall to the ground is a method of: A. determining the patient's mental status. B. investigating the chief complaint. C. determining the mechanism of injury. D. acquiring a SAMPLE history.
investigating the chief complaint
The patient is presenting with mouth breathing, flaring nostrils, and sitting in the tripod position. The EMT knows that this patient: A. is attempting to compensate. B. is probably having a heart attack. C. is having an asthma attack. D. needs an inhaler.
is attempting to compensate
The frequency of respiration is usually calculated as the number of ventilations in: A. 15 seconds. B. one minute. C. two minutes. D. 30 seconds.
one minute.
In infants and children, retraction of the skin, muscles, and other tissues around the clavicle and between the ribs indicates: A. shallow breathing. B. labored breathing. C. see-saw breathing. D. normal breathing.
labored breathing.
The use of accessory muscles in the neck, chest, or abdomen to breathe and nasal flaring is indicative of: A. tripod positioning. B. labored respirations. C. trouble exhaling. D. irregular respiratory rhythm.
labored respirations.
Before relying on a noninvasive blood pressure monitor, the EMT should: A. manually auscultate a blood pressure. B. program the machine to operate every 15 minutes. C. ensure that the cuff is tight. D. program the machine to operate every 5 minutes.
manually auscultate a blood pressure.
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: A. allergic reaction. B. traumatic brain injury. C. subdural hematoma. D. narcotic use.
narcotic use.
If you are in an excessively noisy environment, you may wish to check your patient's blood pressure by: A. dispensation. B. escalation. C. palpation. D. intervention.
palpation.
The "P" in the acronym SAMPLE stands for: A. palpation. B. pertinent past history. C. pain. D. provocation.
pertinent past history.
When your patient tells you he had a heart valve replaced two years ago, this is considered: A. a chief complaint. B. irrelevant to today's problems. C. pertinent past medical history. D. an event leading up to.
pertinent past medical history.
You are attempting to assess the pulse of an elderly man, and you note that you are unable to determine an accurate rate because the pulse disappears whenever the patient inhales. This is called: A. pulsus paradoxus. B. an irregular pulse. C. pulsus interruptus. D. cardiopulmonary interruption.
pulsus paradoxus.