Chapter 9- Patient Assessment

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?

"What does the pain feel like?"

You are assessing the blood pressure of a 36-year-old male who was assaulted. A normal systolic blood pressure for a patient of this age should be approximately:

140 mm Hg

Which of the following situations would MOST likely require additional personnel or resources at the scene?

40-year-old male with an apparent self-inflicted gunshot wound to the head

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?

6

Which of the following patients would you describe as being disoriented?

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

Which of the following general statements about blood pressure measurement is correct?

A normal size cuff should take up two thirds the length from the armpit to the crease at the elbow

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?

An underlying medical condition my have resulted in this incident

Which of the following methods of assessing circulation is LEAST reliable in adult patients?

Capillary refill time

Which of the following injuries would the front seat passenger LEAST likely sustain when the front end of a car strikes a bridge pillar?

Chest

Which of the following questions would allow you to assess the "P" in the SAMPLE history?

Has this ever happened to you before?

Which of the following conditions can cause the skin to be abnormally flushed and red?

High Blood pressure

Which of the following statements regarding the secondary assessment is correct?

If the patient is unstable, the secondary assessment should be performed en route.

Which of the following injuries or conditions would have the LOWEST treatment priority during the primary assessment?

Impressive amount of dried blood in the hair but no active bleeding

Which of the following statements regarding clinical decision making is correct?

Irrelevant or extraneous data can skew your interpretation of a patient's condition, potentially leading to inappropriate care

Which of the following skin findings suggest liver dysfunction?

Jaundice and dry

Which of the following are clinical indicators of respiratory failure?

Lethargy and bradypnea

Which of the following conditions may slow a person's capillary refill time?

Peripheral vasoconstriction

Which of the following patients requires immediate transport following initial stabilization at the scene?

Severe pain to the left lower quadrant of the abdomen

Which of the following statements regarding a patient with traumatic cardiac arrest is correct?

The patient's cardiac rhythm must be assessed, as soon as possible, with a manual cardiac monitor/defibrillator.

When is it appropriate to palpate a trauma patient's pelvis?

When he or she does not report pelvic pain

Rales, rhonchi, and wheezing are examples of:

adventitious breath sounds.

Your primary assessment of a 32-year-old male reveals that he is semiconscious and is breathing at a slow rate with shallow movement of the chest. You should:

begin assisting his ventilations

While assessing the abdomen of a 37-year-old female who experienced blunt abdominal trauma, you note the presence of bruising over the left flank area. This finding suggests:

blood in the retroperitoneal space

The soft, breezy, and lower pitched sounds found at the midclavicular line are known as _________________ sounds.

bronchovesicular

Your scene size-up begins:

by preparing for a specific situation based on the dispatch information.

You arrive at the scene of a motor-vehicle crash where a small car has struck a tree head-on. You see one patient sitting in the driver's seat with the door open. Prior to exiting the ambulance, you should:

don the appropriate protective equipment.

You are extricating a conscious and alert 22-year-old female from her car after she struck the rear end of another car while traveling at 40 mph. She complains only of neck pain and has no visible trauma. Her airbag deployed, but she was not wearing a seatbelt. You should:

lift the airbag and assess for steering wheel deformity

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:

manually stabilize her head in a neutral position.

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:

open her airway and assess her breathing status.

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:

perform a rapid body scan.

Unlike the secondary assessment, the ongoing assessment (reassessment) is:

performed on all patients during transport.

You are assessing the pupils of a patient who was struck in the back of the head. You note that his pupils differ in size by slightly less than 1 mm. The patient is conscious, alert, and oriented to person, place, time, and event. You should suspect:

physiologic anisocoria

You are en route to a trauma center with a victim of a gunshot wound. You reassess his blood pressure and note that it has decreased by 10 mm Hg. After ensuring continued airway patency and adequate ventilation, you should:

reassess for any occult bleeding

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:

request at least one additional ambulance and law enforcement.

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:

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

You are assessing the quality of a trauma patient's respirations. Which of the following clinical findings would indicate labored breathing?

supraclavicular retractions

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:

surveyed the scene and assessed the patient.

Your rapid assessment (rapid body scan) of an injured patient reveals pelvic deformity and a rigid, distended abdomen. After applying high-flow oxygen and immobilizing the patient's spine, you should:

transport promptly and initiate IV therapy en route to the hospital.

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:

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

A 40-year-old female complains of a sudden onset of chest pressure. When assessing the history of her present illness, which of the following patient responses would identify a palliating factor?

"The pressure seems to subside when I sit down."

In general, you should assess the blood pressure in all patients who are at least ____ years of age.

3

Based solely on the mechanism of injury, which of the following adult patients is at greatest risk for serious injuries?

4' 5" patient who fell 14'

The rapid body scan of a seriously ill or injured patient should take no longer than:

60 to 90 seconds.

On which of the following patients should you perform a rapid trauma assessment (rapid scan)?

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

Which of the following actions would you NOT perform during the scene size-up?

Assess a patient's breathing effort.

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:

applying an AED and defibrillating if indicated.

A patient with congenital anisocoria would be expected to have pupils that:

are unequal in size

A 63-year-old male is being transported to the hospital for an acute exacerbation of his emphysema. He is on oxygen via nasal cannula at 4 L/min. During your reassessment, you note that his mental status has deteriorated and his respirations have become markedly slow and shallow. You should:

assist his ventilations with a bag-mask device.

A 49-year-old male collapsed and is now unresponsive. There is no evidence of trauma. Your primary assessment reveals that he is pulseless and apneic. You should:

begin CPR and apply the AED as soon as it is available.

Your primary assessment of a 32-year-old male reveals that he is semiconscious and is breathing at a slow rate with shallow movement of the chest. You should:

begin assisting his ventilations.

Loud, high-pitched and hollow sounds auscultated over the manubrium are called:

bronchial sounds.

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:

continue oxygenation and further monitoring.

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:

control the bleeding with direct pressure.

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:

decreased perfusion.

A young male is found to be unconscious. When assessing his pupils, you note that they dilate when exposed to bright light. This clinical finding is MOST suggestive of:

depressed brain function

In a responsive patient, capnography is used to:

determine the amount of carbon dioxide produced by aerobic metabolism.

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:

diffuse.

During your reassessment of a patient with an illness or injury, it is important to:

document any changes in his or her condition.

During your rapid trauma assessment (rapid body scan) of a man who sustained a gunshot wound to the chest, you note the presence of air under the skin. This clinical finding is referred to as subcutaneous:

emphysema.

Clues about the potential seriousness of your patient's injury or injuries are MOST reliably obtained by:

evaluating the mechanism of injury.

The formulation of an appropriate treatment plan is ultimately based on the:

field impression of the patient.

A 40-year-old female is unconscious following blunt trauma to the chest. During the rapid trauma assessment (rapid body scan), you auscultate the chest and hear rhonchi. This indicates:

fluid in the larger airways in the lungs.

Assessment of a patient's pelvis is appropriately performed by:

gently compressing it inward.

All of the following conditions would require immediate transport after the primary assessment and treatment phase, EXCEPT:

headache without mental status change.

A responsive 40-year-old male complains of chest pain. He is able to speak to you in complete sentences and has no obvious respiratory difficulty. From this information, you can conclude that:

his airway is patent and his breathing is adequate.

Following the primary assessment, the MOST appropriate order in which to proceed when treating a responsive medical patient is:

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

Following the primary assessment, the MOST appropriate order to proceed when treating a responsive medical patient is:

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

When performing the primary assessment of a patient, your goal is to:

identify and treat immediate life-threatening injuries or conditions.

When performing the primary assessment of a patient, your goal is to:

identify and treat immediately life-threatening injuries or conditions.

Trending a critically-injured patient's vital signs will allow you to determine:

if the patient's condition is stabilizing or deteriorating.

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:

perform a rapid trauma assessment

Indicators to the patient that you are actively listening to him or her include:

periodically repeating back important points to the patient.

A 21-year-old male complains of acute shortness of breath with sharp chest pain during inspiration. You auscultate his lungs and hear a grating sound over the left lower lobe during inspiration. This patient's clinical presentation is MOST likely caused by:

pleural inflammation.

When forming a general impression of your patient, you can determine the:

presence of gross external bleeding.

Following the primary assessment, your actions prior to transport of a critically-injured patient should include:

rapid trauma assessment, spinal immobilization, vital signs.

When performing the rapid body scan on an unresponsive patient, you should follow the same approach as the:

rapid trauma assessment.

The general impression of your patient will allow you to obtain all of the following information EXCEPT for the:

rate and regularity of the pulse.

When performing your assessment of a 22-year-old male with hypoglycemia, you note that his mental status has improved and he is now verbally responsive. You should:

reassess his vital signs.

Proper use of personal protective equipment (PPE) will:

reduce your risk of an infectious exposure.

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:

referred pain

During transport of a 34-year-old male with a possible femur fracture, you perform a reassessment. This process begins with:

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:

request at least one additional ambulance

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

request at least one additional ambulance.

When arriving at the scene of a motor-vehicle crash, you should park your ambulance in an area that is:

safe but allows rapid access to the patient.

A patient who is in a tripod position is:

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

The need to perform a detailed physical exam on a patient is based on:

the nature of illness or mechanism of injury.

The nature of a patient's illness is MOST often determined by:

the patient's chief complaint.

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

the patient's reason for calling EMS.

The amount of force applied to the body during a motor-vehicle crash is directly related to:

the speed of the vehicle at the time of impact.

When energy impacts a body structure it:

translates into injury.

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:

transport the patient without delay.

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:

treat him for potentially life-threatening injuries.

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?

What prompted you to call EMS today?

A 39-year-old male complains of severe lower abdominal pain. His airway is patent and his respirations are eupneic. Assessment of his skin reveals that it is cool and clammy. You should:

administer supplemental oxygen.

The concept of standard precautions assumes that:

all blood, body fluids, nonintact skin, and mucous membranes may pose a substantial risk of infection.

Severe abdominal distention may be caused by ascites, which is:

an accumulation of fluid in the peritoneal space

When reassessing a patient during transport, you should:

monitor treatment interventions and modify them as necessary.

A patient who coughs up thick yellow or green sputum:

most likely has an advanced respiratory infection.

A middle-aged woman presents with crushing chest pain, diaphoresis, tachycardia, and nausea. Which of these findings is/are signs?

Diaphoresis and tachycardia

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:

8

In adult females and adolescents, systolic blood pressure is considered critically low when it is less _____ mm Hg or less.

80

What three factors should be evaluated when predicting a trauma patient's potential for serious injuries?

Amount of force applied to the body, the length of time the force was applied, and the area(s) of the body involved.

When assessing a patient's abdomen, which of the following techniques will provide you with the LEAST amount of information?

Auscultation of bowel sounds

Which of the following statements regarding clinical decision making is correct?

Irrelevant or extraneous data can skew your interpretation of a patient's condition, potentially leading to inappropriate care.

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:

injury to the spinal cord.

When assessing a patient with a small-caliber gunshot wound, it is important to remember that:

internal injury severity is often unrelated to the entrance and exit wounds.

A patient who remains flaccid without moving or making a sound with no indication of hearing you:

is considered unresponsive.

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:

leave the scene immediately and request help.

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:

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:

liver inflammation

When auscultating the breath sounds of a patient with respiratory distress, you hear a high-pitched whistling sound during expiration. This suggests:

lower airway obstruction.

When performing a rapid trauma assessment (rapid body scan), you will usually assess all of the following, EXCEPT the:

mastoid process.

An electronic blood pressure cuff that measures readings using stepped deflation:

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 70-year-old male tells you that he took three of his wife's nitroglycerin tablets for chest pain prior to calling EMS. This information is clinically important to you because it:

may have an effect on the treatment you provide.

During your assessment of a 33-year-old female with an altered mental status, you note a fruity odor on her breath. You should:

obtain a blood glucose reading.

When a section of the ribs has been fractured, the injured section falls during inspiration and bulges during expiration. This is called:

paradoxical chest movement.

The focused assessment of a patient is based primarily on the:

patient's chief complaint.

A 20-year-old male twisted his ankle while playing basketball. He is conscious and alert, is breathing adequately, and denies other trauma. After performing the primary assessment, you should:

perform a focused assessment.

Determining the mechanism of injury will contribute to your decision of whether you should:

perform a rapid assessment or focused exam.

You are attempting to obtain a medical history 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:

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

All of the following elements are essential to the AEMT's critical-thinking ability, EXCEPT:

using extraneous data to formulate an appropriate patient care plan.

The finer and somewhat fainter breath sounds noted in the lateral wall of the chest are known as:

vesicular sounds.

An older man complains of chest pain. He is conscious and alert and denies any other symptoms. Your focused assessment of this patient should include:

vital signs, looking at the chest for obvious trauma, auscultation of breath sounds, assessing the external jugular veins, and assessing for edema to the extremities.

Compared to the patient's chief complaint, the primary problem is:

what is actually wrong with the patient.

During your secondary assessment of a 70-year-old male with congestive heart failure, you note the presence of 4+ pitting edema to his lower extremities. This means that:

you are able to make an indentation in the skin of greater than 1".

When obtaining medical history information on a patient who has been serious injured, it is important to remember that:

you should gather as much information as possible without delaying transport.