EMT CHAPTER 11
Your partner is having a difficult time determining normal and abnormal blood pressures for a child. Which of these statements will help him most
"A minimally acceptable systolic pressure can be estimated by doubling the child's age and adding it to 70.
Which of these statements indicates an appropriate understanding of palpating a blood pressure
"A palpated blood pressure is typically a little lower than a blood pressure obtained by auscultation.
Which of these statements made by your EMT partner indicates that he understands assessment of a patient's breathing
"A rate less than 8 times per minute may allow adequate breathing, but requires further evaluation and assessment
The EMT understands the primary reason to obtain a medical history using the SAMPLE mnemonic when he states
"After performing the primary assessment, the SAMPLE mnemonic helps guide the EMT in further assessment and care.
Your EMT student has a good understanding of end-tidal carbon dioxide monitoring when she states
"Any disturbance to the breathing, circulation, or metabolic state of the patient can alter the reading
Which of these statements made by an EMT student indicates that he correctly understands the use of capillary refill when assessing a patient
"Capillary refill is a more reliable sign of perfusion quality in children younger than 6 years than in adolescents or adults.
Which of these statements made by an EMT indicates an accurate understanding of checking a patient's skin temperature
"Checking the skin temperature is not precise, but provides a good estimate of abnormally high or low body temperature
An EMT student asks you if it matters whether the blood pressure cuff seems too small for a patient, if a reading can still be obtained. You should respond
"Cuffs that are too small provide inaccurately high readings."
When using the OPQRST mnemonic, the EMT is getting information as it applies to the "P" category when she asks:
"Do you feel more short of breath when you are lying down?"
Which of these questions would the EMT ask when using the OPQRST mnemonic
"Does the pain feel dull or sharp?"
You notice that your partner routinely takes only one set of vital signs when treating and transporting patients. When asked, he states that he gets just baseline vital signs because they are most important, as they provide information related to the patient's clinical status at the time of the EMS call. How would you respond
"Examining several sets of vital signs can also indicate the effectiveness of your treatment."
An obese female patient has called you with a complaint of abdominal pain. The regular adult cuff will not fit around her arm, so you retrieve the large adult cuff from your supplies. Embarrassed, the woman says, "My arm is so fat. Do you really need to roll up my sleeve to get my blood pressure?" Your best response would be
"I am not concerned with the size of your arm. I am interested in your blood pressure.
A patient with chest pain informs you that the pain is greater when he takes a deep breath. The EMT is using the active listening technique of "facilitation" and "clarification" when he responds by saying:
"I see. Can you describe what the pain feels like?"
When using the SAMPLE mnemonic, which of these statements made by the patient would be categorized under the letter "M"?
"I take Zocor, but I am not sure why.
You are transporting a depressed patient who states that she is thinking of killing herself by taking a "whole bunch of pills." After providing you this information, the patient has refused to speak and has remained silent. Your physical assessment of the patient reveals she is stable. Which of these statements would be most appropriate for you to make at this time
"I understand if you do not want to talk. I will be sitting here if you need anything."
When you are applying the pulse oximeter sensor to a patient's finger, he asks you what this device is for. Your response would be:
"It measures the amount of oxygen being carried by your blood cells."
You have applied the pulse oximeter to a 73-year-old male patient who complains of weakness and heart palpitations. Your partner reports that the patient's breath sounds are clear and equal, with a respiratory rate of 16 breaths/min and skin that is warm but pale in color. He then states the following vital signs: pulse, 92; blood pressure, 168ll0 mm Hg; and SpO2, 92% on room air. Given this information, which of these instructions would be most appropriate
"Let's initiate oxygen at 2 liters per minute via a nasal cannula.
Which of these statements made by a patient would the EMT regard as a symptom
"My pain is sharp, the worst I've ever felt."
An EMT has accurately checked the skin color of a dark-skinned patient. How would this finding be best documented on a patient care report
"Pale color noted to the conjunctiva."
The EMT is correct when he makes which of these statements about assessment of the pupils
"Some people naturally have unequal pupils, but both should react to light."
When obtaining a medical history using the SAMPLE mnemonic, which of these statements relates to the "P" component
"There is a history of pancreatitis
A patient presents with skin that is cool to the touch. The EMT shows he understands this condition when he states
"This may indicate a problem with the patient's blood circulation."
Which of these questions would be asked when obtaining a medical history, using the SAMPLE mnemonic, for a female patient who is crying and complaining of dizziness
"What were you doing when the dizziness started?"
The EMT is appropriately using the SAMPLE mnemonic when he asks which question
"When did you eat last?"
Which of these is an example of an open-ended question?
"Why did you call 911 ?"
Which of these blood pressure readings is normal for a 7-year-old male
114/62 mmHg
Which of these blood pressures represents diastolic hypertension in an adult patient
136/92 mmHg
While reviewing a patient care report for a quality assurance process, the EMT should recognize that a blood pressure has been palpated when she sees
178 / P
You are called for a 2-year-old female child who is sick. When testing her capillary refill, what would be the greatest cause for concern
3-second capillary refill time
The EMT recognizes which heart rate would be considered normal for a 24-year-old male patient who is resting comfortably
62 beats/min
How should the EMT document a pulse oximetry reading on the prehospital care report
97% SpO2
Which of these patients should the EMT recognize as having a normal skin temperature
A 36-year-old male complaining of nausea with warm skin
Which of these patients should the EMT recognize as tachycardic for his or her age bracket
A 37-year-old male with a complaint of fatigue and a heart rate of 104
For which of these patients would a capillary refill time of 3 seconds be most indicative of poor perfusion
A 4-year-old male
An 86-year-old female patient has called 911 for rectal bleeding. There is a large amount of dark red blood and clots in the toilet and on the patient's clothing. The Emergency Medical Responder reports a blood pressure of 84/68 mmHg with a heart rate of 124 beats/min. Given this information, the EMT should expect findings of
A narrowed pulse pressure and possible shock
The fire department has requested your assistance at a residence where the family's carbon monoxide (CO) detector has been going off. There are three patients. You first assess a 28-year-old female patient who states she has a sinus headache but otherwise feels fine. Her vital signs are pulse, 90; respirations, 16 breaths/min; blood pressure, 118/60 mmHg; and SpO2, 100%. Given these assessment findings, you should immediately
Administer high-concentration oxygen
Which of these descriptions would be obtained when asking about the "A" component of the SAMPLE history?
Allergy to penicillin
You are assessing a 49-year-old male patient who complains of lower back pain. Which finding would be pertinent medical information related to the back pain that the EMT will obtain using the SAMPLE mnemonic
Arthritis in the spine and pelvis
You and a paramedic partner are caring for a patient who overdosed on a drug that has caused her to become apneic. Your EMT student is providing BVM ventilations with supplemental oxygen via an endotracheal tube placed by the paramedic. The patient still has a good pulse and acceptable blood pressure. The pulse oximeter reads 95% and the ETCO2 monitor reads 28 mmHg. Given these findings, the EMT should
Ask the EMT student ventilating the patient to slow the ventilatory rate
You are unable to auscultate a blood pressure in a patient's right arm. What should you do next to obtain the most accurate baseline assessment of this patient's vital signs
Auscultate the blood pressure in the left arm
The EMT is correctly using a noninvasive blood pressure monitor when she:
Auscultates a blood pressure before applying and activating the device
Where would the EMT palpate for a popliteal pulse
Behind the knee
Assessment of a patient who is unresponsive reveals pupils that are both large at 6 millimeters and do not change size in response to light. The EMT would best document this finding as:
Bilateral dilation of the pupils, unresponsive to light
Your partner states that he wants to palpate the blood pressure. Which equipment would you hand him
Blood pressure cuff
A patient states that he is short of breath, is light-headed, and has chest pain that worsens when he takes a deep breath. Assessment reveals an open airway, adequate breathing, and a rapid pulse of 120 beats/min. The patient's skin is hot to the touch, and he has a blood pressure of 116/84 mmHg. The patient informs you that he was diagnosed with pneumonia 3 days ago and has not been taking the prescribed antibiotics. Which of these assessment findings would the EMT best recognize as a sign related to the patient's chief complaint?
Blood pressure of 116/84 mmHg
Which of these would indicate a normal pupillary exam has occurred?
Both pupils constrict when light is directed into one eye
When obtaining a blood pressure, the EMT listens for a pulse over which blood vessel
Brachial artery
You determine a patient's heart rate to be 48 beats/min. That heart rate would be categorized as:
Bradycardic
You are assessing a 61-year-old male patient who is confused. During the primary assessment, you cannot locate a radial pulse. Your immediate action should be to
Check for a carotid pulse
You have assisted the patient in taking one of his nitroglycerin tablets due to cardiac-type chest pain. Five minutes later, you note the patient's blood pressure is 108/74 mmHg. To determine if the nitroglycerin has affected the blood pressure, the EMT should
Compare this finding to the baseline blood pressure
A 41-year-old male patient reacts to painful stimuli by moaning. You shine a light at his right pupil only, while looking at both pupils. What would be a normal finding
Constriction of the right and left pupils
When assessing a patient's pulse, you note that it is irregular. To get an accurate heart rate, you would
Count the number of beats that occur in 1 minute
The EMT is correctly calculating a patient's respiratory rate when he or she
Counts the number of breaths for 30 seconds and multiplies by 2
Assessment of a patient's skin color reveals a bluish discoloration. As a knowledgeable EMT, you should identify:
Cyanosis caused by inadequate oxygenation of the tissues
You observe your partner correctly obtaining a patient's blood pressure when he
Deflates the cuff 2 mmHg per second while listening with a stethoscope
During the primary assessment of a geriatric patient complaining of shortness of breath and fever, you quickly locate the radial pulse. What should you do next
Determine the rate and quality of the pulse
When assessing a patient's pupils, the EMT should
Determine the size of the pupil and then look for a change in pupillary size while shining a light in the eye
You believe a patient for whom you are caring is starting to experience respiratory failure. Which of these findings is supportive of this suspicion
ETCO2 of 56 mmHg
You are assessing a confused dark-skinned patient who complains of a headache. When checking his skin color, you should
Evaluate the palms of his hands or conjunctiva
You are transporting a depressed patient who states that she is thinking of killing herself by taking a "whole bunch of pills." After providing this information, the patient has refused to speak and has remained silent. Your physical assessment of the patient reveals she is stable. How often should vital signs be reassessed
Every 15 minutes
You and a paramedic partner are caring for a patient who overdosed on a drug that has caused her to become apneic. Your EMT student is providing BVM ventilations with supplemental oxygen via an endotracheal tube placed by the paramedic. How often should vital signs be reassessed on this patient
Every 5 minutes
You are attempting to get a history from a 56-year-old female patient who is short of breath. When you ask questions, the daughter continually answers for the patient. To best handle this situation, you should:
Explain to the daughter it is important for the patient to answer whenever possible
The purpose of the OPQRST mnemonic is to guide the EMT in
Exploring the patient's chief complaint
What is the name of the pulse that is palpated in the groin area?
Femoral
The EMT is correctly palpating a central pulse when he palpates the
Femoral pulse
When using a pulse oximeter on an adult patient, the EMT knows that the sensor is most often attached to the patient's:
Finger
To test a pediatric patient's capillary refill, the EMT will:
Firmly compress and then release pressure on the nail bed
A pulse oximetry reading obtained on room air is considered normal when it is:
Greater than 97 percent
You have placed the blood pressure cuff on the arm of a patient who is short of breath. What is your next step?
Inflate to a reading of 70 mm Hg, check for a radial pulse, and continue inflation until the pulse is no longer felt
A female patient called 911 when she noticed blood in her stool, and became scared and anxious. Her pulse rate is 124 and her blood pressure is 88/60 mmHg. After you get her vital signs, she nervously asks you how they are. Given her anxiety, you should:
Inform her of the vital signs
You have been dispatched to a residence for a 14-year-old female patient complaining of abdominal pain. As you enter the living room, you see the conscious patient lying on a couch with her father and an Emergency Medical Responder at her side. Which action should the EMT perform first?
Introduce yourself and your partner
An EMT has an accurate understanding of diastolic blood pressure when she tells you that diastolic pressure:
Is the pressure in the arteries when the heart is not contracting
A patient with liver cancer exhibits a yellow discoloration to his entire body. The EMT would correctly document this condition as
Jaundice
You have been dispatched to a residence for a female patient with unknown injuries. At the patient's side, you quickly become aware that the 43-year-old female was assaulted by her husband. The husband comes into the room and states, "Don't you touch her, or I will take care of you, too!" What should be the EMT's immediate action
Leave the house immediately, taking the patient with you, if possible
A patient who appears to be intoxicated has fallen and is complaining of pain to his right arm. He is loud and using profane language. What should be your initial approach to the patient
Let me put an ice pack on your wrist. It will help it feel better.
In patients with which of these conditions would the EMT most likely get an inaccurate pulse oximeter reading despite proper application of the sensor?
Low blood pressure
You have been called to a bar for a patient who was involved in an altercation and is complaining of abdominal pain. Law enforcement is present. The patient has been handcuffed and is sitting on the sidewalk. He has an odor of alcohol on his breath, his speech is slurred, and he is angrily yelling at the police officers. Which action would be most appropriate for the EMT to take when talking to the patient?
Maintain eye contact to help establish a rapport
You are assessing a female patient with a complaint of shortness of breath. When assessing her skin, which finding should be recognized as abnormal?
Moist
As you enter the scene of a medical emergency, the Emergency Medical Responder informs you that the patient is not breathing and has pupils that are fixed and dilated. Based on this description, what do you expect to see when you reach the patient's side
Neither pupil will react when light is directed into the eyes
Which of these would be an indication to palpate the blood pressure
Noisy environment
When evaluating a patient's skin color, the EMT should
Observe the nail beds and/or mucous membranes inside the eyelids
A female patient with a history of asthma called 911 with a complaint of shortness of breath. On scene, you assisted her with the administration of her metered-dose inhaler containing albuterol. What can the EMT do to best determine if this patient's condition is improving?
Obtain a pulse oximetry reading and breath sounds every 5 minutes
A 43-year-old female has accidentally taken too much of her antidepressant medication and is now confused. Emergency Medical Responders are on scene and providing the patient with high-concentration oxygen. As you arrive at the patient's side, your first action should be to
Perform a primary assessment
The EMT should recognize normal skin color in a healthy patient as:
Pink
When you are obtaining the blood pressure of a patient in a standing position, the patient states that he suddenly feels weak and is going to pass out. Your immediate action should be to
Place the patient back into bed
You are trying to get a pulse oximeter reading on an 18-month-old child with difficulty breathing. Every time you place the sensor on the child's finger, he becomes upset and removes it. What is your best course of action
Place the sensor on the child's toe
Which of these methods most accurately assesses a patient's skin temperature
Placing the back of the hand on the patient's abdomen
An EMT has an accurate understanding of systolic blood pressure when he tells you that systolic blood pressure is
Produced when the heart contracts
You have arrived by the side of a cyanotic patient who is responsive only to painful stimuli and exhibiting stridorous respirations. What is the most appropriate action by the EMT
Provide positive pressure ventilation with supplemental oxygen
After you apply the pulse oximeter to a patient who complains of chest discomfort, she asks you what you are assessing. You would respond by telling her that the pulse oximeter
Provides information about the amount of oxygen circulating in the blood
Friends called 911 for a 37-year-old female who intentionally overdosed on a narcotic drug at a college party. Which eye-related findings would reinforce that the patient did indeed take a narcotic
Pupils that are constricted
Which pulse site is commonly palpated during the process of obtaining a blood pressure by the palpation technique
Radial
You have been called to assess a conscious and alert 5-year-old child whose chief complaint is nausea and vomiting over the last 2 hours. When assessing his pulse, you should first check which pulse?
Radial
A patient presents with extremely pale skin. His family states that this is not his normal skin color. His vital signs are pulse, 118; respirations, 18 breaths/min; blood pressure, 102/86 mm Hg; and SpO2, 96%. Which complaint would make the most sense given this clinical presentation
Rectal bleeding
Which step should be taken by the EMT to obtain an accurate pulse oximetry measurement?
Remove nail polish from the patient's fingernail if present
When assessing a patient who does not speak the same language as you or your partner, the best approach in the immediate care of the patient is to:
Request that a family member act as an interpreter
Emergency Medical Responders inform you that a 27-year-old male patient with altered mental status has an open airway and is breathing 9 times every 30 seconds. His pulse rate is 40 beats/min, and he has bruises to his chest. Based on this vital sign and presentation information, the EMT should recognize the:
Respiratory rate as normal
Which of these findings related to breathing would be most concerning to the EMT in an adult patient
Respiratory rate of 20, use of accessory muscles
When should the EMT use the pulse oximeter?
Routinely on all patients with a medical or trauma complaint
Which of these pieces of information would be obtained by the EMT when getting a history using the SAMPLE mnemonic
Sensation of dizziness prior to falling
You are assessing a patient who is in bright sunlight after collapsing in the hot sun at a picnic. If you cannot immediately move the patient out of the sun, assessment of the pupils will be made more accurate by
Shading the patient's eyes
A mother has called 911 because her 2-year-old daughter is fussy and not eating. When assessing the toddler, what would be the best indication of her perfusion status
Skin color and temperature
You are called to a long-term care facility to assess and transport a patient with a high fever. You do not have a thermometer on your unit. Which alternative sign should you use to confirm the patient's increased body temperature
Skin on the abdomen that is hot and flushed
You are caring for a 5-year-old male patient with a complaint of difficulty breathing. Your assessment indicates that the patient is tachypneic with labored breathing. While gaining more information about the patient's respiratory function, which finding would you recognize as most important
Skin retractions between the ribs during inhalation
Which of these patient descriptions contains only vital signs
Skin, warm and dry; heart rate, 74 beats/min; pupils equal and reactive
To assess a patient's blood pressure, the EMT will need a:
Sphygmomanometer
Medical direction has asked that you obtain orthostatic vital signs for a 54-year-old female patient who complains of dizziness and weakness. Her baseline vital signs obtained while she was sitting in a chair were pulse, 84; respirations, 26 breaths/min; blood pressure, 118/62 mmHg; and SpO2, 95%. Which one set of vital signs upon reassessment would indicate that this patient has a positive orthostatic test
Standing blood pressure of 92/54 mm Hg and heart rate of 106 beats/min
Which of these characteristics would be considered a pulse "quality" factor
Strength
A young female patient has been stung by a bee and complains that her "throat is closing up." She states that she is allergic to bee stings; the last time this happened, she had to have a "tube put into my windpipe." She is struggling to breathe and can speak only a few words at a time. Knowing that allergic reactions can cause swelling in the pharynx and the larynx, what airway sound would indicate that the patient indeed has swelling In this area?
Stridor
You determine a patient's radial pulse is readily palpable. but has uneven intervals between beats. This finding would best be documented on the prehospital care report as:
Strong and irregular
Correctly assessing orthostatic vital signs involves
Taking the blood pressure in the supine, seated, and standing positions
When obtaining vital signs for a 67-year-old male patient with dizziness and nausea, your partner states that the pulse seems to disappear periodically when the patient takes a deep breath. As a knowledgeable EMT, your best response would be
That is an important finding. We will have to let the doctor know about it."
A patient who was shoveling snow developed chest pain, immediately sat down in a nearby bus shelter, and called 911. Prior to moving him into the ambulance, your partner performs a primary assessment and reports that the patient's capillary refill is 5 seconds. Which of these would be an appropriate statement for you to make
The cold temperature may cause the capillary refill to be 5 seconds; we should assess further
You are observing a new EMT just hired by your EMS agency. You know he has correctly positioned the blood pressure cuff on the patient's arm when
The cuff is on the same level as the patient's heart
Your partner reports that a patient's blood pressure is 156/78 mmHg. From this reading, you realize
The diastolic blood pressure is 78 mmHg
The EMT is reviewing a patient care report and finds the following documentation "ETCO2 is 43 mmH9." What does this mean?
The exhaled carbon dioxide level is normal
The EMT is correct when he identifies baseline vital signs as:
The first set of vital signs obtained
A 69-year-old man complains of weakness to the left arm and leg. He also states that he is nauseated and has a headache. The patient's past medical history includes stroke and diabetes. In relation to this information, which of these statements is true
The headache is a symptom related to the chief complaint
Which of these statements concerning assessment of the pulse is correct
The heart rate can be determined by doubling the number of beats counted in 30 seconds.
When assessing a patient's pulse, you can locate the right radial pulse, but not the left. What is the most likely explanation for this finding?
The left radial artery may be occluded
An alert and oriented 87-year-old female patient has fallen and suffered a 3-cm laceration to the back of her head. According to the patient, her walker became caught in the carpet, causing her to trip. When obtaining a medical history, who should the EMT address first?
The patient
You cannot obtain a reading on the pulse oximeter after applying the sensor to the patient's finger. What would be the most common reason for this difficulty
The patient's hands are cold
A blood pressure is reported as 116/68 mm Hg. Given this finding, which of these statements is true
The systolic blood pressure is 116 mmHg
When obtaining a blood pressure for a patient, the radial pulse disappears when the gauge reads 130 mmHg. When deflating the cuff, the EMT hears a pulse at 118 mmHg. The pulse disappears at 76 mmHg. Given this, which of these statements is true?
The systolic blood pressure is 118 mm Hg
A family has called 911 for a 41-year-old male family member whom they cannot wake up. They state he has been threatening to kill himself and believe that he may have intentionally overdosed on his pain medications. As you enter the patient's bedroom, you observe him supine on the floor with his eyes closed. As he breathes, you hear snoring respirations. As a knowledgeable EMT, you recognize that this condition is likely caused by
The tongue partially blocking the airway
Which of these statements is true regarding vital signs obtained from a patient with nausea and vomiting
The vital signs will help the EMT determine the relative stability or instability of the patient
An EMT is correctly assessing a patient's radial pulse when he:
Uses his fingertips to feel for a pulse on the anterior and lateral aspects of the patient's wrist
A patient has advanced liver disease from years of exposure to toxic chemicals in his place of employment. Which skin color would the EMT expect given this status
Yellow-orange
