Chapter 10 - Patient Assessment
When palpating the carotid pulse of a responsive patient, you should: Select one: A. ensure that his or her head is in a hyperextended position. B. avoid gentle pressure so that weak pulses can be detected. C. firmly compress the artery because the pulse is often weak. D. avoid compressing both carotid arteries simultaneously.
avoid compressing both carotid arteries simultaneously.
An adult patient who is NOT experiencing difficulty breathing will: Select one: A. have a respiratory rate that is between 20 and 24 breaths/min. B. assume a position that will facilitate effective and easy breathing. C. be able to speak in complete sentences without unusual pauses. D. exhibit an indentation above the clavicles and in between the ribs.
be able to speak in complete sentences without unusual pauses.
When performing the secondary assessment on a trauma patient, you note the presence of Battle sign. This is defined as: Select one: A. swelling to the orbital area. B. unequal pupils. C. bruising behind the ear. D. fluid drainage from the nose.
bruising behind the ear
Capnography is used to: Select one: A. assess how much oxygen is reaching the body's tissues. B. trend a patient's blood pressure and assess for shock. C. determine how much carbon dioxide is being exhaled. D. assess how much oxygen is bound to the hemoglobin.
determine how much carbon dioxide is being exhaled.
A patient with high blood pressure would be expected to have skin that is: Select one: A. mottled and cool. B. pale and moist. C. cyanotic and dry. D. flushed and red.
flushed and red
In patients with deeply pigmented skin, changes in color may be apparent only in certain areas, such as the: Select one: A. lips or oral mucosa. B. dorsum of the hand. C. back of the neck. D. forehead and face.
lips or oral mucosa.
When assessing motor function in a conscious patient's lower extremities, you should expect the patient to: Select one: A. note any changes in temperature. B. wiggle his or her toes on command. C. identify different types of stimuli. D. feel you touching the extremity.
wiggle his or her toes on command.
Which of the following questions would you ask a patient to ascertain the "M" in the SAMPLE history? Select one: A. "How long have you had your chest pain?" B. "When was the last time you ate a meal?" C. "How much Tylenol do you take each day?" D. "Have you ever had any major surgeries?"
"How much Tylenol do you take each day?"
Which of the following patient responses would establish the "E" in the SAMPLE history? Select one: A. "I was mowing the lawn when the pain began." B. "The chest pain started about 45 minutes ago." C. "I am not having any difficulty breathing." D. "I was in the hospital a week ago."
"I was mowing the lawn when the pain began."
The normal respiratory rate for an adult should range from: Select one: A. 10 to 12 breaths per minute. B. 18 to 24 breaths per minute. C. 12 to 20 breaths per minute. D. 24 to 28 breaths per minute.
12 to 20 breaths per minute
he goal of oxygenation for most patients is an oxygen saturation of: Select one: A. 90% to 94% B. 88% to 90% C. 94% to 99% D. 100%
94% to 99%
Which of the following scenarios does NOT involve the presence of any symptoms? Select one: A. A 44-year-old male with abdominal pain and severe dizziness B. A 49-year-old female with blurred vision and ringing in the ears C. A 61-year-old female who is unconscious with facial cyanosis D. A 55-year-old male with a severe headache and 2 days of nausea
A 61-year-old female who is unconscious with facial cyanosis
Which of the following statements regarding the secondary assessment is correct? Select one: A. You may not have time to perform a secondary assessment if you must continually manage life threats that were identified during the primary assessment. B. A focused secondary assessment would be the most appropriate approach for a patient who experienced significant trauma to multiple body systems. C. If your general impression of a patient does not reveal any obvious life threats, you should proceed directly to the secondary assessment. D. 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.
Which of the following patients has signs of an altered mental status? Select one: A. A patient with a head injury who is slow to answer questions B. A patient with an acute allergic reaction and dizziness C. A patient who overdosed and tells you he tried to kill himself D. A diabetic who has nausea and severe lightheadedness
A patient with a head injury who is slow to answer questions
Which of the following is the MOST effective method of assessing the quality of air movement in the lungs? Select one: A. Auscultating breath sounds with a stethoscope B. Looking for the presence of accessory muscle use C. Evaluating the patient's chest for cyanosis D. Applying a pulse oximeter and monitoring the SpO2
Auscultating breath sounds with a stethoscope
A patient in unstable condition should be reassessed at least every: Select one: A. 5 minutes. B. 10 minutes. C. 20 minutes. D. 15 minutes.
5 minutes
For an adult, the normal resting pulse should be between: Select one: A. 40 and 50 beats/min. B. 60 and 100 beats/min. C. 100 and 110 beats/min. D. 50 and 60 beats/min. Feedback
60 and 100 beats/min.
The rapid exam of a patient that occurs following the primary assessment should take no longer than: Select one: A. 30 seconds. B. 90 seconds. C. 120 seconds. D. 60 seconds.
90 seconds
Which of the following factors would MOST likely cause a patient's pulse rate to be slower than normal? Select one: A. Lack of a regular exercise routine B. Internal bleeding from trauma C. Beta blocker medications D. Anxiety or severe stress
Beta blocker medications
Which of the following assessments would be the MOST useful in determining the possible cause of a patient's altered mental status? Select one: A. Respiratory rate B. Blood glucose level C. Capillary refill time D. Blood pressure Feedback
Blood glucose level
Which of the following abnormal breath sounds indicates obstruction of the upper airway? Select one: A. Rales B. Rhonchi C. Stridor D. Crackles
Stridor
Which of the following findings indicates that your patient has a patent airway? Select one: A. Unresponsiveness B. Audible breathing C. Inspiratory stridor D. Ability to speak
ability to speak
What part of the patient assessment process focuses on obtaining additional information about the patient's chief complaint and any medical problems he or she may have? Select one: A. General impression B. History taking C. Primary assessment D. Secondary assessment
History taking
What maneuver should be used to open the airway of an unresponsive patient with suspected trauma? Select one: A. Head tilt-neck lift maneuver B. Tongue-jaw lift maneuver C. Jaw-thrust maneuver D. Head tilt-chin lift maneuver
Jaw-thrust maneuver
Which of the following MOST accurately describes paradoxical movement of the chest wall? Select one: A. A marked decrease in chest wall movement due to abdominal breathing B. Multiple rib fractures that cause a marked deformity of the chest wall C. One side of the chest wall moves opposite the direction of the other D. Only one section of the chest rises on inspiration, while another area falls
Only one section of the chest rises on inspiration, while another area falls
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? Select one: A. Eyes remain closed, makes incomprehensible sounds, exhibits abnormal extension B. Opens eyes in response to pain, uses inappropriate words, withdraws from pain C. Opens eyes spontaneously, is confused when spoken to, exhibits abnormal flexion D. Opens eyes in response to voice, makes incomprehensible sounds, localizes pain
Opens eyes in response to pain, uses inappropriate words, withdraws from pain
When performing a rapid exam on a supine patient, what part of the body is typically assessed last? Select one: A. Anterior chest B. Abdomen C. Posterior D. Extremities
Posterior
Which of the following would the EMT likely NOT perform on a responsive patient with a headache and no apparent life-threatening conditions? Select one: A. Focused secondary assessment B. Noninvasive blood pressure monitoring C. Assessment of oxygen saturation D. Systematic head-to-toe examination
Systematic head-to-toe examination
Which of the following statements regarding the mechanism of injury (MOI) is correct? Select one: A. A nonsignificant MOI rules out the possibility of serious trauma. B. The exact location of a patient's injuries can be determined by the MOI. C. A significant MOI usually results in patient death or permanent disability. D. The MOI may allow you to predict the severity of a patient's injuries.
The MOI may allow you to predict the severity of a patient's injuries.
Which of the following occurs when a patient's respirations are shallow? Select one: A. Tidal volume is markedly reduced. B. Chest rise will be easily noticeable. C. Carbon dioxide elimination is increased. D. Oxygenation occurs more efficiently.
Tidal volume is markedly reduced.
A 71-year-old female slipped on a rug and fell. She is conscious but confused and complains of severe pelvic pain. Her respirations are 22 breaths/min and her heart rate is 120 beats/min. What should you do? Select one: A. Transport her on her left side B. Treat her for possible shock C. Transport her in a seated position D. Gently palpate her pelvis
Treat her for possible shock (?)
An elderly patient has fallen and hit her head. You assess her level of consciousness as unresponsive using the AVPU scale. Your initial care should focus on: Select one: A. airway, breathing, and circulation. B. gathering medical history data. C. obtaining baseline vital signs. D. providing immediate transport.
airway, breathing, and circulation
When using the pulse oximeter as part of your assessment of a patient, it is important to remember that: Select one: A. any situation that causes vasoconstriction or loss of red blood cells, such as anemia or bleeding, may result in an inaccurate or misleading value. B. as long as the patient's oxygen saturation is greater than 95%, oxygen is usually not necessary, even if the patient is experiencing respiratory distress. C. carbon monoxide has no effect on pulse oximetry readings because the pulse oximeter presumes that oxygen is saturating the hemoglobin. D. pulse oximetry is especially useful in patients who have cold extremities because vasoconstriction forces blood to the capillary beds.
any situation that causes vasoconstriction or loss of red blood cells, such as anemia or bleeding, may result in an inaccurate or misleading value.
External bleeding from an extremity can usually be controlled initially by: Select one: A. applying chemical ice packs. B. elevating the extremity. C. applying direct pressure. D. applying a tourniquet
applying direct pressure.
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: Select one: A. immediately transport the child to the hospital. B. begin chest compressions and request backup. C. assess for a brachial pulse for 5 to 10 seconds. D. open the airway and give two rescue breaths.
assess for a brachial pulse for 5 to 10 seconds.
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: Select one: A. assess his blood pressure. B. apply a pulse oximeter. C. assist his ventilations. D. request a paramedic unit.
assist his ventilations
When you shine a light into one pupil, the normal reaction of the other pupil should be to: Select one: A. dilate. B. not react. C. become smaller. D. become larger.
become smaller
When auscultating the blood pressure in a patient's upper extremity, you should place the diaphragm (head) of the stethoscope over the _________ artery. Select one: A. femoral B. apical C. brachial D. radial
brachial
When you inspect a patient's pupils with a penlight, the pupils should normally react to the light by: Select one: A. fluttering. B. enlarging. C. constricting. D. dilating.
constricting
When assessing the skin of an unresponsive patient, you note that it has a bluish tint to it. This finding is called: Select one: A. mottling. B. pallor. C. cyanosis. D. flushing.
cyanosis
A patient's short-term memory is MOST likely intact if they correctly answer questions regarding: Select one: A. event and person. B. person and place. C. time and place. D. day and event.
day and event
Cyanosis of the skin is caused by: Select one: A. venous vasoconstriction. B. decreased blood oxygen. C. peripheral vasodilation. D. increased blood oxygen.
decreased blood oxygen.
When evaluating a patient with multiple complaints, the EMT's responsibility is to: Select one: A. assess each complaint based on the patient's perception of its seriousness. B. definitively rule out serious causes of each of the patient's complaints. C. determine which complaint poses the greatest threat to the patient's life. D. direct his or her attention to the most obvious signs and symptoms.
determine which complaint poses the greatest threat to the patient's life.
A patient with profuse sweating is referred to as being: Select one: A. diaphoretic. B. edematous. C. flushed. D. plethoric.
diaphoretic
The goal of the primary assessment is to: Select one: A. identify patients that require transport to a trauma center. B. identify and rapidly treat all life-threatening conditions. C. determine if the patient's problem is medical or traumatic. D. determine the need to perform a head-to-toe assessment.
identify and rapidly treat all life-threatening conditions.
After performing a primary assessment, a rapid exam of the body should be performed to: Select one: A. identify less-obvious injuries that require immediate treatment. B. find and treat injuries or conditions that do not pose a threat to life. C. look specifically for signs and symptoms of inadequate perfusion. D. determine the need for spinal motion restriction precautions.
identify less-obvious injuries that require immediate treatment.
You respond to a call for a female pedestrian who has been struck by a car. As your partner maintains manual stabilization of her head, you perform a primary assessment. She is unconscious, has ineffective breathing, and has bloody secretions in her mouth. You should: Select one: A. assist her breathing with a bag-valve mask. B. immediately suction her oropharynx. C. quickly insert an oropharyngeal airway. D. assess the rate and quality of her pulse
immediately suction her oropharynx.
Upon arriving at the scene of a patient with difficulty breathing, you determine that the scene is safe. You enter the residence and find the patient sitting in a chair in respiratory distress. Your first action should be to: Select one: A. assess the patient's airway status. B. introduce yourself to the patient. C. obtain a set of baseline vital signs. D. ask the patient what's wrong.
introduce yourself to the patient.
A decrease in blood pressure may indicate: Select one: A. loss of vascular tone. B. forceful cardiac contraction. C. increased blood volume. D. arterial constriction.
loss of vascular tone.
The diastolic blood pressure represents the: Select one: A. minimum amount of pressure that is always present in the arteries. B. average pressure against the arterial walls during a cardiac cycle. C. difference in pressure between ventricular contraction and relaxation. D. increased arterial pressure that occurs during ventricular contraction
minimum amount of pressure that is always present in the arteries.
With regard to the assessment of a patient's cardiovascular status, capillary refill time is MOST reliable in: Select one: A. patients who are significantly hypotensive. B. patients who are older than 70 years of age. C. patients who are younger than 6 years of age. D. patients who were exposed to cold temperatures.
patients who are younger than 6 years of age
The systematic head-to-toe assessment should be performed on: Select one: A. all patients with traumatic injuries who will require EMS transport. B. stable patients who are able to tell you exactly what happened. C. patients with a significant MOI and unresponsive medical patients. D. responsive medical patients and patients without a significant MOI.
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: Select one: A. establish the patient's medical history early. B. take note of the patient's general appearance. C. perform a careful and thorough assessment. D. ask if bystanders are familiar with the patient.
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: Select one: A. fully immobilize her spine, load her into the ambulance, and assess her vital signs. B. perform a detailed head-to-toe exam and prepare for immediate transport. C. assess her vital signs, secure her to a backboard, and transport her immediately. D. identify the specific areas.
perform a detailed head-to-toe exam and prepare for immediate transport.
During your assessment of a 6-month-old male with vomiting and diarrhea, you note that his capillary refill time is approximately 4 seconds. From this information, you should conclude that the infant's: Select one: A. skin temperature is abnormally cold. B. respiratory status is adequate. C. systolic blood pressure is normal. D. peripheral circulation is decreased.
peripheral circulation is decreased.
Normal skin color, temperature, and condition should be: Select one: A. pink, warm, and dry. B. flushed, cool, and dry. C. pale, cool, and moist. D. pink, warm, and moist.
pink, warm, and dry
A 50-year-old male presents with altered mental status. His wife tells you that he had a "small stroke" 3 years ago but has otherwise been in good health. The patient is responsive but unable to follow commands. After administering oxygen if needed, you should: Select one: A. perform a head-to-toe assessment. B. prepare for immediate transport. C. repeat the primary assessment. D. inquire about his family history
prepare for immediate transportation
In responsive patients who are older than 1 year of age, you should palpate the pulse at the ________ artery. Select one: A. radial B. femoral C. carotid D. brachial
radial
Pain that moves from its point of origin to another body location is said to be: Select one: A. provoking. B. referred. C. radiating. D. palliating.
radiating
If a patient develops difficulty breathing after your primary assessment, you should immediately: Select one: A. reevaluate his or her airway status. B. auscultate his or her breath sounds. C. determine his or her respiratory rate. D. begin assisting his or her breathing.
reevaluate his or her airway status.
A pulse with a consistent pattern is considered to be: Select one: A. strong. B. regular. C. weak. D. irregular.
regular
A patient who moves and cries out only when you pinch his or her trapezius muscle is said to be: Select one: A. responsive to painful stimuli. B. conscious and alert. C. completely unresponsive. D. responsive to verbal stimuli.
responsive to painful stimuli
The pulse oximeter is an assessment tool used to evaluate the: Select one: A. amount of exhaled carbon dioxide. B. level of carbon dioxide. C. quantity of red blood cells. D. saturation level of arterial blood.
saturation level of arterial blood.
Clinical signs of labored breathing include all of the following, EXCEPT: Select one: A. supraclavicular retractions. B. shallow chest movement. C. gasping attempts to breathe. D. use of accessory muscles.
shallow chest movements
Jugular venous distention suggests a problem with blood returning to the heart if the patient is: Select one: A. in a supine position. B. in a prone position. C. sitting up at a 45° angle. D. in a recumbent position.
sitting up at a 45° angle.
When assessing a patient's abdomen, you will evaluate for all of the following, EXCEPT: Select one: A. subcutaneous emphysema. B. rigidity and obvious bleeding. C. gross bleeding and tenderness. D. open wounds or eviscerations.
subcutaneous emphysema.
After performing a head tilt-chin lift maneuver to open the airway of an unresponsive patient who has a pulse, you should: Select one: A. place him or her in the recovery position. B. provide positive-pressure ventilatory assistance. C. assess respiratory rate, depth, and regularity. D. suction as needed and insert an airway adjunct.
suction as needed and insert an airway adjunct.
When you use the palpation method to obtain a blood pressure, the measurement you obtain is the: Select one: A. cardiac output pressure. B. pulse pressure. C. systolic blood pressure. D. diastolic blood pressure.
systolic blood pressure
The pressure exerted against the walls of the artery when the left ventricle contracts is called the: Select one: A. pulse pressure. B. systolic pressure. C. apical pulse. D. diastolic pressure.
systolic pressure
You should avoid palpating a patient's pelvis if: Select one: A. the MOI suggests trauma to the pelvis. B. the patient is older than 50 years of age. C. the pelvis does not appear deformed. D. the patient complains of pelvic pain.
the patient complains of pelvic pain.
Reassessment is performed to determine all of the following, EXCEPT: Select one: A. the reason why the patient called EMS. B. the patient's response to your treatment. C. whether or not the patient is deteriorating. D. the nature of any newly identified problems.
the reason why the patient called EMS
When assessing a 62-year-old female with crushing chest pain, you note that her pulse is rapid and irregular. You should administer supplemental oxygen if needed and then: Select one: A. conclude that the irregular pulse is normal based on her age. B. document your findings and perform a detailed assessment. C. transport at once and consider requesting a paramedic unit. D. apply the AED and analyze her cardiac rhythm.
transport at once and consider requesting a paramedic unit.
