Chapter 13 – Patient Assessment

Flashcard maker : Daniel Hardy
An 18-year-old female with a history of diabetes twisted her right ankle while playing volleyball. She is alert and oriented and states that the pain is excruciating. The primary assessment is complete and yields no life-threatening conditions. Which one of the following should you do next?
Assess the right ankle and foot.
Which one of the following assessment findings indicates that the patient has intact motor function in his lower extremities?
He can wiggle his toes when instructed
To stabilize the cervical spine of a trauma patient while simultaneously opening the airway, how should you position her head?
Neutral and in-line
The EMT’s patient is a 45-year-old female with a severe headache. The EMT will perform which one of the following techniques when conducting her secondary assessment?
Assess the head, re-evaluate vital signs, and continue emergency care
Which one of the following findings of dyspnea is most important in determining that the patient is poorly oxygenating?
A pulse oximeter reading of 92%
A 26-year-old male has been ejected from a car after it rolled several times in the median of the interstate. As you perform the primary assessment, you find him supine and unresponsive. Your immediate action is to:
assess his breathing
When assessing breath sounds during the secondary assessment, the EMT shows he is employing a correct technique when he listens
at the left second intercostal space followed by the right second intercostal space.
When performing a secondary assessment on an alert and oriented female with a deformed left leg, the EMT should:
explain to the patient what you are doing before and during assessment
A 69-year-old male called 911 because of the sudden onset of pain and numbness to his left leg. He states that he has a history of blood clots that form in the leg and the pain feels exactly as it did the last time that this occurred. He denies any trauma to the extremity. You perform the primary assessment and find him to be alert and oriented with no life-threatening conditions to the airway, breathing, or circulation. When performing the secondary assessment on this patient, which one of the following is most appropriate?
Physical exam of the leg
When you are caring for a patient with either a medical complaint or traumatic injury, you should typically perform the reassessment
while transporting the patient to the hospital.
You are by the side of a patient who is complaining of shortness of breath and has a history of heart failure. When assessing the airway, which one of the following observations best indicates a patent airway?
She easily tells you that she is having chest pain.
A 28-year-old female has fallen 20 feet from the roof a house. She is lying still and does not appear to be conscious or breathing. On arrival at her side, what should the EMT do first?
Apply manual in-line spinal stabilization
Assessment of a patient’s neck reveals that the trachea is deviated to the left. Based on this assessment finding, the EMT should suspect an injury located to the patient’s:
chest.
A male patient was found in cardiac arrest by co-workers. On arrival you determined him to be in cardiac arrest and you started CPR. The AED was quickly placed and you shocked him once, restoring a heartbeat. During transport, the patient remains unresponsive, but is breathing and has a pulse. When conducting the reassessment phase on this patient, you should do which one of the following?
Recheck vital signs
You cannot locate a radial pulse on a 42-year-old male who is alert, confused, and breathing adequately. Which one of the following should you do immediately?
Check for the carotid pulse.
The \”S\” in SAMPLE stands for:
Sign
Which one of the following patients should the EMT identify as having the best breathing?
34-year-old male who is alert and oriented with good chest rise and fall
A conscious and alert 44-year-old female complains of chest pain and slight shortness of breath. She appears to have no difficulty speaking and states that the pain suddenly started about two hours ago. There is a history of blood clots in the lungs in her family, and she is scared and would like to be evaluated. Which one of the following should you do first?
Place high-flow oxygen via nonrebreather on the patient
You are assessing an eight-month-old whose mother states has been vomiting for two days and not eating or drinking. When assessing the pulse, you should check which site?
Brachial
While you are performing a secondary assessment, your trauma patient complains of the sudden onset of difficulty breathing. Which of the following is your most appropriate response?
Stop your exam and provide appropriate care.
A responsive patient is complaining of a migraine headache, of which she has a known medical history. Which one of the following would be most appropriate when conducting her secondary exam?
Assess her visual acuity
You are transporting an 18-year-old male who has been injured in a motor-vehicle collision. He has a decreased level of consciousness and has suffered injuries to his head, chest, and lower right leg. When you are conducting the reassessment of the patient’s head and neck, which one of the following is appropriate?
Taking time to carefully re-palpate the face and scalp
A five-year-old boy has been vomiting profusely for two days. Your assessment indicates that his airway is open, respirations adequate, and radial pulse fast and weak. His skin is cool and capillary refill time is five seconds. The EMT should understand that the patient is:
poorly perfused
Which one of the following patients is considered the lowest priority for a rapid secondary exam and immediate transport?
72-year-old man complaining of leg pain for a week
An alert and oriented 69-year-old female is complaining of low, right-sided abdominal pain. She describes the pain as \”knife-like\” and states that it started suddenly one hour ago. Her only medical history is hypertension for which she takes the medication enalapril. Which one of the following assessment findings shows that the EMT is appropriately assessing this patient?
No abdominal guarding is noted
The patient’s family states that their 16-year-old daughter has a history of asthma and has been complaining of shortness of breath for the past two days. She has been taking her metered-dose inhaler with some relief, but today they found her lethargic and struggling to breathe in bed. Your assessment reveals her to be responsive to verbal stimuli with an open airway and respirations of 36 per minute. You hear minimal bilateral wheezing. Your immediate action in caring for this patient is to:
provide positive pressure ventilation.
You arrive at the scene of a fall, where a 42-year-old woman fell backward off a step ladder while cleaning windows in her kitchen. She is lying on the floor complaining of pain to her ankle. She tells you, \”If I had just gone to work today instead of using vacation time, this never would have happened!\” Based on information thus far, which one of the following can you conclude?
She is alert with an open airway
You are by the side of a 64-year-old male patient who collapsed at home. After assessing the level of consciousness, airway, and breathing, you determine that he is unresponsive with an open airway, but not breathing. What instruction should you immediately give your partner?
\”Let’s place an oral airway and start ventilations.\”
The EMT recognizes that the best source of information for a responsive medical patient with a specific chief complaint and no known medical history is obtained from the:
patient
A 62-year-old female patient who has been working in her garden has hot, dry skin. You should recognize this as a possible sign of:
heat exposure
Which one of the following statements made by an EMT shows he correctly understands capillary refill?
\”For a capillary refill test to be normal for a child, it must be assessed at room temperature and be less than two seconds.\”
You have been called for a six-month-old male who has had a fever and just seized. Currently, he is not seizing and appears to be sleeping. When performing the primary assessment on this patient, which one of the following is appropriate?
Check for the presence of a pulse in the brachial artery.
When assessing the chest of a patient who was shot multiple times, you find a gunshot wound to the third intercostal space on the left lateral chest. Which one of the following should you do immediately?
Cover the opening with a gloved hand.
During the primary assessment, how should you best determine the adequacy of a patient’s breathing?
Examine the rise and fall of the chest
When assessing for the adequacy of breathing in an unresponsive adult, the EMT should:
observe the chest rise
A patient has called 911 for abdominal pain and generalized weakness. On arrival you note that the patient’s skin is a yellow-orange color. Which one of the following diseases revealed to you during the history would best correlate to this patient’s skin?
Liver disease
At a continuing education seminar being taught by your medical director, he asks the group for one reason why the secondary assessment is beneficial to perform on the trauma patient. Which response is most appropriate?
\”It is useful in finding additional injuries and guiding additional care.\”
A 36-year-old patient who has overdosed on an unknown drug presents with his eyes closed, even when his name is loudly called. Which one of the following should the EMT do first?
Perform a noxious stimuli
When performing the primary assessment of a 45-year-old patient, which one of the following skin findings should concern the EMT?
Cool and moist skin
On which one of the following patients should the EMT perform a rapid head-to-toe secondary assessment, as opposed to a focused secondary assessment?
24-year-old male with stable vitals who is alert and oriented and is complaining of chest pain secondary to a motor-vehicle collision in which the passenger was killed
Which one of the following patients should be classified as unresponsive?
46-year-old-male who does not respond when his fingers are pinched
You have been dispatched to an apartment for an elderly male complaining of shortness of breath. When should you start the process of forming a general impression about this patient?
As you and your partner approach him
Your patient is an 82-year-old and diabetic. Which one of the following assessment parameters is the least reliable sign indicating circulatory status?
Capillary refill
A 20-year-old female patient is found unresponsive. The first step of the secondary assessment for her is to:
conduct a rapid medical assessment
While treating a patient who was assaulted by a mob of angry people in a bar, the EMT finds the patient to be confused, tachycardic, with cool skin and a poor capillary refill. Into which physiologic category should the EMT place this patient?
Unstable
A 62-year-old female was struck by a car traveling approximately 45 miles per hour. After being struck, she was thrown 15 feet onto the sidewalk, impacting the pavement with her head and chest. The primary assessment has been completed and life threats addressed. The patient’s husband is by her side. When performing the secondary exam on this patient, which one of the following should the EMT perform first?
Assess the patient from head to toe for additional injuries
When teaching a group of Emergency Medical Responders about the mechanism of injury, which one of the following points should you stress?
The more significant the mechanism of injury, the greater the chance the patient has been injured.
A 31-year-old male is complaining of left-side flank pain that radiates into his groin. He is alert and oriented and the primary assessment reveals no life-threatening conditions. A nonrebreather face mask delivering 15 liters per minute of oxygen has been applied. Given the patient’s status, your next step should be to:
obtain a medical history from the patient.
You have completed the primary assessment on a patient who was thrown from a motorcycle, impacting his head and back on the nearby sidewalk. Finding no life threats during the primary assessment, what action should you take first when starting a secondary assessment?
Re-evaluate the mechanism of injury
The EMT recognizes that for a trauma patient who is alert and oriented, he should obtain the history during what component of patient assessment?
Secondary assessment
You arrive on the scene of a motor-vehicle collision and are presented with a patient complaining of chest pain after striking his chest on the steering wheel. On scene Emergency Medical Responders are maintaining cervical immobilization manually. He is alert and oriented and has a patent airway. His respirations are 24 with good chest rise and fall, and his skin is warm and dry. Immediately after completing the primary assessment, you should:
provide oxygen via nonrebreather mask
When assessing a critically injured patient, the EMT should detect which one of the following injuries or conditions when performing the secondary assessment?
Bruising and tenderness to the abdomen
At a nursing home, you find a patient extremely short of breath. To best determine if the patient is cyanotic, you should:
examine the lining of the lips and mouth.
Trends in a patient’s condition are best noted during what phase of patient assessment?
Reassessment
The EMT determines the medications a patient takes during which phase of the patient assessment?
History
A 43-year-old male has called 911 with the complaint of difficulty breathing. On scene you note he is breathing at a rate of 18 breaths per minute. He also exhibits intercostal retractions and nasal flaring. The EMT should document this patient’s breathing as:
dyspneic.
When you are caring for a patient with either a medical complaint or traumatic injury, you should typically perform the reassessment:
while transporting the patient to the hospital.
You must check the circulation of an eight-year-old child who has a high fever and has been vomiting for the past two hours. The child is very frightened and crying. Given the situation, you should:
palpate the radial artery
You have been summoned to a retail store where you are directed to a middle-aged woman who was found in the bathroom on the toilet. Your assessment shows her to be responsive to painful stimuli with an open airway and labored breathing. Her pulse is fast and regular and her skin is warm to the touch. The primary assessment has been completed and the appropriate care given. As the stretcher is prepared, you perform the secondary assessment. When assessing her chest, you note the presence of crackles to both lungs. What should you do next?
Assess the abdomen
As you perform the primary assessment on an unresponsive patient, you discover vomitus in her airway. Which one of the following should you do next?
Suction the airway
You are performing a secondary assessment on the unrestrained adult passenger of a motor vehicle that rolled several times at a high rate of speed. The patient is responsive to painful stimuli and in a state of hypoperfusion. When assessing the head, which one of the following is appropriate?
Checking the pupils with a pen light
Which one of the following capillary refill times is considered normal for a five-year-old child?
2 seconds
You have determined that your patient is unresponsive. Which one of the following should you do next?
Open the airway
The EMT recognizes that the best source of information for a responsive medical patient with a specific chief complaint and no known medical history is obtained from the
patient
The EMT should recognize which one of the following patients as breathing at a normal rate?
8-year-old male breathing 26 times per minute
Which one of the following capillary refill times is considered the upper limit of normal for an adult female?
3 seconds
When assessing a trauma patient’s circulation status during the primary assessment, the EMT’s assessment should include:
radial pulse, skin temperature, and presence of external bleeding
An EMT is assessing a nine-month-old infant who is \”not acting right\” per his mother. Assessment reveals him to be extremely irritable, crying weakly, and shows he does not want to be touched by the EMT. Which one of the following best describes this infant’s mental status?
Alert
You have been called for an adult patient who suffered a seizure. He is sitting on the floor, and he looks at you as you enter the room. When questioned, he cannot remember the date or where he is. The patient’s mental status can best be described as:
alert but confused
When assessing a stable patient with a medical complaint, which piece of information will be obtained first and will help to guide the type of exam after the primary assessment has been completed?
Level of consciousness
When you assess the lower back of an elderly patient who fell, he grimaces and tells you that it hurts when you palpate the injury site. You should recognize which one of the following conditions?
Tenderness
While treating a patient who was assaulted by a mob of angry people in a bar, the EMT finds the patient to be confused, tachycardic, with cool skin and a poor capillary refill. Into which physiologic category should the EMT place this patient?
Unstable
Which one of the following about breathing rates must the EMT remember when assessing the respirations of a pediatric patient?
It is usually faster than that of an adult
A 20-year-old female patient is found unresponsive. The first step of the secondary assessment for her is to:
conduct a rapid medical assessment
While completing the secondary assessment of a diabetic patient who just had a seizure and is currently unresponsive, the patient starts to experience another seizure. The EMT should:
return to the airway and ensure its patency during the seizure
You have determined that your patient is unresponsive. Which one of the following should you do next?
Open the airway
When assessing the chest of a patient who was shot multiple times, you find a gunshot wound to the third intercostal space on the left lateral chest. Which one of the following should you do immediately?
Cover the opening with a gloved hand
You have been called to the side of a 37-year-old female whose chief complaint is confusion, anxiety, and chest tightness. Assessment shows her airway to be patent, respirations are rapid at 46 per minute, her heart rate is 134, her blood pressure is 128/54 mmHg, and her SpO2 at 93%. In regards to the respiratory rate, you should recognize which one of the following as true?
It does not allow the lungs enough time to adequately fill
An alert and oriented 69-year-old female is complaining of low, right-sided abdominal pain. She describes the pain as \”knife-like\” and states that it started suddenly one hour ago. Her only medical history is hypertension for which she takes the medication enalapril. Which one of the following assessment findings shows that the EMT is appropriately assessing this patient?
No abdominal guarding is noted
A 41-year-old male patient has fallen from a second-story roof. He is complaining of right leg pain and pain to his pelvic region. When performing the secondary assessment on this patient, which one of the following should the EMT intentionally not perform?
Palpation of the pelvic region
Which one of the following patients should be classified as unresponsive?
46-year-old-male who does not respond when his fingers are pinched
The EMT recognizes that for a trauma patient who is alert and oriented, he should obtain the history during what component of patient assessment?
Secondary assessment
When performing the secondary assessment, the EMT should find which one of the following injuries first?
Bruising to the abdomen
Which of the following physical findings is least consistent with an injured extremity?
Vomiting
Forming a general impression is essential in the assessment of any patient because it:
helps to determine the clinical status of a patient
Which one of the following findings of dyspnea is most important in determining that the patient is poorly oxygenating?
A pulse oximeter reading of 92%
During your primary assessment, you find your patient’s skin to be warm, pink, and dry. This should seemingly indicate:
normal circulation
You have been called for an 83-year-old female who is having difficulty breathing. She informs you that she has congestive heart failure and feels as though she is filling up with fluid. The primary assessment shows her to be alert and oriented with inadequate breathing. Her pulse is rapid and weak, and her skin is cool and dry. When performing a secondary assessment, which one of the following signs related to heart failure would you specifically look for when examining the patient’s neck?
jugular vein distention
You are interviewing a prospective candidate for the position of EMT with your service. During the interview, you ask the applicant to describe the purpose of the primary assessment. Which statement best describes that purpose?
Identify and treat life-threatening conditions.\”
On scene you find a 91-year-old female who fell down two steps after suddenly complaining of a severe headache. She is unresponsive with gurgling respirations. What instruction should you immediately give your partner?
\”Get the suction out and clear out her airway.\”
When assessing breath sounds during the secondary assessment, the EMT shows he is employing a correct technique when he listens:
at the left second intercostal space followed by the right second intercostal space.
Which one of the following patients should receive high-flow oxygen through a nonrebreather face mask?
42-year-old female who is weak and dizzy and adequately breathing 14 times per minute
As you assess a 64-year-old unresponsive female with shortness of breath, you hear snoring respirations. Your immediate action when you reach her side is to:
perform a manual jaw-thrust maneuver.
You are instructing an Emergency Medical Responder course. One of the students asks you how the head tilt-chin lift airway maneuver works to open the airway. Your response is:
\”It opens the airway by lifting the tongue from the back of the throat.\”
You are transporting a 31-year-old male who was severely injured in a motor-vehicle collision. He is unresponsive and being ventilated by your partner with a bag-valve mask. How will you conduct the rapid secondary assessment on this patient?
Perform a head-to-toe exam.
The EMT shows she understands the importance and reason for forming a general impression of the patient when she makes which one of the following statements?
\”Forming a general impression provides me with a rough idea of the patient’s overall status.\”

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