Chapter 13 Patient Assessment

Question 1

Your entire assessment of a patient should: A) appear to be a seamless process. B) yield a definitive field diagnosis. C) only focus on his or her complaint. D) not deviate at all from a strict format.

Answer 1

A

Question 2

Gathering a patient’s medical history and performing a secondary assessment should occur: A) immediately after you form your visual general impression of the patient. B) shortly after making patient contact and determining his or her complaint. C) after initial treatment has been rendered and you are en route to the hospital. D) after life threats have been identified and corrected in the primary assessment.

Answer 2

D

Question 3

3. A key part of making your practice of prehospital care successful is for you to: A) let the patient guide the questions that you ask in order to build a cohesive rapport on which you can build. B) develop and cultivate your own style of assessment and an overall strategy for evaluating and providing care. C) approach every patient in the same fashion with the realization that patient assessment in the field is a static process. D) strictly adhere to your department’s standard operating procedures so that they become a rote series of actions.

Answer 3

B

Question 4

In prehospital care, the priorities of evaluation and treatment are based on: A) the degree of threat to the patient’s life. B) your overall experience as a paramedic. C) the receiving physician’s online orders. D) standard treatment guidelines and algorithms.

Answer 4

A

Question 5

Which of the following is NOT a part of your overall job as a paramedic? A) Efficiently executing a patient care plan B) Quickly identifying your patient’s problem C) Definitively diagnosing the patient’s problem D) Establishing your priorities of patient care

Answer 5

C

Question 6

When determining whether a patient is sick, your MOST effective tool is often: A) a quick visual assessment. B) the patient’s chief complaint. C) past medical history findings. D) the patient’s baseline vital signs.

Answer 6

A

Question 7

You are in the BEST position to decide what, if any, care needs to be provided at the scene versus en route to the hospital once you: A) can qualify that a patient is indeed sick. B) determine how far away the hospital is. C) perform a detailed secondary assessment. D) are able to quantify how sick a patient is.

Answer 7

D

Question 8

You will MOST likely develop your field impression of a patient based on the: A) medications the patient is taking. B) chief complaint and patient history. C) results of your secondary assessment. D) patient’s perception of his or her problem.

Answer 8

B

Question 9

When assessing any patient, the paramedic should remember that: A) the past medical history is of even greater importance if the patient has a traumatic injury. B) it is extremely common for patients with a medical complaint to have an underlying injury. C) some patients with a traumatic injury could also have an underlying medical component. D) the patient’s underlying medical problem can usually be identified by a rapid assessment.

Answer 9

C

Question 10

Which of the following statements regarding the patient assessment process is correct? A) The assessment process must be organized and systematic, yet flexible enough to allow you to maximize the amount of information you can gather. B) It is critical that you think of patient assessment as a static sequence of events that are carried out on every patient that you encounter. C) Expanding your questioning of a patient in order to elicit more information often confuses the patient and should be avoided if possible. D) As the patient interview unfolds, you must remain focused on the patient’s chief complaint, as it is likely his or her most serious problem.

Answer 10

A

Question 11

On most runs, the two MOST important pieces of patient history information that you need to obtain initially are the: A) patient’s name and chief complaint. B) chief complaint and patient’s address. C) patient’s name and family physician. D) chief complaint and the patient’s sex.

Answer 11

A

Question 12

After determining that the scene is safe, the FIRST step in approaching a patient is to: A) determine the chief complaint. B) ask the patient his or her name. C) ascertain the age of the patient. D) introduce yourself to the patient.

Answer 12

D

Question 13

Asking the patient about the date, time, location, and events surrounding the current situation will enable you to: A) rapidly formulate a working diagnosis and prepare a care plan. B) determine if the patient is alert to person, place, time, and event. C) quickly rule out a life-threatening cause of the patient’s problem. D) determine if the patient’s problem is medical or trauma in nature.

Answer 13

B

Question 14

When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine: A) if the two complaints are related. B) when each of the complaints began. C) which complaint has a higher priority. D) the patient’s past medical history.

Answer 14

C

Question 15

The history of present illness is defined as: A) the reason why the patient called EMS in the first place. B) a chronologic account of the patient’s signs and symptoms. C) your perception of the severity of the patient’s condition. D) a past medical problem that is causing the chief complaint.

Answer 15

B

Question 16

Which of the following questions would be of LEAST pertinence when trying to determine a patient’s current health status? A) “Are your mother and father still living?” B) “Are your immunizations up to date?” C) “Are you currently taking any prescription medicines?” D) “Do you have a history of any specific diseases in your family?”

Answer 16

A

Question 17

More often than not, the paramedic will form his or her general impression of a patient based on: A) baseline vital signs and SAMPLE history. B) a rapid, systematic head-to-toe assessment. C) conditions found in the primary assessment. D) the initial presentation and chief complaint.

Answer 17

D

Question 18

Your patient will MOST likely develop a good first impression of you if you: A) look and act professional and confident. B) tell him or her that everything will be okay. C) address him or her as “dear” or “honey.” D) quickly determine his or her chief complaint.

Answer 18

A

Question 19

Working to ensure a patient’s privacy, confidentiality, and comfort level will: A) make the patient feel comfortable in disclosing personal information to you. B) leave no doubt in the patient’s mind that you are truly a professional caregiver. C) establish positive patient rapport and encourage honest, open communication. D) help you gain the trust of the patient’s family more than the trust of the patient.

Answer 19

C

Question 20

The paramedic should address a patient: A) by using the patient’s formal name. B) as the patient wishes to be addressed. C) by the patient’s first name whenever possible. D) in a manner that the paramedic deems most professional.

Answer 20

B

Question 21

Using casual nicknames can be especially problematic when: A) the patient is a male who was involved in an assault. B) assessing geriatric patients who fear losing their independence. C) the patient is critically ill or injured and is semiconscious. D) cultural differences exist between the patient and the paramedic.

Answer 21

D

Question 22

EMS providers who read off a list of questions to the patient to fill in all the blanks on the run report: A) usually provide the most competent patient care. B) tend to make little or no eye contact with the patient. C) are in the best position to establish good patient rapport. D) are reassuring the patient that he or she is not being ignored.

Answer 22

B

Question 23

When transferring a geriatric patient from a hospital to an extended care facility, it is MOST important to: A) review the patient’s transfer paperwork. B) document at least two full sets of vital signs. C) call a radio report to the extended care facility. D) presume that the patient will not wish to speak.

Answer 23

A

Question 24

Paying attention, making eye contact, and repeating key information from the patient’s answers are examples of: A) reflection. B) clarification. C) facilitation. D) interpretation.

Answer 24

C

Question 25

Making your patient aware that you perceive something inconsistent with his or her behavior is called: A) clarification. B) confrontation. C) facilitation. D) interpretation.

Answer 25

B

Question 26

Pausing to consider something significant that you have just been told is called: A) reflection. B) interpretation. C) facilitation. D) clarification.

Answer 26

A

Question 27

A working hypothesis of the nature of a patient’s problem is called the: A) chief complaint. B) field impression. C) history of present illness. D) differential diagnosis.

Answer 27

D

Question 28

An empathetic attitude: A) is often offensive to the patient. B) puts you in your patient’s shoes. C) will put your patient at ease quickly. D) allows you to feel sorry for the patient.

Answer 28

B

Question 29

When asking a patient if he or she uses illegal drugs, you will MOST likely get accurate information if you: A) remain professional and nonjudgmental. B) reassure the patient that you can be trusted and will not tell anyone. C) question the patient in the presence of a trusted family member. D) tell the patient that withholding such information from you is illegal.

Answer 29

A

Question 30

Which of the following questions will yield the LEAST reliable information when assessing a patient with abdominal pain? A) “In your opinion, how severe is the pain?” B) “Are you experiencing any other symptoms?” C) “Does the pain radiate to your chest or back?” D) “Have you ever experienced pain like this before?”

Answer 30

C

Question 31

Before asking a patient about any mental health issues, the paramedic should: A) speak privately with a family member or trusted friend. B) move the patient to the ambulance, where it is more private. C) ask questions relating to his or her physical health. D) perform a comprehensive head-to-toe assessment.

Answer 31

C

Question 32

Which of the following is an example of a leading question? A) “On a scale of 1 to 10, what number would you assign your pain?” B) “Do you think that you are experiencing a cardiac emergency?” C) “Has anything like this ever happened to you before today?” D) “Does the pain stay in your chest or does it move anywhere else?”

Answer 32

B

Question 33

It is appropriate to ask, “Would you say the pain is similar to or worse than with previous episodes?” when determining the _________ of a patient’s pain. A) severity B) quality C) region D) progression

Answer 33

A

Question 34

The mnemonic “OPQRST” is a tool that: A) is only effective when assessing a patient who is experiencing severe pain. B) allows the paramedic to reach a field diagnosis quickly and initiate treatment. C) is used commonly to rule out conditions that are immediately life threatening. D) offers an easy-to-remember approach to analyzing a patient’s chief complaint.

Answer 34

D

Question 35

It would MOST likely be necessary to ask a patient a direct question if: A) he or she is elderly and has more than one medical complaint. B) he or she is not giving you usable facts about himself or herself. C) he or she is having chest pain and a heart attack must be ruled out. D) there are numerous family members and friends present at the scene.

Answer 35

B

Question 36

Your patient says, “I can’t catch my breath.” In response, you state, “That’s very helpful. Let me think about that for a moment.” This dialogue is an example of: A) reflection. B) clarification. C) facilitation. D) interpretation.

Answer 36

A

Question 37

When assessing a patient who is under the influence of alcohol, it is MOST important to remember that: A) the amount of alcohol consumed is often overstated. B) the patient often gives a reliable and accurate history. C) alcohol can mask any number of signs and symptoms. D) suspicions of alcohol intoxication must be documented.

Answer 37

C

Question 38

If you suspect that a patient has been abused, it is MOST important that you: A) request law enforcement personnel if necessary. B) discreetly ask the patient if he or she was abused. C) contact medical control to make him or her aware. D) ask a family member about the possibility of abuse.

Answer 38

A

Question 39

Which of the following findings is LEAST indicative of abuse or domestic violence? A) Multiple injuries that are in various stages of healing B) A patient who refuses to allow a family member to speak for him or her C) Injuries that are inconsistent with the history that you are given D) A husband who towers over his wife and answers your questions for her

Answer 39

B

Question 40

When asking questions pertaining to a patient’s sexual history, it is important to remember that: A) you should inquire about the patient’s HIV status. B) obtaining the history in a private setting is essential. C) a physical examination should be performed as well. D) the patient’s sexual preference is especially relevant.

Answer 40

B

Question 41

If a patient does not respond to a question within a couple of seconds, he or she: A) must be assumed to have an altered mental status until proven otherwise. B) should immediately be asked another question to facilitate gathering data. C) should have the question repeated back to him or her using different terms. D) may be deciding if he or she can trust you enough to answer the question.

Answer 41

D

Question 42

A patient who is overly talkative during your assessment: A) should be interrupted immediately. B) will not give a reliable medical history. C) may have abused methamphetamines. D) is usually an inherently antisocial person.

Answer 42

C

Question 43

When dealing with a patient who has multiple symptoms, the MOST effective way to develop an appropriate care plan is to: A) prioritize the patient’s complaints. B) perform a complete head-to-toe exam. C) address all complaints simultaneously. D) assume that all complaints are linked.

Answer 43

A

Question 44

The paramedic must always keep in mind that the information he or she fails to obtain: A) is usually the result of the patient’s failure to divulge. B) will be obtained by the emergency department physician. C) will usually lead to the provision of substandard treatment. D) may be the information needed to provide appropriate care.

Answer 44

D

Question 45

The MOST negative immediate consequence of providing inappropriate reassurance to your patient in the prehospital setting is: A) a lawsuit lodged against you by the patient or his or her family. B) the patient’s choice not to share as much information with you. C) causing the patient’s family members severe emotional distress. D) emotional distress when the physician tells the patient otherwise.

Answer 45

B

Question 46

If a patient’s family member is hostile and begins shouting at you, you should: A) remain professional and ignore the family member so that you can provide appropriate patient care. B) tell the person that if he or she continues to shout, you will not feel safe and will need to call law enforcement. C) have your partner physically remove the family member from the patient care area and continue your assessment. D) firmly tell the patient that his or her behavior is unacceptable and childish, and that he or she is worsening the situation.

Answer 46

B

Question 47

If a hostile family member suddenly leaves the room, especially in the middle of a conversation with him or her, you should: A) immediately depart the scene and notify law enforcement personnel. B) ignore the family member’s departure and continue to assess your patient. C) have your partner follow the person, while working to defuse the situation. D) ask the patient to follow the person in an attempt to reason with him or her.

Answer 47

C

Question 48

Which of the following statements regarding an intoxicated patient is correct? A) While the patient is trying to explain things to you, his or her anger can escalate faster than if he or she were not intoxicated. B) Although the intoxicated patient is a poor historian, his or her family members usually provide the information that you need. C) You should promptly transport the intoxicated patient, because attempting to obtain a medical history will be unsuccessful. D) The risk of an intoxicated patient’s behavior turning violent is low because his or her cognitive skills are impaired significantly.

Answer 48

A

Question 49

The MOST effective way to obtain a medical history from a patient who is crying is to: A) place your hand on his or her shoulder (if appropriate for the patient) and reassure him or her that you are in control of the situation. B) tactfully advise the patient that you cannot effectively help him or her if he or she continues to cry. C) have one family member calm the patient as you gather the medical history from another family member. D) administer a sedative medication, which will calm the patient and facilitate your gathering of the medical history.

Answer 49

A

Question 50

Situational depression is: A) often characterized by violent bouts of rage. B) ongoing and does not appear to have a cause. C) a condition that usually requires inpatient care. D) a reaction to a stressful event in a patient’s life.

Answer 50

D

Question 51

If your patient becomes seductive or makes sexual advances toward you, you should advise the patient that your relationship with him or her is strictly professional and then: A) continue providing care as usual. B) ensure that a witness is present at all times. C) ask your partner to assume care of the patient. D) threaten the patient with a sexual harassment lawsuit.

Answer 51

B

Question 52

A patient who gives the emergency department physician completely different information than he or she gave to you in the field: A) clearly trusts the physician more than you. B) will cause the physician to question your competence. C) may have an organic condition, such as a brain tumor. D) should be questioned as to why the information was different.

Answer 52

C

Question 53

When caring for a patient who is mentally challenged: A) it is highly unlikely that you will obtain a reliable medical history. B) you may have to obtain the medical history from a family member. C) your priority should be to transport the patient to a psychiatric facility. D) you should speak to the patient as though he or she is younger in age.

Answer 53

B

Question 54

When your patient is a non-English-speaking person, his or her child is often able to function as an interpreter because: A) you can usually teach a child English quickly. B) children quickly absorb a new language in school. C) the child is usually not as scared as his or her parent is. D) most children of non-English-speaking parents speak English.

Answer 54

B

Question 55

Which of the following is NOT an effective way of obtaining a medical history from a patient who is totally deaf? A) Speaking slowly and slightly more loudly to the patient B) Using paper and pencil to write down your questions C) Addressing the patient face-to-face if he or she can read lips D) Using an interpreter who knows American Sign Language

Answer 55

A

Question 56

Objective patient information: A) is observed by the patient. B) is perceived by the patient. C) cannot be quantified. D) is based on fact or observation.

Answer 56

D

Question 57

__________ entails gently striking the surface of the body, typically where it overlies various body cavities. A) Palpation B) Percussion C) Inspection D) Auscultation

Answer 57

B

Question 58

Other than overall patient appearance, the patient’s __________ is/are the MOST objective data for determining his or her status. A) vital signs B) medications C) chief complaint D) medical history

Answer 58

A

Question 59

The residual pressure in the circulatory system while the left ventricle is relaxing is called the: A) pulse pressure. B) diastolic pressure. C) systolic pressure. D) mean arterial pressure.

Answer 59

B

Question 60

Blood pressure is the product of: A) stroke volume and heart rate. B) left ventricular ejection fraction and afterload. C) cardiac output and peripheral vascular resistance. D) right atrial preload and ventricular stroke volume.

Answer 60

C

Question 61

To obtain a heart rate in infants younger than 1 year of age, you should: A) apply a cardiac monitor. B) palpate the brachial artery. C) auscultate directly over the heart. D) count the pulse for a full minute.

Answer 61

B

Question 62

A conscious patient’s respiratory rate should be measured: A) by auscultating the lungs. B) by looking at the abdomen. C) with his or her prior knowledge. D) for a minimum of 30 seconds.

Answer 62

D

Question 63

When using a tympanic device to obtain a patient’s body temperature, you should: A) be aware of extrinsic factors that can skew the reading. B) hold the device in the patient’s ear for 30 to 60 seconds. C) irrigate any wax from the ear with lukewarm water first. D) ensure that the patient is in a laterally recumbent position.

Answer 63

A

Question 64

Which of the following factors would likely NOT skew a pulse oximetry reading? A) Hypertension B) Cold temperature C) Carbon monoxide D) Sickle-cell disease

Answer 64

A

Question 65

An appropriately sized blood pressure cuff should: A) completely encompass the entire upper arm. B) cover at least one third of the patient’s upper arm. C) be one half to two thirds the size of the upper arm. D) cover at least two thirds of the patient’s upper arm.

Answer 65

C

Question 66

Which of the following statements regarding your general survey of the patient is correct? A) Little information can be gained from the patient without a hands-on assessment. B) It is not uncommon for patients in severe pain to present with a quiet and still affect. C) The environment in which the patient is found is more significant than his or her appearance. D) The general patient survey begins as you perform the initial assessment of the patient.

Answer 66

B

Question 67

The skin becomes _________ when red blood cell perfusion to the capillary beds of the skin is poor. A) pale B) flushed C) cyanotic D) mottled

Answer 67

A

Question 68

A patient who does not respond to verbal or tactile stimuli is: A) lethargic. B) semiconscious. C) disoriented. D) unresponsive.

Answer 68

D

Question 69

Flushed skin is commonly seen as a result of all the following, EXCEPT: A) fever. B) heat exposure. C) superficial burns. D) vasoconstriction.

Answer 69

D

Question 70

Poor skin turgor in an infant or child is MOST indicative of: A) shock. B) hypoxemia. C) dehydration. D) elastin deficiency.

Answer 70

C

Question 71

Changes in hair growth or loss of hair are LEAST suggestive of: A) diabetes. B) an infection. C) the aging process. D) radiation therapy.

Answer 71

B

Question 72

The pulse of the superficial temporal artery can be felt: A) just anterior to the ear, in the temporal region. B) inferior to the ear, slightly below the earlobe. C) slightly superior to the ear, in the temporal region. D) posterior to the ear, directly over the mastoid bone.

Answer 72

A

Question 73

Examination of the head is MOST important when assessing a patient who: A) is unresponsive. B) complains of nausea. C) has shortness of breath. D) presents with hemiparesis.

Answer 73

A

Question 74

Bulging of a child’s anterior fontanelle is: A) suggestive of significant dehydration. B) benign if the child is not flailing around. C) suggestive of an intracerebral hemorrhage. D) pathologic when observed in a quiet child.

Answer 74

D

Question 75

A patient who complains of double vision has: A) ptosis. B) anisocoria. C) diplopia. D) hyperopia.

Answer 75

C

Question 76

When assessing visual acuity in the prehospital setting, you should: A) use a Snellen chart. B) examine each eye in isolation. C) check both eyes simultaneously. D) remove any corrective lenses the patient is wearing.

Answer 76

B

Question 77

The diameter of a patient’s pupils and their reactivity to light provide information about the: A) amount of vitreous humor. B) status of cerebral perfusion. C) intactness of the first cranial nerve. D) level of carbon dioxide in the brain.

Answer 77

B

Question 78

Asymmetry of the pupils: A) is a normal finding in up to 40% of the population. B) indicates a significant ocular or neurologic pathology. C) is normal when a light is shone into one of the pupils. D) must be correlated with the patient’s overall presentation.

Answer 78

D

Question 79

When assessing a patient’s conjunctivae, you note they are injected. This means that the conjunctivae are: A) red. B) pale. C) yellow. D) cyanotic.

Answer 79

A

Question 80

An opaque black area against the red reflex of the eye is indicative of: A) retinitis. B) conjunctivitis. C) cataracts. D) macular degeneration.

Answer 80

C

Question 81

Frank blood or clear, watery fluid draining from the ear canal following head trauma is MOST suggestive of a(n): A) basilar skull fracture. B) orbital blowout fracture. C) fracture of the cribriform plate. D) ruptured tympanic membrane.

Answer 81

A

Question 82

Swollen lymph nodes in the anterior neck usually indicate: A) malignancy. B) an infection. C) viral replication. D) an allergic state.

Answer 82

B

Question 83

All of the following are adventitious breath sounds, EXCEPT: A) rales. B) rhonchi. C) wheezes. D) vesicular sounds.

Answer 83

D

Question 84

Percussion of the chest produces ____________ if the pleural space is full of blood. A) a hollow sound B) a dull sound C) a high-pitched note D) hyperresonance

Answer 84

B

Question 85

You would NOT expect to encounter decreased breath sounds in a patient with: A) opiate intoxication. B) cardiac tamponade. C) status asthmaticus. D) pulmonary edema.

Answer 85

B

Question 86

S1, the first heart sound, represents: A) closure of the mitral and tricuspid valves. B) the sound heard at the end of diastole. C) closure of the aortic and pulmonic valves. D) the sound heard at the end of systole.

Answer 86

A

Question 87

The fourth heart sound (S4): A) is normal in 25% of the population. B) occurs immediately before the S2 sound. C) indicates increased pressure in the atria. D) represents increased left ventricular stretching

Answer 87

C

Question 88

When auscultating heart sounds, you should place your stethoscope at the: A) fifth intercostal space, over the apex of the heart. B) second intercostal space, over the base of the heart. C) third or fourth intercostal space, in the midaxillary line. D) sternal border at the second or third intercostal space.

Answer 88

A

Question 89

A bruit indicates _________ blood flow and is MOST significant in the _________ arteries. A) turbulent, femoral B) laminar, carotid C) laminar, brachial D) turbulent, carotid

Answer 89

D

Question 90

To appreciate the S1 sound: A) the patient should be sitting upright and leaning slightly backward. B) ask the patient to breathe normally and hold his or her breath on expiration. C) the patient should be supine with his or her body tilted to the right. D) ask the patient to breathe normally and hold his or her breath on inhalation.

Answer 90

B

Question 91

Arterial pulses are a physical expression of: A) pressure in the vena cavae. B) left ventricular contraction. C) the diastolic blood pressure. D) right ventricular contraction.

Answer 91

B

Question 92

Distention of the jugular veins indicates: A) a state of hypovolemia. B) left-sided heart failure. C) decreased venous pressure. D) increased venous capacitance.

Answer 92

D

Question 93

When examining the anterior abdomen of a patient who complains of abdominal pain: A) auscultate bowel sounds for at least 5 minutes. B) you should first percuss over the four quadrants. C) routinely palpate the least painful area(s) first. D) it is often necessary to administer analgesia first.

Answer 93

C

Question 94

A patient who is absolutely still and resists any movement should be suspected of having: A) peritonitis. B) kidney stones. C) a bowel obstruction. D) intra-abdominal bleeding.

Answer 94

A

Question 95

Which of the following statements regarding ascites is correct? A) Ascites is a collection of fluid within the peritoneal cavity. B) Percussion of the abdomen will often yield hyperresonance. C) The most common cause of ascites is an acute splenic injury. D) The abdomen of a patient with ascites has a sunken appearance.

Answer 95

A

Question 96

What part of the abdominal exam is of LEAST value in the prehospital setting? A) Percussion B) Auscultation C) Inspection D) Palpation

Answer 96

B

Question 97

Abdominal guarding is MOST commonly encountered in patients with: A) acute renal failure. B) peritoneal irritation. C) intra-abdominal bleeding. D) chronic liver inflammation

Answer 97

B

Question 98

Visceral abdominal pain is: A) highly suggestive of a ruptured hollow abdominal organ. B) characterized by a localized area of abdominal tenderness or pain. C) commonly encountered in patients with cholecystitis or pancreatitis. D) often less localized on palpation and is poorly described by the patient

Answer 98

D

Question 99

Assessment of the female genitalia: A) is not performed by the paramedic. B) is only necessary in pregnant patients. C) should be limited to inspection only. D) is a routine part of the physical exam.

Answer 99

C

Question 100

A pathologic fracture occurs when: A) normal forces are applied to abnormal bone structures. B) abnormal forces are applied to abnormal bone structures. C) normal forces are applied to normal bone structures. D) abnormal forces are applied to normal bone structures.

Answer 100

A

Question 101

Clinical signs of an inflamed joint include all of the following, EXCEPT: A) redness. B) swelling. C) deformity. D) increased heat.

Answer 101

C

Question 102

Structural integrity of the pelvis should be assessed by: A) carefully rocking the pelvis back and forth. B) gently pushing in and down on the iliac crests. C) applying firm upward pressure to the pelvic wings. D) placing the patient on his or her side to elicit pain.

Answer 102

B

Question 103

The diagnosis of a problem involving the shoulder can often be made by simply: A) assessing range of motion. B) noting the patient’s posture. C) palpating for gross deformities. D) asking the patient to bend the elbow.

Answer 103

B

Question 104

Lower extremity shortening and/or internal or external rotation are findings often associated with: A) pelvic fractures. B) mid-shaft femur fractures. C) pathologic fractures of the hip. D) proximal lower extremity injury.

Answer 104

D

Question 105

Intermittent claudication is defined as: A) transient swelling of the microvasculature of the extremities. B) bulging of the vessels in the legs while in a standing position. C) enlarged lower extremities due to reduced lymphatic drainage. D) cramplike pain in the lower extremities due to poor circulation.

Answer 105

D

Question 106

In general, +3 pitting edema is characterized by indentation of the skin to a depth of: A) 0 in to ¼ in. B) ¼ in to ½ in. C) ½ in to 1 in. D) greater than 1 in.

Answer 106

C

Question 107

The MOST clinically significant indicator(s) of ischemia in a limb is/are: A) pulselessness. B) poikilothermia. C) parasthesias. D) pain and pallor.

Answer 107

A

Question 108

You would MOST likely encounter bilateral dependent edema in a patient with: A) heart failure. B) arterial occlusion. C) diabetes mellitus. D) deep vein occlusion.

Answer 108

A

Question 109

An inward curve of the lumbar spine just above the buttocks is called: A) scoliosis. B) lordosis. C) kyphosis. D) sclerosis.

Answer 109

B

Question 110

At its worst, kyphosis can become a source of: A) extremity paralysis. B) complete immobility. C) pathologic fractures. D) restrictive lung disease.

Answer 110

D

Question 111

The Babinski sign, grasping, and sucking are: A) voluntary motor responses. B) abnormal findings in infants. C) examples of primitive reflexes. D) signs of nervous system dysfunction.

Answer 111

C

Question 112

If a patient is able to sense smell, his or her __________ nerve is intact. A) abducens B) olfactory C) trigeminal D) trochlear

Answer 112

B

Question 113

The optic nerve is a _______ nerve, and controls _______. A) sensory, light perception and vision B) sensory, hearing and balance perception C) motor, eye movements and pupil dilation D) motor, pupil constriction and eye movement A

Answer 113

A

Question 114

The vestibulocochlear nerve is responsible for the functions of: A) facial and eye movements. B) hearing and balance perception. C) swallowing and gland secretion. D) tongue and neck movements.

Answer 114

B

Question 115

If a patient is able to shrug his or her shoulders and turn his or her head from left to right, the ____________ nerve is likely intact. A) trigeminal B) abducens C) vestibulocochlear D) spinal accessory

Answer 115

D

Question 116

If a patient’s trigeminal nerve is intact, he or she should be able to: A) frown. B) maintain balance. C) clench his or her jaw. D) swallow without difficulty.

Answer 116

C

Question 117

When assessing muscle strength, a score of 5/5 indicates: A) no muscle contraction or twitch. B) minimal movement against resistance. C) normal muscle tone and strength. D) active movement with evident fatigue.

Answer 117

C

Question 118

When scoring a patient’s deep tendon reflexes, normally active reflexes would be assigned a score of: A) 1+. B) 2+. C) 3+. D) 4+.

Answer 118

B

Question 119

The brachioradialis tendon is located: A) proximal to the wrist. B) in the antecubital fossa. C) on the distal humerus. D) directly over the elbow.

Answer 119

A

Question 120

In contrast to dementia, delirium is: A) an acute change in mental status. B) characteristic of Alzheimer’s disease. C) more common in the elderly population. D) a gradual deterioration in cognitive function.

Answer 120

A

Question 121

When assessing a hemodynamically stable child, the toe-to-head approach is generally indicated for children who are: A) younger than 12 months of age. B) younger than 2 years of age. C) 1 to 3 years of age. D) 4 to 5 years of age.

Answer 121

C

Question 122

Proper documentation of your physical examination of a patient is MOST important because it: A) becomes a permanent part of the patient’s medical record and may be subjected to legal issues. B) reflects your subjective findings and forms the basis for your working field diagnosis of the patient. C) facilitates the paramedic’s definitive diagnosis of the patient, leading to the most appropriate care. D) ensures an accurate historical accounting of the patient’s problems prior to entering the hospital.

Answer 122

D

Question 123

Documentation of your physical examination should be: A) subjective in all regards. B) factual and nonjudgmental. C) representative of your perceptions. D) reviewed by the EMS administrator.

Answer 123

B

Question 124

Which of the following hazards would you LEAST likely encounter at the scene of a motor vehicle crash? A) Unruly patient B) Moving traffic C) Broken glass D) Hazardous materials

Answer 124

A

Question 125

Which of the following actions will provide the BEST personal protection when caring for a patient on uneven terrain? A) Wearing a back brace whenever you lift B) Wearing boots that provide good traction C) Using at least four personnel when moving a patient D) Making lifts and moves as controlled as possible

Answer 125

D

Question 126

The general type of illness a patient is experiencing is called the: A) chief complaint. B) nature of illness. C) general impression. D) differential diagnosis.

Answer 126

B

Question 127

Which of the following actions would you likely NOT perform at the scene of a fall before engaging in the care of a conscious patient? A) Gathering dispatch information B) Speaking with immediate family C) Assessing the scene for safety D) Noting the mechanism of injury

Answer 127

B

Question 128

Whether your patient’s problem is medical or traumatic in origin, you must: A) always begin transport within 10 minutes. B) contact medical control as soon as possible. C) qualify and quantify the patient’s condition. D) perform a head-to-toe secondary assessment.

Answer 128

C

Question 129

It is MOST important to identify the age and sex of your patient because: A) age and sex can change how your patient presents. B) the differential diagnosis is modified for older patients. C) this is required information for the patient care report. D) the patient should be assessed by a medic of the same sex.

Answer 129

A

Question 130

After performing your primary assessment of a patient, your next action should be to: A) transport the patient to the closest medical treatment facility. B) move the patient to the ambulance as expeditiously as possible. C) perform a secondary assessment to narrow your differential diagnosis. D) decide what care is needed at the scene versus en route to the hospital.

Answer 130

D

Question 131

When assessing an injured patient’s mental status, the patient knows his name but is unable to recall the events that preceded the injury. From this, you can conclude that: A) the patient’s long-term memory is not intact. B) the patient’s Glasgow Coma Scale score is at least 13. C) the patient’s short-term memory is not intact. D) the patient likely has an intracranial hemorrhage.

Answer 131

C

Question 132

Cognitive function can be MOST accurately defined as: A) one’s state of awareness. B) the ability to use reasoning. C) functional use of the extremities. D) general level of consciousness.

Answer 132

B

Question 133

What is the Glasgow Coma Scale score of a patient who opens her eyes when you call her name, is confused when she speaks, and points to her area of pain? A) 10 B) 11 C) 12 D) 13

Answer 133

C

Question 134

Sonorous respirations are MOST likely caused by: A) an anatomic airway obstruction. B) secretions or blood in the airway. C) swelling of upper airway structures. D) severe inflammation of the epiglottis.

Answer 134

A

Question 135

A responsive patient who is talking or crying: A) has a patent airway. B) is breathing adequately. C) needs supplemental oxygen. D) has no impending airway problem.

Answer 135

A

Question 136

If manual positioning of a patient’s head is required to keep his or her airway open, you should: A) intubate the trachea. B) insert an airway adjunct. C) suction the oropharynx. D) ventilate with a bag-mask device.

Answer 136

B

Question 137

Tidal volume is MOST effectively assessed by: A) auscultating breath sounds. B) noting the patient’s respiratory rate. C) looking for accessory muscle use. D) observing for rise and fall of the chest.

Answer 137

D

Question 138

A patient with a blood pressure of 210/100 mm Hg would be expected to have a pulse that is: A) irregular. B) bounding. C) thready. D) rapid.

Answer 138

B

Question 139

When the blood vessels supplying the skin are fully dilated, the skin becomes: A) cool and pale. B) cold and moist. C) warm and pink. D) blue or mottled.

Answer 139

C

Question 140

An unresponsive patient who has been breathing slowly and shallowly for an extended period of time would MOST likely have ________ skin. A) cyanotic B) flushed C) mottled D) pale

Answer 140

A

Question 141

Stimulation of the sympathetic nervous system causes: A) sweating. B) bradycardia. C) vasodilation. D) warm, moist skin.

Answer 141

A

Question 142

The body’s reaction to increased internal or external temperature would MOST likely cause the skin to become: A) warm and dry. B) hot and dry. C) pale and hot. D) hot and moist.

Answer 142

D

Question 143

A patient in shock due to internal bleeding will benefit MOST from: A) oxygen and thermal management. B) limited scene time and rapid transport. C) a comprehensive physical examination. D) two large-bore IV lines of normal saline.

Answer 143

B

Question 144

Which of the following clinical presentations warrants immediate transport? A) Two days of vomiting; heart rate of 110 beats/min; warm, dry skin B) 38 weeks gestation; crowning; history of hypertension; tachycardia C) 250 mL external blood loss; systolic BP of 130 mm Hg; moderate pain D) Chest discomfort; heart rate of 110 beats/min; systolic BP of 90 mm Hg

Answer 144

D

Question 145

For a responsive patient with a medical problem, you will MOST likely form your working diagnosis based on information gathered during the: A) primary assessment. B) general impression. C) history-taking process. D) detailed physical exam.

Answer 145

C

Question 146

The history of present illness is MOST accurately described as: A) an elaboration of the chief complaint. B) a clinically significant physical finding. C) the patient’s most significant problem. D) the reason why the patient called 9-1-1.

Answer 146

A

Question 147

The focused assessment of a responsive medical patient is guided by: A) the chief complaint. B) SAMPLE history findings. C) baseline vital sign readings. D) the general impression.

Answer 147

A

Question 148

The presence of rhonchi during auscultation of the lungs is MOST suggestive of: A) asthma. B) pneumonia. C) pneumothorax. D) toxic inhalation.

Answer 148

B

Question 149

The presence of rales during auscultation of the chest indicates all of the following conditions, EXCEPT: A) heart failure. B) bronchospasm. C) toxic inhalation. D) pulmonary edema.

Answer 149

B

Question 150

Diffuse pain caused by hollow organ obstruction and stretching of the smooth muscle wall is called __________ pain. A) somatic B) referred C) radiating D) visceral

Answer 150

D

Question 151

What type of pain has its origin in a particular location but is described by the patient as pain in a different location? A) Somatic pain B) Visceral pain C) Referred pain D) Radiating pain

Answer 151

C

Question 152

A patient is generally considered to have orthostatic vital signs when: A) the systolic BP increases and the diastolic BP decreases when going from a lying to a sitting position. B) the heart rate increases by 20 beats/min or more when going from a supine to a standing position. C) the respiratory rate becomes fast and the depth becomes shallow when he or she suddenly stands up. D) he or she experiences chest pain and a rapid, irregular heart rate when going from a seated to a standing position.

Answer 152

B

Question 153

The MOST reliable means of attempting to determine an unresponsive medical patient’s problem is: A) a thorough head-to-toe physical examination. B) cardiac monitoring and blood glucose assessment. C) pulse oximetry, capnography, and serial vital signs. D) information provided by the patient’s family members.

Answer 153

A

Question 154

Serial vital signs: A) are of no value unless they are repeated every 5 minutes. B) provide definitive information about the patient’s problem. C) provide comparative data regarding the patient’s condition. D) establish a baseline to which further vital signs are compared.

Answer 154

C

Question 155

Which of the following mechanisms of injury would be the LEAST likely to cause life-threatening injuries? A) Ejection from an all-terrain vehicle B) Motorcycle crash without a helmet C) Penetrating injury to the chest or abdomen D) Restrained occupant in a vehicle rollover

Answer 155

D

Question 156

Which of the following significant mechanisms of injury is unique to the infant and child? A) Vehicle-pedestrian collision B) Penetrating injury to the head C) Ejection from a car’s back seat D) Fall from greater than 10 ft

Answer 156

D

Question 157

A deformed steering wheel in conjunction with a deployed air bag indicates that the: A) driver wore a lap belt only. B) driver was not wearing a seat belt. C) driver has intrathoracic hemorrhage. D) driver’s legs struck the steering wheel.

Answer 157

B

Question 158

Which of the following statements regarding the rapid exam of a trauma patient is correct? A) The rapid exam is used to identify injuries that must be managed before and during packaging and loading the patient for transport. B) Any trauma patient should receive a rapid head-to-toe exam, even if his or her injury is minor and the mechanism of injury is not significant. C) The rapid exam is the first assessment you will perform on a trauma patient and is designed to find and treat immediate threats to life. D) The rapid exam is a detailed exam that should take between 1 and 2 minutes and should primarily focus on the patient’s chief complaint.

Answer 158

A

Question 159

The rapid exam of a patient is usually performed: A) as soon as your general impression of the patient suggests that he or she is critically injured. B) immediately after determining that the patient has experienced a significant mechanism of injury. C) after all life-threatening conditions have been identified and addressed in the primary assessment. D) following at least one complete set of vital signs, including assessment of the pupils and blood glucose.

Answer 159

C

Question 160

Which of the following is an example of a pertinent negative? A) A family member states that the patient has hypertension. B) A patient tells you that he has developed a plan for suicide. C) A patient with chest discomfort denies shortness of breath. D) An agitated patient tells you that he did not request your help.

Answer 160

C

Question 161

Which of the following is the MOST practical method of assessing for gross neurologic deficits during your assessment of a patient? A) Check deep tendon reflexes with a reflex hammer or similar object. B) Ask the patient if he or she can feel and move his or her fingers and toes. C) Assess capillary refill time at the forehead and the fingernails and toenails. D) Ask the patient to lift both legs and hold them up for 20 to 30 seconds.

Answer 161

B

Question 162

Upon completing your rapid exam of an unresponsive trauma patient’s head and neck, you should next: A) log roll the patient onto a long backboard. B) assess the integrity of the 12 cranial nerves. C) ventilate the patient at 12 to 20 breaths/min. D) apply a properly sized rigid cervical collar.

Answer 162

D

Question 163

What are Korotkoff sounds? A) Abnormal sounds heard over the carotid arteries B) The sounds heard when taking a blood pressure C) Sounds that indicate a significant heart murmur D) Sounds over an artery that indicate turbulent blood flow

Answer 163

B

Question 164

Any time you encounter jugular venous distention in a patient, you should determine: A) where the venous obstruction is that is impeding blood return to the heart. B) what body cavity the patient is bleeding into that is causing lost volume. C) what condition the patient has that is causing decreased venous pressure. D) what is happening to the heart to cause such a large increase in preload.

Answer 164

A

Question 165

When caring for an unresponsive trauma patient, a complete secondary assessment: A) will probably not be performed in its entirety. B) must be performed after the primary assessment. C) should be performed before you begin transport. D) will enable you to immediately detect life threats.

Answer 165

A

Question 166

When assessing the head and face during the full-body exam, you should: A) apply pressure to the eyes to elicit pain. B) remove any dentures if they are present. C) avoid palpating any cranial depressions. D) pack the ears if blood drainage is present.

Answer 166

C

Question 167

When assessing a trauma patient’s chest, you should remember that: A) the presence of hyporesonance to percussion is an indicator of air trapping in the pleural space. B) paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms. C) breath sounds should be assessed routinely in at least two fields prior to visual or tactile assessment. D) a structurally non-intact chest wall should be stabilized by circumferentially wrapping the chest with bandages.

Answer 167

B

Question 168

The soft, breezy, and lower pitched sounds found at the midclavicular line are called: A) tracheal sounds. B) vesicular sounds. C) adventitious sounds. D) bronchovesicular sounds.

Answer 168

D

Question 169

Bruising in the periumbilical area is indicative of: A) a leaking aortic aneurysm. B) intraperitoneal hemorrhage. C) ruptured ectopic pregnancy. D) a ruptured urinary bladder.

Answer 169

B

Question 170

Vascular compromise in a lower extremity is characterized by: A) unilateral pulse deficit and pallor. B) bilaterally diminished pedal pulses. C) warm, flushed skin to the extremity. D) inability to feel or move the extremity.

Answer 170

A

Question 171

A patient with dysarthria has: A) a flat affect. B) painful joints. C) slurred speech. D) severe stuttering

Answer 171

C

Question 172

During a 20-minute transport of a critical patient, you should make a concerted effort to reassess the patient ___ times. A) one B) two C) three D) four

Answer 172

D

Question 173

Which of the following reassessment findings is MOST significant in a patient with penetrating chest trauma? A) Loud heart tones to auscultation B) Blood pressure of 90/76 mm Hg C) Symmetrical chest rise and fall D) Heart rate of 78 beats per minute

Answer 173

B

Question 174

You are about to assess a patient who complains of fever, chills, and coughing up blood. In addition to donning gloves and eye protection, you should: A) place a tight-fitting mask on the patient. B) wear a properly fitted HEPA or N-95 mask. C) immediately notify the health department. D) ask the patient if he or she is HIV-positive.

Answer 174

B

Question 175

At 3:00 a.m. you receive a call for a “man down.” While en route to the scene, you ask the dispatcher to provide additional information, but the dispatcher advises you the caller was abrupt on the phone and then hung up. You should: A) ask the dispatcher if law enforcement is en route to the scene. B) assume the caller was panicked because the patient is critically ill. C) advise the dispatcher to send a second paramedic crew to the scene. D) stage in a safe area until contact with the caller can be reestablished.

Answer 175

A

Question 176

Upon arriving at the scene of a patient with difficulty breathing, you find the patient, a 300-pound man, sitting on the couch in his living room. The patient is conscious and alert and tells you that he is chronically short of breath but feels worse today and wishes to be transported to the hospital. As you begin your assessment, your partner should: A) obtain vital signs. B) contact medical control. C) request lifting assistance. D) prepare a nebulizer treatment.

Answer 176

C

Question 177

You arrive at the scene of a motor vehicle crash in which a small passenger car struck a bridge pillar. The patient, a conscious young woman, is still seated in her car. The scene is safe and law enforcement is directing traffic. Upon initial contact with the patient, you should: A) have your partner manually stabilize her head as you assess her mental status. B) assess her respiratory quality and then apply oxygen via nonrebreathing mask. C) apply a rigid cervical collar and obtain an initial Glasgow Coma Scale score. D) open her airway with the jaw-thrust maneuver and assess respiratory quality.

Answer 177

A

Question 178

A multi-systems trauma patient opens his eyes in response to pain, moans when you ask him his name, and withdraws from painful stimuli. From this information, you should: A) assign him a Glasgow Coma Scale score of 10 and apply oxygen. B) assume that he has an intracerebral hemorrhage. C) hyperventilate him with a bag-mask at 24 breaths/min. D) conclude that he has severe neurologic dysfunction.

Answer 178

D

Question 179

During your primary assessment of a 20-year-old man with blunt chest trauma, you note that he is semiconscious with rapid, shallow breathing. You do not see any obvious bleeding and note that his pulse is rapid and irregular, and his skin is cool and moist. An appropriate action would be to: A) quickly log roll the patient and assess his back. B) apply a cardiac monitor to assess for dysrhythmias. C) perform a secondary assessment while at the scene. D) insert an oral airway and apply supplemental oxygen.

Answer 179

B

Question 180

A 29-year-old woman is in active labor. During your visual exam, you see a limb protruding from her vagina. Upon noting this, it is MOST important to: A) contact online medical control. B) prepare for immediate transport. C) position the patient on her side. D) start an IV line of normal saline.

Answer 180

B

Question 181

A neighbor finds her elderly female friend unresponsive on her kitchen floor. As you are performing your primary assessment, the neighbor tells you that she does not know what happened to her friend. The patient moans when you speak to her and is breathing at a normal rate with adequate depth. You should: A) apply a rigid cervical collar, start an IV of normal saline, and perform immediate endotracheal intubation. B) apply supplemental oxygen via nonrebreathing mask, place her in a lateral recumbent position, and transport. C) insert an airway adjunct, apply supplemental oxygen, and implement spinal motion restriction precautions. D) quickly place her on the stretcher, obtain a 12-lead ECG tracing, and perform a detailed physical exam.

Answer 181

C

Question 182

You are caring for an unresponsive 54-year-old man with an apparent isolated head injury after he fell from a standing position. Your partner is maintaining manual stabilization of the patient’s head while assisting his breathing. Your rapid head-to-toe exam reveals only a large hematoma to the patient’s forehead. Further assessment reveals that the patient is wearing a medical alert bracelet that reads “allergic to codeine.” You should: A) instruct your partner to ventilate the patient at 24 breaths/min. B) perform a detailed secondary assessment and transport at once. C) assess his blood glucose reading and give dextrose if necessary. D) give epinephrine in case he is experiencing an allergic reaction.

Answer 182

C

Question 183

You are transporting a conscious middle-aged woman who fell from a second-story balcony while watering her plants. Full spinal motion restriction precautions have been implemented, supplemental oxygen is being administered, and an IV line of normal saline is in place. With a 15-minute estimated time of arrival at the hospital, the patient’s mental status markedly decreases and her respirations become shallow and are making a gurgling sound. Your FIRST action should be to: A) immediately suction her oropharynx. B) perform immediate endotracheal intubation. C) insert a nasal airway and assist ventilations. D) contact the receiving facility to update them.

Answer 183

A