Deck 7: Patient Assessment in the Field

Question 1

You are evaluating a patient who was a restrained driver of a motor vehicle that crashed into the median barrier at 40 mph. He is awake, alert, and oriented, complaining of neck and back pain. There is a bruise across his upper abdomen in the shape of the seat belt. Based on this information, you should assume he is a ________ trauma patient, and transport him to ________.

A) major; the closest hospital
B) minor; the closest hospital
C) minor; the patient's hospital of choice
D) major; a trauma center

Answer 1

major; a trauma center

Question 2

Which of the following may indicate either cardiac tamponade or tension pneumothorax?

A) Cushing's reflex
B) Hypertension
C) Subcutaneous emphysema
D) Distended neck veins

Answer 2

Distended neck veins

Question 3

A patient is complaining of abdominal pain, nausea, and vomiting. Which of the following will provide you with the most immediately useful information?

A) Checking for discoloration of the tongue
B) Asking about any unusual taste in the mouth
C) Asking about the presence of coffee-grounds emesis
D) Finding out about any unusual stress in the patient's life

Answer 3

Asking about the presence of coffee-grounds emesis

Question 4

A fast, systematic assessment designed to identify other life-threatening injuries after the primary assessment is the:

A) 1-minute exam.
B) rapid secondary assessment.
C) focused physical exam.
D) detailed physical exam.

Question 5

Which of the following best describes why a focused history is important in responsive medical patients?

A) It supports diagnostic impression.
B) It allows treatments to be initiated immediately.
C) It helps to formulate a field diagnosis.
D) It identifies signs of medical complications.

Question 6

The careful, thorough process of eliciting a patient's history and conducting a physical exam is known as the:

A) primary survey.
B) rapid medical assessment.
C) secondary assessment.
D) ongoing assessment.

Question 7

Why is a detailed physical exam rarely performed on critical trauma patients in the prehospital setting?

A) It produces too much patient anxiety.
B) It is used only on medical patients.
C) The rapid trauma assessment performs the same function.
D) It usually yields little immediately useful information.

Question 8

Reassessment should include which of the following?
1) Assess effects of interventions.
2) Check vital signs.
3) Assess skin condition.
4) Do detailed physical exam.
5) Check airway patency.

A) 1, 2, 3, and 5
B) 2, 4, and 5
C) 1, 2, 4, and 5
D) 1, 3, and 4

Question 9

A 60-year-old man presents with altered mental status. There is no evidence of trauma. Which of the following is most likely to give you specific information about the underlying cause of the patient's condition?

A) Pulse oximetry
B) A Babinski reflex
C) End-tidal carbon dioxide monitoring
D) Blood glucose determination

Question 10

Evaluation of the pelvis in the rapid trauma assessment includes pressing on the symphysis pubis in which direction?

A) Inferiorly
B) Posteriorly
C) Laterally
D) Medially

Question 11

Special emphasis should be placed on which of the following during your rapid secondary assessment?

A) Mental status
B) Cranial nerve function
C) Cardiovascular and respiratory systems
D) Areas suggested by the chief complaint

Question 12

Forming a general impression as part of your primary assessment helps you to:

A) determine baseline mental status.
B) determine general clinical status and priority.
C) make a determination about stabilization of the cervical spine.
D) estimate vital signs.

Question 13

Which of the following is NOT part of the medical history?

A) Past injuries
B) Type of health care insurance
C) Current medications
D) Current symptoms

Question 14

Patterns of deterioration in patient condition may include all of the following EXCEPT:

A) skin becomes cool, pale, and moist.
B) the heart rate significantly increases or decreases.
C) the respiratory rate significantly increases or decreases.
D) the level of consciousness increases.

Question 15

Which of the following patient conditions requires immediate transport?

A) Neck pain following a motor vehicle collision
B) Unresponsiveness to painful stimuli after ALS interventions
C) Narcotic overdose
D) Wrist fracture with diminished distal sensation

Question 16

You are en route to a hospital with a patient who appears stable following a motor vehicle collision. To detect changes in the patient's condition, you should do which of the following during transport?

A) Detailed physical examination
B) Neurological assessment
C) Repeat the primary assessment
D) Rapid trauma assessment

Question 17

Which of the following will provide the LEAST information about a patient complaining of abdominal pain?

A) Checking for unusual breath odors
B) Looking for Cullen's sign
C) Assessing reaction of the pupils to light
D) Performing a tilt test

Question 18

Which of the following is NOT a reason that a reassessment is important?

A) It allows you to detect trends in the patient's status.
B) It determines changes in the patient's conditions.
C) It reassures the patient you are taking good care of him.
D) It allows you to assess the effects of interventions.

Question 19

Which of the following is the sequence of steps when assessing a major trauma patient?
1) Secondary assessment
2) Primary assessment
3) Reconsider mechanism of injury
4) History
5) Vital signs
6) Detailed physical exam

A) 2, 5, 3, 1, 4
B) 2, 3, 1, 5, 4
C) 2, 6, 5, 3, 4
D) 2, 1, 3, 4, 5

Question 20

Which of the following statements best describes proper history-taking technique in the assessment of a major trauma patient?

A) Perform the history before assessing the patient.
B) Complete a rapid history by using the SAMPLE acronym.
C) Collect a comprehensive health history.
D) Medical history is not a significant issue in the trauma patient and can be skipped.

Question 21

Trending vital signs is best accomplished by:

A) estimating any values that are missing on the prehospital care record.
B) comparing the prehospital vital signs to the patient's normal vital signs.
C) having each set of vital signs verified by a second EMS provider.
D) taking multiple sets of vital signs.

Question 22

Rebound tenderness in the abdomen is a sign of potential:

A) kidney stone.
B) full urinary bladder.
C) peritoneal irritation.
D) food poisoning.

Question 23

During the reassessment of a stable patient, you should recheck vital signs every 15 minutes. This is an example of:

A) evaluating.
B) reviewing.
C) reflecting.
D) applying principles.

Question 24

Components of a scene size-up include all of the following EXCEPT:

A) patient's chief complaint.
B) number of patients.
C) mechanism of injury.
D) dangers to bystanders.

Question 25

The first step in critical thinking is to:

A) form a concept.
B) conduct a focused exam.
C) ascertain the chief complaint.
D) determine statistically significant conditions.

Question 26

A critical patient's vital signs should be reassessed at least every ________ minutes.

A) 5
B) 10
C) 15
D) 20

Question 27

Changing or stopping interventions that are NOT working is an example of:

A) reviewing your performance.
B) reading the patient.
C) reevaluating.
D) revising the management plan.

Question 28

For which of the following patients should you conduct a focused physical exam?

A) 35-year-old female roller skater with an ankle fractured after falling
B) 22-year-old male with a gunshot wound to the abdomen
C) 65-year-old male with an altered level of consciousness
D) 15-year-old female pedestrian who was struck by a motor vehicle traveling at 25 mph

Question 29

After a call you discuss the patient with the ED physician, comparing diagnoses and care plans. This is an example of:

A) reflecting.
B) evaluating.
C) applying principles.
D) putting it all together.

Question 30

During your focused physical exam of a patient with a suspected myocardial infarction, you should examine:

A) peripheral perfusion status.
B) range of motion in joints.
C) extraocular movements.
D) deep tendon reflexes.

Question 31

Using knowledge and experience to diagnose patients and plan their treatment is called clinical:

A) judgment.
B) intuition.
C) practice.
D) reflection.

Question 32

One of the best ways to minimize patient anxiety during a physical exam is to:

A) never expose any of the patient's body parts.
B) use a calm, professional approach.
C) limit your exam to procedures that do not cause the patient anxiety.
D) warm your hands and instruments before use.

Question 33

An important aspect of the reassessment is to monitor and evaluate all of the following EXCEPT the:

A) accumulation of charges for care.
B) transport priority.
C) effectiveness of interventions.
D) vital signs.

Question 34

You arrive at a location and begin to read the scene by:

A) approaching the patient.
B) observing the immediate surroundings.
C) conducting a focused exam.
D) addressing life threats.

Question 35

Critical thinking is a thought process used to:

A) defend one's actions in a CQI review process.
B) establish credibility with an emergency physician.
C) analyze and evaluate.
D) focus on a situation's most important aspect.

Question 36

After the primary assessment of an unresponsive medical patient with stable vital signs, which of the following is the position in which the patient should be placed?

A) Supine
B) Lateral recumbent
C) Semi-Fowler's
D) Prone

Question 37

Which of the following is TRUE concerning the assessment of an unresponsive medical patient?

A) The approach is the same as for responsive medical patients.
B) You should perform a rapid medical assessment.
C) A comprehensive history is performed prior to assessment.
D) You should perform a detailed physical exam prior to transporting the patient.

Question 38

After considering the information you have collected, you determine the most likely cause of your patient's condition. This step in the critical decision-making process is called:

A) reflecting on the incident.
B) applying the principles.
C) interpreting the data.
D) forming a concept.

Question 39

When responding to calls involving two-vehicle collisions, you must always suspect:

A) multiple patients.
B) patients with altered mental status.
C) flail chest.
D) severe lower extremity injuries.

Question 40

Your patient remains unresponsive after a painful stimulus is applied. The family reports that the patient was found unconscious in bed after complaining of a "terrible headache." Which of the following represents the correct sequence of actions in this situation?
1) Obtain a brief history from the family.
2) Conduct a rapid secondary assessment.
3) Perform a detailed exam.
4) Determine vital signs.
5) Perform a primary assessment.

A) 5, 2, 3, 1
B) 5, 1, 2, 4
C) 5, 1, 3, 4
D) 5, 2, 1, 4

Question 41

Paramedics treat patients with the same techniques as other clinicians, EXCEPT that they:

A) perform these procedures in uncontrollable and unpredictable environments.
B) are far less trained than other practitioners.
C) treat life-threatening emergencies only.
D) are not allowed to make independent decisions.

Question 42

What is one way to read the patient in a primary assessment?

A) Obtain the history from family members.
B) Address life threats.
C) Observe the mechanism of injury.
D) Observe the level of consciousness.

Question 43

Which of the following characteristics is most similar between the prehospital setting and other medical care environments?

A) The need to establish an airway early in patient care
B) The absence of laboratory results to guide treatment
C) Unpredictable circumstances
D) The variety of uncontrolled environments

Question 44

Your 23-year-old female patient presents with relatively normal vital signs and is fully alert and oriented. Her only complaint is lower abdominal pain. If you assume she is pregnant, you are:

A) applying principles.
B) overgeneralizing.
C) interpreting the data.
D) evaluating.

Question 45

The ability to critically evaluate a patient's condition and formulate a treatment plan rests on all of the following EXCEPT:

A) an excellent working knowledge of anatomy and physiology.
B) identifying and dealing with medical ambiguity.
C) strictly following protocols.
D) the ability to focus on large amounts of data.

Question 46

With your field diagnosis in mind, you develop a treatment plan for your patient. This part of the critical decision-making process is called:

A) evaluating the results.
B) applying principles.
C) forming a concept.
D) interpreting the data.

Question 47

As you survey the scene, you are gathering information about your patient and the scene. This step in the critical decision-making process is called:

A) forming a concept.
B) reflecting on the incident.
C) evaluating results.
D) interpreting the data.

Question 48

Which of the following choices is the correct sequence of steps in critical thinking/decision making?
1) Interpreting the data
2) Evaluating results
3) Reflecting on the incident
4) Forming a concept
5) Applying the principles

A) 4, 1, 5, 2, 3
B) 1, 2, 4, 5, 3
C) 4, 3, 5, 2, 1
D) 3, 4, 5, 1, 2