Advanced EMT 2nd Edition (Alexander/Belle) Chapter 15 Scene Size-Up and Primary Assessment

The means by which energy, often mechanical forces, is transmitted to the body, producing the potential for trauma would be defined as the:

A) field impression.

B) mechanism of injury.

C) rapid trauma exam.

D) secondary assessment.

mechanism of injury

During which essential component of patient assessment does the AEMT determine the safety of the scene and formulate a general impression of the nature of the situation?

A) Primary assessment

B) Reassessment

C) Secondary assessment

D) Scene size-up

scene size-up

The energy of moving objects which can produce blunt or penetrating injuries is called:

A) kinetic energy.

B) chemical energy.

C) potential energy.

D) electrical energy.

kinetic energy

Impact with an object that has high surface area and relatively low velocity (speed) will result in:

A) penetrating trauma injury.

B) kinetic energy injury.

C) blunt force injury.

D) potential energy injury.

blunt force injury

________ occurs when an object impacting the body has a small surface area.

A) Penetrating trauma

B) Kinetic energy

C) Blunt trauma

D) Potential energy

penetrating trauma

Which of the following mechanism of injuries does NOT warrant spinal motion restriction?

A) Hanging patient

B) Lightning injuries

C) Unresponsive trauma patient

D) Burn injuries

burn injuries

During which essential component of patient assessment does the AEMT identify and manage any immediate threats to the patient's life and establish priorities for treatment and transport?

A) Primary assessment

B) Reassessment

C) Secondary assessment

D) Scene size-up

primary assessment

Which of the following is NOT part of the scene size-up phase of the patient assessment?

A) Mechanism of injury

B) Patient vital signs

C) Nature of illness

D) General impression

patient vital signs

Which of the following mnemonics represent the components of the primary assessment for all patients?

A) SAMPLE

B) OPQRST

C) ABCD

D) AVPU

ABCD

According to the 2015 recommendations by the American Heart Association, a patient who appears to be unresponsive and not breathing or breathing ineffectively should be assessed using which mnemonic memory aid?

A) ABC

B) CBA

C) ACB

D) CAB

CAB

Which of the following essential minimum equipment is NOT required for performance of the primary assessment?

A) Tourniquet

B) Pulse oximeter

C) Oxygen cylinder

D) Bandage shears

pulse oximeter

A yellowing of the skin, indicating severe liver disease would be called:

A) cyanosis.

B) pallor.

C) jaundice.

D) flushed.

jaundice

The mnemonic used to determine the patient's BEST response to stimuli would be:

A) SAMPLE.

B) OPQRST.

C) ABCD.

D) AVPU.

AVPU

Which of the following methods of eliciting a painful response from a patient is NOT an approved stimuli method?

A) Intraorbital pressure

B) trapezius pinch

C) Supraorbital pressure

D) Sternal rub

intraorbital pressure

Higher mental abilities, such as memory, reasoning, and problem solving would be referred to as:

A) behavioral functions.

B) mental status.

C) cognitive functions.

D) psychomotor functions.

cognitive functions

Devices inserted through the nose or mouth into the pharynx to maintain passage for airflow would be referred to as:

A) bag-mask device.

B) airway adjuncts.

C) nonrebreather device.

D) capnography adjuncts.

airway adjuncts

Which airway sound is indicative of partial airway obstruction and is relieved by manually positioning the head and jaw to move the tongue?

A) Snoring

B) Stridor

C) Wheezing

D) Gurgling

snoring

Which airway sound is indicative of a partial airway obstruction from a foreign body or swelling of the airway?

A) Snoring

B) Stridor

C) Wheezing

D) Gurgling

stridor

Which airway sound is indicative of fluid in the upper airway?

A) Snoring

B) Stridor

C) Wheezing

D) Gurgling

gurgling

The inability to maintain adequate ventilation and oxygenation is defined as:

A) respiratory failure.

B) respiratory arrest.

C) respiratory distress.

D) agonal respirations

respiratory failure

Which of the following is NOT an accessory muscle of breathing?

A) Neck muscles

B) Diaphragm muscle

C) Intercostal muscles

D) Abdominal muscles

diaphragm muscle

The amount of air (in mL) in a normal (unforced) exhalation following a normal inspiration would be referred to as:

A) minute volume.

B) alveolar volume.

C) tidal volume.

D) residual volume.

tidal volume

The average healthy adult has a strong radial pulse at regular rate of ________ times per minute.

A) 80 to 120

B) 40 to 70

C) 50 to 110

D) 60 to 100

60 to 100

Poor perfusion will present with paleness which is also known as:

A) cyanosis.

B) pallor.

C) flushed.

D) jaundice.

pallor

The CORRECT sequence to control significant external bleeding is:

A) direct pressure then tourniquet.

B) tourniquet then splinting.

C) direct pressure then elevation.

D) tourniquet then direct pressure.

direct pressure then tourniquet

Which of the following is NOT a sign of presumptive death?

A) Decapitation

B) Rigor mortis

C) Witnessed arrest

D) Dependent lividity

witnessed arrest

Which of the following is NOT a high priority finding in the primary assessment?

A) Suspected internal bleeding

B) Respiratory arrest

C) Compromised airway

D) Adequate breathing

adequate breathing

No part of the scene size-up or primary assessment can be overlooked, but the way the steps play out depends on the situation. You must balance concern for the patient's BEST interest along with which of the following?

A) Prescribed approach

B) Common sense

C) Flexibility

D) All of the above are required.

all of the above

What serves as a baseline from which to track improvement or deterioration in the patient's condition?

A) The initial findings

B) The latest findings

C) The field impression

D) The general impression

the initial finding

An AEMT's verbal communication and documentation of ________ and ________ findings provide information that hospital staff otherwise might NOT have.

A) mechanism of injury; general impression

B) scene size-up; primary assessment

C) nature of illness; general impression

D) scene size-up; reassessment

scene size-up; primary assessment

Immediately after arriving at an unconscious patient's side the AEMT MUST:

A) identify a detailed understanding of events leading up to the EMS call.

B) identify threats to life, and treat those first.

C) identify patient's medical history so as to understand the physical exam findings.

D) identify all injuries before beginning treatment.

identify threats to life, and treat those first

Basic components of a scene size-up consist of determining all the following EXCEPT:

A) possible violent threats.

B) mechanism of injury or illness.

C) initial vital signs

D) location of patient(s).

initial vital signs

In determining the nature of the illness which of the following would provide insight as to the patient's condition?

A) Patient statements

B) Patients position and appearance

C) Scene evaluation of medications, health care equipment, and illicit drugs

D) All of the above

all of the above

The mechanism of injury is based on all of the following EXCEPT:

A) nature of forces.

B) direction of forces.

C) strength of forces.

D) timing of forces.

timing of forces

You are on the scene of a 34-year-old man who is breathing but not awake. After determining that he does NOT respond to verbal stimuli, your next action would be to:

A) place him on a backboard and perform a secondary assessment en route to the hospital.

B) open his airway.

C) apply a painful stimuli.

D) apply manual cervical spine immobilization.

apply a painful stimuli

What does the "U" in A-V-P-U stand for?

A) Uncooperative

B) Unresponsive

C) Unconscious

D) Unaccessible

unresponsive

You are on the scene of a 33-year-old patient who opens her eyes when you speak to her and is able to mumble a response. This patient's mental status is BEST described as:

A) lethargic.

B) responsive to tactile stimulation.

C) semi-conscious.

D) responsive to verbal stimulation.

responsive to verbal stimulation

A patient who looks at you when you walk into the scene of an EMS call, but will NOT respond to you when you speak and responds aggressively when you touch them, has an assessed mental status of:

A) A.

B) V.

C) P.

D) U.

A

You are called to the scene of a 55-year-old woman lying on the side of the road. There are no bystanders present. You determine that she is unresponsive. You should next:

A) check if the patient is unconscious.

B) open her airway with a head-tilt/chin-lift maneuver.

C) open her airway with a jaw-thrust maneuver.

D) call for additional assistance.

open her airway with the jaw-thrust maneuver

Harsh, high pitched sounds heard on inspiration are known as:

A) rhonchi.

B) stridor.

C) snoring.

D) wheezes.

stridor

Whistling sounds heard on exhalation is known as:

A) wheezes.

B) rhonchi.

C) snoring.

D) stridor.

wheezes

Which is an appropriate method of initially opening the airway of an unconscious trauma patient?

A) Head-tilt/chin-lift

B) Nasal tracheal intubation

C) Oral tracheal intubation

D) Jaw-thrust maneuver

jaw-thrust maneuver

Using a head-tilt/chin-lift maneuver opens the airway by:

A) moving the pharynx to a more posterior position relative to the tongue.

B) reducing airway resistance by establishing a direct passage.

C) aligning the posterior pharynx with the nasal passage.

D) lifting the tongue and epiglottis by muscle and ligament connections.

lifting the tongue and epiglottis by muscle and ligament connections

Normal heart rate for adults should be:

A) 60-90 beats per minute.

B) 60-100 beats per minute.

C) 80-120 beats per minute.

D) 80-100 beats per minute.

60-100 beats per minute

Once cardiac arrest is recognized, the AEMT should immediately:

A) start external chest compressions.

B) open the airway and ventilate with 100 percent oxygen by BVM.

C) assess for mechanism of injury or illness.

D) assess the cardiac rhythm.

start external chest compressions

The Glasgow Coma Scale is BEST used to assess:

A) blood loss severity.

B) blood oxygenation levels.

C) altered mental status.

D) trauma severity.

altered mental status

Using the Glasgow Coma Scale what score would be assigned to a patient with eyes opening to voice, verbally confused, and obeys commands?

A) 4 / 5 / 6 = 15

B) 3 / 4 / 6 = 13

C) 3 / 4 / 5 = 12

D) 3 / 5 / 6 = 14

3 / 4 / 6 = 13

Accurate assessment of a patient's respirations includes which of the following?

A) Respiratory pattern

B) Respiratory rate

C) Tidal volume

D) All of the above

all of the above

Jaundice (yellow skin) is a condition that may indicate:

A) gall bladder dysfunction.

B) pancreatitis.

C) kidney failure.

D) liver dysfunction.

liver dysfunction

Who or what is usually the BEST source of information about the nature of your patient's illness if the patient is alert and oriented?

A) Family members and bystanders

B) The patient

C) Visual cues

D) Diagnostic tests

the patient

In responding to calls of two-car collisions, be prepared to look for:

A) multiple patients.

B) flail chest.

C) severe lower extremity injuries.

D) altered mental status patients.

multiple patients

By forming a general impression during the assessment, you are better able to:

A) determine general clinical status and priority.

B) administer proper medications.

C) stabilize the cervical spine.

D) determine baseline mental status.

determine general clinical status and priority

The sound of gurgling usually indicates:

A) constricted bronchioles.

B) foreign body airway obstruction.

C) fluid in the lower airway.

D) fluid in the upper airway.

fluid in the upper airway

To determine if a patient is breathing, an AEMT should:

A) palpate the patient's trachea.

B) hold a mirror to the patient's mouth and nose.

C) look for chest rise and listen and feel for air movement.

D) auscultate at the 5th and 6th intercostal space.

look for chest rise and listen and feel for air movement

You are assessing an unresponsive adult female patient. when assessing the pulse, you should:

A) palpate for an ulnar pulse.

B) palpate the opposite wrist for a radial pulse.

C) palpate for a carotid pulse.

D) palpate for a popliteal pulse.

palpate for a carotid pulse

You are assessing a 28-year-old man with multiple gunshot wounds to his abdomen. You would expect his skin to be:

A) cool and moist.

B) hot and moist.

C) warm and dry.

D) cold and dry.

cool and moist

A patient with skin described as "clammy" has ________ skin.

A) mottled

B) cool and moist

C) warm and dry

D) ashen

cool and moist

When should the AEMT conduct an evaluation of the scene for hazards that can threaten or harm him?

A) Throughout the entire call

B) After completing the primary assessment

C) Prior to leaving the ambulance

D) Before responding to the call

throughout the entire call

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?

A) She does not have any other injuries.

B) She does not require rapid transport.

C) Her pulse rate is within normal limits.

D) She is alert with an open airway.

she is alert with an open airway

Which one of the following patients should be classified as unresponsive?

A) 70-year-old woman who has suffered a stroke

B) 39-year-old woman who is confused

C) 52-year-old who cannot answer your questions

D) 46-year-old man who does not respond when his fingers are pinched

46-year-old man who does not respond when his fingers are pinched

An intoxicated patient is complaining of a severe headache and a large bruise to the left side of his face after accidentally being struck with a baseball bat. In this situation, being struck with the baseball bat is called the:

A) mechanism of injury.

B) chief complaint.

C) differential diagnosis.

D) nature of illness.

mechanism of injury

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?

A) She can only speak in extremely short sentences.

B) She is lethargic and confused to person, place, and time.

C) She easily tells you that she is having chest pain.

D) She is sitting in an upright position because she cannot lie flat.

she easily tells you that she is having chest pain

On-scene you find a 91-year-old woman 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?

A) "Please perform the head-tilt/chin-lift to open the airway."

B) "Let us move her to the stretcher and get moving to the hospital."

C) "Get the suction out and clear out her airway."

D) "Check her breathing and let me know the rate."

"Get the suction out and clear out her airway."

During the primary assessment, how should you BEST determine the adequacy of a patient's breathing?

A) Compare the respirations and pulse rate.

B) Examine the rise and fall of the chest.

C) Calculate the number of breaths per minute.

D) Determine the patient's mental status.

examine the rise and fall of the chest

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:

A) position her on her side.

B) insert an oral airway.

C) confirm the presence of a pulse.

D) administer oxygen

administer oxygen

A patient has fallen through a large plate glass window. As you approach, you note the patient to be sitting up holding his hand over a large laceration that is spurting bright red blood. Which one of the following should you do immediately?

A) Provide oxygen at 15 liters per minute.

B) Assess the airway for patency.

C) Apply direct pressure to the laceration.

D) Determine the presence and rate of the pulse.

apply direct pressure to the laceration

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?

A) Liver disease

B) Stroke

C) Diabetes

D) Lung cancer

liver disease

Which of the following terms is defined as "a bluish or purple discoloration"?

A) Flushed

B) Cyanosis

C) Jaundice

D) Pallor

cyanosis

An immediate and obvious sign of airway obstruction is the presence of:

A) stridor.

B) coughing.

C) unresponsiveness.

D) pallor.

stridor

Which of the following airway maneuvers can open the airway without hyperextension of the neck?

A) Modified jaw-thrust

B) Head-tilt/chin-lift maneuver

C) Chin-lift-tilt

D) Suspended jaw-chin thrust

modified jaw-thrust

If a modified jaw-thrust maneuver does not open the airway, the AEMT should use:

A) an oral pharyngeal airway.

B) the head-tilt/chin-lift maneuver.

C) the chin-lift-tilt.

D) the suspended jaw-chin thrust.

the head-tilt/chin-lift maneuver

Scene size-up continues alongside patient assessment and management, and does not end until:

A) your full report is submitted.

B) you leave the scene.

C) you hand over the patient's care to the next health care provider.

D) you have reached the emergency department.

you leave the scene

Which of the following is a more specific method for evaluating a patient's level of responsiveness?

A) AVPU

B) GCS

C) ABCD

D) LTD

GCS

Which of the following refers to the types and amounts of energy that a patient was subjected to, resulting in injury?

A) MOI

B) WVC

C) AVPU

D) GCS

MOI

Which of the following sounds are heard primarily during inspiration?

A) Snoring

B) Stridor

C) Gurgling

D) Gagging

stridor

Most patients you encounter will be alert and obviously have an open airway. An adequate airway will be evident in the patient's general appearance through the level of responsiveness, skin color, and ease of speaking and breathing. Your primary assessment of those patients is essentially completed by the time you:

A) have obtained the patient's history.

B) reach the patient's side.

C) leave the scene.

D) transport the patient.

reach the patient's side

A patient who is unresponsive but has adequate breathing and no indications of cervical-spine trauma should be placed on his:

A) left side.

B) right side.

C) back.

D) stomach.

left side

At what point on the GCS scale does the patient begin to have a decreased level of consciousness?

A) 3

B) 8

C) 10

D) 14

14

In order for gas exchange at the lungs to occur, the passageway between the lungs and the environment must be open. This is sometimes referred to as:

A) having a patent airway.

B) responsive breathing.

C) airway circulation.

D) airway access.

having a patent airway

Which of the following conditions can lead to airway obstruction?

A) Dyspnea

B) Apnea

C) Epiglottitis

D) Jaundice

epiglottitis

When assessing a healthy adult, which of the following is considered the average tidal volume?

A) 200 mL

B) 350 mL

C) 500 mL

D) 800 mL

500 mL

When assessing circulation, which of the following would be an indication of good perfusion?

A) Skin with pallor

B) Hot skin

C) Wet skin

D) Dry skin

dry skin

Adding an "E" to ABCD, creating the mnemonic ABCDE, serves as a reminder to

A) examine the patient for trauma.

B) expose patients with significant trauma to check for bleeding.

C) enter additional data on the patient related to the dramatic event.

D) extend the time of the initial assessment.

expose patients with significant trauma to check for bleeding