Chapter 11 ~ Baseline Vital Signs, Monitoring Devices, and History Taking

Which patient description contains only vital signs?

Skin warm and dry, heart rate 74, pupils equal and reactive

Which piece of equipment would the EMT need to obtain a patient's vital signs?

Stethoscope

The EMT is correctly calculating a patient's respiratory rate when he or she:

Counts the number of breaths for 30 seconds and multiplies by 2

Emergency Medical Responders inform you that a 27-year-old male with altered mental status has an open airway and is breathing 9 times every 30 seconds. His pulse rate is 40 beats per minute, and he has bruises to his chest. Based on this information, the EMT should recognize:

Respiratory rate as normal

Which of the following signs related to breathing would be most concerning to the EMT?

Respiratory rate of 20, use of accessory muscles

Which statement made by your partner indicates that he understands assessment of a patient's breathing?

"A rate less than 8 may allow adequate breathing, but requires further evaluation and assessment."

A family has called you for a 41-year-old male they cannot wake up. They state he has been threatening to kill himself and believe that he may have intentionally overdosed on his pain medications. As you enter the patient's bedroom, you observe him supine on the floor with his eyes closed. As he breathes, you hear snoring respirations. As a knowledgeable EMT, you recognize which one of the following?

His tongue is partially blocking the airway

A young female patient has been stung by a bee and states that her throat is closing up. She states that she is allergic to bee stings and the last time this happened, she had to have a tube put into my windpipe. She is struggling to breathe and can only speak a few words at a time. Knowing that allergic reactions can cause swelling in the pharynx and at the level of the larynx, which one of the following respiratory sounds would indicate that the patient indeed has swelling in this area?

Stridor

An EMT is correctly assessing a patient's radial pulse when he:

Uses his fingertips to feel for a pulse at the patient's wrist

When assessing a patient's pulse, you note that it is irregular. To get an accurate heart rate, you would":

Count the number of beats that occur in 1 minute

Which one of the pulses listed below is palpated in the groin area?

Femoral

You have been called to assess and conscious and alert 5-year-old whose chief complaint is nausea and vomiting over the last 2 hours. When assessing his pulse, you should first check which pulse?

Radial

You are assessing a 61-year-old ale who is confused. During the primary assessment, you cannot locate a radial pulse. Your immediate action should be to:

Check the carotid pulse

During the primary assessment of a geriatric patient complaining of shortness of breath and fever, you quickly locate the radial pulse. What should you do next?

Determine the rate and quality of the pulse

Which one of the following statements concerning assessment if the pulse is correct?

"The heart rate can be determined by doubling the number go beats counted in 30 seconds."

You determine a patient's heart rate to be 48 beats per minute. That heart rate would be categorized as:

Bradycardic

The EMT recognizes which one of the following heart rates (beats per minute) as normal for a 24-year-old make?

62

When assessing a patient's pulse, you can locate the right radial pulse, but not the left. Which one of the following is the most likely explanation for this finding?

The left radial artery may be occluded

Which one of the following characteristics is a quality if a patient's pulse?

Strength

You determine a radial pulse is readily palpable, but has uneven intervals between beats. This would best be documented on the prehospital care report as:

Stung and irregular

When evaluating a patient's skin color, the EMT should:

Observe the nail beds and/or mucous membrane inside the eyelids

You are assessing a confused dark-skinned patient complaining of a headache. When checking his skin color, you should:

Evaluate the palms of his hands or the soles of his feet

An EMT has accurately checked the skin color of a patient. Which one of the following indicates correct documentation?

"Pale color noted on the conjunctiva."

Which one of the following is an accurate method of assessing a patient's skin temperature?

Placing the back of the hand on the patient's abdomen

Which one of the following statements made by an EMT indicates an accurate understanding of checking a patient's skin temperature?

"Checking the skin temperature is not precise, but it is a good estimate of abnormal high or low body temperatures."

To test a patient's capillary refill, the EMT will:

Firmly compress and then release pressure on the nail bed

The EMT should recognize normal ski color in a healthy patient as:

Pink

Assessment of a patient's skin color reveals a bluish discoloration, As a knowledgable EMT, you should identify:

Cyanosis caused by inadequate oxygenation of the tissues

A patient presents with extremely pale skin. His family states that this is not his normal skin color. His vital signs are pulse 108, respirations 18, blood pressure 102/86 and spo2 96%. Which one of the following complaints would ,make the most sense given this clinical presentation?

Rectal bleeding

A patient has advanced liver disease from years of exposure to toxic chemicals in his place of employment. Which one of the following skin colors would the EMT expect?

Yellow-orangish

A patient with pancreatic cancer exhibits a yellow discoloration to his entire body. The EMT would correctly document this condition as:

Jaundice

Which one of the following patients should the EMT recognize as having a normal skin temperature?

86-year-old complaining of nausea with warm skin

You are called to a long-term care facility to assess and transport a patient with a high fever. You do not have a thermometer on your unit. Which one of the following signs should you use to confirm the patient's increased body temperature?

Skin on the abdomen that is hot and flushed

A patient presents with skin that is cool to the touch. Th EMT shows he understands this condition when he states:

"This would appear to indicate a problem with the circulation of blood."

You are assessing a female patient with a complaint of shortness of breath. When assessing her skin, which one of the following should be recognize as abnormal?

Moist

For which patient would a capillary refill time of 3 seconds be most indicative of poor perfusion?

4-year-old male

You are called for a 2-year-old child who is sick. When testing her capillary refill, which one of the following would be the most cause for concern?

3-second capillary refill time

A patient who was shoveling snow developed chest pain, immediately sat down in a nearby bus shelter, and called 911. Prior to moving him into the ambulance, your partner performs a primary assessment and reports that the patient's capillary refill is 5 seconds. Which one of the following statements would be most appropriate for you to make?

"The cold temperature may cause the capillary refill to be 5 seconds. We should assess further."

Which one of the following statements made by an EMT student indicates that he correctly understands the use of capillary refill when assessing a patient?

"Capillary refill is a more reliable sign of blood circulation in children under6 years of age than in adolescents or adults."

When assessing a patient's pupils, the EMT should:

Determine the size of the pupil and then look for a change in pupillary size as you sine a light in the eye

You are assessing a patient who is in bright sunlight after collapsing in the hot sun at a picnic. If you cannot immediately move the patient out of the sun, assessment of the pupils will be made more accurate by:

Shading the patients eyes

Friends called 911 for a 37-year-old female who intentionally overdosed on a narcotic drug. Which one of the following eye findings would reinforce that the patient did indeed take a narcotic?

Pupils that are constricted

Assessment of a patient who is unresponsive reveals pupils that are both large at 8 millimeters and do not change in response to light. The EMT would best document this finding as:

Bilateral dilation of the pupils

Which one of the following indicates a normal pupillary exam?

Both pupils constrict when light is directed into the eye

The EMT is correct when he makes which one oft following statements about assessment of the pupils?

"Some people naturally have unequal pupils, but both should react to light."

A 41-year-old male patient reacts to painful stimuli by moaning. You shine a light at his right pupil. Which one of the following reactions would be normal?

Constriction of the left pupil

As you enter the scene of a medical emergency, the Emergency Medical Responder informs you that the patient is not breathing and has pupils that are fixed and dialed. Based on the description, which one of the following are you expecting to see when you reach the patient's side?

Neither pupil will react when the light is directed into the eyes

To assess a patient's blood pressure, the EMT will need a:

Sphygmomanometer

Your partner is having a difficult time determining what a normal and abnormal blood pressure is for a child. Which one of the following statements will help him most?

"A normal systolic pressure can be estimated by doubling the child's age and adding 80 to it."

You have placed the blood pressure cuff on the arm of a patient who is short of breath. What is your next step?

Inflate to a reading of 70 mmHg, Check for a radial pulse, and continue inflation until the pulse is no longer felt

Which one of the following indicates that the EMT has correctly positioned the blood pressure cuff on the patient's arm?

The cuff is on the same level as the patient's heart

When obtaining a blood pressure, the EMT listens for a pulse over what blood vessel?

Brachial artery

AN EMT student asks you if it matters if the blood pressure cuff seems too small for the patient, even though a reading can still be obtained. You should respond:

"Cuffs that are too small provide inaccurately high readings."

You observe your partner correctly obtaining a patient's blood pressure when he:

Deflates the cuff 2 mmHg per second while listening with a stethoscope

A blood pressure is reported as 116/68 mmHg. Which one of the following is true?

The systolic blood pressure is 116 mmHg

An EMT has an accurate understanding go the systolic blood pressure when he tells you that the systolic blood pressure is:

Produced when the heart contracts

When getting a blood pressure on a patient, the radial pulse disappears when the gauge reads 130 mmHg. When deflating the cuff, the EMT hears a pulse at 118 mmHg. The Pulse disappears at 76 mmHg. Which of the following is true?

The systolic blood pressure is 118 mmHg

Your partner reports a patient's blood pressure is 156/78 mmHg. From this reading, you realize:

The diastolic blood pressure is 78 mmHg

An EMT has an accurate understanding of the diastolic blood pressure when she tells you that the diastolic pressure:

IS the pressure in the arteries when the heart is not contracting

What pulse site is commonly used when the EMT elects to palpate a blood pressure?

Radial

Which one of the following is an indication to palpate the blood pressure?

Noisy environment

In the prehospital care report, the EMT should recognize that a blood pressure has been palpated when she sees:

178/P

Which one of the following statements listed below indicates an appropriate understanding of palpating a blood pressure?

"A palpated blood pressure is typically falsely lower than a blood pressure obtained by auscultation."

Your partner states that he was to palpate the blood pressure. What equipment would you hand him?

Blood pressure cuff

Which one of the following illustrates a question that would be asked when obtaining medical history, using the SAMPLE mnemonic, for a female patient who is crying and complaining of dizziness?

"What were you doing when the dizziness started?"

When obtaining a medical history using SAMPLE mnemonic, which one of the following statements relates the the "P" component?

"There is a history of pancreatitis."

Which of the following descriptions would be obtained when asking about the "A" component of the SAMPLE history?

Allergy to penicillin

A 69-year-old man is complain of weakness to the left arm and leg. He also states that he is nauseated and has a headache. The patient's past medical history includes stroke and diabetes. In relation to this information, which one of the following is true?

The headache is a symptom related to the chief complaint

A patient states that he is short of breath, light-headed, and has chest pain that worsens when he takes a deep breath. Assessment reveals an open airway, adequate breathing, and a rapid pulse of 120 beats per minute. His skin is hot to the touch, and he has a blood pressure of 116/86 mmHg. The patient informs you that he was diagnosed with pneumonia three days ago and has not been taking the prescribed antibiotics. Which one of theses assessment findings has not been recognized as a sign related to the patient's chief complaint?

Blood pressure of 116/84 mmHg

The EMT is correct when he identifies baseline vital signs as:

The first set of vital signs obtained

You have assisted the patient in taking one of his nitroglycerin tablets. Five minutes later, you not the blood pressure is 108/74 mmHg. To determine if the nitroglycerin has affected the blood pressure, the EMT should:

Compare to the baseline blood pressure

Which statement is true regarding vital signs obtained from a patient with nausea and vomiting?

The vital signs will help to determine the relative stability or instability of the patient

An obese female has called you with the complaint of abdominal pain. The regular adult cuff will not fit around her arm, so you retrieve the large adult cuff from your supplies. Embarrassed, the women says, :My arm is so fat, do you really need to roll up my sleeve to get a blood pressure?" Your best response would be:

"I am not concerned about the size of your arm. I am interested in your blood pressure."

A female patient who called 911 when she noticed blood in her stool is scared and anxious. Her pulse rate is 124 and her blood pressure is 88/60 mmHg. After you get her vital signs, she nervously asks you if they are normal. Given her anxiety, you should:

Inform her of the vital signs

You notice that your partner routinely only takes one set of vitals when treating and transporting patients. When asked, he states that he only gets baseline vitals since they are most important as they provide information related to the patient's clinical status at the time of the EMS call. How would you respond?

"Examining several sets of vitals signs can indicates the effectiveness of your treatment."

A female patient with a history of asthma called 911 with a complaint of shortness of breath. On scene, you assisted with the administration of her metered dose inhaler containing albuterol. Which one of the following interventions will you use to best determine if the patient is improving or not?

Obtain pulse oximetry reading every 3 minutes

The EMT understands the primary reason to obtain medial history using the SAMPE mnemonic when he states:

"After performing the primary assessment, the SAMPLE mnemonic helps guide the EMT in further assessment and care."

You are assessing a 49-year-old male complaining of lower back pain. which one of the following would be pertinent medical information related to the back pain that the EMT will obtain using the SAMPLE mnemonic?

Arthritis in the spine and pelvis

After you apply the pulse oximeter to a patient complaint of chest discomfort, she asks you what you are assessing. You would respond by telling her that the pulse oximeter:

Measures the amount of oxygen circulating in the blood

When using a pulse oximeter on an adult patient, the EMT knows that the sensor is most often attached to the patient's:

Finger

A pulse oximetry reading is considered normal when it is:

Greater than 97 percent

Which one of the following indicates the correct documentation of a pulse oximetry reading on the prehospital care report?

97%sp02

You have arrived by the side of a cyanotic patient who is responsive only to painful stimuli and exhibiting stridorous respirations. Which one of the following would be most appropriate?

Provide positive pressure ventilations with supplemental oxygen

When should the EMT use a pulse oximeter?

Routinely on all patients with medical or trauma complaint

For which one of the following conditions would the EMT most likely get an inaccurate pulse oximeter reading despite proper application of the sensor?

Low blood pressure

You are trying to get a pulse oximeter reading on an 18-month-old child with difficulty breathing. Every time you place the sensor on the finger, he becomes upset and removes it. The EMT's best course of action would be to:

Place the sensor on the child's toe

You are caring for a 5-year-old male with the complaint of difficulty breathing. Your assessment indicates that the patient is tchypneic with labored breathing. TO get more information about the patient's respiratory function, which one of the following findings would you recognize as most important?

Retractions between ribs

Where would the EMT palpate for a popliteal pulse?

Behind the knee

Which one of the following patients should the EMT recognize as tachycardic

37-year-old male with a complaint of fatigue and a heart rate of 104

When obtaining vital signs on a 67-year-old male with dizziness and nausea, your partner states that the pulse seems to disappear periodically when the patient takes a deep breath. As a knowledgable EMT, your best response would be:

"That is an important finding. We will have to let the doctor know of this."

Which one of the following is a normal blood pressure for a 7-year-old male?

94/62 mmHg

Which one of the following blood pressures represents diastolic hypertension in an adult patient?

136/92 mmHg

An 86-year-old female has called 911 for rectal bleeding. There is a large amount of dark red blood and clots in the toilet and on the patient's clothing. The Emergency Medical Responder reports a blood pressure of 84/68 mmHg with a heart rate of 124 beats per minute. Given this information, the EMT should recognize:

Narrowed pulse pressure and possible shock

A mother has called 911 because her 2-year-old daughter is fussy and not eating. When assessing the toddler, which one of the following is the best indication of her perfusion status?

Skin color and temperature

When obtaining blood pressure on a patient in a standing position, the patient states that he suddenly feels weak and is going to pass out. Your immediate action should be to:

Place the patient back into bed

You are unable to auscultate a blood pressure in a patient's right arm. Which one of the following will allow you to obtain the most accurate baseline assessment of the patient's vital signs?

Auscultate the blood pressure in the patient's left arm

Medical command has asked you to obtain orthostatic vital signs for a 54-year-old female complaining of dizziness and weakness. Her baseline vitals obtained while she was sitting on a chair were: pulse84, respirations 26, blood pressure 118/63 mmHg and spo2 95%. Which one of the following would indicate that the patient has a positive orthostatic set?

Standing blood pressure of 92/54 and heart rate of 106

Correctly assessing orthostatic vital signs involve:

Taking the blood pressure in the supine, seated, and standing positions

When applying the pulse oximeter sensor to a patient's finger, he asked you what it is for. Your response would be:

"It measures the amount of oxygen being carried by you r blood cells."

You have applied the pulse oximeter to a 73-year-old male complaining of weakness and heart palpations. Your partner reports the patient's breath sounds are clear and equal with a respiratory rate if 16 breaths per minute and skin that is warm but pal in color. He continues to state the following vital signs: pulse 92, blood pressure 168/70 mmHg, and spo2 90% on room air. Given this information, which one of the following instructions would be most appropriate?

"Lets give him high-concentration oxygen through a nonrebreather."