Primary Assessment — All Questions

What is the primary purpose of forming a general impression during the primary assessment?

You arrive on scene and find a 72-year-old male sitting upright in a tripod position, using accessory muscles to breathe, and speaking only one or two words at a time. Based on your general impression, how should you categorize this patient?

You are dispatched to a residence for a fall. Upon entering the room, you see a 45-year-old female lying on the floor, conscious, with normal skin color, speaking clearly, and holding her left wrist. What is the most appropriate general impression?

You respond to a motor vehicle collision and find two patients. Patient A is ambulatory, alert, and complaining of neck pain. Patient B is unresponsive, slumped over the steering wheel with snoring respirations. Based on your general impression, which patient should you prioritize?

Which of the following is assessed as part of forming a general impression?

What does the acronym AVPU stand for in the assessment of a patient’s level of consciousness?

You approach a patient who is lying on the ground with eyes closed. When you shout, ‘Can you hear me?’ the patient opens their eyes briefly but does not speak. Using the AVPU scale, how would you classify this patient?

A 58-year-old male is found slumped in a chair. He does not respond to your voice. When you apply a trapezius squeeze, he moans and pulls away. What is his AVPU level?

You are reassessing a trauma patient who was initially alert and oriented. The patient now only opens their eyes and moans when you perform a sternal rub. What does this change in mental status most likely indicate?

A patient who is awake, knows who they are, where they are, the date, and what happened is described as being oriented to which components?

Which airway maneuver should be used first when opening the airway of an unresponsive patient with a suspected spinal injury?

You are treating an unresponsive patient who has no gag reflex after a head-tilt, chin-lift maneuver has been performed. Which airway adjunct is most appropriate to help maintain the airway?

A semiconscious patient with a gag reflex is making gurgling sounds. After suctioning the airway, which adjunct should you consider inserting?

You are ventilating an unresponsive patient with a BVM. Despite having an OPA in place, you notice the patient’s chest is not rising with ventilations. You have repositioned the head and ensured a good mask seal. What should you do next?

How is the correct size of an oropharyngeal airway (OPA) determined?

What is the normal respiratory rate range for an adult at rest?

A 67-year-old female with a history of COPD is breathing at a rate of 28 breaths per minute with diminished breath sounds bilaterally. Her SpO2 reads 86% on room air. She is alert and speaking in short phrases. What is your most appropriate initial action?

You are assessing a patient who was found unresponsive. The patient has a respiratory rate of 6 breaths per minute with shallow chest rise. What should you do?

A patient involved in a motorcycle crash is alert and complaining of chest pain on the right side. His respiratory rate is 24, and you notice decreased breath sounds on the right with visible chest wall bruising. His SpO2 is 92%. What condition should you suspect?

Which of the following is a sign of inadequate breathing in an adult patient?

During the primary assessment, where should the EMT check for a pulse in an unresponsive adult patient?

You are assessing a conscious patient who was involved in a car crash. The patient has a radial pulse that is rapid and weak. Their skin is cool, pale, and diaphoretic. What do these findings suggest?

While assessing a responsive 8-year-old child, you are unable to palpate a radial pulse but can feel a carotid pulse. The child has cool, mottled skin on the extremities. What does the absence of a radial pulse in this child suggest?

A 30-year-old construction worker fell from a scaffold. He is alert, anxious, and complaining of abdominal pain. His pulse is 122 and thready, respirations are 26, skin is pale and diaphoretic, and capillary refill is 4 seconds. What is the most likely explanation for these findings?

You are treating a 45-year-old male who was stabbed in the chest. He is alert, tachypneic, and has diminished breath sounds on the left. When should you transport this patient?

A 22-year-old female twisted her ankle while jogging. She is alert, oriented, has stable vital signs, and her only complaint is pain and swelling at the right ankle. What is the most appropriate transport decision?

You respond to a 78-year-old female complaining of sudden severe headache, confusion, and left-sided weakness that began 30 minutes ago. The nearest hospital is 10 minutes away but lacks stroke intervention capabilities. A comprehensive stroke center is 25 minutes away. Your local protocol directs you to bypass closer facilities for suspected stroke when the additional transport time is less than 30 minutes. Which transport decision is most appropriate?

Which of the following patients would most likely require rapid transport to a trauma center?

What is the definition of a chief complaint?

You respond to a call for a 55-year-old male with “chest pain.” Upon arrival, the patient states, “My stomach has been hurting all morning.” How should you document the chief complaint?

An elderly patient is found sitting on the floor, alert but confused. She cannot tell you why she called 911. Her daughter states that she found her mother on the floor and she was not acting like herself. How should you approach the chief complaint?

You are assessing a patient who opens his eyes only when you pinch his trapezius muscle, speaks in confused and disorganized sentences, and localizes to pain by reaching toward the stimulus with his opposite hand. Using the Glasgow Coma Scale, what is this patient’s GCS score?

Which of the following is considered an immediate life threat that must be addressed during the primary assessment?

You arrive to find a 25-year-old male who was assaulted. He is responsive to verbal stimuli with snoring respirations, has a large laceration on his scalp with active bleeding, and a deformed left femur. In what order should you address these findings?

A patient has been stung by a bee and is now experiencing facial swelling, audible stridor, and widespread hives. What is the most immediate life threat?

You are assessing a patient with a gunshot wound to the right upper chest. The patient is alert but increasingly anxious. Breath sounds are absent on the right, the trachea appears shifted to the left, and neck veins are distended. What life-threatening condition do you suspect?

Which of the following findings during a primary assessment indicates a life-threatening circulatory problem?

What is the correct compression-to-ventilation ratio for single-rescuer CPR on an adult patient?

At what rate should chest compressions be performed on an adult during CPR?

You arrive to find a 60-year-old male in cardiac arrest. A bystander is performing CPR. Your partner retrieves the AED. After applying the pads, the AED analyzes the rhythm and advises “No shock advised.” What should you do next?

You are performing CPR on a 5-year-old child with your partner. What compression-to-ventilation ratio should you use?

You are performing CPR on a cardiac arrest patient when the AED advises a shock. After delivering the shock, you notice the patient has begun gasping irregularly but has no palpable pulse. What is your next action?

What is the approximate oxygen concentration delivered by a nonrebreather mask at 15 liters per minute?

A 50-year-old female complains of mild shortness of breath after climbing stairs. Her SpO2 is 95%, and she has clear lung sounds bilaterally. She states she cannot tolerate anything covering her face. Which oxygen delivery device is most appropriate?

You are treating a patient in severe respiratory distress with an SpO2 of 82%. You apply a nonrebreather mask at 15 liters per minute, but the SpO2 does not improve and the patient’s mental status is declining. What should you do next?

What is the minimum flow rate for a nasal cannula?

A patient with a history of COPD is in moderate respiratory distress with an SpO2 of 88%. A family member says the patient’s doctor told them to “keep the oxygen low.” How should you manage this patient’s oxygen therapy?

What is the first step in controlling external bleeding from an extremity wound?

A patient has a deep laceration on the upper thigh with bright red blood spurting from the wound. Direct pressure with a bulky dressing is not controlling the bleeding. What should you do next?

You respond to an industrial accident where a worker has a deep wound to the axillary (armpit) region with significant hemorrhage. A tourniquet cannot be placed proximal to this wound. What is the most appropriate intervention?

A patient has a large laceration on the forearm with dark red blood flowing steadily from the wound. You apply a pressure dressing, but blood continues to soak through. After applying a second pressure dressing over the first, the bleeding slows but does not stop completely. What should you do?

When a tourniquet is applied to control life-threatening extremity bleeding, what important information must be documented?

Which of the following is the correct position for managing a patient in hypovolemic shock?

A 35-year-old male was involved in a rollover crash and is now unresponsive with a heart rate of 130, blood pressure of 80/50, and cold, clammy skin. What is the most important treatment for this patient?

A patient who was stung by a wasp is now experiencing difficulty breathing, generalized hives, and a blood pressure of 70/40. You recognize this as anaphylactic shock. The patient has a prescribed epinephrine auto-injector. What is your priority action?

A 19-year-old male dove into shallow water and is now lying supine on the beach. He is conscious but cannot move his arms or legs. His heart rate is 54, blood pressure is 80/50, and his skin below the neck is warm, dry, and flushed. What type of shock do you suspect?

You are treating a patient in shock who is not responding to your interventions. The patient is restless, has a heart rate of 140, blood pressure of 60/40, and is becoming increasingly confused. What stage of shock does this presentation most likely represent?

Which of the following is a key component of shock management at the EMT level?

During the general impression, which of the following best describes what the EMT evaluates about the patient’s skin?

Which of the following patient positions observed during the general impression suggests significant respiratory distress?

The general impression is often described as taking place within what timeframe upon first encountering the patient?

Which of the following components is included in the Pediatric Assessment Triangle used to form a general impression of a child?

You arrive at a nursing home and find an 80-year-old female in bed. She is awake, making eye contact, and speaking in full sentences. Her skin appears warm and pink. She tells you she has had diarrhea for two days. Based on your general impression, how should you categorize this patient?

You respond to a playground where a 4-year-old child fell from the monkey bars. Using the Pediatric Assessment Triangle, you observe the child is crying loudly, has no abnormal breathing sounds or retractions, and has pink skin. What does this general impression indicate?

You are called to an office building for a 38-year-old male who collapsed. Upon entering the room, you see the patient lying on the floor, unresponsive, with cyanosis around his lips and no visible chest rise. What does your general impression tell you?

You respond to a call for a diabetic emergency. Upon arrival, you find a 52-year-old male seated at the kitchen table. He is confused, sweating profusely, and his skin is pale. His wife says he has not eaten all day. What does your general impression suggest?

You respond to a report of a person down. On arrival, you see a 60-year-old male lying face down on the sidewalk. You notice a strong odor of alcohol and an empty liquor bottle nearby. How should you approach your general impression?

You arrive at a residence for a 70-year-old female with abdominal pain. She is lying on the couch in the fetal position, moaning, with her knees drawn to her chest. Her skin appears ashen and she is diaphoretic. Based on your general impression, what should you determine?

You respond to a 911 call for a child not acting right. You find a 2-year-old sitting in his mother’s lap. Using the Pediatric Assessment Triangle, you observe the child has a blank stare, is not interacting with you, has audible wheezing with visible intercostal retractions, and has mottled skin on the extremities. What is your general impression?

You respond to a residence where a 65-year-old male is sitting in a recliner. He is alert, conversational, and denies any complaints. His wife called 911 because she noticed his speech sounded slightly different than usual over the past hour. His skin is warm, pink, and dry. Based on your general impression, the patient appears not sick. Should you rely solely on this impression?

You arrive at a park where a 30-year-old female is sitting on a bench, alert and oriented. She says she feels fine now but had an episode of severe chest tightness and difficulty breathing that lasted about 10 minutes and resolved on its own. Her skin is warm, pink, and dry, and she has no visible distress. How should this information influence your general impression?

You are dispatched to a residential fire where a 45-year-old male has been pulled from a smoke-filled room by firefighters. He is sitting upright, alert, and speaking clearly. He has soot around his nostrils and mouth. His skin is flushed and he has a mild cough. Your general impression is that the patient appears stable. Which factor should cause you to reconsider this impression?

You respond to a call for a 16-year-old male who fainted at school. On arrival, the patient is alert, oriented, and embarrassed. He says he locked his knees while standing for a long time in the gym. His skin is warm and pink, and he has no complaints. His friends confirm the story. Your partner says, ‘He just fainted; we can clear him.’ What is the most appropriate response?

A patient who is alert and oriented to person, place, time, and event is documented as which of the following?

Which painful stimulus is considered appropriate for assessing responsiveness to pain in an unresponsive patient?

On the AVPU scale, a patient classified as ‘V’ demonstrates which of the following responses?

Which finding would cause an EMT to classify a patient as having an altered mental status?

When documenting a patient’s orientation status, which of the following is the typical order in which orientation is lost as mental status deteriorates?

You respond to a call for a 75-year-old female who fell in her bathroom. She is sitting on the floor, eyes open, and staring at you. When you ask her name, she mumbles incoherently and does not follow commands. Using AVPU, how would you classify her level of consciousness?

You are assessing a 42-year-old male found lying in an alley. He does not open his eyes or respond when you call out to him. When you apply a trapezius pinch, he flexes his arms toward the stimulus and moans. What is his AVPU classification?

You are assessing a 28-year-old female who took an unknown quantity of sleeping pills approximately one hour ago. She opens her eyes when you call her name and follows simple commands such as squeezing your fingers, but she quickly falls back to sleep when you stop speaking to her. How would you classify her on the AVPU scale?

You are called to a residence for a 68-year-old male with a history of diabetes. His wife states he has been “acting strange” for the past 30 minutes. The patient is awake, knows his name, but thinks he is at the grocery store and says the year is 1998. What is his orientation status?

You respond to a seizure call for a 35-year-old female. Upon arrival, the active seizure has stopped. The patient’s eyes are closed, and she does not respond to your voice. When you apply a painful stimulus, she opens her eyes momentarily and then withdraws her arm. Two minutes later, she begins to moan and open her eyes on her own. What does this progression indicate?

You are transporting a trauma patient who was initially alert and oriented times four. During transport, you notice the patient is now only responding to your voice and cannot tell you where they are. What is the significance of this change?

You respond to a bar for a 50-year-old male who appears intoxicated. He has slurred speech, an unsteady gait, and smells strongly of alcohol. He is alert but disoriented to time. The bartender says the patient had several drinks and then suddenly began acting confused. Which approach is most appropriate?

You are assessing a 78-year-old female in a nursing home. She is responsive to verbal stimuli, but staff tells you this is her baseline mental status due to advanced dementia. Her vital signs are stable and unchanged from her last recorded vitals. How should you factor this information into your assessment?

You respond to a 911 call for a 22-year-old college student found unresponsive in her dorm room. She does not respond to voice or pain. Her roommate found medication bottles nearby, some of which are empty. Her respiratory rate is 6 breaths per minute and her pupils are pinpoint. Based on the level of consciousness and other findings, what should you prioritize?

You are called to a construction site for a worker who fell approximately 15 feet. He is alert and oriented times four, has stable vital signs, and his only complaint is mild back pain. Five minutes later during your reassessment, he becomes increasingly confused and agitated, cannot remember what happened, and begins repeating the same questions. What is the most appropriate action?

What is the most common cause of airway obstruction in an unresponsive patient?

How is the correct size of a nasopharyngeal airway (NPA) determined?

When suctioning the oropharynx of an adult patient, what is the maximum duration for each suction attempt?

Which of the following is a contraindication for inserting a nasopharyngeal airway?

When inserting an oropharyngeal airway in an adult, the device is initially inserted with the tip pointing toward which direction?

You are managing an unresponsive trauma patient with blood pooling in the back of the throat. You have a rigid suction catheter attached to the suction unit. How should you properly suction the airway?

You are called to a restaurant for a 55-year-old male who is choking. He is conscious, clutching his throat, and cannot speak or cough. What is the most appropriate immediate intervention?

You are ventilating an unresponsive patient using a BVM with an OPA in place. You notice that with each ventilation, the patient’s abdomen is distending rather than the chest rising. What is the most likely cause and appropriate correction?

You respond to a call for a 10-year-old child who is unresponsive after being pulled from a swimming pool. The child has no gag reflex and you need to insert an OPA. How does the insertion technique differ from the adult technique?

You are treating a semiconscious patient who has vomited. After suctioning, the patient continues to have copious secretions draining into the oropharynx. The patient has a gag reflex. Which airway management strategy is most appropriate?

You arrive at a scene where an 8-month-old infant is choking on a small toy. The infant is conscious but cannot cry or cough and is turning cyanotic. What is the correct sequence of interventions?

You are treating an unresponsive patient involved in a motor vehicle collision. The patient has blood in the airway and suspected cervical spine injury. You need to open the airway and suction. Which combination of techniques is most appropriate?

You are managing an unresponsive patient with a BVM. You inserted an OPA, but the patient begins to gag and vomit. After removing the OPA and suctioning, the patient remains unresponsive but now has a gag reflex. The airway needs to be maintained. What is your best course of action?

You respond to a house fire where a 40-year-old female was rescued from a bedroom filled with heavy smoke. She is alert and speaking in a hoarse voice. You notice singed nasal hairs, soot in her mouth, and mild facial burns. She states she feels fine and wants to refuse transport. What is your primary concern?

You are ventilating an apneic adult patient with a BVM connected to supplemental oxygen. Your partner is maintaining a jaw-thrust while you squeeze the bag. Despite proper head positioning and a good mask seal confirmed by two-hand technique, the chest is not rising. You have already suctioned and found no visible obstruction. What should you consider next?

Which of the following breath sounds, heard without a stethoscope, indicates a partial upper airway obstruction?

When assessing breathing during the primary assessment, what does the EMT evaluate using the ‘look, listen, and feel’ approach?

What is the normal tidal volume for an average adult at rest?

Which of the following is a sign that a patient is using accessory muscles to breathe?

You respond to a 50-year-old male complaining of difficulty breathing. He is speaking in three to four word sentences between breaths, his respiratory rate is 30, and you observe nasal flaring and supraclavicular retractions. His SpO2 is 89% on room air. How would you classify his breathing status?

You are assessing a 3-year-old child in respiratory distress. The child is sitting in her mother’s lap, has audible wheezing, nasal flaring, and intercostal retractions. Her respiratory rate is 44 breaths per minute. Which of the following respiratory rates helps confirm that this child’s breathing is abnormal?

You respond to a call for a 24-year-old male who was punched in the left side of the chest during an altercation. He is alert and anxious. His respiratory rate is 22, and he says it hurts to take a deep breath. You notice decreased chest expansion on the left side compared to the right. What do these findings suggest?

You are called to a residence for a 70-year-old female with a history of heart failure. She is sitting upright in a chair, unable to lie flat. Her respiratory rate is 26, and you auscultate crackles (rales) bilaterally in the lung bases. She has pink, frothy sputum at her lips. What do these findings indicate about her breathing status?

You respond to a 911 call for a 17-year-old male having an asthma attack. He is sitting upright, has audible expiratory wheezing, a respiratory rate of 32, and an SpO2 of 91%. He has his prescribed albuterol inhaler. After assisting with the inhaler, his wheezing decreases and his SpO2 improves to 95%. What should you do next?

You are assessing an unresponsive patient and observe occasional, irregular, gasping breaths occurring approximately 4 times per minute. There is minimal chest rise with each gasp. How should you classify and manage this breathing pattern?

You respond to a call for an infant who is “breathing funny.” The 6-month-old is awake and crying intermittently. You observe a respiratory rate of 50 breaths per minute with mild subcostal retractions but no cyanosis. The infant’s skin is pink and warm. How should you interpret these findings?

You are assessing a 55-year-old female who called 911 for difficulty breathing. She can speak in full sentences, has a respiratory rate of 20 breaths per minute, clear and equal breath sounds, and an SpO2 of 97% on room air. She states she feels short of breath when she walks to the kitchen but is comfortable at rest. How should you manage this patient?

You respond to a call for a 62-year-old male with COPD who is in severe respiratory distress. He is sitting upright, cyanotic, with a respiratory rate of 8 breaths per minute and very shallow chest rise. He was previously tachypneic and agitated but has now become quiet and appears drowsy. What does this change in presentation most likely indicate?

You are treating a 35-year-old female who was stabbed in the right chest. She has a respiratory rate of 28, diminished breath sounds on the right, and jugular vein distension. Her SpO2 is 88% and dropping despite high-flow oxygen via nonrebreather mask. Her trachea appears midline. Which finding, if it develops, would suggest the patient’s condition is critically worsening?

You are assessing a 45-year-old female who complains of sudden onset shortness of breath. She has no history of respiratory disease. Her respiratory rate is 24, breath sounds are clear and equal bilaterally, SpO2 is 93% on room air, and she appears anxious. She states her right calf has been swollen and painful for the past three days. Which condition should you suspect based on these findings?