Secondary Assessment — All Questions

Which component of the patient history focuses on identifying medications the patient is currently prescribed?

You respond to a 68-year-old female complaining of chest discomfort. She states she takes “a small white pill every morning for her heart.” What is the most appropriate next question to clarify this specific medication?

You are assessing a 45-year-old male who was found unresponsive by his coworker. The patient is now responsive but confused. Who is the best source of information about the events that led to this episode?

You respond to a 72-year-old male with abdominal pain. He reports a history of diabetes, hypertension, and a previous heart attack. He takes metformin, lisinopril, and aspirin daily. He states he ate lunch two hours ago and the pain started about 30 minutes ago. Which finding from this history is most significant for your field impression?

What does the “E” in the SAMPLE history mnemonic stand for?

In the OPQRST mnemonic used to evaluate a patient’s pain, what does the “P” represent?

A 55-year-old male says his chest pain feels like “an elephant sitting on my chest.” Using OPQRST, which component is the patient describing with this phrase?

You are evaluating a 30-year-old female with abdominal pain. She states the pain started gradually about four hours ago and has been getting worse. She says the pain is in her lower right side and does not radiate anywhere. Which OPQRST components have you gathered from this information?

You are assessing a 62-year-old female who reports intermittent chest tightness for the past two days. Today the tightness became constant and she also feels short of breath. She says the discomfort worsens when she walks and improves when she sits still. She rates the discomfort as 5/10. Which OPQRST finding is most concerning and should prompt rapid transport?

What does the “S” in the SAMPLE history mnemonic represent?

What is the normal resting respiratory rate range for an adult patient?

You assess a 78-year-old female who fell at home. Her blood pressure is 98/60 mmHg, pulse is 110 and weak, respirations are 22, and her skin is cool and pale. Which vital sign pattern is most consistent with her presentation?

You are obtaining a blood pressure on a large patient and the standard adult cuff does not fit properly around the upper arm. What is the most appropriate action?

You are transporting a 50-year-old male with chest pain. His initial vital signs were BP 148/92, pulse 88, respirations 18, and SpO2 97%. After administering aspirin per protocol, you reassess and find BP 136/84, pulse 82, respirations 16, and SpO2 98%. How should you interpret this trend?

When assessing a patient’s pulse, which characteristics should the EMT evaluate?

During a secondary assessment of a trauma patient, what technique does the EMT use to systematically evaluate the entire body?

You are performing a secondary assessment on a patient involved in a motorcycle crash. When palpating the pelvis, the patient grimaces and you feel instability. What is the most appropriate next step?

During a secondary assessment of a responsive medical patient complaining of difficulty breathing, which type of physical exam is most appropriate?

You respond to a 22-year-old male who was assaulted. He is alert and oriented, complaining of left-sided rib pain. During your secondary assessment, you note tenderness over the left lower ribs, and the abdomen is rigid and tender in the left upper quadrant. What should this combination of findings lead you to suspect?

The mnemonic DCAP-BTLS is used during the physical exam to identify signs of injury. What does the “T” in DCAP-BTLS stand for?

How often should an EMT reassess vital signs on a stable patient during transport?

You are transporting a 40-year-old female with an allergic reaction. You administered epinephrine via auto-injector five minutes ago. During reassessment, you note her wheezing has improved, but her blood pressure has dropped from 118/76 to 90/58 mmHg and her heart rate increased from 96 to 120. What is the most appropriate action?

During transport, you reassess an unresponsive trauma patient and discover that the patient’s breathing has become shallow and irregular at 8 breaths per minute, down from 16 breaths per minute at the initial assessment. What is the most appropriate intervention?

You are transporting a patient with a femur fracture that you splinted on scene. During reassessment, you check the splinted extremity and find that the foot is now pale and cool with no palpable pedal pulse, although a pulse was present before splinting. What should you do?

How often should vital signs be reassessed on an unstable patient during transport?

What does a pulse oximeter measure?

You place a pulse oximeter on a patient who was rescued from a house fire. The device reads 99%. The patient is confused and has soot around the nose and mouth. How should you interpret this reading?

You are assessing a patient in a cold environment. You attempt to obtain a pulse oximetry reading from the patient’s finger, but the device is unable to detect a signal. What is the most likely cause?

You are treating a patient with difficulty breathing. The pulse oximeter reads 88% on room air. You apply a nonrebreather mask at 15 LPM. After five minutes, the SpO2 has only increased to 90%. The patient remains in respiratory distress with accessory muscle use and speaks in two-word sentences. How should you interpret this situation?

Below what SpO2 reading should an EMT consider a patient to be hypoxic and in need of supplemental oxygen?

What does the “A” in the SAMPLE history mnemonic stand for?

What does the “P” in the SAMPLE history mnemonic represent?

You respond to a 50-year-old male complaining of severe headache. While obtaining a SAMPLE history, he mentions he takes warfarin daily. Why is this medication history particularly significant for this patient?

You are assessing a 3-year-old child with a high fever. The child is crying and cannot provide a history. Which approach is most effective for obtaining the SAMPLE history?

You respond to a 60-year-old female with shortness of breath. She hands you a medication list containing metoprolol, furosemide, lisinopril, and potassium chloride. What underlying condition does this medication combination most strongly suggest?

You are assessing a 38-year-old male with abdominal pain. During SAMPLE history, he reports allergies to sulfa drugs and penicillin, takes no daily medications, has no past medical history, last ate six hours ago, and states the pain “just started out of nowhere.” Which SAMPLE component should prompt further investigation?

What does the “L” in the SAMPLE history mnemonic stand for?

You respond to a 55-year-old male who is confused and unable to provide a history. His wife is not home. You find the following in the kitchen: insulin in the refrigerator, a glucometer on the counter, an inhaler, and a pill organizer with compartments labeled for morning and evening. The morning compartment is full. What can you determine from these clues?

You are obtaining a history from a 70-year-old patient who speaks limited English. A family member offers to translate. What should you consider about using a family member as a translator?

During history-taking, a 42-year-old female with chest pain states she is allergic to aspirin. You were planning to administer aspirin per your chest pain protocol. What is the correct action?

When obtaining a SAMPLE history, why is asking about the patient’s last oral intake important?

You respond to a 22-year-old college student with a severe allergic reaction. She is wheezing and has hives. Her roommate says she ate at a new restaurant tonight. During SAMPLE history, the patient states she has no known allergies. How should you reconcile this information?

What does the “O” in OPQRST stand for?

What does the “R” in OPQRST represent?

A 48-year-old male describes his chest discomfort as “a tightness that feels like pressure.” He rates it 8 out of 10. The discomfort started while he was resting, and it radiates to his left shoulder. Deep breathing does not change the pain, but he says sitting forward slightly decreases it. Which OPQRST components have been addressed?

You are assessing a 35-year-old female with back pain. She describes the pain as “sharp and stabbing” that worsens with movement and improves when she lies still. Using OPQRST, which component does the relationship between movement and pain represent?

You assess a 70-year-old male with chest pressure. Using OPQRST, he reports the pressure started two hours ago (T), is substernal radiating to the jaw (R), feels like “squeezing” (Q), is 9/10 (S), started while watching television (O), and nothing makes it better or worse (P). Based on this OPQRST assessment, which finding is most concerning?

A patient rates her abdominal pain as 4/10 when lying still but 8/10 when you palpate the right lower quadrant. Which OPQRST components have you just assessed?

What does the “T” in OPQRST stand for?

You are assessing a 45-year-old female with right flank pain. She rates the pain as 10/10, describes it as “cramping waves that come and go,” and states the pain radiates to her groin. She is writhing on the couch and cannot find a comfortable position. Which OPQRST finding most strongly suggests a renal (kidney) stone?

When asking a patient about pain severity, which assessment technique provides the most consistent and documentable information?

What is the normal systolic blood pressure range for a healthy adult?

You are assessing a 6-year-old child. Which vital sign values should be considered normal for this age group?

You obtain a blood pressure of 88/54 mmHg on a patient who reports her “normal blood pressure is always around 90/60.” How should you interpret this reading?

You assess a 45-year-old trauma patient and find: blood pressure 132/86, heart rate 68, respiratory rate 14, SpO2 98%. Thirty minutes later during transport, you reassess and find: blood pressure 108/72, heart rate 94, respiratory rate 18, SpO2 97%. What does this trend indicate?

You are assessing a patient’s skin and find it hot, dry, and flushed red. Which condition is this skin finding most consistent with?

What is the normal capillary refill time for an adult, and how is it assessed?

You assess a patient with difficulty breathing and find: blood pressure 168/98, heart rate 110, respiratory rate 28, SpO2 89%, and bilateral crackles (rales) in the lungs. The patient is sitting upright and has pink frothy sputum. What condition do these vital signs and findings collectively suggest?

You are assessing an infant and need to obtain a heart rate. Which method is most accurate for this patient?

When assessing respiratory quality, which of the following characteristics should the EMT evaluate?

You obtain orthostatic vital signs on a patient who feels dizzy when standing. Lying down: BP 128/78, HR 72. Sitting: BP 122/76, HR 78. Standing: BP 96/60, HR 108. What do these findings indicate?

What does the mnemonic DCAP-BTLS help the EMT assess during the physical exam?

While performing a secondary assessment on a patient involved in a fall, you palpate the chest and feel a crackling sensation under the skin of the upper chest and neck. What does this finding indicate?

During a head-to-toe exam of a trauma patient, you observe clear fluid draining from the patient’s right ear. What should you suspect?

When performing auscultation of the chest during a physical exam, what should the EMT listen for?

You are assessing a 40-year-old male who was punched in the face during an altercation. During your physical exam of the face, you note asymmetry of the cheekbones and instability when you gently palpate the midface. What injury should you suspect?

During a secondary assessment of a patient struck by a car, you find that the right leg is shortened, externally rotated, and the patient cannot move it. There is no visible open wound. What does this physical exam finding indicate?

During a secondary assessment, what does checking “PMS” in the extremities refer to?

During the physical exam of a medical patient complaining of abdominal pain, you palpate the abdomen and find it rigid and board-like. The patient guards the area and withdraws from your touch. What does this finding suggest?

You assess an unresponsive patient and note unequal pupils: the left pupil is fixed and dilated while the right pupil is normal and reactive. What does this finding suggest?

During a physical exam of a patient with blunt chest trauma, you notice paradoxical chest wall movement where a section of the chest moves inward during inhalation and outward during exhalation. What does this finding indicate?

During the physical exam of a trauma patient, when should the EMT examine the posterior body (back)?

You are assessing a 65-year-old female who fell down a flight of stairs. She is alert and complains of neck pain and right arm weakness. She has normal strength in her left arm and both legs. Her pupils are equal and reactive. What does this pattern of findings suggest?

During your secondary assessment of a patient with suspected spinal injury, how should you assess for sensation in the extremities?

What are the key components of a patient reassessment during transport?

During transport, you reassess a patient with a suspected femur fracture that you splinted. The patient now reports worsening pain and numbness in the toes of the injured leg. The toes are pale and cool. What should you do?

You administered oral glucose to a patient with suspected hypoglycemia. During reassessment five minutes later, the patient’s mental status has improved from confused to alert and oriented. What does this improvement indicate?

You are transporting a patient with chest pain who received aspirin per protocol. During your first reassessment, the patient’s pain has decreased from 8/10 to 5/10, but the patient now appears pale and diaphoretic with a new complaint of nausea. How should you interpret this?

During reassessment, what should the EMT do if a patient’s condition changes significantly?

You are transporting a patient with a head injury. The patient was initially alert and oriented (GCS 15). During reassessment ten minutes into transport, the patient is now responding only to verbal stimuli and cannot follow commands. What does this decline indicate?

During transport, you reassess a burn patient and discover that a dry sterile dressing you applied to a forearm burn has become soaked through with fluid. The patient also reports increased pain at the burn site. What is the appropriate reassessment action?

You applied a tourniquet to a patient’s upper arm for uncontrolled hemorrhage from a forearm laceration. During reassessment, what specific finding related to the tourniquet must you check?

Why is trending vital signs during reassessment more valuable than a single set of vital signs?

What is the normal SpO2 range for a healthy adult breathing room air?

You place a pulse oximeter on a patient who has dark nail polish on all fingernails. The device displays an SpO2 of 82%, but the patient appears comfortable with no signs of respiratory distress. What should you do?

What does a blood glucose reading of 40 mg/dL indicate?

You obtain a blood glucose reading of 320 mg/dL on a patient who is confused, has rapid deep breathing, and has a fruity odor on the breath. What condition is suggested by these findings?

You are monitoring a patient with COPD who normally uses home oxygen at 2 LPM. The patient’s SpO2 on their home oxygen is 88%. You are considering increasing oxygen delivery. What is the appropriate approach for this patient?

You are attempting to obtain a blood glucose reading on a patient. The glucometer displays an “error” message. What should you do?

Which of the following factors can cause a falsely low pulse oximetry reading?

A patient with a known sickle cell disease history presents with severe pain. The pulse oximeter reads 91%. You know that sickle cell patients can have chronically lower SpO2 values. How should you manage this patient’s oxygen therapy?

You need to check blood glucose on an unresponsive patient. What is the correct technique for obtaining a capillary blood sample?

What information does an automated external defibrillator (AED) provide to the EMT beyond the ability to deliver a shock?

What does the “M” in the SAMPLE history mnemonic stand for?

You respond to a 35-year-old male with chest pain who tells you he takes “a blood thinner, a heart pill, and something for cholesterol” but cannot name any of the medications. What is the most helpful action to identify his medications?

You respond to a 78-year-old female who fell at home. She is alert and complains of hip pain. Her SAMPLE history reveals: allergies to codeine, medications include warfarin and amlodipine, past medical history of atrial fibrillation and hypertension, last ate four hours ago, and she tripped on a throw rug. Which combination of SAMPLE findings is most clinically significant for this patient?

A patient reports knee pain after twisting it during a basketball game. You ask, “On a scale of 0 to 10, how would you rate your pain?” The patient says “6.” You then ask, “What makes the pain worse?” The patient says, “Trying to straighten my leg or put weight on it.” Which OPQRST components have these two questions addressed?

When using OPQRST to assess pain, what information does the “Q” component seek?

A 40-year-old male describes chest pain that is sharp, worsens with deep breathing and lying flat, and improves when he leans forward. The pain is located in the center of his chest and does not radiate. Using OPQRST findings, which condition does this pattern most strongly suggest?

You are assessing a 25-year-old female with abdominal pain. She states the pain started suddenly three hours ago (O and T), is in the right lower quadrant (R), does not radiate, is sharp and constant (Q), is 7/10 (S), and worsens when she coughs or moves (P). Leaning forward does not help. What OPQRST component is most important to communicate to the hospital?

Why is it important to ask about radiation of pain during the OPQRST assessment?

You assess a patient and find the following skin signs: cool, clammy, and pale. Which condition is most consistent with these findings?

You are assessing a patient who has a blood pressure of 80/50, heart rate of 130, respiratory rate of 28, and cool mottled skin. What vital sign pattern is this, and what does it suggest about the patient’s compensatory mechanisms?

What is the normal respiratory rate range for an infant (birth to 1 year)?

You are auscultating blood pressure on a patient. You inflate the cuff to 180 mmHg and slowly deflate. You hear the first Korotkoff sound at 136 mmHg and the sounds disappear at 82 mmHg. What is the patient’s blood pressure?

During your physical exam of an unresponsive patient, you note that both pupils are dilated and fixed (non-reactive to light). What does this bilateral finding suggest?

During a physical exam, what assessment technique involves tapping on the body surface to evaluate underlying structures?

During transport, your patient who was initially alert and conversational becomes increasingly quiet and then stops responding to questions. Vital signs show a dropping blood pressure and rising heart rate. What should you do?

You administered albuterol to a patient with asthma. On reassessment, the patient’s wheezing has resolved and the respiratory rate has decreased from 28 to 20, but the patient now reports feeling jittery and their heart rate has increased from 88 to 116. How should you interpret these findings?

During reassessment, what should the EMT evaluate regarding oxygen therapy?

You are reassessing a patient with a suspected spinal injury who is secured to a long backboard. The patient complains of increasing difficulty breathing while lying flat. What should you consider?

You are using a blood glucose meter and the control solution test reads outside the acceptable range. What does this mean?

What is the clinical significance of a blood glucose reading below 60 mg/dL?

A patient with chronic anemia has a hemoglobin level that is chronically low. How might this affect pulse oximetry readings?

How does a pulse oximeter work to measure oxygen saturation?

You are treating a patient who takes metformin for diabetes. You check the blood glucose and it reads 210 mg/dL. The patient is alert and oriented with no acute complaints besides feeling “a little tired.” How should you interpret and act on this reading?

What is the primary goal of reassessment during patient transport?

You applied a nasal cannula at 4 LPM to a patient with mild respiratory distress. During reassessment, the SpO2 has improved from 91% to 96% and the patient reports feeling better. What should you do?

A patient reports headache pain that started gradually two days ago and has been getting progressively worse. The pain is bilateral and described as a constant pressure. Using OPQRST, what do these findings address?

During a physical exam of a trauma patient, you note jugular venous distention (JVD), muffled heart sounds, and narrowing pulse pressure (the difference between systolic and diastolic readings is decreasing). What condition does this triad of findings suggest?

You are caring for a 58-year-old diabetic patient who is confused and diaphoretic. You suspect hypoglycemia. Which device should you use to confirm your suspicion?

Which device is wrapped around the patient’s upper arm and inflated to measure arterial pressure?