You find an adult lying on a sidewalk with the eyes closed. The patient does not respond when you speak loudly, but groans and pulls the arm away when you pinch the muscle at the top of the shoulder. How do you record the mental status on the AVPU scale?
Choose the one best answer.
Correct. The patient groaned and withdrew only after a painful stimulus. That is P.
Wrong. Unresponsive means no response even to pain. Withdrawal from the pinch is a response.
Wrong. An alert patient has the eyes open and interacts with you without being prompted. This patient did neither.
Wrong. A loud voice got no response at all, so the patient does not reach the V level.
Scene size-up and safety
A man calls because his wife fell in the kitchen. When you knock, a large dog behind the screen door barks and growls at you. The husband waves you in and says the dog is friendly. What do you do?
Choose the one best answer.
Wrong. A bag held out in front is not a barrier against a dog that decides to bite. Have the animal secured instead.
Wrong. An injured crew cannot help anyone. A growling dog is a hazard to remove first, however urgent the call sounds.
Wrong. Animal control is for when no one can secure the animal. Here the owner can, so waiting only delays care.
Correct. The owner can secure the dog in moments. Once it is behind a closed door, you can enter and care for his wife.
Primary assessment
Your partner is doing chest compressions on an adult in cardiac arrest when you arrive with the AED. Arrange the steps for using it.
Put every step in the order you would do it. This item is correct only if the whole list is right.
Steps still to place
Your order
Step 1, correct. Turn the AED on. Turning the AED on starts the voice prompts that guide the rest of the sequence.
Step 2, correct. Attach the pads to the bare chest. Pads go on the bare, dry chest after the device is on. Compressions continue while they are placed.
Step 3, correct. Tell everyone to stand clear while the AED analyzes the rhythm. Movement and touching can interfere with the rhythm analysis, so everyone stands clear.
Step 4, correct. Make sure no one is touching the patient, then press the shock button when advised. The shock is delivered only after you confirm no one is in contact with the patient.
Step 5, correct. Resume chest compressions right away. After the shock you go straight back to compressions. A pulse check comes after about 2 minutes of CPR.
Patient treatment and transport
A woman who is 34 weeks pregnant felt faint while lying flat on her back on the couch. There was no fall or other trauma. She is pale and dizzy, and her blood pressure is 88/56. How do you position her?
Choose the one best answer.
Wrong. Sitting a patient upright with a low blood pressure can make the dizziness worse.
Wrong. Raising the legs keeps her on her back, so the uterus still presses on the vena cava.
Correct. The left side moves the uterus off the inferior vena cava, so more blood returns to the heart.
Wrong. A pillow under the head does nothing to take the uterus off the vena cava.
Operations
At a mass-casualty incident you are using START triage. An adult cannot walk, is breathing 34 times a minute, has a radial pulse, and follows your commands. Which category do you assign?
Choose the one best answer.
Wrong. The patient is breathing on their own, so the black tag does not apply.
Wrong. Minor is for patients who can walk. This patient cannot.
Correct. A rate above 30 is the respiratory trigger for an immediate tag in START.
Wrong. Delayed fits a patient who cannot walk but has a rate of 30 or less, a radial pulse, and follows commands.
Secondary assessment
During the secondary assessment of a patient with chest pain, you take a SAMPLE history. Match each statement to the part of SAMPLE it answers.
Select one choice in each row. This item is correct only if every row is right.
Allergies
Medications
Pertinent past history
Last oral intake
Events leading up
"I ate a sandwich about two hours ago."
"Penicillin gives me hives."
"I was carrying boxes up the stairs when it started."
"I had a stent put in my heart last year."
"I take a water pill every morning."
Correct: Last oral intake. When the patient last ate or drank is the L in SAMPLE.
Correct: Allergies. A reaction to a drug is an allergy, the A in SAMPLE.
Correct: Events leading up. What the patient was doing when the pain began is the E, events leading up.
Correct: Pertinent past history. A prior heart procedure is pertinent past history, the P.
Correct: Medications. A diuretic taken every day is a current medication, the M.
Patient treatment and transport
A patient fell on an outstretched hand and has a painful, deformed forearm with a strong radial pulse. Arrange the steps for splinting it. One step does not belong.
Put the steps that belong in the order you would do them, and leave out any step that does not belong. This item is correct only if the whole list is right.
Steps still to place
Your order
Step 1, correct. Hold the arm still by hand, then check pulse, movement, and sensation below the injury. Holding the arm still prevents more damage, and the first distal check gives a baseline to compare with after splinting.
Step 2, correct. Place a padded rigid splint along the forearm, reaching past the wrist and the elbow. Immobilizing the joint above and the joint below keeps the broken bone ends from moving.
Step 3, correct. Secure the splint with roller gauze, leaving the fingertips exposed. The splint is secured after it is placed. Leaving the fingertips exposed lets you recheck color and sensation.
Step 4, correct. Recheck pulse, movement, and sensation below the injury. The final check shows the splint did not cut off circulation or nerve function. It comes after the splint is secured.
Does not belong. Pull the hand firmly to straighten the forearm before you splint it. Pulling on a deformed arm that still has a good pulse can cause more injury. It is splinted as found.
Secondary assessment
A patient has chest pain and you use OPQRST to ask about it. Match each statement to the part of OPQRST it answers.
Select one choice in each row. This item is correct only if every row is right.
Onset
Provocation
Quality
Region and radiation
Severity
Time
"It's about a 7 out of 10."
"It feels like someone is stabbing me."
"It started all at once while I was watching TV."
"It began about 40 minutes ago."
"It goes from my chest into my left arm."
"It gets worse when I take a deep breath."
Correct: Severity. A pain score from 0 to 10 is severity, the S.
Correct: Quality. How the pain feels in the patient's own words is its quality, the Q.
Correct: Onset. What the patient was doing and whether it began suddenly or gradually is the onset, the O.
Correct: Time. How long ago the pain began is time, the T.
Correct: Region and radiation. Where the pain is and where it spreads is region and radiation, the R.
Correct: Provocation. What makes the pain worse or better is provocation, the P.
Primary assessment
A 3-year-old pulled from a backyard pool has a strong pulse of 110 but is breathing only a few gasps a minute. You open the airway and begin bag-mask ventilation. At what rate do you ventilate?
Choose the one best answer.
Wrong. Every 6 seconds is the adult rescue-breathing rate. A child needs faster ventilation.
Correct. This matches current AHA pediatric guidance of 20 to 30 breaths a minute for a child with a pulse.
Wrong. Every 3 to 5 seconds was the older pediatric rate. The guideline has since been raised.
Wrong. A breath every second is hyperventilation. It raises chest pressure and fills the stomach with air.
Primary assessment
An adult with a deformed, swollen thigh after a motorcycle crash may be bleeding internally. Which findings are early signs that the body is compensating for blood loss? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Wrong. Hypotension appears when compensation is failing. It is a late sign, not an early one.
Correct. A rising heart rate is one of the first ways the body keeps up output after blood loss.
Correct. Reduced blood flow to the brain often shows first as restlessness or anxiety.
Correct. Vessels in the skin constrict to send blood to the core, so the skin turns pale, cool and sweaty.
Wrong. Warm, flushed skin points away from blood loss. Bleeding patients clamp down the vessels in the skin.
Scene size-up and safety
On a cold morning you are called to a house for a woman with a headache and nausea. Her husband and teenage son say they have headaches too. The furnace has been running all night. What do you do first?
Choose the one best answer.
Wrong. A standard pulse oximeter can read normal in carbon monoxide poisoning, so a good number does not clear the scene.
Correct. Several people with the same symptoms in one heated house points to a hidden hazard. Leave it and call fire.
Wrong. Oxygen helps, but treating inside keeps the patients and the crew in the gas.
Wrong. Opening windows does not make the house safe, and you are still breathing the same air.
Primary assessment
A man was stabbed in the right side of the chest. Each time he breathes you hear air moving through the wound, and blood bubbles at the site. You have covered it with your gloved hand. What is the most appropriate care for the wound?
Choose the one best answer.
Correct. An airtight dressing stops air entering through the wound. Watching breathing catches a tension pneumothorax building under the seal.
Wrong. An open wound lets more air in with each breath and the lung can collapse. Cover it right away.
Wrong. Packing gauze into a chest wound does not seal it and can push material into the chest. Chest wounds are sealed, not packed.
Wrong. Gauze lets air pass through, so a dry pad does not seal the wound however much you add.
Primary assessment
You form a general impression of a sick 10-month-old from the doorway using the pediatric assessment triangle. Sort each finding into the part of the triangle it belongs to.
Place every finding. This item is correct only if every finding is in the right column.
Does not look at or follow the parent's face
Correct column: Appearance. How the child looks at people and things is part of appearance. A child who does not track the parent's face may have poor brain perfusion or oxygenation.
Head bobs with each breath
Correct column: Work of breathing. Head bobbing shows the child is using neck muscles to breathe, a sign of increased work of breathing.
Mottled skin on the arms and legs
Correct column: Circulation to the skin. Mottling shows poor blood flow to the skin, part of circulation.
Weak cry, and cannot be comforted by the parent
Correct column: Appearance. The strength of the cry and whether the child can be soothed are both part of appearance. A weak cry and a child who cannot be comforted are worrying signs.
Grunting at the end of each breath
Correct column: Work of breathing. Grunting is an abnormal airway sound that shows increased work of breathing.
Pale lips and skin
Correct column: Circulation to the skin. Pallor is a sign of poor circulation to the skin.
Patient treatment and transport
An older woman was found outside in the cold after wandering from her home overnight. Her clothes are damp. She is confused, her skin is cold, and she has stopped shivering. She has a pulse and is breathing adequately. What is the most appropriate care?
Choose the one best answer.
Wrong. Rubbing the limbs can damage cold tissue, and rough handling can trigger a dangerous heart rhythm in a cold patient.
Correct. Gentle handling protects a cold, irritable heart, and getting her dry and covered in a warm space stops further heat loss.
Wrong. A confused patient may choke on fluids, so nothing goes by mouth in moderate hypothermia.
Wrong. Exertion pushes cold blood from the limbs back to the core and can set off a deadly rhythm. She should be carried.
Patient treatment and transport
A 17-year-old collapsed during football practice on a hot afternoon. He is confused and combative, and his skin is hot to the touch. A cold-water tub is set up at the field. What is the most important treatment?
Choose the one best answer.
Wrong. Slow cooling leaves the brain and organs hot for longer. Heat stroke needs fast cooling.
Wrong. Rest and fluids treat heat exhaustion. A confused patient cannot safely drink, and this is heat stroke.
Wrong. Every minute at a high temperature adds damage. Cooling is not delayed for a measurement.
Correct. Cold-water immersion cools fastest, and how long the body stays hot drives the damage. Cool, then transport.
Primary assessment
After the primary assessment, which patients should be treated as high priority for rapid transport? Select every patient that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. Responding but not following commands is an altered mental status, a sign of a problem with the brain, its oxygen, or its blood flow.
Wrong. Back strain with normal vital signs and normal strength has no sign of a life threat. Assess further, but it is not high priority.
Correct. Chest pain with a systolic pressure under 100 suggests poor perfusion from a heart problem. This patient needs rapid transport.
Wrong. An isolated limb injury with mild pain and good circulation is not a threat to life. Splint it and reassess on the way.
Correct. Bleeding that will not stop with direct pressure is uncontrolled bleeding, and the patient keeps losing blood until a hospital can stop it.
Operations
You are using SALT triage at a train derailment. You ask everyone who can walk to move to a marked area, then ask everyone who is left to wave an arm or a leg. Which group do you assess individually first?
Choose the one best answer.
Wrong. Patients who can walk are the least likely to need lifesaving care, so they are assessed last.
Correct. A patient who cannot walk or wave is the most likely to need a lifesaving intervention, so this group is assessed first.
Wrong. Distance from the ambulances has nothing to do with need. SALT sorts by how patients respond to commands.
Wrong. Waving shows a working airway and some brain function. These patients come second.
Scene size-up and safety
During scene size-up you look at the mechanism of injury. Which findings point to a high-risk mechanism, where you should suspect serious injury even if the patient looks well? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Wrong. A fall from standing in a healthy young adult is a low-energy event. Older adults and patients on blood thinners are a different story.
Correct. Being ejected exposes the body to huge, unpredictable forces. Ejection is a high-risk mechanism on its own.
Correct. A fall of about 20 feet is well past the 10-foot height that makes a fall a high-risk mechanism.
Wrong. A walking-speed bump with a belt on transfers little energy. Assess the patient, but the mechanism itself is not high risk.
Correct. A death in the same passenger compartment shows how much force the occupants took, so the survivors may be seriously hurt too.
Primary assessment
A patient has severe bleeding from a deep wound on the thigh. You placed a tourniquet 2 to 3 inches above the wound and tightened the windlass until it will not turn any further, but bright red blood is still flowing from the wound. What do you do next?
Choose the one best answer.
Correct. Leave the first tourniquet in place and add a second just above it, closer to the torso. Together they compress a wider stretch of the limb.
Wrong. Elevation does not stop arterial bleeding, and waiting lets the patient keep losing blood.
Wrong. Pressure points are not a reliable way to stop limb bleeding, and taking the tourniquet off throws away the control you have.
Wrong. Loosening it lets the bleeding restart in full, and a tourniquet placed over the wound itself cannot squeeze the vessel above the injury.
Operations
At a school bus crash you are triaging children who cannot walk, using JumpSTART. Sort each child into a triage category.
Place every finding. This item is correct only if every finding is in the right column.
Breathing 50 times a minute
Correct column: Immediate (red). A child breathing more than 45 times a minute is tagged immediate in JumpSTART.
Breathing 28 times a minute, has a palpable peripheral pulse, and answers you appropriately
Correct column: Delayed (yellow). A rate between 15 and 45, a peripheral pulse, and an appropriate response to voice make this child delayed.
Not breathing after you position the airway, has a palpable peripheral pulse, and is still not breathing after 5 rescue breaths
Correct column: Deceased or expectant (black). A child who stays apneic after the airway is positioned and 5 rescue breaths are given is tagged deceased or expectant.
Not breathing after you position the airway, has a palpable peripheral pulse, and starts breathing after 5 rescue breaths
Correct column: Immediate (red). Breathing that returns after rescue breaths makes the child immediate, not black.
Breathing 24 times a minute with no palpable peripheral pulse
Correct column: Immediate (red). The rate is in range, but a missing peripheral pulse means poor perfusion, which is immediate.
Original study items. Not an official examination, not affiliated with the National Registry of Emergency Medical Technicians, and not medical advice.