Secondary Assessment — EMT Basic NREMT practice questions

Adult burns — head represents what % of TBSA per Rule of 9s?

1. 4%
2. 9%
3. 18%
4. 36%

Answer: B — 9%

A) Pediatric arm/leg approx. B) Correct — adult head = 9%. C) Trunk anterior or posterior. D) Both legs combined.

Why do many older adults present with a blunted or absent fever response even during serious infection?

1. age-related decline in the body's thermoregulatory and immune response to infection
2. routine use of acetaminophen masking any temperature elevation
3. lower resting body temperature that makes any infection appear as fever
4. increased subcutaneous fat providing extra insulation that raises baseline temperature

Answer: A — age-related decline in the body's thermoregulatory and immune response to infection

A) Correct - aging is associated with a decline in immune responsiveness and thermoregulatory efficiency, so the febrile response to infection is frequently blunted or absent, which is a key reason EMS should not use a normal temperature to rule out serious infection in this population. B) While antipyretics can mask fever, the physiologic blunting occurs independent of medication use and is the primary mechanism tested here. C) Baseline temperature is often slightly lower in older adults, which would make a true fever less likely to be recognized, not more, and this option misstates the relationship. D) Subcutaneous fat changes do not meaningfully explain blunted fever response.

A patient with a chief complaint of "leg swelling for two weeks" is now also short of breath at rest with a sudden onset today. Which statement is MOST accurate?

1. The chronic leg swelling is the priority since it started first
2. The new acute shortness of breath is the priority problem
3. The two findings are unrelated and only the leg should be assessed
4. The chief complaint cannot change once stated

Answer: B — The new acute shortness of breath is the priority problem

B) Correct — the acute change in breathing outranks the chronic complaint and reframes the call; the presenting complaint is not always the life threat. A) Chronological order does not establish priority. C) Dismissing a possible relationship narrows thinking prematurely. D) The EMT's understanding of the problem is expected to evolve as assessment proceeds.

Which statement about assessing pain and injury in geriatric patients is MOST accurate?

1. Older adults typically report pain more intensely than younger patients for the same injury
2. Pain scales are not useful in geriatric patients and should be skipped entirely
3. A calm, pain-free appearance reliably excludes a significant fracture in this population
4. Diminished pain perception in some older adults can mask serious underlying injury

Answer: D — Diminished pain perception in some older adults can mask serious underlying injury

D) Correct - some older adults have diminished pain perception from chronic conditions, neuropathy, or medication effects, so the absence of reported pain does not reliably exclude serious injury such as a hip fracture or intra-abdominal bleeding; the EMT must rely on mechanism, exam findings, and vital sign trends. A) Pain reporting is often blunted rather than exaggerated in this population. B) Pain scales remain a useful trending tool even when the baseline response is altered; they should still be used and documented. C) A calm appearance is not reliable evidence of the absence of significant injury given blunted pain responses.

A diabetic patient is combative and sweaty and repeatedly says, "Leave me alone." Family says he was fine an hour ago. The EMT should MOST appropriately treat the chief complaint as:

1. a refusal of care, since declining help is exactly what the patient is stating
2. intoxication, since the combativeness and sweating closely resemble it
3. a psychiatric emergency that requires law enforcement to manage the behavior
4. an acute change in behavior and mental status of unknown cause

Answer: D — an acute change in behavior and mental status of unknown cause

D) Correct - a sudden behavioral change with diaphoresis in a diabetic is a medical presentation until proven otherwise, and the change itself is the chief complaint. A) Words spoken by a patient with altered mentation cannot constitute an informed refusal, because the capacity to refuse is exactly what is impaired. B) Assuming intoxication is the classic error that delays care for hypoglycemia and for head injury. C) Labeling the presentation psychiatric before medical causes are excluded is a well-documented and dangerous mistake.

An 82-year-old fell at home and is alert but her blood pressure is 108/70 with a heart rate of 78. Her daughter says she takes a beta-blocker daily. The EMT should recognize that this vital sign combination:

1. may mask the tachycardic response to shock because beta-blockers blunt heart rate elevation
2. rules out significant blood loss because the heart rate is within normal limits
3. confirms the patient is hemodynamically stable and can be transported without urgency
4. indicates the fall was caused by a cardiac dysrhythmia rather than a mechanical trip

Answer: A — may mask the tachycardic response to shock because beta-blockers blunt heart rate elevation

A) Correct - beta-blockers blunt the normal compensatory tachycardia seen in early shock, so a geriatric patient on this medication class can be significantly hypoperfused while showing a deceptively normal or even low heart rate; the EMT must rely more heavily on skin signs, mentation, and trending blood pressure. B) A normal-looking heart rate does not rule out blood loss in this population; that is the core misconception this question tests. C) A single reassuring-looking vital sign set should not be read as stability given the medication history. D) The vitals given do not indicate a dysrhythmia, and assuming a cardiac cause without evidence is an unsupported leap.

Pulse oximetry can be unreliable in all EXCEPT:

1. Carbon monoxide poisoning, in which the reading stays high despite severe hypoxia
2. Severe hypoperfusion with cold, poorly perfused extremities
3. Dark nail polish or artificial nails on the finger being used
4. A warm, well-perfused finger on an otherwise healthy adult

Answer: D — A warm, well-perfused finger on an otherwise healthy adult

A) The oximeter cannot distinguish carboxyhemoglobin from oxyhemoglobin, so it reads normal or high while the patient is dangerously hypoxic. B) Shock and vasoconstriction reduce pulsatile flow at the fingertip and produce an unreliable or absent signal. C) Pigment and artificial nails block the light path between the emitter and the detector, distorting the reading. D) Correct - a warm, well-perfused digit is the condition the device is designed for, and the reading there is reliable.

Most important historical data point in suspected stroke:

1. The time the patient was last known to be at their neurologic baseline
2. Family history of stroke in a parent or a sibling, which raises lifetime risk
3. The time and content of the patient's last meal before symptoms started
4. A documented list of the patient's medication and food allergies

Answer: A — The time the patient was last known to be at their neurologic baseline

A) Correct - eligibility for time-sensitive reperfusion therapy is measured from the last known well time, so this single data point drives destination and hospital decisions. B) Family history is a risk factor collected in the medical history but it does not change what the stroke team can offer today. C) Last oral intake belongs in the SAMPLE history and matters for procedures, but it does not define the treatment window. D) Allergies are routinely gathered and are important before medications are given, yet they do not determine stroke treatment eligibility.

An EMT must obtain a history for an unresponsive patient found alone in an apartment. Which source is the BEST starting point?

1. Medication containers, medical alert jewelry, and the scene itself
2. The receiving hospital's stored records, requested by radio while still on scene
3. A neighbor's speculation about what the patient might have taken tonight
4. Deferring the history entirely until the patient regains responsiveness

Answer: A — Medication containers, medical alert jewelry, and the scene itself

A) Correct - when the patient cannot speak, the environment supplies the history: prescription bottles, alert tags, home oxygen equipment, and the position in which the patient was found. B) Hospital records are not obtainable in the field, and pursuing them on scene delays care for no return. C) Speculation is unreliable and can mislead care, although a neighbor's factual observations would be genuinely useful. D) Waiting for responsiveness may mean never obtaining a history at all and delays treatment decisions that are needed now.

APGAR is scored at:

1. At 1 minute and again at 5 minutes after birth
2. At 1 minute only, since the newborn is stable by 5 minutes
3. At 5 and 10 minutes, once the newborn has stabilized
4. Every 15 minutes during the first hour after delivery

Answer: A — At 1 minute and again at 5 minutes after birth

A) Correct — the APGAR score is assigned at 1 minute and again at 5 minutes after birth, giving both an initial picture and a measure of the response to any care provided. B) A single score at 1 minute records the transition but misses the 5-minute reassessment that shows whether the newborn is improving. C) These are later reassessment points, not the standard scoring times, and skipping the 1-minute score loses the baseline. D) Ongoing reassessment of a newborn is appropriate, but that is routine monitoring rather than APGAR scoring.

Diabetic hyperglycemia (DKA) signs?

Slow onset, Kussmaul respirations (deep + rapid), fruity breath, polyuria, polydipsia, dehydration, altered LOC.

Diabetic hypoglycemia signs?

Confusion, sweating, tachycardia, hunger, possible seizure. Blood glucose <70 mg/dL. Give oral glucose if conscious.

Normal adult heart rate?

60-100 bpm.

Normal adult respiratory rate?

12-20 breaths/min.