10 free EMT practice questions: Reassessment & Trending

The patient is stable; these are normal variations within acceptable vital sign ranges: Normal variation means the numbers shift a little and the patient looks the same. A heart rate of 108 is already tachycardia in an adult. This patient's skin also went from warm and dry to pale and cool between the two checks. Those changes point toward shock, not stability.

The patient is improving, as evidenced by the decrease in blood pressure: A lower blood pressure would point to improvement only if the heart rate, breathing, and skin got better too. Here the pressure dropped from 132/86 to 124/80 while everything else got worse. The heart rate rose from 96 to 108, the respirations rose from 16 to 20, and the skin turned pale and cool. A dropping pressure with a rising heart rate and pale, cool skin is the pattern of shock, not recovery.

The vital signs are within normal limits, so no change in transport priority is needed: A patient whose vital signs hold steady between checks can keep the same transport priority. This patient's vital signs did not hold steady. The heart rate rose to 108, which is tachycardia in an adult, and the skin went from warm and dry to pale and cool. Those changes raise the transport priority to emergent.

The patient's condition is worsening despite oxygen therapy: The retractions and accessory muscle use are still there. Any visible distress can look like the patient is getting worse. Every finding moved the other way. The respiratory rate fell from 26 to 22, the retractions eased, and the pulse oximetry rose from 88% to 92%. Those are all signs of improvement.

The patient is improving and transport can be safely delayed: An improving patient can look stable enough to stay on scene. The better speech and the 92% saturation show the oxygen is helping. The asthma attack itself is not over. The patient can get worse again once the NRB comes off, or the bronchospasm can worsen on its own. Transport is still the priority, no matter how well the patient responds to one treatment.

The initial vital signs were unreliable and should be disregarded: Nothing in the question suggests the first set was wrong. The 88% and the rate of 26 were this patient before oxygen. The second set is the same patient after 5 minutes of high-flow oxygen. The change between the two sets is the oxygen working, not a sign the first set was a bad reading.

Apply firm pressure over the abdomen to relieve the distention: Pressing on the abdomen pushes the air back out of the stomach. In an unresponsive patient with an unprotected airway, that pressure can make the patient vomit and aspirate. Pressing on the abdomen is a last resort only. Keep ventilating slowly and do not try to push the stomach contents out.

Increase the rate to 1 breath every 3 seconds: Faster breaths sound like the answer to a dropping SpO₂. The rate of 1 breath every 6 seconds is already right for an adult. The problem is that too little air reaches the lungs with each breath, not that there are too few breaths. Ventilating too fast is one of the two causes of air in the stomach. A faster rate makes the distention and the poor chest rise worse.

Squeeze the bag more forcefully with each ventilation: Squeezing harder sounds like the fix for poor chest rise. Forceful ventilation is the other cause of air in the stomach. Each breath should be slow and gentle, given over 1 second, with just enough air to make the chest rise. More force pushes more air into the stomach. A stomach full of air also limits how far the diaphragm can move.

An anxiety reaction, because the respiratory rate has not changed: Anxiety can make a patient restless, and the breathing rate here has not changed. Anxiety does not make the skin pale and cool, and anxiety does not push the pulse from 92 to 124 over ten minutes. Restlessness is also one of the earliest signs of compensated shock.

Rising intracranial pressure, because the pulse pressure is widening: A widening pulse pressure goes with rising pressure inside the skull. This patient's pulse pressure is going the other way, from 52 down to 24. Rising pressure in the skull also slows the pulse, and this pulse is climbing. The question says there is no head injury.

Stable perfusion, because the systolic pressure has held: A systolic pressure in the normal range can look like perfusion is holding. Blood pressure is often the last number to change in shock. The tightening blood vessels are what keep the systolic pressure up. The same tightening raises the diastolic pressure, narrows the pulse pressure, and makes the skin pale and cool.

The patient has settled into ordinary sleep after the reversal: Ordinary sleep after a reversal would mean a patient who is resting and still breathing well. Sleep does not drop the respirations to 6 a minute or the saturation to 84% on high-flow oxygen. Sleep does not bring back pinpoint pupils either. These are signs of the opioid slowing the breathing down again.

The high-flow oxygen has suppressed the respiratory drive: Oxygen shutting down the drive to breathe is the old hypoxic drive theory, and hypoxic drive is not real. This patient's saturation is 84% on high-flow oxygen, so this patient is not getting too much oxygen. The pinpoint pupils and the slow, shallow breathing are the opioid signs from the start of the call. Never lower the oxygen on a patient who is hypoxic. Assist ventilations with a bag-valve mask instead.

An unrecognized head injury from the collapse is now progressing: A head injury that is getting worse can lower the level of consciousness a second time. Rising pressure inside the skull raises the blood pressure and can make one pupil dilate. This patient's blood pressure is 112/70, and both pupils are pinpoint. The secondary assessment also found no signs of injury.

Begin positive pressure ventilations because the reading has dropped: Positive pressure ventilations are for a patient who is not breathing well enough. This patient's breathing is unlabored at 22 with good chest rise, and the patient is still answering questions. The low number is coming from poor blood flow to the finger. Bagging this patient for a bad reading also takes your attention away from the shock.

Record 79% as the oxygen saturation and continue transport: A reading belongs in the chart when the device has a steady signal. This reading flickers and keeps dropping out, so the device has not measured anything. Writing down 79% puts a false number into the trend you are building with each reassessment.

Replace the pulse oximeter with a different device before rechecking: Swapping devices makes sense when the equipment is broken. Here the problem is the patient. The sensor needs a pulse in the fingertip, and the shock has taken that pulse away. A second device on the same cold finger gives you the same bad reading, and the swap costs time.

Improving, because the pulse rate has increased: The patient is improving, but the pulse is not what shows the improvement. The pulse went from 104 to 126 because albuterol can raise the heart rate and cause palpitations. A faster pulse is a side effect to note and watch, not proof the albuterol is working.

Worsening, because the pulse rate has increased: A rising pulse can mean a patient is getting worse. Everything else here is better. The patient speaks full sentences, the accessory muscle use has stopped, the chest rise is full, and the SpO₂ went from 89% to 96%. A pulse that climbs right after a bronchodilator comes from the medication, not from the patient getting worse.

Worsening, because the respiratory rate has decreased: A falling respiratory rate is a bad sign in a patient who is tiring out. In a tiring patient, the effort drops too, the chest rise gets shallower, and the mental status gets worse. This patient has full chest rise and went from three words to full sentences. The slower rate means less air hunger, not exhaustion.

Perform one final reassessment and then discontinue further reassessment: Stopping after one more check means no one is watching this patient while the patient gets worse. You never stop reassessing a patient who is getting worse in the middle of a call. Keep reassessing at shorter intervals until you hand the patient off to a higher level of care.

Continue reassessing every 15 minutes as originally planned: The new confusion and the pale, clammy skin mean this patient is not stable anymore. How often you reassess depends on how the patient is doing now, so you check every 5 minutes, not every 15.

Stop rechecking vital signs because the patient is deteriorating: Getting worse is the reason to keep checking vital signs, not a reason to stop. Trending the vital signs and mental status matters most when a patient is getting worse. The trends show you further decline and help you set the transport priority.

Every 10 minutes: splits the difference between the stable and unstable times. There is no 10-minute interval. EMS uses only two categories, stable and unstable. This patient is unstable, and an unstable patient gets reassessed every 5 minutes.

Every 15 minutes: the real interval for a stable patient. A stable patient's vital signs are expected to hold steady between checks. This patient is unstable, not stable. With 15 minutes between checks, bleeding, hypoxia, or shock can get worse without anyone noticing.

Every 20 minutes: longer than even the 15-minute check for a stable patient. Twenty minutes is too long between checks for any patient in your care. An unstable patient at risk for shock or bleeding needs a check every 5 minutes.

Continue every 15 minutes because the blood pressure is still normal: The blood pressure is still normal, but a normal blood pressure does not make this patient stable. A change in mental status and a climbing respiratory rate show up earlier than a drop in blood pressure. The body can hold the blood pressure up until shortly before the patient collapses.

Stop reassessing vital signs and complete the detailed physical exam: The detailed physical exam is a lower priority than watching for life threats. You never stop reassessing vital signs to do a detailed exam. A patient who is getting worse needs vital signs checked more often, not less.

Wait until the next 15-minute check to confirm the changes persist: Waiting for the next 15 minute check means ignoring clear signs of decline for up to 15 more minutes. The new confusion and the fast respirations already tell you this patient is getting worse. Act on those changes now.