NREMT Secondary Assessment Flashcards

Question 1

Pulse oximetry — what it cannot tell you

Accepted Answer

It reads saturation, never ventilation. Nail polish, cold or shocked fingers, motion and carbon monoxide all corrupt it, and oxygen can hold it up while carbon dioxide climbs.

Question 2

How often do you reassess a stable versus an unstable patient?

Accepted Answer

Stable: about every 15 minutes. Unstable: about every 5 minutes. Always start with the primary assessment.

Question 3

Signs of tension pneumothorax (EMT level)

Accepted Answer

Worsening respiratory distress, absent breath sounds on one side, hypotension, JVD, tachycardia. Late tracheal deviation. Rapid transport and ALS.

Question 4

What a saturation is a percentage of

Accepted Answer

It is the proportion of hemoglobin carrying oxygen, not how much hemoglobin there is — so a bleeding patient can read normal. Record it with the oxygen being delivered, or the number means nothing later.

Question 5

Sepsis quick screen

Accepted Answer

Infection + new confusion, RR 22 or more, systolic 100 or less. No fever does not rule it out.

Question 6

When the account and the examination disagree

Accepted Answer

Act on the examination and record both. The body dates the event when the clock does not — cooled skin, a dry floor and pressure marks say she has been down far longer than five minutes.

Question 7

OPQRST

Accepted Answer

Onset · Provocation · Quality · Radiation · Severity · Time.

Question 8

One breath is a rise and a fall

Accepted Answer

Count complete cycles, not halves — scoring the rise and the fall separately doubles every rate. Irregular or periodic breathing gets a full sixty seconds; a short sample lands inside a burst or inside a pause.

Question 9

Unresponsive medical patient: secondary assessment order

Accepted Answer

Rapid full-body exam → baseline vital signs → history from family, bystanders and scene → reassess en route.

Question 10

Words for what your hands find

Accepted Answer

Guarding that persists while the patient is distracted is involuntary · grating bone is crepitus · bubble-wrap crackling is air under the skin · a mass that pulses means stop pressing.

Question 11

When distal circulation, movement and sensation are checked

Accepted Answer

At the first examination of the limb, again after anything you do to it, and once more before handover. The first check is the only thing that makes a later deficit interpretable. Keep the fingers and toes uncovered.

Question 12

The exam through clothing and the exam in the cold

Accepted Answer

Fabric spreads your pressure and hides small steps and point tenderness, so a negative exam through a fleece means nothing. In freezing weather, examine region by region in the warm compartment and cover each part again.

Question 13

Cushing triad

Accepted Answer

Hypertension (widening pulse pressure), bradycardia and irregular respirations. A late sign of increased intracranial pressure and possible herniation.

Question 14

SAMPLE

Accepted Answer

Signs/symptoms · Allergies · Medications · Past history · Last oral intake · Events leading up.

Question 15

Blood pressure technique errors and which way they push

Accepted Answer

Cuff too narrow reads high · cuff over clothing distorts · deflating too fast underestimates the systolic · arm above heart level reads low.

Question 16

Stethoscope discipline

Accepted Answer

Diaphragm for the higher-pitched lung sounds, on bare skin — cloth muffles the sound and its own rubbing imitates one. Move left, right, same level, so each field is judged against its partner while it is still fresh.

Question 17

When the cuff is not telling the truth

Accepted Answer

Move to the other arm for a dialysis access, an injury, a running line or a side that lost lymph nodes. Confirm manually when the pulse is irregular or the patient is shivering. Name the site if it was not the upper arm.

Question 18

Old finding or new one?

Accepted Answer

Healed scars, long-standing nail changes, an old amputation, a decade-old weakness. A deficit is new only when somebody tells you what the patient could do yesterday.

Question 19

Examining a frightened small child

Accepted Answer

Toe to head, face and ears last, and keep a parent within reach. The adult order usually ends cooperation at the first step.

Question 20

What a pill organizer actually records

Accepted Answer

Doses taken and doses missed, with dates attached — not the diagnosis. Note which compartments are still full and which day it is, and report that rather than a conclusion about the patient.

Question 21

Silence, and the question asked in private

Accepted Answer

Wait out the pause — it is usually the patient deciding whether to tell you. Some answers exist only away from family, and the move to the ambulance is the easiest privacy you will ever get.

Question 22

OPQRST — pain assessment

Accepted Answer

Onset, Provocation/palliation, Quality, Region/radiation, Severity (0-10), Time (duration and when it started).

Question 23

Reassessment interval — stable vs unstable

Accepted Answer

Reassess every 15 minutes for a stable patient and every 5 minutes for an unstable one, and after every intervention.

Question 24

Guarding you can work around

Accepted Answer

Cold hands, a sudden approach and straight legs make any abdomen tight. Warm your hands, bend the knees, start away from the pain and keep talking. What tightens anyway, while he is distracted, is the real finding.

Question 25

The medication list is a history

Accepted Answer

Every bottle names a condition the patient may not mention, and a label often carries an allergy. Full bottles mean nothing was taken, which is often why you were called.

Question 26

Cuff and limb before the number

Accepted Answer

Bare arm supported at heart level; cuff sized to this limb; bladder centered over the brachial artery; stethoscope on skin in the elbow crease, not under the cuff. Never over a dialysis access or a rolled sleeve acting as a tourniquet.

Question 27

What each letter of DCAP-BTLS finds

Accepted Answer

Deformities · Contusions · Abrasions · Punctures — Burns · Tenderness · Lacerations · Swelling. Eight findings your eyes and hands look for in every region.

Question 28

Weighing a history you did not get from the patient

Accepted Answer

Judge it by access, not by relationship: who was present, who sees the patient daily, how specific the times are. Attribute each account to its source in the report instead of merging them.

Question 29

Skin signs — the three you record

Accepted Answer

Color, temperature and moisture. They change long before a blood pressure does, which is what makes them the earliest perfusion window you have.

Question 30

BE-FAST stroke signs

Accepted Answer

Balance loss, Eyes (vision change), Face droop, Arm drift, Speech difficulty, Time — note last known well and communicate it early.

Question 31

Watch the face, not your hand

Accepted Answer

A grimace, a held breath or a flinch arrives before the words, and in a patient who minimizes everything it is the only report you will get. Your hand tells you nothing your eyes need to be on.

Question 32

Which pain scale for which child

Accepted Answer

Infant and toddler: watch behavior — cry, consolability, facial expression, legs drawn up. Preschool: a scale of drawn faces. School age and up: the zero to ten numeric scale.

Question 33

Capillary refill, honestly

Accepted Answer

Best in infants and small children; one strand of the perfusion picture everywhere else. Cold, age, poor light and nail polish all move it. Press a fingertip pad or the forehead when a nail will not work.

Question 34

Temperature is usually estimated

Accepted Answer

Feel the trunk under the clothing; hands, face and lower legs report the weather. With no thermometer, write what you felt, not a number you did not measure. A thermometer pinned at its lowest value means at or below that, not exactly that.

Question 35

When to abandon the secondary assessment

Accepted Answer

A noisy airway, a falling level of consciousness or bleeding that restarts. Any of the three sends you back to the primary assessment before another region is examined.

Question 36

Lowest acceptable systolic pressure, age 1 to 10

Accepted Answer

70 + (2 × age in years). Older than 10: below 90 is hypotension. Low pressure in a child is a LATE sign of shock.

Question 37

Findings the hospital can never get back

Accepted Answer

The scene, the position you found the patient in, and what changed en route. Lead the handover with those — the nurse will repeat the rest of your exam within minutes.

Question 38

Pupils: PERRL means

Accepted Answer

Pupils Equal, Round, Reactive to Light. One dilated, sluggish pupil in a head-injured patient with altered mental status suggests brain herniation.

Question 39

Allergy or side effect?

Accepted Answer

Ask what actually happens. Nausea or an upset stomach is an intolerance; hives, swelling or trouble breathing is an allergy. Record the reaction the patient describes, not the label.

Question 40

A normal number in an abnormal patient

Accepted Answer

Ask what the number costs: the effort behind it, the patient's own baseline, the direction it is moving, and whether a rate-slowing medicine is holding it where it sits.

Question 41

Blood pressure by auscultation: how far above the disappearance point do you inflate, and what do the first and last sounds mean?

Accepted Answer

Inflate about 30 mmHg above where the pulse disappears. First tapping sound = systolic; disappearance of sound = diastolic. Deflate slowly.

Question 42

Rising intracranial pressure

Accepted Answer

Falling mental status · unequal pupil · slowing pulse · rising BP · irregular breathing (Cushing's).

Question 43

Reading the gap between the two numbers

Accepted Answer

Systolic minus diastolic. 104/88 leaves a narrow 16. Record the gap as a finding and trend it, because it can move while the top number still looks acceptable.

Question 44

What one set of vital signs is worth

Accepted Answer

A timed starting point, nothing more. A single set has no direction, and the same value can belong to a patient compensating well or failing slowly. Direction is the finding; get a second set.

Question 45

How long to count, and why it matters

Accepted Answer

A fifteen-second count multiplies any miscount by four. Count a full minute whenever the rate is irregular, extreme, or matters. If the beat fades mid-count, first rule out your own fingers slipping off the artery.

Question 46

Glasgow Coma Scale

Accepted Answer

Eyes 4 · Verbal 5 · Motor 6 = 15. Lowest 3. GCS 8 or less → airway at risk.

Question 47

APGAR

Accepted Answer

Appearance · Pulse · Grimace · Activity · Respiration. 0–2 each at 1 and 5 min. 7–10 reassuring.

Question 48

The bracelet and the discharge papers

Accepted Answer

A wristband still in place means a recent admission. Ask when he came home and what he was in for, and bring the paperwork: it is the only written diagnosis in the house.

Question 49

Focused exam or rapid head-to-toe?

Accepted Answer

Focused when the patient is alert with an isolated complaint and a minor mechanism. Rapid head-to-toe when the mechanism is significant or the patient cannot tell you where it hurts.

Question 50

Heat stroke

Accepted Answer

Hot + ALTERED = heat stroke. Cool rapidly on scene (cold water immersion best).

Question 51

Objects that state the baseline

Accepted Answer

Walker, grab rails, hospital bed, commode, ramp, home oxygen. All of it was fitted over weeks, so it describes the patient's ordinary day — the thing today's complaint has to be measured against.

Question 52

Reading a medication list as a history

Accepted Answer

Each container names a condition somebody is treating. Count the prescribers, check the fill date against what is left, and ask what each one was started for — three bottles, three conditions.

Question 53

Glucose is a sample, not just a number

Accepted Answer

Clean and dry the site, lance the side of the fingertip, let a free drop form — milking a finger dilutes it with tissue fluid and reads low. A word instead of a number means out of range: record the word, never the edge of the scale.

Question 54

The finding you cannot explain

Accepted Answer

Describe it — site, size, firmness, tenderness — record it and hand it on. Never drop it because it does not fit, and never attach a guessed cause, because the guess travels onward as if you had observed it.

Question 55

One side quieter than the other

Accepted Answer

The patient is his own control, so asymmetry is the finding. Report it at once — a normal oxygen saturation does not exclude air or blood collecting in one half of the chest.

Question 56

The other side is your control

Accepted Answer

One calf, one pupil, one lung field, one grip has no normal value. Uncover and examine the matching part, then report the difference in size, warmth, firmness or strength — that difference is the finding.

Question 57

A reading you do not believe

Accepted Answer

Suspect your technique first — cuff size, sleeve, placement, arm position. Let the arm rest before rechecking, or use the other side; back-to-back inflations leave the limb congested. Two examiners disagreeing? One repeats both in sequence.

Question 58

The chest you cannot see moving

Accepted Answer

Very shallow breathing: rest a hand on the upper abdomen or lower ribs. Under blankets: watch the shoulders and feel air at the mouth. Infants breathe with the abdomen — count before you undress or disturb them.

Question 59

Rapid full-body exam vs focused

Accepted Answer

Full-body when the mechanism is significant OR the patient cannot direct you to the injury. Focused when alert with a localized complaint and a minor mechanism.

Question 60

Normal blood glucose (approx.)

Accepted Answer

About 70 to 100 mg/dL fasting, higher after meals. Under 70 is hypoglycemia; altered mental status plus low glucose is a key finding for oral glucose if the patient can swallow.

Question 61

Consensual pupil response

Accepted Answer

Light in one eye normally constricts BOTH pupils. Watch the opposite pupil every time; a pupil that fails to constrict is the abnormal finding.

Question 62

Rhonchi versus fine crackles

Accepted Answer

Rhonchi: coarse, low-pitched rattling from secretions in larger airways; often change after a cough. Fine crackles: popping from fluid in small airways and air sacs; do not clear with coughing.

Question 63

Rule of nines

Accepted Answer

Adult: head 9 · each arm 9 · each leg 18 · front 18 · back 18 · genitals 1. Infant: head 18, each leg ~14. Palm ≈ 1%.

Question 64

Adult vital signs

Accepted Answer

RR 12–20 · pulse 60–100 · judge perfusion by skin and mental status, not one number.

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