CH 16 Reassessment

Question 1

Reassessment

Answer 1

A procedure for detecting changes in a patients condition. It involves four steps; 1. Repeating of the primary assessment 2. Repeating and recording vital sx 3. Repeating the physical exam 4. Checking interventions

Question 2

Trending

Answer 2

Changes in a patients condition over time, such as slowing respirations or rising pulse rate, that may show improvement

Question 3

Reassessment Step 1

Answer 3

Repeat the Primary Assessment - 1. Reassess mental status 2. Maintain an open airway 3. Monitor breathing for rate and quality 4. Reassess the pulse for rate and quality 5. Monitor skin color and temperature 6. Reestablish patient priorities

Question 4

Reassessment Step 1 - NOTE

Answer 4

*** Life threatening problems that were not detected earlier, can start surfacing **** Interventions bringing the life threatening conditions under control may develop or redevelop before the patient reaches the hospital

Question 5

Reassessment Step 1 - PEDIATRIC NOTE

Answer 5

* Mental status on an unresponsive child or infant can be checked by speaking loudly or flicking their foot (painful stimuli).

Question 6

Reassessment Step 2 - Reassess and Record VS

Answer 6

** During your secondary assessment, you took the recorded the baseline VS. *** In this step you are reassessing the VS and comparing them to the baseline. Checking for improvements, or degradation of the patients condition. **** This is why the baseline is so critical. Without it, you have nothing to compare the reassessment VS to

Question 7

Reassessment Step 3 - Repeat Pertinent Parts of Patient Hx and Physical Exam

Answer 7

* A patients CC can change over time ** One of the main things that may/will change will be the severity of the CC ***This is also your time to reassess your Physical Exam. If you found that your patient had contusions on the chest during your initial physical exam, and your reassessment shows it getting worse, or the chest wall is showing issues not detected or not present at all during the assessment, it will show you that potentially your transport priority needs to be increased

Question 8

Reassessment - Step 4 - Check Interventions

Answer 8

This is going to be your time to check your work. Whatever interventions you initially you are checking. ** When you do this, you want to take a “fresh approach” to it. You want to ensure that your interventions that you made are actually improving your patients condition from when you first started patient care, but you also want to double check your patients condition and see if the interventions are working, or if you need to take any other interventions to assist the patient enroute to the hospital

Question 9

Reassessment - Step 4 - Check Interventions ALWAYS DO THE FOLLOWING

Answer 9

ALWAYS DO THE FOLLOWING IN YOUR INTERVENTION CHECKS: 1. Ensure adequacy of O2 delivery and artificial ventilation 2. Ensure the management of any bleeding is effective. Did your gauze packing stop the bleed? Do you need to add more to it? If it is a puncture, do you need to feed the gauze in TO the wound? Things such as this 3. Ensure adequacy of other interventions ****Just remember that situations change

Question 10

Which of the following best describes the purpose of repeating the primary assessment? 1. To conduct a rapid trauma assessment 2. To take the patient’s past medical hx 3. To recheck for ongoing life-threatening problems 4. To obtain a hx of the present illness

Answer 10

3. To recheck for ongoing life-threatening problems The other 3 choices are components of the secondary assessment, and a rapid trauma assessment would only be performed for seriously injured patients, not all patients

Question 11

A​ 6-year-old male has fallen on his outstretched​ arm, causing a possible fracture. His vital signs have remained essentially the same throughout transport. How would you describe his​ condition? 1. Deteriorating 2. Not possible to determine 3. Returning to normal 4. Unchanged

Answer 11

4. Unchanged

Question 12

Which of the following is true of a trauma patient with a significant mechanism of​ injury? 1. The​ patient’s condition should be reassessed every 5​ minutes, because the patient can be considered unstable. 2. The​ patient’s vital signs are likely impossible to determine with any certainty due to the significance of the mechanism of injury. 3. The​ patient’s trending vital signs should be assumed to remain in line with the baseline vital signs. 4. The patient should be considered to be in stable condition and does not require reassessment.

Answer 12

1. The​ patient’s condition should be reassessed every 5​ minutes, because the patient can be considered unstable.

Question 13

Which of the following actions should be performed for a patient who has been shot in the chest and for whom you have performed a primary and secondary​ assessment? 1. Reassess the patient every 15 minutes and anytime there is a change in condition. 2. Regardless of the​ patient’s condition, reassess the patient only at​ 5-minute intervals. 3. Reassess the patient every 5 minutes and anytime there is a change in condition. 4. Reassess the patient once after 15​ minutes; if vital signs are​ unchanged, additional reassessment is unnecessary.

Answer 13

3. Reassess the patient every 5 minutes and anytime there is a change in condition.

Question 14

A​ 22-year-old female was found severely hyperventilating and was visibly upset. Her initial vital signs were P​ 130, R​ 40, BP​ 190/100. With coaching and compassionate​ care, she has calmed down. Her repeat vital signs are P​ 100, R​ 28, BP​ 160/88. Which of the following would best describe this trend in vital​ signs? 1. Deteriorating 2. Unable to determine 3. Unchanged 4. Returning to normal

Answer 14

4. Returning to normal

Question 15

You have taken several sets of vital signs for a​ patient, whose respiratory rate has changed from 24 with shallow breaths to 20 with full​ breaths, and whose skin has remained pale and dry. You would consider this​ patient’s condition to​ be: 1. Deteriorating 2. Returning to normal 3. Undetermined 4. Remaining unchanged

Answer 15

2. Returning to normal

Question 16

Determining a​ patient’s stability: 1. is necessary for responsive patients 2. is primarily a question of determining 3. helps indicate the frequency with which the patient must be reassessed 4. is entirely dependent on taking the patient’s VS

Answer 16

3. helps indicate the frequency with which the patient must be reassessed

Question 17

While en route to the​ hospital, your​ 67-year-old male patient with chest pain breaks out in a sweat and becomes very pale. He clutches his chest. You should​ next: 1. Administer the patient’s nitro 2. reassess 3. administer O2 4. call for ALS

Answer 17

2. reassess

Question 18

​________ is reassessing and recording findings of the reassessment so they can be compared to earlier findings. 1. Averaging 2. Analysis 3. Trending 4. Critical Thinking

Answer 18

3. Trending

Question 19

Which of the following is false regarding the purpose of immediately documenting vital signs once they are​ obtained? 1. Failure to record the VS immediately is considered falsifying the medical record 2. It may be difficult to recall the BS accurately later on 3. You will be able to report the VS accurately when contacting the receiving facility 4. You will be able to compare each set of VS with the previous ones to detect trends in the patients condition

Answer 19

1. Failure to record the VS immediately is considered falsifying the medical record

Question 20

You are transporting a​ 20-year-old soccer player who injured his ankle during a match. His injury appears to be isolated and he has no significant past medical history. How frequently should you perform a reassessment on this​ patient? 1. 10 minutes 2. 5 minutes 3. 15 minutes 4. 30 minutes

Answer 20

3. 15 minutes

Question 21

You are called for a​ 58-year-old male who is concerned that his blood pressure is too high. He tells you that he has had a headache and is feeling a little dizzy. You notice that his skin is flushed and feels warm to the touch. As you finish taking his vital​ signs, you​ should 1. move the patient to the ambulance for transport 2. assist the patient to take his BP medication 3. begin your reassessment 4. write down the patient’s VS

Answer 21

4. write down the patient’s VS

Question 22

As you arrive at the emergency department with an unresponsive trauma​ patient, the nurse asks for your trending assessment. Why is this information important to the​ nurse? 1. She can evaluate whether or not the patient is improving 2. She can critique your technique of taking VS 3. She can evaluate the quality of care you provided 4. She can determine if you understand the assessment process

Answer 22

1. She can evaluate whether or not the patient is improving

Question 23

You are called for an alert patient with respiratory distress. As part of your primary​ assessment, you place the patient on oxygen via nasal cannula at 2 liters per minute. You continue with the rest of your assessment including taking a set of vital signs. During your​ reassessment, you notice that the​ patient’s respiratory rate has increased to 24 times per minute and he is having increasing trouble breathing. You​ should: 1. increase the flow rate of the nasal cannula to 4 LPM 2. call medical direction for orders to administer his inhaler 3. switch your patient to a nonrebreather mask at 15 LPM 4. assist the patient’s breathing with a BVM

Answer 23

3. switch your patient to a nonrebreather mask at 15 LPM

Question 24

While performing a detailed physical exam on a patient involved in a fall from 30​ feet, the patient​ (who had previously been responding to your​ questions) stops responding. What should you do​ next? 1. Continue the detailed physical assessment 2. Start CPR 3. Repeat the primary assessment 4. Call medical direction for orders

Answer 24

3. Repeat the primary assessment

Question 25

On which of the following patients should a reassessment be​ performed? 1. Patient having difficulty breathing 2. Patient with chest pain 3. patient with a GSW 4. All patients should be reassessed

Answer 25

4. All patients should be reassessed

Question 26

What is the first step in the reassessment​ process? 1. VS 2. Secondary Assessment 3. Focused hx and physical exam 4. Primary assessment

Answer 26

4. Primary assessment

Question 27

You are caring for a teenager who is having a severe allergic reaction. He has hives all over his​ stomach, is having respiratory​ distress, and is wheezing. After you administer​ oxygen, you get a set of vital signs. Medical direction has ordered you to assist with administration of his EpiPen. You will monitor the success of your interventions during​ the: 1. focused exam 2. secondary assessment 3. reassessment 4. primary assessment

Answer 27

3. reassessment

Question 28

While transporting a patient to the​ hospital, the EMT repeats his reassessment including vital signs every 15 minutes until he arrives at the emergency department. According to this​ information, which of the following best describes your​ patient’s current​ status? 1. Poor 2. Stable 3. Not enough information was given to answer the question 4. Unstable

Answer 28

2. Stable

Question 29

Your patient called 911 because he was having chest pain. He states that his pain is a 7 on a​ 10-point scale. As part of your​ care, you assist him with taking his nitroglycerin per medical direction. After waiting a few minutes for the medication to take​ effect, you​ should: 1. administer another dose of nitroglycerin. 2. lay the head of the stretcher down. 3. ask him what his pain is like now. 4. call medical direction to administer another dose.

Answer 29

3. ask him what his pain is like now.

Question 30

You are treating a​ 15-year-old boy who apparently broke his right arm when he fell while skateboarding with his friends. You have completed your primary and secondary assessment including splinting his​ arm, but you found no other injuries or problems. Which of the following is the most important step to do during the​ reassessment? 1. Place the patient on oxygen via nasal cannula. 2. Check distal circulation on his right arm 3. Recheck pupils 4. Visualize his chest for bruising

Answer 30

2. Check distal circulation on his right arm

Question 31

You are transporting a patient whom you are treating for chest pain. You have completed all of your assessments and are writing down some of his personal information such as his address and phone number. As the patient is​ speaking, you notice that he is having increasing difficulty breathing. You​ should: 1. immediately repeat your primary assessment. 2. get a quick set of vital signs. 3. call the hospital and report the difficulty. 4. call for ALS backup.

Answer 31

1. immediately repeat your primary assessment.

Question 32

Your​ patient’s initial vital signs were a pulse of 120 per minute and​ weak, a blood pressure of​ 90/50 mm​ Hg, and a respiratory rate of 24 per minute. Upon​ reassessment, you note that the patient now has a weak pulse of 100 per​ minute, a blood pressure of​ 110/60 mm​ Hg, and a respiratory rate of 20 per minute. Which of the following can you conclude from this​ information? 1. You can transport the patient to a lower level trauma center 2. the baseline VS were inaccurate 3. the patients condition may be improving 4. the patient will survive

Answer 32

3. the patients condition may be improving

Question 33

You are transporting a victim of domestic​ violence, a​ 25-year-old female, who was struck on the head several times with a baseball bat. On the​ scene, she was responsive to verbal stimuli and was bleeding profusely from an open head wound. During​ transport, the patient becomes unresponsive. Which of the following should you do​ next? 1. Secondary Assessment 2. VS and SAMPLE hx 3. Detailed physical exam 4. Primary Assessment

Answer 33

4. Primary Assessment Any time that there has been a change in the patients condition, repeat at least the primary assessment (page 458/ section III text book)

Question 34

You are transporting a patient who has had her neck slashed from side to side. You and your partner are caring for the patient while a police officer drives you to the​ hospital, which is minutes away. You are focusing all of your efforts to maintain her airway and your partner is controlling her bleeding. Which of the following will you be unlikely to​ obtain? 1. Patients gender 2. Pulse and respiratory rates 3. Reassessment results 4. Primary assessment

Answer 34

3. Reassessment results

Question 35

Your patient is an​ 18-year-old female whom you believe may have had a miscarriage and is bleeding heavily. You have completed your primary and secondary assessments and now you need to reassess her to see if the bleeding has stopped. You​ should: 1. take another set of VS to see if her BP has dropped 2. ask her to check herself to see if she is still bleeding 3. in a reassuring tone, explain what you need to do 4. wait and let the hospital staff reassess the bleeding

Answer 35

3. in a reassuring tone, explain what you need to do

Question 36

You are alone in the back of the ambulance where you are ventilating an apneic patient. Which of the following is the best way to manage the​ reassessment? 1. Stay on the scene and request additional help so you will have someone to help you perform a reassessment 2. have your partner stop the ambulance every 5 minutes to help you perform a reassessment 3. continue ventilating the patient during transport and skip the reassessment 4. stop ventilating the patient every 5 minutes so you can perform a reassessment

Answer 36

3. continue ventilating the patient during transport and skip the reassessment

Question 37

You are caring for a woman who sustained a head injury as a result of a domestic dispute. You suspect she has a closed head injury since she cannot remember what happened and one of her pupils is slightly larger than the other. You have been monitoring her vital signs every 5 minutes and you see that her blood pressure is rising and her pulse is dropping. This part of the assessment is​ called: 1. crisis management 2. trending 3. modified secondary assessment 4. intervention check

Answer 37

2. trending

Question 38

Under what circumstance should a reassessment not be​ performed? 1. Ongoing lifesaving interventions are required 2. the patient is being transported to a hospital close to their home 3. the patient has life threatening injuries 4. the patient does not receive a secondary assessment

Answer 38

1. Ongoing lifesaving interventions are required

Question 39

Your​ 76-year-old female patient is having trouble breathing. When you auscultate her​ lungs, you hear crackles​ (rales), and you are concerned that she may have pulmonary edema. Her oxygen saturation is​ 92%, so you place her on​ 100% oxygen via a nonrebreather mask. Her breathing gets a little easier with the oxygen. You decide to expedite transport since she is anxious about her condition.​ Later, as you are completing your​ reassessment, you see that her respirations have slowed to 8 times per minute and she is barely staying awake. What should you do​ next? 1. begin ventilating her with a BVM 2. ask your partner to pull over and wait for ALS backup 3. assist her with using metered dose inhaler 4. shake her to keep her awake

Answer 39

1. begin ventilating her with a BVM

Question 40

You have a long transport of a patient who may have sustained a spinal injury. The patient has been stable throughout your transport. During one of your​ reassessments, your patient tells you that he is losing the feeling in his feet and toes and his fingers are tingling. At this point you​ should: 1. call medical direction for orders 2. remove him from the long spine board 3. spinal immobilize him 4. reassess him every 5 minutes

Answer 40

4. reassess him every 5 minutes

Question 41

Your patient is a​ 23-year-old male with a stab wound to the abdomen. You have bandaged the wound and are transporting the patient to a trauma center. During your​ reassessment, you note that the bandage has become soaked with blood. What should your priority be with this​ patient? 1. notify the receiving facility that the patient has developed arterial bleeding 2. check the patients BP 3. place the patient in the Trendelenburg position 4. control the bleeding

Answer 41

4. control the bleeding

Question 42

You are transporting a​ 30-year-old male who has been shot in the chest. He is suffering from a sucking chest wound and has a decreased level of consciousness. How often should you perform a​ reassessment? 1. Every 10 minutes 2. Every 15 minutes 3. Every 5 minutes 4. Every 30 minutes

Answer 42

3. Every 5 minutes

Question 43

During​ reassessment, you notice that your patient is making gurgling sounds. Which of the following should you do​ immediately? 1. suction the airway 2. increase the amount of O2 being delivered to the patient 3. place the patient in the recovery position 4. assist ventilations with the BVM

Answer 43

1. suction the airway

Question 44

You are treating a​ 57-year-old male for chest pain. You have gathered all pertinent history of the present​ illness, completed two sets of vital​ signs, talked with medical​ direction, and assisted the patient with two doses of his nitroglycerin. Determination of whether or not the nitroglycerin was effective is assessed during​ the: 1. primary and secondary assessment 2. reassessment 3. primary assessment 4. secondary assessment

Answer 44

3. primary assessment