Scene Size-up Practice Questions

52 multiple-choice questions on Scene size-up for paramedic and EMT students, from Chapter 11 (Patient Assessment). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

52 practice questions

1. Scene size-up begins:

   1. A. After the scene is declared safe
   2. B. On arrival at the patient's side
   3. C. With the dispatch information
   4. D. When you step out of the ambulance
   Show answer

   Answer: C. With the dispatch information

   Dispatch details start shaping your plan and safety approach. It begins before you arrive.

2. The first component of scene size-up is:

   1. A. Determining the mechanism of injury
   2. B. Scene safety and standard precautions
   3. C. Counting the number of patients
   4. D. Requesting additional resources early
   Show answer

   Answer: B. Scene safety and standard precautions

   An unsafe scene is not entered until it is made safe.

3. Standard precautions selected for a call should be based on:

   1. A. The patient's chief complaint alone
   2. B. The anticipated risk of exposure
   3. C. Your agency's default for all calls
   4. D. The dispatch code assigned to the call
   Show answer

   Answer: B. The anticipated risk of exposure

   Depending on the anticipated exposure, this may mean gloves alone or gloves, mask, gown, and eye protection. Upgrade as the situation changes.

4. Determining the number of patients is important because it:

   1. A. Shows whether more help is needed
   2. B. Determines the receiving hospital
   3. C. Is required for billing each patient
   4. D. Sets the order of documentation
   Show answer

   Answer: A. Shows whether more help is needed

   Knowing the number of patients early tells you whether additional resources are needed before care begins; call for help before you are committed to one patient. The destination is chosen for each patient later, and billing and documentation order are not reasons for this scene size-up step.

5. Mechanism of injury helps the paramedic:

   1. A. Make a definitive diagnosis
   2. B. Predict likely injury patterns
   3. C. Determine the patient's consent
   4. D. Select the receiving hospital
   Show answer

   Answer: B. Predict likely injury patterns

   High-energy mechanisms warrant a broader search for injury. It sets your index of suspicion.

6. For a medical patient, the equivalent of mechanism of injury is:

   1. A. Nature of the illness
   2. B. Chief complaint
   3. C. Past medical history
   4. D. Initial vital signs
   Show answer

   Answer: A. Nature of the illness

   Gather it from the patient, family, and the scene itself.

7. Clues in the environment, such as medication bottles and home oxygen, are valuable because they:

   1. A. Are mainly needed for billing records
   2. B. Replace the need for a patient history
   3. C. Confirm the diagnosis made by dispatch
   4. D. Reveal history the patient cannot give
   Show answer

   Answer: D. Reveal history the patient cannot give

   Medication bottles, home oxygen, and medical devices reveal conditions and history the patient may be unable to give. They support but do not replace a patient history, dispatch does not make diagnoses for them to confirm, and they are clinical clues rather than billing information. Scan the room before you leave it.

8. If the number of patients exceeds available resources, the paramedic should:

   1. A. Treat the first patient found, then call
   2. B. Begin triage and request more resources
   3. C. Transport the two worst patients at once
   4. D. Wait for a supervisor before acting
   Show answer

   Answer: B. Begin triage and request more resources

   Triage shifts the goal from the individual to the group.

9. A scene that is initially safe:

   1. A. Needs reassessment only if police leave
   2. B. Can become unsafe at any time
   3. C. Remains safe for the rest of the call
   4. D. Is permanently safe once police arrive
   Show answer

   Answer: B. Can become unsafe at any time

   Reassess safety continuously, including during transport. Ongoing awareness is required.

10. Spinal motion restriction consideration begins:

    1. A. After the first set of vital signs
    2. B. After the secondary assessment
    3. C. Only once the patient is in the ambulance
    4. D. At scene size-up, based on mechanism
    Show answer

    Answer: D. At scene size-up, based on mechanism

    Manual stabilization can start with the first contact.

11. The general impression is formed:

    1. A. Within the first few seconds of contact
    2. B. After the first set of vital signs
    3. C. Once the secondary assessment is complete
    4. D. After the SAMPLE history is obtained
    Show answer

    Answer: A. Within the first few seconds of contact

    It is formed from appearance, work of breathing, and skin color, and answers the question: sick or not sick?

12. Which observation best indicates an immediately critical patient from the doorway?

    1. A. A patient who is talking in full sentences
    2. B. A patient who is pale but talking clearly
    3. C. A patient who is gasping or bleeding heavily
    4. D. A patient who is crying loudly and upset
    Show answer

    Answer: C. A patient who is gasping or bleeding heavily

    Unresponsiveness, gasping, or obvious severe bleeding drive immediate intervention rather than further assessment.

13. Scene size-up is:

    1. A. A one-time step completed on arrival
    2. B. A step used only for trauma calls
    3. C. Needed only at multiple-patient incidents
    4. D. An ongoing process throughout the call
    Show answer

    Answer: D. An ongoing process throughout the call

    It begins before arrival and continues throughout the call. Reassess constantly.

14. The components of scene size-up include:

    1. A. Hazards, vital signs, history, and destination choice
    2. B. Safety, airway, breathing, circulation, and transport
    3. C. Safety, chief complaint, GCS, and hospital notification
    4. D. Safety, precautions, mechanism, patient count, resources
    Show answer

    Answer: D. Safety, precautions, mechanism, patient count, resources

    Five elements: scene safety, standard precautions, mechanism of injury or nature of illness, number of patients, and resource needs.

15. Dispatch information should be treated as:

    1. A. Accurate unless the caller is a child
    2. B. Confirmed fact to plan the whole call on
    3. C. Irrelevant once you see the patient
    4. D. A starting point that may be wrong
    Show answer

    Answer: D. A starting point that may be wrong

    It may be incomplete or wrong. Callers are frightened and untrained.

16. Observations made while approaching the scene include:

    1. A. Medication lists and the patient's chief complaint
    2. B. The patient's vital signs and pupil response
    3. C. Hazards, weapons, vehicle damage, and bystanders
    4. D. The patient's medical history and allergies
    Show answer

    Answer: C. Hazards, weapons, vehicle damage, and bystanders

    Look for vehicle damage, weapons, hazards, bystander behavior, and patient position. Information begins at the curb.

17. Vehicle damage patterns suggest:

    1. A. The patient's exact diagnosis on arrival
    2. B. The forces involved and likely injuries
    3. C. Only the direction the vehicle traveled
    4. D. Which occupant was at fault in the crash
    Show answer

    Answer: B. The forces involved and likely injuries

    A starred windshield suggests head injury.

18. A starred windshield suggests:

    1. A. Head or facial impact
    2. B. Lateral impact to the pelvis
    3. C. Lower leg and ankle impact
    4. D. Seat belt injury to the abdomen
    Show answer

    Answer: A. Head or facial impact

    The occupant's head struck the glass; consider cervical spine injury.

19. A bent steering wheel suggests:

    1. A. Hip and femur impact
    2. B. Isolated head or facial impact
    3. C. Lower leg and foot impact
    4. D. Chest or abdominal impact
    Show answer

    Answer: D. Chest or abdominal impact

    Consider cardiac contusion and aortic injury.

20. Knee imprints on the dashboard suggest:

    1. A. Facial and cervical spine injury
    2. B. Ankle and foot fractures
    3. C. Chest wall and rib fractures
    4. D. Hip dislocation or femur fracture
    Show answer

    Answer: D. Hip dislocation or femur fracture

    Force travels up the femur; posterior hip dislocation is classic.

21. Restraint use affects:

    1. A. Only the amount of vehicle damage
    2. B. Legal fault, not injury patterns
    3. C. Only the vehicle's speed at impact
    4. D. The pattern and severity of injuries
    Show answer

    Answer: D. The pattern and severity of injuries

    Unrestrained occupants are at higher risk. Ask about seat belts and airbags.

22. Airbag deployment indicates:

    1. A. A minor crash with low injury risk
    2. B. Significant force, with possible injury
    3. C. The crash happened at low speed
    4. D. The patient is protected from injury
    Show answer

    Answer: B. Significant force, with possible injury

    The patient may still have injuries beneath the airbag. Lift it to check the steering wheel.

23. A fall from height suggests injuries based on:

    1. A. Landing surface alone, regardless of height
    2. B. Height alone, regardless of other factors
    3. C. The patient's age and weight only
    4. D. Height, surface, body part first, and age
    Show answer

    Answer: D. Height, surface, body part first, and age

    Feet-first falls transmit force up the spine.

24. Falls from over three times the patient's height suggest:

    1. A. Low risk if the patient is ambulatory
    2. B. A minor mechanism unless symptoms exist
    3. C. A significant mechanism of injury
    4. D. Isolated lower extremity injury only
    Show answer

    Answer: C. A significant mechanism of injury

    It warrants trauma center consideration. This is about 20 feet in adults.

25. Penetrating trauma assessment includes:

    1. A. Only the weapon type and its caliber
    2. B. Exit wound size, which predicts damage
    3. C. Only the size of the visible entry wound
    4. D. Weapon, distance, wound count, and trajectory
    Show answer

    Answer: D. Weapon, distance, wound count, and trajectory

    Internal damage exceeds the visible wound.

26. For a medical patient, the scene may reveal:

    1. A. Only the family's account of events
    2. B. The cause of illness confirmed by pill labels
    3. C. A definitive diagnosis of the illness
    4. D. Medications, equipment, and living conditions
    Show answer

    Answer: D. Medications, equipment, and living conditions

    Look for medications, oxygen, medical equipment, and living conditions. Scan the room.

27. Pill bottles at a scene should be:

    1. A. Noted and brought or documented
    2. B. Left in place for the police to collect
    3. C. Ignored unless overdose is suspected
    4. D. Disposed of to prevent further ingestion
    Show answer

    Answer: A. Noted and brought or documented

    Include a pill count if overdose is suspected. Time-stamped prescriptions help. Pill bottles reveal medications, doses, and conditions on any medical call, not just overdoses, so note them and bring or document them.

28. You arrive alone at a crash with five injured people, two of them unresponsive. What should you do first?

    1. A. Request more resources and begin triage
    2. B. Start CPR on the first unresponsive patient
    3. C. Load the most injured patient and leave now
    4. D. Fully assess each patient before calling
    Show answer

    Answer: A. Request more resources and begin triage

    When patients outnumber resources, call for help early and triage (for example, START or SALT) so the most salvageable patients are treated first. Committing to one patient, such as starting CPR, or leaving with one abandons the others. Fully assessing everyone before calling delays the resources you need.

29. Resource needs that may be identified during size-up include:

    1. A. A supervisor's approval before any request
    2. B. Only additional ambulances for transport
    3. C. More units, fire, rescue, police, or hazmat
    4. D. Only law enforcement at violent scenes
    Show answer

    Answer: C. More units, fire, rescue, police, or hazmat

    Needs may include additional units, fire, rescue, law enforcement, hazmat, or air medical. Request early.

30. Which patient requires an N95 respirator in addition to gloves before contact?

    1. A. A coughing patient with suspected tuberculosis
    2. B. A patient with a minor laceration on one finger
    3. C. A patient with an isolated ankle sprain
    4. D. A diabetic patient with a low blood glucose
    Show answer

    Answer: A. A coughing patient with suspected tuberculosis

    Standard precautions are chosen by the anticipated exposure. Airborne pathogens such as TB, measles, and varicella require a fit-tested N95. A small laceration needs gloves, plus eye protection if splashing is possible. A sprain or hypoglycemia without body fluid exposure needs gloves only.

31. From the doorway you see a man sitting bolt upright, pale and sweating, speaking in two-word phrases. What does your general impression tell you?

    1. A. He is stable; take a detailed history first
    2. B. Nothing until a full set of vital signs is obtained
    3. C. He is probably anxious and needs reassurance
    4. D. He is sick; move quickly to the primary assessment
    Show answer

    Answer: D. He is sick; move quickly to the primary assessment

    The general impression is a rapid sick-or-not-sick judgment from appearance, position, work of breathing, and skin. Two-word dyspnea, pallor, and diaphoresis mean sick. You do not need vital signs to make that call, and labeling it anxiety or starting with a long history risks missing a life threat.

32. Elements of the general impression include:

    1. A. Appearance, position, breathing effort, skin
    2. B. Medical history, allergies, medications
    3. C. Pulse rate, blood pressure, and SpO2
    4. D. Pupils, blood glucose, and temperature
    Show answer

    Answer: A. Appearance, position, breathing effort, skin

    Age, sex, position, appearance, work of breathing, and skin color are seen from the doorway.

33. A patient found in the tripod position suggests:

    1. A. Lower back pain
    2. B. Severe abdominal pain
    3. C. Respiratory distress
    4. D. Anxiety or panic
    Show answer

    Answer: C. Respiratory distress

    Maximizes breathing mechanics.

34. A patient lying still and avoiding movement suggests:

    1. A. Respiratory distress
    2. B. Panic attack
    3. C. Kidney stone pain
    4. D. Peritonitis
    Show answer

    Answer: D. Peritonitis

    Peritoneal irritation or severe pain makes any movement worse.

35. A patient writhing and unable to find comfort suggests:

    1. A. Spinal cord injury from a fall
    2. B. Peritonitis from a ruptured appendix
    3. C. Colicky pain, such as a kidney stone
    4. D. Respiratory distress from asthma
    Show answer

    Answer: C. Colicky pain, such as a kidney stone

    Colicky visceral pain, as with kidney stones or bowel obstruction, leaves the patient unable to get comfortable.

36. An unresponsive patient found face down requires:

    1. A. A log roll if trauma is possible
    2. B. Assessment in the prone position
    3. C. Immediate transport without a roll
    4. D. A quick roll without precautions
    Show answer

    Answer: A. A log roll if trauma is possible

    Log roll with spinal precautions. Protect the spine.

37. Crime scene awareness during size-up includes:

    1. A. Refusing to enter until detectives arrive
    2. B. Collecting evidence for law enforcement
    3. C. Avoiding disturbing evidence during care
    4. D. Photographing the scene before care
    Show answer

    Answer: C. Avoiding disturbing evidence during care

    Patient care still comes first.

38. Environmental factors in size-up include:

    1. A. The number of bystanders present
    2. B. Weather, lighting, and terrain
    3. C. The distance to the nearest hospital
    4. D. The patient's core temperature only
    Show answer

    Answer: B. Weather, lighting, and terrain

    Weather, temperature, lighting, and terrain affect both patient and crew; think hypothermia on a cold scene.

39. Bystanders at a scene may:

    1. A. Always be helpful and safe to trust
    2. B. Always be ignored to protect privacy
    3. C. Always interfere and should be removed
    4. D. Give history, help, or pose a risk
    Show answer

    Answer: D. Give history, help, or pose a risk

    Bystanders may provide history, assistance, or pose a safety risk. Assess them too.

40. Dispatch reports one patient in a single-car crash. On arrival you see an empty infant car seat in the back but no infant. What should you do?

    1. A. Assume the car seat was empty at the time
    2. B. Focus only on the driver, as dispatched
    3. C. Search for a possible additional patient
    4. D. Ask dispatch to cancel any further units
    Show answer

    Answer: C. Search for a possible additional patient

    Determine the total number of patients before committing to care. Clues such as an empty car seat, extra shoes, or a backpack suggest an ejected or wandering occupant. Dispatch information is only a starting point, so do not assume the seat was empty or cancel resources.

41. If the scene cannot be made safe, the crew should:

    1. A. Wait at a safe distance until secured
    2. B. Leave and cancel the call entirely
    3. C. Enter quickly to reach the patient
    4. D. Send in one provider to assess
    Show answer

    Answer: A. Wait at a safe distance until secured

    Dead providers help no one.

42. Which scene finding most changes the approach?

    1. A. A cluttered house with pets present
    2. B. Violence, hazmat, or multiple patients
    3. C. Family members present and upset
    4. D. A patient who speaks another language
    Show answer

    Answer: B. Violence, hazmat, or multiple patients

    Evidence of violence, hazardous materials, or multiple patients changes safety and resource needs.

43. A car is struck on the driver's door (near-side lateral impact). Which injury pattern should you most suspect in the driver?

    1. A. Isolated facial cuts from the windshield only
    2. B. Bilateral heel and lumbar fractures from landing
    3. C. Posterior hip dislocation from the dashboard impact
    4. D. Left-sided rib, spleen, pelvis, and neck injury
    Show answer

    Answer: D. Left-sided rib, spleen, pelvis, and neck injury

    In a near-side lateral impact the door intrudes into the driver's left side, causing left chest (ribs, lung), spleen, pelvis and acetabulum injuries, and lateral neck flexion injuries. Windshield and dashboard patterns come from frontal impacts. Heel and lumbar fractures come from feet-first falls.

44. A confused 70-year-old cannot give a history. Which scene finding is the most useful clue to the nature of his illness?

    1. A. A walker and grab bars installed in the bathroom
    2. B. Insulin pens on the table and an untouched meal
    3. C. Unopened mail stacked by the door
    4. D. A neat, well-kept living room and kitchen
    Show answer

    Answer: B. Insulin pens on the table and an untouched meal

    For a medical patient the nature of illness comes from the patient, bystanders, and scene clues. Insulin plus an uneaten meal points to hypoglycemia, so check a glucose. A walker and grab bars show limited mobility, stacked mail hints at how long he may have been unwell, and a tidy home reflects living conditions, but none of these points to the cause of his confusion.

45. A size-up update to dispatch is appropriate when:

    1. A. You finish writing the patient care report
    2. B. Conditions differ or more help is needed
    3. C. The patient has been loaded for transport
    4. D. The scene matches the dispatch information
    Show answer

    Answer: B. Conditions differ or more help is needed

    Update dispatch when the scene differs significantly from the dispatch information or when more resources are needed, so help can be sent early and the system stays informed. If the scene matches dispatch there is nothing new to report, and waiting until the patient is loaded or the report is written delays any extra resources.

46. Staging the ambulance for an unsafe scene means:

    1. A. Driving slowly past the address
    2. B. Waiting out of sight until cleared
    3. C. Parking across the street in view
    4. D. Parking directly in front of the scene
    Show answer

    Answer: B. Waiting out of sight until cleared

    Wait at a safe distance, out of sight and out of range.

47. Which best describes the relationship between size-up and the primary assessment?

    1. A. Size-up sets safety and context first
    2. B. They are unrelated and done separately
    3. C. The primary assessment comes first
    4. D. They are the same step with two names
    Show answer

    Answer: A. Size-up sets safety and context first

    Size-up ensures safety and context before the primary assessment identifies life threats.

48. In a closed apartment with a gas heater running, you find two unresponsive adults with no signs of trauma. What should you do first?

    1. A. Start treating them where they lie inside
    2. B. Rely on pulse oximetry to rule out poisoning
    3. C. Suspect CO; ensure crew safety and call fire
    4. D. Open one window and continue the assessment
    Show answer

    Answer: C. Suspect CO; ensure crew safety and call fire

    Several patients with the same symptoms, a fuel-burning heater, and a closed space suggest carbon monoxide. Protect the crew first: use a CO detector, call fire for SCBA and atmospheric monitoring, and remove patients only when it is safe. Standard pulse oximetry reads falsely normal in CO poisoning, and opening a window does not make the space safe.

49. The presence of a hospital bed and home oxygen suggests:

    1. A. A minor, short-term illness
    2. B. A patient who needs no transport
    3. C. A recent discharge with no chronic illness
    4. D. Chronic illness, possibly hospice or DNR
    Show answer

    Answer: D. Chronic illness, possibly hospice or DNR

    Ask about advance directives.

50. Signs of a struggle at a scene suggest:

    1. A. A simple fall with no other concern
    2. B. A medical seizure, not violence
    3. C. An old injury unrelated to this call
    4. D. Possible violence; reassess safety
    Show answer

    Answer: D. Possible violence; reassess safety

    Overturned furniture or blood spatter suggest violence; reassess safety and maintain crime scene awareness. Assuming a simple fall, a seizure, or an unrelated old event can put the crew at risk.

51. A size-up should consider the patient's age because:

    1. A. Age matters only for pediatric patients
    2. B. Age affects consent but not injury
    3. C. Age matters only for patients over 65
    4. D. Age changes how mechanism affects the body
    Show answer

    Answer: D. Age changes how mechanism affects the body

    A fall from standing in an older adult is significant.

52. Midway through treating a patient in a bar, the crowd becomes loud and someone breaks a bottle. What is the best action?

    1. A. Keep treating, since the scene was safe on arrival
    2. B. Ask the crowd to calm down and keep working
    3. C. Reassess safety; move the patient out or leave
    4. D. Finish the full secondary assessment first
    Show answer

    Answer: C. Reassess safety; move the patient out or leave

    Scene size-up continues for the whole call, and a safe scene can become unsafe. When violence threatens, move the patient to the ambulance or retreat and request law enforcement. Initial safety does not protect you, and staying to finish the exam or to manage the crowd yourself puts the crew at risk.