Secondary Assessment Practice Questions

85 multiple-choice questions on Secondary assessment 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.

85 practice questions

1. The secondary assessment is performed:

   1. A. Only after hospital arrival
   2. B. Instead of the primary assessment
   3. C. Before the primary assessment
   4. D. After life threats are managed
   Show answer

   Answer: D. After life threats are managed

   It is done when time and the patient's condition allow. Critical patients may never receive a full secondary exam in the field.

2. The four techniques of physical examination are:

   1. A. Observation, interview, examination, documentation
   2. B. Looking, listening, feeling, and smelling
   3. C. Inspection, palpation, percussion, auscultation
   4. D. Assessment, treatment, transport, documentation
   Show answer

   Answer: C. Inspection, palpation, percussion, auscultation

   Inspection usually yields the most information per second spent.

3. DCAP-BTLS is a memory aid for:

   1. A. Trauma treatment priorities in order
   2. B. Elements of the SAMPLE history
   3. C. Vital signs to record in sequence
   4. D. Findings to look for in a trauma exam
   Show answer

   Answer: D. Findings to look for in a trauma exam

   Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, swelling.

4. A rapid full-body scan should take approximately:

   1. A. 3 to 5 minutes
   2. B. 30 to 90 seconds
   3. C. Until every injury is found
   4. D. 10 to 15 minutes
   Show answer

   Answer: B. 30 to 90 seconds

   It is designed to find life threats quickly, not every injury.

5. Auscultation of lung sounds should include:

   1. A. Both sides at multiple levels
   2. B. A single breath at each apex
   3. C. The bases only, posteriorly
   4. D. The anterior chest at one level
   Show answer

   Answer: A. Both sides at multiple levels

   Compare symmetric points to detect differences.

6. Crackles heard on auscultation suggest:

   1. A. Fluid in the alveoli or small airways
   2. B. Partial upper airway obstruction
   3. C. Narrowing of the lower airways
   4. D. Inflammation of the pleural lining
   Show answer

   Answer: A. Fluid in the alveoli or small airways

   Wheezing suggests narrowed lower airways.

7. A child has a high fever, drools, sits leaning forward, and has soft inspiratory stridor. What is the best approach?

   1. A. Lay her flat and inspect the throat with a tongue blade
   2. B. Have her drink cold fluids to ease the throat pain
   3. C. Start an IV immediately to give fluids
   4. D. Keep her calm and upright; do not examine the throat
   Show answer

   Answer: D. Keep her calm and upright; do not examine the throat

   Fever, drooling, tripod posture, and stridor suggest epiglottitis or another severe upper airway infection. Agitation or a throat exam can trigger complete obstruction, so keep the child calm and upright with her caregiver, give oxygen as tolerated, and transport with airway expertise ready. Lying flat, drinking, and IV attempts can all precipitate obstruction.

8. Jugular venous distention in a seated patient may indicate:

   1. A. Dehydration with low venous return
   2. B. Raised right-sided heart pressure
   3. C. Hypovolemia from blood loss
   4. D. Normal anatomy in most adults
   Show answer

   Answer: B. Raised right-sided heart pressure

   Causes include tamponade, tension pneumothorax, and right heart failure. Combine it with breath sounds and blood pressure to interpret.

9. Palpation of the abdomen should:

   1. A. Be skipped if the patient has pain
   2. B. Use deep pressure before light touch
   3. C. Begin in the most painful quadrant
   4. D. Begin away from the pain and end there
   Show answer

   Answer: D. Begin away from the pain and end there

   Starting at the painful area causes guarding that limits the rest of the exam.

10. Abdominal rigidity or guarding suggests:

    1. A. Recent exercise or muscle strain
    2. B. Anxiety alone, without pathology
    3. C. Normal abdominal muscle tone
    4. D. Peritoneal irritation
    Show answer

    Answer: D. Peritoneal irritation

    This may indicate bleeding or inflammation. Note whether guarding is voluntary or involuntary.

11. Assessment of an extremity should always include:

    1. A. Range of motion at every joint
    2. B. Comparison with standard reference values
    3. C. Distal pulse, motor, and sensation
    4. D. Joint stability under stress
    Show answer

    Answer: C. Distal pulse, motor, and sensation

    Check before and after splinting. Document these findings each time.

12. The Glasgow Coma Scale evaluates:

    1. A. Airway, breathing, and circulation
    2. B. Orientation to person, place, time
    3. C. Pupil response, blood pressure, and pulse
    4. D. Eye opening, verbal, and motor response
    Show answer

    Answer: D. Eye opening, verbal, and motor response

    Scores range from 3 to 15.

13. A patient's eyes open only to pain, he makes incomprehensible sounds, and he withdraws from pain. What is his GCS?

    1. A. 7
    2. B. 9
    3. C. 8
    4. D. 10
    Show answer

    Answer: C. 8

    Eye opening to pain scores 2, incomprehensible sounds score 2 on verbal, and withdrawal from pain scores 4 on motor, for a total of 8. A GCS of 8 or less indicates severe brain injury and a patient who may not protect his airway. (Replaces a duplicate of s02-q031, which asks the GCS motor range.)

14. Stroke screening tools such as the Cincinnati scale assess:

    1. A. Grip strength and gait balance
    2. B. Memory and orientation to time
    3. C. Pupil size and light response
    4. D. Facial droop, arm drift, and speech
    Show answer

    Answer: D. Facial droop, arm drift, and speech

    Time of last known well is essential to document.

15. A focused physical exam for a patient with chest pain should include:

    1. A. Chest, lung sounds, rhythm, and BP
    2. B. Pupils and neurologic status only
    3. C. Abdomen and bowel sounds only
    4. D. Extremities and distal pulses only
    Show answer

    Answer: A. Chest, lung sounds, rhythm, and BP

    Check blood pressure in both arms when indicated and look for heart failure. A 12-lead ECG belongs in that assessment.

16. Reassessing a splint or bandage after movement is necessary because:

    1. A. Movement can loosen it or impair flow
    2. B. Pain relief often lets you remove it
    3. C. Swelling tends to settle after a move
    4. D. Protocols require it after every lift
    Show answer

    Answer: A. Movement can loosen it or impair flow

    Loss of distal circulation is the key danger. Recheck pulse, motor, and sensation each time. Movement can shift or loosen a splint, and swelling tends to build rather than settle, which can make it too tight. Pain relief is not a reason to remove a splint, and the reason to recheck is the patient, not a protocol checklist.

17. The secondary assessment includes:

    1. A. Vital signs alone, repeated every 5 minutes
    2. B. A focused history without examination
    3. C. A physical exam without vital signs
    4. D. Physical exam, vital signs, and history
    Show answer

    Answer: D. Physical exam, vital signs, and history

    Systematic.

18. The secondary assessment may be deferred when:

    1. A. The patient is stable and talking
    2. B. Never; it must always be completed
    3. C. Transport time is under 10 minutes
    4. D. The patient is critically unstable
    Show answer

    Answer: D. The patient is critically unstable

    Life threats then demand continuous attention. Priorities.

19. Inspection involves:

    1. A. Touching to feel for tenderness or masses
    2. B. Looking carefully at the patient
    3. C. Tapping to assess underlying density
    4. D. Listening with a stethoscope over organs
    Show answer

    Answer: B. Looking carefully at the patient

    Often the most informative.

20. Palpation involves:

    1. A. Listening with a stethoscope
    2. B. Looking carefully at the patient
    3. C. Tapping to assess density
    4. D. Touching to feel for tenderness
    Show answer

    Answer: D. Touching to feel for tenderness

    It also assesses deformity, temperature, and pulses. Gentle.

21. Percussion involves:

    1. A. Looking carefully at the patient's body
    2. B. Listening with a stethoscope over organs
    3. C. Tapping to assess underlying density
    4. D. Touching to feel for tenderness or masses
    Show answer

    Answer: C. Tapping to assess underlying density

    Dullness or hyperresonance.

22. Auscultation involves:

    1. A. Listening with a stethoscope
    2. B. Tapping to assess density
    3. C. Touching to feel for tenderness
    4. D. Looking carefully at the patient
    Show answer

    Answer: A. Listening with a stethoscope

    Lungs, heart, bowel.

23. The D in DCAP-BTLS stands for:

    1. A. Deformities
    2. B. Drainage
    3. C. Discoloration
    4. D. Distension
    Show answer

    Answer: A. Deformities

    Abnormal shape.

24. The C in DCAP-BTLS stands for:

    1. A. Capillary refill
    2. B. Color
    3. C. Contusions
    4. D. Cuts
    Show answer

    Answer: C. Contusions

    Bruising.

25. The A in DCAP-BTLS stands for:

    1. A. Abrasions
    2. B. Absence
    3. C. Avulsions
    4. D. Angulation
    Show answer

    Answer: A. Abrasions

    Scrapes.

26. The P in DCAP-BTLS stands for:

    1. A. Pulselessness
    2. B. Punctures
    3. C. Paresthesia
    4. D. Pallor
    Show answer

    Answer: B. Punctures

    Punctures include penetrations. Entry wounds.

27. The B in DCAP-BTLS stands for:

    1. A. Bruising
    2. B. Bleeding
    3. C. Breaks
    4. D. Burns
    Show answer

    Answer: D. Burns

    Thermal, chemical, electrical.

28. The T in DCAP-BTLS stands for:

    1. A. Temperature
    2. B. Trauma
    3. C. Tears
    4. D. Tenderness
    Show answer

    Answer: D. Tenderness

    Pain on palpation.

29. The L in DCAP-BTLS stands for:

    1. A. Lesions
    2. B. Lymphadenopathy
    3. C. Lacerations
    4. D. Lividity
    Show answer

    Answer: C. Lacerations

    Cuts.

30. The S in DCAP-BTLS stands for:

    1. A. Spasm
    2. B. Sensation
    3. C. Swelling
    4. D. Scars
    Show answer

    Answer: C. Swelling

    Edema.

31. The rapid trauma assessment is performed on:

    1. A. Trauma with significant mechanism
    2. B. Every patient, medical or trauma
    3. C. Medical patients who are unresponsive
    4. D. Stable patients with isolated injury
    Show answer

    Answer: A. Trauma with significant mechanism

    Trauma patients with altered mental status also get it. Find hidden injuries.

32. The focused trauma assessment is performed on:

    1. A. Isolated injury, no significant mechanism
    2. B. Critical trauma with multiple injuries
    3. C. Every patient, medical or trauma
    4. D. Medical patients with localized pain
    Show answer

    Answer: A. Isolated injury, no significant mechanism

    Targeted.

33. Head examination includes:

    1. A. Scalp, skull, and all facial structures
    2. B. The scalp only, checking for lacerations
    3. C. The eyes and pupils only, for brain injury
    4. D. The face only, for airway threats
    Show answer

    Answer: A. Scalp, skull, and all facial structures

    Include eyes, ears, nose, and mouth. Look for deformity, drainage, bruising.

34. Battle sign is:

    1. A. Bruising around both eyes
    2. B. Bruising over the cheekbone
    3. C. Bruising behind the ear
    4. D. A laceration of the scalp
    Show answer

    Answer: C. Bruising behind the ear

    It suggests basilar skull fracture. Delayed finding.

35. Raccoon eyes are:

    1. A. Bruising behind the ear from skull fracture
    2. B. Dark circles from allergic congestion
    3. C. Bruising from direct blows to the eye
    4. D. Periorbital bruising from basilar fracture
    Show answer

    Answer: D. Periorbital bruising from basilar fracture

    Delayed finding.

36. Clear fluid draining from the nose or ear suggests:

    1. A. Normal secretions after trauma
    2. B. Middle ear or sinus infection
    3. C. Allergic rhinitis or sinusitis
    4. D. CSF leak from a skull fracture
    Show answer

    Answer: D. CSF leak from a skull fracture

    Do not pack.

37. Neck examination includes:

    1. A. Midline spinal tenderness only
    2. B. JVD only, with the head raised
    3. C. Trachea, JVD, tenderness, and crepitus
    4. D. Tracheal position only, before collaring
    Show answer

    Answer: C. Trachea, JVD, tenderness, and crepitus

    Include deformity and subcutaneous emphysema. Before the collar.

38. Subcutaneous emphysema feels like:

    1. A. Smooth, firm swelling
    2. B. A firm, pulsating mass
    3. C. Warm, fluid-filled swelling
    4. D. Crackling under the skin
    Show answer

    Answer: D. Crackling under the skin

    Air in tissue from airway or lung injury.

39. Tracheal deviation is:

    1. A. A late sign of tension pneumothorax
    2. B. An early sign of tension pneumothorax
    3. C. A common finding in simple rib fracture
    4. D. A normal variant in most adults
    Show answer

    Answer: A. A late sign of tension pneumothorax

    Do not wait for it.

40. Chest examination includes:

    1. A. Auscultation of both sides only
    2. B. Inspection, palpation, and auscultation
    3. C. Inspection for symmetry and wounds only
    4. D. Palpation for crepitus and tenderness only
    Show answer

    Answer: B. Inspection, palpation, and auscultation

    Look, feel, listen.

41. Paradoxical chest movement indicates:

    1. A. Simple pneumothorax
    2. B. Normal breathing
    3. C. Flail chest
    4. D. Single rib fracture
    Show answer

    Answer: C. Flail chest

    Segment moves opposite.

42. A sucking chest wound requires:

    1. A. Wound packing with gauze
    2. B. A bulky pressure dressing
    3. C. An occlusive dressing
    4. D. Elevation of the injured side
    Show answer

    Answer: C. An occlusive dressing

    Vented if possible.

43. After a crash, a patient has decreased breath sounds on the right, hypotension, and JVD. What is most likely?

    1. A. Right tension pneumothorax
    2. B. Left tension pneumothorax
    3. C. Pericardial tamponade alone
    4. D. Massive right hemothorax
    Show answer

    Answer: A. Right tension pneumothorax

    Absent or decreased breath sounds on one side with hypotension and JVD after trauma suggests tension pneumothorax on the side of the decreased sounds, which needs needle decompression. Tamponade causes JVD and hypotension but equal breath sounds. A massive hemothorax also decreases breath sounds and causes hypotension, but blood loss usually leaves the neck veins flat rather than distended.

44. Abdominal examination includes:

    1. A. Auscultation of all quadrants only
    2. B. Inspection, then gentle palpation
    3. C. Deep palpation of the painful area only
    4. D. Inspection only, no palpation
    Show answer

    Answer: B. Inspection, then gentle palpation

    Inspect for distention, bruising, and wounds, then palpate all quadrants. Painful area last.

45. Seat belt bruising across the abdomen suggests:

    1. A. Proper belt use, so low injury risk
    2. B. Possible abdominal and lumbar spine injury
    3. C. Minor injury unless vitals are abnormal
    4. D. Superficial skin injury, nothing deeper
    Show answer

    Answer: B. Possible abdominal and lumbar spine injury

    Seat belt sign.

46. Cullen sign is:

    1. A. Periumbilical bruising from bleeding
    2. B. Flank bruising from kidney trauma
    3. C. Bruising across the lower chest wall
    4. D. Bruising behind the ear from fracture
    Show answer

    Answer: A. Periumbilical bruising from bleeding

    It suggests intra-abdominal bleeding. Delayed.

47. Grey Turner sign is:

    1. A. Periumbilical bruising from bleeding
    2. B. Bruising over the sternum from CPR
    3. C. Neck bruising from strangulation
    4. D. Flank bruising from hidden bleeding
    Show answer

    Answer: D. Flank bruising from hidden bleeding

    The bleeding is retroperitoneal. Delayed.

48. Pelvic examination in trauma involves:

    1. A. Skipping assessment; apply a binder
    2. B. Rocking the pelvis side to side
    3. C. Gentle pressure, done only once
    4. D. Repeated compression to recheck
    Show answer

    Answer: C. Gentle pressure, done only once

    Repeated rocking dislodges clots.

49. An unstable pelvis requires:

    1. A. A pelvic binder and minimal movement
    2. B. Traction splints on both legs
    3. C. Log rolling to inspect the back
    4. D. Repeated checks for stability en route
    Show answer

    Answer: A. A pelvic binder and minimal movement

    Bleeding control.

50. A patient with a deformed tibia has no pedal pulse and a cool, pale foot. What should you do?

    1. A. Splint it in place as found and disregard the pulse
    2. B. Elevate the leg and apply a cold pack
    3. C. Wait for the ED to manage the pulse
    4. D. Realign with gentle traction, splint, and recheck
    Show answer

    Answer: D. Realign with gentle traction, splint, and recheck

    A pulseless, cool, pale extremity distal to a long-bone deformity suggests vascular compromise. Most protocols allow gentle realignment toward anatomic position with traction to restore circulation, then splinting and rechecking pulse, motor, and sensation. Splinting without addressing the pulse, elevating and icing a pulseless limb, or waiting risks limb loss. Follow local protocol on realignment.

51. After you apply a traction splint, the patient's foot is now numb and pale. What should you do?

    1. A. Check and loosen the straps, then recheck
    2. B. Elevate the leg and recheck in 15 minutes
    3. C. Add more traction to secure the leg
    4. D. Remove the splint and move the patient
    Show answer

    Answer: A. Check and loosen the straps, then recheck

    Distal pulse, motor, and sensation are checked before and after any splint, because a splint that is too tight can cut off circulation. New numbness and pallor mean you should check and loosen the straps or padding and recheck. Waiting to recheck or adding traction risks ischemia, and removing the splint loses stabilization.

52. Posterior examination requires:

    1. A. Sitting the patient up to look
    2. B. Rolling only after hospital imaging
    3. C. Log rolling with spinal precautions
    4. D. Skipping it if the front is normal
    Show answer

    Answer: C. Log rolling with spinal precautions

    Inspect and palpate the back. Hidden injuries.

53. Spinal examination includes:

    1. A. Range of motion testing of the neck
    2. B. Inspection only, without touching
    3. C. Palpation only, with the patient seated
    4. D. Inspection and palpation for step-off
    Show answer

    Answer: D. Inspection and palpation for step-off

    Check for tenderness and deformity. Midline tenderness.

54. The focused medical assessment targets:

    1. A. Vital signs alone, repeated often
    2. B. The history alone, without an exam
    3. C. Every body system in sequence
    4. D. Systems related to the chief complaint
    Show answer

    Answer: D. Systems related to the chief complaint

    Chest pain gets a cardiac exam.

55. A respiratory complaint exam includes:

    1. A. Auscultation of lung sounds only
    2. B. Pulse oximetry reading alone
    3. C. Respiratory rate counted for 30 seconds
    4. D. Work of breathing, lung sounds, SpO2, ETCO2
    Show answer

    Answer: D. Work of breathing, lung sounds, SpO2, ETCO2

    Look for signs of heart failure. Comprehensive.

56. A cardiac complaint exam includes:

    1. A. Peripheral pulses in all four limbs
    2. B. Rhythm, 12-lead, perfusion, JVD, and edema
    3. C. Vital signs alone, repeated every 5 minutes
    4. D. A 12-lead ECG alone, without exam
    Show answer

    Answer: B. Rhythm, 12-lead, perfusion, JVD, and edema

    Listen to heart sounds as well. Look for failure.

57. A neurologic exam includes:

    1. A. Pupil size and reactivity alone
    2. B. A GCS score alone, as the full exam
    3. C. Mental status, pupils, motor, and sensory
    4. D. Motor strength in all four limbs only
    Show answer

    Answer: C. Mental status, pupils, motor, and sensory

    Add cranial nerves and coordination. Stroke scales.

58. On a Cincinnati scale, a patient has facial droop and arm drift but normal speech. How should you interpret the stroke screen?

    1. A. Positive; one abnormal finding suggests stroke
    2. B. Negative; all three findings must be abnormal to count
    3. C. Negative; speech must be abnormal to count
    4. D. Inconclusive until a CT scan is available
    Show answer

    Answer: A. Positive; one abnormal finding suggests stroke

    Any single abnormal finding on the Cincinnati Prehospital Stroke Scale (facial droop, arm drift, or abnormal speech) makes the screen positive, with roughly a 72% probability of stroke. Do not wait for all three or for speech changes, and do not delay stroke alerting or transport for imaging.

59. Large vessel occlusion scales such as LAMS or RACE add:

    1. A. Pupil size and reactivity checks
    2. B. Severity items such as gaze and neglect
    3. C. Speech testing in greater detail only
    4. D. Only a repeat of the Cincinnati items
    Show answer

    Answer: B. Severity items such as gaze and neglect

    They identify thrombectomy candidates. Destination decision.

60. Arm drift is tested by:

    1. A. Passively lifting each arm and letting go
    2. B. Both arms held out, eyes closed, 10 seconds
    3. C. Squeezing both of the provider's hands
    4. D. Raising one arm at a time overhead
    Show answer

    Answer: B. Both arms held out, eyes closed, 10 seconds

    Drift suggests weakness.

61. Pronator drift is:

    1. A. Upward drift from muscle spasm
    2. B. A normal finding in older adults
    3. C. Fine tremor of the outstretched hands
    4. D. Arm drifting down and pronating
    Show answer

    Answer: D. Arm drifting down and pronating

    It indicates upper motor neuron weakness. Subtle weakness.

62. Sensory examination tests:

    1. A. Position sense only, in the toes
    2. B. Light touch only, on one side
    3. C. Light touch and pain, at minimum
    4. D. Pain response only, by pinching
    Show answer

    Answer: C. Light touch and pain, at minimum

    Temperature and position may also be tested. Compare sides.

63. A dermatome level helps:

    1. A. Grade peripheral nerve strength
    2. B. Map skin injuries in burn patients
    3. C. Localize spinal cord injury
    4. D. Measure muscle strength by level
    Show answer

    Answer: C. Localize spinal cord injury

    Know key levels.

64. Cranial nerve assessment in the field commonly includes:

    1. A. Pupils, facial symmetry, eye movements
    2. B. All 12 nerves tested in full detail
    3. C. Pupils only, for herniation signs
    4. D. Facial symmetry only, for stroke
    Show answer

    Answer: A. Pupils, facial symmetry, eye movements

    Swallowing is often checked too. Practical subset.

65. Abdominal complaint exam includes:

    1. A. Inspection, palpation, peritoneal signs
    2. B. Auscultation for 2 minutes per quadrant
    3. C. Deep palpation of the painful area
    4. D. Inspection for distention only
    Show answer

    Answer: A. Inspection, palpation, peritoneal signs

    Palpate all quadrants; auscultation may be included. Order matters.

66. A patient with abdominal pain winces when the stretcher bumps over a curb. What does this suggest?

    1. A. Kidney stone pain, which worsens with stillness
    2. B. Normal anxiety about the ambulance ride
    3. C. Peritoneal irritation, as from appendicitis
    4. D. Gastroenteritis without peritoneal signs
    Show answer

    Answer: C. Peritoneal irritation, as from appendicitis

    Pain from jarring (bumps, heel drop, coughing) is a sign of peritoneal irritation, like rebound tenderness, and suggests appendicitis or another surgical abdomen. Kidney stone patients writhe and are not made worse by jarring in this way. This is a real exam finding, not anxiety, and it argues against simple gastroenteritis.

67. Guarding is:

    1. A. Always an involuntary, unconscious reflex
    2. B. Muscle tensing over an inflamed area
    3. C. Voluntary tensing caused only by anxiety
    4. D. A normal reflex response to light touch
    Show answer

    Answer: B. Muscle tensing over an inflamed area

    It may be voluntary or involuntary. Involuntary is more significant.

68. Pulsatile abdominal mass suggests:

    1. A. Abdominal aortic aneurysm
    2. B. Fecal impaction or bowel loop
    3. C. An incarcerated hernia
    4. D. A distended urinary bladder
    Show answer

    Answer: A. Abdominal aortic aneurysm

    Do not palpate deeply.

69. Murphy sign suggests:

    1. A. Cholecystitis
    2. B. Appendicitis
    3. C. Bowel obstruction
    4. D. Pancreatitis
    Show answer

    Answer: A. Cholecystitis

    Pain on inspiration with RUQ palpation.

70. McBurney point tenderness suggests:

    1. A. Cholecystitis
    2. B. Appendicitis
    3. C. Pancreatitis
    4. D. Kidney stone
    Show answer

    Answer: B. Appendicitis

    RLQ.

71. Costovertebral angle tenderness suggests:

    1. A. Kidney infection or stone
    2. B. Acute pancreatic inflammation
    3. C. Acute retrocecal appendicitis
    4. D. Acute gallbladder inflammation
    Show answer

    Answer: A. Kidney infection or stone

    Flank.

72. Skin examination includes:

    1. A. Rashes and lesions only, for infection
    2. B. Temperature only, using the back of the hand
    3. C. Color, temperature, moisture, and lesions
    4. D. Color only, as a perfusion indicator
    Show answer

    Answer: C. Color, temperature, moisture, and lesions

    Include turgor and rashes. Petechiae and purpura matter.

73. Petechiae suggest:

    1. A. A mild allergic skin reaction
    2. B. Simple bruising from minor trauma
    3. C. Platelet problems or meningococcemia
    4. D. A normal finding after exercise
    Show answer

    Answer: C. Platelet problems or meningococcemia

    Nonblanching.

74. Urticaria suggests:

    1. A. Bacterial infection
    2. B. Normal skin finding
    3. C. Bleeding disorder
    4. D. Allergic reaction
    Show answer

    Answer: D. Allergic reaction

    Hives.

75. Jugular venous distention is assessed with the patient at:

    1. A. Lying completely flat
    2. B. About 45 degrees
    3. C. Sitting fully upright
    4. D. Standing upright
    Show answer

    Answer: B. About 45 degrees

    Distention above the clavicle is abnormal.

76. Peripheral edema is assessed by:

    1. A. Inspecting the ankles for visible swelling
    2. B. Pressing over the tibia and grading the pit
    3. C. Measuring calf circumference with a tape
    4. D. Asking whether shoes have felt tight
    Show answer

    Answer: B. Pressing over the tibia and grading the pit

    1 to 4 plus. Press over the tibia or ankle; pitting is graded 1+ to 4+.

77. Heart sounds are auscultated at:

    1. A. Aortic, pulmonic, tricuspid, and mitral areas
    2. B. Only at the apex, over the mitral area
    3. C. Only at the base, over the aortic area
    4. D. Only over the left chest, where the heart lies
    Show answer

    Answer: A. Aortic, pulmonic, tricuspid, and mitral areas

    Murmurs and rubs. Listening at all four areas helps identify murmurs and rubs.

78. A new murmur after MI suggests:

    1. A. Papillary muscle rupture or septal defect
    2. B. Expected healing of the infarcted wall
    3. C. A benign flow murmur from anxiety or fever
    4. D. Mild dehydration from poor intake
    Show answer

    Answer: A. Papillary muscle rupture or septal defect

    Emergency. A new murmur after MI suggests a mechanical complication.

79. Bowel sounds in the field:

    1. A. Are essential to rule out obstruction
    2. B. Reliably diagnose an acute abdomen
    3. C. Must be heard for 5 minutes per quadrant
    4. D. Add little and take too long
    Show answer

    Answer: D. Add little and take too long

    Low yield. Auscultating bowel sounds has limited value in the field and is time-consuming.

80. The secondary assessment of a pediatric patient:

    1. A. Follows the same head-to-toe order as adults
    2. B. Is done with the caregiver out of the room
    3. C. Is skipped unless the child is injured
    4. D. Is adapted to age, often done toe to head
    Show answer

    Answer: D. Is adapted to age, often done toe to head

    Build trust. Keeping the caregiver present helps.

81. The secondary assessment of a geriatric patient:

    1. A. Considers baseline and atypical signs
    2. B. Is shortened to limit patient fatigue
    3. C. Is identical to that of a younger adult
    4. D. Focuses mainly on cognitive testing
    Show answer

    Answer: A. Considers baseline and atypical signs

    Thoroughness. Account for baseline function, atypical presentations, and fragile skin.

82. When documenting the secondary assessment, what should be recorded?

    1. A. A brief overall impression of the patient
    2. B. Abnormal findings, leaving out normals
    3. C. Relevant normal and abnormal findings
    4. D. Vital signs, with exam findings omitted
    Show answer

    Answer: C. Relevant normal and abnormal findings

    Document relevant normal and abnormal findings by body region; pertinent negatives prove what you assessed. An overall impression alone, abnormal findings without the normals, or vital signs without exam findings leave gaps in the record.

83. Which finding during secondary assessment most changes management?

    1. A. Midline spinal tenderness after trauma
    2. B. An old, well-healed surgical scar on the abdomen
    3. C. Mild abrasions on both knees
    4. D. A large bruise on the forearm
    Show answer

    Answer: A. Midline spinal tenderness after trauma

    Spinal precautions. Midline tenderness in a trauma patient calls for spinal motion restriction.

84. Which finding during secondary assessment is most ominous?

    1. A. A new focal neurologic deficit
    2. B. A healed scar over the sternum
    3. C. Mild tenderness over the ribs
    4. D. Mild swelling of a sprained ankle
    Show answer

    Answer: A. A new focal neurologic deficit

    Stroke or injury.

85. The purpose of the secondary assessment is to:

    1. A. Establish a definitive diagnosis
    2. B. Find all problems and refine the impression
    3. C. Complete the full documentation of the call
    4. D. Find and treat immediate life threats
    Show answer

    Answer: B. Find all problems and refine the impression

    Complete the picture. Life threats belong to the primary assessment; the secondary assessment finds all injuries and conditions.