10 free AEMT practice questions: Recognizing Deterioration and Reassessment

Every 5 minutes, because a transported patient counts as unstable: Every 5 minutes is the schedule for an unstable patient, and nothing here is unstable. This patient has a normal pulse, a normal blood pressure, a normal SpO₂, and a splinted knee. Riding in an ambulance does not make a patient unstable.

Once more just before arrival, since two matching sets settle it: Two matching sets tell you the patient is stable right now. The hospital is still 35 minutes away. A patient who looks the same at minute zero and minute ten can still change at minute twenty. That's why the reassessment schedule keeps running until you arrive.

Only if the patient reports a new complaint during the ride: Waiting for the patient to report a change leaves your assessment up to the patient. Plenty of real problems show up in the skin, the pulse, and the mental status before the patient notices anything.

Every 15 minutes, since the systolic is still above 90: A systolic above 90 does not mean this patient is okay. In compensated shock, the body holds the blood pressure up while the pulse climbs and the skin turns pale. Both sets of vital signs show compensation happening. Every 15 minutes is too long for this patient.

Twice more, spaced evenly across the remaining 30 minutes: Spacing the checks evenly ties the schedule to the length of the drive. How often you reassess depends on how sick the patient is. Two more checks over 30 minutes is far too few for a patient who is getting worse.

Every 10 minutes, since the patient is still awake and answering: You recheck mental status at every reassessment. How often you reassess depends on how unstable the patient is. This patient answers slowly while the pulse climbs and the blood pressure falls. A patient like this is unstable, and an unstable patient gets checked every 5 minutes.

The arm was positioned poorly, so the radial pulse needs rechecking: A badly positioned arm can make a radial pulse hard to feel, and you can check positioning in one second. Positioning does not explain both radial pulses going away at the same time. This patient also has abdominal tenderness after a fall. Rechecking your technique spends time this patient does not have.

Perfusion is adequate, since the central pulse is still strong: A strong carotid pulse is what you expect while the body is still compensating. A strong carotid pulse does not mean perfusion is adequate. Trusting the carotid pulse here is the same mistake as trusting a normal blood pressure to rule out shock.

The bleeding has stopped, since the pressure held at the first check: Blood pressure is a late sign of shock. The 118/74 at the first check only tells you the body was compensating at that point. A normal pressure at the first check does not mean the bleeding stopped.

A fever is driving the pulse, since a rising temperature raises it: A fever does raise the pulse, but a fever does not make capillary refill go from 2 seconds to 4. The capillary refill is what separates a warm child with a fever from a child who is losing fluid.

The two sets disagree, so a third set is needed before deciding: The two sets do not disagree. A child's blood pressure is the last number to move, so a rising pulse with a steady blood pressure is what you expect. A third set only costs time.

Perfusion is stable, since the blood pressure barely moved at all: A steady blood pressure looks like stability, and in children the blood pressure is the worst number to trust. A child's blood pressure holds until the child crashes.

Hold the report until arrival, when the whole picture is available: Holding the report until arrival takes away the warning time the hospital needs. A call now gives the team time to get people together and open a room before this patient comes through the door.

Repeat the vital signs in 15 minutes to confirm the trend first: Repeating the vital signs is how you confirm a trend. Fifteen minutes is the whole rest of the trip, so you would be at the hospital before the next set. An unstable patient gets reassessed far more often than every 15 minutes. The second set of vital signs already shows the direction this patient is going.

Keep the current priority, since the patient still responds to voice: Answering only to a loud voice is not the same as alert. At the start of transport this patient was alert and talking. The drop in mental status is the finding, even though the patient still responds to voice.

The patient is being ventilated faster than the rate that was set: Ventilating faster than the set rate is a real cause of a falling EtCO2, because faster breaths blow off more carbon dioxide. The question tells you the ventilation rate has not changed. The drop from 37 to 26 has to come from something other than the bag.

The sampling line has come loose from the BVM circuit: A sampling line that comes loose from the circuit is worth a quick look. A loose line causes a sudden loss of the waveform, not a slow drift. Here the trace kept its shape while the EtCO2 drifted from 37 to 26 over ten minutes. A loose line also cannot raise the pulse to 122 or lower the blood pressure.

Ventilation has improved, so the value is settling toward normal: Normal EtCO2 runs 35 to 45 mmHg. A reading of 26 is below normal, and the number is moving away from normal, not settling toward it. With the heart rate climbing to 122, this patient is getting worse.

Keep the mask in place, since a saturation of 96% shows good breathing: A saturation of 96% looks reassuring. The oxygen from the mask holds the saturation up for a while. In a patient who is hypoventilating, the saturation is the last thing to fall.

Insert a nasopharyngeal airway and recheck the saturation in 5 minutes: A nasopharyngeal airway helps a patient whose airway is blocked. Nothing here says this patient's airway is blocked. Rechecking in 5 minutes at a rate of 6 lets the carbon dioxide keep building up.

Apply CPAP to support the shallow breaths: CPAP needs an awake patient who is breathing with enough effort. A patient who took a large dose of a sleep medication and is breathing 6 times a minute has neither. The tight mask also adds a risk of aspiration.

Open the line wide, since 500 mL was not enough to raise the pressure: Opening the line wide makes sense when the line is in the vein and the patient needs more volume. This line is not in the vein. Running the line faster pushes more saline into the forearm and does nothing for the pressure.

Raise the fluid bag higher so gravity can overcome the resistance: Raising the bag makes the fluid flow faster, but the height of the bag does not change where the fluid goes. The saline would just go into the same swollen tissue faster.

Apply a warm pack to the arm and keep the current line running: A warm pack can make the swollen arm more comfortable later. A warm pack does not get any fluid into a patient who is bleeding. Leaving the line running keeps pushing saline into the tissue.

Stop all fluid now, since the heart failure makes any more unsafe: A heart failure history is a reason to go carefully with fluid. Stopping now leaves a patient who is improving still short on volume. The pressure and the pulse are getting better, and the lungs are still clear.

Run a full liter wide open to finish correcting the fluid deficit: A full liter wide open would correct the deficit quickly. Pouring that liter into a failing heart backs the fluid up into the lungs. The heart failure history is exactly what makes the speed dangerous here.

Switch to a slow maintenance drip and reassess at the hospital: A slow maintenance drip runs too slowly to keep fixing a real fluid loss. Waiting until the hospital to reassess gives up what the next few minutes of lung checks would tell you.

Remove the oxygen, since the drowsiness started after it was applied: The drowsiness did start after the oxygen went on. This patient is still only at 88% on oxygen. Taking the oxygen off makes the hypoxia worse within minutes, and hypoxia is what kills on that timescale. The drowsiness tells you to add ventilation, never to take oxygen away.

Give a nebulized bronchodilator treatment and reassess in 5 minutes: A bronchodilator is the right drug for COPD, and one may already be running. A bronchodilator opens the airways for a patient who is still moving air. At 10 shallow breaths a minute, this patient is not moving enough air to carry the drug in or to wait for it to work.

Check a blood glucose level to explain the new drowsiness: A glucose check is quick, and new drowsiness is a fair reason to check one. The glucose result does not change what has to happen in the next thirty seconds. Air has to start moving in and out of a chest that has almost stopped moving.