10 free AEMT practice questions: Recognizing Deterioration and Reassessment

Every 5 minutes, because a transported patient counts as unstable: Five minutes is the unstable interval, and nothing here is unstable. A normal pulse, a normal pressure, a normal saturation and an isolated splinted knee do not buy this patient the every 5 minute schedule. Riding in an ambulance is not a vital sign.

Once more just before arrival, since two matching sets settle it: Two matching sets tell you the direction right now, not the direction for the next 35 minutes. A patient who looks identical at minute zero and minute ten can still change at minute twenty, which is exactly why the interval keeps running instead of closing.

Only if the patient reports a new complaint during the ride: Waiting for the patient to volunteer a change hands your assessment to the patient. Plenty of real deterioration shows up in skin, pulse and mental status before the patient notices anything worth mentioning.

Every 15 minutes, since the systolic is still above 90: A systolic above 90 is not a clean bill of health. Compensation holds the pressure up while the pulse climbs and the skin turns, which is precisely what these two sets show. Reading only the systolic is how a compensating patient gets put on a 15 minute schedule.

Twice more, spaced evenly across the remaining 30 minutes: Spacing checks evenly across the ride treats reassessment as a chore to be spread out rather than as monitoring. The interval is tied to how sick the patient is, not to how long the drive is.

Every 10 minutes, since the patient is still awake and answering: Mental status is one of the things you are rechecking, not the thing that sets how often you recheck. A patient answering slowly on a falling pressure and a climbing rate is unstable, and unstable buys the five minute clock.

The arm was positioned poorly, so the radial pulse needs rechecking: Positioning is worth ruling out in one second, and it does not explain both sides going away together in a patient with abdominal tenderness after a fall. Chasing the technique buys time you do not have.

Perfusion is adequate, since the central pulse is still strong: A strong central pulse is what you would expect while compensation is still working. Reading it as reassurance is the same error as reading a normal blood pressure as no shock.

The bleeding has stopped, since the pressure held at the first check: Blood pressure is a late sign. A systolic that held at the first check tells you compensation was holding then, not that the bleeding stopped.

A fever is driving the pulse, since a rising temperature raises it: Fever does raise the pulse, and it does not lengthen capillary refill from 2 seconds to 4. The skin finding is the one that separates a warm febrile child from a child who is losing volume.

The two sets disagree, so a third set is needed before deciding: The two sets do not disagree. They agree completely once you know that pediatric blood pressure is the last number to move, and a third set only costs time.

Perfusion is stable, since the blood pressure barely moved at all: Reading the steady blood pressure as stability is the single most tested pediatric trap. In children the pressure holds until the child crashes, so it is the worst number to lean on.

Hold the report until arrival, when the whole picture is available: Saving the report for arrival costs the receiving team the only thing early notification buys, which is time to assemble people and open a room before the patient rolls through the door.

Repeat the vital signs in 15 minutes to confirm the trend first: Waiting fifteen minutes for confirmation is a third of the remaining trip. The second set already confirmed the first, and a trend that has declared itself does not need a tiebreaker.

Keep the current priority, since the patient still responds to voice: Responding to a loud voice is not the same as alert, and treating it as good enough ignores the direction. Mental status is the finding here, not the label you can still put on it.

The patient is being ventilated faster than the rate that was set: Ventilating too fast does drive the number down, which is why the question fixes the rate. The rate did not change, so the explanation has to come from somewhere other than the bag.

The sampling line has come loose from the bag valve mask circuit: A disconnected sampling line is worth a two second look, and it produces a sudden loss of the waveform rather than a steady drift with a shape still present. The pulse and pressure moving alongside it point at the patient.

Ventilation has improved, so the value is settling toward normal: Normal is 35 to 45 mmHg, so 26 is below the range rather than settling into it. Calling a falling value improvement gets this exactly backward.

Keep the mask in place, since a saturation of 96% shows good breathing: The reassuring number is exactly the trap. Oxygen delivered by mask props the saturation up for a while, and the saturation is the last thing to fall in a patient who is hypoventilating.

Insert a nasopharyngeal airway and recheck the saturation in 5 minutes: An airway adjunct helps a patient whose airway is obstructed, and nothing here says the airway is blocked. Waiting another five minutes at a rate of 6 lets the carbon dioxide keep climbing.

Apply continuous positive airway pressure to support the shallow breaths: Continuous positive airway pressure needs an awake patient with adequate spontaneous effort. A drugged patient breathing 6 times a minute has neither, and the tight mask adds an aspiration risk on top.

Open the line wide, since 500 mL was not enough to raise the pressure: Opening a line that is not in the vein pushes more saline into the forearm and does nothing for the pressure. The failure to respond is the clue to check the site, not the reason to run faster.

Raise the fluid bag higher so gravity can overcome the resistance: Height changes flow rate, not location. The fluid would simply infiltrate faster into the same tissue.

Apply a warm pack to the arm and keep the current line running: A warm pack is a comfort measure for the swollen arm later, and it does not deliver a drop of volume to a patient who is bleeding. Leaving the line running keeps the damage going.

Stop all fluid now, since the heart failure makes any more unsafe: Stopping now leaves a patient who is responding well still short of volume. A heart failure history is a reason to go carefully, not a reason to withhold fluid from someone who is dehydrated and improving.

Run a full liter wide open to finish correcting the fluid deficit: A liter wide open into a failing heart is how clear lungs become wet ones. The cardiac history is exactly what makes the speed the hazard here.

Switch to a slow maintenance drip and reassess at the hospital: A maintenance drip trickles in too slowly to keep correcting a real deficit, and deferring the reassessment to the hospital gives up the information the next few minutes would provide.

Remove the oxygen, since the drowsiness started after it was applied: Taking oxygen away from a patient sitting at 88% makes the hypoxia worse within minutes, and hypoxia is what kills on that timescale. The drowsiness is a reason to add ventilation, never a reason to subtract oxygen.

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

Check a blood glucose level to explain the new drowsiness: Glucose is worth knowing and it is quick, and new drowsiness is a fair reason to check it. Nothing it comes back as changes what has to happen in the next thirty seconds, which is air moving in and out of a chest that has nearly stopped.