10 free EMT practice questions: Circulation Assessment

An indication for positive pressure ventilations: Positive pressure ventilations are for a newborn who is not breathing well. This newborn is crying hard, and the trunk and lips are pink. Blue hands and feet alone do not call for ventilations.

An indication for high-concentration oxygen: Central color is what tells you if a newborn is getting enough oxygen. This newborn's trunk and lips are already pink, so high-concentration oxygen is not needed.

A sign of inadequate circulation requiring rapid transport: Rapid transport fits a newborn with signs of poor circulation. The pink trunk, the pulse of 150, and the respiratory rate of 45 show the circulation is fine. The blue hands and feet by themselves are expected at this age.

The reading is accurate because 99% falls within the normal range: A reading of 99% is in the normal range, so the number looks good. The question already tells you the signal is faint and keeps dropping out. The device itself is showing you the number is not reliable.

The reading shows supplemental oxygen is unnecessary: A normal-looking saturation can seem to mean oxygen is not needed. This patient has pale, cool, clammy skin, a pulse of 128, and a blood pressure of 92/70. Those signs call for high-concentration oxygen no matter what a faulty probe shows.

The reading rules out serious internal blood loss: Vomiting blood, a systolic pressure of 92, and a weak, fast pulse show this patient is bleeding. A pulse oximeter measures oxygen saturation, not blood volume. No oximeter reading, good or bad, can rule out internal bleeding.

Scalp wounds keep bleeding after pressure is released: How much a scalp wound bleeds does not explain why this amount of blood loss matters more in a child than in an adult. The bleeding here is already controlled with direct pressure. The concern is the child's total blood volume, not how stubbornly a scalp wound bleeds.

A child's blood pressure drops before the pulse rises: A falling blood pressure is a late sign in a child, not an early one. Children compensate with a rising pulse first. Blood pressure is usually the last vital sign to fall.

Blood clots more slowly in children than in adults: Blood does not clot more slowly in children than in adults. Clotting speed is not the reason a given amount of blood loss carries more weight in a small child. The small blood volume is the reason.

As the normal rise expected in late pregnancy: The heart rate does go up in late pregnancy, often by 10 to 20 beats a minute by the third trimester. The prenatal card already gives you this patient's own baseline, a pulse of 92 last week. Today's pulse of 116 is a jump above her baseline after a crash. That jump has to be handled as possible shock.

As a response to pain from the seat belt injury: Pain from a seat belt injury can raise the pulse and the breathing rate. This patient calls the soreness mild. Mild soreness does not explain a pulse of 116 and respirations of 24. Rule out shock first instead of blaming the pain.

As an effect of the increased blood volume: The mother's blood volume goes up by as much as 50% by the third trimester. The extra blood hides blood loss and delays a drop in blood pressure. A bigger blood volume does not make the heart beat faster. The rise to 116 still points to possible shock.

Estimate the systolic pressure from the pulse sites still palpable: The idea that a radial pulse you can feel means a set systolic pressure is still passed around in the field. A systolic pressure guessed from pulse sites is an estimate, not a measurement. You have a cuff, and palpation gives you a real systolic number in this exact situation.

Record both a systolic and a diastolic pressure by palpation: Palpation sounds like a quieter version of listening with a stethoscope. Feeling for the pulse only tells you when the pulse comes back. The return of the pulse gives you a systolic number and no diastolic number.

Move the cuff to the opposite arm and listen again: The problem here is the road and siren noise and this patient's poor perfusion. Neither one changes when the cuff moves to the other arm.

Tighten it only until the bleeding slows while a distal pulse is still present: Tightening until the bleeding only slows is how you control venous or capillary bleeding with a pressure dressing. This bleeding is arterial and life threatening. A distal pulse that is still present means the artery is only partly squeezed. Blood is still getting through, so the patient keeps bleeding.

Place it directly over the wound to compress the injured vessel: Pressure right over the wound is how a pressure dressing or hemostatic gauze works. Those are useful for junctional wounds or wounds that are not on an arm or leg. A limb tourniquet has to go above the wound, over the bone. From there, the tourniquet squeezes the artery that feeds the wound.

Plan to loosen it every few minutes to allow blood flow to return to the limb: Loosening a tourniquet every few minutes is old teaching meant to save the tissue below the tourniquet. Each time you loosen the tourniquet, the artery opens and the bleeding starts again. Once a tourniquet is on, leave it tight and in place until a higher level of care takes it off.

The blood pressure is unchanged and not clinically significant: The systolic number is almost the same, so the blood pressure can look unchanged. The diastolic went from 80 to 98, and the pulse pressure dropped by half. A pulse pressure that narrows like this is a real sign of shock.

The diastolic reading must be an error, since it is unusually high: A diastolic of 98 is high, but the reading is not an equipment error. In early compensated shock, the blood vessels tighten and the diastolic goes up. Do not throw the reading out.

A widening pulse pressure, which rules out shock: A widening pulse pressure means the gap between the systolic and the diastolic gets bigger. Here the gap went from 40 to 20, so the pulse pressure is narrowing. A narrowing pulse pressure points toward early compensated shock instead of ruling shock out.

No shock: the normal blood pressure shows that perfusion remains adequate: A normal blood pressure never rules out shock. Compensated shock means perfusion is already poor while the body is still holding the pressure up. This patient's skin, pulse, and narrow pulse pressure all show poor perfusion.

Decompensated shock: the pulse of 120/min shows compensation has failed: Decompensated shock is when the systolic pressure starts to fall. This patient's systolic pressure is still 118. A pulse of 120 is the body compensating, and a fast pulse does not mean compensation has failed.

Stable: the rapid pulse reflects anxiety rather than a circulatory problem: Anxiety can raise the pulse in a scared patient. After a car hits someone, anxiety and restlessness are early signs that the brain is not getting enough blood flow. A pulse of 120 with pale, cool, clammy skin is compensated shock, not nerves. Calling this patient stable would give a shock patient an unsafe, low transport priority.

120/80: With 120/80, the pulse pressure is 40 mmHg. A pulse pressure of 40 is normal.

138/72: Subtract 72 from 138 and you get a pulse pressure of 66 mmHg. A gap that big is widened. A widened pulse pressure goes with problems like rising intracranial pressure, the pressure inside the skull, not compensated shock.

92/50: The pulse pressure for 92/50 is 42 mmHg. The systolic number is low, but a gap of 42 is a normal width.

The patient is improving because the initially elevated blood pressure has come down: A blood pressure coming down would be good news if the first reading was hypertension that needed to settle. The first pressure here was being held up by compensation. The narrow pulse pressure in the first set was the clue. The drop to 86/64 came with a faster pulse, mottled skin, and new confusion. Every other finding got worse at the same time. A pressure falling while everything else gets worse is decompensation, not improvement.

The rising pulse is the only significant change between the two sets: The pulse did rise, from 116 to 134. The pulse is only one of several significant changes. The blood pressure dropped, the skin turned mottled, and the patient became confused. Each of those changes is serious on its own. The falling blood pressure is the most serious change of all.

The first set of vital signs already represented decompensated shock: Decompensated shock means the blood pressure has already fallen. The first set had a blood pressure being held up, with signs of compensation. A maintained blood pressure with signs of compensation is compensated shock. The pressure did not fall until the second set.