NREMT sample question? Help

[omare61]

I'm having trouble with this question:

You arrive at a college softball game to find a 21 y/o female player sitting on the bench. She c/o generalized chest pn and appears to be breathing hard with slight tripoding. You have examined the scene, taken BSI precautions, and completed your primary assessment. V/S are BP 132/88; HR 104, strong and regular; Temp 97.4ºF; SPO2 97%; Resp 20, regular but heavy. In your secondary assessment, what is the first question you ask her?

A. Do you have a hx of cardiac problems?
B. Have you fallen or had anything hit your chest recently?
C. Do you have a hx of asthma?
D. Are you taking any medications?


My problem:
I remember SAMPLE history. Signs and symptoms, medications, pertinent past history, last oral intake and events leading up the illness.

Choice A would be within pertinent past history. Choice B would be Events leading up to the illness. Choice C would also be pertinent past history. Choice D would be medications.

I think the best answer is D because "Medications" comes first in the SAMPLE history order and could cause these symptoms, but is that really what you would want to ask first?. I also think the best answer would be B because you want to rule out a trauma so you can proceed with interventions. You know she played softball-perhaps and injury. On the other hand "events leading up to the illness is the E-Last in the SAMPLE history order. Choice A would be good too because she could have over-exercised and hurt her already messed up heart.

Which is the correct answer?

The answer could not be C because asthma because an asthmatic would not experience pain.

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[azerkail]

you forgot a = allergies =P

SAMPLE is not necessarily the order you go through during an assessment, but to help guide your line of questioning during the interview to get pertinent information for your report at transfer of care.

that being said, this one is a toughie. i think knowing how the chest pain came about will help set the tone for the rest of the call if you run it as a CORE or trauma call.

 

[leviathan]

If I had to choose I would say B. It is the only one which tries to figure out how it all started. You should really start with a history before moving onto medical history (cardiac problems, asthma) or medications. Also if you discovered this was from a trauma you may be considering spinal precautions, which should be initiated up front in your primary survey. Of course they say its now in the secondary so you might assume it's already been ruled out.

All together I feel this is a poorly written question that requires you to make too many assumptions about background information.

 

[omare61]

If I had to choose I would say B. It is the only one which tries to figure out how it all started. You should really start with a history before moving onto medical history (cardiac problems, asthma) or medications. Also if you discovered this was from a trauma you may be considering spinal precautions, which should be initiated up front in your primary survey. Of course they say its now in the secondary so you might assume it's already been ruled out.

All together I feel this is a poorly written question that requires you to make too many assumptions about background information.

It says "secondary assessment" so you would have ruled out B.

The problem is: NREMT is filled with these kinds of poorly written questions. I easily overthink.

 

[tremulousNeedle]

If I had to choose I would say B. It is the only one which tries to figure out how it all started. You should really start with a history before moving onto medical history (cardiac problems, asthma) or medications. Also if you discovered this was from a trauma you may be considering spinal precautions, which should be initiated up front in your primary survey. Of course they say its now in the secondary so you might assume it's already been ruled out.

All together I feel this is a poorly written question that requires you to make too many assumptions about background information.

I agree with Leviathan. B. As an emergency medicine physician and the previous EMT, the key to answering poorly written test questions is deciphering what the author is trying to assess. In the NREMT world, the secondary assessment is basically a physical exam. However; if you look at all the answer options those are actually all historical responses, none of them are actually part of any physical assessment, so then it just comes down to what needs to be asked first. Clarifying the nature of the illness or the mechanism of injury takes priority over all of the other options (I.e. onset, provocation, etc.). This link will help you anticipate the ordering of what the NREMT wants.

http://www.nremt.org/nremt/downloads/Patient Assesment.pdf

 

[Davidasaurus]

Although it doesn't come up first in SAMPLE, choice B would be my answer for this particular question.

On the NREMT they ask a lot of questions similar to this, although the SAMPLE acronym is a great way of remembering what all to ask a patient, the order doesn't necessarily constitute the importance.

Another example would be a patient displaying symptoms of a stroke. The length of problematic symptoms (How long the patient has been experiencing hemiparesis/facial drooping/etc) is the most important when retrieving background information although it comes up last in SAMPLE OPQRST.