NREMT Practice Exam Questions and Answers 2022/2023
Which of the following indicates that a patient is in decompensated shock?
A: Restlessness and
... [Show More] anxiety
B: Diaphoresis and pallor
C: Tachycardia and tachypnea
D: Falling blood pressure - ANSWER D | Reason:
During shock, the compensatory mechanisms of the body attempt to maintain the blood pressure. This is accomplished by increases in heart rate, shunting of blood from the skin to more vital organs, and increasing the respiratory rate to increase the oxygen content of the blood. Once these compensatory mechanisms fail, the blood pressure will fall (hypotension). Hypotension signifies a state of decompensated shock. You must not rely on the patient's blood pressure as an indicator of overall perfusion. Restlessness, anxiety, tachycardia, tachypnea, and cool clammy skin (diaphoresis) are earlier signs of shock and do not necessarily indicate a decompensated state.
Which of the following is MOST indicative of a primary cardiac problem?
A: Irregular pulse
B: Tachypnea
C: Sudden fainting
D: Tachycardia - ANSWER A | Reason:
An irregular pulse signifies an abnormality within the electrical conduction system of the heart. Tachycardia, sudden fainting (syncope), and tachypnea (rapid breathing) can indicate many things other than cardiac problems, such as shock, heat-related problems, and diabetic complications. You should always consider the possibility of a cardiac problem in a patient with an irregular pulse.
A 50-year-old man presents with crushing chest pain of sudden onset. He is diaphoretic, apprehensive, and tachypneic. You should:
A: obtain baseline vital signs.
B: apply supplemental oxygen.
C: ask him if he takes nitroglycerin.
D: perform a complete physical exam. - ANSWER B: | Reason
All of the interventions and assessments listed in this question should be performed on a patient who presents with chest pain, pressure, or discomfort. However, supplemental oxygen is indicated for any patient with a potential cardiac problem and should be given as soon as possible; this is especially true when the patient has potential respiratory involvement as well (ie, dyspnea, tachypnea). Administer oxygen in a concentration sufficient to maintain an oxygen saturation of 94% or greater. Aspirin (up to 325 mg) should also be administered as soon as possible, unless the patient is allergic to it. After applying oxygen and administering aspirin, you should perform a physical exam and obtain baseline vital signs. You would inquire about any prescription medications the patient is taking (eg, NTG) during the SAMPLE history.
Immediately following a generalized motor seizure, most patients are: - ANSWER D: | Reason -After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure.
Freshly oxygenated blood returns to the heart via the ?
A:vena cavae.
B:aorta.
C:pulmonary artery.
D:pulmonary vein. - ANSWER D: - Reason |
The pulmonary vein is the only vein that carries oxygen-rich blood. It carries blood from the lungs back to the left atrium. All other veins in the human body, including the vena cavae, carry deoxygenated blood back to the heart. The aorta is the largest artery in the body and branches immediately from the left ventricle, carrying freshly oxygenated blood to the rest of the body. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs for reoxygenation.
A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of speed. You find him in a prone position approximately 50 feet from his car. He is not moving and does not appear to be breathing. You should:
A:manually stabilize his head.
B:administer high-flow oxygen.
C:assess his breathing effort.
D:use the jaw-thrust maneuver. - ANSWER A: | Reason - When a trauma patient is found in a prone ( face down ) position, especially if he or she is unresponsive, your first action should be to manually stabilize his or her head; this action is based on the assumption that he or she has a spinal injury. Next, log roll the patient to a supinr position ( while continuing to manually stabilize the head) , open the air way with the jaw thrust maneuver , clear the airway with suction if needed, and access for breathing, it would be extremely difficult to adequately open the patients airway while he or she is in a prone position. Depending on the patients breathing effort, administer high flow of oxygenor ventilate using a bag mask device
The safest emergency vehicle operator is one who:
A:has a positive attitude.
B:drives with lights and siren.
C:drives with due regard.
D:is physically fit. - ANSWER C : - One of the most important attributes of a safe emergency vehicle operator is the ability to drive with due regard for others. This means that the operator must be aware of others around him or her and to keep their safety in mind. The EMT should never assume that all drivers will see or hear the ambulance. A positive attitude about one's ability to safely operate an emergency vehicle is also an important attribute. Although sometimes indicated for the patient's condition, the use of lights and siren increase the risk of an ambulance crash.
You are dispatched to the scene of a motorcycle crash. Upon arrival, you find the patient lying facedown approximately 25 feet from his bike. He is not wearing a helmet and is moaning. You should:
A:apply a cervical collar.
B:evaluate the status of his airway.
C:stabilize his head manually.
D:log roll him to a supine position. - ANSWER You selected C; This is correct!
Reason:
The mechanism of injury for this patient was significant. In his present position (prone), you cannot effectively assess his airway. Therefore, your first action should be to manually stabilize his head. Then, you must log roll him into a supine position, keeping his head in an in-line position. If possible, log roll him directly onto a long backboard. After the patient is supine, assess the status of his airway, assess his breathing adequacy, administer high-flow oxygen or begin assisted ventilations if needed, and continue with your primary assessment. Apply a cervical collar as soon as possible, but assess his posterior neck first.
Internal or external bleeding would be especially severe in a patient:
A:who is hypotensive.
B:with hemophilia.
C:with heart disease.
D:who takes aspirin. - ANSWER You selected B; This is correct!
Reason:
Hemophilia is a condition in which the patient lacks one or more of the blood's clotting factors. There are several forms of hemophilia, most of which are hereditary and some of which are severe. Sometimes bleeding occurs spontaneously in patients with hemophilia. Because the patient's blood does not clot, all injuries, no matter how minor they appear, are potentially serious. Aspirin does not destroy the blood's clotting factors; it decreases the ability of platelets to stick together. Although this may cause prolonged bleeding time, the patient with hemophilia, who lacks key clotting factors, will bleed more severely. Many patients with heart disease take aspirin daily to prevent clot formation in a coronary artery. When blood pressure is low (hypotension), the driving force of the blood through the blood vessels is reduced; as a result, bleeding tends to be less severe relative to patients with high blood pressure. Unfortunately, however, hypotension indicates decompensated shock.
When you arrive at a residence for a man who is "not acting right," you enter the house and find him sitting on his couch. Which of the following findings would be MOST indicative of an altered mental status?
A:Odor of alcohol.
B:Slurred speech.
C:Tired appearance.
D:Eyes are closed. - ANSWER You selected B; This is correct!
Reason:
Often, an altered mental status can be difficult to assess, especially if you do not know how the patient normally acts. However, there are key findings that should increase your index of suspicion. An abnormal speech pattern, such as slurring or incoherent words, can be the result of a diabetic problem, alcohol intoxication, or drug ingestion. All of these can cause an altered mental status. The odor of alcohol suggests intoxication as a potential cause of his problem, but cannot be quantified. Just because the patient's eyes or closed or he has a tired appearance does not necessarily indicate that he has an altered mental status.
A 50-year-old woman with a history of epilepsy is actively seizing. Care for this patient should focus primarily on:
A:protecting her from injury and ensuring adequate ventilation.
B:administering high-flow oxygen and requesting an ALS ambulance.
C:frequently suctioning her airway and carefully restraining her.
D:placing a bite block in between her molars and giving her oxygen. - ANSWER The correct answer is A;
Reason:
Seizure deaths are most frequently the result of hypoxia. When a person is actively seizing, he or she is not breathing adequately. Your primary focus when treating a seizure patient is to protect him or her from injury and to ensure adequate ventilation and oxygenation. Many seizing patients require assisted ventilation. Suction the oropharynx only if the patient has secretions in his or her mouth. Do NOT insert anything into the mouth of a seizing patient; doing so may cause an airway obstruction or damage the soft tissues of the mouth, resulting in bleeding. Do not attempt to restrain an actively seizing patient; doing so may result in musculoskeletal injuries. Request an ALS ambulance per your local protocols
A 16-year-old, 125-pound male ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal should you administer?
A: 51g
B: 60g
C: 57g
D: 54g - ANSWER A: First, you must determine the patient's weight in kilograms (kg). Either of the following formulae can be used to convert pounds to kilograms: Formula 1: weight (in pounds) ÷ 2.2 = weight in kg. Formula 2: weight (in pounds) ÷ 2 - 10% = weight in kg. On the basis of the above formulae, a 125-pound patient weighs 57 kg. Using formula 1, the equation is as follows: 125 (weight in pounds) ÷ 2.2 = 56.81 (57 [rounded to the nearest tenth]). Using formula 2, the equation is as follows: 125 (weight in pounds) ÷ 2 = 62.5 (63 [rounded to the nearest tenth] - 6.3 (10% of 63) = 56.7 (57 [rounded to the nearest tenth]). Since the drug order is for 1 g/kg, you should administer 57 g of activated charcoal to your 125-pound patient.
When caring for a patient with an acute behavioral crisis, your primary concern should be:
A:gathering all of the patient's medications.
B:ensuring you and your partner's safety.
C:providing safe transport to the hospital.
D:obtaining a complete past medical history. - ANSWER You selected B; This is correct!
Reason:
When caring for a patient with a behavioral or emotional crisis, your primary concern should be for your own personal safety as well as your partner's safety. Your ultimate goal is to transport the patient to the hospital safely. Gather as much medical history information as possible, but keep in mind that many patients experiencing an emotional or behavioral crisis will not readily provide this information. It is important to remember that patients with emotional or behavioral crises may appear calm initially; however, there is always the potential for them to turn violent.
Following an apparent febrile seizure, a 4-year-old boy is alert and crying. His skin is hot and moist. Appropriate treatment this child includes:
A:rapidly cooling the child in cold water.
B:keeping the child warm and providing transport.
C:offering oxygen and providing transport.
D:allowing the parents to tranport - ANSWER You selected C; This is correct!
Reason:
Most children with febrile seizures do not have any permanent aftereffects. The most appropriate treatment is to offer the child oxygen (usually via the blow-by technique), allow a parent to accompany the child in the back of the ambulance, and transport to the hospital. Although most seizures in children result from a simple infection (ie, ear infection) that causes an abrupt rise in body temperature, other illnesses such as meningitis and encephalitis can cause seizures as well and are far more serious. For this reason, any child with fever and seizures should be evaluated in the emergency department. Rapid cooling of the child should be avoided as this will likely cause shivering, which could abruptly increase the child's temperature and cause another seizure. Children with a fever should be kept cool during transport (ie, removing clothing), but not to the point where they shiver.
When you begin to assess a woman in labor, she states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be MOST appropriate to ask next?
A:Has your bag of waters broken yet?
B:At how many weeks gestation are you?
C:How many other children do you have?
D:Have you had regular prenatal care? - ANSWER The correct answer is B;
Reason:
When assessing a patient in labor, the first question you should ask is how far along in the pregnancy she is. If she is at less than 37 weeks gestation (37 to 42 weeks is term), you should prepare for possible resuscitation of the newborn if delivery occurs in the field. Other questions, such as asking if her amniotic sac (bag of waters) has ruptured and whether or not she has received prenatal care, also can help you anticipate and prepare for potential complications. You should also inquire as to how many times the patient has been pregnant, regardless of whether she carried the baby to term (gravida), and the number of times she has carried a baby beyond 28 weeks, regardless of whether it was born dead or alive (para).
Management for a women who presents with a prolapsed umbilical cord includes all of the following, EXCEPT:
A:lifting the baby's head off of the umbilical cord.
B:relieving pressure off of the cord by gently pulling on it.
C:placing the mother in a position that elevates her hips.
D:ensuring that the cord stays moist during transport. - ANSWER You selected B; This is correct!
Reason:
Management of a prolapsed umbilical cord includes administering high-flow oxygen to the mother; placing the mother in a position that elevates her hips (eg, knee-chest position); carefully inserting your gloved fingers into the vagina to lift the baby's head off of the cord; ensuring that the cord stays moist by covering it with moist, sterile dressings; and transporting rapidly. Never make any attempt to pull on the umbilical cord for any reason; doing so may damage the cord, resulting in severe hemorrhage.
A 6-year-old boy presents with a high fever, a headache, and a stiff neck. He is conscious, but is not acting as a normal 6-year-old boy should. His mother told you that he vomited once before your arrival. You should be MOST concerned with:
A:the risk of permanent neurological damage.
B:the potential for a febrile seizure.
C:treating him for severe dehydration.
D:performing a secondary assessment at the scene. - ANSWER The correct answer is A;
Reason:
The child's symptoms (eg, high fever, headache, stiff neck [nuchal rigidity]) are consistent with meningitis, inflammation and infection of the protective coverings of the brain and spinal cord (meninges). Meningitis can be viral, bacterial, or fungal in nature. One form of meningitis, Neisseria meningitidis (N. meningitidis), deserves special attention. N. meningitidis is a bacterium that causes a rapid onset of symptoms, and can cause shock, permanent neurological damage, or death; this should be your primary concern. Administer oxygen as tolerated and transport without delay. If the child experiences a seizure, it will likely be the result of increased intracranial pressure secondary to meningitis, not his fever. Nonetheless, you should monitor him carefully and be prepared to treat any seizure activity. The child may be dehydrated; however, there is little you can do for this at the scene; again, transport without delay. A secondary assessment should be performed, if time permits; however, this should be performed en route to the hospital.
Which of the following statements regarding crowning is correct?
A:It is safe to transport the patient during crowning if the hospital is close.
B:Crowning represents the end of the second stage of labor.
C:Crowning always occurs immediately after the amniotic sac has ruptured.
D:Gentle pressure should be applied to the baby's head during crowning. - ANSWER You selected D; This is correct!
Reason:
Crowning occurs when the baby's head is visible at the vaginal opening; it is an obvious sign of delivery in progress. When crowning is observed, you should apply gentle pressure to the infant's head to prevent an explosive delivery. Care must be taken to avoid putting pressure on the fontanelles (the soft spots on the infant's head). Crowning represents the end of the first stage of labor and the beginning of the second stage; it does not always occur immediately after the amniotic sac has ruptured. If the infant's head is born and the amniotic sac is still intact, you need to pinch the thin membrane with your fingers, which will usually cause the sac to easily rupture, and then suction the infant's mouth and nose.
Upon arriving at a scene in which a tanker truck overturned and is spilling an unknown liquid on the ground, you should:
A:quickly identify the material.
B:park upwind from the scene.
C:turn off your warning lights.
D:stay downhill from the scene. - ANSWER The correct answer is B;
Reason:
At the scene of a potential or actual hazardous materials incident, you should park the ambulance in an area that is both upwind and uphill from the incident. However, you must be prepared to quickly relocate if the wind direction changes. Staying uphill is important because many hazardous materials collect in low-lying areas, such as valleys. After ensuring that you are in a safe place, attempt to identify the chemical involved by reading the placard on the tanker (with binoculars) and referencing the placard number in the emergency response guidebook (ERG).
You are called to a local park for a 7-year-old boy with respiratory distress. During your assessment, you find that the patient is wheezing and has widespread hives and facial edema. What should you suspect has occurred?
A:Heat illness
B:Poison oak exposure
C:Acute asthma attack
D:Allergic reaction - ANSWER You selected D; This is correct!
Reason:
Wheezing, hives, and edema are hallmark findings of an allergic reaction. In this case, the patient is having a severe reaction. Although wheezing occurs in patients with asthma, hives and facial edema do not. Wheezing is not associated with head-related illnesses. Exposure to poison oak or poison ivy causes a local reaction, such as redness and itching or burning; it is not commonly associated with systemic symptoms.
Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. Management of this situation should include:
A:applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord.
B:positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport.
C:giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur.
D:positioning the mother with her hips elevated, administering high-flow oxygen, and providing transport. - ANSWER You selected D; This is correct!
Reason:
Limb presentations represent a dire emergency for the newborn and do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the birth canal and remove pressure from the umbilical cord. Administer high-flow oxygen to the mother, cover the protruding limb with a sterile sheet (or any clean sheet, if a sterile sheet is not available), and transport immediately. Do NOT pull on the protruding limb as this may cause injury to the newborn.
You are called to treat a 55-year-old man who is experiencing difficulty breathing. After making contact with your patient, he extends his arm out to allow you to take his blood pressure. This is an example of:
A:implied consent.
B:informed consent.
C:actual consent.
D:formal consent. - ANSWER You selected C; This is correct!
Reason:
Actual consent, also referred to as expressed consent, is when the patient asks for your help outright. This may also include nonverbal gestures, such as extending the arm to you to allow you to take the blood pressure. Informed consent involves explaining your proposed treatment to the patient, including the potential benefits and risks of the treatment. Implied consent involves treating an unresponsive patient or minor child (when the parents are not present) based on the assumption that the patient (or the parents of a minor) would consent to emergency treatment.
You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should:
A:recognize that the patient's injuries disqualify him as an organ donor.
B:provide rapid transport only because the patient likely will not survive.
C:request authorization from medical control not to initiate care.
D:manage the patient aggressively and provide rapid transport. [Show Less]