NREMT Cognitive Exam (EMT) — Questions and Answers

Question 1: What is the first thing you should do after receiving orders from the medical direction physician?

Repeat the orders exactly as you heard them. (Correct answer)
Question anything you did not understand.
Document the orders in your report.
Carry out the orders immediately.

Correct answer: Repeat the orders exactly as you heard them.

After receiving orders from medical direction, repeating them exactly as heard is a critical step in closed-loop communication. This practice ensures that the EMT correctly understood the physician's instructions and allows the physician to confirm the accuracy of the relayed orders. This minimizes miscommunication and helps prevent medical errors, ultimately enhancing patient safety.

Question 2: What is the primary concern when a patient in the third trimester lies flat on her back during transport?

Increased respiratory effort from diaphragm elevation
Supine hypotension syndrome from aortocaval compression (Correct answer)
Back pain from uterine weight
Aspiration risk from gastroesophageal reflux

Correct answer: Supine hypotension syndrome from aortocaval compression

The enlarged uterus in the third trimester can compress the aorta and inferior vena cava when supine, reducing cardiac output and causing maternal hypotension (supine hypotension syndrome).

Question 3: The SAMPLE history mnemonic stands for:

Symptoms, Assessment, Mechanism, Pupils, Lung sounds, Extremities
Signs/Symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading to illness (Correct answer)
Signs, Allergies, Medications, Pain, Last vital signs, Events
Scene, Airway, Medical history, Pulse, Level of consciousness, Environment

Correct answer: Signs/Symptoms, Allergies, Medications, Pertinent past history, Last oral intake, Events leading to illness

SAMPLE is a structured history-taking tool: Signs/Symptoms, Allergies, Medications, Pertinent past medical history, Last oral intake, Events leading to the current illness or injury.

Question 4: An oral and nasal airway should be:

Cleaned well for reuse after the run
Used in order to prevent the need for suctioning
Used to keep the tongue from blocking the airway (Correct answer)
Inserted in all critically injured patients

Correct answer: Used to keep the tongue from blocking the airway

Oral and nasal airways are designed to prevent the tongue from obstructing the upper airway, which is a common cause of airway compromise in unconscious patients. They create a patent passage for air to move to and from the lungs. These adjuncts do not prevent the need for suctioning, nor are they inserted in all critically injured patients without assessing airway patency first.

Question 5: Your 16 year old trauma patient has what appears to be a mid-shaft femur fracture. You notice that there is a laceration directly over the suspected fracture. Bleeding is controlled. What type of fracture would this be?

Greenstick
Comminuted
Closed
Open (Correct answer)

Correct answer: Open

An open fracture, also known as a compound fracture, is characterized by a break in the skin overlying the fractured bone, exposing the bone to the external environment. The presence of a laceration directly over the suspected femur fracture indicates that the bone may have pierced the skin or the skin was broken by the same force. This significantly increases the risk of infection compared to a closed fracture.

Question 6: _______________ is the term that describes how a patient gets injured.

Mechanics of injury
Mechanism of injury (Correct answer)
Injury pattern
Energy transfer

Correct answer: Mechanism of injury

The term "mechanism of injury" (MOI) specifically refers to the forces and events that caused a patient's injury. Understanding the MOI helps EMS providers predict potential injuries based on the type and severity of the incident. This knowledge guides their assessment and treatment strategies.

Question 7: You are transporting an elderly male patient in respiratory distress with a history of COPD... The patient has very shallow, rapid respirations with minimal chest wall motion and slight wheezing in the upper lung fields. Given this situation, what would you expect the arterial carbon dioxide levels to be?

Elevated (Correct answer)
Lowered
Not enough information to determine
Normal

Correct answer: Elevated

Shallow, rapid respirations with minimal chest wall motion in a COPD patient indicate ineffective ventilation. This type of breathing pattern does not allow for adequate gas exchange, leading to the retention of carbon dioxide in the blood. Consequently, the arterial carbon dioxide levels would be elevated, a condition known as hypercapnia.

Question 8: What is the correct blood flow through the heart and lungs?

Inferior/superior vena cavae, right atrium, right ventricle, lungs, left atrium, left ventricle, aorta (Correct answer)
Aorta, left atrium, left ventricle, lungs, right atrium, right ventricle, Inferior/superior vena cavae
Inferior/superior vena cavae, right atrium, right ventricle, aorta, lungs, left atrium, left ventricle
Right atrium, right ventricle, Inferior/superior vena cavae, lungs, aorta, left ventricle, left atrium

Correct answer: Inferior/superior vena cavae, right atrium, right ventricle, lungs, left atrium, left ventricle, aorta

Deoxygenated blood enters the right atrium from the body via the superior and inferior vena cavae. It then flows to the right ventricle, which pumps it to the lungs for oxygenation. Oxygenated blood returns from the lungs to the left atrium, then to the left ventricle, which pumps it out to the body via the aorta.

Question 9: You've arrived at the scene of what appears to be a domestic dispute over child molestation. You are asking a 5-year-old child about elimination habits. What word would be best to use when questioning this child?

'Pee-Pee' (Correct answer)
Deltrusion
Micturation
Urination

Correct answer: 'Pee-Pee'

When communicating with a young child, it is essential to use age-appropriate language that they can easily understand. Using simple, common terms like 'pee-pee' for urination helps the child feel more comfortable and facilitates clearer communication, especially when discussing sensitive topics. This approach improves the accuracy of information gathered during assessment.

Question 10: At a motor vehicle crash, the EMT observes a downed power line touching one of the involved vehicles. The appropriate action is:

Ask the patient to exit the vehicle immediately
Stage at a safe distance, contact dispatch for utility company response, and do not allow anyone to approach the vehicle (Correct answer)
Attempt to move the power line with a wooden stick
Touch the vehicle to assess the patient through the window

Correct answer: Stage at a safe distance, contact dispatch for utility company response, and do not allow anyone to approach the vehicle

Downed power lines represent an electrocution and arc flash hazard. The vehicle is electrified and anyone touching it or the ground near it can be electrocuted. Stage safely and await utility company response.

Question 11: Your patient is a 32-year-old male who was complaining of ...Your patient is a 32-year-old male who was complaining of a severe, crushing feeling in the center of his chest and shortness of breath that began while he was mowing his lawn 45 minutes prior to your arrival. He is now only responding to painful stimuli. Presently, his minute ventilation is still adequate, his pulse oximeter reads 95% on room air, and you find his skin to be pale, cool, and diaphoretic. What would be your initial action?

Sublingual nitroglycerin.
4-6 liters oxygen by nasal cannula.
325 mg aspirin.
12- 15 liters oxygen by nonrebreather. (Correct answer)

Correct answer: 12- 15 liters oxygen by nonrebreather.

This patient presents with severe crushing chest pain, shortness of breath, and signs of poor perfusion (pale, cool, diaphoretic skin), strongly suggesting an acute coronary syndrome and potential hypoxia. Administering high-flow oxygen via a nonrebreather mask is the initial priority to improve oxygenation and reduce myocardial workload. Optimizing oxygen delivery is critical before other interventions like aspirin or nitroglycerin.

Question 12: To willfully leave a patient who is in need of care without a signed or verbal refusal of care is ____?

Implied Refusal
Abandonment (Correct answer)
Against Medical Advice
Allowed if the patient is rude or abusive

Correct answer: Abandonment

Abandonment occurs when an EMS provider initiates patient care but then leaves the patient without ensuring that another equally or more qualified medical professional has taken over care, or without a valid refusal of care. This is a serious legal and ethical violation because it places the patient at significant risk by discontinuing necessary medical attention prematurely.

Question 13: Which of the following is a common way for patients to describe heart attack pain?

Intermittent (comes and goes)
Crushing or squeezing (Correct answer)
Like “pins and needles”
Less severe than indigestion

Correct answer: Crushing or squeezing

Patients experiencing a heart attack (myocardial infarction) frequently describe the chest pain as a severe, oppressive sensation. Common descriptors include "crushing," "squeezing," "pressure," or "tightness," often radiating to the arm, jaw, or back. This type of pain is typically persistent, not intermittent, and much more severe than indigestion.

Question 14: A patient has a pulse oximetry reading of 89% on room air. The EMT should:

Apply a non-rebreather mask at 15 L/min and reassess (Correct answer)
Document the reading and continue assessment
Immediately intubate the patient
Place the patient on 2 L/min nasal cannula only

Correct answer: Apply a non-rebreather mask at 15 L/min and reassess

An SpO2 of 89% on room air indicates significant hypoxemia. High-flow oxygen via non-rebreather mask should be applied immediately and reassessed after a few minutes.

Question 15: Cardiac Compromise is:

A heart attack
A period of time when the heart stops
Angina
Any type of heart problem (Correct answer)

Correct answer: Any type of heart problem

Cardiac compromise is a broad term that encompasses any condition or event that impairs the heart's ability to function effectively. This includes a wide range of problems such as angina, myocardial infarction (heart attack), heart failure, or arrhythmias. It signifies that the heart's pumping ability or electrical activity is somehow impaired.

Question 16: The first step in artificial ventilation with a bagvalve-mask unit in patients with no suspected trauma is to:

Have an assistant squeeze the bag until the patient’s chest rises.
Position the mask correctly on the face using both hands.
Place the patient’s head in a hyperextended, sniffing position. (Correct answer)
Insert an airway adjunct and select the correct mask size.

Correct answer: Place the patient’s head in a hyperextended, sniffing position.

For patients with no suspected trauma, the head-tilt/chin-lift maneuver is the initial and most effective way to open the airway. This maneuver lifts the tongue off the posterior pharynx, which is the most common cause of airway obstruction in an unconscious patient. Once the airway is open, an airway adjunct can be inserted, and the mask positioned.

Question 17: You are at the scene of an MVA, in which there are three patients, all of which have minor visible injuries. Two are refusing treatment and the last is complaining of neck and back pain. How should you proceed?

Obtain signed refusals from the first two patients then proceed to the third
Treat the third patient, nothing else is needed for the other two
Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient. (Correct answer)
Treat all three patients, they are visibly injured and need medical attention

Correct answer: Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient.

In a multi-patient scenario where some patients refuse care and one requires immediate attention, it is efficient and appropriate to delegate tasks. Your priority is the patient with potential spinal injuries (neck and back pain), requiring immediate assessment and stabilization. Simultaneously, your partner can obtain legally binding refusals from the other two patients, ensuring proper documentation and respecting patient autonomy.

Question 18: A patient in active labor reports feeling a strong urge to push and says the baby is coming. The EMT sees crowning. The proper technique for controlling the head delivery is:

Tell the patient to push as hard as possible to speed delivery
Cover the vaginal opening with a sterile drape and transport immediately
Apply gentle counterpressure to the baby's head to guide a slow, controlled delivery (Correct answer)
Pull down on the baby's head to assist delivery

Correct answer: Apply gentle counterpressure to the baby's head to guide a slow, controlled delivery

Gentle counterpressure to the crowning head guides a slow, controlled delivery, reducing the risk of rapid expulsion that can cause maternal lacerations and neonatal injury.

Question 19: What is the normal blood loss during delivery?

500 mL (Correct answer)
250 mL.
1,000 mL.
100 mL.

Correct answer: 500 mL

The normal blood loss during a vaginal delivery is typically considered to be up to 500 mL. While some blood loss is expected, anything exceeding this amount, or 1000 mL for a C-section, is classified as postpartum hemorrhage and requires immediate medical attention. EMS providers must monitor blood loss closely to identify and manage potential complications promptly.

Question 20: Postpartum hemorrhage is defined as blood loss exceeding how much after vaginal delivery?

1000 mL
500 mL (Correct answer)
100 mL
250 mL

Correct answer: 500 mL

Postpartum hemorrhage (PPH) is defined as blood loss greater than 500 mL following vaginal delivery (or 1000 mL following cesarean section). It is a leading cause of maternal mortality worldwide.

Question 21: Please answer the following question. As the head of the Quality Assurance Committee for your service, you review all patient care reports prior to passing them on to the medical director. On one trip sheet, you note the following narrative: Patient states that he cannot move his bowls and has had abdomenal pane for three weaks. Patient also states that he has had a fever and took too Tylenol tablets this morming, but then became naseated. What advice would you give the paramedic regarding this report?

Have the EMT-B do all of the documenting.
Get a dictionary and look up any questionable words when documenting. (Correct answer)
Make up abbreviations for any words he is unsure of how to spell.
Only document what you know how to spell.

Correct answer: Get a dictionary and look up any questionable words when documenting.

Accurate and professional documentation is paramount in EMS, as patient care reports are legal documents. Misspellings and grammatical errors can lead to misinterpretation of patient conditions, compromise legal defensibility, and reflect poorly on the provider's professionalism. Using a dictionary to look up questionable words ensures clarity, accuracy, and credibility in documentation.

Question 22: Which of the following situations would require the EMT to 'stage' and await law enforcement clearance before approaching?

A domestic violence call where the perpetrator's status is unknown (Correct answer)
A cardiac arrest with CPR in progress by bystanders
A single-car MVC with no obvious hazards
An elderly patient who fell in their bathroom

Correct answer: A domestic violence call where the perpetrator's status is unknown

Domestic violence scenes present a risk of violence from the perpetrator to EMS responders. EMS should stage and await law enforcement clearance before entering, as the perpetrator may still be on scene and dangerous.

Question 23: Food poisoning may be difficult in the field to diagnose due to its broad range of symptoms and the time it takes to make the patient ill. All of the following are types of food borne illness except?

Escherichia coli (E. coli)
Salmonella
Encephalitis (Correct answer)
Champylobacter

Correct answer: Encephalitis

Salmonella, Campylobacter, and Escherichia coli (E. coli) are all well-known bacterial pathogens that commonly cause foodborne illnesses, leading to symptoms like nausea, vomiting, diarrhea, and abdominal cramps. Encephalitis, however, is an inflammation of the brain, typically caused by viral infections, and is not a type of foodborne illness itself, although some severe foodborne infections could rarely lead to neurological complications.

Question 24: When assessing a patient complaining of depression, which of the following would be most suggestive that the patient is at risk for suicide?

Hostility toward concerned family members
Recent diagnosis of hypertension
Packing away of cherished possessions
Previous attempt that was unsuccessful (Correct answer)

Correct answer: Previous attempt that was unsuccessful

A history of previous suicide attempts is the single strongest predictor of future suicide attempts and completed suicide. Individuals who have attempted suicide before are at a significantly higher risk because they have already overcome the psychological barrier to self-harm. Therefore, any mention of a past attempt should elevate a clinician's concern and prompt immediate intervention.

Question 25: What is the first stage of labor?

Crowning.
Delivery of the baby.
Dilation of the cervix (Correct answer)
Delivery of the placenta.

Correct answer: Dilation of the cervix

The first stage of labor, known as the dilation stage, is characterized by the onset of regular contractions that cause progressive effacement (thinning) and dilation (opening) of the cervix. This stage is typically the longest and ends when the cervix is fully dilated to 10 centimeters, allowing the baby to pass through.

Question 26: Your 16-year-old trauma patient appears to have a femur fracture in the mid-shaft. There is a laceration directly over the suspected fracture, which you observe. The bleeding is under control. What kind of fracture could this be?

Closed
Greenstick
Comminuted
Open (Correct answer)

Correct answer: Open

An open fracture, also known as a compound fracture, occurs when the bone breaks and pierces through the skin, creating an open wound. The presence of a laceration directly over the suspected fracture indicates that the bone has communicated with the outside environment. This type of fracture carries a higher risk of infection due to exposure.

Question 27: Upon delivery, the umbilical cord is wrapped around the baby's neck (nuchal cord). The EMT should:

Stop the delivery and transport immediately
Pull the baby's body quickly to snap the cord free
Immediately cut the cord before delivering the body
Attempt to loop the cord over the baby's head; if tight, clamp and cut before body delivery (Correct answer)

Correct answer: Attempt to loop the cord over the baby's head; if tight, clamp and cut before body delivery

A nuchal cord should be looped over the baby's head if loose enough. If the cord is too tight to loop, it should be double-clamped and cut before delivering the body to prevent cord avulsion.

Question 28: Which of the following is NOT a sign of adequate breathing?

Breathing limited to abdominal muscles. (Correct answer)
Air moving in and out of the nose and mouth.
Equal expansion of both sides of the chest
Absence of blue / grey skin coloration

Correct answer: Breathing limited to abdominal muscles.

Adequate breathing involves a normal rate, rhythm, and depth, with equal chest expansion and minimal accessory muscle use. Breathing limited primarily to abdominal muscles, especially in adults, can indicate respiratory distress or fatigue. This suggests the patient is relying on accessory muscles rather than normal diaphragmatic and intercostal muscle function, which points to inadequate ventilation.

Question 29: When calculating a pediatric drug dose using the weight of 20 kg, and the protocol calls for 0.01 mg/kg of epinephrine 1:10,000, what is the correct dose?

2.0 mg
0.1 mg
0.02 mg
0.2 mg (Correct answer)

Correct answer: 0.2 mg

0.01 mg/kg × 20 kg = 0.2 mg. This is the standard IV/IO epinephrine dose for pediatric cardiac arrest using the 1:10,000 concentration.

Question 30: The normal heart rate for a newborn (0-3 months) is:

80 – 100
100 – 120
120 – 140
140 – 160 (Correct answer)

Correct answer: 140 – 160

The normal heart rate for a newborn (0-3 months) is significantly higher than that of an adult, typically ranging from 140 to 160 beats per minute. This elevated rate is necessary to meet the metabolic demands of their rapidly growing bodies and compensate for a smaller stroke volume compared to older children and adults.

Question 31: You are transporting a 48-year-old male patient between medical facilities... During the history, you learn that the patient was involved in a fall at work and suffered a hip fracture and a head injury. The patient is now presenting with labored breathing at 30/min that has progressively worsened over the last 24 hours, a heart rate of 104, and a blood pressure of 98/70. On auscultation, you hear diffuse rales. The patient denies any complaints of pain other than those related to his recent fall. What is the most likely cause of the patient's respiratory distress?

Acute bronchitis
Adult respiratory distress syndrome (Correct answer)
Cardiogenic shock
Congestive heart failure

Correct answer: Adult respiratory distress syndrome

The patient's history of trauma (hip fracture, head injury), progressively worsening labored breathing, diffuse rales, and signs of hypoperfusion (BP 98/70, HR 104) are highly suggestive of Adult Respiratory Distress Syndrome (ARDS). ARDS is a severe lung condition often triggered by major trauma or sepsis, characterized by widespread inflammation, fluid accumulation in the alveoli (rales), and impaired gas exchange, leading to severe respiratory failure.

Question 32: What is the normal respiratory rate for an adult patient at rest?

30–40 breaths per minute
12–20 breaths per minute (Correct answer)
6–10 breaths per minute
22–30 breaths per minute

Correct answer: 12–20 breaths per minute

A normal adult respiratory rate is 12–20 breaths per minute. Rates below 12 (bradypnea) or above 20 (tachypnea) may indicate respiratory distress or other underlying conditions requiring intervention.

Question 33: When you arrive at the receiving facility you must transfer care to the ED staff... When you arrive at the receiving facility you must transfer care to the ED staff. By giving a report to the attending nursing staff about the past medical history, the patient’s complaint assessment, and interventions you have just allowed for what?

Prime directive
Continuity of care (Correct answer)
Quality transfer of care
Quantum of care

Correct answer: Continuity of care

Providing a thorough patient report to the receiving emergency department staff is crucial for maintaining continuity of care. This detailed handover ensures that the hospital team receives all pertinent information regarding the patient's history, assessment findings, and interventions performed by EMS. This allows them to seamlessly continue medical treatment without interruption or repetition, optimizing patient outcomes.

Question 34: The single largest cause of death for Americans is/are:

Chronic obstructive airway disease.
Traumatic injuries.
Coronary heart disease. (Correct answer)
Cancer.

Correct answer: Coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death for both men and women in the United States. It involves the narrowing or blockage of the coronary arteries, which supply blood to the heart, often due to atherosclerosis. This can lead to myocardial infarctions (heart attacks), angina, and other serious cardiac events, making it the most significant cause of mortality.

Question 35: Upon arriving at a scene, the EMT observes a patient lying on the ground and bystanders running away. The first priority is:

Immediately rush to the patient to begin assessment
Begin treating from a distance without approaching
Ensure scene safety before approaching; identify what caused bystanders to flee (Correct answer)
Contact medical direction for guidance

Correct answer: Ensure scene safety before approaching; identify what caused bystanders to flee

Scene safety always precedes patient contact. If bystanders are fleeing, there is likely an active hazard. The EMT must identify and address the hazard or stage at a safe distance until the scene is cleared.

Question 36: Medical control has ordered you to assist a patient with a metered dose inhaler. Before assisting this patient, you must ensure what

The hospital has more of the same medication for arrival
It is their medication and is within the expiration date (Correct answer)
They are not choking
It's not leaking

Correct answer: It is their medication and is within the expiration date

Before assisting a patient with any medication, it is crucial to confirm the 'five rights' of medication administration. Ensuring it is the patient's prescribed medication and has not expired prevents administering the wrong drug or an ineffective one. This step is essential for patient safety and therapeutic efficacy.

Question 37: What is a sign of preeclampsia?

Increased appetite.
Frequent urination.
Low blood pressure.
High blood pressure and swelling (Correct answer)

Correct answer: High blood pressure and swelling

Preeclampsia is a serious pregnancy complication characterized by new-onset high blood pressure (hypertension) and often protein in the urine after 20 weeks of gestation. Other common signs include significant swelling (edema), especially in the face and hands, and severe headaches. If left untreated, it can progress to eclampsia, which involves seizures and is life-threatening for both mother and baby.

Question 38: You find that your diabetic patient is hypoglycemic. You have oral glucose to give to the patient. You will give 15 grams of instant glucose to the patient except if they are ___________?

Semi conscious with gag reflex and the ability to swallow
Conscious with an altered mental status and blood sugar of 80mg/dl
Conscious with blood sugar
Semi conscious without the ability to swallow (Correct answer)

Correct answer: Semi conscious without the ability to swallow

Oral glucose should only be administered to patients who are conscious and possess an intact gag reflex, ensuring they can safely swallow the gel or liquid. Administering oral glucose to a semi-conscious patient without the ability to swallow poses a significant aspiration risk, where the glucose could enter the lungs. In such cases, intravenous dextrose or intramuscular glucagon is the appropriate intervention.

Question 39: Following a normal delivery, normal findings in a newborn at 1 minute include all of the following EXCEPT:

Vigorous crying and active movement
Central cyanosis with no respiratory effort (Correct answer)
Heart rate of 120 beats per minute
Pink trunk with blue hands and feet (acrocyanosis)

Correct answer: Central cyanosis with no respiratory effort

Central cyanosis (blueness of the trunk, lips, and face) with absent respiratory effort is abnormal in a newborn at 1 minute and requires immediate resuscitative intervention.

Question 40: A blue or greyish coloration of the skin caused by lack of oxygen in the blood is called?

Tinting
Cyanosis (Correct answer)
Suffocation
None of the above

Correct answer: Cyanosis

Cyanosis is a medical sign characterized by a bluish or grayish discoloration of the skin, mucous membranes, and nail beds. This coloration is caused by the presence of deoxygenated hemoglobin in the blood, indicating a lack of sufficient oxygen delivery to the tissues. It is a critical sign of hypoxemia or poor circulation.

Question 41: After aggressive airway control, the next treatment choice would be epinephrine. Why would epinephrine be such a good choice?

All of the above (Correct answer)
It constricts blood vessels
It speeds up the heart
It dilates the bronchioles

Correct answer: All of the above

Epinephrine is the drug of choice for anaphylaxis because it addresses multiple life-threatening symptoms simultaneously. It constricts blood vessels (alpha-adrenergic effect) to raise blood pressure, dilates the bronchioles (beta-2 adrenergic effect) to improve breathing, and speeds up the heart (beta-1 adrenergic effect) to improve cardiac output. These combined actions effectively reverse the systemic effects of anaphylactic shock.

Question 42: Which of the following patients would be appropriate for air medical transport from your scene?

55 year male with multiple bee stings with no complaints of shortness of breath, difficulty swallowing or hives
55 year male with an isolated lower leg fracture secondary to stepping in a hole at a construction site
55 year male status post fall from standing complaining of ankle swelling and contusion to left elbow.
55 year male high speed motor cycle accident vs. a cement highway barrier (Correct answer)

Correct answer: 55 year male high speed motor cycle accident vs. a cement highway barrier

Air medical transport is typically reserved for critically injured or ill patients who require rapid transport to a specialized facility, especially when ground transport time is prolonged or the patient's condition is unstable. A high-speed motorcycle accident versus a cement highway barrier indicates significant mechanism of injury and potential for multi-system trauma, making air transport appropriate for rapid access to definitive care.

Question 43: Two large tubes that bring air to and from the lungs are known as what?

Larynx
Ronchi
Bronchi (Correct answer)
Diaphragm

Correct answer: Bronchi

The trachea, or windpipe, branches into two main tubes called the primary bronchi (singular: bronchus). These two large tubes then enter the lungs, where they further divide into smaller bronchi and bronchioles, ultimately leading to the alveoli for gas exchange. They are the primary conduits for air movement into and out of the lungs.

Question 44: You are dispatched to a residence of a 46-year-old female patient complaining of nausea, vomiting, diarrhea, and abdominal cramping. She states that the onset occurred shortly after eating some cheesecake. Her only medical history is lactose intolerance. Her blood pressure is 136/88 mm Hg. Her radial pulse is 94 beats per minute and her respiratory rate is 18 breaths per minute. She vomited two times prior to your arrival. From what condition is this patient most likely suffering?

Peptic ulcer disease
Diverticulitis
Acute gastroenteritis (Correct answer)
Gastrointestinal reflux disease

Correct answer: Acute gastroenteritis

The patient's symptoms of nausea, vomiting, diarrhea, and abdominal cramping, with an acute onset after eating, are highly characteristic of acute gastroenteritis. This condition, often caused by viral or bacterial infection or food poisoning, involves inflammation of the stomach and intestines. While lactose intolerance might contribute, the overall presentation strongly points to gastroenteritis.

Question 45: During the inhalation phase of ventilation, which of the following occurs?

The diaphragm relaxes, which causes the chest cavity to shrink.
When the diaphragm and intercostal muscles tighten, the chest cavity expands. (Correct answer)
The chest cavity is enlarged as the diaphragm contracts and the intercostal muscles relax.
The diaphragm moves upward as it contracts, forcing the lungs to expand outward.

Correct answer: When the diaphragm and intercostal muscles tighten, the chest cavity expands.

During the inhalation phase of ventilation, both the diaphragm and the intercostal muscles contract. The diaphragm moves downward, and the intercostal muscles pull the rib cage upward and outward. This coordinated action increases the volume of the thoracic cavity, creating a negative pressure that draws air into the lungs from the atmosphere.

Question 46: A patient delivers a baby in the field. After 20 minutes, the placenta has not been delivered. The EMT should:

Clamp the cord again and wait another 20 minutes
Pull on the umbilical cord to manually extract the placenta
Manually reach into the uterus to remove the placenta
Transport to the hospital; do not attempt to pull the placenta out (Correct answer)

Correct answer: Transport to the hospital; do not attempt to pull the placenta out

Placenta delivery normally occurs within 30 minutes of delivery. Attempting to pull or manually remove the placenta in the field risks uterine inversion and hemorrhage. Transport without manipulation.

Question 47: Which are not blood components that are responsible for clot formation?

Platelets
Fibrin
Thrombin
Plaque (Correct answer)

Correct answer: Plaque

Blood components responsible for clot formation include platelets, which initiate the clotting process, and proteins like thrombin and fibrin, which form the structural mesh of the clot. Plaque, however, is a buildup of fatty deposits, cholesterol, and other substances on arterial walls, contributing to atherosclerosis and narrowing of vessels, but it is not a direct blood component involved in the clotting cascade.

Question 48: An AED is used to treat patients in:

Acute Myocardial Infarction
Asystole
Pulseless Electrical Activity
Ventricular Fibrillation (Correct answer)

Correct answer: Ventricular Fibrillation

An Automated External Defibrillator (AED) is specifically designed to deliver an electrical shock to correct certain life-threatening cardiac arrhythmias. Its primary indication is for ventricular fibrillation (VF), a chaotic electrical activity in the ventricles that prevents the heart from pumping blood, and pulseless ventricular tachycardia (pVT). It does not treat asystole or PEA, which are non-shockable rhythms.

Question 49: What are the rules or standards that govern the conduct of EMS professionals?

Codes
Ethics (Correct answer)
Standards
Morals

Correct answer: Ethics

Ethics refers to the moral principles that govern a person's or group's behavior, providing a framework for professional conduct. In EMS, ethics guide decisions and actions to ensure patient welfare, maintain confidentiality, act with integrity, and uphold the public's trust. These principles define the expected standards of behavior for EMS professionals.

Question 50: You are transporting an elderly male patient in respiratory distress with a history of COPD...The patient has very shallow, rapid respirations with minimal chest wall motion and slight wheezing in the upper lung fields. Given this situation, what would you expect the arterial carbon dioxide levels to be?

Normal
Not enough information to determine
Lowered
Elevated (Correct answer)

Correct answer: Elevated

The patient's history of COPD, combined with shallow, rapid respirations and minimal chest wall motion, indicates ineffective ventilation. This impaired gas exchange means that carbon dioxide is not being adequately expelled from the lungs. Consequently, carbon dioxide will accumulate in the bloodstream, leading to elevated arterial carbon dioxide levels (hypercapnia).

Question 51: Arriving on scene of any allergic reaction, what is the clinician's first concern regarding the patient?

What caused the reaction
Is the airway swelling and respiratory effort (Correct answer)
Will I get stung
Are there hives

Correct answer: Is the airway swelling and respiratory effort

Anaphylaxis is a life-threatening allergic reaction primarily characterized by rapid airway swelling (angioedema) and bronchoconstriction, which can quickly lead to respiratory distress and arrest. Therefore, assessing and managing the patient's airway and breathing is the absolute first priority to prevent fatal compromise. Other concerns, while important, are secondary to securing a patent airway and ensuring adequate ventilation.

Question 52: To assess a patient with a stroke, there are two major assessment tools: the Cincinnati Stroke Scale and the Los Angeles Prehospital Stroke Screen. Which one of these two tools uses arm drift as a diagnostic tool?

Neither
Both
Cincinnati Stroke Scale (Correct answer)
Los Angeles Prehospital Stroke Screen

Correct answer: Cincinnati Stroke Scale

The Cincinnati Prehospital Stroke Scale is a rapid assessment tool used by EMS to identify potential stroke patients. It evaluates three key signs: facial droop, arm drift, and abnormal speech. Arm drift specifically involves asking the patient to hold both arms out with palms up and observing if one arm drifts downward, indicating unilateral weakness.

Question 53: What is negligence?

Acting heroically.
Following protocols.
Providing extra care.
Failing to provide reasonable care causing harm (Correct answer)

Correct answer: Failing to provide reasonable care causing harm

Negligence is failing to provide care that a reasonably prudent person would give, resulting in harm.

Question 54: While assessing the carotid and radial pulse in your unresponsive patient, you determine that the carotid pulse is weak and rapid, and the peripheral pulses are absent. What other clinical assessment finding would you expect to be present?

An irregular rhythm of the pulse
A decrease in the respiratory rate
An increase in arterial pressure
Cool and pale skin (Correct answer)

Correct answer: Cool and pale skin

A weak and rapid carotid pulse with absent peripheral pulses indicates significant hypoperfusion, often due to shock. In this state, the body shunts blood away from the periphery to vital organs through vasoconstriction in the skin. This physiological response manifests clinically as cool, pale, and often clammy skin, as blood flow to the skin is significantly reduced.

Question 55: You are performing rescue breaths using an Ambu bag attached to 100% O2. After several breaths you notice the patients O2 saturation has dropped significantly. What should you do next?

Change the seal on the mask
Remove the oral airway from the patients mouth
Reposition the patient's head (Correct answer)
Increase the rate of respirations

Correct answer: Reposition the patient's head

If a patient's oxygen saturation drops significantly during rescue breaths, the most common and immediate problem is an obstructed airway, often caused by the tongue falling back. Repositioning the patient's head, typically using a head-tilt chin-lift or jaw-thrust maneuver, is the first and most crucial step to open the airway and allow for effective ventilation. A proper airway is paramount for oxygen delivery.

Question 56: A pregnant patient at 28 weeks gestation has been in a motor vehicle collision and appears hemodynamically stable. The EMT should:

Position in left lateral recumbent to prevent supine hypotension, and transport to a facility with obstetric capabilities (Correct answer)
Transport supine on a backboard if spinal injury is suspected, and monitor for delayed signs of placental abruption
Focus only on obvious injuries; the fetus is well protected by amniotic fluid
Treat and release since vital signs are stable

Correct answer: Position in left lateral recumbent to prevent supine hypotension, and transport to a facility with obstetric capabilities

Pregnant trauma patients should be positioned left lateral when possible to prevent aortocaval compression (supine hypotension). Obstetric capabilities at the receiving facility are important for fetal monitoring.

Question 57: You are called to a nursing home for a patient with swelling to her legs... You are called to a nursing home for a patient with swelling to her legs. Upon arrival, you find a 76-year-old patient sitting in a wheelchair. Assessment confirms pitting edema to both lower legs. You are able to palpate a dorsalis pedal pulse bilaterally. Her skin is warm, pink, and dry. Her lungs are clear bilaterally. Which of the following conditions do you suspect?

Deep vein thrombosis.
Atherosclerosis.
Bilateral acute arterial occlusion.
Chronic CHF (Correct answer)

Correct answer: Chronic CHF

The patient's presentation of bilateral pitting edema in the lower legs, along with clear lung sounds and warm, pink, dry skin, points towards a chronic fluid retention issue without acute pulmonary involvement. While DVT is usually unilateral and arterial occlusion would cause absent pulses and cool skin, chronic congestive heart failure (CHF) often manifests with peripheral edema due to fluid overload and impaired cardiac pumping, even if lung sounds are clear in a compensated state.

Question 58: Your patient is not responding to your loud verbal stimuli. You find the following medications: Glucophage and Lipitor. What is the likely cause of the patient’s problem?

Coronary Artery Disease
High cholesterol
High blood pressure
Diabetic reaction (Correct answer)

Correct answer: Diabetic reaction

Glucophage (metformin) is a medication specifically prescribed to manage Type 2 diabetes by lowering blood glucose levels. If a patient taking Glucophage is unresponsive, a diabetic reaction, particularly hypoglycemia (low blood sugar), is a highly probable cause. Lipitor (atorvastatin) is for high cholesterol and is less likely to cause acute unresponsiveness.

Question 59: Your patient is a 17-year-old guy who was discovered face down in a pool. He's being held face up on the water's surface currently. He is breathing and has a pulse, but he is unconscious. What is the most effective treatment for this patient?

Jump into the pool and begin CPR
Wait for a trained water rescue team
Remove the patient from the pool, immobilize, and transport.
Apply cervical and spinal immobilization while the patient is still in the pool (Correct answer)

Correct answer: Apply cervical and spinal immobilization while the patient is still in the pool

Any unconscious patient found in a pool, especially face down, should be treated as if they have a potential spinal injury due to the possibility of a diving accident or impact during the fall. Therefore, the most effective initial treatment is to apply cervical and spinal immobilization *while the patient is still in the water* to prevent further injury during extrication. CPR is not indicated if the patient has a pulse and is breathing.

Question 60: When you arrive at the receiving facility you must transfer care to the ED staff. By giving a report to the attending nursing staff about the past medical history, the patient’s complaint assessment, and interventions you have just allowed for what?

Continuity of care (Correct answer)
Quantum of care
Prime directive
Quality transfer of care

Correct answer: Continuity of care

Giving a thorough verbal report to the receiving hospital staff is crucial for ensuring continuity of care. This detailed handover allows the emergency department team to quickly understand the patient's medical history, chief complaint, assessment findings, and all interventions performed by EMS. This seamless transfer of information prevents delays and ensures the patient receives uninterrupted, appropriate treatment.

Question 61: A laceration, spurting brigA laceration, spurting bright red blood, most likely means what type of injury?ht red blood most likely means what type of injury.

Capillary
Arterial (Correct answer)
Venous
Amputation

Correct answer: Arterial

Arterial bleeding is characterized by bright red blood that often spurts or pulses rhythmically with each heartbeat. This is because arteries carry oxygenated blood directly from the heart under high pressure. Venous blood is typically darker red and flows steadily, while capillary bleeding is a slow ooze.

Question 62: Your patient is an 80-year old male with shortness of breath. Which of the following could your patient be suffering from?

All of the above (Correct answer)
A myocardial infarction
Cardiac compromise
Congestive heart failure

Correct answer: All of the above

Shortness of breath in an elderly patient is a non-specific symptom that can indicate several serious cardiac conditions. Congestive heart failure often causes fluid buildup in the lungs, leading to dyspnea, while a myocardial infarction can impair the heart's pumping ability, also resulting in breathing difficulties. Both of these conditions fall under the umbrella of cardiac compromise, making 'All of the above' the correct answer.

Question 63: Your patient has an injury that consists of overstretched & torn ligaments. What type of injury does this patient have?

Fracture
Dislocation
Sprain (Correct answer)
Strain

Correct answer: Sprain

A sprain is a specific type of injury that involves the stretching or tearing of ligaments, which are the tough bands of fibrous tissue connecting bones to other bones at a joint. In contrast, a strain affects muscles or tendons, a fracture is a broken bone, and a dislocation is when bones at a joint are forced out of alignment.

Question 64: What are the signs and symptoms of shock

Increased heart rate, increased respirations, hypotension (Correct answer)
Decreased heart rate, increased respirations, hypotension
Increased heart rate, decreased respirations, hypertension
Decreased heart rate, increased respirations, hypertension

Correct answer: Increased heart rate, increased respirations, hypotension

Shock is a life-threatening condition characterized by inadequate tissue perfusion. The body's initial compensatory mechanisms include increasing heart rate (tachycardia) and respiratory rate (tachypnea) to try and improve oxygen delivery. However, as shock progresses and compensatory mechanisms fail, blood pressure begins to drop (hypotension), indicating decompensated shock and a critical state.

Question 65: Poisonous ingestions by children usually occur ____________?

through purposeful self inflection
accidentally (Correct answer)
by being forced upon them
from abuse eglect

Correct answer: accidentally

Poisonous ingestions in children are overwhelmingly accidental, often due to their natural curiosity and tendency to explore their environment by putting objects in their mouths. They may mistake medications for candy or drink household cleaners, highlighting the critical importance of child-proofing and safe storage of hazardous materials to prevent such incidents.

Question 66: Diabetic Ketoacidosis (DKA) has the following signs and symptoms; Acetone on breath, dry skin, poor skin turgor, altered mental status, confusion, thirst, and frequent urination. What other symptoms are associated with DKA?

Appearance of intoxication (Correct answer)
Normal mental status
Diaphoresis
Tremors

Correct answer: Appearance of intoxication

Diabetic Ketoacidosis (DKA) can cause altered mental status, confusion, and a fruity (acetone) odor on the breath. These symptoms, combined with potential unsteady gait or slurred speech due to dehydration and metabolic derangement, can mimic the appearance of alcohol intoxication. This makes DKA a critical differential diagnosis for EMS when encountering individuals who appear intoxicated.

Question 67: What is the maximum amount of time that may pass while attempting an intubation?

10 Seconds
30 Seconds (Correct answer)
1 minute
10 Minutes

Correct answer: 30 Seconds

Each attempt at endotracheal intubation should be limited to a maximum of 30 seconds. Prolonged intubation attempts can lead to significant hypoxia and bradycardia, especially in critically ill patients. If intubation is unsuccessful within 30 seconds, the clinician should stop, ventilate the patient with a bag-mask device, and reoxygenate before attempting again.

Question 68: You respond to the scene of a residential natural gas explosion to find a 36-year-old male patient complaining of a diminished ability to hear, moderate dyspnea, and acute abdominal pain. These symptoms are likely due to what mechanism?

Primary blast injury (Correct answer)
Tertiary blast injury
Toxic inhalation of natural gas
Secondary blast injury

Correct answer: Primary blast injury

Primary blast injuries are caused by the direct effects of the blast wave itself, which can damage gas-filled organs. Symptoms like diminished hearing (due to ruptured eardrums), moderate dyspnea (from lung contusions or barotrauma), and acute abdominal pain (indicating potential bowel rupture) are classic signs of primary blast injury, as the pressure wave directly impacts these susceptible organs.

Question 69: You are dispatched to 123 Somewhere Rd to a call for an injured woman... You are dispatched to 123 Somewhere Rd to a call for an injured woman. As you approach the door of the home, a man opens the door and tells you "this is none of your business" and to "get out of here". What is the correct course of action in this case?

Return to the ambulance drive a safe distance away and call for the police to help (Correct answer)
Reason with the man and explain that the women may need medical attention
Barge past the man and help the woman in the home
Return to the ambulance and tell dispatch that the patient has refused care

Correct answer: Return to the ambulance drive a safe distance away and call for the police to help

As an EMT, your safety is paramount. If a person denies access to a potential patient and creates a hostile or unsafe environment, you should not force entry. Retreating to a safe distance and contacting law enforcement is the appropriate action to ensure your safety and allow police to investigate the situation and secure the scene, potentially enabling you to provide care once the area is safe.

Question 70: After removing a heat stroke patient from the hot environment and excess clothing, what is the next most important cooling intervention?

Apply cool packs to the neck, armpits, and groin and fan the patient (Correct answer)
Administer oral fluids to rehydrate the patient
Wait for ALS to arrive before initiating cooling measures
Wrap the patient in a blanket to prevent shivering during transport

Correct answer: Apply cool packs to the neck, armpits, and groin and fan the patient

Applying cool packs to high-vascularity areas (neck, axillae, groin) and fanning promotes rapid cooling through conduction and evaporation, which is critical in heat stroke management.

Question 71: Of the two types of energy trWhich type of energy transfer is a motor vehicle crash (MVC) with frontal impact, non-restrained driver with bent steering wheel, and spidered windshield?ansfer, which type would a Motor Vehicle crash (MVC) with frontal impact

Blunt (Correct answer)
Decelerating
High velocity penetrating
Low velocity penetrating

Correct answer: Blunt

A motor vehicle crash with frontal impact, a non-restrained driver, a bent steering wheel, and a spidered windshield are all classic indicators of blunt trauma. Blunt trauma occurs when the body strikes or is struck by a blunt object, causing injury without penetrating the skin. The forces involved in this scenario are characteristic of blunt force energy transfer.

NREMT Cognitive Exam (EMT)

This computer adaptive test (CAT) evaluates the cognitive knowledge and critical thinking skills required for entry-level Emergency Medical Technicians.

Questions

120 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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